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The following represents an updated progress report in support of the CSC's Response to the Office of the Correctional Investigator's Deaths in Custody Study, the Correctional Investigator's Report: A Preventable Death and the CSC National Board of Investigation into the Death of an Offender at Grand Valley Institution for Women .
CSC continues to be thankful of the input and feedback that the Office of the Correctional Investigator (OCI) provides us on a regular basis. Their Socratic approach to this very important issue has resulted in the Service identifying new ideas and approaches that cannot be found in other correctional jurisdictions.
When an offender unexpectedly dies in custody, it is among the most tragic of events that can happen in a correctional facility. Although violence related and drug overdose deaths do occur, a non-natural death in CSC custody may often be due to a suicide associated with a mental health issue.
Four out of five offenders admitted to the federal corrections system are identified as having a substance abuse problem and many of those have been diagnosed with one or more mental health problems, with a rise expected to continue in the foreseeable future. The combination of these factors has recently led to the House of Commons Committee on Public Safety and National Security to undertake a study on Mental Health and Addictions in Federal Corrections.
This offender population profile presents significant challenges for CSC to safely accommodate and effectively address program and treatment needs on a case by case basis within the reality of a penitentiary environment. For example, the physical design of many of our institutions, including some of the treatment centres that accommodate our more acute cases, is not well suited to deliver mental health treatment. As well, the lack of readily available mental health professionals in some of the communities where the penitentiaries are located is an ongoing challenge.
The capacity to help offenders control the behaviour and distress that often accompanies a struggle with mental illness can be limited in an institution. Segregation is sometimes the only option available to stabilize an offender. The use of segregation does not reflect the preferred option of the Service. However, it sometimes becomes the only option available to manage the outwardly violent behaviour of individuals or to protect them from being preyed upon by other inmates. The periodic use of segregation as a tool to manage the more acute cases perhaps represents the most difficult challenge for CSC and the most compelling need for better and more effective treatment alternatives, especially when a death in custody occurs under these circumstances.
CSC takes the issues of mental health and deaths in custody very seriously and we have taken concrete steps to address these challenges. We are starting to implement a Continuum of Care that has improved our capacity to respond to mental health issues. The model contains an Institutional Mental Health Initiative (IMHI) and a Community Mental Health Initiative (CMHI) and it relies on education, training, awareness and collaborative working relationships. It takes a holistic approach based on the integration and delivery of care by staff from a variety of disciplines. This approach brings together mental health professionals and correctional practitioners to help individual offenders and prepare them for safe release, ideally back to communities where follow-up treatment can be accessed.
Key elements of the continuum begin with mental health screening for all offenders during intake assessment; identification of treatment needs and referral for primary and acute care when necessary while in custody; and development of clinical discharge plans where appropriate to enable community mental health care with the support of partner agencies while under CSC supervision upon release.
As of February, 2010, approximately 4300 offenders have completed the Computerized Mental Health Intake Screening System (CoMHISS) that was implemented in 2008 to help identify offenders experiencing significant psychological/mental distress at intake. As of September, 2009, approximately 450 offenders have received community mental health Clinical Discharge Planning since the services were first offered in April, 2006, and approximately 2000 offenders have received services under the CMHI in the community over that period.
In terms of training, approximately 2350 staff and contractors have received our two day mental health training package including 1200 institutional nurses and correctional officers as well as 1150 front-line community staff consisting mostly of parole officers and staff that work in community based residential facilities under contract to CSC.
CSC also distributed the Institutional Mental Health Service (Primary Care) Guidelines to all staff on December 21, 2009. Together with various other measures, including enhanced supervision and early assessment improvements, the guidelines are one step in CSC's effort to avert suicide attempts, ensure timely intervention, and help offenders cope with mental illness under the conditions presented by their confinement. The goal is to bring the stability and preparation necessary for offenders to fully participate in the programs that will help them to achieve a safe release and involvement in follow-up care in the community.
The previous progress report outlined a number of initiatives grouped around the major themes that emerged from our response to the key reviews and investigations connected with deaths in custody: Mental Health, Security, Administrative Segregation, Training, Capacity at Women's Institutions, Investigations, Grievances, Values and Ethics, as well as a number of related policy revisions.
Work continues on those undertakings and CSC has expanded its efforts in several key areas of direct relevance to the most pressing concerns. We have also reviewed the recommendations offered in a recent communication from the OCI and we are moving to address those suggestions within our overall effort.
We are in the process of acting upon a full scale identification of infrastructure vulnerabilities linked to deaths in custody, such as cell call buttons and observation sight lines, that has taken place during the past year at every one of our correctional facilities and we are now taking stock of the physical implementation of those measures.
An audit of the operation of CSC Regional Psychiatric and Treatment Centres is taking place and the results are scheduled for presentation to the service's Audit Committee in June 2010 before it is tabled and ready for discussion at the Executive Committee.
An independent review by outside recognized experts is underway into the nature and use of segregation in medium and women's institutions that will report in April, 2010, to the Commissioner and that will examine placements of offenders identified with mental health concerns; long-term performance indicators; contributing factors; level of psychological services; types of supports and interventions; and the use and types of alternative measures. We will also be presenting our long-term accommodation plan in coming months in an attempt to address some of the longstanding issues associated with the aging infrastructure of our facilities.
During the interim, our National Population Management Committee has been tasked with the review of specific cases that are spending lengthy periods in segregation and to increase the focus on accommodation and treatment alternatives.
A verification team is now travelling across the country to assess the extent to which the elements of the strategies and commitments that we have made thus far to prevent and mitigate deaths in custody are having effect and to recommend ways to further improve capacity and support for the operational staff that are working with mentally distressed inmates at risk for suicide. They are visiting several maximum and medium security sites and a report of their findings is also to be presented to the Commissioner in April, 2010.
As a result of discussion with the OCI, a systemic effort is now underway to create a measurable set of performance indicators that will integrate the findings we receive from our review exercise. This will ultimately form the basis of an accountability framework that will assess our performance and the results we must achieve from the steps we are taking to strengthen our capacity to prevent deaths in custody.
For example, we are assessing how we can monitor many of the key issues in this area such as flagging the cases admitted to segregation with identified mental health issues; tracking the numbers of days they spend in segregation; focusing on incidents of self-harm in segregation and capturing the types of intervention measures; identifying the acute cases and determining the use of alternative measures to segregation and the related completion of clinical management plans. The Commissioner will be responding to the Correctional Investigator's correspondence indicating the intent of the Service to establish clear, measurable indicators.
We will also assess the results of our efforts in several key areas including the measuring of reductions in suicides, drug overdoses, days spent in segregation, and the use of force interventions involving those with serious mental health issues.
We intend to consult with the OCI on the development of the accountability framework and once we determine the specific performance indicators we will use these indices as the basis of the quarterly summaries that we now provide to the OCI.
We will also use the overall analysis of the results to provide the input for periodic updates on our Web site for public information, and for inclusion in our Report on Plans and Priorities, including the more detailed Corporate Business Plan, as well as for the Departmental Performance Report, for accountability purposes.
While our operational and health care staff continue to provide services and interventions to those most in need, the leadership of the organization must continue to provide the support and operational frameworks for them to be successful.
We will continue in our efforts to recruit the best people possible in sufficient numbers to work with and assist the growing numbers of offenders coming into the federal corrections system being diagnosed with mental health issues. This is an ongoing challenge as we compete with communities across the country looking for the same individuals to provide quality care to Canadians that are experiencing mental health problems. We must also continue to ensure that our staff from all occupational groups in our institutions and working in the community are provided with training, encouragement and assistance to understand, effectively respond to and support the treatment plans that are developed and implemented for our offenders.
We are committed to providing the best possible care to offenders and strive to minimize the number of deaths in custody. While we recognize that deaths in custody will occur, we are committed to ensuring that our policy framework, our response protocols, our training and our hiring practices contribute to minimizing preventable deaths in federal custody.