Effectively Responding to the Rising Challenge of Mental Health & Addictions in

Corrections

How to Effectively & Efficiently Treat These Issues to Reduce Recidivism

Canadian Congress on Criminal Justice Conference October 2013

Presenters

Heather Kerr, MSW, RSW

Executive Director Stonehenge Therapeutic Community Guelph, Ontario 519-837-147- ext 230 hkerr@stonehengetc.com

Heather Callender, MA

Executive Director St. Leonard's Society of London London, Ontario519-850-3777 x228hcallender@slcs.ca

Prevalence of Mental Health Issues in Community Corrections:

The Research

Provincial Statistics

•Just over 18% of 8,948 inmates have psychiatric disorders

•31% of 575 females

•30% of the population have one of the following: Developmentally delayed Psychiatric Disorder Serious Drug and/or Alcohol issues

(June 2010)

Prevalence of Mental Health Issues in Community Corrections:

The Research

•Towards an Integrated Network 2008•Community Connections 2010

•Sample solutions/promising practices•Wrap-around•Strong relations with provincial health agencies•Recovery model

Prevalence of Mental Health Issues in Community Corrections:

The Research

The Requirement:

Sections 76 and 86 of the Corrections and Conditional Release Act for Correctional Mental Health Program 61 states:

“rehabilitative programming and health care, including essential mental health care

must be made available to inmates”

Prevalence of Addiction Issues in Community Corrections:The Research

Canadian national prevalence data: 7 of 10 offenders in the federal system have engaged in problematic use of alcohol and drugs during the one-year period prior to their incarcerationIn Canada, about 51% of federal prisoners have an alcohol problem and about 48% experience problems with drugs

Women offenders: In general, women in prison have more severe substance abuse problems than men and are more likely to be involved in “hard” drugs (e.g., cocaine, heroin, barbiturates, amphetamines, etc.)

Aboriginal offenders: In general, Aboriginal offenders in Canada report more serious substance abuse problems than non-Aboriginal offenders. Aboriginal offenders are twice as likely to report severe alcohol abuse problems than are their non-Aboriginal counterparts. Aboriginal and non-Aboriginal offenders report similar rates of severe drug abuse problems

Prevalence of Addiction Issues in Community Corrections:The Research

Recidivism:

Substance use is a major factor in contributing to the re-admission of offenders back into custody following release.

Canadian studies have demonstrated that as many as 70% of offender release suspensions involve alcohol and other drugs

Offenders with more serious substance abuse problems are more likely to be readmitted to custody following release

CCSA 2004

Offender Access to Mental Health Care in the Community:

The Challenge

•Mutual distrust that exists between the mental health providers and the community corrections system

•Information sharing restrictions

•Complex clients with complex needs that transcend the capacity of individual key workers or single agencies to meet

WHO should provide this care?

Relapse – A Part of Recovery but a Show Stopper for Risk

The Challenge

The Stages of Change tell us relapse is an almost inevitable part of the change/recovery process (Prochaska)

Relapse rates from addiction = 40 to 60% (NIDA)

For many offenders the highest criminogenic risk factor for re-offending is substance abuse (Andrew & Bonta)

Solutions:Educate correctional staffListen and learn about risk to build a balanced perspectiveHalfway back programs

Social Determinants of Health:

The Solution

Social determinants of health = conditions in which people are born, grow, live, work and age.

Unlike biological factors (genetics and age), these conditions can change and be influenced by public policies and other interventions

Social determinants of health have a significant influence on overall health. About 50% of people’s health can be attributed to socioeconomic factors while 10% is attributed to physical environment factors, 15% to biological factors, and 25% to the health care system itself

(Keon & Pepin, 2009) (World Health Organization 2011).

Social Determinants of Health:

The Solution

Social Determinants of Health:

The Solution

Focusing on social determinants of health builds optimal health of offenders, reduces recidivism and reduces costs

•Finding a safe home and learning to be part of a neighbourhood (Bring in the garbage can!) •Finding the right job – safe, meaningful (no Friday beer runs)•Engaging family or finding new “family” supports (“Adoption”)•Making new, meaningful friendships (B&B example)•A family doctor – what is a good patient•Healthy hobbies

Care Resolutions & Multi-Sectorial Funding/Partnerships:

The Solution

• Access to programs• Flexible but consistent service delivery• Understanding of the complex client• Cross Sector Funding and Support• Community Integration and Partnerships• Mental Health can be viewed on a continuum

• proper interventions are needed at proper time to ensure success

TC Model – Peer Support:

The Solution

Peer Support Models in Corrections:

•Life Line – winner of the CCJA award last year•Peer Supports – Grand Valley Institution for Women

Effective and Cost Efficient ?

TC Model – Peer Support:

The Solution

Peer Supports – A Continuum:Therapeutic Community model is a “best fit” for community correctional clients, offering a “practicing model” where cognitive and emotive changes are practiced in the therapeutic community before re-entering society.

Buddy SystemGraduated Jobs Outing Plans and Outing Debrief vetted through Re-entry GroupSenior ResidentsAlumni – Talks - Giving Back

Motivational Interviewing, Stages of Change, Strength-based:

The Solution

Strength-Based Model of Care

Cross Sector Training and Support

Using theory and best practices to enhance care in the programs

Staffing Diversification

Questions & Answers