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Women Offender Programs and Issues

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The 2002 Mental Health Strategy For Women Offenders

Jane Laishes
Mental Health, Health Services
2002

RTF

ADDITIONAL ELEMENTS ESSENTIAL TO THE DELIVERY OF MENTAL HEALTH SERVICES FOR WOMEN OFFENDERS

The following elements have been categorized under three main headings: physical environment, professional service delivery, and characteristics of interventions. Although the majority of these elements are the same as those articulated in the 1997 Strategy given their continued relevance, many elements have been expanded upon and three new elements have been included: mental health interdisciplinary team, supervision of mental health service providers, and involvement of other professionals.

Physical Environment

Structure and Environment: The facilities for women offenders have been designed for independent living with a communal living space in each house including, a kitchen, dining area, bathrooms, a utility/ laundry room, and access to the grounds. Cooking, cleaning, and other household duties are shared activities. Programs take place in the main buildings. The general institutional environment should be consistent, supportive, and constructive. Women offenders need to understand the expectations placed on them, which can increase feelings of personal well-being. Consistent structure and environment are central to the success of treatment programming endeavors. Further, the administration and staff must seek to provide a therapeutic, educational, and generally predictable environment throughout the facility. Facilities should be designed to accommodate the needs of both physically disabled and aging offenders. Facilities should also be designed to incorporate other factors known to promote well-being such as natural light, fresh air, and exercise, as well as spiritual spaces.

Professional Services Delivery

Mental Health Interdisciplinary Team: Consistent with the requirements of CD 850, Mental Health Services (Appendix H) each institution must have a mental health interdisciplinary team that meets on a regular basis and is comprised of a psychologist, nurse, parole officer, and ad hoc members as appropriate, to function as a coordinating body to those inmates in need of mental health services. An interdisciplinary team approach has been adopted as it is based on individual evaluation, planning, and program implementation. The team is composed of individual members from different disciplines, and non-professionals that meet to plan and coordinate a wide range of services. Teamwork is characterized by shared purpose and creativity in problem solving, with the end result being greater than the sum of individual discipline's treatment approaches. Most importantly, interdisciplinary planning is focused on the goals of the offender and services are tailored to fit the individual's vocational and quality of life goals, cutting across disciplines.

Coordination of Mental Health Service Providers: All mental health service providers, such as behavioural counsellors, nurses, primary workers, ancillary therapists, including those on contract, must be involved in ongoing consultation, to share relevant offender information, conduct appropriate assessments, undertake treatment planning, monitor progress, and ensure continuity of care. Coordination and consultation are also important to ensure that mental health service providers, as well as other institutional staff, are not isolated which can lead to staff burn-out. The coordination of non-mental health service providers should occur via the mental health interdisciplinary team.

Supervision of Mental Health Service Providers: All mental health providers should be in receipt of clinical supervision. In particular, psychologists should be in receipt of supervision as per The Standards of Supervision (in draft) and in accordance with CD 840, Psychological Services (Appendix I).

Integration/Information Sharing: Management must ensure that the model of mental health delivery integrate all related activities that are part of the continuum of mental health care. Management must also ensure that the psychologist play a role in decisions with respect to those programs that address such issues as sexual abuse and substance abuse even though these programs may not fall under the rubric of mental health per se. Further, mental health services must be integrated into each woman's correctional plan and the primary worker/ parole officer must play a role in the coordination and delivery of each woman's mental health treatment plan. The sharing of mental health information with the woman's entire case management team, within the limits of confidentiality, is essential to ensure effective support and monitoring of her progress. Additional information regarding information sharing can be found in CD 840, Psychological Services (Appendix I).

Elder Services: For Aboriginal women offenders, Elders should be an integral part of the mental health interdisciplinary team. Easy access to the services of Elders should be available, with provision for necessary ceremonies and teachings. Mental health programs for Aboriginal women should be developed and delivered by Aboriginal organizations or individuals with demonstrated awareness of their concerns and needs while incarcerated.

Involvement of Other Professionals: The involvement of other professionals such as social workers, occupational and recreational therapists, and chaplains should be considered, where appropriate, in the delivery of mental health programs and services.

Staff Training/Education: It is critical to ensure that staff are given ongoing training and education in the mental health problems faced by incarcerated women, in order that they acquire the necessary knowledge and skills to effectively work with this population. This awareness will increase staff confidence as well as help to create an atmosphere of understanding and acceptance for those with mental health problems.

Regular support and feedback to staff is essential when working in an often stressful and demanding environment. Of particular importance is the need for ongoing training regarding the maintenance of appropriate and professional boundaries between staff and inmates. Staff training should also include education on Aboriginal medicine, teachings, and ceremonies that may possibly include participating in Aboriginal ceremonies.

Characteristics of Interventions

Role of the Psychologist: The CCRA, Section 87, states that the Service is to take into consideration an offender's state of health and health care needs in all decisions affecting the offender. Given this requirement and the degree of mental health concerns in the women offender population, the psychologist must, where appropriate, play a key role in the management of individual cases to aid in individualized case planning, treatment planning, behavioural management, program delivery, and in striving toward the creation of a treatment supportive milieu. Given that psychologists are involved in the identification of each woman's needs, they must also play a role in assigning women to appropriate programs, whether these are mental health or other programs that would support mental wellness in a holistic context. However, the parole officer will be the individual case coordinator for all women including those who require mental health services.

Offender Involvement: Offenders should be involved in program development and delivery to the greatest extent possible. Offenders should also be involved in the consultation phase of newly developed mental health programs. As well, there may be groups that offenders could reasonably and effectively be trained to facilitate which could positively affect their self-esteem.

Critical Mass: Group size needs to be considered in the delivery of mental health programs and services. Although most programs are designed for 8 to 12 participants, given the small number of women offenders in each facility, some mental health programs may have fewer participants. However, wherever possible, groups should be run with a minimum of three participants.

Capability: Interventions should be culturally appropriate and geared to women's literacy levels. They should also be able to address the needs of low-functioning, chronically ill, or aging women, with the possibility of groups specifically targetting the needs of these offenders.

Crisis Resolution: Creative approaches to crisis resolution or intervention should be sought. These could include not only the involvement of the mental health interdisciplinary team but also peer support visits with other inmates, and possibly visits with family or community members during critical periods when the women may require a great deal of support. For Aboriginal women offenders, the inclusion of Elders is critical.

Transfers: Transfers in and out of mental health treatment environments must be managed in such a way that the potential adaptation difficulties for the woman being transferred are responded to and minimized. Transitional care plans, including bridging and other supports are essential to the successful management of transfers.

Creative Approaches: Creative approaches should be explored wherever possible including relaxation techniques, conflict resolution, body work (i.e. acupuncture, therapeutic massage, etc.), wilderness programs, story writing, journalling, drama, art therapy, pet therapy, meditation, yoga, role plays, peer counselling, and mentorship programs.

For Aboriginal women and others who are interested in Aboriginal culture and medicine, activities including sweats, fasts, cedar baths, drumming/dancing, and ceremonies should be made available.

Linkages: The role of other activities and interests such as physical exercise, hobbies, intellectual and spiritual activities, and contact with family and friends should be encouraged for their significant contribution to women's overall mental well-being. Contact with family and friends can play a crucial role in helping women make the transition back into the community. As well, programs for women should be designed to support their relationships with their children, where appropriate.

Employment: The development of useful employment skills and positive work attitudes for those with mental health problems who are incarcerated is extremely important. Employment skills are known to enhance self-esteem and successful reintegration. Without employment skills women are likely to be released into continuing poverty, thus potentially increasing their risk for recidivism.

Support/Reference Materials: The development of a reference section in the inmate library comprised of books related to mental health should be created. Educational videos on a variety of topics including mental disorders, substance abuse, parenting skills, and stress management should be included.

Diversity: Effort should be made to increase the diversity of the mental health staff to reflect the diversity of the prison population. This would include recruiting staff of different ethnicities, sexual orientations, ages, and languages.

Bridging: Bridging services between institutions, and between institutions and the community, are vital to decreasing recidivism and the gaps in service provision to women offenders. In addition, regular facilities must be able to support and build on the changes made in specialized treatment programs. Bridging services should be developed to support the gains made in treatment especially since many of those with mental health problems are revoked not as a result of new charges, but because of mental health issues (Bonta et al., 1998) e.g., non-compliance with psychotropic medications resulting in a deterioration of overall functioning.

Continuity of care could be provided through developing linkages to community resources before women leave the institution, or through ambulatory care services and supportive counselling in the community that focuses on relapse prevention issues. These services would assist in the women's transition to the community.