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, Ontario
519-850-3777 x228
hcallender@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
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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 incarceration
In 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 reoffending is substance abuse (Andrew & Bonta)
Solutions:
 Educate correctional staff
 Listen and learn about risk to build a balanced perspective
 Halfway 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
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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.
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Buddy System
Graduated Jobs
Outing Plans and Outing Debrief vetted through Re-entry Group
Senior Residents
Alumni – 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