Let's Talk

Mental Health Services for Women Offenders

Continuing to Create Choices

Photo: Paul Pollard

Statistics may vary from one year to the next, but one thing is certain: women offenders are twice as likely to suffer from mental illness as male inmates, with major depression and schizophrenia heading the list. Latest figures show that 25 percent of women in federal custody were diagnosed as having a mental health problem at the time of intake, compared with 12 percent of male offenders.

Though there is no typical profile of women offenders with mental health disorders, an expert committee, commenting on CSC's 10-year Status Report on Women's Corrections 1996-2006, agreed that women with mental health issues "are among the most vulnerable of the imprisoned population," due to harmful life experiences. These experiences include a history of poverty, family violence, physical and sexual abuse, trauma and addiction.

A Women-centred Approach

A series of studies carried out in the late 1990s, confirmed that mentally ill women offenders had special needs, and that their best hope lay in the provision of intensive programming in a structured environment, removed from the general prison population.

By this time, a women's mental health strategy had been developed by CSC, and most women offenders had been moved into separate institutions, including the Okimaw Ohci Healing Lodge, in Saskatchewan, for incarcerated Aboriginal women. Still lacking were dedicated treatment units.

Following the closure in 2000 of the Kingston Prison for Women, a major step forward was taken with the creation of Structured Living Environment houses in each region for minimum and medium-security women with mental health disorders and Secure Units for those classified as maximum security.

Having these facilities region-wide makes it easier for the women to preserve community and family ties, especially with their children. Two thirds of incarcerated women have children under the age of five.

"The bond between federal women offenders and their children is important," says Dr. Allister Webster, a psychologist at Nova Institution for Women in Truro, Nova Scotia. "Providing opportunities for the women to maintain a connection with their families/children can greatly contribute to a woman's success in reaching her reintegration goals. CSC has placed the women facilities as closely as possible to the women's home communities so they can maintain valued familial relationships, and build towards a successful reintegration," he adds.

Structured Living Environment Houses (SLEs)

The SLEs, with a total of 40 beds (8 per region), offer around-the-clock support. The layout includes a living space, a program area, two therapeutic quiet spaces and staff offices. All staff members have specialized training in mental health issues and work as a multidisciplinary team, providing correctional and rehabilitation programming as well. Placement in the SLE is voluntary and only occurs after a thorough assessment by a case management team. Overall, the SLEs operate as a therapeutic environment incorporating the principles and practices of Dialectical Behaviour Therapy and Psychosocial Rehabilitation.

Dialectical Behaviour Therapy (DBT)

"DBT is a psychological treatment designed to assist individuals develop adaptive skills and strategies targeting problematic behaviours that interfere with effectively coping in one's environment and that prevent an individual from feeling she has a "life worth living". The notion of "a life worth living" is based on the woman's perspective," says Dr. Webster, who also acts as national clinical advisor for DBT. "This isn't about what you or I might suggest as appropriate."

"It rather allows a woman to define it for herself. This is significant," Dr. Webster notes. "For many women, their needs focus on personal empowerment, to be able to take control over the direction of their lives and to develop a sense of ownership."

"Adapted to the realities of prison life, DBT is a combination of individual psychotherapy and groups skills training sessions, backed up by coaching support and team consultations. The goal is to assist the women to develop and utilize adaptive coping strategies. As the woman integrates adaptive skills and strategies, she is less likely to engage in maladaptive coping strategies that sometimes include self-destructive patterns of thoughts, feelings, and behaviours."

It is particularly suitable for those suffering from high levels of distress, suicidal behaviour, low self-image and cognitive distortion. By working through a series of skill development modules, the women learn to practise mindfulness (similar to the Buddhist notion of living fully in the moment), build greater tolerance for distressing events, gain control over their emotions and improve their interpersonal skills — for example, learning how to ask for what you need and how to say "no" tactfully.

Psychosocial Rehabilitation (PSR)

PSR focuses on those with severe and persistent mental illness. It helps the women identify their needs, build on their strengths and develop basic skills for everyday living, to the point where they may once again be able to function in the community.

Intensive Treatment

For women who require intensive, psychiatric treatment, there are two facilities, one in Saskatchewan and the other in Quebec. The Women's Mental Health Treatment Unit, at the Regional Psychiatric Centre in Saskatoon, provides emergency and ongoing psychiatric care, along with other specialized treatments, including DBT. Aboriginal programming is also offered and there is a sweat lodge on the grounds.

L'Institut Philippe-Pinel de Montréal offers a similar range of services to women in need of psychiatric inpatient treatment. The bilingual institution, though separate from CSC, provides a certain number of beds on a contract basis.

In both cases, a stringent referral process is in place, to ensure the woman's needs are fully understood and that all other options have been thoroughly explored.

Primary and Transitional Care

Within each regular institution, women offenders in need of psychological services may request one-on-one service with a psychologist, or they might be provided with access to a group. "Waiting times can vary", says Dr. Webster, "depending upon treatment availability, but we try to maintain community standards." Primary care can include anger and stress management, coping with eating disorders, substance abuse, adjustment issues, self-esteem issues and other mental health related challenges. Psychological support is available to women returning to the general prison population from treatment facilities to assist in transition and to assist in the prevention of relapses. Access to Native Elders and traditional healing practices is also available to the women.

Transitional care involves discharge planning months in advance of the release date and connecting the women with community agencies and other supports. Under the new Community Mental Health Initiative, psychiatric nurses and social workers in each district parole office are already helping them access the services they need to make a safe and successful return to their home communities. ♦