1st Session, 41st Parliament,
Volume 148, Issue 139
Tuesday, February 26, 2013
The Honourable Noël A. Kinsella, Speaker
Improved Mental Health for Inmates
On the Order:
Resuming debate on the inquiry of the Honourable Senator Runciman calling the attention of the Senate to the need for improved mental health treatment for inmates, especially female inmates, in federal correctional institutions and the viability of providing such treatment through alternative service delivery options.
The Hon. the Speaker pro tempore: I note that this matter stands in the name of Senator Carignan but that Senator Jaffer will be making a presentation.
Hon. Mobina S. B. Jaffer: Honourable senators, I have asked Senator Carignan if he could let me proceed today and he has kindly agreed that I can do so.
I am pleased to add my voice to Senator Runciman’s call to improve mental health treatment for federally sentenced women. Senator Runciman’s commitment to addressing the challenges that face inmates with mental illness is long-standing, and I want to thank him for raising this issue in the Senate.
At its most fundamental level, ensuring mental health treatment for federally sentenced women is about protecting the rights of citizens, of mothers, of wives, of daughters, of human beings.
In his novel The House of the Dead, the Russian author Fyodor Dostoyevsky says:
The degree of civilization within a society can be judged by entering its prisons.
Honourable senators, that was in 1862. More than 150 years later, we are compelled to question the degree of our civilization. The case of Ashley Smith would be reason enough to ask that question, but that case is just the tip of the iceberg.
Honourable senators, in 2009, 29 per cent of federally sentenced women were identified at admission as presenting mental health problems. This proportion has more than doubled over the past decade.
Thirty-three per cent of federally sentenced women were identified, at intake, as having a past mental health diagnosis, representing a 63 per cent increase over the past decade. What is more, 48 per cent of women were identified, at intake, as having a current need for prescribed medication.
Since 2003, at intake, approximately 77 per cent of federally sentenced women report abusing both alcohol and drugs. Just under half of these women report having engaged in self-harming behaviour.
Elizabeth Bingham and Rebecca Sutton of the University of Toronto’s International Human Rights program observed the following in their 2012 report Cruel, Inhuman and Degrading? Canada’s treatment of federally-sentenced women with mental health issues. They say: “Ms. Smith’s problems were extreme but not unique.”
As the Office of the Correctional Investigator reported four and a half years ago, Ms. Smith’s death “was the result of individual failures that occurred in combination with much larger systemic issues within ill-functioning and under-resourced correctional mental health systems.”
Just weeks ago, Kinew James, a 35-year-old federally sentenced Aboriginal woman, died at the Regional Psychiatric Centre in Saskatoon. Investigations are ongoing, and the Canadian Association of Elizabeth Fry Societies and the John Howard Society have asked questions about the care that Ms. James received.
Asked to comment on the link between Ms. Smith’s and Ms. James’ cases, the Correctional Investigator, Mr. Howard Sapers, said:
I think what these situations underscore is the constant challenge that correctional service faces to be vigilant and to provide safe custody and care for some very very difficult to manage individuals.
Mr. Sapers put it more succinctly in his appearance before the Legal and Constitutional Affairs committee last year when he said: “… prisons are not hospitals, but some offenders are patients.”
Honourable senators, I want to use my time today to profile two groups of federally sentenced women — Aboriginal women and Black women — who are the most disserved by the ill- functioning and under-resourced correctional mental health systems to which Mr. Sapers refers.
Over the past 10 years, the number of federally sentenced Aboriginal women has increased by 80 per cent. Though they represent only 4 per cent of the Canadian female population, Aboriginal women make up over 32 per cent of federally sentenced women. Aboriginal women are also overrepresented among federally sentenced women with mental health issues.
Federally sentenced Aboriginal women are more likely to be single mothers, more likely to be incarcerated at a younger age, more likely to have a lower level of education, more likely to reoffend and more likely to be seen as “high risk” and consequently placed in maximum security or segregation more often and for longer periods of time.
In 2003, the Canadian Human Rights Commission reported that one Aboriginal woman had been held in segregation for 567 days. In 2006, another Aboriginal woman reportedly spent the majority of her sentence in isolation, over 1,500 days.
For Aboriginal women with mental health issues, segregation and maximum security classification are likely to exacerbate their condition and negatively impact their access to the services they require to rehabilitate.
Instead of receiving a comprehensive mental health treatment plan, too many federally sentenced Aboriginal women are placed in segregation, which shows that the current system is unable to regard federally sentenced Aboriginal women with particular mental health needs as patients who require treatment.
This reliance on segregation has been condemned by the Correctional Investigator, who stated in his 2011-12 Annual Report:
I once more recommend, in keeping with Canada’s domestic and international human rights commitments, laws and norms, an absolute prohibition on the practice of placing mentally ill offenders and those at risk of suicide or serious self-injury in prolonged segregation.
Honourable senators, Aboriginals in Canada face systemic oppression, compounded by disturbing rates of long-term mental, physical and sexual abuse, and overwhelming rates of poverty.
According to the Canadian Association of Elizabeth Fry Societies, an alarming 91 per cent of federally sentenced Aboriginal women report a history of physical or sexual violence. Due to insufficient mental health services, once they enter federal correctional institutions, prison often becomes an extension of life on the outside — where their voices are ignored.
Honourable senators, I want to share with you a story of a 25- year-old Bobby Lee Worm, an Aboriginal woman from Saskatchewan who entered a federal correctional institution in 2006.
Ms. Worm suffered from physical, emotional and sexual abuse throughout her childhood and adolescence. Many of her family members were sent to residential schools. As a result of the abuse that she endured, Ms. Worm suffers from post-traumatic stress disorder and depression. For various reasons, Ms. Worm has spent the majority of her sentence in solitary confinement — a total of over three years in segregation. Like many other federally sentenced Aboriginal women, Ms. Worm’s condition severely deteriorated in segregation, partly because she was not given access to treatment or spiritual services.
Many federally sentenced Aboriginal women are single mothers. When these women are incarcerated, their children, by extension, are punished by being separated from their mother. Many of them are placed in foster care or juvenile detention centres or are shuffled between family members. Some will never return to their mother’s care once she is released.
One woman stated:
… the biggest problem of being a mother in prison is that I can’t care for my children. You can write to them and maybe talk to them on the phone. But you can’t make decisions for them; you are stripped of it. You are not a mother in prison.
Federally sentenced Aboriginal women with children are further penalized when this separation causes anxiety and depression and they have only limited access to the health care they need and rightfully deserve.
Serving a sentence does not mean that you are a bad mother. The Canadian Association of Elizabeth Fry Societies argues that such discriminatory and punitive stereotypes impact the ability of women to maintain relationships with their children while they are in prison, and make it increasingly difficult to reclaim custody from child welfare services after release.
The CSC created a Mother-Child Program so that children have the opportunity to reside with their mother in a federal correctional institution. However, federally sentenced Aboriginal women are not served by this program.
First, those convicted of serious crimes, which included many Aboriginal women with mental health needs, cannot be considered for the program.
Second, as of 2008, considerable documentation is required from Child and Family Services in order to participate in the program.
Third, participation in the program is predicated on the consideration of the “best interests of the child,” a criterion often abused to restrict access as a form of punishment.
Finally, federally sentenced Aboriginal women are often in federal correctional institutions far from their homes, without the financial means to transport their child to their location, so they cannot participate.
According to a 2011 report, there are no Aboriginal women participating in this program. We continue to treat federally sentenced Aboriginal women simply as criminals, unworthy of compassion or respect, rather than individuals with their own human rights, victims of a system designed to see them fail.
When designing mental health services, we need to ensure that programs and services are created in collaboration with Aboriginal communities, and that they are tailored to specifically address the mental health needs of Aboriginal women. Healing lodges, such as the Okimaw Ohci Healing Lodge for women, have been successful in offering services and programs that view healing holistically. Healing plans include institutional services, skills development, treatment and cultural programs, and incorporate balance, individual autonomy, non- coercion, collectivism, interconnectedness and healing.
Unfortunately, almost 50 per cent of Aboriginal federally sentenced women are precluded from accessing healing lodges because they are classified as maximum security. However, due to the success of healing lodges in lowering the recidivism rate, many are urging the CSC to expand their availability to federally sentenced Aboriginal women, especially those with mental health issues, who are too often over-classified as maximum security.
While access to healing lodges should be increased, it is also important to expand services in prison. Each facility should provide access to Aboriginal staff, culturally sensitive training for all staff members, culturally relevant programs, access to Aboriginal forms of healing and access to Aboriginal elders. We have a duty, a moral and legal obligation, to ensure that women like Bobby Lee Worm are no longer invisible.
According to the University of Toronto’s International Human Rights Program, women’s disadvantage in the federal correctional system arises from their low numbers and a failure to recognize their particular security needs. This creates issues in a variety of areas, including segregation, security classification, the appropriate response to security incidents, and cross-gender staffing.
This disadvantage is especially true for federally sentenced Black women. Black Canadian women comprise 2.6 per cent of the female population. However, they make up 10 per cent of the federally sentenced female population within Canada. In fact, over the last ten years, the number of federally sentenced Black Canadians has risen by 50 per cent.
A 1994 report from the Commission on Systemic Racism in the Ontario Criminal Justice System found that federally sentenced Black Canadians reported racial inequality in the delivery of and access to services.
Additionally, inmates reported racial stereotyping by correctional officers that impeded the use of facilities they had requested.
Honourable senators, I want to share with you a story from the Canadian Association of Elizabeth Fry Societies that demonstrates the damage that racial and gender stereotyping can inflict on federally sentenced Black women.
Jane is a federally sentenced Black woman who is in a relationship with another woman in her prison unit. After being made aware of the relationship, a staff member believes that Jane is recruiting young women as a pimp. Jane has filed a grievance but is warned by other staff that such behaviour may make her liable to a transfer to a maximum-security prison. In this case, racial stereotypes prevail that lead to the possibility of a maximum-security transfer.
In the United Kingdom, the Office of National Statistics assesses mental health needs of incarcerated men and women of Afro-Caribbean descent. Studies in the U.K. have shown that Black female prisoners are more likely to require mental health care facilities than other women. Accordingly, there has been a push toward better mental health services for this significant population in British prisons.
In Canada, we also need to recognize that visible minority women may have specific needs and may therefore require specific services, because, to be absolutely clear, honourable senators, the public interest is not served when the mental health needs of federally sentenced women are ignored.
In the U.K., the National Association for the Care and Resettlement of Offenders, NACRO, published a report in 2007 that highlights a revolutionary form of alternative mental health care that serves the Afro-Caribbean population. This alternative service diverts Afro-Caribbeans with mental health issues from psychiatric hospitals to community settings as a first point of contact at the advent of their mental health assessment. NACRO reports that this initiative led to a significant decrease in the number of Afro-Caribbeans admitted to psychiatric hospitals.
By engaging with Black and Aboriginal communities…
The Hon. the Speaker pro tempore: Senator Jaffer’s time has expired.
Senator Jaffer: Honourable senators, could I have an additional five minutes?
The Hon. the Speaker pro tempore: Do honourable senators agree to a five-minute extension?
Hon. Senators: Agreed.
Senator Jaffer: Thank you, honourable senators.
By engaging with Black and Aboriginal communities, correctional services and mental health providers can ensure they are delivering appropriate services that are both culturally and racially sensitive.
These services could provide avenues, such as support groups, that will connect federally sentenced Black women and empower them to advocate for better access to mental health care facilities.
Honourable senators, I want to share with you an experience I had at the Vancouver General Hospital a few weeks ago. I was there, caring for a sick relative, for almost ten hours. While waiting, I observed a police officer bring a handcuffed woman into the emergency ward. She was very quiet and it was obvious that she was confused. After a while, a triage nurse came and spoke to her and suggested that her handcuffs would be removed if she agreed that she would not run away. She agreed, her handcuffs were removed and the police officer left the woman sitting at the entrance.
While this was going on, three police officers arrived with a very upset man who was bleeding. Whether he had hurt himself or had been in a fight, I did not know. He was very agitated, and the police officers were doing everything they could to calm him.
In the meantime, out in the open for all to hear, a psychiatrist questioned the young lady, who stated the reason for her anxiety. She was given some medicine and discharged.
Throughout the time I was there, I saw many police officers come and leave patients behind. When the police left, if there was any untoward behaviour, four muscular security men would descend on the patient and either remove her or surround her, shouting commands until she toed the line.
As the evening progressed, and as I tried to support a very sick relative who had suffered a stroke, I would suddenly hear a commotion, followed by these four muscular security men descending on a patient. In my mind’s eye, I visualized them with batons, though they did not have any, marching in unison toward the patient. When I was leaving the hospital, I saw a young woman being picked up by the security men, almost like a chicken, and being taken somewhere.
I was just an observer at the emergency ward. I had no special insight into the other patients’ medical needs. Nonetheless, it seemed clear to me that an awful number of people who visited the emergency ward that evening suffered from a form of mental illness.
To be clear, the nurses, police officers and security personnel were doing the best they could in a difficult situation; but we are faced with the failure of a system ill-equipped and poorly designed to meet the needs of inmates with mental illness and, indeed, the needs of all Canadians with mental illness.
I know very little about mental health issues, but I can stand here and say that now I am convinced that we have to find ways to heal or help patients who are very obviously in desperate need of expert medical attention.
Honourable senators, I encourage all of us together to convert this inquiry into a study on how to treat people with mental illness, especially federally sentenced women.
More immediately, honourable senators, I will be proposing legislation within weeks in this chamber, a natural next step from the conversation that Senator Runciman has begun, namely, how can we ensure that federally sentenced women receive the mental health treatment they require?
As parliamentarians, we have a duty to work together to find solutions to provide treatment and care with dignity. This is not to question our compassion, our generosity or our righteousness. Rather, as Dostoyevsky put it only a few years before our country was born, it is to question our civilization, for the degree of our civilization is judged by our prisons.
(On motion of Senator Carignan, debated adjourned.)