Jury Recommendations into the death of Terry Baker

Within CSC, health services are provided through an interdisciplinary approach, which involves team members from different disciplines working collaboratively, with a common purpose, to set goals, make decisions, and share resources and responsibilities. Such an approach requires that a team of clinicians from different disciplines, together with the offender, undertake assessment, diagnosis, intervention, goal setting, and the creation of a treatment plan. The delivery of care is provided by health care professionals who are registered or licensed in Canada, many of whom provide the same services in their local communities.

As in the community and consistent with professional standards, CSC provides mental health care based on an interdisciplinary team model; such teams include psychologists, nurses, physicians, social workers, occupational therapists, psychoeducators (in the Quebec Region), pharmacists, and/or psychiatrists. These professionals are trained in the delivery of mental health services and qualified to respond to the needs of offenders throughout their sentence as per their clinical judgment. Multidisciplinary health team members may also include non-registered health care staff working under the supervision of registered health professionals, such as behavioural science technicians or mental health officers. Health care teams also work in close collaboration with other service providers, such as behavioural counsellors, Elders, and ad hoc members as required and with the offender’s consent.

CSC’s recent implementation of the Person Health Care Home Model further reinforces the importance of the interdisciplinary team in building an Integrated Interdisciplinary Care Plan to help inmates achieve their identified health goals.

A significant investment portion of Bill C-83: an Act to amend the Corrections and Conditional Release Act (CCRA) and another Act, is dedicated to enhancing psychiatric services and diagnostic formulation at intake, primary and intermediate care settings, as well as Regional Treatment Centres. Enhancements to psychiatry clinics support assessment, diagnosis, and pharmacological treatment of inmates with mental illnesses, that contributes to lower levels of impairment thereby promoting recovery and preventing deterioration to more serious impairment and the need for more intensive treatment. The mandatory requirements for correctional psychiatry are the same as in the community and CSC psychiatrists work to the full scope of their profession and offer community-equivalent care to their federally incarcerated patients. The contracting requirements for qualifications of resources are consistent across the country with the use of national contracting templates.

The role of psychiatrists within CSC includes, among other things, to conduct psychiatric examinations and provide treatment to offenders including those who are certified; liaise with health care, case management and correctional program personnel, and participate in interdisciplinary team meetings; provide advice and recommendations to CSC staff regarding psychiatric care; participate in discharge and release planning as requested; develop care plans and discharge summaries in accordance with mental health service delivery guidelines; provide consultation to other health care providers to ensure continuity of care; provide consultation and advice on mental health services to the mental health team, or institutional management, or both as requested; participate in meetings including the Regional Medical Advisory Committee, case conferences, and other related activities as requested; and participate in the evaluation of the efficiency, quality and delivery of services.

Furthermore, CSC has also established contracted regional and national psychiatry leads whose role includes, among other things, to provide oversight and leadership for their discipline and to work in conjunction with CSC Regional and National Health Services management team and other members of the Healthcare Team to advance the healthcare of inmates.

CSC continually monitors staffing levels to address vacancies of all health professionals. It is important to note that recruitment of health professionals continues to be a challenge amid a Canada-wide health professional recruitment crisis, however, CSC has dedicated resources for outreach and other recruitment activities.

As noted, CSC’s Person Health Care Home Model of care ensures inmates receive mental health services at a level of care that corresponds to their level of mental health need along a continuum of care from intake to warrant expiry, including primary mental health care, intermediate mental health care, and psychiatric hospital care/regional treatment centres. Presently, women inmates with mental health needs that have been assessed by a mental health professional as requiring more intensive support than can be provided through primary or intermediate mental health care can be referred for admission to the Regional Psychiatric Centre, in Saskatchewan, or the Philippe Pinel National Institute of Forensic Psychiatry, in Quebec.

As noted above, CSC’s model of care ensures that patients receive mental health services at a level of care that corresponds to their individual level of mental health need along a continuum of care from intake to warrant expiry, including primary mental health care, intermediate mental health care, and psychiatric hospital care/regional treatment centres. Intermediate mental health care is provided to inmates who do not require admission to a hospital and whose needs exceed the level of care provided through primary care based on an assessment of the inmate’s significant impairment in level of functioning.

For minimum and medium security women offenders with mental health needs, intermediate level care is provided in Structured Living Environments, which have been established at each of the five women's facilities. These five units provide a more intense level of mental health services. For women classified as minimum or medium security, the Enhanced Support House provides multi-purpose and voluntary short-term supportive mainstream environment for inmates who require additional staff support and/or greater access to interventions. At these sites, women classified as maximum security live in secure units, where a high level of intervention and supervision is provided. Intermediate care is also available for maximum security women in the Secure Units and for all security levels at CSC’s Regional Psychiatric Centre in Saskatoon, Saskatchewan. Presently, women inmates with mental health needs that have been assessed by a mental health professional as requiring more intensive support than can be provided through primary or intermediate mental health care can be referred for admission at the Regional Psychiatric Centre, in Saskatchewan, or at the Philippe Pinel National Institute of Forensic Psychiatry, in Quebec.

Notwithstanding the existing in-patient capacity within the accredited CSC Regional Psychiatric facility in the Prairie Region, as well as the long-standing agreement with the Philippe Pinel National Institute of Forensic Psychiatry, CSC continues to explore avenues to better respond to the mental health needs of inmates. However, CSC cannot compel provincial hospitals to enter into exchange of service agreements, and, in the absence of such agreements, it is not possible to send inmates to an external psychiatric hospital for an indefinite term. CSC can only send inmates on escorted temporary absences for discrete treatments. Where there is no exchange of service agreement, and a second medical opinion is sought, CSC can contract a health care professional to conduct an examination and assessment of the inmate, either in the community or at a CSC institution. It is important to note, however, that CSC is not able to compel a provincial hospital to admit an inmate. Moreover, even under an exchange of service agreement, the provincial hospital determines admission and discharge based on their clinical admission and discharge criteria. As for issues regarding consent to treatment, this is governed by relevant health legislation and is not specific to or determined by CSC.

As a point of precision, administrative segregation was abolished in 2019 following the passage of Bill C-83, therefore “segregation status” is no longer terminology in use in the Corrections and Conditional Release Act (CCRA), nor within CSC policies and guidelines. In the current iteration of the CCRA, inmates who cannot be maintained in the mainstream inmate population for security or other reasons are transferred to Structured Intervention Units (SIUs), which provide them with opportunities to interact with others, to participate in programs, and to have access to interventions and services that respond to the inmate’s specific needs and risks. Current SIU policy requires that inmates transferred to an SIU, or subject to restricted movement, be referred to a Health Care Professional for assessment which includes mental health.  The assessment must be completed within 24 hours of the inmate’s authorized transfer to an SIU or upon being subject to restricted movement.  This assessment is to be conducted in a private setting and will reoccur every 14 days from transfer.  All inmates transferred to an SIU, or subject to restricted movement, receive a daily visit by a registered health care professional which includes a visual observation of the inmate, without physical barriers unless required for reasons of safety.  Additionally, a mental health assessment is completed no later than the 28th day from the inmate’s authorization for transfer to an SIU. This assessment can occur earlier, based on the individual needs of the inmate.

With respect to this recommendation, the Health Services Sector in consultation with the Women Offender and Policy Sectors, will review clinical oversight as outlined in Commissioners Directive 843, Interventions to Preserve Life and Prevent Serious Bodily Injury, for enhanced observation/clinical seclusion.

All offenders will continue to benefit from the support and representation provided by non-governmental agencies such as the John Howard Society, the Native Women's Association of Canada, Canadian Association of Elizabeth Fry Societies (CAEFS), as well as the Office of the Correctional Investigator, the Citizens Advisory Committee, and other volunteers active in federal corrections. Typically, these organizations are provided unimpeded access to all CSC facilities unless there are circumstances that present a risk to the security of the institution or of any person.

Offenders can also contact their legal representatives and have direct telephone and written grievance access to CSC's Right's, Redress and Resolution Branch. In addition, every institution has an elected inmate committee that can also play a strong role in ensuring that the rights of every offender are respected.

Furthermore, CSC in collaboration with CAEFS created a new paid inmate job in 2015, called the peer advocate. The job description was developed in collaboration with CAEFS, and the training is regularly provided by CAEFS.

Finally, all women offenders who are transferred to Structured Intervention Units or in observation cells have access to a private meeting space designated for this purpose, when meeting with the Rights Advisor-Inmate Advocate, the Office of the Correctional Investigator, Citizens Advisory Committee, non-governmental organizations, and community agencies, as well as for any other meetings where privacy is required. More specifically, Secure Unit interview rooms have been constructed at all women's institutions to facilitate meetings that are sensitive or personal in nature between women and external representatives or CSC staff.

It is noted that, when incidents of suicide and self-injurious behaviour arise, staff are required to respond immediately to ensure the safety of the person and provide appropriate support. Commissioner’s Directive (CD) 843, Interventions to Preserve Life and Prevent Serious Bodily Injury, emphasizes predominantly health focussed and least restrictive measures in responding to incidents of suicide and self-injury. This may include short term utilization of enhanced observation and the use of restraints; however, such options are intended to be interventions of last resort. Responses to incidents are also guided by the Engagement and Intervention Model (EIM), which encourages de-escalation and least restrictive measures.

As noted in CD 843, the Pinel Restraint System (PRS) is the only restraint system to be used for self-injurious behaviour and will only be used as a last resort after all reasonable efforts to use alternative, less restrictive measures and de-escalation strategies have been considered or implemented and assessed as not effective. It is to be used for the shortest amount of time required to manage an emergency safety risk and will only be applied and removed by trained staff. In balancing the security and health-related responses, as outlined in Commissioner’s Directive 567, Management of Incidents, the EIM, and CD 843, the Institutional Head authorizes the application and removal of the PRS in situations where an offender is engaged in self-injury. Nonetheless, the Institutional Head is required by policy to consider risk-related advice from Health Services, whenever possible, prior to authorizing or changing the use of the PRS. Lastly, in some circumstances enhanced observation and restraint can be used in accordance with provincial mental health legislation, in lieu of CD 843, provided the assessment, oversight, and data collection meet or exceed the requirements of the policy. 

Commissioner’s Directive (CD) 843, Interventions to Preserve Life and Prevent Serious Bodily Injury,outlines the requirements for ongoing health and mental health assessments while the Pinel Restraint System is in use. Specifically, when a nurse is present during the application, an initial assessment of the inmate’s physical and mental health will be conducted once the restraints have been applied. Further, if there is no nurse available during the application, a nurse will be called to attend the institution and complete this assessment within two hours of its application or arrangements will be made for this assessment to be completed by another health care professional. The timelines for additional ongoing health assessments are also outlined in policy, providing opportunities to re-evaluate the health of the inmate, as well as consider the appropriateness of modification and removal of restraints.

CD 843 also requires a health care professional to complete a mental health assessment, in person, as soon as reasonably practicable, and normally within six hours of the application of restraints. At all times while placed in the PRS, the inmate is under constant observation, by direct view, by a dedicated Correctional Officer or Primary Worker in a women’s site. In Regional Treatment Centres, this observation may also be completed by a health care professional. This constant observation ensures the inmate’s safety and ongoing monitoring for changes in general appearance and behaviour.  

As for the level of therapeutic support provided to inmates under restraints, it is adjusted on a case-by-case basis based on the specifics of the case. While some inmates may require ongoing reassurance from staff, others will be better served by a reduced level of stimulation which will allow them more easily to regain their abilities to self-regulate. Offering one-on-one constant therapeutic support while under restraints may be detrimental to some inmates.

CSC’s Mental Health Guidelines include requirements for review of suicide and self-injury vulnerabilities and needs after incidents of suicide attempt or self-injury. After every incident of non-suicidal self-injury or attempted suicide, a Critical Response and Incident Management Plan(CRIMP) must be completed. A CRIMP is a review of an inmate’s behaviour after each incident that is intended to encourage and support a collaborative approach including both health and operations for the inmate to resume usual activities as soon as practicable. CRIMPs are documented in the patient’s Electronic Medical Record (EMR), ensuring that members of the patient’s care team have access to this information, including the Most Responsible Provider, institutional psychiatrist, and institutional physician, as appropriate.

The EMR has been updated to include an Integrated Interdisciplinary Care Plan (IICP) for every inmate. The IICP can be accessed by all health care staff and integrates mental health considerations. Health care professionals, including the institutional psychiatrist, have easy access to relevant information related to vulnerabilities of suicide and self-injury, and are able to adapt their interventions accordingly when providing services to inmates under their care, which ensures enhanced continuity of care.

Please refer to Terry Baker’s Recommendation 14.

Please refer to Terry Baker’s Recommendation 14.

Since 2018, offenders have been able to hold a visit by live video on an institutional computer. These visits normally last 50 minutes. This ensures that inmates develop and maintain family and community ties if their visitor is unable to come to the institution. Consideration is also being given by CSC to expand the opportunities for contact with family and support persons through the use of more modern video technology platforms.

During the pandemic, CSC enhanced access to video visitation to help inmates maintain their relationships with family and friends. Video visits are available at all CSC institutions, and the number of video visit kiosks has increased from 57 to 102. Although video visitation does not replace in-person visits, it provides visitors another more intimate way to communicate with an inmate when in-person visits are not possible.

Finally, during the application or re-application to the Institutional Mother-Child Program, the Institutional Head will institute a plan to support the mother’s contact with their child during the application process, which could include granting immediate video visitation for approved visitors or additional telephone communication, prioritization of visiting application, and other measures as appropriate. As part of the Institutional Mother-Child Program, other alternatives to establish and/or maintain the mother-child bond can also be utilized to support participants, including use of escorted/unescorted temporary absences, recording of stories, and pumping/storing of breast milk.

In the event an inmate is transferred away from her home community, sources of family or other persons of support, the Institutional Head has discretion to provide for longer visits and access to family or support persons via telephone contact.

Note that mothers who were released to the community as participants in the residential Mother-Child Program and who maintained custody of their child in the community are eligible for an expedited re-application process if they are returned to CSC custody.

Offenders continue to benefit from the support and representation provided by non-governmental agencies such as the John Howard Society, the Native Women's Association of Canada, and Canadian Association of Elizabeth Fry Societies, as well as the Office of the Correctional Investigator, the Citizen’s Advisory Committee, and other volunteers active in federal corrections. Typically, these organizations are provided unimpeded access to all CSC facilities unless there are circumstances that present a risk to the security of the institution or of any person.

CSC recognizes the importance of peer support and acknowledges its role in assisting individuals within the correctional environment. As such, CSC has implemented a peer mentorship program at women offender institutions. It involves inmate-initiated confidential support and information, as well as guidance to appropriate resources and services within and outside the institution. 

Furthermore, CSC in collaboration with CAEFS created a paid inmate job in 2015, called the peer advocate. The job description was developed in collaboration with CAEFS, and the training is regularly provided by CAEFS. CAEFS Regional Advocates conduct monthly site visits, produce monthly letters to the Warden, and train and provide ongoing supervision and support to CAEFS Peer Advocates. To do so, peer advocates are given the broadest range of access possible within penitentiary environments to support individuals who may benefit from their assistance.

Sections 90 and 91 of the Corrections and Conditional Release Act (CCRA) require that there be a procedure for the fair and expeditious resolution of offenders’ complaints and grievances on matters within the jurisdiction of the Commissioner and that every offender have complete access to the procedure without negative consequences.

In addition, CSC implemented a Complaints and Grievances Resolution Review Committee in 2022, a paperless workflow for grievance decisions in 2023, and an Alternate Dispute Resolution Pilot Project in 2023. These initiatives are contributing to the timely resolution of complaints and grievances.

Offenders can also submit a human rights complaint to the Canadian Human Rights Commission (CHRC). CSC’s Rights, Redress and Resolution Branch works with CHRC to redress and resolve issues raised in complaints.

Finally, to ensure that offenders’ voices are present in the grievance resolution process, every institution has an elected inmate committee that can also play a strong role in ensuring that the rights of every offender are respected.

Please also refer to information provided under AS Recommendation 36.

Please refer to AS Recommendation 73.

That inmates are protected from reprisals related to contacting the RA-IA and exercising their rights.

Inmate rights are enshrined in the Corrections and Conditional Release Act, Corrections and Conditional Release Regulations, Canadian Charter of Rights and Freedoms and the Canadian Human Rights Act. CSC is mandated to treat inmates with legality, dignity, and respect.

Sections 90 and 91 of the Corrections and Conditional Release Act (CCRA) require that there be a procedure for the fair and expeditious resolution of offenders’ complaints and grievances on matters within the jurisdiction of the Commissioner and that every offender have complete access to the procedure without negative consequences.

In addition, every institution has an elected inmate committee that can also play a strong role in ensuring that the rights of every offender are respected.

Finally, the Office of the Correctional Investigator, in its prison ombudsman’s role, holds CSC to account, ensuring liberties and rights are not impaired. CSC’s mission, values, principles, and strategic objectives guide employees to be fair, transparent, and accountable safeguarding the occurrence of reprisal directed toward an inmate exercising legislated rights.

A key principle of CSC’s Mental Health Strategy is that inmates are the central partner in the interdisciplinary team and can collaborate with staff to develop and monitor their own treatment plans. CSC recognizes the value of involving inmates in their care, and in policy review and development. CSC has recently explored new opportunities for inmates to share their experiences and knowledge. For example, in 2023, a total of 50 interviews were conducted with inmates residing in Structured Intervention Units (SIUs) across the country to gather feedback on their experience and perception of health care while in the SIU, particularly the daily visits completed by a health care professional (typically a nurse) and mental health assessments. Also in 2023, Health Services conducted inmates’ experience interviews to gather their feedback regarding person-centered, stigma-free, and respectful communication. Lived experience interviews are also planned as part of the review of CSC’s overall suicide and self-injury prevention strategy. Additional information about the strategy can be found in response to Recommendation 1.

Such initiatives, relying on open and safe communication between CSC and inmates, are believed to be essential in making informed decisions and ensuring the continued delivery of quality, evidence-informed health services. CSC will explore further opportunities to involve inmates with a variety of lived experiences, including those who have experienced mental health issues within correctional systems, in planning, research, training, and policy development, particularly in the development of activities and policies that will directly impact their care.

Additionally,over the next year, CSC’s Research Branch will be working towards incorporating diverse perspectives reflecting lived experience within research design and methodology (including but not limited to federally sentenced women experiencing mental health issues).

While it is expected that staff take responsibility for notifying their manager when they are experiencing burn out or any other health related issue, CSC strongly encourages a supervisor or manager to play a role by promoting the Employee Assistance Program (EAP) to all staff if they think an employee is experiencing difficulties. In addition to the EAP peer support network, management may also direct employees to the Critical Incident Stress Management Program for early intervention support after a critical incident in the workplace. Management can reference the many available resources on the CSC intranet under Employee Essential (Managers, and Your Wellbeing). In addition, CSC’s external EAP provider, Telus Health and the Centre of Expertise on Mental Health in the Workplace provides resources, tools and services for managers and employees.

Please refer to Jury Recommendation 43.

Please refer to Jury Recommendation 57.

Productive relationships with diverse partners, stakeholders, victims’ groups, and others involved in support of public safety is a corporate priority for CSC. Additionally, CSC has established a unique partnership at Regional Psychiatric Centre (RPC) in the Prairies, which is a secure forensic psychiatric inpatient facility operated by CSC.  This partnership is formalized through an affiliation agreement with the University of Saskatchewan in Saskatoon. The collaboration aims to facilitate, promote, and support research in psychiatry and related fields, as well as to provide internship opportunities in psychiatry to enhance recruitment efforts for CSC.  Please also refer to AS Recommendation 7.

The CSC Research Branch continues to conduct research to inform and improve capacity to address mental health needs of federal offenders. Over the last few decades, the CSC Research Branch has conducted numerous studies to support a better understanding of federally incarcerated women, including for  research that focuses on mental health (Prevalence of mental disorder among federal women offenders: Intake and in-custody - Canada.ca), self injurious behaviour (descriptive profiles, approaches to encourage desistance, correlates and trajectories; A descriptive analysis of self-injurious behaviour in federally sentenced women - Canada.ca), suicide risk (review of suicide risk assessment tools; Suicide risk assessment instruments: a review of current literature - Canada.ca), and intellectual deficits (prevalence, profiles and outcomes; Intellectual deficits among incoming federally sentenced men and women offenders: prevalence, profiles, and outcomes - Canada.ca).

Furthermore, research has been conducted with respect to women:

• in segregation before it was abolished in federal corrections (Profile of women in segregation - Canada.ca).

As well, there has been research on approaches to divert women from segregation/SIU’s and/or provide interventions to encourage discharge/transfer out of segregation/SIU’s (e.g., Developing the risk of administrative segregation tool to predict admissions to segregation - Canada.ca).

Studies were also conducted to evaluate the psychosocial rehabilitation of women in women’s Structured Living Environments (SLE; e.g., Evaluation of psychosocial rehabilitation within the women's structured living environments / [by] Antonia Sly and Kelly Taylor. : PS83-3/163E-PDF - Government of Canada Publications - Canada.ca), and more specifically the impact of DBT within a women’s SLE (Preliminary evaluation of dialectical behavior therapy within a women's structured living environment / [by] Antonia Sly and Kelly Taylor. : PS83-3/145E-PDF - Government of Canada Publications - Canada.ca).

The CSC Research Branch uses various dissemination strategies to ensure that research findings are shared with internal and external stakeholders, including but not limited to presentations, briefings, one-page summaries. Research products are made available on the CSC Research website and can also be accessed through the Government of Canada Publications catalogue.

CSC staff are notified of research reports and new research being released on a regular basis.

A printed copy of the verdict and recommendations was posted in an appropriate and prominent location in each of CSC’s Institutions and Treatment Centres for all staff to read within a month following receipt of the Coroner’s Jury Verdict and Recommendations final version.

An electronic copy of the Jury’s Verdict and Recommendations was posted within a month following receipt of the final version, on the internal intranet site accessible to all staff, and on the CSC website, accessible to members of the public.

Please refer to Recommendation 1.

Liaising with external mental health resources is considered a key factor in achieving CSC’s priority to address the mental health needs of inmates and, as such, the organization continually engages with partners to support service delivery. For example, CSC has a long-standing contract with the Ministère de la santé et des services sociaux du Québec for the provision of specialized psychiatric and forensic services in both official languages at the Philippe Pinel National Institute of Forensic Psychiatry.

It is important to recognize that CSC cannot compel external hospitals to enter into exchange of service agreements. Nonetheless, with the assistance of our contracted National Senior Psychiatrist, CSC continues to collaborate effectively with diverse partners and stakeholders, including external hospitals. Mental health consultants are also contracted on an as-needed basis for extensive case reviews of complex cases and to provide clinical guidance.

CSC is committed to exploring opportunities to work in close collaboration with external mental health experts on an ongoing basis, to ensure that we continue to provide the highest standard of care in line with community standards.

Section 29 of the CCRA outlines the ability of the Commissioner to authorize the transfer of an incarcerated person to a hospital, or mental health facility, among other transfer stipulations. Health Services within CSC are provided based on an assessment of need and can range from outpatient health care in mainstream federal institutions, to 24-hour inpatient care at CSC Regional Treatment Centres, which are accredited psychiatric facilities. Recognizing that the ongoing and sustained collaboration of partners is integral to enhancing the quality and accessibility of care and health services for inmates, CSC is currently developing a National Partnership Plan that will help CSC further strengthen external partnerships, including with psychiatric hospitals in the community.

Aligned with Health Services Sector priorities to provide culturally responsive and person-centred care, the national health services partnership engagement plan includes working with stakeholders, external health services, and other organizations and levels of government to enhance health services in key areas. This includes building and strengthening partnerships with psychiatric facilities in the community, taking into consideration their admission criteria and issues of consent for inmates, as well as continuing to collaborate with and maintaining existing relationships. For instance, CSC has a longstanding agreement with Philippe Pinel National Institute of Forensic Psychiatry for the provision of specialized psychiatric and forensic services in both official languages. CSC remains committed to exploring and establishing additional collaborative initiatives to support the provision of federal care and health services.

Finally, PS is aware of the challenges associated with transferring inmates to provincial health care facilities, including the capacity challenges facing community health care and the lack of appropriate security infrastructure in place. PS has engaged with CSC on this issue to receive information and updates and will endeavour to analyze barriers and identify potential solutions as part of our ongoing policy analysis.

As is required by the CCRA, PS and CSC support the professional autonomy and clinical independence of registered health care professionals, including their ability to exercise their professional judgment in the care and treatment of offenders.

Registered health care professionals within CSC must adhere to the standards of their respective Colleges or Associations and are responsible for providing ethical and competent services consistent with provincial and national standards, as well as the relevant regulatory body. Inmates can submit complaints related to the provision of physical and mental health care to provincial Colleges, and these complaints are investigated by the College. Inmates can also submit complaints to the Office of the Correctional Investigator (OCI), which is the independent oversight body for CSC. The OCI is mandated to investigate individual complaints and systemic issues related to the provision of physical and mental health services inside federal correctional institutions.

Additionally, the CCRA requires the support of registered health care professionals in their promotion of patient centered care and patient advocacy. CSC policy (Commissioner’s Directive 800 – Health Services) reinforces patient advocacy as a core responsibility for all health care professionals, including those providing services under contract. Consistent with the requirements of their professional health regulatory colleges, staff will use their expertise and influence to advocate on behalf of patients for provision of care that advances their health and wellbeing.

In support of these commitments, CSC has taken action to develop a dedicated Patient Advocacy Service (PAS) that is distinct from direct clinical care and the broader realm of advocacy provided by health care professionals. A review of patient advocacy principles and models in place in Canada and internationally has been completed. CSC continues to develop and refine the patient advocacy model for federal corrections.  Ongoing discussions are occurring at all levels in the organization to support the delivery of quality and patient-centred care, with an anticipated implementation date of March 2025.

The PAS will enhance direct advocacy and patient navigation support for persons in federal custody. Individual-level intervention will be provided by dedicated Patient Advocates at select institutions, and general information and education will be available for other institutional sites. The PAS will be distinct from direct clinical care and the broader realm of advocacy provided by regulated health professionals. The specialized Patient Advocate role will complement and add value to the current health care system, rather than duplicate or conflict with existing initiatives.

CSC also continues to encourage and support the advocacy work of external independent bodies. This includes facilitating access to provincially appointed Patient Advocates for inmates certified under provincial mental health legislation, as well as inmate advocates from non-government agencies, such as the John Howard Society, the Native Women's Association of Canada, and Canadian Association of Elizabeth Fry Societies. CSC also supports the involvement of family or other representatives serving as a support or substitute decision maker for an inmate. As well, every institution has an elected Inmate Committee that can play a role in decisions affecting the patient population, including reviewing draft policy and providing comments for consideration.

Finally, CSC has implemented a professional practice model whose primary objective is to strengthen the integration of professional standards and development, as well as the monitoring of compliance with policies. In each region, professional practice leads for psychology, nursing, occupational therapy, and social work are available for consultation, offering their respective expertise and identifying best practices in care. A National Health Professional Advisory Committee has been established to help support allied health professionals and enhance the quality of care provided throughout CSC.

This recommendation was addressed to Public Safety Canada.

As mentioned in Recommendation 7, the practice of administrative segregation was ended in 2019 and Structured Intervention Units (SIU) were brought in as a new model.  The SIU model responds to our obligations under Canadian law. Many safeguards specified in Canada’s legislation were guided by international sources such as the Mandela Rules.

In addition, the CCRA contains safeguards to ensure that inmates in SIUs do not experience conditions similar to solitary confinement, as defined in the Mandela Rules. A key safeguard in place is external oversight. The importance of this cannot be understated. Independent External Decision Makers (IEDMs) across the country provide oversight of an inmate’s conditions and duration of confinement in an SIU. IEDMs monitor and review inmate cases on an ongoing basis and provide recommendations and decisions to the Correctional Service of Canada (CSC). Their decisions are binding.

This recommendation was addressed to Public Safety Canada.

CSC developed a process in consultation with women offender institutions’ wardens and CAEFS’ Executive Director to ensure standardized, relevant, and timely responses to CAEFS’ letters in addressing identified issues or concerns. This process acknowledges factual accuracy, and provides revisions to erroneous information, where required, and responds to issues raised and corresponding recommendations. However, to ensure that the above objectives are achieved, that comprehensive responses are provided in response to issues raised, and that personal privacy of persons in custody and CSC staff is ensured, CSC is not supportive of publishing the letters. The process has been implemented.

CSC will be developing a process, in consultation with the Wardens of women offender institutions and CAEFS Executive Director, to ensure standardized, relevant, and timely responses to CAEFS letters in addressing identified issues or concerns, and in considering recommendations made by CAEFS Regional Advocacy Representatives. CSC will endeavour to provide a response to letters within 30 days of receipt. The process has been implemented.

This recommendation was addressed to Public Safety Canada.

CSC is supportive of working collaboratively with CAEFS to consider ways to bolster the Peer Advocacy program.

CSC will also review inmate handbooks of all women offender institutions for potential enhancement of Peer Advocate program role, ensure signage is present in women offender institutions that provides information on the Peer Advocacy program, along with contact information for representatives, and review the Advocacy Worker for Women Inmates Work Description, by March of 2025.

As noted in Recommendation 1, CSC’s model of integrated health care ensures that patients receive health services at a level of care that corresponds to their individual level of health and mental health need along a continuum of care from intake to warrant expiry. Commissioner’s Directive (CD) 843, Interventions to Preserve Life and Prevent Serious Bodily Harm, outlines provisions for transferring inmates to a Regional Treatment Centre or appropriate health care facility/unit (i.e., Regional Hospital or Intermediate Mental Health Unit), to ensure they are provided with care that meets their level of need.

Within CSC’s current model of care, inmates who require more intensive or specialized care are considered for admission to Intermediate Mental Health Care units or Psychiatric Hospital Care at one of the five Regional Treatment Centres (RTCs). This is also reiterated in CD 843 and may be applicable for inmates with ongoing or increased risk for suicide/self-injury. The five accredited Regional Hospitals and five accredited RTCs provide 24-hour care for inpatient services. In all other institutions, where health care is provided through an institutional clinic, hours of operation are established to meet operational requirements while still meeting the essential health care needs of inmates. CSC is currently completing a review of the staffing complement at all RTCs, to ensure the resource model aligns with community-based organizations and allows for the best quality of patient care. Notwithstanding, CSC has a five-year plan to increase nursing staff presence at each RTC. Moreover, the addition of Nurse Supervisors at each Regional Treatment Centre site will ensure 24/7 clinical on-site leadership.

Similar staffing changes are being made at several mainstream institutions throughout the organization, such as increasing the complement of nurses at all institutions for women (one site per region), as well as maximum-security sites for men providing intermediate mental health care (one site per region), to enable the provision of 24/7 health care. Continued investments in mental health will support the implementation of 24/7 health care at designated institutions. CSC will implement these changes by the end of the 2024/25 fiscal year. The implementation of 24/7 is expected to lead to better access to health care professionals thus contributing to reduced wait times to access health services and reduced use of enhanced observation as outlined in CD 843. CSC will monitor clinical outcomes closely in the first year of implementation to ensure effective and efficient health care that responds to the assessed needs of individual patients.

In the interim, all CSC institutions have established protocols that allow for quick access to external emergency services when required in the absence of health professionals on site.

On June 21, 2019, Bill C-83: an Act to amend the Corrections and Conditional Release Act and another Act¸ received Royal Assent. The Act made significant changes to the federal correctional system, including affirming the importance of clinically independent, patient centered health care, and the introduction of patient advocacy services. Specifically, section 89.1 of the Corrections and Conditional Release Act states: “The Service shall provide, in respect of inmates in penitentiaries designated by the Commissioner, access to patient advocacy services to support inmates in relation to their health care matters; and to enable inmates and their families or an individual identified by the inmate as a support person to understand the rights and responsibilities of inmates related to health care.”

CSC’s support of professional autonomy and the clinical independence of registered health care professionals, including their ability to exercise, without undue influence, their professional judgement in the care and treatment of inmates is now reflected in the legislation. Consistent with the requirements of professional health regulatory colleges, the role of health care professionals includes a patient advocacy function for the provision of care that advances health and well-being. The legislation clarifies this existing responsibility and supports health care professionals in providing patient centred care.

Furthermore, in recognition of the fundamental value and role of patient advocacy in the delivery of quality health care, CSC has developed the Patient Advocacy Framework for Federal Corrections. It outlines the approach to providing and ensuring access to advocacy and navigation support to meet the health-related priorities of inmates. Patient advocacy services will help inmates better understand their health care rights and responsibilities. As part of this overarching Framework, CSC will finalize and implement a patient advocacy model within the 2024-25 fiscal year.

As described in the above Recommendation 15 response, CSC is currently in the process of developing a patient advocacy model that will meet the Corrections and Conditional Release Act requirement by providing inmates with the opportunity to obtain support in relation to their health care matters.

CSC’s Mental Health Guidelines (MHG)outline the requirements for the completion ofInterdisciplinary Management Plans (IMPs). The IMP is an integrated clinical, case management, and security intervention plan to assist staff with the effective management of inmates with complex non-suicidal self-injury needs, for them to resume usual activities as soon as practicable. This may include those who repeatedly self-injure and whose ongoing behaviours make it difficult to safely support the inmate. The IMP is completed by the Interdisciplinary Health Team, in accordance with timelines outlined in the MHG. Psychiatrists, as part of the Interdisciplinary Health Team, are involved in the development of Safety Plans and IMPs in accordance with CSC’s policies, including the MHG, andthe Clinical Framework for Identification, Management, and Intervention for Individuals with Suicide and Self-Injury Vulnerabilities.

To provide inmates with efficient, effective health services, all institutional staff and CSC contractors are required, per Commissioner’s Directive 800, Health Services, to relay an offender’s request for health services to a health care professional in a timely manner. It should also be noted that all staff are required to inform a health care professional of the condition of any offender who appears to have a physical or mental health concern, whether the offender identifies a health concern.

CSC’s Mental Health Guidelines (MHG) provide additional details to health care staff regarding the referral process and the prioritization of services, as well as detailed requirements specific to each level of care.

As described in the MHG, once a referral or inmate request is received, a structured process is in place, at each level of care, to ensure the request is appropriately triaged for follow-up. Prioritization of services should be made with a person-centred focus with respect to policy, evidence-based practice, and professional standards. Flexibility and clinical judgement are required to ensure identified mental health needs are identified and appropriately addressed, while taking into consideration that mental health need is not fixed and requires regular re-evaluation in response to changing levels of functioning or need. The prioritization of services ensures that urgent referrals are followed-up on immediately and takes into consideration several factors, including the level of urgency and the presence of any urgent crisis/emergent situations.

In addition to the information presented in Recommendation 1, it is noted that CSC recognizes the development and manifestation of Borderline Personality Disorder (BPD) are multi-faceted, as well as that this disorder is a common diagnosis in many complex, high needs offenders with self-harm and suicidal behaviour. Since December 2012, CSC has worked in partnership with Canada’s largest mental health and addiction teaching hospital, the Centre for Addiction and Mental Health (CAMH) for the provision of ongoing consultation in the implementation and delivery of Dialectical Behaviour Therapy (DBT).

Furthermore, in 2018-2019, CSC created a working group, led by CSC’s National Senior Psychiatrist, to develop guidelines for the management of inmates suffering from BPD within CSC. As a result, in July 2022, CSC published the Clinical Handbook for Borderline Personality Disorder which included comprehensive literature review to ensure that at the time of writing, the content is informed by the latest available evidence. The handbook was developed to aid staff in their work with inmates with BPD, and provides evidence-based principles for assessment, crisis management, and treatment.

Please refer to Recommendation 1.

CSC is committed to using language that is respectful, avoids contributing to stigma, and supports the effective prevention and intervention for inmates who engage in self-injurious and/or suicidal behaviors. By the end of October 2024, CSC will identify and establish suitable alternatives to the term “instigator” within the Incident Reporting module, to identify a term that reflects and acknowledges the sensitivity of these occurrences.

Once an Offender Management System enhancement can be implemented to add this new term, CSC will issue a bulletin to inform staff of the new terminology and direct them not to identify offenders who engage in these behaviours as “instigators”. The security bulletin will also instruct staff to not categorize these occurrences as “disciplinary problems” or “disruptive behaviours” when reporting and recording those incidents.

A practice reminder has been promulgated, reminding staff on how to support respectful and stigma-free communication about suicide and self-harm with offenders under CSC’s custody and/or community supervision. Health services commits to ensuring that as health and policies come up for review, efforts will be made to align with stigma free principles and practices.

Please see Recommendation 21.

When a person in custody at a CSC institution or regional treatment centres is in a mental health crisis or is decompensating, CSC staff on their health care and case management teams must perform a thorough review of all of the person’s past treatment plans to assess what may have been successful interventions in the past that could be considered and used in the present.

CSC health services have extensive policies and processes to identify, monitor, and respond to offenders who are in mental health crisis or decompensation, and licensed health care professionals must provide care in accordance with the standards of practice, legislation, and by-laws of their provincial college or licensing body, including comprehensive file review as part of determining the most appropriate interventions for each patient.

CSC’s Mental Health Guidelines include specific guidance on the coordination of care and consultations, as well as outlining key roles of health professionals in the assessment and treatment process, including responsibilities for comprehensive file reviews. The Mental Health Guidelines also specifycontent for the Treatment/Intervention Plan, including an evaluation of previous treatment reports and discharge reports. Moreover, the evaluation process includes a review of collateral information, which would include any relevant information from any external consultations or sources.

The purpose of CD 843, Interventions to Preserve life and Prevent Serious Bodily Harm, is to ensure the safety of inmates who are self-injurious, are suicidal, or have a serious mental illness with significant impairment, by using observation or restraint as a last resort. The purpose of observations is for the preservation of life and prevention of serious bodily injury, while maintaining the dignity of the inmate within a safe and secure environment. Observation levels under CD 843 are health mechanisms to ensure the safety of the inmate when they are at elevated risk of harming themselves and need to be maintained in a secure environment. Such measures are also to be applied for the shortest duration possible as informed by daily assessments of the mental state of the inmate by a registered health professional.

CSC recognizes that inmates know their needs and should be actively involved in making treatment decisions to address these needs. Person-centered care, in which the inmate is an active member of the health care team, supports comprehensive and integrated health care, and is a priority for CSC. Inmates are encouraged to provide input into their care and treatment plans, including safety plans. CSC’s approach to suicide prevention is based on close collaboration with the inmate, who is at the heart of the development of a safety plan, which identifies strategies of managing their vulnerabilities, including when in times of crisis.

CSC has implemented several mechanisms over the years to facilitate the review of its correctional operations and health services. Enhanced observation is to be used for the shortest possible duration and only after all reasonable efforts to use less restrictive measures and de-escalation strategies have been considered or implemented and assessed as ineffective. To this effect, as stated in the CD, the Interdisciplinary Mental Health Team (IMHT) will review all uses of restraints or enhanced observation as soon as reasonably possible following an incident to propose strategies to respond to future incidents. Concerning a requirement for the Warden to visit observation cells, inmates under enhanced observation must be assessed at least every 24 hours by a Health Professional, including on weekends or statutory holidays. These mental health assessments will assist in determining whether enhanced observation continues to be required or if the enhanced observation needs to be modified or discontinued, with the goal of returning the inmate to regular activities as soon as practicable.

Furthermore, the CD requires that to identify and guide quality improvement initiatives:

1. the Chief, Mental Health Services, will collect data on the use of the Pinel Restraint System and enhanced observation and discuss the data at least monthly at the Interdisciplinary Mental Heath Team meeting;
2. the Regional Complex Mental Health Committee (now the National Person-Centred Health Committee) will review data on the use of the Pinel Restraint System and enhanced observation quarterly;
3. the National Complex Mental Health Committee (now the Regional Person-Centred Heath Committee) will review data on the use of the Pinel Restraint System and enhanced observation bi-annually;
4. health management at the local, regional, and national levels will provide data and reviews to their respective Quality Improvement and Patient Safety Committees when potential quality improvement initiatives have been identified.

CSC acknowledges that recruitment and retention of qualified mental health professionals is essential in the provision of effective mental health services. CSC’s health services are provided by a range of registered health care professionals, many of whom provide the same services in their local communities. These professionals adhere to the same professional standards as those practicing in the community. Additionally, they are trained in the delivery of mental health services and qualified to respond to the needs of inmates throughout their sentence, in accordance with professional practice standards and their clinical judgment.

Furthermore, CSC requires that health care professionals complete extensive training on topics such as, the Clinical Framework for Identification, Management, and Intervention for Individuals with Suicide and Self-Injury Vulnerabilities, Dialectical Behaviour Therapy, the Pinel Restraint System, and Trauma Informed Care. Additionally, CSC offers training on the Integrated Modular Treatment for Personality Disorders. Health care professionals also have access to relevant clinical information that can help guide their interventions, such as the Clinical Handbook for Borderline Personality Disorder.

CSC also reiterates the clinical coaching available to CSC’s health professionals through existing contracts with the Centre for Addiction and Mental Health or with other external consultants on an as-needed basis, as well as through consulting with the National Person-Centred Health Committee or the Regional Person-Centred Health Committees. Additionally, CSC has established regional and national psychiatry leads whose role includes oversight and leadership for their discipline and to work in conjunction with CSC Regional and National Health Services management team and other members of the Healthcare Team to advance the healthcare of inmates.

As a result, in July 2022, CSC strengthened the clinical support available to teams working with inmates experiencing mental health issues through the publication of the Clinical Handbook for Borderline Personality Disorder, namely through the possibility of consulting with regional and national committees such as the National Person-Centred Health Committee and the Regional Person-Centred Health Committees, as mentioned in response to Recommendation 25.

Recruitment and retention efforts in Health Services have focused on key areas including the implementation of professional practice structures to support frontline staff, enhanced ongoing professional development, and the implementation of more senior leadership positions at each institution to support staff and better organize care delivery.

Following the passage of Bill C-83, which reiterates that CSC must support the professional autonomy and clinical independence of registered health care professionals in the provision of patient-centred care and ensure that their rights are respected, CSC Health Services have promoted a professional practice model whose primary objective is to strengthen the integration of professional standards and development, in complementarity with the monitoring of compliance with policies. In each region, professional practice leads for psychology, nursing, occupational therapy, and social work are actively working on implementing this model, by being available for consultation, offering their respective expertise and remaining on the lookout for the latest trends in care. As such, these qualified mental health professionals constitute precious resources when it comes to meeting high standards for the treatment of inmates presenting with various mental health problems, including BPD. The National Professional Practice Advisory Committee provides oversight of CSC Professional Practice, as well as advice and recommendations to the Health Services Executive Team on matters relating to professional practice.

Research in the field of mental health and personality disorders is rapidly evolving, which requires a considerable time investment for Psychologists to remain current and up to date with the most recent developments. It is important to note that Psychologists are required by their licensing bodies to ensure that they develop, perfect, and maintain their knowledge and skills in the field in which they carry out their professional activities. They have a professional obligation to seek out and pursue relevant clinical training as part of their continuing education requirements. To assist Psychologists and other registered health professionals in maintaining knowledge in their field, effective May 24, 2023, CSC procured access to three Elton B. Stevens Company (EBSCO) databases (EBSCO is an online host for academic and health databases that provides access to current research from a number of journals) for use by CSC health professionals. The databases included the Psychology and Behavioral Sciences Collection, which is a database providing comprehensive information on topics relating to psychiatry, psychology, and mental health. This database provides CSC health professionals with access to full text articles from over 300 journals.

In addition, Professional Practice Leads (PPL) for Psychology are available in each region to provide psychologists with consultation, support and information about recent developments. The PPL is responsible for ensuring that services meet professional practice and regulatory requirements.  Their key responsibilities include: ensuring compliance with professional standards and regulatory requirements of health professions; providing direction and advice regarding efficiency opportunities; advise and educate management and staff on changes related to legislation, regulation and policy and procedures of professional bodies; support delivery of education and evaluation; and participate in the development and implementation of organization wide changes.

CSC, as part of the Federal Government of Canada, is subject to the requirements for Canadian federal departmental accountability for performance information and evaluation, as outlined in the federal Policy for Results. CSC’s policy framework comprises national policy instruments which, collectively, stipulate the responsibilities and accountabilities on the policy objectives the organization will accomplish, and provides indicators on which the performance of the Service will be evaluated.  Policy instruments are developed in a manner that enable the assessment of the level of compliance and/or achievement of the policy objectives. All instruments within the policy framework align within the overall governance structure and “Core Responsibilities” for the Service in accordance with the CSC’s Corporate Business Plan, which further details the core responsibilities of CSC’s Organizational Structure, Program Inventory, and Departmental Results Framework (DRF). The DRF establishes an objective basis for the collection and reporting of performance information in relation to Core Responsibilities to improve programs, policies, and services in support of the Policy on Results. This includes indicators on mental health and self harm. On an annual basis, CSC reports to Parliament and Canadians in relation to departmental performance indicators, as well as performance and achievements over the past fiscal year against the plans, priorities, and expected results.

CSC utilizes several information sharing strategies to ensure that those with a need to know are aware of relevant information as soon as possible. “Need to know” is defined as information that is pertinent and necessary to an individual performing their duties. These strategies include the Offender Management System, unit logbooks, daily operational meetings (which include Security Intelligence Officers (SIOs), case management officers, and members of interdisciplinary health teams), shared meeting minutes, security intelligence briefings, as well as direct staff communication. SIOs are trained to notify relevant staff if they receive urgent security and intelligence reports or information, including information related to the health care or mental health of an offender, to ensure awareness and appropriate follow up. Additionally, Commissioner’s Directive 705-5, Supplementary Assessments, requires staff to immediately refer a case to mental health services when an inmate requiring such interventions is evident.

The recording and sharing of security information will normally be completed by all institutional and community staff using the reports described in Commissioner’s Directive 568-2, Recording and Sharing of Intelligence Information and Intelligence. Each report has specifically delineated distribution and filing instructions, as well as direction on who can author and sign. To meet legislative and policy sensitivity and confidentiality requirements and abide by government security policy related to personal information, it is necessary that most of the security and intelligence reports only be accessed by those with a need to know. This is accomplished by filing these reports in the Preventive Security (PS) file (as well as relevant electronic repositories) and ensuring access control, as delineated in Commissioner’s Directive 568-6, Creation, Control and Handling of Preventive Security and Intelligence Files, and adhering to paragraph 4 of Commissioner’s Directive 701, Information Sharing. Lastly, staff with a need to know, including case management teams and interdisciplinary health teams, regularly access the PS file of offenders on their caseload, to ensure they are aware of all relevant security intelligence information.

CSC promotes an interdisciplinary approach to mental health issues and continually updates its policies and work to ensure information-sharing practices are in-line with community standards, legislation, and best practices. Relevant health information is shared in accordance with CSC policy, including the Guidelines for Sharing Personal Health Information, which articulates the "need to know" principle.

Each inmate/patient has an Interdisciplinary Team consisting of a Correctional Officer (CO), Parole Officer (PO), and Clinical Case Coordinator (CCC), supported by the unit management team, Security Intelligence Officer (SIO), the Clinical Division, and senior management of the institution. During Interdisciplinary Team Meetings (IDTMs), teams discuss patients identified as having serious mental illness with significant impairment, patients being monitored with enhanced observation, as well as team member observations of patients regarding well-being, behaviour, and engagement in interventions. IDTMs allow discussions to occur between regularly scheduled case conferences and provide an opportunity to trigger further individualized focus if required. The information discussed is documented and saved on a shared drive and the minutes distributed to unit staff via email. Senior management in operations and health services can review the minutes and follow up with any areas of concern. IDTMs occur on the units weekly, in addition to individual Case Conferences, which follow a schedule to review case specific needs.

Case Conferences are opportunities for each assigned team member (CO, CCC, PO), unit managers (Correctional Manager - CM) and Chief of Health Services (CHS) or Chief of Mental Health Services (CMHS) to meet with the patient and discuss relevant health/mental health concerns, behaviour, and engagement in interventions/treatment plan. The SIO is also included to share relevant security related information with the team.

In addition to Case Conferences and IDTMs, units utilize a shift report to document observations and interventions throughout a 24-hour period. The CM and Clinical Team Lead review unit concerns and individual cases requiring specific attention daily. A daily operational briefing is also held by the CM in charge of the institution where any unit or individual concerns are raised for awareness. Follow-up is ensured by the Assistant Warden Operations and CHS or CMHS.

Further to the unit based IDTMs and Case Conferences, other platforms for communication between Health Services and Security include morning minutes, shift briefings (attended by health services and security staff), unit white boards, logbooks, shift reports, and Statement Observation Reports (SORs).

CSC’s model of mental health services delivery promotes engaging with an inmate’s identified circle of support as it can provide a valuable resource for working collaboratively to address a person’s health needs. These can include family, friends, external health partners, as well as CSC health (i.e., the Interdisciplinary Health Team) and non-health staff (parole officer, correctional officers, correctional program officers, teachers, chaplains, or elders/spiritual advisors). It is important to reiterate that identification of people in the inmate’s circle of support is done with full engagement and consent of the person, if they are legally capable to do so. Engaging such supports can be beneficial with evidence of better mental health outcomes, including improved ongoing adherence to treatment, and decreased frequency and severity of relapse. Roles for supports can include encouraging and supporting interventions; monitoring symptoms and signs of changes to health needs; helping in crisis management; assisting in navigating through health services; providing information on the inmate that can assist health professionals to better understanding the inmate and their health needs as part of both assessment and treatment; and enhancing compliance with treatment. For inmates who are not capable of providing consent to assessment and treatment, provincial legislation must be followed, including engagement with Substitute Decision Makers as required for decisions on treatment.

Family/supports or spiritual, cultural contacts are encouraged and supported as much as possible within CSC. Commissioner’s Directive 800, Health Services, identifies that the provision of health care must adhere to professional standards. Professional standards for registered health care providers recognize the involvement of family members in treatment. The decision to include family must be made with the consent of the inmate and based on an assessment by the treatment team that participation will enhance treatment.

Additionally, every inmate who presents a moderate or high acquired capacity for suicide requires a Safety Plan, which is a collaborative living document developed by the inmate and staff to prepare proactively for coping with early signs of a problem. External Coping speaks to the importance of family connection and communication. The fifth step of Safety Planning is “Using External Help.” At this stage, the focus is on non-specialized (i.e., non-professional) help. People identified in this section can include peers and external social supports (e.g., family member, friends from the community).

Recognizing the importance of accurate and timely data on key indicators, including self-harm, observation, and Structured Intervention Units (SIUs), CSC has mechanisms for tracking and reporting this information. CSC staff have access to the Corporate Reporting System, which reports on incident data by month and year, and numerous reports are produced related to SIU use and distributed monthly. Staff have access to reports of inmates on observation through the Offender Management System. Indicators related to SIUs, and self-harm are a part of CSC’s public facing Departmental Results Report that is published yearly.

Furthermore, Health Services staff have access to dashboards that support clinical care, the most relevant ones focused on assessment of vulnerability to suicide, rates of self-harm and overdose in the past 4 weeks, as well as specific dashboards focussing on the health needs and outcomes of those in SIUs. Staff also have access to corresponding patient lists that support these dashboards and provide reminders at the inmate level of scheduled clinical activities such as completion or updating of assessments. As these dashboards contain confidential health information with high risk of re-identification due to small numbers, they are only available to health services staff who already have access to this information through the Electronic Medical Record. However, summary data from these dashboards is shared on an as needed basis.

CSC recognizes the importance of providing employment opportunities, skills development, and life skills for inmates, including those incarcerated at a young age.

CSC offers a variety of employment and essential skills programs to assist offenders in preparation for their safe and successful community reintegration. These programs are structured interventions and activities that help offenders gain employment skills and life skills. Programs include the National Employability Skills Program (NESP), Community Integration Program (CIP) for men, Social Integration Program for Women (SIPW), vocational certifications, on-the-job-training, and apprenticeship training hours in a variety of fields. These interventions are offered to all offenders with a focus on those with moderate to high employment needs.

Specifically, the NESP helps offenders to increase their employability skills, which improves their likelihood of finding work and maintaining it upon release. The program aims to enhance skills related to communication, problem-solving, managing information, positive attitudes and behaviours, adaptability, and working with others.

CSC also offers a variety of social programs to assist offenders in adjusting to incarceration and preparing for community reintegration. Social programs are structured and unstructured interventions and activities, which help offenders learn important skills, make positive social connections and healthy life choices, and address issues related to community living and employment.

The CIP was revised in 2021-2022 to provide offenders with current, applicable, and culturally relevant information to support their release. The program’s referral criteria were also reviewed, and two criteria were added to ensure that all offenders (including offenders incarcerated at a young age), who are one year prior to release and may benefit from the program, are captured accordingly. CSC continues to work towards building a sustainable delivery strategy for the CIP that involves more consistent referrals at intake, as well as enhanced delivery and reporting mechanisms.

In addition, CSC made several updates to the Structured Intervention Unit Social Program (SIU-SP), to adequately respond to the SIU population’s emerging needs. New activities were developed to supplement the existing SIU-SP activities. Every proposed activity included in the program was developed to address the factors that research identifies as being linked to offenders’ transfer to the SIU.

The SIPW is designed to help women offenders plan for a successful transition into the community. The SIPW assists women offenders in addressing concerns related to their upcoming release and social integration. SIPW is offered to all women offenders, prior to their release to the community. The Program is aimed at helping participants identify their strengths and areas for improvement. Participants also learn and review practical skills to maximize the potential for a successful social integration. The goal of this program is to target community living issues or other barriers to reintegration. SIPWs holistic, considering all life areas; physical, spiritual, mental, and emotional. Participants explore topics such as: time management, health and wellbeing, importance of self care, building social support networks, creating new relationships, managing difficult relationships, parenting skills, résumé writing, job interview skills, leisure, employment, budgeting; and expectations of being on parole.

Furthermore, CORCAN, a Special Operating Agency within CSC, responsible for the employment and employability program for federal offenders has gathered and analysed information on employment needs and interests of offenders through feedback forms completed by incarcerated offenders and those under community supervision. The information gathered, along with ongoing labour market analysis, is considered when determining the type of employment intervention offered. CORCAN is also conducting an employment review within all institutions to assess process, policy gaps, and types of employment offered. The expected outcome is to establish a structured and integrated employment program model based on offenders needs, operational requirements and labour trends.

CSC remains active in maintaining existing and developing new partnerships with various external stakeholders to collaborate in helping persons in custody develop employment and life skills. CORCAN continues to work towards providing employment and employability skills to offenders in the institutions and in the community to assist in obtaining meaningful employment, and to become law abiding citizens, thus reducing the risk of recidivism.

In terms of requests for cell moves, CSC’s current policy, Commissioner’s Directive 550, Inmate Accommodation, specifies that the Institutional Head may give priority for a single cell to inmates with a precarious medical condition, a known mental health problem, or other factors to ensure a safe and secure environment. Operational practices support the policy in that, when inmates request a cell move, the Correctional Officers and/or Correctional Managers, consider them on a case-by-case basis. In making their decision to allow or deny a move, the availability of a cell and the risk associated with the move are considered.

For example, CSC has a policy and guidelines on Incompatible Offenders, which provide direction on how staff should respond to and manage interpersonal challenges between offenders. 

Sections 90 and 91 of the Corrections and Conditional Release Act (CCRA) require that there be a procedure for the fair and expeditious resolution of offenders’ complaints and grievances on matters within the jurisdiction of the Commissioner and that every offender have complete access to the procedure without negative consequences.  An offender’s use of the Complaint and Grievance Process has no impact on their privileges, temporary absences, or other parole considerations.

Sections 90 and 91 of the Corrections and Conditional Release Act (CCRA) require that there be a procedure for the fair and expeditious resolution of offenders’ complaints and grievances on matters within the jurisdiction of the Commissioner and that every offender has complete access without negative consequences.

Our current policy in relation to the first two levels of the grievance process (complaints and initial grievances) includes timeframes of 15 and 25 working days, respectively (within 45 calendar days).  However, the current timeframes for the resolution of third (final-level) grievances are between 60 and 80 working days but CSC is currently resolving final-level grievances within an average of 49 working days and will build on its current positive progress to ensure timely resolution, including through changes to internal policy.

In addition, CSC implemented a Complaints and Grievances Resolution Review Committee in 2022, a paperless workflow for grievance decisions in 2023, and an Alternate Dispute Resolution Pilot Project in 2023. These initiatives are contributing to the timely resolution of complaints and grievances.

Finally, to ensure that offenders’ voices are present in the grievance resolution process, every institution has an elected inmate committee that can also play a strong role in ensuring that the rights of every offender are respected.

In accordance with legislation and regulated professional standards, health professionals are required to consider issues of consent and ensure that informed consent of an inmate is obtained for health assessments and treatment, as well as the sharing of personal health information. As per CSC’s Mental Health Guidelines, section 2.6.1, obtaining informed consent requires that the limitations to confidentiality, including those specific to a correctional environment, or distribution of information gathered from the services provided are explained to the inmate.

Within CSC, relevant health information may be shared in keeping with professional standards and only upon the inmate’s consent to its disclosure. Notwithstanding the obligation to protect personal health information, there are requirements under law where health professionals are required to divulge information, including in a correctional or forensic context, such as information suggesting a risk of danger to that inmate or to another person and information relevant for decision-making or supervision purposes. These and other limits of confidentiality specific to the service being provided must be explained to the inmate by the health professional. Since sharing mental health information with the inmate’s case management team or other relevant staff (such as security staff or program staff) is an inherent part of providing health services within a federal environment, CSC sees value in consulting with front-line health care providers to better understand how this may impact their ability to provide essential health services.

The assessment of the offender’s risk forms the basis for any conditional release decision made by the Parole Board of Canada. CSC provides information to the Board on the offender’s criminal history, their involvement in programs and interventions, their release plan and release suitability and ultimately makes a recommendation to the Parole Board, including a recommendation for conditions of release. An inmate’s repeated or long stays at Regional Treatment Centres or psychiatric facilities is not considered a risk in itself, however, CSC will review the inmate’s behaviour as well as the progress they have made, including the necessary supports that are in place to enhance the success of temporary absences or conditional release.

CSC offers a peer mentorship program in all its women offender institutions. Peer mentorship is a non-judgmental approach using trained women offenders to assist one another in coping effectively with their present circumstances. Peer mentorship is not about providing therapeutic counselling, but involves inmate-initiated confidential support and information, as well as guidance to appropriate resources and services within and outside the institution. It is a gender-specific approach with an aim of empowering women offenders and increasing self-efficacy.

CSC is currently reviewing the peer mentorship program with a focus on new inmates and their orientation. The revised program is expected to be finalized by March 31, 2025. Once completed, CSC will also explore the inclusion of this program and primary contact in inmate handbooks by September 30, 2025.

A process for posting available resources for inmates is currently in place at the site level, however, a reminder to the Institutional Heads to ensure compliance with this expectation was sent by the Deputy Commissioner for Women in September 2024.

In consultation with CSC’s Deputy Commissioner for Women, Human Resource Management will review the title and the content of the Behavioural Counsellor job description and pay particular attention to references to providing counselling or therapy to offenders. The final revision is expected to be completed in December 2024. Once the job description and title has been reviewed, any updates will be made as required, including to the Statement of Merit Criteria. All advertised selection processes and appointments from then on will reference the updated information, which will also be communicated to staff following implementation.

Existing policy, such as Commissioner’s Directive 578, Intensive Intervention Strategy in Women Offender Institutions/Units, ensures Behavioural Counsellors (BC), who are not registered health professionals, collaborate with a registered health care professional regarding the delivery of mental health services. The work description for BCs, states that they are to provide behavioural interventions in support of approved mental health treatment models and that this will be done with functional supervision from a licensed mental health professional when related to treatment activities. The policy also specifies that BCs “(…) under the functional supervision of a licensed mental health professional, provides ongoing feedback related to the skills training and treatment tools used in conjunction with the Dialectical Behavioural Therapy (DBT) and other treatment modalities”. It should also be specified that BCs working in institutions for women are involved in DBT training, namely, Self-Study, Introduction and Coaching, Consultation Team, Skills training components, as well as ongoing Refresher training.

Employee benefits such as lunch breaks, rest periods, vacation, and other type of leave are contained in collective agreements. CSC management has the responsibility to respect the provisions of collective agreements and ensure that the rights and benefits they contain (e.g., hours of work, breaks, lunch periods, leave, etc.) are appropriately managed. Any additional benefits are to be collectively bargained between Treasury Board of Canada Secretariat (the “Employer”) and the bargaining agents which represent the employees.

Within institutional routines, breaks must occur within certain hours, which is taken into consideration and managed on a rotational basis. Deployment Standards outline the posts that must be filled and those that can be operationally adjusted to assist with managing rostering pressures. Institutional senior management at CSC institutions and Regional Treatment Centres will ensure that there is adequate staffing coverage on all shifts to permit all staff, regardless of rank or position, to take regular lunch and health breaks in full. Institutional senior management shall also ensure that adequate staffing exists to permit front line staff the ability to take periods of rest or relief.

Behavioural Counsellors are currently targeted for Suicide and Self-Injury Intervention initial training that focuses on suicide and self-injury vulnerabilities experienced by offenders as well as staff responsibilities in suicide and self-injury intervention. Following this initial training, Behavioural Counsellors complete training developed specifically for CSC Health Care Professionals, namely Suicide and Self-Injury Assessment and Suicide and Self-Injury Needs Classification and Intervention Planning, followed thereafter by annual Continuous Development training. These courses focus on Health Care Professionals’ specific roles and responsibilities in suicide and self-injury intervention.

While some of CSC training such as Suicide and Self-Injury Intervention, Trauma-Informed Approach and the Employee Mental Health Refresher Training introduce concepts around indirect trauma, compassion fatigue, and burnout, CSC will undertake a review of the training in Fiscal Year 2025 to 2026 and implement revisions accordingly in 2026.

CSC has training on Supporting Employee Mental Health in a Correctional Setting for Managers and Supervisors as part of the Mental Health Preparedness and Refresher Training Program. This training provides managers with strategies, tools, and resources to support their employees as well as empower self-care practices. CSC will review its trainings in Fiscal Year 2025 to 2026 and implement revisions accordingly in 2026.

CSC is currently adjusting the target group for Fundamentals of Mental Health training. Revisions, which are expected to be completed by April 2025, will include all CSC staff and will be delivered in the New Employee Orientation Program. 

Mental health issues, and specifically Borderline Personality Disorder, are included in the Fundamentals of Mental Health Training which will be delivered to all staff in the New Employee Orientation Program as of April 2025.

CSC employees also have access to online training courses such as: Cognitive Disorders and Personality Disorders, Effective Interventions for Offenders who Engage in Self-injury, Introduction to Trauma-Informed Approach in Corrections, and the Application of Trauma-Informed Approach in Corrections.

The Trauma-Informed Approach was added to the National Training Standard for case management staff on April 1, 2024.

CSC employees complete the following mandatory training: Suicide and Self-Injury Intervention Training, and the Suicide and Self-Injury Intervention Continuous Development Training. Training is delivered in the New Employee Orientation Program and the Correctional Training Program with the continuous development training being offered annually to staff that have interactions with offenders.

CSC’s Suicide and Self-Injury Intervention and continuous development training addresses the reasons for self-injurious behaviour in a correctional setting as well as effective responses that encourage engagement with the offender and interdisciplinary teamwork. 

The Cognitive Disorders and Personality Disorders online course is currently available to employees. This training will be provided as part of Parole Officer Continuous Development in 2024-2025 to all case management staff. There is currently a module on Cognitive Disorders in the Fundamentals of Mental Health online course and this topic will be expanded in the Fundamentals of Mental Health in-class revised training targeting all CSC staff, when completed in April 2025.

As a further resource, the Hub contains a range of Responsivity Resource Kits that provides program staff with the tools required to work and interact effectively with offenders that have diverse needs. This includes resources kits for offenders with intellectual disabilities, learning disabilities, as well mental health needs.  Behavioural Counsellors at Women’s Sites are included in the Dialectical Behavioural Therapy National Training Standards which includes training on working with people with Borderline Personality Disorder.

Frontline staff currently have access to a variety of services in support of their psychological wellness, provided through their benefits and additional avenues.  The Public Service Health Care Plan – Canada Life provides coverage to employees for mental health related services and products not covered under provincial or territorial health care plans.

In addition, CSC’s internal Employee Assistance Program (EAP) is a voluntary and confidential support service comprised of over 800 specially trained EAP and Critical Incident Stress Management (CISM) peers. Peers are available to respond in a timely manner in support of their colleagues in times of stress, post-trauma or crisis.

Furthermore, various Workers' Compensation Boards across Canada provide wage-loss benefits, medical coverage, and support to help people get back to work after a work-related injury or illness (including psychological disability/illness). Boards provide no-fault collective liability insurance and access to industry-specific health and safety information.

Finally, Sunlife/Industrial Alliance provides long-term disability insurance benefits under the Disability Insurance (DI) Plan to eligible employees of the public service, including eligible members of certain designated groups, who become totally disabled and are unable to work. The DI Plan covers employees included in collective bargaining who are employed by the Treasury Board or a designated agency or corporation.

These programs, services and EAP/CISM peer contact information is all readily accessible on the organization’s intranet, as well as promoted through information campaigns and embedded in the National Training Standards curriculum.

CSC is in the process of developing confidential electronic forms for employees to provide anonymous feedback on Telus Health, Employee Assistance, and Critical Incident Stress Management Peer services. It is anticipated the feedback forms will be available for use by the end of 2024. Data collection will then commence, and the Employee Assistance Program will review feedback received and consider changes and improvements in support services that CSC can offer its employees.

Based on this recommendation, CSC will look at existing processes and/or develop standardized processes to ensure participant’s feedback is received, and responses are monitored, to improve training content and delivery, if applicable by March 31. 2025.

Casual employees can find information related to their work position on the Hub, including modules on CSC’s mission, CSC and the Law, History of Solitary Confinement, Implementation of Structured Intervention Units in Canada CSC facilities, governing legislation, policies, procedures, and Commissioner’s Directives. Also, casual employees must complete, as part of a National Training Standard mandatory requirement, the New Employee Orientation Program Kickstarter A within 15 business days of commencing employment, which includes 15.75 hours of online training.

Contract employees are provided a document titled: “The Information Guide for Contractors” which also includes information on the above-mentioned topics.

The Suicide and Self-Injury Intervention initial training course has a test included in the Correctional Training Program. However, participants have unlimited attempts to pass. CSC will look at the impact of including several attempts to pass and adjust accordingly by March 31, 2025.

Mental health crisis, such as suicidal or self-injurious behaviours, are complex clinical issues with operational impacts that require a comprehensive and multifaceted approach; as such, responses to such situations need to balance health with security considerations. Taking this into account, as noted in Recommendation 1, the Engagement and Intervention Model (EIM) incorporates a person-centred, integrated approach which promotes engagement and intervention strategies for security and health responses.

Introduced in 2018, the EIM is a risk-based model intended to guide staff in both security and health activities to prevent, respond to, and resolve incidents, using the most reasonable interventions. It is a critical thinking model that provides descriptive response options, incorporating a strong health response component, to reinforce dynamic decision-making and judgment through assessment and reassessment of situational factors, as well as implementation of a range of responses, including verbal and non-verbal communication, negotiation, conflict resolution, and de-escalation techniques. The EIM was developed to emphasize the importance of non-physical and de-escalation responses to incidents.

The EIM encompasses a health-focused response in situations involving a mental health crisis and/or medical emergency. When Health Services professionals are on site, they assume responsibility for the overall management of the health intervention as soon as they arrive on scene. Health Services professionals specify any health interventions that is required and this intervention is initiated when it is deemed safe to do so.

All engagement and intervention strategies are person-centered and take into consideration the offender’s health and wellbeing, as well as the safety of all persons. Consideration is given to the needs of the offender, which may be diverse and complex (e.g., culture, age, religion, physical/mental health, substance use, history of violence, gender, etc.). Internal and external factors that can affect an offender’s behaviour are also considered. Every intervention is managed using the safest and most reasonable response and be limited to only what is necessary and proportionate to resolve the situation.

CSC provides specific training on the use of the Pinel Restraints System (PRS), for both health services staff and operations staff. PRS training for Operations staff was reviewed and updated in January 2023. Included in the training content is the recognition of the impact the application of Pinel restraints can have on an inmate. The training reinforces the Engagement and Intervention Model (EIM) in that every intervention is person-centred with a focus on de-escalation and least restrictive approach while the level of risk is continuously being reassessed. 

Health training highlights the importance of the therapeutic relationship between the care team and the person. Training includes themes such as: the value of creating an alliance with the person to help minimize the use of the PRS and maximize the person’s independence, improving quality of life, as well as the importance of preserving the person’s self-worth and dignity.

Recognizing that restraints are to be used as a last resort, training encourages staff to consider several factors when determining the best interventions for each case. For example, exploring how restraining someone may reinforce the inequality of power in the staff-patient relationship, addressing the underlying power dynamic that is involved and how restraints can be seen to exacerbate the power and control held by staff, thus creating a greater power imbalance and more of a sense of “them and us”. The training also elaborates on how restraints can be experienced as abusive, degrading, and traumatic by some inmates. These are important factors to consider when making decisions around the use of restraints and should be balanced with the need to ensure the safety and security of the inmate.

The theme of justification and fairness is also echoed throughout and is integral to the inmate being able to process, understand, and move on from the experience of being restrained. Finally, training addresses other questions pertaining to the inmate’s subjective experience such as how interacting with the person before, during, and after the restraining process may help decrease the negative impact of the measure.

The Corrections and Conditional Release Act was amended in 2019 to authorize CSC to use body scanner technology to prevent the entry of contraband into federal correctional institutions. Overall, the implementation of Body Scanner technology, a safe and less intrusive tool (in terms of the preservation of dignity), will reduce the need for routine and non routine strip searches of offenders. 

Amendments to the Corrections and Conditional Release Regulations (CCRR) are required to operationalize this legislative modification. Once the regulatory amendments come into force, CSC be able to use body scanners to detect contraband that is located on, or inside, an offender’s body. CCRR amendments are expected to come into force on October 1, 2024.  CSC will begin to procure body scanner devices beginning Fall 2024 and deploy these devices to sites over the next several years. 

Since July 2022, CSC has been piloting body scanner technology at Bath Institution and Edmonton Institution for Women.  Until the amendments come into force, inmates must agree to go through the body scanner.  Generally, both staff and inmates alike have responded positively to the use of body scanners as it reduces the need for strip searches.

The practice of solitary confinement was ended in Canadian federal correctional institutions as part of the abolition of administrative segregation and the creation of Structured Intervention Units (SIU) in 2019. SIUs are used as a last resort to manage those who cannot safely reside within a mainstream inmate population and are intended as a temporary measure to assist inmates and provide them with the opportunity to engage in targeted interventions and programs to support their safe return to a mainstream inmate population as quickly as possible.

The CCRA requires that when a decision not to remain in an SIU is rendered, the inmate must be released from the SIU as soon as possible. However, there are instances when it is not possible to release the inmate the same day.  For example, if inmates need to be transferred to another Region to integrate an institution’s mainstream population, they must wait for the next inter-regional transfer to occur.  In other instances, inmates will refuse to leave the SIUs for a number of reasons. In those instances, CSC continues to engage with the inmates to identify the concerns that may be causing their refusal and looks at options for them to integrate into the mainstream inmate population. CSC continues to develop strategies to achieve sound correctional outcomes, including building trust with these offenders.

The current legislation that guides the management of Structured Intervention Units specifies clearly whether reviews are to take place within a certain number of “calendar days” or “working days” and the CSC’s policies and Commissioner’s Directives flow from the legislation.

CSC offers a robust training suite for recently appointed senior and middle management staff. This training suite provides the required tools and knowledge to assist in improving their understanding and application of managerial tasks, as well as the numerous stakes and challenges encountered in the management of an institutional environment. Therefore, a shadow shift would be unnecessary.

The existing training also provides necessary tools and essential knowledge which will assist them in fulfilling their roles in managing correctional operations and social reintegration in a safe, secure, humane, and reasonable way, while respecting the rule of law and the values of CSC. The training suite is to be completed within 12 to 18 months following appointment.

CSC’s governing legislation, the Corrections and Conditional Release Act and the Corrections and Conditional Release Regulationsrefers to, and defines, inmate and offender.  While these are the terms we use in official documents, CSC believes in the capacity of individuals to change and understands they are not defined by their conviction history.  For this reason, in the day-to-day practice, CSC staff generally address offenders by their name and respect their preferred pronoun. 

CSC’s policy around the death of an inmate specifies that a staff member must engage with the next of kin to determine their wishes while also ensuring the inmate’s wishes are respected. CD 530, Death of an Inmate, is available on CSC’s Intranet and external website.

Upon completion of a Board of Investigation (BOI) or Quality Care Review (QCR) following a death in custody, board members and reviewers are responsible for forwarding all paper records including handwritten notes and correspondence in their possession to National Headquarters to be placed on the file and make certain all electronic records are appropriately saved in CSC’s standardized electronic document and records management solution. The retention period for QCR review records is 10 years. BOI record retention is set at 25 years.

CSC is committed to providing ongoing education and resources. Information Management, Access to Information and Protection of Privacy updates, bulletins, guidance, training, and reminders of the importance of protecting and storing information of business value are available on the Hub and are regularly included in Commissioner messages and this Week at CSC.

CSC will publish the response to its website by October 8, 2024, as per the agreed deadline. It will also be shared with all staff by email.

Upon receipt of the jury’s verdict and recommendations, CSC took steps to ensure the information was available in both official languages for dissemination to staff and the public, and the documents were coded for posting online. The verdict and recommendations were shared with all staff, along with a message about the Inquest, and posted on CSC’s Intranet and public website on August 20, 2024.

As noted above, by October 8, 2024, CSC will also post and share its responses to the recommendations with all staff and the public. Given the length of the physical document, it is not feasible to post these in institutions. However, staff in institutions have access to the Intranet and website to print the document, as needed. CSC is also taking steps to produce a poster that can displayed in all institutions and treatments centres indicating where to obtain more information, the full verdict and recommendations, and CSC’s response to the Inquest.

This recommendation was addressed to the Office of the Correctional Investigator.