Breaking Down Barriers for better success in changing times

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

2. Introduction • Background • Shelter and Access • Towards an Integrated Network • Community Connections • CAROW initiative • Ontario Projects What’s New What’s Next

3. Why It Matters “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

4. Who We Are and What We Do 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

5. The Background • 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

6. A Web of Complexities • Stigma and Discrimination • Inadequate community health services • Inadequate training for service providers • Inadequate Funding • Eligibility criteria

7. Current Statistics • 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

8. Current Statistics • 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.

9. The Challenges • 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

10. Connecting the Issues

11. Why A Strategy is Essential • 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.

12. Creating a National Mental Health Strategy:Models to Consider

13. Canadian Legislation • 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

14. Turning Revolving Doors into Doors of Opportunity • 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

15. Mental Health Commission of Canada: Toward Recovery and Well-Being • 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:ChezSoi – CSC participates

16. Community Connections:Project Goals and Outcomes • Community Awareness Increased • Exchange of Knowledge on Effective Interventions • Promote Cross-Sectoral Understanding and Collaboration • Enhanced Capacity for Staff inResidential Programs and Training • Contribute to a National Strategy

17. Project Outcomes • 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

18. Key Findings: Community Connections Site Studies • 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

19. Key Findings: Community Connections Survey • 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

20. Community Connections: What is needed • Assessing Needs • Accessible mental health care • Identifying what works • Building Bridges

21. Community Connections: Key Principles

22. Promising Practices: Accept - Circles and Conditional Release • 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

23. Promising Practices:Empowerment and Recovery • 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

24. Community Connections: Promising Practices and Progress • 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)

25. W Community Connections: Promising Practices and Progress • 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

26. Community Connections:Suggested Solutions • 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

27. Community Connections The Complexities of Connecting • 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

28. Community Connections The Benefits of Connecting 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

29. CAROW Collaboration • 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

30. Boost your Benefits!

31. What can be done?A Web of Solutions • Communication • Collaboration • Agreement on success indicators • Broad-based evaluations • Overarching principles

32. What the Strategy Needs to Succeed • For Everyone: • Have a plan • Human rights focus • Programs and policy to be evidence-based • Shelter • The Individual is the centre

33. The Message • 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?)

34. The Way Forward “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.

35. Reyal Jensen Jardine-Douglas They Mattered Their deaths must lead us to better solutions.

37. Conclusion “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 • OttawaON K1R 6H5 • 613.223.5170 • slsc@on.aibn.com • www.stleonards.ca