January 7, 2019
Hon. Sylvia Jones
Ministry of Community Safety and Correctional Services
18th Floor, George Drew Building
25 Grosvenor Street
Toronto, Ontario M7A 1Y6
Dear Minister Jones:
Thank you for providing the Ontario Human Rights Commission (OHRC) with the opportunity to tour Vanier Centre for Women (Vanier) in Milton, Ontario as part of the OHRC monitoring of the settlement in the Jahn matter. I am writing today to provide you with a summary of what we learned on our December 4, 2018 visit.
I also want to extend a special thank you to Superintendent Robyn Degan and her team for being so welcoming, informative and open. I also want to thank Lou Ann Lucier, Regional Director (Central) and Kacy Cumming, Deputy Regional Director (Central) for providing information from a corporate perspective. Unfortunately, despite our advance efforts to provide prisoners with meaningful opportunities to speak to the OHRC directly, we were told that there had not been any prisoner requests to meet with us. We also did not have an opportunity to meet with the local union representative or correctional officers.
Overall, we were pleased to see important good faith efforts being made by management and staff at the institution to address the human rights needs of prisoners. However, such efforts were often not enough to ensure the protection of prisoners’ human rights and were hampered by continuing systemic failures, including in particular the failure to establish a mental health facility for women in the corrections system.
The Ministry should also be taking steps to ensure that (a) the use of restraints for self-harm are strictly regulated in accordance with recommendations made by the federal Office of the Correctional Investigator, (b) its risk assessment tools are gender and culturally responsive, (c) prisoners are able to contact families in a manner that is not prohibitively expensive, and (d) that segregation use is strictly limited and subject to independent oversight.
Accommodation of mental health disabilities
Vanier houses approximately 200 women, many of whom have unique needs, and approximately 60% of whom are on remand. Staff and management confirmed that many of the women suffer from mental health disabilities and addictions (often to opioids), often rooted in trauma previously experienced in the community. There are high rates of post-traumatic stress disorder (PTSD) amongst the prisoners.
Management noted that psychiatric services are available six days per week, and that there is a full-time staff psychologist, as well as social workers. They also noted the availability of a wide variety of programs, including those delivered by community agencies such as the Elizabeth Fry Society. This is very positive and sets Vanier apart from other institutions that the OHRC has visited.
Still, we are concerned about some approaches that staff have adopted in order to address high rates of self-harm amongst the women housed at Vanier. While we understand the challenges posed by chronic self-harming behaviour, we are concerned about use of the restraint chair as a regular part of “therapeutic interventions” for these women. The staff psychologist characterized use of the restraint chair as “therapeutic” and a “necessity” at Vanier and noted that it sometimes helped women to reintegrate into general population units.
In its 2013 final report, Risky Business: An Investigation of the Treatment and Management of Chronic Self-Injury Among Federally Sentenced Women, the federal Office of the Correctional Investigator notes that:
76. There is little doubt that management of self-injurious offenders is complex and demanding work. The Office continues to believe that a handful of the most prolific self-injurious offenders simply do not belong in a federal penitentiary. These offenders should be transferred to external psychiatric facilities that are better equipped to accommodate and care for acute and complex mental health needs underlying their self-injurious behaviours.
77. Recent CSC [Correctional Service of Canada] studies suggest that women offenders may be more likely than male offenders to engage in self-injurious behaviours and have considerably higher rates of self-injury, highlighting the need for an approach recognizing the unique needs of women. As the investigation finds, the literature suggests that punitive responses such as the use of force, segregation, transfer, restraints and the removal of personal items are counterproductive and that women who self-injure need “ongoing, coordinated and empathetic support.” Effective clinical interventions are those that are informed by and address the underlying motivations for self-injurious behaviour (often traumatic psychological, physical or sexual abuse) rather than interventions that simply try to momentarily stop it. Community mental health practitioners support this position and further stress the importance of engaging with a patient, particularly when waiting for clinical staff to respond or during a seclusion placement.
78. The investigation notes that pepper spray, physical handling and restraints are commonly used in an attempt to stop, interrupt or prevent prison self-injury. These interventions often simply contain or reduce the immediate risk of harm; they do not, nor are they intended to deal with the underlying reasons or symptoms of mental illness so often manifested in self-injury.
The Correctional Investigator further highlights the fundamental distinction between using restraints in a health care environment and their use in a correctional facility, noting that in a health care facility the intervention is “authorized, applied and monitored by registered health care professionals, not security personnel.”
The Correctional Investigator goes on to make a number of recommendations, which we encourage Ontario to adopt. The recommendations are attached to this letter as an appendix.
Vanier’s challenges with managing a vulnerable population with high needs are exacerbated by the fact that there is no provincial correctional facility for women that is also designated as a Schedule 1 psychiatric facility under the Mental Health Act.
This very issue was raised and meant to be addressed through the Jahn v MCSCS human rights case and settlement. A key matter in the Jahn case was that women in Ontario’s correctional system could not receive the same level of mental health care as men, who have access to the St. Lawrence Valley Correctional and Treatment Centre. As part of the Jahn settlement, the Ministry was required to consult with mental health experts, issue a report on how best to serve female inmates with major mental illness, and then commit to implementing the report’s recommendations within 18 months. The March 2015 report made several recommendations, including that the Ministry implement a Schedule 1 facility for women, in partnership with a forensic hospital. As part of its obligation to implement the recommendations, the Ministry committed to repurposing an existing facility (the Roy McMurtry Youth Centre) to create a Female Secure Treatment Unit that would be designated as a Schedule 1 facility, and that this was expected to be operational by early 2018. To date, the Ministry’s legal commitment under the Jahn settlement to implement the report’s recommendation remains unfulfilled.
The experiences of the women at Vanier continue to demonstrate the urgent need for such a facility, and the OHRC calls on the Ministry to take immediate steps to bring itself into compliance with this term of the 2013 Jahn settlement.
Accommodation of addictions
As noted above, staff and management advised that many of the women at Vanier suffer from addictions, often rooted in trauma previously experienced in the community.
Management confirmed the relatively easy access to illegal drugs within the prison environment. They noted that there were two recent overdose-related deaths in custody. And while there are no addictions counsellors available to the women at Vanier, the OHRC was pleased to learn that the Ministry has changed its policy to allow women who wish to participate in harm-reduction programs such as methadone or suboxone to commence these programs while in custody at Vanier.
This is consistent with the OHRC’s past recommendations to government, and is a practice that should be adopted across the system.
Risk assessment tool
Management confirmed that Vanier uses a risk assessment tool that was developed for male prisoners and which has not been normed for females or Indigenous peoples.
A Vanier staff member told us that she believes that due to the high rates of trauma that women experience, the current risk assessment tool results in female prisoners being over-classified as maximum or medium security.
This experience is consistent with the findings of the Supreme Court of Canada in R v Ewert that such risk assessment tools can be susceptible to cultural bias, and the continued use of such tools may overestimate the risk posed by Indigenous inmates.
We understand that MCSCS is reviewing its risk assessment tools and we would encourage it to adopt a gender and culturally responsive risk assessment tool consistent with its obligations under the Human Rights Code.
Prisoners at Vanier face particular challenges in terms of ensuring family and community contact. Management confirmed that many women held at Vanier come from communities across the province, and that visits to the jail are infrequent compared to other facilities. In addition to geographical issues, there is a further gendered aspect to this situation, since male prisoners are most frequently visited by caregivers and family members who are women, and similar supports often do not exist for women in prison. In this context, the importance of telephone calls to families and communities is heightened and has unique Human Rights Code aspects. As currently configured, Vanier’s phone system requires that prisoners make collect calls that are often prohibitively expensive for families (costing hundreds or thousands of dollars per month), and requires family members to have a land line (which is becoming less common).
We have heard similar concerns in our visits to the province’s correctional facilities in Monteith and Kenora, where the barriers to communication have a disproportionate effect on Indigenous prisoners who often live in remote communities. The OHRC therefore urges the Ministry to adopt system-wide changes to correctional institution telephone systems in order to accommodate the needs of prisoners.
We note that this recommendation is consistent with Recommendation 18 of the recent verdict of the Coroner’s Jury at the Inquest into the death of Cleve Geddes.
Use of segregation
We were provided with an opportunity to visit the prisoner who has been held in segregation in excess of 405 days. Overall, we remain concerned that there are currently no statutory or policy limits on long-term segregation placements, and no processes for independent oversight and review. We encourage the government to address these long-standing issues by quickly proclaiming and implementing the Correctional Services and Reintegration Act.
Again, we note that this recommendation is consistent with Recommendation 48 of the recent verdict of the Coroner’s Jury at the Inquest into the death of Cleve Geddes.
Thank you once again for providing me with the opportunity to visit the Vanier Centre for Women.
Consistent with our mandate to report on the state of human rights in the province, and in the interest of transparency and accountability, we will make the contents of this letter public.
Renu Mandhane, B.A., J.D., LL.M.
Ontario Human Rights Commission
cc: Hon. Caroline Mulroney, Attorney General
Paul Dubé, Ontario Ombudsman
Justice David Cole, Ontario’s Independent Reviewer, Jahn Settlement
Kelly Hannah-Moffat, Ontario’s Independent Expert on Human Rights and Corrections, Jahn Settlement
Federal Investigator Recommendations
1. Chronic self-injury should be treated and managed first and foremost as a mental health concern, not a security, compliance, behavioural or control issue.
2. Chronic self-injurious women offenders should have clinical management/treatment plans in place. Such plans should clearly address intervention, treatment and prevention measures. For Aboriginal women who chronically self-harm, the treatment plans should include culturally appropriate measures informed by Gladue principles andinsights.
3. The CSC should transfer the most chronic and complex cases of self-injury to external provincial health care facilities.
4. The use of restraint equipment to control or manage self-injurious behaviour should always be considered a use of force intervention and therefore be subject to regular use of force reporting, monitoring, accountability and review procedures.
5. In cases of self-injury, physical restraints should be applied as a last resort and for the shortest time necessary to manage the period of imminent risk of self-harm. The authority to apply, monitor and discontinue use of restraint equipment should be exercised by one or more registered health care professionals, not security personnel.
6. Under no circumstances should a non-consenting or uncertified offender in a Pinel Restraint System be subject to forced medical injections.
7. Restraint equipment should not be used on a self-injurious offender for punitive, administrative or retaliatory purposes.
8. 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 a Pinel Restraint System.
9. CSC should appoint an independent patient advocate or a quality care coordinator at each of the five regional treatment centres, inclusive of the Churchill Unit, Regional Psychiatric Centre, Prairies.
10. The known preventive/protective factors for prison self-injury—time out of cell, purposeful and meaningful activities (including employment, education, programming, hobby craft), frequency of contacts with family, positive peer association, counselling and therapy—should be communicated widely across the Service to develop the awareness and knowledge base to better inform intervention and prevention efforts.
11. CSC should conduct a review of its use of force and health care policies to ensure better congruence and priority between the respective roles of emergency responders, decision-makers, security personnel and health care providers. Security of the institution should not automatically or necessarily trump immediate health care needs.
12. Health care staff input is required whenever a self-injurious offender is placed in a seclusion, observation or segregation cell.
13. There should be an absolute prohibition on the practice of placing self-injurious offenders in conditions of long-term clinical seclusion, isolation, observation or segregation.
14. CSC should be prohibited from constructing or using padded cells in its regional treatment centres.
15. CSC should re-evaluate the need for 24/7 health care coverage at all medium, maximum and multi-level security institutions on a site specific basis.
16. Front-line staff working with chronic self-injurious offenders should be provided with training and competencies above and beyond the basic Fundamentals of Mental Healthawareness package currently offered by CSC to all staff. As a matter of course, CSC should implement staff respite measures in recognition of the consuming physical and emotional demands of working with complex needs offenders.