:
I do, Mr. Chair, and I'm very happy to have that opportunity. I believe the members will have a copy of what I'm going to be saying as well. If they happen to want to follow along or refer back to it as we go along today, they'll be able to do that.
I want to say, first of all, that you've been very patient with us at the Mental Health Commission because you've invited us to come here, three of us. Mr. Préfontaine has worked very hard to try to get the three of us here. Judge Ted Ormston, who is the chair of one of our advisory committees, our chief operating officer, and I as secretary of the board were intending to come along. We haven't been able to find a date that you had and was possible for us. But I'll just say to you that if you have further interest after this meeting, Mr. Chair and members of the committee, in hearing more from us, I'm sure those other people will be able to make time for you individually, collectively, or however you'd like to do it. So thank you for inviting us.
I want to move right along, and I want to situate my remarks—as you would expect me to do, I think, since I'm from the Mental Health Commission—about mental health and addiction care for federally incarcerated offenders in the context of the work of the Mental Health Commission of Canada.
The MHCC, as I'll refer to it as a short form, had its origins in the report tabled by the Standing Committee on Social Affairs, Science and Technology. That report was tabled in May 2006 and was prepared under the leadership of someone many of you will know, the Honourable Michael Kirby, and his deputy chair for that committee, Dr. Wilbert Keon.
Appropriately titled “Out of the Shadows at Last”, this was the first ever—it's hard to believe for somebody like me who has worked in correctional services since 1960 and in the mental health field—comprehensive study of mental health, mental illness, and addiction services in Canada. Many of you may have seen that report. If you haven't, it's that thick. It's well worth referring to. It has a specific section referring to the federally incarcerated offender group and the work of the Correctional Service of Canada, which would be helpful.
Their process in that committee, the Senate committee, was to make proposals that would transform the systems and services provided for persons living with a mental illness and/or addictive behaviours in Canada. Some of you will know that about 60% of the people who have a mental illness also have a substance abuse problem. So the crossover is very high.
One of the 118 recommendations in that report proposed the creation of a Mental Health Commission. The purpose of this national, not federal, commission was to provide a body empowered to accelerate the development and implementation of effective solutions and to maintain a needed national focus on mental health issues. Again, if any of you know Michael Kirby, you'll know he makes it his business to keep a focus on whatever task he is given. In all of the activities of the commission, we strive to be a catalyst for change. So that's our byword. In the federal budget of March 2007, the federal government announced the creation and funding of a Mental Health Commission with Michael Kirby as its chair.
The commission was asked to focus on certain specific tasks. They are the development of a mental health strategy for Canada, the development of a knowledge exchange centre for this field, and the creation and implementation of a 10-year anti-stigma/anti-discrimination program. And then subsequently, the federal government asked the commission to establish a five-year research/demonstration project for homeless mentally ill persons situated in five cities in Canada. Some of you will be familiar with that activity, which is very much under way at the moment.
The commission itself has a 10-year life, so it will run on longer than do those demonstration projects in homelessness.
The commission has just published a phase one report concerning the mental health strategy. It is the product of an extensive consultation across Canada. All of you as members, I think, have received it. It's the product of an extensive consultation across Canada to determine what should be included in a national strategy.
Entitled Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada, this report provides a comprehensive, high-level platform for the next stage of development and consultation. This second phase will present the “how”--what should be in the strategy for Canada for mental health and justice, for example, the whole justice field. So this second phase is going to work on the “how” of the transformation, is expected to be completed by late 2011.
For example, it will include what are eight distinct advisory committees, such as the one chaired by Judge Ted Ormston. Judge Ted Ormston will provide what the public government bodies, our staff, and those various persons, perhaps you yourselves, believe should be in sections of the report. It's certainly going to deal with the widest possible range of mental health and addiction matters, from children and youth to seniors, to addicted persons, to those who fall into the criminal justice system.
I trust that committee members will have that report. Mr. Préfontaine indicates that you received it.
The Toward Recovery and Well-Being report could be useful to this committee as you perhaps consider the value of a national mental health and substance abuse strategy for the Correctional Service of Canada. We believe that such a strategy could be useful in providing a sound framework for determining funding priorities, program development, and change within the Correctional Service of Canada. We encourage that if they do, or you do, recommend that they undertake having a national strategy for corrections, it be integrated with the national strategy that the Mental Health Commission is developing. It makes sense to have sub-strategies, if I can put it that way, across Canada. The last thing we need in this poor old mental health and criminal justice field is more fragmentation. We've got plenty of that.
Just as the general mental health and addiction service system is poorly integrated and with many challenges as clients move through it--maybe you have relatives, as almost all of us do, who have moved through the mental health system--we know how fragmented it is, so also is the criminal justice system faced with similar obstacles, but ones that are often even more substantial. A mental health strategy for the Correctional Service of Canada could be a good start.
Stigma, and the discrimination that emanates from it, is a hurdle that Canadians must overcome if the mental health and addiction service is to function to best effect. The commission's Opening Minds program was recently launched, and the campaign that goes with it is absolutely essential in raising public awareness about stigma and its impacts. Most of us who work at the Mental Health Commission don't think that the changes we're involved in and helping to promote are going to get very far unless there is a reduction in the stigma and discrimination against people in corrections.
Just as stigma is a large issue to overcome with the general public, the stigma and fear that attaches to criminal behaviour when combined with mental illness is a much greater challenge. It's our view that any program to transform mental health and addictions care for the Correctional Service of Canada will need to be accompanied by an anti-stigma program directed at staff and other inmates, as well as the general public.
You might be interested to know that the stigma program, the general one that we're operating, is focusing first on the area of stigmatization of youth and also the stigmatization of mentally ill people within the health care system. Our vice-chair, Dr. David Goldbloom, a very well-known doctor in Canada, a psychiatrist, would be the first to say that patients who come to hospitals for general care face a tremendous amount of discrimination from all levels of staff within the system. All of us have grown up with this kind of sense of apprehension about what to do about the mentally ill, and physicians aren't any different. They get relatively little training. For general practitioners in this area, when someone appears who has a mental illness, it's very difficult to know what to do, and to do it in a short time. If you have a broken arm, they're much more adroit at handling that.
So training and retraining will be vital aspects of system and service delivery transformation for mental health and addictions in the criminal justice system. We believe that a robust knowledge transfer and exchange program should accompany this training for it to have the most widespread and highest impact.
I know from my past work in the mental health field that the Community Living agency in Ontario, a very large agency devoted to helping people who are developmentally challenged, has a marvellous and very expensive website that people who are staff in institutions can go to and refer to documents written by other staff who write in layperson's language so that people can understand it, whether it's in the middle of the night or in the middle of the day when they're trying to find something out.
There are literally thousands of people who work in correctional services and the criminal justice system in Canada. We need to give them easier access to information that will help them do their work. The Mental Health Commission is not a traditional service agency. Its central methodology is to establish research demonstration projects, often in partnership with other agencies, in a wide variety of sectors as we search, or help others search, for better ways to structure the system and to provide service.
My personal experience with correctional services over the years has been that the system has shifted from one set of programs and beliefs to another without ever having sufficient research to know what has had the best effect. I watched it for twenty years while I was in the correctional services department in Ontario, and we went from industrial farms to treatment to educational programs. It was whatever the government of the day or the staff of the day thought might work best, but it was very poorly researched. That's been the history of correctional services in Canada.
Your committee, I think, has an opportunity to suggest that research demonstration projects become a key component of any major changes that may be instituted within the Correctional Service of Canada. For those persons faced with a serious mental illness under the responsibility of CSC, there are regional treatment centres. I'm sure you know about them, and I think you visited one of them just recently. However, we think it would be helpful to have an intermediate-level mental health facility for persons who've responded to treatment in the RTCs, one or the other of them, so that they're not shunted directly back into the regular criminal justice population of correctional services.
There needs to be some intermediate level. A coherent strategy for those affected by mental health and addictions would afford an opportunity to build on the changes begun at the regional treatment centre in an intermediate environment with more support and with access to continued but less intensive treatment. Indeed, it might be beneficial for persons with a mental illness or a serious substance abuse issue to go to that kind of intermediate facility before discharge to the community, whether they come from the regional treatment centre or whether they come from a general correctional institution. It would provide a place to get people who have a mental health or substance abuse problem or both to be readied in a better way for the outside world.
If you look at it from a public safety point of view, it might very well make them less difficult, less dangerous, and less likely to reoffend, and certainly there would be an improvement in their care.
I think that kind of intermediate-level facility would provide an excellent opportunity as well for a demonstration project with rigorous research as a component of it, so we'd recommend that kind of facility, but we really wouldn't be strongly in favour of it unless it was heavily researched to see if it really does pay off. Between 2004 and 2008 in Ontario, the mental health services saw an increase of $220 million in their budgets. This still represented a decline in the proportion of the health care dollars spent on these vital services in Ontario.
In that same period, the spending on services for those with substance abuse issues in Ontario saw very little increase at all. While mental health systems have been studied exhaustively and in spite of thoughtful recommendations, governments have usually chosen to put their health care dollar elsewhere.
:
It certainly isn't simple, and there's no uniform way to do it.
For example, yesterday I attended a meeting in Toronto, where agencies that are dealing with the Somali community, the Caribbean community, and the Tamil community are working with a different approach from just straight individual mental health or psychological care for individuals. They are trying to connect the community into it, to do it in a way that connects to the spiritual beliefs of these folks and to their community. Many of the newcomers to Canada have very strong family connections, very strong spiritual connections. They may also get into trouble with the law; they may also have a mental illness. One has to develop a program that connects all of those dots, I think.
That's what this group of staff are trying to do. It's a very interesting set of programs that's being researched. These are people who are meeting midway through a project to assess it. I was there listening attentively, as a Mental Health Commission person. There are examples of programs like this, which are going to be preventative.
I think we need to do much more with our newcomers to Canada who have come from traumatic situations. Some of the people I was in the room with yesterday have lived lives in other countries, before they came here, that I would never imagine. If we don't do something better than we're doing at the moment with many of those people, some of them are going to fall off the train. They're going to end up in the hands of the Correctional Service of Canada some time along the line and be in great difficulty, like those Hungarian folks I spoke about whom I was involved with way back in 1959. If those young men hadn't got into that positive program in that institution, they might have very well ended up in serious grief later on. Having a coherent program with many facets is something that simply has to be done, if we're going to be preventative.
The Canadian Mental Health Association and others—the Mood Disorders Association, the Schizophrenia Society—spend most of their time trying to be preventative, trying to educate the community to deal differently with the mentally ill and substance abuse population. We could all learn a lot from the kinds of programs they've had that are working—because they are working, in many cases. They're very weakly funded, for the most part. We have a habit of waiting until people sort of hit us over the head with a serious offence before we act on many of these things.
The gist of your question, I think, is that we should be intervening earlier, and we certainly should. They're doing that in schools—and not just with psychiatrists, I think; many people with less advanced training can do that kind of work in schools and intervene early. In the U.S., you would be much more likely to see a social worker and then a psychologist before you got to see a psychiatrist. In Canada, our habit has been to go in with guns blazing. If you have a psychiatric illness, we often take you to the most highly trained person first. We don't fund psychologists the same way; we don't fund social workers the same way. That's another factor.
:
Well, we certainly aren't, that's for sure. We're not turning out enough people.
I would look less at the training of people at the advanced level. Psychiatrists are getting very good training. Psychologists are getting terrific training. Social workers are getting better and better training. We need to look at the next layer down, I think. What about teachers and how diversified their training can be, or people in the schools who can help to intervene in these situations, doing the early intervention kind of stuff? It doesn't have to be a psychiatrist or even a social worker or psychologist. Lots of people can be trained at a basic level to be helpful.
The Mental Health Commission is probably going to take on a program that's been operating in Alberta called Mental Health First Aid. You may never have heard of it, but it's being widely used across the world these days. It was invented in Australia. It's a training program of a very basic sort. It's a kind of CPR for mental health, I'd say. So if you know how to help a person who's having heart difficulty and do mouth-to-mouth respiration, this is the equivalent in mental health terms.
We need to have many more people trained at that kind of simple level without any highfalutin kind of advanced training so they can refer people on and sort them out. There are all kinds of young people in high school. If you have teenagers in your house, you probably wonder some days if they aren't all mentally ill, and other days you think they're fine. It's a trauma for all of us to go through teenage years, and it's very difficult to know sometimes whether somebody's in serious difficulty or they're not. Somebody with a bit of training can begin to help sort that out for teachers and others in their school, so we need that kind of training as much as anything, I think.
We certainly need more people with advanced training. I know Correctional Services of Canada has difficulty getting enough psychologists, getting enough people who are trained in these various disciplines. Some of that has to do with whether they feel they're in an environment that can give them hope as a therapist, I guess, or as a helper. You have to change the environment of the institution to some extent to make it interesting to people, to make it attractive.
When I started in the Department of Reform Institutions in 1960 in Ontario, people at my social work school at the U of T said, “Well, there's one place not to work, and that's the Department of Reform Institutions. That's for sure.” So I was foolish enough to go there, and I stayed for 20 years. People have to be attracted into those kinds of difficult environments. Those of you who've worked in police work know the same thing. It isn't easy to be a police person. It certainly isn't easy to be a police person dealing with mentally ill people. That's for sure.
One of you asked where we are wasting our money. Those of you who are police officers will know that we're wasting a tremendous amount of money having two police officers sitting in an emergency ward of a hospital for hours and hours supervising someone who has a serious mental illness until somebody gets around to seeing them, and then they might be discharged. I see nodding heads, of course. That's a terrible waste of resources. So we need to do something about that, and we can do a better job in that kind of situation than we're doing now.
I want to welcome you, as well, and wish you a merry Christmas.
I was very interested to hear what you had to say about the waste of time and money on the policing side. I'm glad to hear someone acknowledge that, because I spent a number of years policing, much like my colleagues on this side of the House. I'll tell you that situation you described, where two police offers sit—as I was sitting—for between five and ten hours, sometimes longer, in a hospital, only to have the patient, who is clearly exhibiting some kind of mental illness, be released because the criterion that has to be met by the psychiatrist is simply whether they are a danger immediately to themselves or others--that is very disappointing. And I feel we fail these people at that point. I strongly believe that's where the prevention Mr. Kania talks about comes in. That's one aspect of prevention that needs to be inserted at that point. We will have to work strongly with the provinces to encourage them to see about perhaps alleviating some of that wasteful time and money.
I also enjoyed what you said in your dissertation at the beginning, when you talked about developing a program similar to what you have for health care professionals. I note that you've passed out some pamphlets that refer to those all-important projects and programs that the Mental Health Commission is endeavouring to offer. I would like you to explain how you suggest we mirror these in the Correctional Service.
I understand when you talk about the anti-stigma program. Your Opening Minds program is very clear in your pamphlet, so I understand education. I don't quite get how we do the research demonstration project, the one you have for the health care professionals and the one that is being financed by the Government of Canada, where we're taking homeless people and putting them into housing and studying whether or not that has a positive impact on their receiving further relations or further treatment, as opposed to the placebo group who will not be receiving housing, and they're going to watch and see how they transition into treatment. How do you suggest we do that within a correctional facility? How do we research and do a demonstration project, as you're suggesting, within a secure facility?
I'm not sure how we do that, and I'd love to hear your suggestions on how it gets done.