1. Effectively Responding to the Rising Challenge of Mental Health & Addictions in Corrections How to Effectively & Efficiently Treat These Issues to Reduce Recidivism Canadian Congress on Criminal Justice Conference October 2013

2. Presenters Heather Kerr, MSW, RSW Executive Director Stonehenge Therapeutic Community Guelph, Ontario 519-837-147- ext 230 hkerr@stonehengetc.com Heather Callender, MA Executive Director St. Leonard's Society of London London, Ontario 519-850-3777 x228 hcallender@slcs.ca

3. Prevalence of Mental Health Issues in Community Corrections: The Research Provincial Statistics Just over 18% of 8,948 inmates have psychiatric disorders 31% of 575 females 30% of the population have one of the following: Developmentally delayed Psychiatric Disorder Serious Drug and/or Alcohol issues (June 2010)

4. Prevalence of Mental Health Issues in Community Corrections: The Research Towards an Integrated Network 2008 Community Connections 2010 Sample solutions/promising practices Wrap-around Strong relations with provincial health agencies Recovery model

5. Prevalence of Mental Health Issues in Community Corrections: The Research The Requirement: Sections 76 and 86 of the Corrections and Conditional Release Act for Correctional Mental Health Program 61 states: “rehabilitative programming and health care, including essential mental health care must be made available to inmates”

6. Prevalence of Addiction Issues in Community Corrections: The Research Canadian national prevalence data: 7 of 10 offenders in the federal system have engaged in problematic use of alcohol and drugs during the one-year period prior to their incarceration In Canada, about 51% of federal prisoners have an alcohol problem and about 48% experience problems with drugs Women offenders: In general, women in prison have more severe substance abuse problems than men and are more likely to be involved in “hard” drugs (e.g., cocaine, heroin, barbiturates, amphetamines, etc.) Aboriginal offenders: In general, Aboriginal offenders in Canada report more serious substance abuse problems than non-Aboriginal offenders. Aboriginal offenders are twice as likely to report severe alcohol abuse problems than are their non-Aboriginal counterparts. Aboriginal and non-Aboriginal offenders report similar rates of severe drug abuse problems

7. Prevalence of Addiction Issues in Community Corrections: The Research Recidivism: Substance use is a major factor in contributing to the re-admission of offenders back into custody following release. Canadian studies have demonstrated that as many as 70% of offender release suspensions involve alcohol and other drugs Offenders with more serious substance abuse problems are more likely to be readmitted to custody following release CCSA 2004

8. Offender Access to Mental Health Care in the Community: The Challenge Mutual distrust that exists between the mental health providers and the community corrections system Information sharing restrictions Complex clients with complex needs that transcend the capacity of individual key workers or single agencies to meet WHO should provide this care?

9. Relapse – A Part of Recovery but a Show Stopper for Risk The Challenge The Stages of Change tell us relapse is an almost inevitable part of the change/recovery process (Prochaska) Relapse rates from addiction = 40 to 60% ( NIDA) For many offenders the highest criminogenic risk factor for re- offending is substance abuse (Andrew & Bonta) Solutions: Educate correctional staff Listen and learn about risk to build a balanced perspective Halfway back programs

10. Social Determinants of Health: The Solution Social determinants of health = conditions in which people are born, grow, live, work and age. Unlike biological factors (genetics and age), these conditions can change and be influenced by public policies and other interventions Social determinants of health have a significant influence on overall health. About 50% of people’s health can be attributed to socioeconomic factors while 10% is attributed to physical environment factors, 15% to biological factors, and 25% to the health care system itself (Keon & Pepin, 2009) (World Health Organization 2011).

11. Social Determinants of Health: The Solution

12. Social Determinants of Health: The Solution Focusing on social determinants of health builds optimal health of offenders, reduces recidivism and reduces costs Finding a safe home and learning to be part of a neighbourhood (Bring in the garbage can!) Finding the right job – safe, meaningful (no Friday beer runs) Engaging family or finding new “family” supports (“Adoption”) Making new, meaningful friendships (B&B example) A family doctor – what is a good patient Healthy hobbies

13. Care Resolutions & Multi-Sectorial Funding/Partnerships: The Solution Access to programs Flexible but consistent service delivery Understanding of the complex client Cross Sector Funding and Support Community Integration and Partnerships Mental Health can be viewed on a continuum proper interventions are needed at proper time to ensure success

14. TC Model – Peer Support: The Solution Peer Support Models in Corrections: Life Line – winner of the CCJA award last year Peer Supports – Grand Valley Institution for Women  Effective and Cost Efficient ?

15. TC Model – Peer Support: The Solution Peer Supports – A Continuum: Therapeutic Community model is a “best fit” for community correctional clients, offering a “practicing model” where cognitive and emotive changes are practiced in the therapeutic community before re-entering society. Buddy System Graduated Jobs Outing Plans and Outing Debrief vetted through Re-entry Group Senior Residents Alumni – Talks - Giving Back

16. Motivational Interviewing, Stages of Change, Strength-based: The Solution Strength-Based Model of Care Cross Sector Training and Support Using theory and best practices to enhance care in the programs Staffing Diversification

17. Questions & Answers