Opinion

Health-care behind bars: Equity and accountability in Canada’s correctional services

Ed. note: Inmates’ identities have been modified for privacy reasons.

Canada’s correctional system, by many reports, is broken, dangerous, racist, expensive and “not even working.”

Indeed, the Office of the Correctional Investigator cites many incidents of mistreatment that have no place in any prison, let alone the 53 correctional institutions Canada houses. Incidents such as an inmate diagnosed with multiple sclerosis and debilitating pain having his medications withdrawn by correctional officers. Or an inmate with severe mental health disorders being held down by four guards during an altercation, with one guard kneeling across his neck and yelling obscenities.

The toll of these situations on the health and wellbeing of inmates – and the community – is only worsening. While the number of inmates in prison has declined since 2013, the Correctional Service of Canada (CSC) added almost 1,200 correctional officers and spent $6 billion annually over the past decade, resulting in four in 10 prisons with more correctional officers than inmates. Furthermore, there have been substantial increases in use of force, self-injurious behaviours and withholding of medical care. Moreover, the proportion of prisoners from Black and Indigenous backgrounds and those with serious mental illnesses and elderly offenders is growing, with fewer opportunities for parole than white prisoners. An independent oversight panel recently reported that 48.9 per cent of prisoners in structured intervention units, supposedly humane replacements for segregation, are Indigenous (80 out of 166).

More than 40 per cent of inmates released are returned to custody within two years, usually due to parole violations and lack of safe, timely reintegration services (e.g., post-incarceration housing, employment and continuity of health care). Stigma surrounding previously incarcerated individuals also detracts from their reintegration.

Shortcomings in prison health care

The Canada Health Act (CHA) governs publicly funded health-care insurance and protects Canadians’ right of access to universal health care without financial or other barriers. However, contrary to popular belief, these rights do not apply to federal prisoners, nor are they covered by provincial health insurance plans.

“(Inmates) do not get the protections of the universal health-care principles that apply to just about everybody else,” notes Catherine Latimer, the executive director of the John Howard Society of Canada, a national community organization which advocates for prisoners’ rights and prison reform. As a result, “the (CSC) is required to establish the health-care regime for prisoners.” Indeed, the Society recently challenged the exclusion of federal prisoners from the “insured persons” definition under the CHA, asserting that it violates various Charter rights to life and not to be subject to cruel punishment.

What does this mean? “Whenever you have correctional authorities delivering health care, there’s going to be irreconcilable conflict between the institution and the health-care needs of the individual,” notes Latimer. “Security issues will always trump the health needs of the individuals.”

This lack of care contravenes the United Nations’ Nelson Mandela Rules, which assert the quality of health care provided to prisoners must align to that available to the general population. Indeed, the United States and New Zealand have created federally mandated “resource centres” to prevent substandard care for incarcerated individuals. Closer to home, three Canadian provinces (Nova Scotia, Alberta and British Columbia) have shifted the responsibility of prisoners’ health care from correctional institutions to their health-care departments.

While this is a start, various shortcomings persist, from delayed or missed cancer diagnosis to having prescriptions cut arbitrarily. Moreover, complaints against the CSC often are deferred to provincial medical licensing boards. However, as provincial bodies, they cannot force documents or cooperation from federal authorities, often closing off routes to resolutions.

The impact of these shortcomings is evident. The health status of prisoners is “poor compared with the general Canadian population.” This disadvantage means prisoners are at much higher risk of physical and mental health ailments: nine times more likely to suffer from depression; 11 times more likely to suffer from psychosis and schizophrenia; and five times more likely to suffer from substance-use disorders and overdose in Ontario alone. There is also a higher burden of chronic illness (HIV, chronic obstructive pulmonary disease, diabetes).

‘Prison health is public health’: Advocacy efforts for reintegration

The various health issues faced by prisoners might beg the question: “Why should we care about prisoners as a community? They commit crimes, they pay the price, right?”

Indeed, former inmates carry the “orange jumpsuit” stigma with them as they struggle to live a stable livelihood and access necessary services upon release. But excluding prisoners who have served their sentence can prevent them from recovering health and social standing, thus denying them opportunities to contribute meaningfully to their communities. A 2020 paper, Prison Health as Public Health in Ontario Corrections, urged the Ontario government to transfer the responsibility for health care in prisons to the Ministry of Health and Long-Term Care. Any care provided must adhere to the values of equivalency, accessibility and continuity of care, as enshrined in the Correctional Services and Reintegration Act, 2018. This would offer an opportunity to define what exact services incarcerated individuals can fairly and reliably access.

Similarly, Public Safety Canada’s report on social reintegration of offenders aims to “stop the cycle of failed adaptation by repeat offenders” by promoting reintegration programs that pay attention to opportunities for collaboration with community agencies and organizations. Building on these, CSC’s Mental Health Strategy encourages a federal and provincial/territorial partnership in tackling inmates’ mental health needs through “enhanced service delivery” in Canada’s correctional facilities. While calls for a collaborative approach exist, the long-standing lack of coordination between the correctional system and social-service providers compounds difficulties with reintegration. Moving away from this untailored, “one-size-fits-all” model of prison re-education and job training, can allow prisoners to successfully access community services and address pressing health conditions, without fear of care being revoked.

Lots more work to do …

“We need to look at what we are doing for prisoners, what is available to the rest of our population,” notes Kiran Patel, a staff psychiatrist in the Forensic Division of the Complex Care and Recovery Programme at the Centre for Addiction and Mental Health. “The folks in prison … are often viewed by society as being separate from us. But they aren’t different.”

Acknowledging this is key to sweeping aside the stigma that is wrongfully accorded to ex-prisoners in the community. “We should give them the same level of care that all of us expect and require when we need it in the community.”

Latimer’s message illustrates the need to advocate for quality health-care access in Canada’s correctional systems. “Former prisoners face a lot of challenges as they’re coming back to communities … (If we do not meet these challenges), they come back into the community at a higher cost, both in terms of the actual medical costs but also (to) people’s ability to rehabilitate and reintegrate successfully.”

Undoubtedly, a lot more work needs to be done. We only hint at the complexity of health-care issues in Canada’s correctional systems. Just as we come together as a community to deliver justice against crime, so too must we staunchly support and rehabilitate ex-offenders into more productive community members, breaking the cycle of recidivism and unjust mistreatment.

We would like to acknowledge Raw Talk Podcast’s episode #102 team: Atefeh and Kayvan are Show Hosts on the episode; Angela, Zeynep and Braeden are our Content Creators; Anukrati is our Audio Engineer; and Noor is our Co-Executive Producer.

To learn more about the issues faced by Canada’s correctional health-care system, as well as what is being done by government and community advocacy groups to combat them, we invite you to listen to episode #102 of Raw Talk Podcast, titled “Healthcare behind Bars.” Also, check out the podcast run by the John Howard Society, “Voices Inside and Out,” hosted by episode guests Catherine Latimer and Lawrence da Silva, where they highlight more inmates’ experiences through and outside Canada’s penal system.

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Authors

Junayd Hussain

Contributor

Junayd Hussain is an MSc candidate at University of Ottawa’s School of Epidemiology and Public Health and a science writer at Raw Talk Podcast.

Vaidhehi Veena Sanmugananthan is an MSc student at the Institute of Medical Science at the University of Toronto and is a Science Writer at Raw Talk Podcast.

Noor Al-Kaabi

Contributor

Noor Al-Kaabi is an MSc student at the Institute of Medical Sciences at the University of Toronto and a show host and co-executive producer at Raw Talk Podcast.

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