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Mental Health, Health Services
SUMMARY OF THE CSC REPORTS USED TO SUPPORT THE DEVELOPMENT OF THE INTENSIVE INTERVENTION STRATEGY (IIS)
A number of studies of CSC's incarcerated women were undertaken in an attempt to better define the mental health and maximum security populations who were targetted for the Intensive Intervention Strategy. Key amongst these reports are the following:
In 1998, an outbreak of self-injurious behaviour occurred in the women's unit of the Regional Psychiatric Centre in the Prairies. During an eight month period, there were 82 self-injurious incidents, of which the vast majority involved four women. An investigation highlighted the need for a greater clinical expertise and leadership in cognitive-behavioural techniques, a greater integrated Aboriginal component, an improved therapeutic environment, and a multi-disciplinary approach (LaPlante & McDonagh, 1998).
In 1999, a needs analysis was undertaken to obtain information regarding the mental health, living skills, and security needs of women with intensive mental health needs, and those classified as maximum security. Key findings from this study were as follows:
The most frequently identified treatment need was for psychological support including the need for individual counselling. This study generated information that assisted in the choice, design, and implementation of the primary treatment interventions to be used in the Intensive Intervention Strategy (McDonagh, Noël, Wichmann, in press).
In 1999, a qualitative research study was undertaken to help identify interventions necessary to address the issues and needs of maximum security women, and to facilitate the reduction of women's maximum security classification. Interviews conducted with women inmates and staff captured the perspectives and experiences of non-Aboriginal, federally sentenced women who were classified as maximum security in order to increase an understanding of their personal and institutional realities (McDonagh, 1999).
Key findings were as follows:
A companion report to McDonagh's work, presented the opinions, observations, and suggestions of federally sentenced maximum security Aboriginal women and CSC staff on the procedures, policies, and programs that were in place to help reduce the women's security levels (Morin, 1999). Amongst Morin's key findings were the need for a specialized treatment program to address suicidal and self-injurious behaviour, and the need for full-time Elder counselling services.
Another study that examined the experience of women in federal penitentiaries made the following observations with respect to programming (Warner, 1998).
OVERVIEW OF WOMEN OFFENDERS IN CSC
The following tables provide information with respect to women offender's their security classification, Criminal Code offense category, length of sentence, ethnic background, and the number of Community Residential Facility (CRF) accommodation beds available for various types of conditional release (though mostly for day parole). Women on day parole are accommodated in CRF such as halfway houses managed by non-profit organizations, satellite apartments, and increasingly, in private home placements.
|SECURITY CLASSIFICATION||% OF OFFENDERS|
|Maximum security ||12%|
|Medium security ||42%|
|Minimum security ||34%|
|New admissions (not yet classified) ||12%|
|OFFENSE CATEGORIES||% OF OFFENDERS INCARCERATED||% OF OFFENDERS COMMUNITY|
|First degree murder (life sentence, eligible for parole after 25 years) ||4%||1%|
|Second degree murder (life sentence, eligible for parole set by Court between 10 and 25 years) ||14%||12%|
|Schedule I offense (violent offenses, e.g. armed robbery, assault) ||50%||29%|
|Schedule II offense (drug offense) ||21%||46%|
|Non-Schedule offense ||10%||13%|
|LENGTH OF SENTENCE||% OF OFFENDERS INCARCERATED||% OF OFFENDERS COMMUNITY|
|Under 3 years ||36%||33%|
|3-6 years ||27%||35%|
|6-10 years ||13%||11%|
|10 years + ||5%||8%|
|ETHNIC BACKGROUND||INCARCERATED POPULATION||COMMUNITY POPULATION|
|Other/Not stated ||7%||9%|
|REGION||Beds available for women in Women-only agencies||Beds available for women in Co-ed agencies|
FEDERAL WOMEN'S CORRECTIONS HISTORY OF EVENTS
Opening of Prison for Women in Kingston, Ontario
Since the opening of the Prison for Women, there have been a variety of Task Forces and Commissions that have examined the disadvantaged situation for federally incarcerated women, and there were numerous calls for the closure of the Prison for Women.
A joint initiative by the Federal Government and relevant private sector groups was undertaken in 1989, through the establishment of the Task Force on Federally Sentenced Women.
After extensive consultations and research which incorporated the views and experiences of federally sentenced women, the April 1990 report of the Task Force on Federally Sentenced Women entitled, Creating Choices was published. The report recommended the following:
In September 1990, the Federal Government announced acceptance of the Task Force recommendations and initiated implementation.
The new regional facilities for women offenders began operations. Nova Institution (1995) in Truro, Nova Scotia; Joliette Institution (1997) in Joliette, Quebec; Grand Valley Institution (1997) in Kitchener, Ontario; Edmonton Institution for Women (1995) in Edmonton, Alberta; and the Okimaw Ohci Healing Lodge (1995) in Maple Creek, Saskatchewan. Women offenders in British Columbia are incarcerated through an exchange of service agreement at the provincial Burnaby Correctional Centre for Women.
In 1996, following several escapes and other incidents, it became evident that a small portion of the women offenders required a greater degree of structure and control than the regional facilities could provide within their existing structure. There were also several inmates who required more intensive treatment for mental health disorders than was available.
This situation prompted CSC to incarcerate these maximum-security women and those with intensive mental health needs in small units in men's institutions and at the Prison for Women in Kingston. However, at the same time CSC made a commitment to develop a national strategy for high risk-high need women.
The Intensive Intervention Strategy was introduced calling for the modification and expansion of the existing enhanced units of the regional facilities to accommodate those women offenders classified as maximum security and the construction of Structure Living Environment houses at each of the regional facilities to accommodate women, classified as medium- and minimum-security, with mental health needs requiring more intensive support to successfully manage them at these security levels.
The new strategy provides safe and secure accommodation for these women while emphasizing intensive staff intervention, programming, and treatment.
The Prison for Women in Kingston closed.
The Structured Living Environments opened each of the four regional facilities.
The Secure Units at each of the four regional facilities are scheduled to open.
GENDER DIFFERENCES WITH RESPECT TO MENTAL HEALTH
Women are twice as likely to be diagnosed with depression. Incarcerated women are three times more likely.
Women are more likely to be assessed with symptoms of schizophrenia.
|Sexual / Physical Abuse|
Higher reported rates of both for women.
Higher reported rates for women.
|Antisocial Personality Disorder|
Incarcerated women: 29%.
|Personality Disorder / Anxiety|
Women are more likely to be diagnosed with both.
Women more likely to have a co-existing psychiatric disorder, experience more stigmatization for their abuse of drugs/alcohol, and experience more serious physical consequences of drug and alcohol use.
Women in prison are as likely as men to have a history of substance abuse but more likely than male inmates to have used hard drugs such as cocaine and heroin and to have taken drugs intravenously.
|Mental Health Treatment in the Community|
A 1995 study at Prison for Women (PFW) found that federally incarcerated women were 3 times as likely to have received mental health treatment in the community compared to men.
MENTAL HEALTH PROBLEMS OF INCARCERATED WOMEN COMPARED TO COMMUNITY SAMPLES
|Women in community||Women Inmates|
|Substance Use Disorders - Alcohol||4.3%||36%|
|Substance Use Disorders - Drugs||3.8%||26%|
|Antisocial Personality Disorder||1.2%||29%|
|Childhood sexual abuse||20 - 54%||47 - 90%|
|Physical abuse in adult intimate relationships||27%||69%|
RELEVANT POLICY CONSIDERATIONS
The Corrections and Conditional Release Act (CCRA) Principles identify:
|4.(h)||that correctional policies, programs and practices respect gender, ethnic, cultural and linguistic differences and be responsive to the special needs of women and aboriginal peoples, as well as to the needs of other groups of offenders with special requirements.|
The CCRA Section 77 states that the Service shall:
|77.(a)||provide programs designed particularly to address the needs of female offenders|
Section 86 of the CCRA states that:
|86.(1)||The Service shall provide every inmate with
(a) essential health care (which includes mental health care) and
(b) reasonable access to non-essential mental health care that will contribute to the inmate's rehabilitation and successful reintegration into the community (see Appendix G for the portion of CD 800, Health Services for the definition of essential Health Services).
|86.(2)||The provision of health care under subsection (1) shall conform to professionally accepted standards.|
The CCRA Section 87 further states that:
|87.||The Service shall take into consideration an offender's state of health and health care needs
(a) In all decisions affecting the offender, including decisions relating to placement, transfer, administrative segregation and disciplinary matters; and
(b) In the preparation of the offender for release and the supervision of the offender.
The policy or Commissioner's Directive 850 - Mental Health Services, (Appendix H) states that:
|Mental health services and programs for inmates shall provide a continuum of essential care for those suffering from mental, emotional, or behavioural disorders consistent with professional and community standards including:
(a) individual assessment/diagnostic; and
(b) treatment for those suffering from acute, sub-acute or chronic mental disorders shall be provided in an appropriate facility.
Other relevant policies include Commissioner's Directive 840 - Psychological Services (Appendix I) and Commissioner's Directive 843 - Prevention, Management, and Response to Suicide and Self-Injury (Appendix K).
Any mental health strategy must also respond to the needs of Aboriginal offenders as per the CCRA section 80 and CD 702 - Aboriginal Programming (Appendix J) which require that the needs of all Aboriginal offenders are identified and that programs and services be developed and maintained to meet those needs. Further, all components of the Mental Health Strategy for Women Offenders must be developed and assessed according to their cultural relevance for Aboriginal women offenders.
COMMISSIONER'S DIRECTIVE 800 - HEALTH SERVICES
Relevant sections to Strategy
1. To ensure that inmates have access to essential medical, dental and mental health services in keeping with generally accepted community practices.
ESSENTIAL HEALTH SERVICES
2. Inmates shall have access to screening, referral and treatment services. Essential services shall include:
a. emergency health care (i.e., delay of the service will endanger the life of the inmate);
b. urgent health care (i.e., the condition is likely to deteriorate to an emergency or affect the inmate's ability to carry on the activities of daily living);
c. mental health care provided in response to disturbances of thought, mood, perception, orientation or memory that significantly impairs judgment, behaviour, the capacity to recognize reality or the ability to meet the ordinary demands of life. This includes the provision of both acute and long-term mental health care services; and
d. dental care for acute dental conditions where the inmate is experiencing swelling pain or trauma; preventive treatment (i.e., necessary fillings, extractions, etc.) subject to the motivation displayed by the inmate to take an active part in the process; and removable dental prostheses as recommended by the institutional dentist. All other dental care will be initiated and funded by the inmate.
3. Inmates shall have reasonable access to other health services (i.e., conditions not outlined above) which may be provided in keeping with community practice. The provision of these services will be subject to considerations such as the length of time prior to release and operational requirements.
4. In support of providing essential health services, emphasis will be placed on health promotion/illness prevention.
COMMISSIONER'S DIRECTIVE 850 - MENTAL HEALTH SERVICES
1. To ensure appropriate access to professional mental health services. These services contribute to the improvement and maintenance of the inmate's mental health and adjustment to incarceration and assist them in becoming law-abiding citizens.
MENTAL HEALTH TEAM
2. The team shall be comprised of a psychologist, nurse, case management officer, a psychiatrist when necessary, and ad hoc members as appropriate, and will function as a coordinating body to those inmates in need of mental health services.
3. Functions of the team include: identifying needs and service requirements, priorization for mental health services, and monitoring and documenting the clinical progress of individual inmates on at least a monthly basis.
REQUIREMENTS ON ADMISSION
4. On admission, an assessment of each inmate's mental health shall be made.
5. The informed consent of the inmate is required for any assessment, procedures and treatment provided by the Service. For exceptions to this policy, refer to Commissioner's Directive 803 entitled Consent to Health Service Assessment, Treatment and Release of Information.
SERVICES AND PROGRAMS
6. Mental health services and programs for inmates shall provide a continuum of essential care for those suffering from mental, emotional, or behavioural disorders consistent with professional and community standards including: individual assessment/diagnostic; and treatment for those suffering from acute, sub-acute or chronic mental disorders shall be provided in an appropriate facility.
REGIONAL MENTAL HEALTH CENTRES RESPONSIBILITIES
7. Regional Psychiatric Centres, Regional Treatment Centres and Regional Mental Health Units shall be responsible for the planning and implementation of essential mental health services in their respective regions in collaboration with regional and national management.
8. Mental health practitioners shall provide mental health services and programs in accordance with professional standards. They shall provide leadership and guidance in the provision of programs delivered by others.
9. The mental health professional shall make appropriate referrals to community agencies to ensure that required services are provided to the inmate on release.
10. The Service may obtain appropriate mental health services for offenders in the community where these services are not provided for by the respective provincial health of other jurisdictions (e.g. Health Canada for status Aboriginal offenders).
COMMISSIONER'S DIRECTIVE 840 - PSYCHOLOGICAL SERVICES
1. To ensure the provision of psychological services to offenders in order to assist them with the resolution of mental health problems and behavioural disorders and to help them learn and adopt socially acceptable behaviour patterns and to prevent or attenuate their relapse following intervention.
TYPES OF PSYCHOLOGICAL SERVICES
2. Psychological services for offenders shall be available at all institutions and the Service shall facilitate access to essential psychological services for offenders under conditional release in the community. Services shall include:
b. therapeutic intervention;
c. crisis intervention;
d. program development, delivery and evaluation.
3. Psychological services provided for essential mental health needs shall be comparable to those available in the surrounding community.
4. All psychological services shall focus on the needs of the offender, specifically the behaviour that contributed to criminal activity, on the assessment risk posed by the offender and on strategies to reduce and/or manage risk.
5. All psychological services shall be delivered in accordance with professional standards in the community and compatible guidelines established by the Service, including those services rendered by psychologists under contract.
6. The psychologist is one member of the Unit based multi-disciplinary team responsible for the management of the offender's case.
7. All assessment shall focus on offender risk, need and responsivity and on the management of risk, utilizing a variety of scientifically validated assessment methodologies in an integrated process.
8. As an integral part of the Intake Assessment process all offenders shall be screened on admission by appropriate personnel to determine which among them require more in-depth assessment. Offenders shall be re-assessed during and following treatment and following any significant crisis situation. Certain offenders will require pre-release assessments.
9. The referral and completion of pre-release assessments shall be such that they are available in time to be incorporated in reports to decision-makers at times of eligibility.
10. The pre-release assessment report must provide an evaluation of the level of risk posed by the offender, provide options for the management of risk and an identification of problems which might be encountered that would increase the risk. If the offender is being considered for release, the report shall also include specific recommendations concerning the continuing need for intervention in the community, including but not limited to psychological services.
11. The psychologist shall remain continually aware that he/she is a consultant to the decision-maker in the evaluation of options rather than the decision-maker him/herself.
12. Assessments and interventions shall be both culturally and gender sensitive.
13. Intervention shall be provided in priority to those offenders who require it most, with higher risk/higher need offenders receiving more intensive treatment. Problem behavior directly related to criminality and essential mental health needs shall be primary treatment targets.
14. Psychologists will identify treatment targets in keeping with applicable research literature (e.g. sexual deviation, substance abuse, anger/ aggressive behavior; criminal attitudes, values and beliefs; poor social skills; interpersonal problem-solving; empathy deficits; and impulsivity).
15. The delivery of treatment should be matched to methods proven to be effective with offenders, subject to ongoing program development and innovation.
16. Interventions shall be theoretically and empirically based. Programs require clearly articulated admission criteria and individual participants require specific treatment objectives, methods for attaining goals and a strategy for measuring treatment gains. Issues of treatability, frequency of contact and likely consequences of relapse must also be addressed.
17. Treatment shall be aimed at symptom reduction, skill acquisition, the identification of high risk situations, viable coping strategies for offenders and relapse prevention.
18. Documentation must be maintained relating to treatment activities. In addition, psychologists shall submit treatment progress reports and/or treatment summaries as appropriate, in consultation with case management staff.
19. Psychological reports prepared by CSC employees belong to and are under the control of CSC. CSC also has control of psychological reports prepared by outside consultants under contract with CSC where, under the contract, these reports belong to CSC.
20. Under the Privacy Act, personal psychological information can not, as a general rule, be disclosed without the consent of the individual to whom it relates. However, the Privacy Act recognizes a number of exceptions to this general rule.
21. Pursuant to one exception, personal information may be used for the purpose for which it was collected. Thus, relevant personal psychological information will be fully disclosed within CSC for the purposes of case management including release decision-making and the supervision or surveillance of the offender in the institution or the community.
22. Pursuant to a second exception, personal information may be disclosed where authorized by law. Thus, pursuant to subsection 25(1) of the Corrections and Conditional Release Act, psychological information that is relevant to release decision-making or the supervision or surveillance of offenders must be given at the appropriate time to the National Parole Board, provincial governments, provincial parole boards, the police and any body authorized by CSC to supervise offenders. Pursuant to subsection 25(3), psychological information must be shared with the police where CSC believes on reasonable grounds that an inmate who is about to be released on warrant expiry poses a threat to any person after release and where that information is relevant to the perceived threat.
23. Pursuant to this second exception, the Corrections and Conditional Release Act also contains a number of provision concerning offender access to information including psychological information. Subsection 23(2) requires that, on request, inmates be given access to the same information as would be disclosed under the access and privacy legislation. Section 27 requires that an inmate who is entitled to make representations about a decision under Part I of the Act about that inmate or to reasons for that decision be given the information that will be or was considered in making the decision or a summary thereof unless, except in the case of disciplinary matters, disclosure can be refused for reasons of safety, security or to protect a lawful investigation. Section 141 requires that, subject to certain limited exceptions like those relating to section 27, an offender be given all the information to be considered by the National Parole Board in reviewing that offenders case or a summary thereof.
24. Regions shall establish procedures to evaluate and monitor the quality of psychological services provided to offenders. As a minimum, such procedures shall include:
a. Institutionally/District developed mea-sures of timeliness of response to requests for service, timeliness of completion of required reports, and volume of work performed;
b. Psychologists identified as having a functional supervision responsibility, on a ratio no greater than one for every seven psychology positions in a region, who shall advise the Deputy Wardens/District Director on the quality of work performed by Institutional/District psychologists and psychologists under contract and to provide professional guidance and support to those psychologists by:i) being available for consultation;ii) conducting an annual review of a reasonable sample of each psycholo-gist's case files;iii) visiting each site at least twice per year to assess the strengths and weaknesses of the psychology service and share those findings with the psychologists and their line supervisor.
c. Regionally identified external psycholo-gists, with recognized qualifications and affiliations, who are prepared to serve as members of external review committees when situations arise which require such a review of the work of a given psychologist.
25. Newly appointed psychologists, including contract psychologists, shall be provided with orientation training focusing on psychological services within the Correctional Service of Canada as well as ongoing opportunities for continuing education. Prior to the expiration of the probationary period for indeterminate psychologists, the psychologist providing functional supervision shall provide compre-hensive assessment of quality of work to the Deputy Warden or District Director.
COMMISSIONER'S DIRECTIVE 702 - ABORIGINAL PROGRAMMING
Relevant sections to Strategy
1. To ensure that Aboriginal Offenders are provided with an equitable opportunity to practice their culture and traditions without discrimination and with an opportunity to implement traditional Aboriginal healing practices.
2. To recognize and respect that Aboriginal cultures and traditional practices contribute to the holistic healing of the Aboriginal Offender and his or her eventual reintegration into society.
3. To recognize that Aboriginal Offenders have the collective and individual right to maintain and develop their distinct identities and characteristics including the right to identify themselves as Aboriginal.
4. To ensure and recognize that Aboriginal Offenders have the right to practice and revitalize their cultural traditions and customs including the preservation, protection and access to cultural sites, ceremonial objects and traditional medicines.
5. To ensure that the needs of all Aboriginal offenders are identified and that programs and services are developed and maintained to meet those needs.
9. "Ceremonial objects" include objects deemed by traditional Elders as sacred or ceremonial in nature and include, but are not necessarily limited to the following: medicine bundles and bags; sweet grass; ceremonial pipes; sacred waters; sweat lodges; drums; cedar; rattles; sage; and eagle feather.
12. "Elder" means any person recognized by an external Aboriginal community as having knowledge and understanding of the traditional culture of the community, including the physical manifestations of the culture of the people and their spiritual and social traditions. Knowledge and wisdom, coupled with the recognition and respect of the people of the community, are the essential defining characteristics of an Elder. Some Elders may have additional attributes, such as those of traditional healer. Elders may be identified as such by Aboriginal communities only.
ABORIGINAL PROGRAMS REQUIREMENTS
23. All operational units accommodating Aboriginal offenders shall provide traditional social, cultural and spiritual programs to all identified Aboriginal offenders. To this end, all operational units shall offer specialized programs and services by providing any of the following or a combination thereof:
a. Aboriginal staff; or
b. Aboriginal individuals or organizations under contract to deliver the programs and services; or
c. Aboriginal brotherhoods or sisterhoods, operating as self-help groups, with the support required to assist their efforts.
24. All core programming will be designed and implemented consistent with the Corrections and Conditional Release Act.
25. Treatment or training programs or services which are designed specifically to meet the needs of Aboriginal offenders shall replace regular programs whenever:
a. there are situations in which other offenders may lack sufficient sensitivity to the needs of Aboriginal offenders, e.g. group counselling;
b. language is a factor;
c. differences in cultural approaches to learning require different techniques; and
d. the problems addressed by the programs have a different basis for Aboriginal inmates than for non-Aboriginal inmates.
COMMISSIONER'S DIRECTIVE 843 PREVENTION, MANAGEMENT AND RESPONSE TO SUICIDE AND SELF-INJURY Effective: 2002-09-03
|1.||To ensure the safety of and intervention for offenders who are suicidal or self-injurious.
Note: For the purposes of this directive, Community Correctional Centres shall follow the directions relating to offenders.
|2.||Sections 85-88 of the Corrections and Conditional Release Act.|
|3.||Commissioner's Directive 041 - Incident Investigations;
Commissioner's Directive 253 - Employee Assistance Program;
Commissioner's Directive 530 - Death of Inmates and Day Parolees;
Commissioner's Directive 567-3 - Use of Restraint Equipment;
Commissioner's Directive 580 - Discipline of Inmates;
Commissioner's Directive 590 - Administrative Segregation;
Commissioner's Directive 620 - Reporting and Recording of Security Information;
Standard Operating Practices 700-04 - Offender Intake Assessment and Correctional Planning.
|4.||Suicide: the intentional taking of one's own life.|
|5.||Suicide attempt: an intentional self-inflicted injury or action that does not result in death although death was intended.|
|6.||Self-injury: the deliberate harm of one's body without conscious suicidal intent.|
|7.||Suicide watch: the isolation of an inmate in response to an assessment of imminent danger of self-injury or suicide|
|8.||Protection of life takes precedence over preservation of evidence.|
|9.||Self-injurious or suicidal offenders shall not be subject to disciplinary measures for their self-injurious behaviour.|
|10.||With the offender's consent, the input of support persons or groups shall be taken into consideration in the treatment plan to respond to the risk of self-injurious or suicidal behaviour.|
|11.||Institutional Heads and District Directors shall:
a. ensure that staff have knowledge to detect and respond to behaviours that may be indicative of suicidal or self-injurious intent;
b. ensure that staff are aware of the relevant institutional or community procedures and resources regarding intervention for suicide and self-injury;
c. ensure that offenders at high risk for suicide or self-injury are referred on an emergency basis to the institutional psychologist, the district psychologist or appropriate community resources;
d. ensure that an interdisciplinary mental health team, led by the institutional psychologist, is established for inmates at risk for suicide or self-injury;
e. ensure that the district psychologist, in consultation with the parole officer, determines the form of support most appropriate for an offender in the community at risk for suicide or self-injury;
f. establish a reporting system to ensure key personnel are informed of the status of offenders at high risk for suicide or self-injury until they no longer present a high risk;
g. ensure that potential or actual self-injuries, suicide attempts and suicides are thoroughly documented by those responsible for any aspect of the case;
h. ensure that inmates have access to approved suicide awareness and prevention workshops and that offenders in the community have access to relevant community resources and information.
|12.||The sections of the Offender Intake Assessment pertaining to suicide and mental health shall be administered to all inmates:
a. within 24 hours of the initial admission; and
b. within 24 hours of a transfer from another institution.
|13.||Inmates who are potentially suicidal or self-injurious shall be referred to a psychologist on an emergency basis.|
|14.||The psychologist or a designated member of the interdisciplinary mental health team shall closely manage the case.|
|15.||Restraints, including security garments, may be used to reduce the risk of self-injury. This shall be done in accordance with Commissioner's Directive 567-3, entitled Use of Restraint Equipment.|
|RESPONSE TO SUICIDAL AND SELF-INJURIOUS OFFENDERS|
|16.||Staff shall take the necessary actions to ensure that suicidal and self-injurious offenders are referred on an emergency basis to a psychologist or a health service professional for appropriate intervention.|
|17.||The psychologist or designated members of the interdisciplinary mental health team shall determine the degree of risk for suicide or self-injury and the appropriate level of intervention.|
|18.||An inmate identified as being at a high risk for suicide or self-injury shall be placed on suicide watch, if the level of risk has not or cannot be reduced to an acceptably low level through other interventions.|
|19.||When an inmate is identified as being at a high risk for suicide or self-injury, the psychiatrist or institutional physician shall review the inmate's medication profile and method of medication administration taking into account the inmate's suicide status.|
|20.||If there will be a delay before an inmate is seen by a psychologist or health professional, the manager in charge may choose to place the inmate on suicide watch.|
|21.||The psychologist or designated members of the interdisciplinary mental health team managing the case shall provide staff with directions on the specific conditions of the suicide watch, including the procedures to be used to monitor the inmate's activities.|
|22.||Inmates placed on suicide watch shall be accommodated in a suicide watch cell designated by the institution, under continuous staff observation.|
|23.||The psychologist or designated member of the interdisciplinary mental health team will recommend to the manager in charge when the suicide watch can be terminated.|
|24.||No inmate considered imminently suicidal or self-injurious shall be transferred to an institution other than a treatment facility unless the psychologist managing the case, in consultation with other health service professionals, deems that the transfer would reduce or eliminate the inmate's potential for suicide or self-injury.|
|25.||It may be necessary to transfer a minimum-security inmate to a higher security institution for suicide watch or other interventions.|
|26.||The psychologist of the sending institution shall advise the psychologist at the receiving institution prior to the transfer and provide written notification of the inmate's suicidal state to ensure continuity of care with respect to treatment and monitoring.|
|ACTION TO BE TAKEN AS A RESULT OF SELF-INJURY OR SUICIDE|
|27.||When an act of self-injury or a suicide attempt is in progress, staff shall immediately:
a. intervene with life-saving measures, including first aid; and
b. request assistance, as appropriate.
|28.||When a death by suicide occurs, psychologists, health care professionals, chaplains or appropriate others such as elders shall offer support services to offenders. In addition, the following policies shall take effect:
a. Commissioner's Directive 041 - Incident Investigations;
b. Commissioner's Directive 253 - Employee Assistance Program; and
c. Commissioner's Directive 620 - Reporting and Recording of Security Information.
WOMEN'S MENTAL HEALTH CONTINUUM OF CARE
|ASSESSMENT SERVICES||NON-MENTAL HEALTH PROFESSIONALS||AMBULATORY CARE||INTERMEDIATE CARE||INTENSIVE CARE||COMMUNITY SERVICES|
|Intensive Intervention Strategy:
Structured Living Environment
|· Mental Health Interdisciplinary Team
· Treatment planning
· Psychiatric referral
· peer support
· other programs e.g. substance abuse, suicide prevention
|· individual counselling
· crisis resolution
· therapeutic groups
· prevention / maintenance
· psycho-educational groups
|· symptom stabilization
· psychosocial rehabilitation
· Dialectical Behavior Therapy
· skills training
· therapeutic groups
|· residential treatment beds
· high degree of support
· symptom stabilization and treatment
· Intensive Healing Program (for those not responsive or manageable in the SLE environments)
|· covers all levels of care programs offered by community agencies
· Aboriginal Services
· bridging services
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