Role of the Psychologist: The CCRA, Section 87, states that the Service is to take into consideration an offender's state of health and health care needs in all decisions affecting the offender. Given this requirement and the degree of mental health concerns in the women offender population, the psychologist must, where appropriate, play a key role in the management of individual cases to aid in individualized case planning, treatment planning, behavioural management, program delivery, and in striving toward the creation of a treatment supportive milieu. Given that psychologists are involved in the identification of each woman’s needs, they must also play a role in assigning women to appropriate programs, whether these are mental health or other programs that would support mental wellness in a holistic context. However, the parole officer will be the individual case coordinator for all women including those who require mental health services.
Offender Involvement: Offenders should be involved in program development and delivery to the greatest extent possible. Offenders should also be involved in the consultation phase of newly developed mental health programs. As well, there may be groups that offenders could reasonably and effectively be trained to facilitate which could positively affect their self-esteem.
Critical Mass: Group size needs to be considered in the delivery of mental health programs and services. Although most programs are designed for 8 to 12 participants, given the small number of women offenders in each facility, some mental health programs may have fewer participants. However, wherever possible, groups should be run with a minimum of three participants.
Capability: Interventions should be culturally appropriate and geared to women’s literacy levels. They should also be able to address the needs of low-functioning, chronically ill, or aging women, with the possibility of groups specifically targetting the needs of these offenders.
Crisis Resolution: Creative approaches to crisis resolution or intervention should be sought. These could include not only the involvement of the mental health interdisciplinary team but also peer support visits with other inmates, and possibly visits with family or community members during critical periods when the women may require a great deal of support. For Aboriginal women offenders, the inclusion of Elders is critical.
Transfers: Transfers in and out of mental health treatment environments must be managed in such a way that the potential adaptation difficulties for the woman being transferred are responded to and minimized. Transitional care plans, including bridging and other supports are essential to the successful management of transfers.
Creative Approaches: Creative approaches should be explored wherever possible including relaxation techniques, conflict resolution, body work (i.e. acupuncture, therapeutic massage, etc.), wilderness programs, story writing, journalling, drama, art therapy, pet therapy, meditation, yoga, role plays, peer counselling, and mentorship programs.
For Aboriginal women and others who are interested in Aboriginal culture and medicine, activities including sweats, fasts, cedar baths, drumming/dancing, and ceremonies should be made available.
Linkages: The role of other activities and interests such as physical exercise, hobbies, intellectual and spiritual activities, and contact with family and friends should be encouraged for their significant contribution to women’s overall mental well-being. Contact with family and friends can play a crucial role in helping women make the transition back into the community. As well, programs for women should be designed to support their relationships with their children, where appropriate.
Employment: The development of useful employment skills and positive work attitudes for those with mental health problems who are incarcerated is extremely important. Employment skills are known to enhance self-esteem and successful reintegration. Without employment skills women are likely to be released into continuing poverty, thus potentially increasing their risk for recidivism.
Support/Reference Materials: The development of a reference section in the inmate library comprised of books related to mental health should be created. Educational videos on a variety of topics including mental disorders, substance abuse, parenting skills, and stress management should be included.
Diversity: Effort should be made to increase the diversity of the mental health staff to reflect the diversity of the prison population. This would include recruiting staff of different ethnicities, sexual orientations, ages, and languages.
Bridging: Bridging services between institutions, and between institutions and the community, are vital to decreasing recidivism and the gaps in service provision to women offenders. In addition, regular facilities must be able to support and build on the changes made in specialized treatment programs. Bridging services should be developed to support the gains made in treatment especially since many of those with mental health problems are revoked not as a result of new charges, but because of mental health issues (Bonta et al., 1998) e.g., non-compliance with psychotropic medications resulting in a deterioration of overall functioning.
Continuity of care could be provided through developing linkages to community resources before women leave the institution, or through ambulatory care services and supportive counselling in the community that focuses on relapse prevention issues. These services would assist in the women's transition to the community.
DESCRIPTION OF SERVICES: CONTINUUM OF CARE Based on their experiences and needs, a continuum of mental health care to address the needs of women offenders should include the following elements as found in Appendix L and listed below. It should be noted that the elements of the Continuum of Care have not changed since the 1997 Strategy, however a number of interventions and services have been developed in support of many of the essential elements of the continuum.