Women Offender Programs and Issues

"Giving Us A Chance"

 

(Revised Edition)
Needs Assessment:
Mental Health Resources
For Federally Sentenced Women
In The Regional Facilities

Margo Rivera, M.Ed., Ph.D.
March 31, 1996

 

The individual assessments of the women have been removed from this edition and non-identifying profiles have been created in order to protect the personal information of these women.

Acknowledgments

My heartfelt thanks to all the imprisoned women who spoke to me about their struggles, their hopes and their needs. And to the staff, whose knowledge, experience and determination that federally sentenced women be offered more in the future than they have been in the past, made it possible for me to be part of the process of making it happen. I am honoured to help in a small way with the challenge of creating from the vision, a reality.

Prison For Women, Kingston, Ontario
Thérèse Leblanc, Warden
Dr. Roy Brown, Psychiatrist
Sophie Kleywegt, Native Liaison Worker, Elder Co-ordinator
Members of the Native Sisterhood
Psychology staff
Dr. Jean Folsom, Chief Psychologist
Punch Gaylord, Administrator
Jill Atkinson
Jane Barker Betty-Ann Howard
Franca Cortoni Beth Merriam
Dr. Julie Darke Shoshana Pollack
Jan Heney Brenda Restoule

Edmonton Institution for Women, Edmonton, Alberta
Jan Fox, Warden
Health Care Team
Ineka MacDougall, Team Leader
Dr. Les Block, Psychologist; Dr. Amy Bourquet, Family Medicine
Dr. Maggie Twiddle, Consulting Psychiatrist
Carol Hutchinson, Director, Elizabeth Fry Society, Program Advisory Committee EI4W

Regional Psychiatric Centre, Saskatoon, Saskatchewan
Joan Lavellee, Elder
Brenda LePage, Patient Care Manager
Dr. Aubrey Levin, Psychiatrist
Dr. Cindy Pressé, Psychologist
Bernice Wapass, Aboriginal Program Officer

Nova Institution For Woman, Truro Nova Scotia
Chris Manuge, Warden
Frona Allen, Team Leader, Operations
Genevieve Butterworth, Team Leader, Programs
Sylvia Frausin-Murphy, Psychologist
Mary Haylock, Feminist Counsellor
Ancel Langille, Leisure Program Director
Anne-Marie MacDonald, Case Management Co-ordinator
Sandra Nimmo, Program Development
Christine Sandeson, Art Expression Facilitator
Lorie Shimmell, Occupational Therapist
Matilda Snachi, Native Liaison Officer
Denise Thibault, Nurse, Case Management Officer

National Headquarters, Correctional Service of Canada
Jane Laishes, Mental Health
Hilda Vanneste, FSW Programs

 

Executive Summary

Sometime in the year 1996, the Prison for Women -- until very recently Canada' s only penitentiary for federally sentenced women prisoners -- will finally close its doors. Official reports from shortly after the construction of the Prison for Women was completed in 1934 have uniformly identified the facility as inadequate and inappropriate for addressing the needs of women prisoners -- "unfit for bears, much less women," according to the MacGuigan Report (1977). The closing of P4W represents a significant accomplishment for the Correctional Services of Canada (CSC) in this last decade of the millennium, an event to be celebrated by those who embrace the cause of justice for women.

The 1990 report of the Task Force on Federally Sentenced Women, "Creating Choices," was the final official report to insist that the Prison for Women be closed. It further recommended that five regional facilities be built to house federally sentenced women for the part of their sentence that must, under law, be served in a penitentiary. The task force articulated the following five principles to provide direction for CSC in creating facilities and programs which would reflect the unique experiences and meet the unique needs of prisoners who are women: Empowerment; Meaningful and Responsible Choices; Respect and Dignity; Supportive Environment; and, Shared Responsibility . The guiding statement of principle in the development and maintenance of facilities for federally sentenced women, as set forth in "Creating Choices," is that,

The Correctional Service of Canada with the support of communities, has the responsibility to create the environment that empowers federally sentenced women to make meaningful and responsible choices in order that they may live with dignity and respect.

As the new facilities were constructed and began to open, a concern developed that, in creating facilities that emphasized personal responsibility and "dynamic security," a minority of federally sentenced women would not be able to participate constructively in such an environment without very special and specialized attention being paid to their need for an enhanced level of psychological support services.

A few women, still currently residing at P4W are, by their own estimation and/or that of concerned staff, not suitable for transfer to the new facilities. A high degree of self-destructive and occasionally violent behaviour that is a manifestation of their disturbance makes it likely that they will not be able to manage day to day living with the degree of self-sufficiency that is the norm at the new facilities. The particular situations of these women highlighted the question, "Have the new facilities incorporated into their operating plan an appropriate level of what are usually termed mental health services to enable the entire population of federally sentenced women to take responsibility for their lives within the new settings and to make meaningful choices and substantial and constructive life changes?"

This is the issue I was asked to address in a time-limited (February 1 - March 31, 1996) needs assessment of the mental health needs of a group of federally sentenced women currently residing at P4W, Edmonton Institution for Women and Nova Institution for Women. I talked to women prisoners, correctional staff, health care providers, counsellors and Elders, and I came to the conclusion that many of them had come to already -- that there were some women whose need for intensive healing intervention was so acute and so pressing that the new facilities, as they are now set up, would not be able to meet those needs, even minimally. In fact, their presence, without appropriate supports, would be likely to endanger the success of the these facilities. At least as important a conclusion was that it was not just these women whose emotional needs are not being adequately addressed in the operation of the new facilities in a way that mirrors -- or even approaches -- the vision for change that was put forth in "Creating Choices."

As a result of these conclusions, I make two levels of recommendations. Numbers one, two, three and four can and should be implemented immediately (within four to six months). Numbers five and six can and should be implemented within a one to two-year time frame if concrete efforts in that direction begin immediately.

 

Recommendation One

CSC create a healing facility to house eight women in immediate need of intensive, secure psychological treatment to enable them to deal with the problems that lead to severe self-destructive and destructive behaviour. This is a resource designed to treat non-psychotic women (often labeled "borderline personality disorder," and sometimes, "anti-social personality disorder" in psychiatric settings) who understand their difficulties as emotional in origin and therefore wish to access this kind of demanding and intensive healing program. Involvement in the healing program would be voluntary; only those women who acknowledge a need and desire for an intensive and specialized setting of this sort would be likely to benefit from treatment.

I recommend that this facility be set up in Kingston, Ontario, so that it is initially not attached to any particular institution, so that women who are already in Kingston would not have to move to another city or province before they are ready to transfer to their home facility, and to enable CSC access to treatment staff who already have years of valuable experience in counselling these women and many other women with similar histories and difficulties. The Isabel McNeill House, situated across the street from the Prison for Women and now housing women with a minimum security classification, might be a suitable location, with perimeter security added and some adjustment to a few of the rooms on the second and third floors to allow for individual occupancy of bedrooms.

Such a facility (henceforth referred to as The Healing House) needs to be operational before the final closing of the Prison for Women -­presumably, therefore, in the late summer or early fall of this year, 1996.

 

Recommendation Two

CSC take whatever measures are necessary enhance the security of some part of the Healing Lodge to the degree necessary to make it a real choice for Aboriginal women whose emotional and social difficulties could be best dealt with in an Aboriginal healing program, but who are now excluded because of their high security classification and behavioural problems resulting from severe emotional disturbance. Add Healing Lodge staffing to meet the greater needs of these women for intensive support.

CSC create a weekly pre-Healing Lodge program at the Edmonton Institution for Women -- including a group session facilitated by one Healing Lodge staff person and one EI4W staff person and an individual support session for each woman with a member of the Healing Lodge staff -­for all Aboriginal women who want to be accepted into the Healing Lodge. This program would enable the Aboriginal women who wish to be accepted into the Healing Lodge, but are not ready for participation, to develop clear goals with consistent encouragement and monitoring from Healing Lodge and EI4W staff and from the other women who are also trying to gain admittance into the Healing Lodge. This will enable these women to take the steps necessary to be accepted into the program -- or to understand clearly why they are not yet accepted.

 

Recommendation Three

CSC negotiate for specialized in-patient mental health services in an institution close to each regional facility. These hospital beds would only be used occasionally by women whose stability is threatened by a psychotic illness and who need time-limited medical treatment to adjust medication levels and re-establish stability.

There appear to be very few federally sentenced women suffering from major mental illnesses, such as schizophrenia, psychotic depression, bipolar disorder, or an organic syndrome. Because they are not large in number does not mean, however, that their need for appropriate psychiatric care should be left to chance, or only addressed on a case-by-case emergency basis. Planning in each region needs to take place to ensure equal access to appropriate mental health care for women who suffer from major mental illnesses.

 

Recommendation Four

CSC ensure that basic, culturally-appropriate individual and group counselling services are available at each institution immediately. Women therapists should be easily available, and they should be trained and experienced in providing both long-term intensive therapy and short-term problem­solving and/or crisis counselling to women with addictions and to women who have suffered a wide variety of personal trauma, including physical and sexual abuse.

If they are to understand the importance of implementing the "Creating Choices" vision of empowerment and meaningful choice, therapists in the facilities need to be committed to a feminist model of service delivery that acknowledges the social determinants of individual experience and emphasizes mutually respectful and cooperative therapeutic relationships within a context of acknowledged power differential.

Staffing should represent, to as great a degree as possible, the racial, ethnic and cultural mix of the population at each institution, so that women experience themselves being offered respect for their cultural backgrounds as well as for them as individuals. Counselling services should be provided in the languages that the women are most comfortable speaking, so that a woman, for example, whose first or most familiar language, is French, should not be forced to struggle to express herself in English at the same time as she is trying to talk freely about painful and personal matters. Part-time counsellors can meet the needs of women who do not share a language with many others, or community programs can be utilized to meet the needs of some women for culturally-appropriate counselling in their own language.

Communication among the key providers of healing services in all six new facilities should be organized immediately with a view to sharing ideas and developing some commonality of counselling programming across the country. At least six meetings (each hosted by a different regional facility and by the Healing Lodge) should be facilitated over the next two years, attended by the key counselling staff at each institution. Though a clearly defined plan for integrating psychological services into the facilities' core operation needs some time to be theorized and implemented, it is important that some basic commonalties be established in order to ensure that federally sentenced women in all parts of the country have equal access to appropriate counselling services as soon as possible.

 

Recommendation Five

CSC create a working group, with representatives from the Healing House and all institutions, including the Healing Lodge, to implement the integration of healing resources into the operations of all institutions serving federally sentenced women.

One aspect of this group's work would be to develop specialized cottages at each institutional site to serve the needs of women with addictions, women in need of a long-term, intensive healing program (similar to the one that will be created more immediately in the Healing House) and women who need shorter-term intensive healing intervention.

Another aspect of the committee's mandate would be to develop a strategy to integrate a thorough assessment and plan for appropriate healing into each federally sentenced woman's correctional plan in a way that the woman experiences as empowering from the first day she arrives at the institution.

As well as developing a strategy to implement healing interventions into the core operation of each institution, the committee would develop training modules to enable the institutions to integrate the strategy into its core functioning and would create a monitoring structure to ensure equal access to a uniformly high level of psychological services in every region of the country.

 

Recommendation Six

CSC create a policy document outlining the objectives that will guide the operation of the regional facilities for federally sentenced women and clearly defined policies regarding maintenance of security and program development that are consistent with those objectives. A working group be created with representatives from each institution to monitor the implementation of these policies, so that there is basic consistence of service delivery across the country.

 

Assessments

I did not enter into this process with any of the preceding recommendations in mind. It was the input of all of the people who shared themselves and their insights and experience with me over this two-month period that generated these ideas. The most powerful influence on my developing understanding of the possibilities of creating a framework for deep emotional healing within a correctional context came from the voices of the imprisoned women who spoke with me. Some talked with me briefly, and some at considerable length. All of the women communicated generously and with respect. They talked to me about their life experiences before prison about the fear and-pain and rage (and sometimes joy and laughter and love) that constitutes life in prison for them, and about the effects of all of these experiences, inside and outside the prison boundaries, on who they are and who they are becoming as women. I hope that the following short summaries of my assessment of their current needs for psychological healing resources are reflective of the spirit of their communication with me.

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The following profiles are not the profiles that originally appeared in Dr. Rivera's report. Rather, in order to protect the women's stories and personal information, the following six profiles represent a combination of the stories of all of the women who were assessed by Dr. Rivera as requiring a specific intervention. Dr. Rivera had indicated that more than one intervention might be possible for some women. This must be kept in mind in looking at the number of women representing each particular intervention. It is also important to note that 10 of the 25 women originally assessed were Aboriginal.

Dr. Rivera has reviewed and approved of the profiles as accurate generic representations of the assessments that initially appeared in her report.

Healing House (8 women were determined to be in this category)

Karen, 32 yrs.

“There should be some place for women to go who need help....I'd be the first one there waiting for the door to be open.”

“I don't feel safe enough to go on the street.”

“I'm going to lose all my friends: the staff here have been my support. If I have to go into another prison, I'll lose all my self-respect, and I'll drug, I'll kill, and I'll escape.”

Karen has been incarcerated in federal penitentiaries since the age of twenty, and from the age of sixteen to twenty she lived in a psychiatric hospital. After escaping three times from provincial custody, she was sent to the Prison for Women and has lived there her entire adult life except for a one-year stay in a provincial psychiatric facility. Karen has spent most of her sentence in segregation, and it is likely she will remain in segregation until the prison closes. Though her emotional well-being is significantly damaged by the isolation of segregation, her inability to control her violent behaviour makes it imperative that she remain locked away from other women.

She considers P4W her home, and she is terrified to leave for another setting. She has applied to transfer to the Kitchener facility when P4W closes, because she knows she has to go somewhere, but she does not want to go there or to any other prison. Karen speaks in contradictory ways about her circumstances at different times. Within one hour, she told me she had been looking for help since she was fifteen years old and also that she had no hope of getting any better.

Karen suffers from a severe posttraumatic dissociative condition and all the classical symptoms of her childhood history of abuse and neglect -- severe anxiety, depression, emotional lability, fear of being alone, and obsessive-compulsive thinking and behaviour. She harms herself frequently and very seriously, sometimes with near-lethal consequences. More than once, she has opened an artery by slashing herself deeply with a knife.

Karen seems to be convinced that she has been unsuccessful in communicating how serious her problems are. She does not speak about this in a complacent way -- to enhance her self-importance -- but rather as a cry for help. She describes obsessive thoughts, violent thoughts that she calls evil. She takes high doses of Nosanan; also Tegritol and Anafril. She says the medications help a bit, mostly by making her sleep a lot.

Karen describes sexual assaults on her in the institution, “I want it, want it to be more violent than it is, and then I also get very scared and want it to stop”. In the grip of intense feelings, Karen often reports impulses to behave in a sexually inappropriate way with professionals, has harmed herself seriously and has made near-lethal suicide attempts.

Karen recently attacked another inmate with a knife and describes the incident as a pleasurable experience that set her body vibrating. Karen is emotionally labile, extremely vulnerable and needy, and is plagued with violent impulses. She will continue to present a real danger to the community unless she is able to access intensive and appropriate treatment. She said about segregation, “I'm happy here, I feel I'm not going to hurt anyone.”

Karen has recently seen the connection between her violent impulses and the sexual abuse she endured as a child. The therapeutic relationship that she has formed with a psychologist at P4W has enabled her to begin to understand the links between past and present, but she declares she has not even begun to gain a measure of control over her impulses. Karen seems to be highly motivated to engage in an intensive treatment regime, and is not likely to heal from her own formative experiences of abuse without long-term treatment in an exceptionally secure setting.

Karen is a woman who would benefit greatly from a healing program such as The Healing House, which would offer a secure, non-violent environment, in combination with intensive therapeutic programming. Though she has not been able to make much progress in getting her symptoms under control in the prison environment, in which her terror and compensatory rage are always being triggered and re-triggered, she has shown that she can create a strong therapeutic alliance and has, in fact worked hard at understanding the source of her problems in therapy with the prison psychologists. If she is not able to access an intensive healing program -- and she has to move from the only home she has known as an adult, which, clearly, is inevitable -- I believe she will be a serious risk for harming or killing herself, and quite possibly will present a risk to others as well.

Structured Living Unit (2 women were determined to be in this category)

Jo-Ann, 36 yrs.

Jo-Ann has a long history of involvement in both the corrections and mental health systems. Neurological testing indicates pervasive brain damage, with no localized impairment. She has significant deficits in coping skills and adaptive behaviours. She has had serious drug and alcohol problems and tests as having below average intellectual functioning. According to her testing she functions at approximately the level of a nine year old in these areas. This may well be cultural -- a result of a childhood history of deprivation and abuse ( a variety of foster homes since age 10 months) -- rather than a reflection of innate ability, as her reading skills are close to average and her use of language is clear, accurate and complex.

Jo-Ann is, at times, significantly out of touch with reality and unmanageable. She has a history of self injury and suicide attempts. She scares the other inmates, and she can be violent with them. She is not a woman who benefits from emotional contact with others, and she will probably have a difficult time in a setting in which a great deal of interaction is demanded. Jo-Ann's history of assaultive behaviour makes her a danger in a group of vulnerable adults. She bursts out in frustration, in response to behavioural constraints, personal criticism, or when she is not able to get the focused attention from others that she wants so desperately.

She is a hard worker, but she works best on her own. Her main concern about her future placement at the Nova facility was related to the possibility of continuing full-time employment in that setting. She says that she is a good worker and that if she does not have full-time work to keep her busy in Nova, she will be lost. She seems proud of her work as a cleaner, and the structure and the recognition that the work provides is a lifeline for her.

Jo-Ann spoke proudly about having completed all the programs related to her problems that P4W had to offer. Change is not easy for Jo-Ann, and she may well react to the move to Nova with exacerbated explosiveness. She would not benefit from -- or participate in -- a program of intensive psychotherapy, but needs to be monitored closely by a psychiatrist regarding medication, to ensure basic stabilization. She should be provided with as much practical structure as possible, particularly long hours of hard work, and be given positive feedback for work, to enable her to maintain as much stability as possible during the transitional period.

Jo-Ann is used to living in mental health facilities. She talks about the people on rehab wards of mental health hospitals as “my people”. Some of her pseudo-psychotic presentation may well be imitative of the schizophrenics she has lived with in hospital. Jo-Ann could quite possible manage in the Structured Living Unit at Nova Institution for Women. It was the experience of her counsellors at P4W that if Jo-Ann is given a great deal of time, attention, structure, and lots of positive feedback for any accomplishments, she can make progress in goals that are concrete and measurable. Generally, the psychology personnel at P4W did not have the luxury of spending as much time with her as she needed. It is possible that in a setting such as the Structured Living Unit, she could get the constant input and positively charged supervision from staff that she needs as a woman who is in many ways functioning as a child.

Enhanced Unit (3 women were determined to be in this category)

Debbie, 25 yrs.

"Don't believe everything you read about me."

Debbie is a young Aboriginal woman who has spent all of her adult life in prison as a result of a chronic drug problem that she has had since early adolescence. She has a history of sadistic and ongoing childhood sexual abuse, and she has suffered since she was in grade school from severe hyperactivity. Her solution to the pain and agitation she experiences constantly is to self-medicate, and she is committed to her addictions.

Debbie speaks very positively of her contact with the Elders and the Native Sisterhood at P4W. She says this experience has helped her get in touch with her roots and gain a sense of self. She has also begun to understand how she has used drugs as a way of dealing with feelings she cannot handle. She says that when she is not high she is the kind of person that will give anyone a chance, but, unfortunately, she is often high. She has access to a variety of illegal drugs in prison, and she also avails herself of whatever prescription medications Health services are willing to provide. Even when medicated to this degree, she appears extremely agitated, with little ability to concentrate for very long.

Debbie is rebellious, and has many disciplinary offenses in P4W for verbal abuse of the staff. Many of her offenses -- both in and out of the institution have been violent. Debbie exhibits severe moods swings, emotional liability, and intense neediness in combination with aggressive devaluing of those she needs. Debbie had applied to serve her time in the Healing Lodge, however due to her security level she is unable to benefit from this program. She has become withdrawn and has begun to slash her arms as a way of expressing her frustration at what she perceives of as the inconsistencies in the new facility. “Don't mix me up and tell me this is a new thing when it's not,” she declares in angry response to a level of security that includes strip searches for women in the enhanced unit after visits and programs. Debbie seems to have benefited from her stay in the RPC. She needs a level of professional counselling, ideally with and Aboriginal healer, that is not yet available at EI4W.

Debbie's explosive anger at men, that is a consequence of her sadistic physical and sexual abuse, gets stirred up easily, and she has not yet come close to coming to terms with her rage. She is due to be released in the not too distant future, and she is likely to be a danger both to herself and to others if she does not get the help she needs. Debbie is aware of this, at times, and she is very anxious about it. However, to volunteer for a healing program that would involve the sacrifice of her addiction -- her major mood modulator and coping mechanism -- she would have to be highly motivated to bear a great deal more intense feeling without the soothing effect of drugs than she has been so far. However, that she values her Aboriginal experience so highly and has worked so constructively in that context may be a sign that it is possible that she would be interested in a healing program with a well incorporated Aboriginal component. This program would have to incorporate Aboriginal ways of doing things, and may also prepare participants for the Healing Lodge.

Debbie needs intensive treatment, and it must be near her home (rather than in a treatment facility in another part of the country) because her mother who lives in the band reserve is her major support person and her visits are very important to Debbie. I think her only chance of breaking out of the cycle of drugs, violence and self-abuse would be a long-term stay in a high-security healing program in which both her drug use and her violent actions could be contained, at the same time as she was receiving appropriate therapeutic input. Only if she moves into a milieu in which her bravado is not constantly reinforced and her defenses against feeling are removed will she open up enough to get what she needs to change her anti-social behaviour patterns. Otherwise, I think she will be an ongoing security and management risk for any institution in which she resides, and her significant emotional needs will always be masked by her volatile behaviour.

Individual Counselling (6 women were determined to be in this category)

Lucie, 25 yrs.

"I miss my counsellor from P4 W so much. I'm used to talking to someone that way at least once a week."

Lucie recently arrived at EI4W, and is serving a relatively short sentence for aggravated assault. Lucie has a long history of serious drug abuse, and she was on the street at thirteen years of age, making money as a prostitute to support her drug habit. Lucie had been seeing the Fancophone counsellor at P4W and would benefit from continuing to see a French-speaking counsellor on a regular basis, although this is presently not available to her. She says her counselling has enabled her to understand and get control over her addiction, and that she misses the opportunity to have weekly counselling with someone who is not involved in the security aspect of the institution. She is determined to stay clean and sober, and she has the support of her aunt and cousin in this struggle. Both of them were involved in drugs and alcohol when she was on the street, and they are both clean now and a great support to Lucie in her attempt to build a new life for herself. Her cousin is dying, however, and his death is likely to be a difficult experience for Lucie.

Lucie grew up in a home that was chaotic and violent. She saw her mother beaten by men, and these same men sexually abused her as a child. Her father left her mother for a man when Lucie was very young. He died of complications of the AIDS virus in November, 1995. Lucie herself has recently been diagnosed as HIV-positive, and she is still extremely shaky talking about this and all its implications. In the past, she has suffered from bulimia and has engaged in self-injurious behaviour when under stress, and, though she told me she thought that all that is behind her now, Lucie slashed herself very seriously within a couple of weeks of my visit. Lucie is very fragile emotionally, and she needs to become connected to a counsellor to enable her to deal further with her history of abuse and all of the traumatic and dangerous experiences she endured as an adolescent on the street and to build the strengths she needs to create the new life she so desires.

Lucie has a four year-old daughter who has lived with her mother since her birth. She plans to live with her mother and daughter after her release. She is not entirely sure her mother will be able to treat her like an adult, and therefore has some misgivings about living with her, but she says her mother's attitude towards her has softened since her HIV diagnosis, and she has hopes that she can get the support she will need from her.

I interviewed Lucie just after she had returned from her first day pass to attend a graphics workshop. She was extremely excited about the experience, particularly because it meant to her that the staff trusted her enough to offer her the opportunity to leave the institution. How the staff regard her is very important to Lucie, and she becomes elated when she perceives herself as well thought of and disappointed and angry when she believes her behaviour and actions are misinterpreted. She is clearly a woman who can be much more effectively motivated through kindness and encouragement than through rules and regulations.

Although excited about her first pass, Lucie also talked about the intense level of anxiety she experienced being out on the street among crowds of people. She said that she has gotten used to being in an institution and that she will need a great deal of help adjusting to life outside again. Lucie should have as much help as she needs to deal with both the effects of her life before prison and the effects of being incarcerated before she is released into the community, or she will be all too vulnerable to re-escaping into drugs and alcohol. She has shown that she appreciates and can make good use of counselling, and as soon as French-speaking women counsellors are available at her institution, Lucie should be one of the first women to have access to this service. Any release plans should involve a great deal of practice, and a very secure supportive structure in the community which incorporates her need for assistance in coping with her HIV diagnoses.

Hospital Beds (1 woman was determined to be in this category)

Patty, 38 yrs.

“There should be a psychiatric ward here. Some people need time-outs.”

Patty is serving ten years for manslaughter. She has been diagnosed a paranoid schizophrenic and has a long history of involvement with both the mental health and the corrections systems, including 50-60 admissions to Waterford Hospital in St. John's Newfoundland.

Patty suffers from hepatitis and does not seem to be able to tolerate Interferon. She is much more comfortable talking about her medical needs than her psychiatric problems. She exhibits significant negative symptomatology of schizophrenia -blunt affect and little energy or ability to relate interpersonally or accomplish much in the way of work -- and she can be verbally idiosyncratic, obsessional, rigid and delusional. In prison, she repeatedly complains about being raped when asleep (in her locked room) and about poison in her food.

Because she was unmanageable at P4W, Patty spent two years at St. Thomas Psychiatric Hospital as part of her current sentence. She was pleased to tell me that the day that I interviewed her was the first anniversary of her return to P4W from St. Thomas. She said that, although there were advantages to the hospital (more visits allowed, extra clothes and food from visitors), she prefers the prison because there is less pressure to get counselling, go to programs, and relate to others. She is very clear that she would participate in no programs related to psychological issues, in this prison or any other.

In the past four months, Patty appears to have stabilized on her medications, and she has not been a management problem. If she remains medication-responsive, she can probably manage in the Kitchener facility. She may not be able to live easily in a cottage setting, however, where interaction with other women and a fair bit of responsibility for contributing to the general welfare of the group is demanded. If pressured to perform on a higher level than she feels able to do, she may become reactive. Caution needs to be used in any attempts to encourage her to function interdependently. She is not someone who could benefit from a program intensive psychotherapy, such as is proposed for nonpsychotic women suffering from serious problems in interpersonal relationships and self-care. Her problems are of a different nature and would only be exacerbated by that sort of program.

When Patty was out of control at P4W, she was -- according to her records and staff reports -- dramatically out of touch with reality and dramatically unmanageable. Regional resources need to be developed in conjunction with each regional facility to enable women such as Patty to access psychiatric medicine within an appropriately secure hospital context when they develop acute symptoms of their mental illness and become unresponsive to their medication. A prison is no place for a woman in the grip of an acute bout of a psychotic illness, and hospital beds should be as available to federally sentenced women as they are to women suffering from acute psychoses in the community.

Aboriginal Needs (10 women were determined to be in this category)

Elaine, 27 yrs.

“They say I'm a hopeless case.”

“He's not here, but he's still on my skin in the scars.”

“Aboriginal women learn to deal with our past to put it behind us, not repeat it over and over.”

Elaine is a young Metis woman who is serving a life sentence for second degree murder. Her mother suffered from severe alcoholism and committed suicide when Elaine was only ten months of age at which point she was adopted into a White family. Elaine states that she was physically and sexually abused by her stepbrothers throughout her childhood. By the time she was twelve years old she had been in detention centres and working the streets as a prostitute, and had been involved in pornography. She has been a street kid who maintained an image of toughness throughout adolescence that brought her in contact with the law many times for violent actions. An uncle was charged with sexually abusing her, and he committed suicide rather than face the consequences of his actions. She has had a long-term serious drug problem.

Elaine has been a long-term management and security problem in the penitentiary. She becomes extremely angry - at any representative of authority, at her peers, and at herself. She has had many institutional charges, and has engaged in serious acts of violence against other women. She also injures herself brutally. Explosive acting out of rage serves as a stabilizing mechanism for Elaine. When she is not enraged, she is often panicked, severely anxious, and suffers from significant obsessive-compulsive thinking and behaviour.

While at P4W Elaine participated in the Native Spirituality program and found it helpful. She participated actively in Sisterhood and inmate council activities. She saw the elders every day, and described feeling drained and at peace after participating in a sweat. Elaine applied to serve her time in the Healing Lodge, and she was extremely disappointed that she was not accepted, and slashed herself in response to the rejection.

Elaine is full of rage and contempt for white mental health services and it is unlikely that she would be interested in participating in any treatment program except one offered by Aboriginal healers. One of the Elders with whom Elaine communicated often during her stay at P4W thought that she would need extremely intensive support to cope constructively with the program at the Healing Lodge, but that, if she was paired with another, very strong Aboriginal woman, she might have a chance to make the progress that has eluded her so far in the course of her long prison experience. It is important that Elaine be given a chance to participate in a structured program within the institution that will offer her clear and consistent guidance as to how to ready herself for acceptance to the Healing Lodge.

For Elaine to make the substantial changes she needs to make if she is to do anything for the rest of her life beyond following the con code and engaging in escalating acts of violence towards others and herself, she needs more intensive help. Elaine is a woman with very few internal resources on which to build new ways of coping with life. She needs a rich program with consistent input from people she can look up to. She has a very low frustration tolerance, and without a great deal of input, structure and continuous positive-reinforcement, she is likely to lose what she gains very quickly. She is then at high risk for acting violently against herself and/or others to take the edge off her acute sense of pain and loneliness.

If the Healing Lodge is to be an appropriate setting for Elaine, more intensive security will need to be built into its facility. Only in an environment that Elaine chooses, and an environment that offers deep and consistent healing interventions in combination with powerful support and the external security that will enable her to be contained from without when she cannot contain herself from within, will Elaine have a chance to internalize the personal and cultural values that she admires and turn things around for herself, if that is what she wants to do.

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Findings

There are many things that can be learned from my visits to four facilities for federally sentenced women and my assessment of the needs of twenty-six the women for therapeutic services. I can only touch upon a few of them in the time constraints of this project.

 

Profile

The women I focused on were chosen by staff in the facilities I visited as having particularly obvious needs for psychological services. I am most struck by their uniqueness as human beings and as women. Every woman I spoke with stands out clearly in my mind. Recently, as I was returning from interviewing a woman in the Special Needs Unit at the Prison for Women, a staff person said to me, making conversation as people do, "Are they all starting to blur into one at this point?" I was about to smile and nod inanely, and then I thought about it for a moment and replied honestly, "No, not at all. Each woman is so much herself, and so far, I am carrying them all clearly within me."

There are, of course, some important commonalties, and one of the things studies do is document them and note their importance.

The group of federally sentenced women who were selected for their emotional problems and their possible need for enhanced psychological services had a much higher level of physical and sexual abuse in their backgrounds than the other federally sentenced women did. As a group, women in prison, and particularly women in the Kingston Prison for Women, have been found, not surprisingly, to have much higher levels of abuse in their backgrounds than women in the general population. Of the twenty-six women interviewed, only two women did not report a history of childhood abuse, and one of them suffers from a major mental illness and refused to talk about any such issues. More than 90% of them were victimized -- many of them continuously and brutally -- as children and/or young teenagers.

Fifteen of these women (57%) have been hospitalized for psychiatric problems -- some of them many times. At least nine of them -- 34% -- suffer from a full-blown dissociative condition, either Dissociative Identity Disorder (DID) or Dissociative Disorder Not Otherwise Specified (DDNOS), conditions resulting in significant alterations in consciousness and awareness that are associated with severe childhood trauma. Every one of them used psychological services in prison, some of them with high frequency, both on a planned and on an emergency basis. Twenty-three of these women (88%) have had serious problems with substance abuse. Many of them acknowledge using drugs with great frequency throughout their prison career. In summary, this group of twenty-six women had significantly higher levels of abuse in their histories and more serious psychological and substance abuse problems, both past and present, than the average federally sentenced woman, who has much higher levels of these problems than the average woman in the general population. This is truly a group of women with a great need for intensive healing as a central part of any realistic attempt at rehabilitation.

 

Policy and Practice Consistency

In providing a blueprint for the development of a holistic plan for creating a new and empowering context within which to serve federally sentenced women in Canada, the Task Force Report, "Creating Choices", used a touchstone to ensure that the plan met the challenge of embodying its fundamental principles: Empowerment; Meaningful and Responsible Choices; Respect and Dignity; Supportive Environment; and, Shared Responsibility. The test required that the plan create choices for federally sentenced women based on the driving principles, that it mirror caring responses for women in the community, including Aboriginal and other ethnic communities, and that it ensure that women be treated with respect and dignity and empower them to take responsibility for their lives. The final question in the touchstone -- or test -- for the plan proposed is Does it 'speak the truth and let the truth be heard'? a quote from a letter written by Linda Jordan, Native Women's Association of Canada, as part of a "Survey of Federally Sentenced Aboriginal Women in the Community" (Sugar & Fox, 1990).

One truth that emerged from my study was that there is a big and potentially dangerous gap in the process of implementing the recommendations of "Creating Choices." The document draws a picture with wide brush strokes of what a different and liberating model of imprisoning and rehabilitating federally sentenced women would be like. General principles are sometimes amplified by specific suggestions and program recommendations.

There has been, however, no clear formulation of a new structure into which the new principles and the new programs will be built. Through two months of being dropped in a rather intensive way into the organization, it became clear to me that everyone involved -­administration, staff, and, most of all, the federally sentenced women themselves -- are experiencing the effects of this missing piece. Again and again, women spoke to me about inconsistency, about being told one thing by one person and another by someone else, or by the same person the next day. Staff acknowledged that they were often flying by the seat of their pants, creating policies as circumstances arose, and then changing them when they did not work.

Some of the very basic assumptions that obviously drove the design of the facilities are creating serious problems. For example, building a facility in an urban area and not fencing it in securely makes it necessary to supervise women more closely than either staff or the women are comfortable with One woman said plaintively, "We didn't ask to have a place built without a fence, so that those of us who are maximum security have to be escorted everywhere by staff. There is less freedom here than at P4W, where you can go wherever you want without anyone worrying about escape." Another woman said she was desperate for a job as groundskeeper, and she was assured that she could do this kind of work. Then, the offer was rescinded because, at a medium security level, she cannot be outdoors unsupervised.

As a result of the low level of security, some practices were more strict (and frankly oppressive) than any women had experienced in other facilities. When I visited the Edmonton facility, strip searching women in the enhanced unit as they returned from programming or from excursions outside the institution was routine. This same practice operated side by side with others in which women were supported by the same staff who strip searched them. The Warden and the health care team leader described the attempts of the staff to operationalize the policy about self-mutilatory behaviour being seen as a mental health rather than a security issue, and support being offered in addition to any necessary medical treatment, rather than punishment. A primary support worker stayed with one woman much of the night after an incident of self-harm, talking to her and rubbing her feet to comfort her. In these situations, neither the support nor the security measures have been thoroughly thought through and integrated with each other. Only after this has been done can appropriate training offered to the primary workers. The present situation of powerful, evocative, unintegrated (and probably some unnecessary and unwise) support and security measures could easily create a power keg or blow the lid off an already tense situation.

As a result of this gap in clear policy and practice mandate, there appeared to be very few guidelines in the two new facilities I visited, within which to place concrete policies around either security or rehabilitation. There were obvious differences in the way EI4W and Nova were being set up and run, due, at least in part, to the different backgrounds, philosophies and styles of the Wardens and their staff. What they both shared was some degree of directionlessness. This seemed to make both staff and women nervous and insecure. One woman said to me, "If this building were built from the staff members, it would fall down, they are so inconsistent about everything. First they say one thing, then another, then someone else says something else again" Some of this is, of course, the growing pains of any new endeavor. Most of it, however, appeared to me to derive from the reality that the facilities have been designed, built and women moved in before a clear philosophy about the operation of the facilities and program policies deriving from this philosophy have been developed, or, if such guidelines have been developed and are in writing somewhere, before they have been understood and incorporated by management and staff. There also seemed to be relatively little ongoing communication among staff from the different institutions, so that they are not able to benefit very much from each other's strengths, to learn from each other's mistakes, and to support each other as they embark on this exciting journey of creating a new prison system for federally sentenced women.

 

Psychological Services

Neither the Edmonton Institution for Women nor Nova is equipped at the present time to meet the needs of the few most seriously disturbed women who are still residing at P4W. In fact, there are a couple of women out west and one woman down east whose needs may well outstrip the resources of the facilities to which they have already transferred. Eventually, all the regional facilities should have a specialized healing cottage integrated into its program, and they could then possibly undertake the much of the intensive and secure healing program that will be developed in The Healing House. For the present time, however, trying to integrate the most disturbed women into the general program of the regional facilities is likely, not only to deprive the individual women of the psychological treatment they need, but to create a level of disruption that will undermine the smooth and successful operation of the facilities.

As well as not being in a position to meet the needs of the most severely disturbed of the federally sentenced women, the regional facilities have some significant gaps in their capacity to meet the needs of the other women in their charge, some of whom suffer from long-standing emotional and behavioural problems, most of whom need considerable healing in order to make big changes in their lives. Of the twenty-six women I interviewed, only a handful (six to eight) will participate in The Healing House. The other eighteen to twenty of these women -- who were identified as having enhanced needs by the institutions (P4W, EI4W, Nova) -- and a large majority of the other federally sentenced women as well, have pressing needs for psychological support in order to deal with the issues that have resulted in their being women imprisoned for serious crimes.

Occasionally, I heard the mention of a policy to replace individual counselling with group therapy. I do not know whether this is indeed a policy for providing psychological services in the regional facilities for federally sentenced women, and if so, if it is philosophically or financially driven. In any case, research clearly documents that women who have experienced the degree of trauma in their lives that most federally sentenced women have, often in combination with pervasive neglect of their basic personal and social needs, need a multi-leveled intervention for there to be any chance of a thoroughly successful outcome. Group therapy and peer support groups are effective tools that empower many women. Many of the federally sentenced women also need life skills training and psycho­educational programs to enable them to understand their problems and take steps to resolve them. A great many of them need to upgrade their education and be trained in marketable skills, so that they can support themselves upon release, and not have to turn to crime to meet their material needs. All of these services can be delivered on a group basis.

However, for many of the women, whose core needs for nurturance and protection were not consistently met in childhood, the relationship that they make with a counsellor they see -- on their own once or twice weekly -- is the grounding upon which they can build the internal strength, the personal confidence and motivation to reach out and participate actively in these group-based programs. Offering a great many group programs without the opportunity to participate regularly in an individual healing relationship would be like offering an infant or a young child totally group-based care without any chance to feel special and central to one or more caretaker who thinks she is the most unique and wonderful child in the world.

Every woman I spoke with who had participated in individual counselling at one time spoke about its benefits. They appreciated being listened to respectfully and non-judgmentally, having a safe place to go and talk about painful issues, getting concrete help in overcoming severe addictions, and coming to understand, for the first time, that behaviour in the present is often a repeat of what has been learned in the past and new behaviours can be learned. Even when they did not know what they wanted to talk about with their therapist, they were grateful to have someone to talk with who knew them well and supported them in their struggles.

Aboriginal women -- in individual interviews and in a meeting that the P4W Sisterhood held to communicate with me about their needs and their resources -- emphasized the importance to them of being able to confide, on a one-to-one tasks, in an Aboriginal counsellor, one who not only shared their background but who was involved in the Aboriginal traditions of healing, Native spirituality ceremonies and other cultural activities.

Most of the non-psychology staff saw a central role for counselling in the women's correctional programming. A couple of times, the opinion that psychology at P4W was isolated and operating at odds with the correctional operation of the prison, and that talking about past traumas stirs women up and makes them harder to handle, was voiced by staff, though not by any of the women who had engaged in counselling for abuse-related issues.

Though this concern was expressed by only two of the individuals I interviewed, it should be given serious consideration, for a couple of reasons. For one, it is possible that other staff hold the same opinion about individual therapy being counter-productive in a prison setting, but some of them did not feel free to express it to me, a psychologist. Also, it is possible that within the core of the complaint lurks some key solutions to creating a structure within the new institutions that will prevent the healing services developed there from becoming isolated and marginalized within the institutional community, as they obviously have been to a significant degree at the Prison for Women. The solution cannot be, however, to delete the opportunity to participate in an individual healing relationship from the programming of the new facilities, or their capacity to be able to empower federally sentenced women to make meaningful changes in their lives will be powerfully undermined.

The Edmonton Institution for Women has very few resources for the many women in their charge who need psychological services.

The Health Care Team, in combination with the Primary Support Workers, had been handling the psychological needs of the women up to the time of my visit in mid-February. The only member of the team with specialized training in mental health issues was a part-time male psychologist, who, according to the Warden, was hired mostly to do reports for the parole board. As he was the only trained counsellor on staff, however, he was actually doing all of the little individual counselling that was occurring and the bulk of the crisis counselling and consultation to front-line staff regarding incidents of attempted suicide and self-harm activity.

I spoke to the psychiatrist on call for the facility, Dr. Maggie Twiddle, who is on the staff of the intensive care forensic unit of the Alberta Hospital, a psychiatric facility. She had only been to the EI4W three times since its opening in November, and she said that the family medicine practitioner on staff was doing most of the front-line psychiatric care.

Dr. Twiddle expressed concern that there was some naiveté on the part of the staff about the degree of disturbance of a few of the women at the facility and questioned the capacity of the institution to handle the problems of some of the more violent women for very long. She did not consider the Alberta Hospital an appropriate resource for any of the women, except on a short term basis for medication adjustment and stabilization for organic, schizophrenic or severely bipolar women. Previously, Dr. Twiddle pointed out, the Prairie Regional Psychiatric Centre was a resource for women who were not psychotic but whose level of emotional disturbance put them in the position of needing enhanced mental health resources. She was concerned that there was no longer the possibility of transferring women to the RPC with the closure of the Assinoboine unit for women. No one, however, either at the EI4W or the RPC (with the exception of the RPC psychiatrist), thought that the Regional Psychiatric Centre was an appropriate setting for the treatment of emotionally disturbed federally sentenced women.

Dr. Twiddle raised an important issue regarding policy and practice regarding psychotropic medications. In fact, she suggested that one of the precipitants of the first rash of self-harm activity at the Edmonton Institution for Women may well have been her policy of refusing to prescribe minor tranquilizers and hypnotics for some of the federally sentenced women who were requesting such medication. At both P4W and the RPC, some women were prescribed these medications, and the policy at the EI4W is different. Both Drs. Twiddle and Bourquet believe that the addictive potential of such medications make them counter-therapeutic for use with a population with histories of substance abuse in a setting where drug abuse is often an ongoing problem. This is an issue that needs serious consideration, weighing the benefits of the calming effect of these medications with their potential for abuse. The other issue that needs to be addressed is the potential for deleterious effects on behaviour if medications are changed when a woman transfers from one facility to another. This was an issue raised in each setting, including P4W, where women arriving from other facilities sometimes are ordered different medications immediately upon arrival. Although, of course, the final decision about the prescription of medication lies with the prescribing physician, it makes sense for CSC to look at these issues and generate some guidelines.

In general, there were scarce psychological services at the Edmonton Institution for Women. The Warden recognizes the need for female counsellors, and she said that the institution had plans to hire some feminist therapists from the community to undertake the individual counselling of the women, but at the time of my visit, this was not yet in the works. Women who requested counselling said that they were given a date for a psychiatric assessment three weeks ahead, and only after the assessment, were they to be told whether their request for ongoing counselling would be granted. This practice reflects a lack of awareness about the needs of women with backgrounds of physical, emotional and sexual abuse, often combined with ongoing substance abuse problems, for supportive counselling and about the appropriate process for facilitating the process of meeting these needs.

A psychiatric assessment is not necessary to determine whether a woman needs counselling and what kind of counselling she needs. At least one full-time psychologist and two or more well-trained counsellors of other disciplines are the bare minimum staff needed for a population as large and diverse as the one at the Edmonton Institution for Women will soon be. Aboriginal counsellors with knowledge of their culture and training and experience working with trauma survivors and are also necessary to meet the needs of the large Aboriginal population at the facility. These service providers should be offering assessments to all women on the day they arrive at the facility, with the goal of focusing on their immediate need for support and their more long-term need for healing services. Weekly counselling/therapy, group sessions and crisis problem-solving interventions should be offered in the institution so that they can be accessed in a timely way by women in need. Additional involvement in community group programs or, on an ongoing basis, with community therapists, can be offered to women who can and wish to leave the institution regularly, but they cannot replace a trained, experienced in-house staff that is easily accessible and aware of the women's circumstances in the prison.

Though the need for Aboriginal counselling has not yet been met, Aboriginal women are offered other enriching cultural and spiritual programming at the Edmonton Institution. A group, called the Neichi Training Program for drug and alcohol counselling, is being facilitated by Iris Bear. The Aboriginal women who were availing themselves of this resource, spoke highly of its relevance and the effectiveness of its leader. A Native Spirituality program has been established, and an Elder is on site most days. The first sweat had been held the week before my visit, and the women who participated found it a grounding and healing experience. Native crafts were also a popular activity. During my visit, women were making hundreds of dreamcatchers that had been ordered for some government function, and they were pleased to be paid for this work. The Native spirituality room at the Edmonton facility is particularly beautiful.

Five of the eight women I interviewed at the Edmonton Institution were Aboriginal; they had all applied to serve their time in the Healing Lodge, and their applications had been denied for a variety of reasons, including their maximum security classification. Each of these women has institutional charges relating to violent actions; a couple of them have accumulated many such charges over the course of a long prison career. They need intensive support from Aboriginal counsellors, and they need to have some clear plan for being able to structure their programming and their behaviour with the goal of reducing their security classification and engaging in activities that would ready them for participation in the Healing Lodge program. These resources need to be integrated into the program at the EI4W in a way that the women get a supportive and consistent message from everyone they interact with, primary support workers, Aboriginal counsellors, Elders, etc.

More connection with the Healing Lodge needs to be integrated into the Edmonton facility program -- perhaps a liaison worker who visited once a week and met with each woman who was trying to get accepted into the Healing Lodge, reviewing her progress of the preceding week and giving her realistic support for working on her program participation and behavioural change. This could be organized into a pre-Healing Lodge program that would take place one day each week and include a goals group, facilitated by the Healing Lodge staff liaison and a member of the counselling staff at EI4W. In such a group, realistic and concrete goals are created that would lead to behavioural change in the direction of preparing the individual for the Healing Lodge. Each week, each woman's progress in meeting her goals would be monitored, through both self-report and feedback by other group members and staff, and new goals are made for the coming week. As this group would be completely voluntary, motivation would be high for women to work hard at meeting their goals and supporting other women to meet theirs. The group could meet together after the goal session to prepare and eat a communal mid-day meal. As it seemed appropriate, cultural and spiritual events might be planned on these days and sometimes integrated into them.

However it is organized, it is extremely important that the Edmonton Institution is not perceived of as a dumping ground by Aboriginal women who are not accepted into the Healing Lodge. If more integration is not effected between the Healing Lodge and the EI4W, some Aboriginal women will continue to be inclined to see the facility in this way and make little effort to buy into its philosophy or programming. Since a large percentage of women at the Edmonton facility are Aboriginal, a cynical attitude on the part of a sizable minority will not only make it hard to reach out to those women effectively but will have an undermining effect on the operation of the facility in general.

At the Nova Institution for Women, there are more counselling services provided along the lines of the philosophy of "Creating Choices." A full-time female psychologist, experienced in working with women with emotional difficulties, is trying to create a milieu-based program of support among the women, stressing mutual respect and responsibility for one another's struggles. The first day of my visit, every woman in residence at the time had met to discuss the situation of one young woman who was in the enhanced unit because she found it hard to cope in the cottage. All the women offered to support her and give her extra help if she came back to the cottage. Though it did not immediately solve the problem of the woman who wanted out of a cottage setting, the strategy gave both her and the other women an important message -- that support will be offered generously by the community when anyone is in trouble. Individual therapy is also available for any woman who requests it, and counselling seems to be provided on both a formal and a more ad hoc basis.

An art expression program has been set up, and some of the women use it regularly. A program for healing from the effects of trauma, based on a module form of organization, has begun to be implemented. Part 1 offers a general orientation to issues of trauma and loss, starting with encouraging women to understand their present-day losses in coming into the prison. The second part of the program is a psycho-educational group, offering eight classes that give women the basic information they need about the effects of trauma and about the healing process, so that they are in a position to make an informed decision about whether to engage in a treatment process, and if they wish to do so, what form of therapy they wish to participate in -- individual sessions, group therapy, a peer support group, or all of these.

At the time of my visit, there were few specialized resources for Native women. An Elder and a Native Liaison worker are on staff, very much on a part-time basis, but there is no sweat lodge, no Native craft program or Sisterhood program. The main reason for this is that there are only two Aboriginal women at Nova, only one of whom has much interest in establishing a Native spiritual and cultural program. There also seems to be little communication between the Elder and the liaison worker, and between the Nova staff and the two Aboriginal workers. The communication needs to be tightened up and some serious program planning initiated under the leadership of the Aboriginal woman who is knowledgeable and keen, as there will soon be other Aboriginal women at the facility, and they will need an active program.

A Structured Living House has been built at Nova, and some of the more limited and/or needy women will be provided with on-site supervision and programming in an intensive way that reflects their need level. As far as I know, this is the only regional facility so far to make particular provision for housing some of the women with a higher than average level of need, outside of placing them in the enhanced unit. The program had not yet been established when I visited Nova, but it may serve as a prototype for more specialized cottage programming. Because of the small population of Nova, the Structured Living Cottage will house both intellectually limited and low-functioning women and women with psychological and behavioural problems. It will be interesting to see if this proves to be a workable mix.”

The use of the enhanced unit for a variety of functions is one of the most striking issues in both facilities, although it is more obvious in Edmonton because of its size. The reality of running a federal prison serving many women -- some of whom are upset and suicidal, some who are new and completely unknown to the staff, some who are explosive and violent toward others, some of whom are in constant danger of being assaulted and/or killed by others, and some of whom refuse to cooperate with the most basic rules of the facility, means that there is more demand for a secure space where women can be protected from themselves and each other than was envisioned by the authors of "Creating Choices."

Different solutions are being tried out in response to immediate need. Nova has a maximum security cottage, which is exactly like the other cottages, except that it is staffed twenty-four hours a day, and the doors are locked. They are trying to use their enhanced unit for assessment space for women who are newly arrived at the facility. However, one women's behaviour demanded the security of the enhanced unit, and she did not want to leave when I was there. Edmonton seemed to be placing upset/depressed, upset/volatile and uncooperative, newcomers, and maximum security women who are doing well, all in the enhanced unit, dividing them into the two sides of the unit as best they could.

The use of the enhanced units and the possible need for specialized housing for women with special needs -- sometimes more secure than the other cottages, but not so radically different from them as the enhanced unit -- is one of the most pressing issues to be worked out in the new facilities. A number of the women in the enhanced unit in Edmonton spoke of their feeling of being "low" -- low in status, self-respect, resources and freedom -- compared to the other women, some of whom are their close friends. "Look at those houses," one of the women from the enhanced unit said to me in a tone combining wonder and envy, as we stood by a window looking out onto the yard.

I was struck by her vulnerability and her pain. This status differential -- being in the enhanced unit versus being in cottages -­- is not an issue the women have had to face in the RPC or at P4W, unless they were in segregation, which only happened when a woman's situation was acutely or chronically dire. In the Edmonton facility, some women see themselves in the enhanced unit for the foreseeable future. Unless they are completely incorrigible in terms of being a danger to themselves and others, this is probably not a good policy, and alternative arrangements ought to be created as soon as possible.

The issue of protective custody does not seem to be resolved in either of these facilities. Hopefully, it will not be as serious a problem in the new facilities as it has been at P4W. However, the concern about custody arrangements for women who have harmed and/or killed babies and small children and women who are sex offenders combined with the demand to set up mother/child living arrangements in the new facilities makes for a complex and delicate question to which there is probably no easy and obvious answer. My understanding is that the Grand Valley Institution plans to divide their enhanced unit into four sections, one of which will house women for whom there are serious protective custody concerns.

In summary, in my brief and rich involvement with Edmonton Institution for Women and Nova Institution for Women, I found a tremendous swirl of energy, driven by an intense desire to provide a new form of delivering prison services to federally sentenced women. There are no blueprints. No one in Canada has ever tried to run prisons according to this model before. It was my mandate to look at psychological services that are needed and have not been provided, and I hope I have done that.

However, what there is, in both these institutions, is much more notable than what there is not. There is a clear determination to establish women-centred places and programs that will be responsive to the needs of federally sentenced women in a way that will be unique and effective. The first steps have been taken along that road, and some of the next steps are just as exciting and challenging as the first. There is no doubt in my mind that, given the enthusiasm of the staff, many of whom have never worked in a prison before, and the energy of the federally sentenced women, many of whom have never been in prisons like these before, the next steps will be taken with creativity and dispatch.

 

Recommendations

I am hoping that each recommendation that is made in this report contributes to the process of bridging the gap between the general recommendations made in "Creating Choices" and the lived reality of two hundred federally sentenced women scattered across a large country. The needs of a few particularly disturbed women are not entirely different from the needs of all the other women in federal prisons. They have more of them, maybe, and they will not allow anyone to ignore them. As well as creating and enhancing some services for this group of women (Recommendations One, Two and Three), it is important to build a more secure structure for every woman whose life experiences have brought her to one of the federal prisons for women (Recommendations Four, Five and Six).

I have used the word healing more often than not in this report to refer to the range of services that are sometimes called mental health services, sometimes called psychological services, and sometimes called counselling. In doing so, I have tried to broaden the base of our thinking about the needs of women for resources that lead to a profound healing of the mental, emotional and spiritual wounds that are so key to federally sentenced women's life experience. It is my hope that the challenge of addressing the issue of incorporating badly needed healing services into the health services program for federally sentenced women will offer CSC an opportunity to look at the way in which all services are delivered to these women in the new facilities. "Creating Choices" needs to be taken further, nuanced and made applicable to the broad range of needs and opportunities that the lives of federally sentenced women represent.

 

Recommendation One

CSC immediately before the final closure of the Prison for Women -- presumably, therefore, in the late summer or early fall of this year, 1996) create a healing facility that could house eight women in need of intensive, secure psychological treatment to enable them to deal with the problems that lead to severe self-destructive and destructive behaviour. This would be a resource designed to treat non-psychotic women (often diagnosed "borderline personality disorder" and sometimes "anti-social personality disorder" in psychiatric settings) who understand their difficulties as emotional in origin and therefore wish to access this kind of demanding and intensive healing program. Participation in The Healing House program would be voluntary.

 

Location

There are a number of advantages to locating the healing facility in the Kingston area. This resource will be used as a resource for federally sentenced women throughout Canada; it should not be attached to any regional facility. Most of the women who would initially occupy the house have not yet been transferred from P4W; they could be easily moved to another location in the same city before being transferred, eventually, to their home facility. Locating The Healing House in the Kingston area would allow access to treatment and support staff who have a wealth of expertise in counselling these women and many other women with similar histories and difficulties.

It is important to capitalize on the years of experience, research, and program development that made the therapy services provided at the Prison for Women highly regarded by the many women who availed themselves of them, according to the Program Evaluation of Therapeutic Services at the Prison for Women (Kendall, 1993) and the Survey of Federally Sentenced Women: Report to the Task Force on Federally Sentenced Women on the Prison Survey. (Straw et al., 1990). The findings of these studies were supported by my research. All of the women who had received therapy services at P4W commented on their value. There are valuable resources in the Kingston area that could provide a solid base for creating an innovative and effective intensive treatment program for federally sentenced women with serious emotional and behavioural difficulties.

 

Program

The program at The Healing House would be multi-modal. A cognitive/behavioural therapeutic structure -- dynamic in theory, supportive in stance, and feminist in philosophical orientation -­would be the basic program orientation. The program culture would be one in which the responsibility for the healing and growth of each individual woman and the peaceful and constructive functioning of the community is understood to rest with every member of the program community, participants and staff. Women applying for participation would agree to work as a responsible team member with the other program participants and with the staff in encouraging positive change in all members of the program.

Clear behavioural parameters would be set for program participation. Since it is understood that many of the women for whom the program is designed would have had -- and in many cases, continue to have -- a powerful struggle against addictions to drugs and alcohol, an absolute ban on any non-prescription drug and against alcohol would be à basic program rule. As most of the women would be arriving from P4W, where access to drugs is virtually unlimited, this is an issue that would need to be broached with each applicant, with the understanding that she is free not to apply to the program, but she is not free to break this rule, and, if she does, it will be understood as a direct acknowledgment that she is not ready to participate in this particular program and as a request that someone more motivated to help herself and not undermine the healing of others be invited to take her place.

Other behavioural parameters, regarding violence toward others, serious self-harm, respectful treatment of self and others, will be clearly outlined, and it will be understood to be the individual's responsibility to get herself help as soon as she experiences her behaviour as beginning to go out of control. Other participants and staff will be responsible for providing the appropriate help for individuals who are having these kind of difficulties.

As all of the women participating in this program would have problems with explosive and self-destructive behaviour, they would all have the opportunity to be helpers in these situations much more often than they would be needing such help from others. This culture of mutual responsibility encourages growth and self-respect, and quite often, when help is perceived to be available upon demand -- without the necessity of demonstrating the need for help with escalating self-destructive or violent actions -- the highest level of functioning possible for the individual at a given time is the result. A signed agreement, outlining a participant's rights and responsibilities, including clear guidelines regarding confidentiality and its limits, will precede acceptance into the program.

As well as agreeing to the basic program philosophy and agreeing to abide by its rules, potential participants would need to show that they have the motivation and the ability to set reasonable goals for change for themselves before being accepted into the program. They must also be willing to share their personal goals with all other members of the program community, participants and staff. Community groups will be facilitated each weekday, during which each woman's progress is monitored -- both by herself and with feedback from others -- and new goals are set. These community groups are the core of the program.

Individually-structured program for change: All women participate in the goal-setting and progress-monitoring community groups. Depending on their particular needs and problems, individual women participate in particular components of the program in a way that enables them to have the greatest chance of meeting their goals.

The following activities are among those that would be available:

Psychoeducational groups on a variety of topics, such as learning to communicate effectively, creating a healthy support system, managing powerful emotions, understanding and managing anger, disordered eating, violence in intimate relations, sexuality, substance abuse, learning how to play, spirituality... Topics for psychoeducational groups (which are time-limited -- for example, 1 1/2 hour a week for eight weeks) will be selected in response to the particular choices and goals of the current program population.

If there are Aboriginal women who choose to participate in the program, appropriate cultural and spiritual programs would be part of these women's healing plan. An Elder should be contracted to be part of the program planning at The Healing House, and a Native counsellor be part of the staff.

Other important aspects of daily programming would be:

Exercise
Recreation
Expressive therapies (art, music, movement, poetry, journal-writing)
Life-skills, educational and vocational training

 

Living Arrangements

The Isabel McNeill House, now housing minimum security federally sentenced women, could provide a possible location for The Healing House. With some internal changes that would make smaller single bedrooms out of currently large rooms sleeping two or three women, secure perimeter fencing, as well as a few other changes to provide the requisite security, this house might do very well as a healing facility for a maximum of eight women. A living room, kitchen, dining space and laundry would enable The Healing House participants to be responsible for helping with the planning and preparation of their meals, doing their personal laundry and organizing and sharing housekeeping responsibilities for the common areas.

A communal smoking room would be provided, so that non-smokers rights to a smoke-free environment in other communal areas would be respected.

This site includes a couple of offices that could be used for counselling, a group space/classroom, an expressive arts room, a visiting room, and an administrative office. Room for both indoor and outdoor recreation would be available, as there is a large yard and a garage that is used as a recreation area/exercise space. A ping pony table and pool table should be part of the indoor recreation area. A sweat lodge could be built in the far corner of large yard, if it is considered an appropriate space.

 

Staffing

Every staff person will be a full member of the therapeutic team. Though they will have different levels of training and experience, be educated in different disciplines and be assigned specialized work, they will all be selected with an eye to their ability to form respectful and cooperative relationships with the program participants and other staff, an understanding of the program philosophy and a demonstrated competence at working in a therapeutic milieu that emphasizes the values of empowerment, mutuality, creativity and profound respect for every living creature. As well, they must show a capacity to withstand pressure (both internal and from the women themselves) to exercise oppressive control over the program participants and a high level of skill at creating an atmosphere in which the women are motivated and empowered to regain control over their own lives.

A program director will carry the ultimate responsibility for the operation of the program. The program director may be the clinical director as well, or there may be another, full-time or part-time clinical director. At least two full-time and very experienced therapists (and other part-time therapists from the community to provide culturally-appropriate counselling, and counselling in the language of the program participants, or to provide groups or other programming in special areas) would facilitate groups and provide individual therapy to the program participants. An experienced expressive therapist should be available in the art room full time (or more than one expressive therapist, with different specialties, each part-time). An Aboriginal counsellor, an Elder and, if anyone is interested, a Native craftsperson could all participate in the program on a part-time basis.

A full-time administrative assistant will be needed to provide a variety of support services for the program, including clerical, testing, data collection and administrative. It is important that the administrative assistant share in all of the personal qualities that are required of every other staff member. A psychiatrist and family practitioner will be required on a part-time basis, depending on the needs of a given program population. It would probably be helpful if one or more of the primary support workers have a nursing background; if not, nursing services might be needed, again depending on the needs of any particular group of women.

The primary support workers are the core program staff, and they provide basic coverage. Staffing levels are beyond my area of competence, and I cannot estimate how many primary workers would be needed to provide appropriate levels of 24-hour coverage, including absences and holidays. Primary workers would be women, trained in some area of health or social services, who demonstrate a capacity to provide effective and appropriate support to troubled and sometimes agitated and explosive women. They would need to be trained by CSC in aspects of their job that related to correctional procedures and security. Primary support workers provide support, supervision and programming for both individuals and groups of women. Each program participant is assigned a primary support worker to help her with developing and monitoring her correctional plan, offering practical and emotional support as she negotiates the program, and keeping track of all the important paperwork regarding the woman assigned to her that is key to smooth functioning in the correctional system.

As well as being responsible for the women assigned to them in very particular and practical ways, primary support workers will share program coverage, and they will engage in program activities according to their interests and talents. For example, in the course of a day's work, one primary support worker might play volleyball and then ping pony with a group of women for two hours, prepare dinner with three women and show them her special recipe for salad dressing, spend an hour updating a woman's correctional plan with her, and then listen quietly as a woman describes how she does not dare sleep because she keeps waking up terrified with nightmares. She may take out her guitar and play quietly when she thinks everyone is settled down, to be joined by two women who are also having trouble sleeping, and they may sing camp songs together until she goes home for the night.

Primary support workers are the heart of the healing program. Though without a specialized and complex therapy process, the daily living aspects of the program would be no more than a humane prison situation, the therapy process is profoundly augmented and grounded by a rich and rewarding day-to-day living environment. Much of the deepest healing that will occur in this kind of program will be in situations that are the same as the past (eating a meal with a group of people) but radically different at the same time (eating a meal prepared cooperatively and peacefully with people who are struggling together for a better life for themselves and for each other). Every act of work and play throughout the course of the day is an important and sacred component of the healing process, and it is the primary support workers who are key to making this central aspect of the program function effectively.

The high level of staffing that would be necessary to run an effective program represents a significant outlay of resources for a relatively small number of women. However, it is important to take into consideration the enormous resources that some of these very women are using at the present time, in terms of extra staffing and intensive supervision, in a milieu that everyone involved with their care and custody agrees is not only not creating positive change for them but is sometimes aggressively reinforcing their problems, making them more disturbed and more destructive. These resources -- well-used in the context of an intensive healing program-- may well repay themselves many times over. In any case, they would finally provide a humane healing environment for a group of women who have been the least well-served by the correctional system -- and many other parts of our society as well -- over the years.

 

Evaluation

A thorough evaluation protocol must be built into the ongoing operation of The Healing House from day one of the planning process. Initially, this would involve thorough documentation of the creation and implementation of the program and a regimen of psychological testing of participants to provide baseline measures to monitor change. During the planning period, visiting one or more sites in North America in which innovative prison healing programs have been established might well be cost effective, in building on their experiences and avoiding reproducing their most egregious errors.

During the first year of program operation, most of the program evaluation data will relate to ability to initiate different aspects of the program and participant and staff satisfaction with their effectiveness. Outcome data take longer to accumulate and analyze, but as much information should be gathered and a well-thought through and comprehensive data base developed as part of the planning procedure. This type of program is innovative, and it is important to monitor its effectiveness.

The Healing House will also provide a model for the healing cottages that will eventually be integrated into the operation of each institution. It is especially crucial, therefore, that systematic track be kept of what works and what needs to be altered, so that the experience of establishing and operating its program can be of maximum use to the working group developing the strategy for integrating effective healing resources into all regional institutional programs.

 

Recommendation Two

CSC take whatever measures are necessary to enhance the security of some part of the Healing Lodge to some degree, to make it a real choice for more Aboriginal women whose emotional and social difficulties could be best dealt with in an Aboriginal healing program, but who are now excluded because of their high security classification.

One of the Elders spoke to me about her concerns about the present practice of excluding some of the most disturbed Aboriginal women from participation in the Healing Lodge. She summed up her view by saying, "You break the circle when you exclude someone."

The practical and program enhancement that would be necessary and appropriate to enable some of the more volatile and disturbed Native women to participate safely in the Healing Lodge would need to be developed by the Warden, staff and federally sentenced women participants at the Healing Lodge, in communication with the Keepers of the Vision Circle.

Even with enhanced security (perhaps just the capacity to lock and alarm one of the cottages at night), there will be Aboriginal women whose behaviour is such that their presence at the Healing Lodge would undermine the safety and the progress of the other women participants. These women need a structured connection with the Healing Lodge program while they are at the EI4W to offer them the ongoing motivation to work consistently at making the changes necessary to enable them to be constructive participants in the Healing Lodge.

Therefore, I recommend that CSC create a weekly pre­Healing Lodge program at the Edmonton Institution for Women -- including a group session facilitated by one Healing Lodge staff person and one EI4W staff person and an individual support session for each woman with a member of the Healing Lodge staff-- for all Aboriginal women who want to be accepted into the Healing Lodge. This program would enable the Aboriginal women who wish to be accepted into the Healing Lodge, but are not ready for participation, to develop clear goals with consistent encouragement and monitoring from Healing Lodge and EI4W staff and from the other women who are also trying to gain admittance into the Healing Lodge.

 

Recommendation Three

CSC negotiate for specialized in-patient mental health services in an institution close to each regional facility. These hospital beds would only be used occasionally by women whose stability is threatened by a psychotic illness and who need time-limited medical treatment to adjust medication levels and re-establish stability.

There appear to be very few federally sentenced women suffering from major mental illnesses, such as schizophrenia, psychotic depression, bipolar disorder, or an organic syndrome. Because they are not large in number does not mean, however, that their need for appropriate psychiatric care should be left to chance, or only addressed on a case-by-case emergency basis. Planning in each region needs to take place to ensure equal access to appropriate mental health care for women who suffer from major mental illnesses.

 

Recommendation Four

CSC ensure that basic, culturally-appropriate individual and group counselling services are available at each institution immediately. Women therapists should be easily available, and they should be trained and experienced in providing both long-term intensive therapy and short-term problem­solving and/or crisis counselling to women with addictions and to women who have suffered a wide variety of personal trauma, including physical and sexual abuse.

Communication among the core providers of healing services in all six new facilities should be organized immediately with a view to sharing ideas and developing some commonalty of counselling programming across the country. At least six meetings (each hosted by a different regional facility and by the Healing Lodge) should be facilitated over the next two years, attended by the key counselling/healing staff at each institution. Though a clearly defined plan for integrating psychological services into the facilities' core operation needs some time to be theorized and implemented, it is important that some basic commonalties be established in order to ensure that federally sentenced women in all parts of the country have equal access to appropriate healing services as soon as possible.

Research has consistently demonstrated that women's offenses are generally linked to personal and social problems stemming from life experiences of socio-economic inequality, such as poverty, violence and racism. This certainly holds true for the federally sentenced women I interviewed in Kingston, Edmonton, Saskatoon and Truro.

It is obvious, therefore, that any strategy designed to help women find other ways of coping than engaging in criminal behaviour needs to address the source of these behavioural patterns -- the personal and social experiences that have led to their eventual incarceration in a federal prison. Common to almost all the oppressive experiences women in prison have throughout their lives are exposure to a wide variety of traumatic experiences and a feeling of helplessness in response to their circumstances. A constellation of reactions to this pervasive and at times, acute sense of powerlessness -- the realization that nothing the woman can do will keep her from being violated -- have been long documented in the literature about psychological trauma.

Often termed posttraumatic stress, this group of reactions can range from profound passivity to violent reactivity. Some women cycle repeatedly between these poles, using drugs and alcohol alternately to soothe themselves into the passive state and, at other times, to reduce their fear level and enhance their ability to react aggressively to threat. These emotional reactions play themselves out in women's relationships and in many other aspects of their day-to-day functioning. Criminal behaviour is often an outcome of these compulsive and ongoing patterns of coping -- for example, crimes related to procuring or selling drugs or crimes related to volatile reactions in personal relationships.

Creating an aesthetically pleasing environment and treating federally sentenced women with the basic respect that should be accorded to any human being are important parts of the process of helping them create new, pro-social lives for themselves. Without these basic structural changes that speak to their worth as individuals, psychological treatment will always be limited in its effects. However, the provision of basic rights regarding a humane living environment and respectful relationships is not enough to heal the deep wounds that, in many cases, are the fallout from these women's life histories of interpersonal deprivation and violation.

Throughout this report, I have used the word healing (connected to the Greek word therapeia) to refer to the range of resources that are specifically geared to healing these wounds, opening them up in a compassionate and appropriately-timed fashion, cleaning them out and moving on to re-building lives on new, less damaged foundations. This is as necessary for many of the women serving time in federal penitentiaries as fresh air, sunshine, healthy food, education, skills-training, and respectful relationships with authority figures.

Eventually, all regional facilities for federally sentenced women should have a program to deliver healing services integrated into the body of the program. Women living in these facilities should have the opportunity to participate in an therapeutic program like The Healing House program, if they chose to do so. Some of the women need it more than others; a few FSW probably can cope with very few therapeutic resources. But most of the women -- not just the women who were listed for me to interview because they had obvious problems -- need access to an ongoing therapy program, whether only in emergencies, or once or twice a week on a more intensive basis.

It is important not to rush into developing this kind of program (including a healing cottage and assessment and therapy services thoroughly integrated into the core institutional program). Recommendation five speaks to a process of thoughtful planning to ensure uniformly high quality of services and equality of opportunity across the country. However, basic counselling services should be available immediately at every institution.

If the therapists (many of them possibly hired, for the time being, on a contract basis, so as to avoid getting trapped into particular staffing arrangements and ways of working before an integrated program can be created and implemented) are to understand the importance of implementing the "Creating Choices" vision of empowerment and meaningful choice, they need to be committed to a feminist model of service delivery that acknowledges the social determinants of individual experience and emphasizes mutually respectful and cooperative therapeutic relationships within a context of acknowledged power differential.

Staffing should represent, to as great a degree as practically possible, the racial, ethnic and cultural mix of the population at each institution, so that women experience themselves being offered respect for their cultural backgrounds as well as for them as individuals. Counselling services should be provided in the languages that the women are most comfortable speaking, so that a woman, for example, whose first or most familiar language, is French, should not be forced to struggle to express herself in English at the same time as she is trying to talk freely about painful and personal matters. Part-time counsellors on contract can meet the needs of women who do not share a language with many others, or community programs can be utilized to meet the needs of some women for culturally-appropriate counselling in their own language.

 

Recommendation Five

CSC create a working group, with representatives from The Healing House and all institutions, including the Healing Lodge, to implement the integration of healing resources into the operations of all institutions serving federally sentenced women.

One aspect of this group's work would be to develop specialized cottages at each institutional site to serve the needs of women with addictions, women in need of a long-term, intensive healing program (similar to the one that will be created more immediately in the Healing House) and women who need shorter-term intensive healing intervention.

Another aspect of the committee's mandate would be to develop a strategy to integrate a thorough assessment and plan for appropriate healing into each federally sentenced woman's correctional plan in a way that the woman experiences as empowering from the first day she arrives at the institution.

As well as developing a strategy to implement healing interventions into the core operation of each institution, the committee would develop training modules to enable the institutions to integrate the strategy into its core functioning and would create a monitoring structure to ensure equal access to a uniformly high level of psychological services in every region of the country.

 

Recommendation Six

CSC create a policy document outlining the objectives that will guide the operation of the regional facilities for federally sentenced women and clearly defined policies regarding maintenance of security and program development that are consistent with those objectives.

A working group be struck with representatives from each institution to monitor the implementation of these policies, so that -- as well as opportunity for regional creativity and diversity in programming for federally sentenced women -­each facility across the country meet clearly defined standards for excellence in all aspects of service delivery.