Commissioner's Speeches

31st Canadian Congress on Criminal Justice: Building and Sustaining Safe, Healthy Communities "Improving Capacities to Address Mental Health Needs of Offenders"

Remarks by:

Keith Coulter, Commissioner, Correctional Service of Canada
November 1, 2007, Toronto, Ontario

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Thank you, Dan. Distinguished international colleagues, special guests, colleagues, ladies and gentlemen. Good morning, everyone. I am very pleased to be here today.

From my perspective, these congresses provide an important forum to discuss critical issues in our criminal justice system. For the Correctional Service of Canada, they provide a productive environment to exchange ideas, share best practices and engage in serious discussions about what are the best ways to address the issues pertinent to our specific area of endeavour which is, of course, the business of effective corrections.

I know I speak for all of CSC when I say that we are all very pleased for this chance to share our knowledge and experience.

One of the really good things about coming here is seeing so many people that are in this business. After a couple of years as the head of the Correctional Service of Canada, I see many, many familiar faces in this room, including some international colleagues, some colleagues at the provincial level and people who are CSC’s partners in communities from coast to coast to coast.

I am particularly pleased that the focus of this year’s congress is on mental health since this is an area that has become a major preoccupation for the Correctional Service of Canada. Indeed at CSC, one of our top priorities is to meet the challenges we currently face in providing care to offenders with serious mental health issues. Many of you may already be aware that CSC has been struggling in recent years to manage a growing population of offenders with mental health disorders. This is the overarching reality that is a starting point for what I’m about to say.

There are, of course, a lot of very serious questions about how a country like Canada could reach the point where its corrections systems — federal, provincial and territorial - have become, as Glenn Thompson put it earlier today, the welfare system of last resort for mental health cases. I assure you that I have, like I know many of you do, some serious thoughts and feelings about all of this but that’s not the focus of my words here today. Rather, the simple fact that underpins my remarks is that at CSC, we do not choose who comes through the front doors of our federal penitentiaries. So our professional focus has to be on getting organized to manage the population we actually have, which now includes this growing population of offenders with mental health issues, the overwhelming majority of whom have committed violent crimes.

To take one step back, for those of you who may not know, CSC has a legislated mandate to maintain custody of all offenders in Canada serving sentences of two years or more, to provide programs and other interventions to prepare offenders for safe release back into the community, and to supervise offenders conditionally released into the community. On any given day, we are responsible for about 22,000 offenders, of whom roughly 60 per cent are in our 58 penitentiaries, while the other 40 per cent are supervised by CSC parole officers working out of 71 parole offices and 16 community correctional centres across Canada.

Offenders serving sentences in our federal penitentiaries are excluded from the Canada Health Act. So, medical care - for them - is not covered by Health Canada or any provincial health care system. Therefore, essentially by default, CSC is responsible for providing health care services directly to these offenders. This is prescribed in our governing legislation, the Corrections and Conditional Release Act. We thus have a legal obligation to provide professional standard health care to all offenders under federal jurisdiction. Our responsibilities here are very clear. We must provide basic physical health services to offenders such as dental care, medical check-ups and emergency care. And we must also provide mental health care in order to diagnose, treat and manage offenders’ mental health disorders effectively.

We have worked very hard over the years in order to fulfill our obligation to improve our ability to respond to urgent mental health needs in our institutions and in the community.

Let me briefly describe where we are today with respect to building our capacity. First of all, for male offenders, we have five regional mental health treatment centres, one in each of our five regions: Atlantic, Québec, Ontario, the Prairies and Pacific. In addition, in our regular institutions, we also have psychologists and other mental health professionals who provide limited mental health support mostly - in the form of crisis intervention and counselling. Male offenders requiring intensive treatment are normally transferred to one of the five regional treatment centres.

Women offenders who have serious mental health needs are placed in separate units known as Structured Living Environment houses in our women’s institutions. These houses offer around-the-clock support incorporating the most intensive treatment and support that we are able to provide.

Some offenders who have mental health problems are placed in Philippe-Pinel Institution in Montreal, and a few are placed in a special unit in our Regional Psychiatric Centre in Saskatoon.

On the community side, we’ve hired social workers to assist in release planning and transition to the community for offenders with mental health disorders. In addition, trained mental health care professionals, working out of parole offices, help provide support to offenders with mental health disorders who are living in the community under our supervision. The simple fact, however - and I’m going to be very frank here - is that we are experiencing difficulties in keeping up with our changing realities around mental health.

In facilities across the country, the number of offenders with mental health needs is growing. And things have changed significantly, even from only a decade ago. In March 2007, the percentage of male offenders identified at admission as having a mental health disorder was 12 per cent. This is a 71-per-cent increase since 1997. Also in March of 2007, 25 per cent of women offenders in federal custody were identified at admission as presenting serious mental health problems, an increase of 100 per cent over the same 10-year period. And for male Aboriginal offenders, the increase was well over 100 per cent from the 13 per cent identified as having mental disorders in 1997.

And there are other alarming indicators. For example, federal offenders have a much higher prevalence of mental disorders than the general public and the prevalence of most disorders is higher still among women offenders. Many inmates have several mental health disorders, often coupled with addiction disorders that require very comprehensive diagnosis and treatment. Offenders with intellectual disabilities or Fetal Alcohol Spectrum Disorders also require particular interventions. And many have long, sad histories of problems like family disruption, foster care and poor life and social skills compounded, in most cases, by substance abuse.

In some of our community residential facilities, up to 50 per cent of our offenders have serious mental health problems. The last four years have also shown a steady increase in the rate of return to custody of offenders with mental health disorders within two years of the end of their sentence. This obviously suggests that many offenders have serious long-term mental health problems and that communities do not have the capacity to provide the required support to mental health cases. In addition to the offender population with severe mental health disorders, many more have less severe mental health issues. Many more offenders for example have at least some symptoms of depression.

Let me be clear here. When we speak about the mental health population in our federal penitentiaries, we’re speaking about one of the most vulnerable populations in Canada. We’re talking about individuals who struggle every day to cope with very basic mental health issues. They come to our institutions in obvious need of appropriate mental health care and they have no other way to get on the right path to become law-abiding citizens. In this context, the challenges for CSC are enormous. If there’s any good news in this story, it is that CSC understands these challenges. We know what we need to do.

For example, we need to move more quickly to assess an offender’s mental health when he or she walks through the front door of the correctional system. We need to provide better training for all of our staff. And we need to provide a more consistent approach to mental health across our entire organization. And we also know that we need better physical space for mental health care in our institutions and we need more services for offenders after release. And we know we must find better ways to attract the required professional capacity such as nurses, social workers, psychologists and psychiatrists who are willing to take up the challenge of working in a correctional environment.

In short, we know we need to do a lot of things better to implement a model that allows for continuity of care from intake to release and beyond. We know that despite the outstanding efforts of the very dedicated men and women who are doing everything within their power to make a difference, we still have some very significant gaps.

I can assure you that our shortcomings in this area have not gone unnoticed.

On the contrary, our shortcomings have been highlighted in a very public way. For example, in his recent annual report, including the one tabled in the House of Commons last week, the Correctional Investigator, Howard Sapers, included many recommendations for improvements in the area of mental health. And of the 118 recommendations made in Senator Kirby’s report, 11 relate directly to CSC.

I should add here that while we may have some quibbles in some areas, CSC is in general agreement with the recommendations from both the Correctional Investigator and the Kirby-Keon Senate Report. And in my experience, when you have general agreement among a large government agency like CSC, its independent review body and a parliamentary committee that has extensively examined the issues, it’s likely that the direction being defined is actually the right one to take.

Consistent with the Senate Report, our primary goal in federal corrections at this juncture is to raise the standard of mental health care - both within our institutions and in the community - to be equivalent to the care available to non-offender members of the general community. I must say here that given our changing realities, the status quo is not, in my eyes, an option. Simply put, we need to make some very significant adjustments or we will fail to meet our most basic obligations. Moreover, if any mental health disorders remain untreated, we will create a more difficult environment that places both staff and inmates at greater risk. And if offenders who are being inadequately diagnosed or treated are released into the community, public safety, the paramount consideration in everything that CSC does, will also be at greater risk.

So in the face of these changing realities and challenges, CSC is very focused on finding solutions. And the good news is that we’ve definitely started to turn the page during the last couple of years by taking some concrete steps towards building the capacity we need to address the mental health challenges of offenders.

Our first step was to put together a comprehensive mental health strategy. Finalized in 2004, our strategy is focused on enhancing our capacity to address the needs of offenders. The strategy has six core elements.

First, improved mental health screening and assessment at admission to ensure that all offenders receive adequate screening when they enter the correctional system and that those showing disorders promptly receive full assessment and an individualized treatment plan.

Second, improved primary mental health care to provide, within the institutional setting, along with coordinated and comprehensive mental health care to offenders including: psychological assessment and management, treatment, crisis intervention, personal support and information about illness, prevention measures, and health maintenance.

Third, intermediary mental health units in our institutions, to offer men the same kind of intermediary services that are presently offered to women offenders to give them a safe and structured area with support services and efficient care every day.

Fourth, improved services at our mental health treatment centres to allow us to provide offenders with a level of care equivalent to that provided by community forensics psychiatric hospitals while ensuring that our unique correctional security requirements are met.

Fifth, a more robust training program for correctional staff and mental health professionals to ensure that all front-line workers recognize and react to mental health situations and issues in the most effective way possible.

And finally, mental health support in the community to ensure that offenders receive the best possible preparation for reintegration.

When this strategy was developed in 2004, not much could be done in the way of implementation because we had no funding available to try to move the yardstick significantly. However, things have changed since then and we are now moving towards implementation. As a first step, the community health initiative received government funding in 2005. This initiative includes discharge planning and additional staff to provide direct mental health care service to offenders in the community to ensure no loss in treatment and support.

This is, of course, an area in which many of you work with us, and I’m happy to say that we are making significant strides forward to coordinate our efforts with community partners and service providers. While I wish we could have put some elements in place more quickly than we’ve been able to do, my assessment is that we are now starting to get traction in key areas. So we are certainly starting to feel better about where we are at and where we are going with the community part of our strategy.

With respect to the rest of our strategy, we received earlier this year, in Budget 2007, funding over two years to begin to implement the institutional elements of our strategy. We’re now really focused on getting the pieces in place to deliver the desired results. And we are engaged in discussions within the federal government with respect to funding for implementation over the longer term.

In addition, we have recently put in place a structure that will allow us to bring a sharper organizational focus and the right level of leadership for successful implementation. The senior level structure of federal government organizations like CSC are approved by Treasury Board ministers and I’m happy to say that earlier this year, Treasury Board approved a new structure for CSC which includes a new health services sector.

I am pleased to announce that this sector is now led by an Assistant Commissioner, Leslie MacLean, who came to us from Health Canada.

In Leslie MacLean, we now have a senior manager on my executive committee who can bring strong leadership to help us deliver on all of our health care responsibilities, including delivery on our mental health strategy. I hope you’ll have a chance to meet with Leslie who is here at this event because she’ll be a key player for CSC as we move forward on health care issues in the coming months and years.

While these are definitely steps in a positive direction, we still need to secure long-term funding for successful implementation of our mental health strategy. When it considered our need for funding in many areas in the last budget process, the government decided to provide CSC with two-year bridge funding to enable us to meet our most urgent requirements while a comprehensive independent review of Corrections was conducted.

This included the two-year funding for initial implementation of the institutional part of our mental health strategy. Shortly after the budget in April, the government launched the review and the independent panel that is conducting this review will deliver its report to the Minister in the near future. This report, I should add, will be made public. In its terms of reference, the panel was asked, among other things, to look at the availability and effectiveness of mental health programs and services in institutions and in communities.

Other aspects of the panel’s work that relate, in my mind, to the issues around mental health were that it was asked to report on CSC’s infrastructure capacity and on its capacity to maintain safety and security in institutions and communities; meet basic policy and legal obligations;and adapt to the changes in the offender profile. The key thing here, as it always is in exercises like this, will be the government’s response to whatever the panel recommends.

This response will set the stage for the important decisions that will have to be taken about the level of resources that CSC is provided over the longer term in key areas like mental health which, in turn, will have a significant impact on what we’re able to accomplish. CSC is obviously hoping that the result of all of this will be decisions that provide a longer term foundation for implementation of our comprehensive mental health strategy and thus the foundation for an effective way to deal with the mental health issues of offenders in the federal correctional system.

So permit me to summarize. The short story here is that we know we have some serious gaps and we have some incredibly committed and capable people trying to fill them. We have a comprehensive strategy and a new governance structure that will help us move forward. We have long-term funding on the community side and shorter term funding on the institutional side pending the results of the independent review process. We are in motion and we are building capacity. But there are still some important decision points ahead that will determine how all of this works out.

As we move forward, it is very clear to me that we will also have to be a learning organization that is open to new ideas and input and is willing to make adjustments to our strategies and policies where they are needed. And perhaps, more than anything else, we will need strong partnerships to be successful.

On this last point, I have to say as I look around this room and see representatives from many organizations we partner with, both in our institutions and in communities across Canada, it’s clear to me that fostering and strengthening these partnerships will be absolutely critical if CSC is to move the yardsticks forward in the coming years in this key priority area.

So I will close by taking advantage of this opportunity to signal that CSC is open for business in this area. We are ready and eager to explore new ways to work with our partners to deliver what, from my perspective at least, absolutely has to be delivered here. And as I have made clear to my colleagues who are Heads of Corrections in the provinces and territories, CSC is eager to pursue joint ventures, wherever possible and practical, to increase efficiency and effectiveness. And I personally believe that mental health is an area where we can work with other jurisdictions in the common interest of Canadians.

Finally, I would like to thank those of you who work with us in the area of mental health for what you do. Your contributions are often, in my eyes, enormous. And I would like to thank everybody here for listening to this brief account of some of our serious challenges in the federal corrections system in the area of mental health - and the way we are trying to meet them.

Thank you.