Out of Sight, Back Into Mind: Federal Offenders with

mental disorders preparing for release into the community

Canadian Criminal Justice Association Pan-Canadian Congress

Claude TellierVeronica Felizardo

October 2011

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Presentation Objectives

• Overview of Canada’s correctional systems

• Mental Health issues present in Correctional Service of Canada’s offender population

• Overview of the CSC Mental Health Strategy

• Key elements and results of the Community Mental Health Initiative

• Mental Health Strategy for Corrections in Canada

Overview of Canada’s Correctional Systems

• Responsibility for corrections is divided between the federal and provincial governments.

• Correctional Service of Canada is responsible for offenders serving sentences of two years or longer.

• Provinces and territories are responsible for offenders sentenced to terms of less than two years.

• As of 2008, the incarceration rate in Canada was 116 per 100,000 (CCRSO 2010).

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Incarceration Rate

4

303

843 684

80 104 177187

Rate per 100,000 adult population, 2010*Numbers include federal, provincial and territorial incarceration rate

(Source: Statistic Canada)

87 71

83

59

87

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Mental Health and Corrections

• People with serious mental illness (SMI) are often charged with more serious crimes than other people arrested for similar behaviours (Hockstedler, 1987; New York State Office of Mental Health Forensic Task Force, 1991)

• Persons with SMI are generally incarcerated for longer than those with no mental illness (Criminal Justice Mental Health Consensus Project, 2003; Ditton, 1999)

• In recent years, the population of mentally disordered people within the criminal justice system has been growing significantly (Schneider, 2000)

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Mental Health and Corrections

• Estimates vary on the prevalence of mental health issues within prisons:• Brink et al (2001) found that 31.7% of 267 new intakes in

federal penitentiaries in British Columbia had a current diagnosis, with 12% meeting the criteria for a serious mood or psychotic disorder.

• Fazel & Dinesh (2002) found that “typically about one in seven prisoners in western countries have psychotic illnesses or major depression” (p.548).

• Data from Correctional Service of Canada indicates that 13% of male offenders and 29% of women offenders in federal custody self-identified at intake as presenting mental health problems, and these rates have approximately doubled since 1996/97.

• Approximately 90% of Canadian federal offenders diagnosed with a mental disorder have at least one other disorder. 6

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Canadian Context

• Out of the Shadows at Last: Transforming Mental Health and Mental Illness and Addiction Services in Canada (2006)• Comprehensive examination of mental health needs and

services in Canada

• Mental Health Commission of Canada (2007)• National Mental Health Strategy• Anti-Stigma Initiative • Knowledge Exchange Centre• Homelessness Research Demonstration Projects• Partners for Mental Health

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Mental Health and Offenders:CSC’s Context

• Addressing offender mental health needs is a key priority of CSC

• Legislation requires CSC to provide essential health services, including mental health services, and reasonable access to non-essential mental health services that will contribute to the offenders successful reintegration into the community rehabilitation.

• CSC’s Mental Health Strategy approved in 2004; updated in 2010

• CSC’s Independent Review Panel Report (2007)• Includes several recommendations for a robust continuum of

mental health services, from intake to release, with a strong focus on linking with community partners.

Warrant Expiry

Date

Intake Throughout incarceration

6-9 months prior to anticipated release

Release to the community

Mental Health Initiatives, Public Health and Regional Treatment Centres

IMHC

*CoMHISS

CoMHISS: Computerized Mental Health Intake Screening SystemIMHC: Institutional Mental Health CareCMHC: Community Mental Health Care

Intermediate Mental Health Care

(currently unfunded)

IMHC

Primary CareTraining

Regional Treatment Centres

Public Health

• Discharge planning (physical health)

CMHC • Discharge

planning (mental health)

• Training

CMHC

• Mental Health Specialists• Contracts (psychiatrists

and community agencies) • Training• Community Psychology

Community Partnerships

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CSC’s Mental Health Strategy

• Approved in 2004; updated in 2010

• Full-spectrum response to mental health needs in institutions and communities:• Comprehensive mental health assessment at admission• Enhanced primary mental health care in all institutions• Enhanced resources at mental health treatment centres• Development of intermediate care mental health units in regular

institutions (currently unfunded)• Increased mental health support in the community

CSC’s Mental Health Strategy: Institutional Mental Health Care (IMHC)

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Computerized Mental Health Intake Screening System (CoMHISS)

Mental health screening to identify offenders with mental health needs

Given to all offenders at intake in order to assist in identifying offenders

who show symptoms associated with possible mental health problems that require follow-up assessment by a mental health professional

Primary Mental Health Care Team is available in all mainstream institutions. teams employ a multi-disciplinary approach focusing on mental

health promotion, prevention, early intervention, treatment, support, and continuing care

CSC’s Mental Health Strategy: IMHC

Results

CoMHISS

As of March 2011:

Approximately 8600 men offenders and 500 women offenders have completed CoMHISS

Automatic referrals are made to Psychology for offenders that exceed cut-offs

System “automatically” produces statistical reports at institutional, regional and national levels

Mental health data available for research and reporting 12

CSC’s Mental Health Strategy: Throughout Incarceration

IMHC

Primary Care TrainingMental Health services for those identified with mental health needs or in crisis periodsOffenders will be identified at screening or can be referred anytime by institutional staff

Regional TreatmentCentres

Specialized mental health treatment to offenders with mental health needs who are in an acute state or needing long term care

Intermediate Mental Health Care

Included in strategyIntended for offenders whose mental health needs are not so severe as to require care in a psychiatric facilityImplemented as a pilot at Kingston Penitentiary (Ontario)

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CSC’s Mental Health Strategy: Throughout Incarceration

Primary Mental Health Care

As of March 2010: 64 front-line positions staffed to

establish primary mental health teams 17 contracts in place (psychiatry and

other mental health services)

From April 2010 to March 2011: 9200 offenders received mental health

services 93.2% male 6.8% female 17.5% Aboriginal

Training

As of March 2011, CSC has provided 4300 institutional staff mental health training:

3300 correctional officers 400 nurses 300 parole officers/program

officers

Results(IMHC)

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6-9 months prior to anticipated release

Public Health

Discharge planning (physical health)

Discharge planning by institutional nurse regarding health services follow-up in the community and discharge medication

Given to all offenders

Offenders are seen 6-9 months and 3 weeks prior to release.

CMHC

Discharge planning (mental health)

Training*

Comprehensive discharge planning to prepare offenders with mental health needs for their return to the community

Referred by Institutional Parole Officers 9 months prior to release

Elaboration on next slide

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Fundamentals of Mental Health Training: Objectives

• Increase understanding of what it’s like to have a mental disorder• stigma, discrimination

• Increase knowledge of offenders with mental disorders• Symptoms and interventions/treatments• Relationship between mental disorder and risk• legislation, CSC initiatives

• Enhance skills and strategies for effectively interacting with and supporting offenders with mental disorders• recognizing and describing symptoms• communication and interpersonal skills• tailoring skills and strategies for women offenders, Aboriginal

offenders• referring, consulting and collaborating with mental health

professionals, community resources, family members

CSC’s Mental Health Strategy: CMHC

CMHC

• Mental Health Specialists

• Contracts (psychiatrists and community agencies)

• Training

• Community Psychologists

Results

As of March 2011 CSC has trained: Approximately 1265 community case

management staff (e.g. parole, community correctional centre and halfway house staff)

Approximately 350 staff working in the community have received a one day follow-up training on FASD and/or Effective Intervention Strategies

Risk of suspension and revocation in the group who received Community Mental Health Specialist Services was 34% and 59% lower, respectively than the comparison group (CMHC Evaluation)

As of March 2011, approximately 2600 unique offenders have received Community Mental Health Specialist Services and approximately 750 unique offenders have received a Clinical Discharge Planning service.

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Warrant Expiry Date

Community Partnerships

Transfer of care to provincial health services

Referred by Community Mental Health Specialists prior to Warrant Expiry Date

Results

Community Capacity Building

Since April 2007 to March 2011, CMHC staff have made approximately 10 600 contacts with individuals and agencies

CMHC staff have communicated with approximately 5400 different individuals and agencies.

National Corrections Mental Health Strategy

Heads of Corrections established an FPT working group on mental health whose mandate is to develop a Strategy in consultation and collaboration with the Mental Health Commission of Canada

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OFFENDER

Institutional

Parole Officer

Institutional Mental

Health Team

Clinical Discharge Planning Services

Community Resources

Meaningful OccupationFamily/Support Network

Leisure/Social

Activities

Community Mental

Health Services

Community

Parole Officer

Mental Health Strategy for Corrections in CanadaBackground

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• Federal/Provincial/Territorial Working Group established in November 2008

• Mandated to develop a Mental Health Strategy for Corrections in Canada

• Strategy and Action Plan approved in June 2011

Mental Health Strategy for Corrections in CanadaVISION

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Building Wellness along the Continuum of Care: Connecting Services

Individuals in the corrections system experiencing mental health problems and/or mental illnesses will have timely access to essential services and supports to achieve their best possible mental health and well-being. A focus on continuity of care will enhance the effectiveness of services accessed prior to, during and after being in the care and custody of a corrections system. This will improve individual health outcomes and ultimately contribute to safe communities.

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Mental Health Strategy for Corrections in CanadaKey Elements

Mental Health Promotion• The effective delivery of mental health services along the continuum of care is realized in an environment that promotes wellness, prevents illness and makes active efforts to reduce stigma.

Screening and Assessment• Early identification and ongoing assessment of mental health needs

of individuals is essential for providing appropriate support and treatment of those who are at risk for harming themselves or others, for commencing timely treatment, and for information placement and correctional planning.

Mental Health Strategy for Corrections in CanadaKey Elements

Treatment, Services and Supports• A range of appropriate and effective mental health treatment and

adjunct services is essential to alleviate symptoms including risk of self-injury and suicide, enhance recovery and well-being, enable individuals to actively participate in correctional programs, and for safer integration of individuals with mental health problems or mental illnesses into institutional and community environments.

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Mental Health Strategy for Corrections in CanadaKey Elements

Suicide and Self-Injury Prevention and Management• A comprehensive approach to the prevention and management of

suicide and self-injury is essential for managing the increased risk of suicide and self-injurious behaviour among individuals in the corrections system. Early identification of risk for suicide or self-injury is important in establishing mental health treatment, monitoring and support plans, as well as for placement considerations. Staff are trained to identify symptoms and factors that may indicate an elevated risk for suicide or self-injury, and to intervene appropriately.

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Mental Health Strategy for Corrections in CanadaKey Elements

Transitional Services and Supports• Dedicated transitional services are required to support a seamless continuity

of care from the community to the corrections system and upon return to the community. These services will be provided during the pre-sentence period, at the time of intake, within and between institutions, and upon release to the community, with an emphasis on connecting with community resources.

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Mental Health Strategy for Corrections in CanadaKey Elements

Staff Education, Training and Support• Staff require ongoing support and comprehensive education and

training in mental health to enhance their well-being, knowledge, and skills to interact effectively and provide appropriate support for individuals with mental health problems and/or mental illnesses.

Community Supports and Partnerships• Outreach initiatives to build relationships with partners are essential

to optimize individual mental health and well-being, enhance continuum of care, and contribute to the shared responsibility of public safety.

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Mental Health Strategy for Corrections in CanadaStrategic Priorities and Key Plans

Knowledge Generation and Sharing• Prevalence Data

Enhanced Service Delivery• Evidenced-based screening tools• Evidenced-based assessment tools• Discharge planning practices• Suicide and Self-Injury Prevention

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Mental Health Strategy for Corrections in CanadaStrategic Priorities and Key Plans

Improved Human Resource Management• Mental health training• Staff support for cumulative and critical incident stress management

Building Community Supports and Partnerships• Information-sharing and collaboration between correctional

jurisdictions and key stakeholders/partners.

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Challenges / Barriers to Community Reintegration

• Institutionalization• Reluctance to work with offenders with mental disorders• Post-release aftercare• Mental Health = Risk for Violence?• Disconnect between federal and provincial services

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Successes

• Improvement in the discharge planning process and transition of offenders with mental disorders to the community.

• The provision of more effective and timely mental health intervention and services to offenders in the community.

• Improved correctional results for offenders with mental disorders with the impact of increased public safety.

• Improved quality of life for offenders with mental disorders.

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Challenges

• Recruitment of mental health professionals

• Integrating new mental health positions within CSC infrastructure

• Establishing linkages between the offender and limited community resources – finding synergies

• Need is bigger than just persistently mentally ill

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For more information

Internet: www.csc-scc.gc.ca

Claude Tellier, Director, Community Mental Health and PartnershipsClaude.Tellier@csc-scc,gc,ca

Veronica FelizardoSenior Project Manager, Federal/Provincial/Territorial and Mental

Health PartnershipsVeronica.Felizardo@csc-scc.gc.ca