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 Tellier
Veronica Felizardo
October 2011
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
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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).
3
Incarceration Rate
303
843
684
68
80
104
187
87
177
83
87
71
59
Rate per 100,000 adult population, 2010
*Numbers include federal, provincial and territorial incarceration rate
(Source: Statistic Canada)
4
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 diagnosed6
with a mental disorder have at least one other disorder.
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
7
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 nonessential 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.
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Mental Health Initiatives, Public Health and Regional Treatment Centres
Throughout
incarceration
Intake
IMHC
*CoMHISS
IMHC
Primary Care
Training
Regional
Treatment
Centres
Intermediate
Mental Health Care
(currently unfunded)
6-9 months prior to
anticipated release
Public Health
CMHC
• Discharge
• Discharge
planning (physical planning (mental
health)
health)
• Training
Warrant
Expiry
Date
Release to the
community
CMHC
Community
Partnerships
• Mental Health Specialists
• Contracts (psychiatrists and
community agencies)
• Training
• Community Psychology
CoMHISS: Computerized Mental Health Intake Screening System
IMHC: Institutional Mental Health Care
CMHC: Community Mental Health Care
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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
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CSC’s Mental Health Strategy:
Institutional Mental Health Care (IMHC)
 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
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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
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CSC’s Mental Health Strategy:
Throughout Incarceration
IMHC
Regional Treatment
Centres
Intermediate Mental
Health Care
Primary Care
Training
Mental Health services
for those identified with
mental health needs or in
crisis periods
Offenders will be
identified at screening or
can be referred anytime
by institutional staff
Specialized mental
health treatment to
offenders with mental
health needs who are in
an acute state or needing
long term care
Included in strategy
Intended for offenders
whose mental health
needs are not so
severe as to require
care in a psychiatric
facility
Implemented as a pilot
at Kingston Penitentiary
(Ontario)
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CSC’s Mental Health Strategy:
Throughout Incarceration
Results
(IMHC)
Primary Mental Health Care
Training
As of March 2011, CSC has provided
4300 institutional staff mental health
training:
 3300 correctional officers
 400 nurses
 300 parole officers/program
officers
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
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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
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CSC’s Mental Health Strategy:
CMHC
Results
CMHC
• Mental Health Specialists
• Contracts (psychiatrists
and community agencies)
• Training
•Community Psychologists
 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.
 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 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
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have received a one day follow-up training on FASD
and/or Effective Intervention Strategies
Warrant Expiry Date
Results
Community
Partnerships
 Transfer of care to provincial
health services
 Referred by Community Mental
Health Specialists prior to
Warrant Expiry Date
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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Community
Mental
Institutional
Mental
Clinical Discharge
Planning Services
Community Resources
Health
Team
Health
Services
Leisure/Social
OFFENDER
Activities
Institutional
Meaningful Occupation
Community
Family/Support Network
Parole Officer
Parole Officer
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Mental Health Strategy for Corrections in Canada
Background
• 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
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Mental Health Strategy for Corrections in Canada
VISION
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.
21
Mental Health Strategy for Corrections in Canada
Key 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.
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Mental Health Strategy for Corrections in Canada
Key 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 Canada
Key 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 Canada
Key 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 Canada
Key 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 Canada
Strategic 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 Canada
Strategic 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 Partnerships
Claude.Tellier@csc-scc,gc,ca
Veronica Felizardo
Senior Project Manager, Federal/Provincial/Territorial and Mental
Health Partnerships
Veronica.Felizardo@csc-scc.gc.ca
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