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P6s. 1A13 078
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préalablement par l'auteur.
' REPORT ON VISITS
TO THE
SOCIAL THERAPY UNIT (OAK RIDGE),
PENETANGUISHENE MENTAL HEALTH CENTRE
AND THE
THERAPEUTIC COMMUNITY UNIT, SPRINGHILL INSTITUTION.)
CANADIAN PENITENTIARY SERVICE //
LIBRARY MINISTRY OF THE SOLICITOR
16 1982
BIBLIOTHÈQUE MiNISTÈRE DU SOLLICITEUR GÉNÉRAL
Prepared by: R.E. Watkins, M.Sc. Chief, Psychological Services Living Unit and Human Relations Directorate Offender Program Branch Canadian Penitentiary Service
Report on Visits to the Social Therapy Unit (Oak Ridge), Penetanguishene
Mental Health Centre, and the Therapeutic Community Unit, Springhill
Institution, Canadian Penitentiary Service.
Baqkground: In December of 1977, Acting DCIP requested
that I visit the Social Therapy Unit at Oak Ridge in order to famil-
iarize myself with the program in place there. This request Was in
response to Recommendation #45 of the Parliamentary Sub-Committee
Report on the Penitentiary System in Canada (1) WhilP the main
responsibility of responding to Recowiendation /14!", was subsequetly
given to the Medical and Health Care Services Branch by SMC, it was
thought appropriate by senior officers qf the Offender Programs Branch
that this Branch prepare a position paper in response to the recom-
mendation from its own perspective as well. With this in mind, a visit
to the Oak Ridge Complex at the Penetanguishene Mental Health Unit was
scheduled for January 23-27, 1978.
Similarly, and subsequently, a visit to assess the Therapeutic Community
Unit program at Springhill Institution was planned. The Parliamentary
Sub-Committee Report commented upon this program. (2) This assessment
was to be done in the light of my examination of the Oak Ridge Social
Therapy Unit. (The theoretical underpinnings of both of these program
may be seen as arising from the same base.) A visit to Springhill
Institution was scheduled for April 4-7, 1978, for this purpose.
...2
2.
Social Therapy Unit, Oak Ridge
The Oak Ridge Complex for the criminally insane at the Penetanguishene
Mental Health Centre is comprised of two units - the Social Therapy
Unit (STU) and the Activity Therapy Usait (ATU). Each of these two
units consists of four wards or ranges. The wards contain thirty-eight,
cell-like, individual rooms with open-barred doors. Patients assigned
to ATU are generally those who have been assessed to be of lower intel-
ligence (i.e., mentally retarded) and therefore not capable of bene-
fitting from the STU program. Other types of patients to be found there
are those who are judged to be unsuitable candidates for STU (for
various reasons), the physically disabled, the chronically ill and the
elderly. The program in this unit is centred around occupational
training and therapy for the patients. No further attention will be
paid to the Activity Therapy Unit as it does not fall within the scope
of this report.
The four wards of the Social Therapy Unit (STU) represent a progression
in an individual's treatment program. The wards are symbolized by
letters and treatment progression is related inversely to letter juxta-
position in an alphabetic sense. To illustrate: H Ward - this ward
serves two purposes: 1) it acts as a reception unit (M.A.P. program)
for all newcomers to STU; and 2) it acts as a dissociation/isolation
unit (Time-Out program) for those patients who are judged to be
regressing in terms of commitment to, and/or participation in, the
treatment programs; G Ward - the initial therapeutic community
...3
3.
experience entered into upon successful completion of the M.A.P.
program (i.e., M ,-. motivation, A = attitude, and P = participation)
of H Ward and where the emphasis is placed upon developing communication
skills, group solving of community problems and improving an individ-
ual's ability to relate to the community as a whole and to its members
individually; this is achieved through a series of patient committee
structures; F Ward - the second community experience of a more intense
nature than G Ward and featuring a "tribal system" where the emphasis
is placed upon the person as an individual and the discovery of self
in relation to a freer community organization; E Ward - the work ward
where patients, who have graduated successfully through H, G and F
Wards, now reside while engaging in work activities during the day. A
general progression of patient autonomy is noted - virtually no
autonomy on H Ward to a maximized amount of autonomy (given the insti-
tutional context) on E Ward.
Patients on STU come from three basic sources. One of these sources
is the courts which refer those wbo bee- n found 1W. .L Guilty by
Reason of Insanity", those who have been found "Unfit to Stand Trial"
and those who are remanded for observation for periods of thirty or
sixty,days. The federal and provincial correctional institutions
provide a second source of patients for STU. It is important to note
that certification is a requirement of admission in these cases, as
well as in other cases. The third source of patients consists of
other mental health centres in the province.
.. .4
4.
The STU program, in its inception, was based upon five major assump-
tions: 1) sickness as the failure of communication; 2) dialogue as
therapy; 3) the patient as the agent of therapy; 4) total experience
(i.e., total immersion into group 'structures and processes and the
consequent requirement to communicate and explore inter and intra-
personal relationships); and 5) coercion as the goal to freedom. (3)
Major components of the program are confrontation, anxiety arousal,
analysis, community (in the sense of fellow patients) support and
feedback (both from staff and fellow patients). Much of the thera-
peutic process is carried out by the patients themselves within the
group, tribal and dyad structures. The professional staff is small in
number, consisting of seven persons altogether during my visit to Oak
Ridge: a psychiatrist, a psychologist, a psychometrist, an occupational
therapist and three nurses. The roles of these seven staff members were
virtually indistinguishable with the exception of a few medical functions
(performed by the psychiatrist and the nurses) and in the staff feed-
back sessions which were led by the psychiatrist who is the Unit
Director. The remaining staff component consists of custodial officers.
The Parliamentary Sub-Committee Report makes reference to the fact that
the "inmate code" is absent on the STU and that "undesirables"
(e.g., sexual offenders) are accepted by the other patients. My obser-
vations supported these comments to a large degree. However, I feel I
must offer the following qualifying remarks. There remains evidence
of a "we-they" reference structure on the part of the patients vis-à-vis
...5
5.
the professional staff and particularly vis-à-vis the custodial staff.
There exists evidence of varying degrees of acceptance of the so-called
"undesirables", however the threat of violence appears to be completely
absent. There is also evident a tension between professional staff and
custodial not unlike that present in federal penitentiaries. Attempts
to deal with this problem are made through weekly meetings between
professional staff and custodial unit supervisors. However, and not
unexpectedly, some communication problems remain. Acceptance of the
STU program is not universal by the custodial staff particularly at the
lower levels.
The STU program comes under the heading of "coercive programs" in a
classification schema of treatment programs. It warrants this classi-
fication on several counts; to begin with, there is the fact of
certification - most, if not all, of the participants in the program
have been certified as being mentally ill (and thus committable to
the institution), decertification (and therefore release) depends upon
performance and participation in the program. Needless to say, this
fact lends a fair degree of externally generated motivation to the
patient to initially participate in the program. Coercion also is
applied in ensuring the patient's continued participatinn and interest
in the program. This is illustrated by the fact that patients can be
removed from any aspect of the program and sent to the Time-Out
program (i.e., dissociation/isolation). One might also argue that
...6
6.
some forms of individual therapy utilized in the program (i.e., certain
of the drug and alcohol treatment programs) are of a coercive nature.
The fixed, step-by-step nature of the program with no allowance for
variation and individual preference is another example.
The coercive nature of the program points out essential qualitative
differences between the STU setting at Oak Ridge and federal peniten-
tiaries in general (with the possible exception of the Regional Psy-
chiatric Centres), differences which are of significance to the
Offender Programs Branch. In the federal penitentiary context, it has
been argued by some that incarceration is the sole penalty of law-
breaking and that participation in institutional programs of a reha-
bilitative nature is purely a voluntary option for the offender. In
other words he has the "privilege" (or "right"?) to refuse "treatment"
(or conversely, under the "opportunities model", the Service provides
program opportunities to incarcerates which may, or may not, involve
attempts to motivate the individual to participate but certainly does
not encompass the element of coercion).
Such considerations anticipate problems such as the following: peni-
tentiary sentences are usually determinate, therefore why should one
undertake a commitment (and personal emotional risk) to a very inten-
sive program such as the STU program when one's eventual release is
not dependent upon such participation. Even were such a commitment
to be given, how does one hold an individual to that commitment when
...7
7.
the going gets tough if participation is supposedly voluntary. There-
in lies a very difficult problem when considering the implementation of
the STU program in a non-psychiatric, medium or maximum security
institution.
Another point of interest concerns a perceived relationship between the
STU program of Oak Ridge and the Living Unit programs of CPS, in con-
junction with the environments in which each program is applied. Many
of the basic tenets of the STU program are shared with other "Thera-
peutic Community" types of programs. In philosophy, orientation and
theory they all share a common base. Thus the Living Unit (LU) program
of CPS and the STU program can be considered as variations on a theme
in relation to the Therapeutic Community model in the abstract. The
major difference between the STU program and the LU program is one of
degree in terms of "therapy" or "treatment" offered, the model through
which this service is delivered and the environment in which it is
applied. STU patients are certified as mentally ill; a medical model
is applied in a mental hospital (maximum security) environment and
through therapy a "cure" is strived for (albeit with a strong emphasis
on social and interpersonal interactions - i.e., a predominantly social
psychiatry medical model). The "cure" calls for very intensive therapy
at a deep emotional level. Penitentiary inmates, on the other hand,
constitute a "normal" population (in the psychiatric sense); a medical
model does not necessarily apply, nor is the environment of program
application that of a mental hospital. An approach which stresses a
social learning (or relearning) approach in a non-mental hospital
...8
8.
environment would seem more appropriate. The concepts of open communi-
cation, a supportive atmosphere, the learning of more adaptive social
skills and problem solving behaviors and the selective reinforcement of
positive and negative behaviors (which are common to both approaches)
can be applied through a program (4) which encompasses a social learning
model in its application and is adapted to, and incorporated into, a
penitentiary environment. The LU program, in its "pure" form, is an
attempt to meet these conditions.
The question of the so-called "right" to refuse treatment does not arise
with the Living Unit approach to therapeutic community principles.
Because the inmate is not considered "ill" or "abnormal" in a medical or
psychiatric sense, psychiatric therapy is not warranted. Rather, a
program, which is basically socially oriented and which operates as part
and parcel of the institutional environment, would seem more appropriate.
Thus the program is built into the institutional regime and becomes part
of normal institutional life (e.g., range meetings). The question of
forced or coercive treatment simply does not arise. This fact would
seem to render a program such as the LU program as being more conducive
to the non-psychiatric, federal institutions.
In the foregoing, while comparing the STU and LU programs, I have used
the terms "therapy" and "treatment". This was done for illustrative
purposes only. It should be remembered in this context that the LU
program eschews the use of these terms. A social learning model or
approach is applied. No attempt is made to deal with deep-seated
emotional problems in a psychiatric sense. The objective is to
...9
9.
provide "normal" individuals with social learning opportunities so
that a more socially acceptable and adaptative responsP rPpertoirP
may be acquired by the incarcerate. Insight into emotional problems
may result from this approach as well as better control of emotional
impulses. The primary aim however is of a "social adjustment" nature
and not therapeutic intervention in a psychiatric sense.
The Parliamentary Sub-Committee Report on the Penitentiary Service in
Canada states that the use of the term "patient" in the text of the
Report when discussing the STU program does not "imply any specifically
medical treatment" (5) . This statement should not, on the other hand,
be misinterpreted to mean that the STU program is not, basically, a
medical program. The program deals with the treatment of certified
individuals under medical direction. A medical (social psychiatric)
model is applied in the treatment program. The individualited drug and
alcohol "immersion" therapy techniques specifi ,ally require the presence
of medical consultation if not outright medical direction.
In conclusion, it is suggested that the adoption of the STU model
presents serious theoretical and practical problems for non-medical,
non-psychiatric institutions and thus for the Offender Program Branch.
As a first step in the implementation of Recommendation #45 of the
Parliamentary Sub-Committee Report it is recommended that the Regional
Psychiatric Centres (RPC) be the focus of attention where conditions
10.
and models of treatment more closelyapproemate_those of the STU
program at Oak Ridge.
Once this has been achieved and the benefits of the program made
evident to other incarcerates, perhaps the problems of motivation,
participation and commitment can be overcome in non-psychiatric
institutions and pilot projects (i.e., programs) can be instituted in
these institutions for those individuals who either need or wish to
participate in such a program. Furthermore, a pool of trained inmate
therapists will then be available from the RPC programs. These individ-
uals, in turn, will greatly aid in the introduction of pilot projects
in other medium and maximum security institutions. It is projected,
however, that universal participation of federal inmates in STU-like
programs will never be realized (if that ever was the goal) and that
the LU program will be crucial in serving a similar function for what
is seen as the non-participating "normal" majority. That is, will
provide the opportunity for social learning and .social adaptation
experiences to those "normal" individuals who neither require nor wish
a "treatment" or "therapy" program in the psychiatric sense. In my
view, the STU and LU programs should not be perceived as competing
and/or mutually exclusive programs. Rather, they should be perceived as
being complementary in nature; each being of value and benefit in the
particular environments within which they function best.
...11
THERAPEUTIC COMMUNITY UNIT, SPRINGHILL INSTITUTION
Springhill Institution, a medium security institution, has four
residential units. Three of the residential units are designated
as living units and are operated in accordance with Living Unit
program guidelines. The fourth residential unit, Unit #10, has
been designated as the "Therapeutic Community Unit" (TCU). The TCU
program was instituted in July, 1969.
The following rationale was recently offered as the basis for the
operation of TCU. The therapeutic community is composed of a group
of inmates and staff working together toward a therapeutic goal.
This goal consists of the creating of an environment which will
induce the inmate to learn non-delinquent alternatives to those
behaviour patterns that placed him in his present predicament (i.e.,
incarceration). (6) One of the essential differences between the TCU
program and the LU program is that the notion of therapy is stressed
in TCU whereas therepeutic intervention, per se, is not an element
of the LU program. The latter, as noted above, stresses an environ-
mentally-structured approach to social learning (or relearning) and
social adaptation.
The physical structure of TCU is similar to most medium security,
living unit program penitentiaries. There are three wings of cells,
two ranges per wing, with approximately 17 cells per range. A fourth
and smaller range of cells located over the main entrance to the unit
12.
was renovated to provide space for what is now the community meeting
room. The staff complement consists of two Living Unit Development
Officers (LUDO's), one Living Unit Supervisor (LU-2) and fifteen
Living Unit Officers (LU-1's). The terminology used for, and
classification of, staff in STU are identical to that utilized for
regular living unit residences in CPS. TCU differs from other
residential units under the Living Unit program in that all three
work shifts are covered by LU 'staff (as opposed to other residential
units where the night shift is manned by a security officer - i.e.,
CX staff - only). Other institutional personnel are available to
TCU in a resource capacity. Such personnel include the institutional
psychiatrist, psychologists, chaplains, etc. A NPS officer is
assigned to TCU from the Truro NPS office and participates in staff
meetings, inmate interviews, and community meetings as much as is
possible given his schedule and travel demands.
One observer commented that the essential differences between the
TCU program and the LU program at Springhill Institution consisted of
the following: 1) more frequent community meetings in TCU (thus
intensifying contacts); 2) availability of TCU staff on a twenty-
four hour basis; and 3) cells are not locked thereby giving the
unit residents more control over their daily lives in terms of
allowing them to determine their own hour of retirement for the
night and the ability to seek the privacy of their cell as they see
fit. (7) One should comment here that the nature of the aforementioned
3
13.
community meetings are different than the range meetings of the
traditional LU program. On TCU an attempt is made, during these
meetings, to assume a therapeutic, insightful approach to discussions
concerning matters affecting the functioning of the community and,
in particular, to behaviour considered detrimental to the community.
Also staff "wash-up" (i.e., feedback) meetings were recently
reinstituted. All available staff attend these meetings which are
led by the institutional psychiatrist.
The TCU program then, may be thought of as falling somewhere between
the STU program on the one hand, and the LU program on the other. It
might be useful, for illustrative purposes, to pursue a continuum
analogy in a rudimentary comparative analysis of the three programs.
One continuum would be of a theoretical, conceptual nature. On this
continuum the TCU program would fall, let us say, mid-way between the
STU and LU programs. The TCU program is not a medical program in the
manner of the STU program though it does borrow some elements from a
medical model such as that of therapeutic intervention, yet it adopts
as well a social learning approach similar to that of the LU program.
The second comparative continuum would consider the practical aspects
of the programs, i.e., its operation. On this continuum the TCU
program would again be located between the other two programs but, in
this case, much more closely aligned with the LU program than with
the STU program. There are many reasons for this placement, the
majority of which are environmental, administrative and organizational
14.
in nature. In terms of therapeutic intervention the main instruments
for this are the TCU daily community meetings. Therefore the
emphasis and practice of therapeutic intervention at Springhill
differs markedly from the STU program at Oak Ridge, particularly on
the dimensions of intensity and depth.
The Parliamentary Sub-Committee Report makes reference to the TCU
program. It indicates that the program has fallen short of "... reaching
a satisfying therapeutic climate..." (8) and therefore its goals. Two
reasons for this may be extracted from a reading of the Report: 1) too
large a "community" population, particularly in relation to partici-
pation in community meetings where the group meets en masse; and 2) the
fact that "... the prison sub-culture had not been fractionalized..."
again seemingly due to the numbers problem as well as to the intake
philosophy of the unit (i.e., lack of a slow integration process of
new inmates into the unit). I interpret this to mean that the "inmate
code" had not been successfully broken down.
Yet a recent review (9) of the TCU program unearthed the following
information: 1) TCU had fewer disciplinary offences and less use of
dissociation than the other three units; 2) inmates who had been
behaviour problems in other units adjusted well in the TCU environ-
ment; 3) inmates in TCU have consistently refused to participate
in planned incidents of collective action initiated by inmates on
other units and have thus proved to be a stabilizing factor within
the institution; 4) a former policeman (now an inmate) was placed
...15
15
on TCU and was accepted there with no special arrangements being
necessary for his protection, indicating perhaps a greater degree
of acceptance on this unit of so-called "undesirable" inmates;
5) relationships between staff and inmates appear to be of a
closer nature on TCU as compared with the other units; and 6) the
incidence of damage to property in the unit is lower in TCU than in
the remainder of the institution.
What does one conclude from these findings? Notably, that there
seems to be a qualitative difference between the TCU and LU programs
at Springhill Institution. To what can one attribute the difference?
Presumably to the four or five basic differences pointed out earlier
in this section, that is: 1) more frequent community meetings;
2) TCU (LU) staff "counsellor" availability on a twenty-four hour
basis; 3) allowing inmates the autonomy to determine their own
individual bedttmes and privacy needs; 4) a willingness by staff
and inmates alike to discuss mutual problems in depth in the open
forum of the community meeting; and 5) the opportunity for the TCU
staff to receive and to give feedback. Does this mean that the LU
program in the other three residential units is failing? Not neces-
sarily, as an in-depth study of those units was not undertaken. It
perhaps can be said however that range meetings in these units should
be held with greater frequency; that more emphasis must be put into
staff training programs particularly for the LU "counsellors". Those
latter two points are fairly generally perceived as needs indigenous
to most LU programs throughout the Service.
...16
16.
Perhaps the TCU program more closely approximates the ideal LU
operation despite its emphasis on so-called "therepeutic intervention".
Perhaps there are aspects of the TCU program that could be usefully
adapted to the LU program such as the five noted above. Lastly, a
close look should be taken at the functioning of these units in
relation to the LU program guidelines to ensure the guidelines are
being adhered to. The findings do indicate, as well, that the TCU
program has not been a total and dismal failure; a conclusion that
one might extract from the Parliamentary Sub-Committee Report. In-
sofar as the "inmate code" is concerned, while one could not claim
a total breakdown of the code (nor would one expect it), I did
witness events that certainly indicated a partial breakdown of the
"code" ( cf., also inmate statements appended to Report of Visit to
00)% the Atlantic Region ).
I .did not find evidence of any undue amount of conflict between
custodial staff and professional staff as mentioned in the Parlia-
mentary Sub-Committee Report.(11)
I did see evidence of tension
between TCU staff in general and the administration. Such tension
I perceived as being due to the dynamic of attempting to operate the
TCU program within the administrative confines of the institution, of
the Service and within a system with a basic LU program orientation.
All these factors, at times, override the perceived needs of TCU. •
Many people have commented upon the fluctuating nature of TCU over
its nine-year history in terms of the vivacity and viability of the
.. .17
17.
program. There seems to be periods when interest and motivation
flag. During my visit the program seemed to be in an up-swing
phase, having been examined only recently as to its needs and its
viability. A similar phenomenon of phasic fluctuations in program
vivacity was reported during my visit at Oak Ridge and is often
reported in the program evaluation literature. I strongly felt
that the professional resource staff at Springhill Institution
must take a renewed interest in TCU.
Another area of comment concerned the number of inmates in the TCU
program (i.e., sixty-eight or more). This number seems a bit unwieldy
to deal with in a therapeutic manner. One is overwhelmed with the
idea of sixty-eight individuals participating in a therapy-oriented
community meeting. Yet there is a trade-off involved were one to
fractionalize the population. This occurs through the loss of a
"one community" identity and its being replaced by several sub commu-
nity identities (e.g., wings or ranges). It was the considered
opinion of the TCU staff that it would be a mistake to attempt to
fractionalize the community. Such fractionalization (and subsequent
loss of community identity) was cited as one reason why the other
three residential units at Springhill Institution seemed to be
functioning less effectively than TCU. I attended two community
meetings where upwards of sixty-five inmates were in attendance (plus
staff and resource persons). The quality of the meetings, given the
numbers, was surprisingly good. However, content tended to be as
much informational in nature as therapeutic.
,..18
18.
A comparative study of the LU and TCU programs at Springhill Insti-
tution was conducted by a research team from the University of
Moncton in 1975. (12) The research findings were inconclusive in
terms of program superiority but did find many areas of overlap
in the two programs as has been alluded to earlier in this report.
The report also commented that the quality of the therapeutic
intervention attempts left much to be desired, generally because the
staff lacked the necessary training in the skills required for such
intervention.
Part of the reason for my visit to Springhill Institution was to
assess the TCU program in the light of the STU program. However,
I soon found any attempt at such a comparison to be of an "apples
and oranges" nature. The TCU program does not, nor cannot, attempt
therapeutic intervention in the manner of a program such as the STU
program. However, as has been noted above, the TCU program does
possess many positive features which, in the Springhill experience,
renders it seemingly somewhat superior to the other residential
units at that institution. As suggested earlier, perhaps the LU
program could benefit from examining those aspects in which TCU
Offers with a possible view to their incorporation in the LU program.
FOOTNOTES
(1) Report to Parliament by the Sub-Committee on the Penitentiary System in Canada. Minister of Supply and Services, Canada, 1977. pp.119-122.
(2) Ibid. p.121.
(3) Maier, G.J. and Hawke, T.J. Penetang: People and Paradox. Penetanguishene Mental Health Centre, undated. 26 pp.
(4) Henriksen, S.P. Guidelines to the Living Unit Program in Medium Security Institutions. Unpublished Document. Ministry of the Solicitor General, 1976. 245 pp. plus appendices.
(5) Report to Parliament ... Op.cit. p.120, para. 570.
(6) Garneau, M.L.J. Therapeutic Community. Unpublished Document. Ministry of the Solicitor General, 1976. 3 pp.
(7) Garneau, M.L.J. Report of Visit to the Atlantic Regiun. January 23-25, 1978. Unpublished Document. Ministry of the Solicitor General, 1978. 8 pp. plus addenda.
(8) Report to Parliament ... Op.cit. p.121, para. 581.
(9) Garneau, M.L.J. 1978. Op.cit.
(10) Garneau, M.L.J. 1978. Op.cit.
(11) Report to Parliament ... Op.cit. p.121, para. 581.
(12) Desjardin, L. and Loubert, C. Comparative Study of the Therapeutic Community and Living Units at Springhill. Unpublished Document. Ministry of the Solicitor General and the University of Moncton, 1975. 9 pp. (translated summary).
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