Episode 14: Healthcare in Canada's prisons

Naomi: At the end of that door, it opens up into a recreation area where, for housing any patients in health care that they can go to and have their rec time.

Kirstan: The Correctional Service of Canada is mandated by law to provide essential health care to incarcerated individuals. In fact, providing health services and mental health care during incarceration directly contributes to safer communities.

Kirstan: From health assessments to treatment, health education to harm reduction, CSC staff work diligently every day to support this mandate.

Kirstan: I'm your host, Kirstan Gagnon, and welcome to another episode of Prisons Inside / Out.

Kirstan: Substance use issues are among the most common health issues faced by the offender population which can influence criminal behavior. In fact, approximately 60% of offenders entering the federal correctional system report a history of substance use at the time of their initial assessment.

Kirstan: To address this health issue, CSC provides a range of interventions, including harm reduction, opioid agonist treatment, peer support, and psychoeducation. These services are a key part of the health care offered in federal prisons in Canada. They help offenders successfully reintegrate into society as healthier, law-abiding citizens while reducing disease transmission risks and recidivism rates. To help us unpack this and other aspects of health care in federal prisons, we met with Naomi, at Drumheller Institution, in Alberta.

Kirstan: Well, thank you so much for joining me and thank you so much for the tour. Really learned a lot about the facility through our tours this morning. I noticed that health care is a very busy spot. Talk to me a bit about how your day goes.

Naomi: Health care is very busy on any given day. So they are open from 7 a.m. to 7 p.m., seven days a week. We offer a number of services. We have our physician. We have a nurse practitioner, We have a physiotherapist, an optometrist, a dentist and an X-ray tech that comes in. We also have what's known as like ‘screening’ or a walk-in clinic with the nurses.

Kirstan: So the full spectrum of services that an inmate would get in the community, for example. What about mental health?

Naomi: So we do have a great mental health team here at the institution. Our team is made up of our Chief of Healthcare and then we have psychologists, we have a social worker, we have occupational therapy. We have an addictions counselor here. We have a mental health nurse. And then we have, like I said, our social worker.

Kirstan: So tell me a bit about yourself. Your background is in health care, and you work for Correctional Service of Canada now, for the past over eight years. Correct? And prior to that, you were with, the province's health services. How is it different?

Naomi: Yeah. I was a nurse in the public health care system, and I got an opportunity to come up and try corrections nursing. And honestly, I fell in love with corrections nursing. From my first tour, I thought it was so interesting. I couldn't, you know, the services that are provided within the institution, it surprised me. I didn't realize how vast everything was. It's different in the fact that, for me personally, I felt coming here I was actually doing a service. I felt that I was helping people, which was always my goal in nursing. And yes, I was helping people in a different way, but in this aspect, I was providing education and teaching and could really see the effects of that teaching and of helping somebody. I found it very rewarding. And to just see that there was such a need in a population and not realizing it before, you know, a need for that education and that guidance and those therapeutic relationships. So, it really changed in that way — I felt it was more, supportive and educational and necessary. We're still providing treatments. And, you know, you're targeting like, okay, there's this problem, there's this medical problem and still treating it, and they're going to get better right away. But there was that ability to teach chronic care and those types of things that I really just enjoyed.

Kirstan: So I was wondering about whether you feel safe working in, a prison setting.

Naomi: That's actually funny because that is one of the questions I get asked from the public all the time is: “You worked for the public health system and now you're working inside an institution, do you feel safe?” And I always say I feel safer than I did working in the emergency room on a night shift. Because there, the nurses kind of are the frontline of security and you're just treating whatever patient comes in and whatever condition, and it's just you. But here, you know: one our patients behave themselves and two we have the Correctional Officers that are working with us side by side

So I feel safer inside the prison than I did outside of the prison.

Kirstan: Let's talk a bit about harm reduction. Because we know that individuals that come into our care and custody, they may come with an addiction and substance use issues. And we must work to help support them and educate them, like you said. But I understand there's programs available here at this institution for those willing to participate. Can you tell me a bit about what's available?

Naomi: Absolutely. So harm reduction is something that I think is very important and I'm very passionate about. It's about meeting the patients where they are at on their journey. Again, that's just with support and education, so that they need to know what is available to them. And so, I think it isn't just a one-shoe-fits-all type of, you know, there's not one Band-Aid we can put on the situation.

Then we also have our smart recovery program. So it is a program that is taught by mental health, our social worker and our addictions counselor facilitate that. So it is a program that teaches abstinence but from a harm reduction approach, like that gives them tools and resources that they can use on their journey, so they can participate in that if they wish to.

Kirstan: Do they understand the link between their addiction and maybe their crimes as well in the past? Like are we making those linkages with the programing aspect?

Naomi: I think so, not every one, but definitely a lot know that their addiction, sometimes, is what really drove their crime. And I think one of the big things that we're trying to do here, especially in this institution, is reduce the stigma. How do we build those therapeutic relationships? How do we reach them so that they know that there is no shame? We see them as a person and we're here to help in whatever manner that we can. Whether it be to help them, you know, if they want to stop using any kind of substance, how can we support them and what's the best program for them? Maybe they need OAT, maybe they just need the addictions counselor. Maybe it's just through conversation every day with the health care team and, you know, listening to their stories and listening to their struggles on their journey or lots of times we want to see them and we want them to know that we see them and we're here to help them.

So, I think to me, to answer your question is: Yes, I think many of them do know, they just don't necessarily... you know, there's been a lot of shame. I think, just in the public and everything when it comes to substance use disorders. And I think there's a lot of work that's being done to change everyone's perspective perhaps around it. But, you know, from our stance in Health Services here, that is definitely one of the things that we're really trying to change, and we're trying to build those therapeutic relationships so that we can open that door so we can have those tough conversations and hopefully, you know, we can help transform somebody's life.

Kirstan: And when you talk about safe injection areas, some of our listeners may be wondering where do the inmates get these drugs? And how does that work? What's that about? Like Correctional Service doesn't give drugs to the inmates, correct?

Naomi: Correct. We do not supply drugs to the population. So Operations, they do their best to keep drugs out of the institution. And by having a safe consumption site inside of a federal institution, we're not saying that it's okay, but we're acknowledging that there is an issue. And how can we, from a health perspective, keep everyone safe? So, it's kind of walking that line between we understand it's wrong, but it's no different in the community, I think with the safe consumption sites and the RCMP or the police services, right? They're not necessarily legal, but they acknowledge the fact that people are using these substances. So how can we keep people safe?

Kirstan: And I think that's the key word — because if they have access to clean needles, you're reducing the spread of infectious diseases but also that key opportunity I think for education. You'd mentioned to us earlier that there's a nurse that sits outside of the door to monitor the individual who's, you know, using. And then we would collect all that equipment, the needle and everything afterwards.

Naomi: So when they come to the site and they've been approved, obviously, the nurse will talk to them about what they need. So the nurse would open up the cell and the patient would come in and you can inside you have a little table here and they have a chair. So they are set up with all the items that they need and then the nurse will literally lock the door and then she will hand him all his supplies and everything through the metal slot. Then they have ten minutes to consume and then they are observed for 30 minutes because that's the most risk for an overdose (in that time). And then afterwards, if he is cleared, if she feels he's not too intoxicated or anything like that, she will clear him to leave.

So then after, they're finished, then they have to hold up the syringe in the window for the nurse to see. And she just needs to make sure that the plunger and that the needle is actually still attached. And then they put it back in here. And then they have to hold up the tourniquet and show us that it's still in a complete condition. Right? That they haven't ripped anything off of it. And then once that's all done, they put all the supplies in there and then they're disposed of and then starts the observation time.

Naomi: What we have to understand is these patients or the participants that we have coming to our program their intent is to use something. And do they have the education, the knowledge, do they know how to inject safely? Do they know what they're using? And we don't want them to do it in their cell being taught by someone else who perhaps doesn't even know proper technique or anything like that.

So, you know, it's really getting your mind behind the fact that we could just allow them to continue doing what they're doing and it's not safe and then, you know, it might increase risks of infection, it might increase wounds, or they can sit there with the nurse and she can talk to them about how to safely use a substance and make sure they understand, you know, the technique that they're using and we know that they're using safe, clean supplies. But as I had said before, after we've gone through those initial steps of teaching them all that and making sure they have an understanding, it gives the opportunity for the nurse and the participant to have those conversations. It's not something I think that occurs initially, but through them coming to the site, over time, they start to build that relationship.

And I've actually received letters from participants who talk about coming to health care and how they had a sense of community and a sense of belonging and they didn't feel judged. And so that really, you know, was great feedback for the nurses to know that they were doing a good job and they were making a difference in these participants’ lives. You know, and we have had success stories where we were able to help patients just through our continued, you know, they might be coming every day and we're talking to them every day. And through those relationships that were built with them, we've actually helped patients on their journey to recovery. And actually some guys, some of our participants, you know, they've succeeded in transitioning off using the illicit substances. So it's wonderful when you see that.

Kirstan: That's great. And would you say you've prevented overdoses?

Naomi: Yes, we have seen a reduction in overdoses. Do overdoses still occur? Absolutely. As I said in the OPS site, they can only inject or snort their substance. They can't smoke. So there is still that risk if they're smoking a substance for overdose. And not everybody, as we are talking about, not everything works for everybody, not everybody wants to participate in the OPS site, right? They're not they're not ready for that. So there is still some overdoses that are occurring. But have we had as many fatal overdoses? No, we have seen a reduction. And I think just there's been more harm reduction teaching and, you know, education and trying to support our population.

Kirstan: And you might not know the answer to this, but I was wondering if somebody is in one of those rooms using (and of course, they're monitored), but then they later go back to the main area, could that be a risk in terms of could they become dangerous to others if they're on something and we don't necessarily know what it is?

Naomi: That's a question that comes up a lot, actually. And, you know, when we were first starting to implement the program that concern was raised. And I think what people fail to see is that most of our participants come down there and they're just using a small amount and just to function in their day, because that's how they get through their day. So we are not seeing people who are overdosing or are in, you know, altered level of consciousness after. And if the nurse had concerns, because they are monitored, we would ask them to stay in health care under supervision until we felt that they were safe to go back out into the population and continue on with their day.

Kirstan: That's a really important point. So they would just keep on monitoring them until they felt, okay, you're ready to go.

Naomi: We wouldn't release somebody back out if there was concern still.

Kirstan: And what are you most proud of?

Naomi: I would say the Overdose Prevention Service and at Drumheller Institution, the Health Services I'd say approach to harm reduction. You know, it was the first in CSC, the first site to open an overdose prevention site. It was a lot because we are inside a correctional facility. There were a lot of barriers and challenges to overcome. However, the team's ability to adapt and to really embrace the harm reduction idea of meeting the patients where they're at and their ability to try and build those therapeutic relationships and make our patients have a sense of belonging in health care and understanding that we're there to help, I think has been a huge success for Drumheller Health Services, and I'm really proud of the team.

And I'm really proud of the institution as a whole because, you know, as Health Services we have the harm reduction approach. But then we have, you know, our Correctional Officers and our interventions teams and our senior managers, and everybody had to buy into that concept and really support it for it to be a success. And this institution has. And so, I'd say I'm really proud of everyone.

Kirstan: And hearing you talk about some of the accomplishments you've had along the way, certainly it helps Canadians as well. If some of those inmates are later released into the community (eventually, some may never be) but for those who are, I think it makes for a healthier Canadian population.

Naomi: Absolutely. That's our whole job is, you know, we're supposed to be rehabilitating them and helping them integrate back into our community. And so every little bit of work that we're doing inside here to teach and promote health education and putting our safety measures in place and acknowledging substance use disorder and providing treatment for that, I really do think has a positive impact on the Canadian population. So that when you know they are released, if ever, back into the population, they have an understanding and they have a knowledge and they're, you know, trying to be healthier and they're trying to, you know, if they're still using substances, you know, they're doing it safer and they have an understanding of the health system as well, which really benefits everyone as a whole I feel.

Kirstan: Well, thanks so much. I really appreciated the interview today and the time you spent with us.

Naomi: Well, thank you for coming, we enjoyed having you.

Kirstan: That's all for this episode of Prisons Inside / Out. A big thank you again to Naomi for her time. This has been a production of the Correctional Service of Canada, and I've been your host, Kirstan Gagnon. Thanks for listening.