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.
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,
representing respective increases of 61% and 71% since 1997.
Moreover, in 2007-2008:
- 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.
According to the Correctional Investigator “federal penitentiaries in Canada
probably house the largest populations of the mentally ill in this country.”
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.
Finally, the Committee was informed that deficient diagnostic practices at
admission also play a role in underestimating the actual incidence of mental
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
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.
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. 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”.
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
Some witnesses also argued that “substance abuse disorders usually
occur after the onset of… a mental illness of some kind.”
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.” 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
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
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
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.” 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.
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.
They were more often classified as maximum security upon admission than in the
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. 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.
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 .
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.
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.
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.