Front line justice workers focus on the mentally ill

Increasing incarceration of people with mental issues is cruel and unusual punishment – NUPGE.

By Mike Martin

Download NUPGE submission to the Mental Health Commission of CanadaOttawa (8 Oct. 2009) - A Canadian union whose members work at the front lines of the justice system is leading the way in public discussion of the growth of mental health issues in Canada's criminal justice system. This growth is reaching crisis proportions with threatening implications for the entire community.

According to James Clancy, president of the National Union of Public and General Employees (NUPGE), this problem has been ignored or overlooked for too long, so his union held a conference in September as a follow up to a submission it made to the Mental Health Commission of Canada in May 2008.

"We want to be forward looking and try to find solutions to this issue," said Clancy. "There is a growing recognition that how we are treating people with mental issues in this country amounts to cruel and unusual punishment when we find them in jail or prisons. They should be receiving care and treatment in a hospital or mental care institution."

These sentiments were echoed throughout the day as presenters outlined the increased challenges that people with mental illnesses face within the criminal justice system. Two of these presentations, from Howard Sapers, the Correctional Investigator of Canada, and from Fiona Wilson-Bates, a detective with the Vancouver Police Department, highlighted not only the need for change but also the fact that this problem is not getting any better; it's actually getting progressively worse.

Unique role

Sapers is in a unique role to observe the situation and to document the growth in problems within the federal jurisdiction when it comes to dealing with people with mental health issues who enter Canada's prison system. His job as the correctional investigator requires him to review all prisoner complaints in federal institutions and to make recommendations to resolve them. What concerns Sapers is what should concern us all.

"Health related complaints are the number one area of prisoner complaints, and more and more of these complaints relate to mental health issues," Sapers told the symposium. "There are a rising number of mentally ill people in federal prisons, including up to 30 percent of all women inmates. And how we are dealing with them may be making their health condition worse."

He talked about the tension between trying to ensure a secure environment at the same time as providing treatment for the mentally ill within institutions. While the prisons were doing a better job than in the past, security concerns seemed to trump treatment on a fairly regular basis. In many cases, prisoners with mental health issues were being placed in Special Handling Units, for their own safety and the safety of other inmates and staff, but this practice was likely only making matters worse.

"If you were to design the worst possible location to place a person with a mental illness," Sapers noted, "it would probably be the Special Handling Unit."

Change too slow

The Correctional Investigator for Canada and others have long been pressing for major reforms of how inmates with mental illness are being treated in federal institutions. But change has been slow in coming. There have been new allocations of resources for training correctional staff and there is a mental health strategy in place for Corrections Canada that will provide much needed resources over time to deal with issue. But if you listen closely to Sapers you get the feeling that this might be too little, too late. Of the six priorities of Corrections Canada's mental health strategy, the first to be implemented was not assessment and treatment as one might think, but discharge planning.

Sapers is a strong advocate for both prisoners within the federal correctional system, and the need to rethink our policies and programs for dealing with mental health issues. In his view, "it is not the role of jails or prisons to be mental health facilities. Warehousing the mentally ill is just wrong."

He noted the Supreme Court decision said that a "citizen lawbreaker" still retained his or her rights as a citizen first, and that prevention and treatment of the mentally ill was the only way forward.

Pointed critique

The perspective presented by Detective Fiona Wilson-Bates of the Vancouver Police Department was much more from the pointy end of the stick on the debate concerning how to deal with the mentally ill who come into contact with the justice system. In 2008 she released a report called Lost in Transition: How a lack of capacity in the Mental Health System is Failing Vancouver's Mentally Ill and Draining Police Resources.

This report tracked the interaction of Vancouver Police Officers with people who were visibly suffering from a mental illness during a 16 day period in 2007. Of the 1,154 calls for service that were recorded, 31 percent involved at least one mentally ill person and in higher crime areas like the Downtown Eastside in Vancouver, the numbers were over 50 percent of all calls for intervention by the police.

According to Detective Wilson-Bates, her research clearly showed that "police officers in Vancouver were becoming front-line mental health workers." Not by choice, but simply because no other part of the system had the capacity or seeming interest to take on the problem.

Excessive interaction

Her research also revealed a myriad of reasons why there was an excessive police interaction with the mentally ill. These included a mental health system that had not been adequately resourced to deal with the de-institution of mental health facilities in British Columbia; a lack of information sharing between community mental health resources; and "an unwillingness on the part of service providers to fully utilize the current mental health legislative provisions due to a lack of available resources and/or personal ideology."

She also noted that people who need community resources the most were probably the least likely to receive them. In the Downtown Eastside, for example, people who lack resources for adequate housing were being preyed upon by drug dealers, pimps, and predatory landlords who often took advantage of their vulnerabilities. This often led to increased victimization and a need to participate in petty crime such as prostitution or low level drug-dealing, which brought them back into contact with the police. When this arises the police do what they can, but often these people end up in jail because no hospital or clinic wants to deal with them.

"Without question we criminalize the mentally ill," said Detective Wilson-Bates. "The police perceive that their only option is to take them to jail."

One of the other interesting aspects to Detective Wilson-Bates' report is that it highlights the cost to society and taxpayers of having police deal with the mentally ill. A conservative estimate of this cost in Vancouver is about 90 full-time officers, at an annual cost of $90 million dollars a year.

Forcing the issue

Maybe this is why the issue has been forced onto the public agenda, at least in British Columbia. It isn't just a police issue or a mental health issue. It has now become a taxpayer issue. In the long term that may just be enough to start the tide moving in another direction, towards prevention and treatment from justice and jails.

In the short term, however, the picture is still pretty grim. Participants at the symposium from all over the country told similarly chilling tales about the situation in their provinces and institutions: no training in dealing with the mentally ill for front line workers; inmates, even young people, being locked in segregation for long periods of time; facilities built in the 1800s trying to deal with issues in this millennium; and seemingly no concern or attention being paid to this issue by politicians or policy makers.

One correctional worker from Saskatchewan asked an important question: "Isn't it sad that a union has to be the one that is fighting to get more resources to deal with the mentally ill, to help get them treatment so that they can stay out of jail, to get training so that we can treat them better if they do come into an institution?"

Maybe so, but at least in the case of mental health and the justice system, it's really important that NUPGE has taken this issue on.

Mike Martin is a freelance writer and consultant specializing in workplace wellness. This report was originally posted on the Public Values website.

More information:
• The mental health crisis in Canada's justice system
NUPGE submission: No health without mental health - pdf