Guidelines 711-5: Health Services in Structured Intervention Units

Number: 711-5

In effect: 2025-06-09

• Corrections and Conditional Release Act (CCRA), sections 4(c), 4(g), 31, 32(1), 37.1 to 37.5, 86, 86.1 and 87
• Corrections and Conditional Release Regulations (CCRR), sections 22(1)(a), 23(1)(c) and 23.08 to 23.1

To provide staff and contractors with direction on the provision of health services to inmates within the Structured Intervention Unit (SIU) and subject to restricted movement.

Applies to all Correctional Service of Canada (CSC) staff and contractors involved in the transfer, management, oversight, provision of interventions and services, and decision making of SIU inmates or inmates subject to restricted movement

• Responsibilities
• Enquiries
• Annex A: Cross-references and definitions

Responsibilities

1. The Assistant Commissioner, Health Services, will:
   1. ensure the development of health services guidelines and tools for staff that outlines procedures and processes on health care for SIU inmates or inmates subject to restricted movement
   2. as chair of the Health Committee, ensure the Committee:
      1. renders a decision on the implementation of a registered health care professional’s recommendation in cases where the recommendation has not been implemented by the Institutional Head, as soon as practicable and with consideration of the individual’s representations, Correctional Plan and health needs, as well as the appropriateness of their current placement and their security classification and any other relevant considerations
      2. shares their decision, and the reasons for it, with the Institutional Head and the Manager, Health Care and Rehabilitation Programs and Services, without delay
      3. notifies the Independent External Decision Maker without delay when, following an Institutional Head’s decision to not implement a recommendation of a registered health care professional, the Committee determines that an inmate should remain in an SIU or the inmate’s conditions of confinement should not be altered, and
      4. documents their decision in the SIU application and Electronic Medical Record, including a summary of the implementation or partial implementation and the reasons for not fully implementing the recommendation, if applicable.

2. The Regional Director, Health Services, will:
   1. ensure the provision of health services to SIU inmates or inmates subject to restricted movement
   2. ensure compliance with the established notification process for registered health care professional recommendations to the Institutional Head.

3. The Institutional Head will:
   1. ensure Standing Orders for the SIU include the requirement for a referral for a health assessment, including mental health, to be completed at the time of the SIU transfer authorization
   2. render a decision on whether the inmate should remain in an SIU or whether the inmate's conditions of confinement should be altered based on the registered health care professional’s recommendation, as soon as practicable, and share the written decision, justification and original health care recommendation with the registered health care professional, the inmate, and their legal representative, if applicable, within two (2) working days
   3. inform the Health Committee when the recommendation of the registered health care professional is not fully implemented, in writing and without delay, and
   4. ensure the inmate is informed of the registered health care professional’s recommendations and Health Committee decisions, both in writing and verbally, as soon as practicable.

4. The Manager, Health Care and Rehabilitation Programs and Services, will:
   1. establish a process for the timely disclosure of requested documentation to the Independent External Decision Maker, and
   2. ensure that a procedure is in place for staff and contractors to refer inmates in an SIU or subject to restricted movement to Health Services.

5. The Chief, Health Services, and Chief, Mental Health Services, will:
   1. establish a process to ensure the quality and accuracy of the data and information recorded in the SIU application by Health Services staff
   2. ensure that registered health care professionals complete a health assessment within the designated timeframes, including mental health, in accordance with the Mental Health Guidelines, and
   3. ensure that relevant information on the inmate’s health is provided for decisions relating to SIU transfers and conditions of confinement.

6. The registered health care professional will submit a recommendation to the Institutional Head if they believe that the conditions of confinement for an individual should be altered for health reasons, or the placement in the SIU should be terminated, and include the basis upon which the recommendation was reached and any health care needs requiring accommodation:
   1. when the Most Responsible Team cannot address or manage the health needs, and
   2. no more than 24 hours after forming the opinion.

Enquiries

7. Strategic Policy Division
   National Headquarters
   Email: Gen-NHQPolicy-Politi@CSC-SCC.gc.ca

Assistant Commissioner,
Health Services
Marie Doyle

Annex A

Cross-references and definitions

Cross-references

• CD 001: Mission, Values and Ethics Framework of the Correctional Service of Canada
• CD 228: Information Management
• CD 701: Information Sharing
• CD 702: Indigenous Offenders
• CD 711: Structured Intervention Units
• GL 711-1: Transfer of Inmates to a Structured Intervention Unit
• GL 711-2: Management of Structured Intervention Unit Inmates and Inmates Subject to Restricted Movement
• GL 711-3: Transfer of Inmates Out of a Structured Intervention Unit
• GL 711-4: Correctional Interventions and Services in Structured Intervention Units
• GL 711-6: Referrals to and Information Sharing with Independent External Decisions Makers
• CD 800: Health Services
• GL 800-3: Consent to Health Service Assessment, Treatment and Release of Information
• GL 800-4: Response to Medical Emergencies
• CD 843: Interventions to Preserve Life and Prevent Serious Bodily Harm
• Guidelines for Sharing Personal Health Information
• Health Consultation and Assessment for Structured Intervention and Restricted Movement Guidelines
• Mental Health Guidelines
• Offender Records System User’s Guide

Definitions

Conditions of confinement: for the purpose of the SIU policy suite, the living conditions of an inmate while in an SIU or subject to restricted movement, which includes, but is not limited to, showers, cleanliness of the unit, working conditions of range and unit amenities, the frequency, duration and type of opportunities made available to the inmate, as well as the conditions under which these opportunities are provided, including whether barriers are used to mediate or interpose human interactions.

Contractors: for the purpose of the SIU policy suite, people under contract with CSC to provide specific interventions and services to SIU inmates, including Elders, Elder Helpers, Teachers, Chaplains, and Spiritual Advisors.

Health Committee: committee referred to in subsection 37.31(3) of the CCRA and chaired by the Assistant Commissioner, Health Services.

Independent External Decision Maker: appointed by the Minister to review the cases of inmates confined in an SIU or subject to restricted movement in accordance with conditions and timeframes identified within the CCRA and CCRR.

Inmate subject to restricted movement: any inmate who is authorized for transfer to an SIU and placed on restricted movement status pending their physical movement to an SIU.

Most Responsible Team: a team established to coordinate the provision of integrated health services and facilitate interdisciplinary case consultation. It is responsible for identifying needs and service requirements; prioritizing services; and discussing current clinical, operational, and case management issues or concerns, short and long-term goals, roles and responsibilities of all staff intervening with individuals with high needs, and emergent mental health issues.

SIU application: application used by CSC staff and applicable contractors to document SIU decisions, the daily activities, interactions with inmates and other information related to an inmate’s confinement in an SIU or when subject to restricted movement.

SIU inmate: any inmate authorized or approved for transfer to an SIU and who is physically residing in an SIU.

Without delay: “without delay” means immediately, unless there are compelling circumstances preventing immediate action and, in those circumstances, the delay cannot be more than 24 hours.