Access to Physical and Mental Health Care

On a consistent basis, delivery and access to health care services remains the number one area of offender complaint to the Office. Federal offenders are excluded from the Canada Health Act and are not covered by Health Canada or provincial health care systems. With an annual expenditure now exceeding $200M, the Correctional Service provides essential physical and mental health services directly to offenders inside federal penitentiaries. Under the Corrections and Conditional Release Act, the Service must ensure reasonable access to health care in conformity with professionally accepted standards of practice. The Service is further obligated to consider an offender's state of health and health care needs in decisions prior to penitentiary placement, transfer, segregation, discipline and community release and supervision.

Issues of Concern

The federal correctional system faces serious capacity, accessibility, quality of care and health service delivery challenges and constraints:

• Bed space at the five regional treatment centres (psychiatric hospitals)
• Aging and inappropriate infrastructure
• Lack of "intermediate" mental health care units
• Management of self-injurious offenders
• Recruitment and retention of mental health care professionals
• Sharing of information between health care and front-line staff.
• Meeting the needs of aging inmates
• Operational dilemmas - prison vs. hospital, inmate vs. patient, security vs. treatment
• Infectious diseases, drugs in prison and harm reduction
• Informed consent and involuntary treatment

Reports & Recommendations

• Annual Report 2014-2015 (HTML) (PDF, 2mb)
  • Heath Care in Federal Institutions
• Annual Report 2013-2014 (HTML) (PDF, 5mb)
  • Access to Health Care
• Annual Report 2012-2013 (HTML) (PDF, 744kb)
  • Access to Health Care
• Risky Business: An Investigation of the Treatment and Management of Chronic Self-Injury Among Federally Sentenced Women
  Final Report (HTML) (PDF, 353kb)
  
  • News Release (HTML)
  • Backgrounder (HTML)
• Annual Report 2011-2012 (HTML) (PDF, 1.4mb)
  • Access to Physical and Mental Health Care - OCI Recommendations & CSC Responses
• Annual Report 2010-2011 (HTML) (PDF, 2.1mb)
  • Access to Mental Health Services - OCI Recommendations & CSC Responses
  • Physical Health Care - Special Focus on Elderly Offenders - OCI Recommendations & CSC Responses
• Annual Report 2009-2010 (HTML) (PDF, 2mb)
  • Access to Physical and Mental Health Care - OCI Recommendations & CSC Responses
• Annual Report 2008-2009 (HTML) (PDF, 2mb)
  • Mental Health - OCI Recommendations & CSC Responses
  • Addressing Incidents of Self-harm - OCI Recommendations & CSC Responses
  • Health Services Review - OCI Recommendations & CSC Responses
• Under Warrant: A Review of the Implementation of the Correctional Service of Canada's Mental Health Strategy (September 23, 2010) (HTML) (PDF, 529kb)
  
  

Speeches and Remarks

• Health Care and Federal Corrections: An Ombudsman’s Perspective 2013-10-03 (HTML)
  
  
• Speaking Notes for Correctional Investigator - A Legacy of Missed Opportunities: The Case of Ashley Smith, Health Law Institute Open Seminar Series, University of Alberta (November 2011) (HTML)
  
  
• Speaking Notes for Correctional Investigator - Appearance before the Standing Committee on Public Safety and National Security (June 2009) (HTML)
  
  
• Speaking Notes for Correctional Investigator - Appearance before the Special Senate Committee on Aging (February 2008) (HTML)
  
  

Presentations

• Mental Health in Federal Corrections - CASHRA Annual Conference 2012 (June 2012) (HTML) (PDF, 767kb)
  
  
• Mental Health and Corrections: Saint Francis Xavier University Department of Psychology Colloquium Series (March 2011) (HTML) (PDF, 682kb)
  
  

In the Media

• Ashley Smith inquest: What should we do with other self-harming inmates?, The Star (December 19, 2013)
  
  
• Get severely mentally-ill out of prison, into secure hospitals: prison watchdog, Global News (August 8, 2013)
  
  
• Ashley Smith inquest: Did difficult inmate belong in a jail or a psychiatric facility?, The Star (March 24, 2013)
  
  
• Prison watchdog: Some lessons 'ignored' since Ashley Smith death, CTV News (November 4, 2012)
  
  
• Action needed on self-injury, segregation among inmates with mental illness in prisons, The Hill Times (October 29, 2012)
  
  
• Suicide attempts, self-harm rising in Canada's prisons, CBC News (October 23, 2012)
  
  
• Mental health problems treated as security issue in federal prisons, report says, The Star (October 23, 2012)
  
  
• Number of prisoners who self-harm almost tripled over past five years: report, The Canadian Press (October 23, 2012)
  
  
• UN urges Canada to ban solitary confinement for mentally ill prisoners, The Star (June 2, 2012)
  
  
• Where is the plan to replace disappearing treatment for mentally ill prisoners?, The Star (April 27, 2012)
  
  
• Les cas d'automutilation augmentent dans les prisons, La Press (March 5, 2012)
  
  
• Vieillir en prison : les établissements sont mal adaptés (in French), Radio Canada (March 1, 2012)
  
  
• Le C-10 ne fera rien pour traiter les graves pénuries de soins de santé mentale dans nos prisons (in French), Canadian Drug Policy Coalition (February 23, 2012)
  
  
• Rapport du Bureau de l'enquêteur correctionnel - Les pénitenciers sont mal adaptés aux détenus vieillissants (in French), Le Devoir (November 2, 2011)
  
  
• Aging prison population facing new challenges: federal ombudsman report, The Canadian Press (November 1, 2011)
  
  
• Where death is only escape, National Post (July 16, 2011)
  
  
• 'Prison isn't a hospital,' investigator says, The Telegram, (July 09, 2011)
  
  
• Mental health and justice officials collaborate at national symposium, (May 25, 2011)
  
  
• Il y a trop de criminels avec des maladies mentales dans les prison, dit Toews (in French), La Presse Canadienne (May 25, 2011)
  
  
• Older prisoners pose new challenges for Canada's prisons, UBC Journalism News Services THETHUNDERBIRD.CA (posted March 31, 2011)
  
  
• Report finds Serious Gaps in the Planning and Delivery of Mental Health Services for Federally Sentenced Offenders, OCI (September 23, 2010)
  
  
• Prisons given funding, but no clear plan, The Star, (September 22, 2010)
  
  
• Pan-Canadian strategy being developed to tackle mental health in prisons, CMAJ (December 14, 2010)
  
  
• End long isolation of mentally ill inmates: watchdog, CTV News (September 8, 2010)
  
  
• No more Ashley Smiths, Globe and Mail (September 8, 2010)
  
  
• The wrong fix: We put the mentally ill in jail. Now they're ending up in solitary, Maclean's (January 21, 2010)
  
  
• Correctional Investigator of Canada Welcomes Call for National Strategy on Delivery of Mental Health Services to Youth and Adult Offenders, OCI (June 9, 2008)

Additional Information and Resources

• Mental Health and Drug and Alcohol Addiction in the Federal Correctional System, (December 2010)
  
  
• Planning Services for Elderly Inmates with Mental Illness (PDF, 373kb), Corrections Today (June 2010)
  
  
• A Comparative Review of Suicide and Self-Injury Investigative Reports in a Canadian Federal Correctional Population, Correctional Service of Canada (May 2010)
  
  
• Criminal Justice Standards on Treatment of Prisoners, (February 2010)
  
  
• A Sourcebook on Solitary Confinement, Mannheim Centre for Criminology, London (2008)
  
  
• Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada, Report of the Standing Senate Committee on Social Affairs, Science and Technology (May 2006)