Response of the Correctional Service of Canada to the 38th Annual Report of the Correctional Investigator 2010 - 2011

INTRODUCTION

The Correctional Service of Canada (CSC) is responsible for administering court-imposed sentences for offenders sentenced to two years or more, including supervising those under conditional release in the community. CSC also administers post-sentence supervision of offenders with Long Term Supervision Orders for up to 10 years. On an average day in fiscal year 2010-2011, CSC was responsible for 14,200 incarcerated offenders and 8,600 offenders in the community. CSC manages 57 institutions, 16 community correctional centres, 84 parole offices and sub-offices and employs approximately 17,400 people.

While CSC's original five priorities remain its pillars, a sixth priority was added to reflect the reality that CSC does not, and cannot, work alone to fulfil its mandate:

1. Safe transition to and management of eligible offenders in the community;
2. Safety and security of staff and offenders in our institutions and in the community;
3. Enhanced capacities to provide effective interventions for First Nations, Métis and Inuit offenders;
4. Improved capacities to address mental health needs of offenders;
5. Strengthening management practices; and
6. Productive relationships with increasingly diverse partners, stakeholders, and others involved in public safety.

The sixth priority recognizes the role of CSC partners and stakeholders in the federal correctional process and reiterates CSC's commitment to enhancing public safety through building, sustaining and improving these productive and collaborative relationships.

The recommendations of the 2007 Report of the CSC Review Panel "A Roadmap to Strengthening Public Safety, formed the basis of CSC's Transformation Agenda that focused on five areas:

1. Enhancing offender accountability
2. Eliminating drugs
3. Enhancing correctional programs and interventions
4. Modernizing physical infrastructure
5. Strengthening community corrections

With Phase One - Transformation - and Phase Two - Integration - both now completed, CSC is now in Phase Three which focuses on ensuring continued integration of these initiatives. CSC has made significant progress in integrating into its daily operations the recommendations of the Review Panel. The ongoing integration and strengthening of these initiatives continues to be of utmost importance to ensure CSC effectively manages today's challenging offender population.

The introduction of new legislation such as the abolition of Accelerated Parole Review, as well as legislation such as the Truth in Sentencing Act and the Tackling Violent Crime Act is expected to result in increased numbers of federal offenders with a wider range of needs, underscoring the requirement for both short and long-term capital planning and for adjustments to correctional programming and population management strategies. CSC has developed a multi-faceted accommodation strategy to address the increase in the offender population that includes extending and increasing temporary accommodation measures as well as constructing new units within existing institutions. This will result in more than 2,700 additional spaces in federal correctional institutions across Canada.

Over the last decade, CSC has been facing numerous challenges stemming from a more complex and diverse offender population profile, resulting in new pressures on CSC and its operations. Aboriginal offenders continue to be disproportionately represented and generally assessed as higher risk and higher need. Overall, offenders now have more extensive histories of violence and CSC is managing more offenders associated with gangs and organized crime and offenders with Long Term Supervision Orders. CSC has witnessed an increase in the proportion of male offenders and female offenders identified with mental health problems at admission. CSC is striving to improve both the level of care and the correctional results for offenders with mental disorders by implementing its comprehensive Mental Health Strategy. The Strategy works to address offenders' mental health care needs at all stages of incarceration, from intake to transitional care for offenders being released into the community.

Offenders also continue to exhibit a high prevalence of substance abuse problems and infectious diseases. In addition, as the offender population ages, the prevalence of health problems increases resulting in increased pressure on CSC health care systems.

CSC's priorities and objectives are focused on the protection of the public and the safety of staff and offenders. In response to the challenging offender profile, and to contribute to public safety, CSC will continue to focus on its priorities, further enhance Transformation initiatives and foster productive relationships with stakeholders, partners and the Office of the Correctional Investigator.

ACCESS TO MENTAL HEALTH SERVICES

Recommendation #1:

I recommend that the Service pursue alternative mental health service delivery arrangements and agreements with the provinces and territories consistent with the 'Assessment Framework for Alternative Service Delivery' as well as the Standing Committee's report on 'Mental Health and Drug and Alcohol Addiction in the Federal Correctional System.'

CSC continues to pursue alternative mental health service delivery arrangements and agreements with the provinces and territories where appropriate and cost effective. CSC has existing arrangements that have led to enhanced partnerships with other jurisdictions. For instance, CSC recently engaged with a community psychiatric facility that is currently providing services for a federal offender. In addition, the introduction of Grand Rounds at a CSC regional treatment centre is another way in which CSC currently engages community partners. Grand Rounds is a forum usually held every 4-6 months, for health care professionals in which a speaker, typically a subject matter expert, will do a case study presentation or topic presentation to aid with the development and learning for the health care professionals attending. This is followed by a Question and Answer session. Also, CSC has had a lengthy working relationship with Institut Philippe-Pinel in Montreal.

When crises arise in institutions, CSC uses local hospitals and/or local psychiatric facilities for short term interventions. These transfers are carried out in accordance with the applicable legislation, e.g. pursuant to consent to treatment legislation or the applicable mental health act however, CSC recognizes the need for more established links to external specialized mental health services and continues to pursue these partnerships.

CSC is currently reviewing existing partnerships for mental health service delivery with a view of determining feasibility of replicating similar partnerships in other regions. It is anticipated this review will be completed in December 2011.

Recommendation #2:

I recommend that the Service implement the Management Action Plan to address compliance and performance deficiencies identified in the January 2011 internal audit of the Regional Treatment Centres and the Regional Psychiatric Centre in FY 2011-12, and provide an update prior to March 31, 2012.

Through its internal audit processes, CSC continually looks for opportunities to enhance efficiencies and effectiveness with respect to the services it provides to offenders.

CSC is currently implementing actions identified in the Management Action Plan from the internal audit of the Regional Treatment Centres and the Regional Psychiatric Centre (2011).

The Audit and Management Action Plan (http://www.csc-scc.gc.ca/text/pa/adt-rtc-rpc-378-1-252/adt-rtc-rpc-378-1-252-eng.shtml) documents were made publicly available in April 2011. An updated response will be available prior to March 31, 2012.

Recommendation 3:

I recommend that all placements in physical restraints for health care purposes, effective immediately and without exception, should be considered a 'reportable' use of force. Staff who may be called upon to apply Pinel restraints should receive training with respect to the reporting, monitoring and safe use of this type of restraint.

CSC's National Training Standards already includes the training of staff on the application of the Pinel restraints. This training is compulsory to meet organizational priorities including the requirements of Commissioner Directives 567 (Management of Security Incidents); 567-1 (Use of Force); 844 (Use of Restraint Equipment for Health Purposes) and to meet our legislated mandate pursuant to Corrections and Conditional Release Act (CCRA) and Corrections and Conditional Release Regulations (CCRR). At the completion of the training the individual will successfully demonstrate proficiency in the practical application and the theoretical knowledge of law and policy that are required to be qualified in the physical application of the Pinel soft restraint system.

While we do not support the recommendation for all placements in Pinel restraints to be considered a reportable use of force the newly revised CD 843 (Prevention, Management and Response to Suicide and Self-Injuries) clearly defines the conditions, circumstances and processes for those cases in which it is to be considered a reportable use of force. This policy will be promulgated in the near future and CSC will review a sample of occurrences of the use of physical restraints for health care purposes with the external Health Care Advisory Committee in the coming year.

Recommendation 4:

I recommend that the Service's Health Care Advisory Committee be engaged to explore models for enhanced oversight and accountability of clinical treatment practices and guidelines for managing self-injury in prisons, inclusive of patient advocacy, use of physical restraints, involuntary treatment and informed consent in a correctional setting.

CSC will consult with the Health Care Advisory Committee in the coming year to assess and identify models for enhanced oversight and accountability of clinical treatment practices and guidelines for managing self-injurious behaviour in federal penitentiaries.

Recommendation 5:

I recommend, pending the development and evaluation of a proven treatment program at the Complex Needs/ Unit pilot and permanent funding for its ongoing operation that the most serious, chronic and complex cases of self-injury in CSC custody be reviewed for immediate transfer to provincial mental health care treatment facilities.

CSC is committed to providing appropriate essential mental health services within professionally accepted standards and applicable legislation. Individual assessments will be conducted on those offenders who have been identified as the most chronic and complex cases of self-injury to provide assurances that appropriate treatment options are in place and if required, cases will be assessed as to whether a placement in a provincial mental health facility is possible.

In addition, the Health Care Advisory Committee is scheduled to visit various Pacific sites in September 2011, including the Complex Needs Unit/Program. CSC will seek feedback from this advisory committee, as appropriate.

PHYSICAL HEALTH CARE - SPECIAL FOCUS ON ELDERLY OFFENDERS

Recommendation 6:

I recommend that the Service develop a more appropriate range of programming and activities tailored to the older offender, including physical fitness and exercise regimes, as well as other interventions that are responsive to the unique mobility, learning, assistive and independent living needs of the elderly inmate.

Upon admission, all older offenders and those with self care needs undergo a functional assessment, which measures their ability to perform daily living activities. Results of this assessment influence further health related consultations as well as special needs for accommodation and services. Throughout the inmate's sentence he/she is assessed in terms of their ability to function in their environment.

In addition to the above, CSC is currently conducting research on male and female older offenders that will help inform future strategies and initiatives.

Recommendation 7:

I recommend where necessary, CSC hire more staff with training and experience in palliative care and gerontology. Sensitivity and awareness training regarding issues affecting older offenders should be added to the training and refresher curriculums of both new and experienced staff.

In 2009, CSC updated the national Hospice Palliative Care (HPC) Guidelines to provide direction and tools necessary for a consistent approach to the provision of care to terminally ill inmates within CSC. Consistent with professional practice standards, CSC uses a patient- and family-centred HPC approach that seeks to address the physical, psychological, social, and spiritual needs and expectations of the offender in collaboration with their close relations. The updated guidelines were followed by the development of a pilot Palliative Care Training Module in November 2010 and the launch of the training sessions in March 2011.

Similarly, in November 2010, CSC launched the "Older Offender Training Module" for CSC nurses with the opportunity for other members of the interdisciplinary team to participate. The two day training provides education in a number of areas such as normal aging, diseases associated with aging, performing a comprehensive geriatric assessment, and behaviour issues (bullying, depression, suicide, and delirium).

Recommendation 8:

I recommend where new construction is planned, age-related physical and mental impairments should be part of the infrastructure design, and include plans and space for sufficient number of accessible living arrangements.

The new units that are being constructed include cells and rooms that are accessible. In conjunction with the new units being built, we are also continuously modifying some of our facilities as the needs of the inmate population change.

As part of the development of its Long Term Accommodation Strategy, CSC will continue to take every opportunity to ensure the needs of the inmate population are considered.

Recommendation 9:

I recommend that the Service prepare a national older offender strategy for 2011-12 that includes a geriatric release component as well as enhanced post-release supports.

CSC recognizes that a comprehensive discharge plan that addresses the physical, mental, emotional, social and spiritual needs of individuals, best ensures post-release access to health care and other community services to facilitate continuity of care after a period of incarceration.

CSC will continue to implement the framework that is already in place to ensure appropriate release planning of offenders, including geriatric offenders. As part of the planning process, when indicated, a functional assessment is completed by health care services and identified areas of concern are taken into consideration in the development of an individualized release plan. For example, a functional assessment might suggest the need for a certain type of accommodation.

As well as part of the pre-release decision process, a community strategy is developed that outlines the way in which the various dynamic factors will continue to be addressed in the community, the way in which the offender will be monitored and determines the level of intervention to be applied upon the offender's release to the community. The identification of the offenders' functional needs and required resources are included in the plan.

Continuity of care is directed by health services and institutional/community reintegration policies, discharge planning guidelines for both physical and mental health needs, and affiliated official forms to be completed for all types of transfers and a release to the community. CSC Regional Discharge Planners continue to develop a network of community resources through education, networking, and partnerships.

DEATHS IN CUSTODY

Recommendation 10:

I recommend that CSC make its performance strategy for preventing deaths in custody public and annually report against clear performance indicators, as per the Office's recommendations contained in the Quarterly Reporting exercise.

CSC is moving in this direction, the first report for the period of April-September, 2010 of the Offender Deaths in Custody Performance Measurement Strategy - April, 2010 to April, 2015 is being finalised and will be shared with the Office of the Correctional Investigator and made publicly available by October, 2011.

Recommendation 11:

I recommend that CSC make its response to the reports of the Verification Team and the Independent Review Committee public, and provide annual updates on progress made against recommendations.

The Corrective Measures and Management Action Plan (CMMAP) for the Verification Team Report and the Independent Review Committee (IRC) are being finalized and will be submitted to the Executive Committee in September 2011 for approval. Once approved by the Executive Committee, appropriate steps will be taken to publish the IRC final report and the CMMAP on CSC internal and external websites and updated twice a year in order to reflect progress made against recommendations in the reports.

Recommendation 12:

Pursuant to section 180 of the CCRA, I recommend that the Minister of Public Safety direct the Service to immediately suspend the Mortality Review exercise until such time as the Guidelines can be independently and expertly validated to meet requirements of the legislation. In the interests of transparency and accountability, the results of this review should be made public.

The Mortality Review Process offers a systematic and comprehensive approach to reviewing natural in-custody deaths. As part of the Mortality Review Process we regularly consult with Coroners. In August 2010, CSC presented an overview of the Mortality Review Process at the Annual Meeting of Coroners/Medical Examiners. In general, our process for reviewing death by natural causes was well received and they offered some helpful suggestions for improvements.

CSC will continue to actively liaise with coroners and seek their input as we review natural in-custody deaths.

Consistent with our built in accountability measures, the Mortality Review Summaries and file closures will continue to be presented for CSC Executive Committee decision; and periodically a roll-up of key findings will also be prepared for CSC Executive Committee and widely distributed throughout the organization as a way of sharing the results of the process, demonstrating transparency and providing information that CSC can use to improve or modify practices. In addition, we plan to seek the input of Health Care Advisory Committee on the process.

Recommendation 13:

Until the Mortality Review Process is validated, I recommend that an external medical doctor review all natural in-custody deaths and independently report his/her findings and recommendations to the Commissioner of Corrections.

The Mortality Review Process offers a systematic and comprehensive approach to reviewing natural in-custody deaths. For example, in August 2010 CSC we presented an overview of the Mortality Review Process at the annual meeting of Coroners/Medical Examiners. In general, our process for reviewing death by natural causes was well received and they offered some helpful suggestions for improvements.

In addition, we plan to seek the input of the external Health Care Advisory Committee on our process. As part of the built in accountability measures, the mortality review summaries and file closures will continue to be presented to CSC Executive Committee; and periodically a roll-up of key findings will also be prepared for CSC Executive Committee and widely distributed throughout the organization as a way of sharing the results of the process, demonstrating transparency and providing information that CSC can use to improve or modify practices.

Recommendation 14:

I recommend that the Service's practices and procedures for preparing terminally ill offenders for 'release by exception' consideration be independently reviewed to ensure CSC standards are being met and that cases are being prepared with appropriate diligence, rigour and timeliness.

The Mortality Review Process reports on the inmate's eligibility for Parole by Exception and records the reason why he or she may not have been considered or released under this authority. Management within CSC worked closely to ensure that there was sound case management in the review of each case. In any instances where it would be determined that from a case management perspective could have been accomplished, this continues to be the appropriate venue for it to be raised.

In terms of care provided, in 2009, as noted earlier, CSC updated the national Hospice Palliative Care (HPC) Guidelines to provide direction and tools necessary for a consistent approach for the provision of care of terminally ill inmates within CSC. Consistent with professional practice standards, CSC uses a patient- and family-centred HPC approach that seeks to address the physical, psychological, social, and spiritual needs and expectations of the offender in collaboration with their close relations.

In cases where inmates are not eligible, are not supported or are denied Parole by Exception by the Parole Board of Canada, CSC ensures that there are measures taken, although taking into consideration any operational requirements, to help the offender and their close relations in the final stages of the inmate's life. For example, CSC may accommodate special visits, more possibilities for telephone calls, etc.).

CONDITIONS OF CONFINEMENT

Recommendation 15:

I recommend that the revised Commissioner's Directive on Inmate Accommodation contain:

i. An explicit and express prohibition against double-bunking in all segregation, segregation-like settings and the Secure Units for women.

Double-bunking in the secure unit or administrative segregation will only be used as an option of last resort when all other alternatives have been exhausted. CSC reviews its policies to ensure institutional heads clearly understand that double-bunking in those areas are a last resort.

ii. Specific instruction that double-bunking assignments must be signed and approved by the Warden and reviewed by regional authorities on a quarterly basis.

CSC will review its processes for approving and monitoring double-bunking assignments and issue a new protocol by October 2011.

iii. Exemptions to use non-purpose built space for inmate accommodation on a temporary or emergency basis must be approved by the Commissioner of Corrections and include a plan to return the space to its intended use within a defined time-frame.

Exemptions to use non-purpose built space for inmate accommodation on a temporary or emergency basis will continue to be the responsibility of the Regional Deputy Commissioner and they will report all occurrences to the Commissioner of Corrections on a weekly basis. The Regional Deputy Commissioners will be required to identify a plan to return such space to its intended purposes as soon as practical.

Recommendation 16:

I recommend that the Service audit compliance with its legal obligation to ensure that mental health considerations are taken into account - and documented - in a decision to initiate or maintain segregation placements.

At present, CSC is already monitoring this process through the National Audit Tool conducted yearly on segregation issues by National Headquarters. In addition to this ongoing practice, for the next 12 months, CSC (National Headquarters) will conduct a random review of segregation placements and maintenance of placements and report these results to the Commissioner of Corrections on a quarterly basis. At the end of the 12 months, the practice of quarterly reviews will be re-considered by CSC's Executive Committee.

Recommendation 17:

I recommend CSC implement recommendations contained in the 'Report of External Review of Correctional Service of Canada Offender Complaints and Grievance Process' and move forward immediately with the introduction of Grievance Coordinators and Mediators at all medium, maximum and multi-level institutions.

Alternative Dispute Resolution (ADR) has been identified in the Offender Redress External Review as an important means to reduce the number of complaints and grievances at the institutional level who deal with 79% of complaints and grievances yearly. CSC's has initiated a pilot project that will occur in one maximum and one medium security institution in each of the five regions. The project will be launched in September 2011 for an 18 month period.

ACCESS TO PROGRAMS

Recommendation 18:

I recommended that the ICPM pilot be independently reviewed and expertly evaluated in the next fiscal year on the basis of clear performance and outcome indicators and that the results of this review should be shared with Parole Board Canada and made public. Aboriginal specific programming should be maintained until the evaluation is complete.

A study on ICPM's efficiency has been drafted by CSC and the study on ICPM's effectiveness will be conducted with results expected in fiscal year 2012-2013. CSC will also proceed with an independent external research study on ICPM. In addition, correctional programs are scheduled to be evaluated in accordance with CSC's Five-Year Evaluation Plan. The evaluation will be shared with the public, Parole Board of Canada, the Office of the Correctional Investigator and other key stakeholders.

The ICPM includes a specific culturally relevant stream for Aboriginal Offenders to ensure the Continuum of Care Strategy for Aboriginal Offenders is fully incorporated. The Aboriginal ICPM is anchored in Aboriginal culture and has a repertoire of skills within its content. As with the other streams of the ICPM, the Aboriginal program is designed around the Risk-Needs-Responsivity principles, and conforms to the same standards as the other ICPM streams. As with the other streams, there is an intake Primer, High, Moderate, Institutional Program Maintenance and Community Program Maintenance, all of which are Aboriginal specific.

In addition, the Aboriginal ICPM is facilitated by an Aboriginal Correctional Program Officer (ACPO) and assisted by an Elder with reference to specific session deliveries as well as lead by an Elder for ceremonies and spiritual components. The Program Elder is also called upon to assist within the Motivational Module intervention strategy when an Aboriginal offender drops out of a program, refuses to participate in the program or requires assistance with program content to gain a further understanding of correct interpretation and implementation of program content and skills.

Therefore, programming for Aboriginal offenders will be maintained as part of the Aboriginal ICPM and is part of the pilot and therefore, will be part of the evaluation.

ABORIGINAL ISSUES

Recommendation 19:

I recommend CSC undertake an operational review of Aboriginal offender's access to spirituality and ceremonies at all security designations to ensure practices at the institutional level are consistently supported and developed to the extent that policy and the law require.

CSC will carry out a review to ensure institutional Aboriginal offenders have access to spirituality and ceremony in a manner that is consistent with national policy.

The Strategic Plan for Aboriginal Corrections (SPAC) is undergoing a comprehensive evaluation. Given the SPAC is based on the continuum of care, which is centered on spirituality and culture, CSC should receive recommendations related to any gap in offender accessibility.

CSC is currently conducting a comprehensive review of all the standing orders related to Commissioner's Directive (CD) 259-Exposure to Second-Hand Smoke to ensure the appropriate accommodation of Aboriginal spiritual practices at each institution. This review should be completed by September 2011. Where standing orders exist relating to CD-702, Aboriginal Offenders the review will begin in September 2011.

Regions will be asked to provide a site by site review of the availability of Elders, spiritual services, and other relevant information related to spirituality.

CSC is in the process of expanding its Pathways Initiative, from seven sites to up to 25 sites. These sites are currently undergoing a review and approval process to be completed in March 2012. All information with the exception of the SPAC evaluation will be available by April 2012.

FEDERALLY SENTENCED WOMEN

Recommendation 20:

I recommend that the Service aggressively implement a range of population management measures at the regional women's facilities that are consistent with Creating Choices and reflect the least restrictive principle enunciated in the CCRA.

CSC has developed a population management strategy for women offender institutions that considers the unique needs of federally sentenced women and is consistent with the principles of Creating Choices and the CCRA.

The long-term measure to address additional forecasted population pressures is an increase of 144 beds at women offender facilities over the next two fiscal years.

In the interim, short- and mid-term options include:

• Maximizing current capacity through double bunking in the Secure Unit;
• Facilitating voluntary transfers to other regions;
• Amending the Section 81 agreement with Native Counselling Services of Alberta to include up to 16 beds for women;
• Exploring innovative Exchange of Services Agreements with provinces to identify the possibility of additional beds for women offenders.
• Examining the possibility of using temporary accommodations such as portable units/trailers at some sites;
• Exploring opportunities for additional mental health beds for women;
• Emphasising timely and effective case management planning and preparation for security reclassification and parole board reviews at the earliest opportunity for eligible offenders;
• Augmenting staffing levels in key areas (i.e. Social Workers, Correctional Program Officers, Employment Counsellors) to promote timely and effective interventions; and
• The use of non-purpose built space to accommodate women offenders occurs on a case by case basis and only when no other reasonable options are immediately available. In these instances, the privacy and dignity of the women is a primary consideration.

Recommendation 21:

I recommend that the Service explore additional partnerships and agreements with the provinces and territories to allow for the transfer of severely mentally ill women offenders to specialized treatment facilities.

CSC continues to pursue additional partnerships and agreements with the provinces and territories where appropriate and cost effective. CSC has existing arrangements that have led to enhanced partnerships with other jurisdictions. For instance, CSC recently engaged with a community psychiatric facility that is currently providing services for a federal woman offender. In addition, the introduction of Grand Rounds at a regional treatment centre is another way in which CSC engages with community partners. Grand Rounds is a forum usually held every 4-6 months, for health care professionals in which a speaker, typically a subject matter expert, will do a case study presentation or topic presentation to aid with the development and learning for the health care professionals attending. This is followed by a Question and Answer session. Also, CSC has had a lengthy working relationship with Institut Philippe-Pinel in Montreal.

When crises arise in institutions, CSC uses local hospitals and/or local psychiatric facilities for short term interventions. These transfers are carried out in accordance with the applicable legislation, e.g. pursuant to consent to treatment legislation or the applicable mental health act; however, CSC recognizes the need for more established links to external specialized mental health services and continues to pursue these partnerships.

CSC is currently reviewing existing partnerships for mental health service delivery with a view of determining feasibility of replicating similar partnerships in other regions. It is anticipated this review will be completed in December 2011.