QUÉBEC CITY, May 11 2011 /CNW Telbec/ - The Québec Ombudsman's report on
public services for detainees with mental health disorders was tabled
this morning in the National Assembly. The report highlights the fact
that mental health services in Québec were structured without due
consideration for the detention community's specific features, and
identifies major deficiencies in terms of access to and continuity of
the health services and social services available to detainees with
mental health disorders.
Among other things, Ombudsperson Raymonde Saint-Germain recommends that,
as of April 1, 2012, the Ministère de la Santé et des Services sociaux should take responsibility
for dispensing socio-sanitary services in Québec's 19 detention
facilities. She also recommends that a coherent clinical vision should be developed, and that steps should be taken to ensure more effective preventive action upon admission, during
detention and upon release from a detention facility.
The report is based on an examination of the complaints received and on
the Québec Ombudsman's interventions in detention facilities. At the
Québec Ombudsman's request, a profile was also prepared by the Centre
international de criminologie comparée (Université de Montréal) from a
sample of 671 detainees' records. The Québec Ombudsman completed the
profile through a series of focus groups composed of representatives
from correctional services, the legal community and the health and
social services network, as well as a review of the scientific
The report examines the entire process, from the police intervention
through incarceration to release, and presents observations together
with proposed solutions at each step.
PRIOR TO INCARCERATION: THE POLICE INTERVENTION AND INITIATIVES
INVOLVING ALTERNATIVES TO JUDICIAL ACTION
Police officers are regularly called as first responders to situations
involving people with mental health disorders. Their role is
fundamental. However, they do not always receive either the support or
the training they need. Among other things, the crisis intervention
services offered by the health and social service network and certain
community organizations are used to varying degrees, depending on the
police officers and regions concerned.
In cases where referral to the social services is the most appropriate
solution (for example, finding accommodation for people in psychosocial
emergencies), the existing resources are simply not sufficient.
The success of court initiatives offering alternatives to judicial
action is dependent to a large extent on the availability of stringent,
effective and safe community treatment programs. However, programs such
as these are not available in every region.
The Québec Ombudsman recommends that police training for interventions involving psychosocial and psychiatric
crisis situations should be enriched and that officers should have access to appropriate social service resources for support in such situations.
The Québec Ombudsman also makes a number of recommendations concerning initiatives offering alternatives to judicial action, adjustments to the
legal process and awareness for legal system stakeholders regarding specific issues
relating to initiatives offering alternatives to judicial action.
Upon admission, there is no systematic screening for mental health
disorders; only the risk of suicide is assessed. If people are not
identified through screening, they have little chance of receiving a
medical diagnosis and appropriate services.
Medication continuity is often compromised during the 48 hours following
admission to a detention facility. Withdrawal of medication can
destabilize a person, and this, combined with the radical change of
physical environment caused by incarceration, can lead to serious
The large number of transfers from one detention facility to another,
along with inadequate exchanges of information, can have particularly
serious consequences for people with mental health disorders,
especially in terms of regular medication and stability.
In 2006-2007, only one-quarter of detention facilities had medical care
personnel on duty 24 hours per day, to assist and advise correctional
services employees during crises.
Access to psychiatric consultations and certain other services,
including rehabilitation and psychosocial monitoring, is lacking.
The rules governing the confidentiality of medical information exchanges
between the medical care team and the correctional team are unclear.
Legal representatives, including the Public Curator, are not always
notified immediately of situations requiring their input.
The needs of people with mental health disorders are complex and
variable, and a coherent clinical vision is needed to ensure that
appropriate services are provided efficiently throughout the detention
The Québec Ombudsman therefore makes a number of recommendations
concerning the organization of services, including the necessity to transfer responsibility for delivering socio-sanitary services in
detention facilities to the Ministère de la Santé et des Services
sociaux and, at the same time, introduce an implementation plan setting out the roles, responsibilities and
resources required by each network (health and social services; correctional
The Québec Ombudsman also recommends the introduction of a clinical structure for detainees, including systematic screening for mental health disorders and medication needs,
contact with the case manager concerned if the person was being treated in the community before being detained,
contact with the Public Curator or legal representative if the person is under protective supervision, an assessment of the services required during detention and upon release, and a training program for correctional services personnel.
UPON RELEASE FROM THE DETENTION FACILITY
Often, the case records of people who were being treated in the
community prior to being detained are closed during the detention
In most cases, the clinical personnel who provide socio-sanitary
services in detention facilities do not provide follow-up after the
person is released.
People are often left to their own devices when they return to the
community, and are not put into contact with the resources that could
The measures recommended in government plans have not really been built
into the daily practice of case workers.
The best results in terms of social reintegration and lower repeat
offender rates for former detainees with chronic mental health
disorders appear to be obtained by ensuring continuity of medical, social and control services.
Accordingly, the Québec Ombudsman recommends that the Ministère de la
Santé et des Services sociaux should establish the resource level
required to provide treatment in the community for every person likely to benefit
from it. It also recommends that a health professional in a detention facility should not be able to
terminate a person's treatment until another one from the health and
social service network has taken over responsibility for the person.
According to Ombudsperson Raymonde Saint-Germain, "it would be wrong not
to consider the highly positive impact of successful social
reintegration in reducing repeat offences, taking into account their
considerable financial, human and social costs, not to mention the risk
they pose to public safety. Providing appropriate services for
detainees with mental health disorders is one way of improving their
well-being and helping to build a sustainable sense of safety for their
families and for society in general".
The report may be consulted in the "Cases and Documentation" section of
the Québec Ombudsman's website at: http://www.protecteurducitoyen.qc.ca/en/major-cases-and-documentation/special-reports/index.html.
SOURCE Protecteur du citoyen
For further information:
Source: The Québec Ombudsman
Joanne Trudel, Communications Manager