Federal Prison Staff Mishandling Mentally Ill Women Inmates: Ombudsman

Howard Sapers, federal corrections ombudsman, makes 16 recommendations on how to change the way the system treats troubled women offenders.

Correctional Service watchdog Howard Sapers reports ongoing concerns about the capacity of Correctional Service of Canada to manage mental illness.
By: Tonda MacCharles Ottawa Bureau reporter, Published on Mon Sep 30 2013

OTTAWA—Six years after the death of Ashley Smith, an investigation by the federal prisons watchdog says guards and managers are still taking a dangerously wrong approach to troubled women offenders.

The damning report is the result of an investigation by the office of Howard Sapers, the federal corrections ombudsman.

Entitled Risky Business, it says the prison system still deals with women offenders who harm themselves with an onslaught of security measures focused on controlling and punishing them, which escalates tensions and leads to greater harm.

Prison guards continue to use pepper spray, segregation, physical restraints, disciplinary and sometimes criminal charges and institutional transfers to control the most chronic and complex offenders who have untreated mental health issues, says Sapers.

The report by the Office of the Correctional Investigator was released Monday even as a coroner’s inquest into 19-year-old Ashley Smith’s death in 2007 is still in the midst of hearing testimony from key witnesses.

Yet Sapers has independently reached worrisome conclusions about the fate of other women like her in the federal system.

“The investigation raises ongoing concerns and questions about the capacity of the Correctional Service of Canada to safely and appropriately manage the most acute cases of mental illness and chronic self-injury,” said Sapers in a release.

Over the last five years the number of self-injury incidents in federal correctional facilities has more than tripled, with a disproportionate number of those committed by a small number of women within the penitentiary system. And within that group aboriginal women are a particular concern — making up nearly half the inmates who may bite, cut or suffocate themselves.

Sapers says he doesn’t question the “integrity, commitment or professionalism” of federal efforts, but he says there are a “handful of mentally disordered women offenders whose “symptoms, behaviours or severity of illness” are beyond the capacity of CSC to manage.

The report released Monday made a number of findings:

“A federal penitentiary is not the place for treating complex cases of chronic self-injury and/or acute mental illness; transfers to external treatment centres that are better equipped in terms of clinical staff, treatment interventions and facilities need to be more purposefully pursued as a matter of priority.”

Sapers says women likely to hurt themselves “are hesitant to disclose thoughts of self-harm for fear of punishment or placement in segregation.”

Resorting to punitive or restraint measures tends to make matters worse, he said; it exacerbates the frequency and severity of self-injury and may escalate the situation, with the inmate resisting or becoming combative.

And other approaches now in use are no better, the report says. Prolonged clinical seclusion, isolation, observation, or segregation of chronic self-injurious offenders “is counterproductive to therapeutic treatment aims and potentially unsafe.”

Even today, says Sapers, there is a lack of cohesion and collaboration between mental health and security staff in responding to prison self-injury, with security measures trumping clinical intervention “regardless of the individual risk.”

He condemns the assumption that a mentally ill offender consents to or has agreed to comply with the use restraint gear to subdue them, saying there is no real “informed and voluntary consent” to such measures in a prison environment.

Sapers finds significant gaps in the availability of treatment options; a lack of “culturally safe” or appropriate responses to aboriginal women; and little evidence to suggest that staff are even aware that the Supreme Court of Canada requires the system to weigh and accommodate the unique situation of aboriginal offenders.

He says security staff “generally overlook . . . factors such as prior mental health considerations” in cases of self-injury.

He says on the one hand, managers and prison staff take an approach that purports to focus on “preservation of life” in the management of the most difficult cases, “regardless of actual risk.” In some extreme and rare cases, says Sapers, “CSC efforts are reduced to simply keeping an offender alive. This is not therapeutic or good correctional practice.”

On the other hand, he suggests, prison staff fail to comply with policy directives that already exist on the use of clinical measures to manage self-injurious and suicidal behaviour.

He makes 16 recommendations.

Key among them is one that Sapers has long advocated: that the most chronic and complex cases of offenders who harm themselves be “treated and managed first and foremost as a mental health concern, not a security, compliance, behavioural or control issue.”

He says prison staff should transfer the most chronic and complex cases of self-injury to external provincial health care facilities.

There should be clinical management and treatment plans in place for those offenders while in prison; the use of restraint equipment should be limited, and where used, it should be subject to the same kinds of reporting and accountability procedures applied when guards use other force measures — such as using pepper spray or drawing weapons.

“Under no circumstances should a non-consenting” offender who is strapped in be “subject to forced medical injections,” says Sapers. Restraint equipment should not be used on a self-harming offender “for punitive, administrative or retaliatory purposes.”

“Human dignity should be maintained at all times during the period in which a self-injurious offender is physically restrained. Clothing should never be forcibly removed nor should an inmate ever be permitted to be naked while in” bodily restraints known as a Pinel Restraint System, said Sapers. (Corrections Canada calls it a medical restraining device — a system of seven restraining belts or straps that attach to a bed, chair, or stretcher that can decrease one’s range of movement by tying a person at the waist, pelvis and arms.)

Sapers says health care staff should be involved whenever a self-injurious offender is put in a seclusion, observation or segregation cell, and there should be an absolute ban on isolating the offender “long-term.”

Further, Sapers says, the federal correctional system should be prohibited from constructing or using padded cells in its regional treatment centres.

The first was recently built at the Regional Psychiatric Centre in Saskatoon that serves the Prairie region.

Reproduced from http://www.thestar.com/news/canada/2013/09/30/federal_prison_staff_mishandling_mentally_ill_women_inmates_ombudsman.html