Transcript Slide 1

Breaking Down Barriers
for better success in changing times
Community in Concert: We CAN Work it Out
Elizabeth White
October 28, 2011
Canadian Criminal Justice Association Congress
Quebec City, Quebec
1





Background
Shelter and Access
Towards an Integrated Network
Community Connections
CAROW initiative
◦ Ontario Projects
What’s New
What’s Next
2
“Violence and mental disorder is a small part of the overall
picture of interpersonal violence but one where there is a
significant possibility of reducing the levels of violence
by improved risk assessment and treatment
intervention.”
Bradford, JM
Canadian Journal of Psychiatry
Vol. 53 No. 10 October, 2008. Canada
3
St. Leonard’s Society of Canada is a membership based, charitable
organization founded in 1967.
Our mission is to provide a humane and informed justice policy and
responsible leadership to foster safe communities.
SLSC addresses the needs of the community and its members by promoting
socially responsible conduct throughout the justice system in an effective and
ethical manner.

Endorse evidence based approaches to criminal and social justice

Conduct research and develop policy

Support its member affiliates

Advance collaborative relationships and communication among individuals
and organizations dedicated to social justice
4



Deinstitutionalization intended to reduce in-patient
service in favour of community-based outpatient
services
Essential redistribution of funds did not happen
Community-based programs overburdened and
under-trained
5



Stigma and Discrimination
Inadequate community
health services
Inadequate training for
service providers

Inadequate Funding

Eligibility criteria
6






Ontario: Since 2004, the total number of mentally
disordered inmates increased by 5.7%
Just over 18 % of the 8,948 inmates had a psychiatric
disorder. (June 2010)
31% of the 575 female offenders
30% of the jail population is developmentally
delayed, psychiatric disorder, and serious drug and
alcohol
Quebec: People with schizophrenic disorders @4
times, people with major depression @3.5 times
Both groups equally overrepresented in
homelessness
7





Newfoundland & Labrador 2008 - @ 25% male
and @60% female inmates had mental disorder
diagnosis on admission.
@90% have mental health issues when substance
abuse and antisocial personality included.
Federal 13% male and 29% female admissions
present mental health “problems”.
Roughly doubled since 1996/97.
International: Population increasing 5-10%
each year in prison and hospital.
8



Issue: reducing the criminalization of individuals
with mental health problems
Need to close gaps in services to the population
Issue: Many service providers find themselves
ill-equipped to deal with individuals who suffer
from mental health & social problems
Lack of effective collaboration and partnerships
between systems has had a huge impact on
available services
9
Mental
Disorder
Shelter
Criminalization
10

Canada Health Act S.3:
“protect, promote and restore the physical
and mental well-being of residents of Canada
and to facilitate reasonable access to health
services without financial or other barriers.”

We must strive to achieve compliance with the
legislative framework.
11
Focus on a
Perspective of
Change
Develop
tangible
protocols
Generate
flexible and
adaptable
strategies
Include
community
demographics
Encourage
Initiatives that
focus on
Reducing
Stigma and
Discrimination
Build on values
of dignity and
respect
Develop
Community
Capacity
Promote
sustainable
communities
Focus on the
individual
Identify shared
goals and
objectives
Promote and
support
advocacy
Develop an
action plan
Promote a
Continuum of
Care
Improve
Availability and
Accessibility
Incorporate the
social
determinants of
health
Develop a
holistic
approach
12


The Corrections and Conditional Release Act
S.86 states that CSC shall provide inmates
(not ‘offenders’) “essential health care and
reasonable access to non-essential mental
health care that will contribute to their
rehabilitation in the community”.
Once term of incarceration is complete, offenders
become eligible for health services under the
Canada Health Act
13


Too many years of closed doors and revolving
doors in and out of hospitals, shelters and prisons
Duty of care for CBRFs?
◦ no direct case law: this does not mean that one
does not exist
“Although the state’s responsibility and ability to
protect against troubling incidents is reduced
outside the walls of institutions, the phenomena of
recidivism and reincarceration or relapse and
rehospitalization display a continuity of state
interest in these situations of diminished liberty”
Kaiser, A. 2010
14


Development of a Strategy focused on Mental Health,
“a state of well-being”, rather than Mental Illness
Goal of Equitable and Timely Access
◦ Seamless integration of services




Recovery: Living well with disease
Gap: Little mention then of corrections
Now: CSC co-chairs the FPT Correctional working
group on mental health: MHCC participates.
At Home:Chez Soi – CSC participates
15





Community Awareness Increased
Exchange of Knowledge on Effective
Interventions
Promote Cross-Sectoral Understanding and
Collaboration
Enhanced Capacity for Staff in
Residential Programs and Training
Contribute to a National Strategy
16




Increased awareness of service providers
Communities are better informed about
the criminalization of citizens with mental
health issues.
Cross-sectoral understanding
Improved training for correctional and
residential service providers
17




From the survey data 7 CBRF locations participated in site
studies and roundtables with local mental health service
providers in New Westminster B.C., London ON, Toronto
ON, Joliette QC, Halifax NS
All participating CBRFs worked with individuals who have
mental health disorders
Most predominant disorders included: PTSD,
schizophrenia, bipolar disorder, depression, generalized
anxiety, FASD
All expressed a difficulty with connecting clients to
appropriate services in the community
18





Resistance on the part of mental health agencies to work with
CBRF clients due to criminal histories, especially if they
involve violence
Networking is predominant method of being made aware of
services in the community*
Privacy laws/policies are the greatest obstacles to information
sharing among services and limit the disclosure of care plans
Majority of CBRFs do not have a mental health worker on staff
Respondents were split on whether their discharge planning
practices were successful – early planning appears to be the
key to successfully connecting residents to community
services
19




Assessing Needs
Accessible mental health care
Identifying what works
Building Bridges
20
Accuracy
Partnerships
Discharge
Planning
• Having accurate diagnoses prerelease and creating treatment
plans to be carried out by CBRF
staff
• Between CBRF and individual prerelease
• Between CBRF, the resident, and
community mental health agencies
• Establish a support system that is
accessible post-warrant expiry
21

Circles of Support and Accountability (CoSA)





Reintegration for high risk sex offenders
Restorative Justice principles
Circle concept – Wrap-around
Potential circles for other populations
Community-Based Residential Facilities
 Integrate into community-based mental health
services
22

Create choice - Give voice


Connections Clubhouse relies on mental health clients
to design and deliver community supports - Clients
gain responsibility and confidence
Recovery has been defined as “living well in the
presence or absence of one’s mental illness”


Patient centred
Beyond silos
23

In facilities/residences


24 hour one on one support
Wrap around services

Trusting relationships with staff

CSC



Improving mental health services within institutions
Implementing community mental health strategies
Risk of suspension and revocation in the group who
received Community Mental Health Specialist Service
was 34% and 59% lower, respectively, than the
comparison group (CMHI Evaluation)
24
Work in Coalition


Cleaning Coalition: No one owns it, everyone is
invested in it
Meet People at their Point of Need


Intensive second stage residential program
Open the Doors


Welcome the community in, go out into the
community
25


Macro level change in legislation is needed to create
formalized interagency structures
Policy allowing for transitional housing to be adequately
funded, and ensure mental health services are available
for offenders on conditional release

Encourage support from local municipalities

Mental health housing with staging/graduated systems

Streamline application processes for housing, ID cards

Increase inter-agency communication
26


Stigma and Discrimination from the
community, direct service providers, and the
media
Not enough training for community corrections
service providers

Never Enough Funding

Eligibility Criteria
27
Positive Outcomes for Participants:



Establishing connections to potential funders
Tours of CBRFs have been requested by community
corrections personnel and health service providers
CBRF execs have gone on tours of second stage
housing initiatives in hopes of gaining new ideas
and approaches to creating their own
28

Spring 2011: Implement a Strategy using
awareness of service provision excellence and
destigmatization to achieve access

Provincial, Federal and Local

Pulling the Pieces Together

Forum
29
Share
Ideas
Create
Opportunities
Connect
30

Communication

Collaboration



Agreement on success
indicators
Broad-based
evaluations
Overarching principles
31

For Everyone:
 Have a plan
 Human rights focus
 Programs and policy to be evidence-based
 Shelter
 The Individual is the centre
32

Quote from CBRF staff, Community Connections
Survey:
“I suppose the key point is that we are a
community based program and are willing to
partner with any stakeholders to ensure
appropriate services are available and
accessible.”
(Re: survey question What are some key points that mental health
services need to know about your facility and the work that you
do?)
33
“It starts with having a place to
stay, having support, and then
trying to find the balance to
make sure they don’t fall
through the cracks.”
- British Columbia Case Study Interviewee.
34
Their deaths must lead us to better solutions.
Ashley
Smith
Edmond
Yu
Reyal
Jensen
JardineDouglas
Timothy
Mclean
35
36
“People, even more than things,
have to be restored, renewed,
revived, reclaimed and
redeemed; never throw out
anyone.” - Audrey Hepburn
St. Leonard’s Society of Canada
208-211 Bronson Avenue
Ottawa ON K1R 6H5
613.223.5170
[email protected]
www.stleonards.ca
37