The goal of mental health services for women offenders has been modified since the 1997 Strategy. The major focus of the change was to remove the reference to recidivism given that it is a CCRA requirement to provide treatment to address mental disorder, irrespective of recidivism. For some women offenders with mental health problems, mental health intervention may, in and of itself, address criminality and reduce recidivism. For others, it is only once their mental health problems have been addressed that their ability to function improves to enable them to engage in programming to address other issues. The revised goal is as follows:
To develop and maintain a coordinated continuum of care that addresses
the varied mental health needs of women offenders in order to maximize
well-being and to promote effective reintegration.
KEY PRINCIPLES UNDERLYING THE DELIVERY OF MENTAL HEALTH PROGRAMS AND SERVICES FOR WOMEN OFFENDERS
There are a number of principles essential to the development of any and all mental health services for women offenders. These principles were articulated in the 1997 Strategy and they reappear in this revised version as they remain valid.
Wellness - including:
holistic program delivery, that is, program delivery that recognizes body, mind, spirit, and emotions and their interconnections in a family and community-oriented context
the avoidance of labels (including psychiatric diagnoses) insofar as these may function to reduce women to only their mental health issues
reinforcement of the skills necessary for personal development and independent living in the community
the necessity of involving mental health professionals as well as others including Aboriginal service providers, community resources, families, etc. in treatment plans
Access (consistent with CCRA section 86) - reasonable access to appropriate essential and non-essential professional mental health services including:
early identification of mental health problems and treatment needs
timely interventions that minimize symptom escalation and prevent acute crisis situations
interventions tailored to acknowledge the complexities of the cases of women who have several mental health and other diagnoses/ issues that require simultaneous intervention
services provided in keeping with community standards
However, it should be noted that as result of various limitations - fiscal, operational, and geographic - women may require transfer to other regions, institutions, or community facilities, to access treatment options that would not otherwise be available in their facility.
Women-Centered - the continuum of mental health services must be offered in a gender-specific and gender-appropriate manner such that:
only personnel sensitive to women and women’s issues are involved
treatment programs and services are designed to meet the specific needs of women offenders while acknowledging personal autonomy, connection to others, and positive mutually respectful relationships
Client Participation (a principle of fundamental justice) - women offenders must be involved in their assessment and mental health treatment such that:
Least Restrictive Measures (consistent with CCRA - Principle d) such that:
treatment is based on the least restrictive/intensive form of intervention possible
women are housed in the least restrictive environment possible with the lowest level of security required to ensure public safety
ADDITIONAL ELEMENTS ESSENTIAL TO THE DELIVERY OF MENTAL HEALTH SERVICES FOR WOMEN OFFENDERS
The following elements have been categorized under three main headings: physical environment, professional service delivery, and characteristics of interventions. Although the majority of these elements are the same as those articulated in the 1997 Strategy given their continued relevance, many elements have been expanded upon and three new elements have been included: mental health interdisciplinary team, supervision of mental health service providers, and involvement of other professionals.
Structure and Environment: The facilities for women offenders have been designed for independent living with a communal living space in each house including, a kitchen, dining area, bathrooms, a utility/ laundry room, and access to the grounds. Cooking, cleaning, and other household duties are shared activities. Programs take place in the main buildings. The general institutional environment should be consistent, supportive, and constructive. Women offenders need to understand the expectations placed on them, which can increase feelings of personal well-being. Consistent structure and environment are central to the success of treatment programming endeavors. Further, the administration and staff must seek to provide a therapeutic, educational, and generally predictable environment throughout the facility. Facilities should be designed to accommodate the needs of both physically disabled and aging offenders. Facilities should also be designed to incorporate other factors known to promote well-being such as natural light, fresh air, and exercise, as well as spiritual spaces.
Professional Services Delivery
Mental Health Interdisciplinary Team: Consistent with the requirements of
CD 850, Mental Health Services (Appendix H) each institution must have a mental health interdisciplinary team that meets on a regular basis and is comprised of a psychologist, nurse, parole officer, and ad hoc members as appropriate, to function as a coordinating body to those inmates in need of mental health services. An interdisciplinary team approach has been adopted as it is based on individual evaluation, planning, and program implementation. The team is composed of individual members from different disciplines, and non-professionals that meet to plan and coordinate a wide range of services. Teamwork is characterized by shared purpose and creativity in problem solving, with the end result being greater than the sum of individual discipline's treatment approaches. Most importantly, interdisciplinary planning is focused on the goals of the offender and services are tailored to fit the individual's vocational and quality of life goals, cutting across disciplines.
Coordination of Mental Health Service Providers: All mental health service providers, such as behavioural counsellors, nurses, primary workers, ancillary therapists, including those on contract, must be involved in ongoing consultation,
to share relevant offender information, conduct appropriate assessments, undertake treatment planning, monitor progress, and ensure continuity of care. Coordination and consultation are also important to ensure that mental health service providers, as well as other institutional staff, are not isolated which can lead to staff burn-out. The coordination of non-mental health service providers should occur via the mental health interdisciplinary team.
Supervision of Mental Health Service Providers: All mental health providers should be in receipt of clinical supervision. In particular, psychologists should be in receipt of supervision as per The Standards of Supervision (in draft) and in accordance with CD 840, Psychological Services (Appendix I).
Integration/Information Sharing: Management must ensure that the model of mental health delivery integrate all related activities that are part of the continuum of mental health care. Management must also ensure that the psychologist play a role in decisions with respect to those programs that address such issues as sexual abuse and substance abuse even though these programs may not fall under the rubric of mental health per se. Further, mental health services must be integrated into each woman’s correctional plan and the primary worker/ parole officer must play a role in the coordination and delivery of each woman’s mental health treatment plan. The sharing of mental health information with the woman’s entire case management team, within the limits of confidentiality, is essential to ensure effective support and monitoring of her progress. Additional information regarding information sharing can be found in CD 840, Psychological Services (Appendix I).
Elder Services: For Aboriginal women offenders, Elders should be an integral part of the mental health interdisciplinary team. Easy access to the services of Elders should be available, with provision for necessary ceremonies and teachings. Mental health programs for Aboriginal women should be developed and delivered by Aboriginal organizations or individuals with demonstrated awareness of their concerns and needs while incarcerated.
Involvement of Other Professionals: The involvement of other professionals such as social workers, occupational and recreational therapists, and chaplains should be considered, where appropriate, in the delivery of mental health programs and services.
Staff Training/Education: It is critical to ensure that staff are given ongoing training and education in the mental health problems faced by incarcerated women,
in order that they acquire the necessary knowledge and skills to effectively work with this population. This awareness will increase staff confidence as well as help to create an atmosphere of understanding and acceptance for those with mental health problems.
Regular support and feedback to staff is essential when working in an often stressful and demanding environment. Of particular importance is the need for ongoing training regarding the maintenance of appropriate and professional boundaries between staff and inmates. Staff training should also include education on Aboriginal medicine, teachings, and ceremonies that may possibly include participating in Aboriginal ceremonies.