Commissioner's Directive

POLICY OBJECTIVES

1. To provide direction regarding the provision of psychological services related to mental health care of offenders in order to:

1. assist them with the resolution of mental health problems and behavioural disorders;
2. help them learn and adopt socially acceptable behaviour patterns; and
3. assist them to maintain, before and following release, the gains made in treatment.

2. To provide direction regarding the provision of psychological services related to case management/reintegration goals, including the preparation of psychological risk assessments in order to evaluate and to assist in the management of the risk of criminal behaviour, as well as the provision of treatment aimed at modifying criminal behaviour.

AuthoritY

3. Corrections and Conditional Release Act(CCRA), sections 3, 3.1, 4 and 85-88

APPLICATION

4. This Commissioner’s Directive applies to all individuals involved in the provision of psychological services to offenders.

Responsibilities

5. In addition to the responsibilities outlined in CD 850 - Mental Health Services, the Assistant Commissioner, Health Services, provides functional direction regarding the provision of psychological services.

6. he Senior Psychologist, National Headquarters, together with other members of the National Psychology Management Group and in consultation with the Health Services Sector, Correctional Operations and Programs Sector and other sectors, develops standards for the provision of psychological services in CSC.

7. The Assistant Deputy Commissioner, Institutional Operations, implements nationally developed procedures to evaluate and monitor the quality and timeliness of psychological services provided to offenders.

8. The Regional Psychologist is responsible for the overall quality assurance of the provision of psychological services in the region.

9. The Institutional Head/District Director ensures that psychological services are in place to provide:

1. essential mental health care;
2. reasonable access to non-essential mental health care that will contribute to the offender’s rehabilitation and successful reintegration to the community;
3.  psychological risk assessments; and
4. other psychological services that contribute to case management/reintegration objectives.

10. The Chief Psychologist works with Psychologists, licensed mental health service providers, and other staff reporting to him/her in order to promote the provision of psychological and mental health services consistent with professional and national standards.

11. Psychologists with a supervisory and/or quality assurance responsibility:

1. provide ongoing documentation of supervisory and/or quality assurance activities; and
2. keep their supervisors informed of the quality of work done by individuals providing services under contract, to ensure that these services meet the Statement of Work as well as established standards of practice, as outlined in the CSC Psychological Services Manual.

12. Psychologists, including those providing services under contract, must:

1. deliver all psychological services in accordance with professional standards and ethics, as well as standards established by CSC;
2. provide services that are evidence-based or based on widely-accepted theoretical principles;
3. if delivering or directly supervising services to offenders, be registered for autonomous practice in a province or territory of Canada, preferably in the province of practice, and adhere to the provincial legislation and the provincial regulatory body’s Code of Conduct in the province of practice regarding the provision of psychological services;
4. practice only within their areas of competence; and
5. ensure that services, including counselling and assessments, are conducted in a manner sensitive to the special needs of Aboriginal and women offenders, and other offenders with special needs. When services are provided to Aboriginal offenders, their Aboriginal social histories and relevant cultural factors must be taken into consideration.

PROCEDURES

Types of Psychological Services

13. Psychological services will normally include:

1. assessments, including:
   1. diagnosis of mental disorders,
   2. suicide risk assessment,
   3. assessment of current mental status of offenders,
   4. assessment of risk for criminal behaviour and violence, areas of need, likely response to intervention, and issues related to the management of risk, to assist decisions regarding conditional release and/or detention, and
   5. other psychological assessments as required, such as a specialized risk assessment for participation in the mother-child program;
2. prevention and management of self-injury and suicide;
3. treatment;
4. crisis intervention;
5. psychological and mental health program development, delivery and evaluation;
6. research; and
7. consultation.

Psychological Assessment and Diagnosis

14. Upon admission to federal custody, offenders will be screened by trained personnel under the supervision of a Psychologist to determine the offender’s mental health status and the need for contact with a Psychologist.

15.  Offenders who present with mental health issues will be seen by a Psychologist, or other mental health staff under the supervision of a Psychologist, to identify their mental health needs and to determine the need for an in-depth assessment of their mental health.

16. Assessments will also be completed in response to referrals. The Chief Psychologist or a delegated Psychologist will screen assessment referrals for their appropriateness.

17. Reasons for assessment may include the need:

1. for diagnosis of a mental disorder;
2. to inform treatment needs and planning;
3. to identify criminal risk factors; and
4. to assist in case management decision-making.

18. Targets for psychological assessments may include but are not restricted to:

1. mental health problems such as psychosis, depression, anxiety, phobias, etc.;
2. biological, psychological and social determinants of behaviour;
3. brain injury, degenerative brain diseases;
4. cognitive impairments affecting learning, memory, problem solving, intellectual ability and the ability to function successfully;
5. criminal behaviour, risk for criminal recidivism and violence, identification of criminogenic risk, need and responsivity factors, as well as strategies for managing risk;
6. stress, anger and other problems related to lifestyle and emotion management;
7. marital and family relationships and problems; and
8. other issues deemed relevant by the Psychologist involved in the case.

19. Mental health assessments, one broad type of psychological assessment, will be conducted over the course of the offender’s sentence as required. They may address any or all of the following: diagnosis of mental disorders, cognitive functioning, the offender’s ability to adapt in the institution and/or live successfully in the community, risk factors for criminal behaviour, or other relevant issues.

20. Psychological risk assessments, a second type of psychological assessment, will be conducted at admission and prior to consideration for release or for detention for offenders who meet established referral criteria. They will:

1. focus on offender risk for criminal and violent recidivism, need and responsivity and on the management of risk;
2. use a variety of scientifically-validated assessment methodologies in an integrated process;
3. provide an evaluation of the level of risk posed by the offender, options for the management of that risk and the identification of factors that might increase or decrease risk; and
4. if the offender is being considered for release, include recommendations for the need for intervention in the community, including mental health services, and recommendations for supervision and risk management.

21. Psychological assessment reports for decision-making purposes will be completed according to the timeframes specified in CD 705-5 – Supplementary Intake Assessments, CD 709 – Administrative Segregation, CD 712-1 – Pre-Release Decision Making, CD 712-2 – Detention and other relevant policy documents.

Psychological Treatment

22. Psychologists will identify treatment targets consistent with offender needs, based upon relevant assessments. More intensive treatment will be provided to offenders with higher needs and/or who are at higher risk.

23. Treatment targets are of two types, related to the provision of:

1. mental health services; and
2. psychological services aimed at contributing to successful reintegration and/or reducing the risk of criminal recidivism.

24. Treatment will:

1. involve a number of components, including assessment, planning, delivery of treatment according to a written treatment plan, and monitoring of progress; and
2. be aimed at symptom reduction, the development of viable coping strategies, prevention of relapse, and problems associated with risk for criminal behaviour.

Consent for Services

25. As per CD 803 – Consent to Health Service Assessment, Treatment and Release of Information, except where an offender is determined by a Physician to be incapable of giving or refusing consent, all psychological services will be provided with the informed consent of the offender.

26. Notwithstanding the previous paragraph, a Psychologist will offer a written opinion and inform appropriate staff, regardless of the offender’s consent, concerning:

1. the offender’s risk to re-offend based on available information, in the interest of public safety; and
2. the offender’s imminent risk for self-injury or suicide or for causing serious bodily injury or death to other persons.

Management of Health Information

Documentation of Offender Contacts

27.  Psychologists and all other mental health staff reporting to Psychological Services will:

1. document on the Offender Management System, the psychology file, and other relevant file banks all significant offender contacts relating to assessment or treatment activities in accordance with professional standards, as outlined in the CSC Psychological Services Manual; and
2. prepare treatment progress reports and/or treatment summaries as appropriate, consistent with professional standards and standards established by CSC.

Psychological Reports

28.  Psychological reports prepared by staff or contractors belong to CSC. These documents include the original raw data, test materials and test results.

29.  When possible, the Psychologist will review his/her reports with the offender.

Psychology Files

30.  Psychology files, paper-based and electronic, must be labelled PROTECTED B. They have the same status as Health Care files with respect to the sensitivity of the information and to limitations on access by those who are not health professionals. Psychologists are responsible for maintaining them in a way consistent with professional standards, and in accordance with the Offender Records System User’s Guide, Retention and Disposal Schedules and Disposition Authorities.

31.  Psychologists, staff providing psychological services, and other licensed health professionals have unsupervised access to psychology files on a need-to-know basis.

32.  Access to information on the psychology files may be granted to those who are not licensed health professionals, on a need-to-know basis, as per CD 803 – Consent to Health Service Assessment, Treatment and Release of Information, and the Guidelines for Sharing Personal Health Information. Access to the psychology files themselves will normally be granted only under the supervision of a Psychologist or a delegated member of the Psychology unit.

33.  The offender has a right to reasonable access to his/her psychology file, except where the mental health professional believes it is not in the offender’s best interest or where CSC staff believes that providing access to the information may pose a risk to the safety and security of the institution.

34.  An offender’s review of his/her own psychology file must be done under the supervision of a Psychologist or a delegated Mental Health staff member.

35.  The offender will be responsible for any costs associated with the copying of the requested records.

Confidentiality

36.  The confidentiality of the offender’s personal health information will be maintained unless the offender consents to its disclosure, with some specific exceptions as per CD 803 – Consent to Health Service Assessment, Treatment and Release of Information.

Disclosure of Information Without Consent

37.  Information on the psychology file that is relevant to the offender’s risk to re-offend or the management of this risk will be disclosed to those with a need to know, regardless of whether the offender consents, consistent with section 25 of the CCRA and CD 803 – Consent to Health Service Assessment, Treatment and Release of Information.

38.  The offender will be notified when information on his/her psychology file is disclosed without consent, unless to do so would jeopardize the safety of another person or the security of the institution. This disclosure will be documented on the offender’s psychology file.

Monitoring and Evaluation

39.  Psychologists with supervisory responsibility will provide oversight of both the quantitative and qualitative dimensions of psychological services:

1. quantitative: the demand for psychological services, volume and nature of work completed, and the timeliness of its completion. One of the procedures to evaluate this component includes a nationally-adopted tracking database; and
2. qualitative: the degree to which psychological services meet professional standards and national service standards established by CSC.

40.  Supervisory and quality assurance activities will be documented and evaluated on an ongoing basis in a way consistent with CSC standards.

ENQUIRIES

41.  Strategic Policy Division
National Headquarters
Email: GEN-NHQpolicy-politi@csc-scc.gc.ca

Commissioner,

Original Signed by:

Don Head

ANNEX A : CROSS-REFERENCES AND DEFINITIONS

CROSS-REFERENCES

• CD 009 – Research
• CD 253 – Employee Assistance Program
• CD 700 – Correctional Interventions
• CD 701 – Information Sharing
• CD 702 – Aboriginal Offenders
• CD 705 – Intake Assessment Process and Correctional Plan Framework
• CD 705-1 – Preliminary Assessments and Post-Sentence Community Assessments
• CD 705-3 – Immediate Needs Identification and Admission Interviews
• CD 705-5 – Supplementary Intake Assessments
• CD 709 – Administrative Segregation
• CD 712-1 – Pre-Release Decision Making
• CD 712-2 – Detention
• CD 726 – Correctional Programs
• CD 800 – Health Services
• CD 803 – Consent to Health Service Assessment, Treatment and Release of Information
• CD 843 – Management of Inmate Self-Injurious and Suicidal Behaviour
• CD 850 – Mental Health Services

• Access to Information Act
• Privacy Act,paragraphs 77(1)(n) and (o)(General)
• Guidelines for Sharing Personal Health Information
• CSC Psychological Services Manual

DEFINITIONS

Areas of competence : competence in a specific area of practice, achieved by taking relevant courses and/or by completing a period of supervised practice as approved by their registering bodies where applicable.

Contractor : a person providing services of a prescribed class to the Correctional Service of Canada under a contract.

Diagnosis of mental disorders : a description or conclusion regarding a person’s mental and emotional condition within the context of an established system for classifying mental disorders, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). It is reached on the basis of evidence and opinion through a process of distinguishing the nature of that condition and ruling out alternative conclusions or explanations. Communication of a diagnosis is a controlled act, governed by provincial legislation and guided by professional standards.

Mental health care : care provided in response to disturbances of thought, mood, perception, orientation or memory that significantly impair judgment, behaviour, the capacity to recognize reality or the ability to meet the ordinary demands of life. This includes the provision of both acute and long-term mental health care services.

National Psychology Management Group : an advisory body providing consultation to Psychologists, senior managers, and various external partners (including regulatory bodies), as well as a working group whose goal is to promote and facilitate improvements in policy and practice related to the provision of psychological services in CSC. The National Psychology Management Group is comprised of:

1. Senior Psychologist, National Headquarters;
2. National Manager, Mental Health;
3. Regional Psychologists; and
4. ad hoc members as necessary.

Psychological assessment : an evaluation of a person’s mental, emotional and social functioning. The assessment process may include, but is not limited to, the gathering, integration and interpretation of psychological data through the use of tests, interviews, case studies, behavioural observations, collateral information, and file review, and specifically designed devices and measurement procedures. The type and nature of the assessment are guided by the referral question and the needs of the offender. Two major types of psychological assessment are mental health assessments and criminal risk assessments.

Psychological risk assessment : an evaluation of offender risk, need and responsivity and the manageability of risk, done from a psycho-social perspective, utilizing a variety of scientifically-validated assessment methodologies in an integrated process. It also includes reference to appropriate strategies for the management of risk.

Psychological services : services provided by a licensed Psychologist and by unlicensed staff who are under the direct supervision of a licensed Psychologist.