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Women Offender Programs and Issues

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Implementing Choices at Regional Facilities: Program Proposals for Women Offenders with Special Needs

II. Identification of Women with Special Needs

Although there has been a recognition that women with special functioning and mental health needs have very individual circumstances and characteristics, they have ended up being grouped together for the purposes of research and planning (Rivera, 1996; Whitehall, 1995) in relation to their "high" needs and inability to function in the housing and programming presently available in the regional facilities. This categorization by exclusion has at times resulted in grouping them as if there are significant commonalties among them which can be addressed through common programs. Moreover, when special programs are established, there is operational pressure to access them for anyone who needs higher levels of supervision which can in turn result in incompatible and/or contradictory mixes of individuals (e.g., the Nova structured living house). A large number of the staff and the federally sentenced women who were interviewed indicated that it is essential to describe different constellations of needs and generate different programming proposals based on these constellations.

The "Constellations of Special Needs" concept was identified and used during the interviews as a valuable tool which could provide a foundation from which to group needs and develop programming proposals (Earl, 1998). Three constellations of special needs are represented by circles which overlap each other to produce what mathematicians label a vend diagram (see Figure 1). In particular, one circle of special needs is characterized by women who have challenged or borderline intellectual functioning and a deficiency of basic life skills, a second constellation of needs involves those with special emotional problems relating to either extreme and persistent distress and/or a major mental illness, and a third set of needs describes those with a high level of distrustful attitudes and anti-social behaviour. While some women may be categorized as having needs primarily in one sphere, others may fall in an overlapping area representing two, or even all three areas. Needs change with time and in relation to the demands and characteristics of the prison setting such that a person might shift positions toward one circle or another. Needs may also vary in intensity with the ultimate hope, at least for some, that their needs would lessen such that they

Figure 1: Constellations of Special Needs

Among Federally Sentenced Women

could function successfully in the existing houses without specialized programming and structure, thus moving toward increased independence and responsibility. Finally, any grouping concept has to recognize that each person is unique and there are inevitably complex interactions and middle ground between groupings.

The subsequent discussion of the numbers of women in each grouping of needs is tentative and based on brief discussions with the women, interviews with staff who work with them on an intensive basis, and some file reviews. This process is not appropriate as a means to propose individual decisions on placement which would depend on the choices of the women and the full multi-disciplinary assessment process proposed for each program. However, this review does provide a numerical context in which one can roughly identify the numbers in the various groupings and determine the need for program type and size accordingly.

Basic Skill Needs & Cognitive Challenges. These women have intellectual limitations and have important needs with respect to basic interpersonal, social, daily living, and self-care skills. There are presently six women from Atlantic Canada in maximum-security facilities at Springhill or P4W whose needs seem to fall primarily within this grouping. They are high needs/low risk women who remain in maximum facilities because they require levels of staff supervision and support not now available within regional facilities. Staff in both facilities believe that their needs can be met in regional facilities if the resources are in place and if they are committed to making the transition. Three at Springhill express the desire to go to Nova if it were possible. A fourth is Inuit and has applied to go to the Aboriginal Healing Lodge and it remains to be seen if she can be accommodated there. She indicated a desire to go to Nova relative to remaining in Springhill. One more has had previous difficulties at Nova and has just moved from Springhill to P4W by choice. She has spent much of her life in highly structured and institutional environments and is comfortable within them, hence might be hesitant to move in the near future and could easily act out if she were forced to move. There are also two women now at Nova who fall in this grouping. One has been doing well in a regular house at Nova in large part due to the high level of support offered to her by other women in the house. The second woman has only been at Nova for a few weeks and it remains to be seen whether she will be successful in coping with the regular living accommodations. Both of them would benefit from specific life skill programming which might accompany a new program at Nova for this grouping. However, if they can function effectively within the regular houses with peer support, this may provide them with more independence. One of these woman particularly depends on a few inmates who may find it difficult to continue their high level of support over time.

An informal review of the women on the Special Needs Unit at P4W from outside the Atlantic Region with the Head Psychologist and Director of Programming, Dr. Fred Tobin, indicated that there was one woman with clear cognitive limitations and basic programming needs along with three others who have basic skill needs, a low level of daily functioning, and significant learning difficulties. A review with the Grand Valley management team of women with serious difficulties within their institution, identified two individuals with significant basic skill needs and behaviour problems combined with borderline intellectual functioning.

Overall, there appear to be six women presently in the Ontario region with needs within this constellation and up to eight Atlantic Canadians (see Table 1). Ten of the fourteen are now housed in maximum-security facilities. Relative to its population and number of federally sentenced women, Atlantic Canadians make up a disproportionately large percentage of this grouping. Only one is from a First Nations culture which is low relative to the overall percentages among federally sentenced women. These numbers will fluctuate over time as individual women are released and others move into the system. Although some of these women do not have long-term sentences, their pattern in the community is to re-offend in a relatively short period as they have a history of institutionalization and an inability to function with higher levels of independence. Unless there are major changes in community support systems and in their ability to function, they are likely to be long-term residents of the penitentiary system. The numbers in this grouping are unlikely to significantly decrease over time without major changes in correctional and support services.

Table 1: Numbers of Women with Special Needs
in Ontario and Atlantic Canada

 

Nova

Springhill

Prison for

Women

Grand Valley

Totals

Basic Skill Needs & Cognitive Challenges: Potential for Medium-security

2*

4

5-6**

2

13-14

Basic Skill Needs & Cognitive Challenges at Maximum-security    

0-1

 

0-1

Emotional Distress Needs: Potential for Medium-security  

1

3***

6@

10

Emotional Distress Needs at Maximum-security  

1

3

 

4

Attitude & Behaviour Needs

at Maximum-security

 

2

12****

 

14

Totals

2

8

24

8

42

* These women need special programs but may not necessarily require an alternative living environment.

** Two of these women are from Atlantic Canada, including the one who is questionable for this category at present.

*** One of these women is from Atlantic Canada.

**** Some of these women are awaiting re-classification and transfer to medium-security at Grand Valley while there are also women at Grand Valley who may require transfer to maximum-security at P4W.

@ It is difficult to assess numbers in this category as Grand Valley staff presented 4 additional women with significant emotional distress who for the moment are doing better with special supports in the regular houses. These women might move into needing more support or those not now coping may move out of needing it.

Emotional/Distress Needs. This constellation of needs is in itself very disparate but refers to a wide range of people who have difficulties which primarily are associated with severe mental health problems such as depression, disassociation, extreme anxiety, persistent self-injury, schizophrenia, manic-depressive illness, eating disorders, etc. Their ability to perform basic life skills, and their level of cognitive functioning in the average range, separate them in terms of needs from the previous group. However, it is more difficult to distinguish them from women with high levels of need who might be in the third constellation characterized by distrustful attitudes and anti-social behaviours. Some of these behavioural characteristics such as depression, self-injury, extreme anxiety, etc., are exhibited by most women in a penitentiary at particular time periods, given the pressure and stress of the environment and their personal situations. Moreover, women who may be angry, distrustful, and sticking to the "inmate code" in one setting or time period, may seek help and share serious mental health problems in another situation. Or women who may have originally sought help for major mental health problems, may turn to anger and acting out when their needs are not met.

Keeping these issues in mind, there are women with a distinct constellation of needs for whom their mental health problems are primary, persistent and extreme such that they require more support and supervision than is available within the regular houses at the regional facilities, yet they do not necessarily require maximum-security environments. If they remain in regular houses, they isolate themselves, pose a high risk to self-injury, or possibly suicide, are unable to manage their own emotional distress, and/or produce chaos in the interpersonal relationships in the house which may end in violence. These women can be distinguished from women who have a pattern of anti-social attitudes and behaviour and require higher levels of security, core correctional programs, and clear consequences for their actions. For example, Tobin (1997b) coordinated a broad multi-disciplinary file review of the needs of the twenty-six women at P4W on more than one hundred variables. Three constellations of variables were identified: items related to criminal behaviour and belief systems, items related to treatment and life skill needs addressed in core correctional programs, and items related to emotional and psychological factors and/or major mental disorders. A correlational analysis identified that the twenty-six women could be divided into two clusters of needs. "Cluster one may be seen as individuals who have a criminal belief system and who exhibit a number of deficits in life skills, coping behaviour, etc... The second cluster captures those women who primarily present with mental health needs" (Tobin, 1997b).

Within the emotional/distress constellation of needs are two sub-groups, the first suffering from major mental illnesses with active psychoses, and the second expressing acute and persistent distress through their words and behaviour patterns. At present, there are two women at P4W with persistent psychotic illnesses with active symptoms, both of whom are viewed to require this maximum-security environment for the foreseeable future. Two women at Grand Valley are identified by the management team as actively psychotic and in distress in the regular houses. There are no women for whom a major psychotic illness is the primary presenting issue in Atlantic Canada although two women in the basic skills grouping described above have a diagnosis of schizophrenia, yet the psychotic symptoms have not been evident in recent years.

The second sub-group of women expressing "acute distress" is relatively larger. They exhibit diverse difficulties that include depression, extreme anxiety, self-injury and self-damaging behaviours, substance abuse, emotional instability, problems with anger, extreme interpersonal problems, and/or a distorted self-image. The label of "borderline personality" is now very "current" in the psychiatric literature, particularly in relation to women, and has been applied to a significant number of them. This diagnostic labeling approach remains controversial and the most prominent issue is that these women express and demonstrate unique combinations of needs and behavioural difficulties that are of an emotional nature and which prevent them from coping in the regular houses at regional facilities, yet they could be supported in medium-security environments with appropriate programs. They have in a number of cases entered the correctional system because mental health support and inpatient treatment has been cut back or closed to them at a community level. Their sentences vary in severity and length, but again, those with shorter sentences are likely to return to prison in a relatively short period if their emotional issues are not addressed and effective support systems are not available to them in the community.

There are two women in Springhill who are viewed by staff as having high emotional needs. One is viewed as appropriate for a medium-security environment with significant supports whereas it is felt that the other requires a maximum-security environment for the foreseeable future. Two other women at Springhill are viewed differently depending on the respondents, but are generally seen as being able to function in the regular Nova houses when they are ready for a medium-security environment. No one at Nova is now unable to function in the regular houses due to acute distress, although two women who would have been viewed as in this grouping, have been released in the past year.

In Ontario at P4W, three women are viewed as having high acute emotional distress needs, who could function in a medium-security environment with higher levels of support and programming than is now available. One woman exhibits acute emotional distress and is seen to require a maximum-security environment. The Grand Valley management team additionally identified six women who are not coping in the regular houses due to acute emotional distress. Three of them are presently residing on the Enhanced Unit to provide increased support and supervision. Four pose significant threats for self-injury. In addition, the Grand Valley management team identified four other women who have been through periods where they were not able to cope in the general population and/or require special support from health staff to continue to function in the regular houses.

Overall, Ontario appears to have the higher need for programming for women with emotional distress. The "active psychosis" sub-group is very small and restricted to Ontario. The acute distress sub-group includes three women at P4W and approximately six at Grand Valley who require special supports to function at the medium-security level. Only one woman in Atlantic Canada is presently viewed as having acute distress needs who could be supported at the regional facility with special programming.

Attitude & Behaviour Needs. Women with this constellation of needs are viewed as requiring intensive programming and security based on patterns of anti-social attitudes and behaviour, escape risk, and/or institutional adjustment. Although they may have important mental health needs and require particular attention if they are to move to a regional facility, their ability to successfully move from a maximum-security to a medium-security environment is not based on intensive mental health programming and/or alternative living accommodations in the regional facility. Key issues are their openness to change and core programming, and their institutional behaviour. These women are not within the mandate of this study and were not interviewed nor reviewed at length with staff. Two women were identified as falling within this constellation of needs at Springhill and there are now twelve women on the maximum-security range at P4W. These women have been interviewed and considered in depth as part of the work of SkyBlue Morin and Donna McDonagh in their reviews of aboriginal and non-aboriginal women with maximum-security classifications, projects that occurred simultaneously with this research project.

Summary of Analysis of Constellations of Needs. The women offenders presently in maximum-security environments who could be maintained with additional and alternative program resources at the regional facilities must be distinguished by their constellation of needs: those with cognitive challenges and basic skill needs, and those with emotional distress needs. A third group of women in maximum-security environments may require intensive programming to assist them in changing their attitudes and behaviour, but when they are ready, can function within the regular programs at the regional facilities. Given the distinct sets of needs with respect to women in the cognitive and basic skills grouping relative to those in the emotional distress grouping, two distinct program models are required and proposed in this report. Efforts to mix these groupings in the past have proven inappropriate and explosive.

Between Springhill and P4W, there are 13 or 14 women presently housed in maximum environments who have potential for being supported in the regional facilities with specialized and alternative programs (see Table 1). The high number of women presently at Grand Valley in emotional distress are only being managed with the use of the eight-cell enhanced unit. The potential for a serious incident there is high if specialized resources and living arrangements are not provided to that facility for the women who are already there. Women with cognitive and basic skill needs are disproportionately from Atlantic Canada while women with emotional distress needs are disproportionately from Ontario.