This chapter provides an overview of the incidence of mental disorders and addiction problems within the federal inmate population. It also discusses the challenges facing CSC in the management of an offender population with complex and diversified characteristics.

4.1      THE IMPACT OF MENTAL DISORDERS AND ADDICTIONS WITHIN THE FEDERAL INMATE POPULATION

Appearing before the Committee, CSC Commissioner Don Head stated that slightly more than one in ten male offenders (12%) and one in five female offenders (21%) had serious mental health problems when admitted to detention,[25] representing respective increases of 61% and 71% since 1997.

Moreover, in 2007-2008:[26]

• 21.8% of female offenders and 10.4% of male offenders had a “mental health indicator at time of admission”;
• 30.1% of female offenders and 14.5% of male offenders had had “past psychiatric hospitalization”;
• 33.2% of female offenders and 20.6% of male offenders admitted having had psychiatric medication prescribed, a percentage which had almost doubled since 1998-1999; and,
• 8.7% of female offenders and 5.9% of male offenders were psychiatric outpatients when admitted to detention.

According to information received by the Committee, mental disorders are up to three times as common among federal inmates as in the Canadian population at large.[27] According to the Correctional Investigator “federal penitentiaries in Canada probably house the largest populations of the mentally ill in this country.”[28]

While these data are alarming, witnesses pointed out that they in fact considerably underestimate the actual incidence of mental disorders in the federal correctional system. This is because it was only recently that CSC set up a system for tracking mental illness upon admission, and also because mild or moderate mental health problems are often difficult to detect.[29] Finally, the Committee was informed that deficient diagnostic practices at admission also play a role in underestimating the actual incidence of mental health disorders.

According to the definition of mental illness used by the authors, James Livingston, researcher and author of the report Mental Health and Substance Use Services in Correctional Settings: A Review of Minimum Standards and Best Practices, notes that the incidence reported in the documentation varies from 10% to 80%.

Throughout the Committee’s study, various explanations were advanced to account for the high prevalence of mental disorders in Canada’s correctional system. They included the de-institutionalization of psychiatric patients, cuts in social services, the growing involvement of the justice system in social relations, the introduction of zero-tolerance policies with respect to drugs, and restrictions on committal practices.

A number of witnesses, including some in Norway and England, supported the theory of the de-institutionalization of psychiatric patients. The goal of this de-institutionalization movement, which followed developments in psychopharmacology, was to humanize mental health treatment by abandoning asylums as care facilities and limiting the number and duration of hospitalizations. It seems the expected results were not achieved, because the expansion in treatment services and community support fell short of what was needed to support such a movement.

Although all of our witnesses agreed that the de-institutionalization trend had an obvious impact on the Canadian correctional system, some emphasized that it cannot be the only explanation for the substantial increase in the number of federal offenders with mental disorders. Appearing before the Committee, the Correctional Investigator stated:

In fact, I think you can track some of the growth in the mentally ill being in federal corrections because of other policy changes elsewhere. But it’s not just the de-institutionalization; there are policies around zero tolerance, and engaging the police in situations today that perhaps the police wouldn’t have been engaged in a decade or more ago, and using the courts in some ways today that perhaps weren’t being used a decade or more ago.[30]

Throughout the study, many witnesses also told the Committee that the federal correctional system also house a large number of offenders addicted to drugs or alcohol. Data indicates that about four out of every five offenders admitted to CSC correctional institutions have serious drug or alcohol abuse problems. Half of these offenders reportedly committed a crime under the influence of drugs, alcohol or other intoxicants.[31] Regarding the Nova Institution for Women in Dorchester, Adèle McInnis, Warden, told the Committee that about 90% of the inmates have needs varying from moderate to high with respect to drugs, alcohol or both.

A number of witnesses heard from in Canada, Norway and England pointed out that many inmates who suffer from substance abuse also suffer from mental disorders; the expression they used was “concurrent disorders”.[32]

In some cases, mental disorders are the result of the use of mood-altering drugs, while in other cases drug use conceals mental health disorders. This is true, for example, of those who abuse substances to cope with their anxiety or depression. As we propose in Chapter 5, in order to treat these offenders effectively, correctional administrations must use integrated treatment models: the concurrent treatment of substance abuse and the mental disorder.[33]

Some witnesses also argued that “substance abuse disorders usually occur after the onset of… a mental illness of some kind.”[34] According to the Executive Director of the John Howard Society of Canada, Craig Jones: “… if we filter the [CSC] commissioner’s understanding [that about 80% of federal offenders have substance abuse problems, either alcohol and/or drugs when admitted] through what we know about the co-occurrence of substance abuse and mental health we can say reasonably that roughly 80% of the current prison population suffers from a concurrent disorder.”[35] This statement was, however, challenged by other witnesses who pointed out that not all offenders with drug or alcohol problems are necessarily addicts. Moreover, not all drug addicts necessarily suffer from mental health problems[36] just as not all persons affected by mental illness are necessarily addicts. The Committee was unable to come to a conclusion on this issue since the CSC officials met during the study did not provide any data regarding the incidence of mental health problems concomitant with addictions in the federal prison population.

4.2       THE VULNERABILITY OF INMATES WITH MENTAL HEALTH AND ADDICTION PROBLEMS

Offenders with mental health problems are highly vulnerable within the inmate population. During our inquiry, all the offenders with mental disorders that the Committee spoke to said they did not feel safe in traditional correctional institutions. They also noted that they were frequently the victims of intimidation and violence by the other inmates.

In addition, statistics compiled by correctional administrations on suicides and self-injury incidents show that offenders with mental health disorders are more likely than other offenders to attempt suicide, or injure themselves.

The Committee recognizes that offenders with mental disorders generally have difficulty adapting to the correctional environment. “[They] do not always comprehend… the rules of institutional life,and do not always conform or adjust properly to them.”[37] Adjustment difficulties are exacerbated by the fact that irrational and compulsive behaviours associated with mental disorders are often interpreted as acts of violence, rather than mental health disorders, and lead to responsive actions based on notions of security rather than treatment.^[38]

4.3       THE CHALLENGE CORRECTIONAL SERVICE CANADA FACES IN MANAGING SUCH A POPULATION

Managing such an inmate population presents a substantial challenge for CSC, which has to ensure inmate security and provide care and programs designed to respond effectively to their needs. The challenge is complicated by the fact that in recent years, the federal correctional system has been coping with a change in the profile of the inmate population. Federal inmates have reportedly become more violent, and more aggressive. When our study was conducted, CSC estimated that about 60% of inmates had a history of violence.[39] They were more often classified as maximum security upon admission than in the past.[40] A greater number of inmates were also affiliated to gangs and other criminal organizations. As noted in the CSC Review Panel report, the CSC estimates that about one in six male offenders and one in ten female offenders currently have an affiliation to gang or organized crime.[41] These factors are in addition to the substantial increase in the number of offenders affected by mental health disorders and serious drug or alcohol abuse problems when admitted to CSC facilities.

In order to understand the challenges faced by CSC, we also have to consider the fact that in general, inmates are in poorer health than the population as a whole.[42] The prison population is characterized in particular by a high prevalence of infectious diseases, such as HIV and hepatitis C. Estimates are that federal inmates are 7 to 10 times more likely than the rest of the population to be HIV positive, and close to 30 times more likely to have contracted hepatitis C [43]. Moreover, as a group, they are generally disadvantaged in terms of employment, housing, income and social relations.

The growing seriousness of inmates’ mental health problems presents substantial challenges for CSC, which admits to being fully aware of the problem. It openly acknowledges the harmful consequences of the inadequacy of mental health services provided in its correctional facilities. Indeed, it states in its 2008-2009 Report on Plans and Priorities:

Inmates with untreated mental health disorders cannot fully engage in their correctional plans. They may compromise the safety of other inmates and front-line staff, and may become unstable within the community upon release, particularly where service providers may not perceive offenders as one of their client groups.[44]

For CSC, the difficulty of managing a population that needs more care and services is compounded by a number of factors. Among these are the aging infrastructure of a number of its correctional facilities, inadequate funding, difficulties in recruiting and retaining mental health professionals, and conflicting priorities in a correctional system designed to both assist and control offenders. The Correctional Investigator told us:

There are many reasons that progress is slow and hampered. A lot of it has to do with the timing of that money. A lot of it has to do with the recruitment and retention of health care professionals. A lot of it has to do with competing priorities within a prison system. Part of it has to do with that tension I talked about, when I said we’re talking about a prison system and not a health system.

It would be very easy to say that the Correctional Service simply failed or mismanaged that file, but that would be easy, and it would be incorrect. The Correctional Service is very alive to this challenge. I know you’re going to be meeting with the commissioner of corrections, and I would encourage you to ask him that question.

I’ll tell you it’s not due to a lack of good intentions, and there are some structural and operational reasons, but I’ll also tell you it’s a lack of a sense of urgency, immediacy, and priority.[45]

The Committee urges the federal government to acknowledge the critical nature of this problem by contributing to research and the implementation of innovative and effective solutions for mental health and addictions and by substantially increasing CSC’s budget for the management of an inmate population confronted by these problems. In order to reduce the burden on federal, provincial and territorial correctional facilities in the longer term, governments should, in the Committee’s opinion, invest more in mental health disorder prevention and diversion initiatives. The next chapter of this report contains more specific observations and recommendations concerning mental health and addiction services provided in the community and within the federal correctional system.

---