Psychiatry in the federal correctional system in Canada

The unique challenges of the correctional healthcare environment are well-documented. Access to community-equivalent care, voluntary informed consent of offenders with mental disorder, violence risk, suicide risk, medication misuse, and clinical seclusion, confinement and segregation are just a few of the challenges faced by correctional psychiatric services. This paper shares experiences for dealing with the ongoing challenges for psychiatrists working in the field. It provides an overview of the current state of mental healthcare in the federal correctional system in Canada, the legislative framework and initiatives aimed at addressing the healthcare needs of federal inmates.

A Real Second Chance

Amendments to the compassionate release provisions of the federal First Step Act and Second Chance Acts provide some opportunity for release for elderly and infirm federal inmates. This article examines the reentry successes of three Pennsylvania state inmates, all convicted of homicide, who won their release as re-sentenced juvenile lifers or through commutation. The author came to know them through a reentry group affiliated with a Pittsburgh university. Their success and scholarship about the low recidivism rates for violent offenders over the age fifty suggest that the criminal justice system should abolish the imposition of life sentences. More than avoid recidivism, each of these returning citizens has made positive contributions to their communities, both in and out of prison. They are working, obtaining educations, engaging in charitable work and political advocacy, and writing about their experiences. Their example and their description of many similarly-situated older inmates still in prison teach that society should not rest the argument for their release solely on compassion and pity. Rather, older inmates have learned coping skills that can help restore the communities that their crimes harmed and that they were taken from during their incarceration. For these reasons, the author suggests that prison sentences generally should provide for release after an inmate serves twenty-five years and attains the age of fifty.

Let My People Go

The COVID-19 pandemic has opened our eyes to the myriad vulnerabilities in the prison health care system. We need only record the number of pandemic-related deaths of federal inmates to grasp that the prison health care system is profoundly ill-equipped to handle the needs of inmates during a public health crisis. Currently, prisoner infection rates outpace those of the general, unincarcerated population by more than 150%, and prisoners are dying four times as often as prison staff who test positive. Results are far worse for elderly inmates. While COVID-19 afflicts people of all health profiles, its grip on the elderly is the most arresting. Though some effort has been exerted, federal prison officials fail to adequately protect the rights of the imprisoned elderly. It cannot be ignored that prison officials owe basic duties of care to the incarcerated, chief among them, the responsibility to provide adequate health care. However, prisons, by their very nature, are unable to care for an old and ailing population. This glaring deficiency is rendered indisputable by the novel coronavirus pandemic. For this reason, vulnerable inmates, especially the elderly, should be released to home confinement forthwith. Anything less is profoundly inhumane and represents a colossal miscarriage of justice.

Psychopathy in the Medical Emergency Department

Psychopathy is a personality disorder representing an admixture of a fearless and dominant temperament with an impulsive and antisocial orientation. A sample of 1,026 participants in the waiting room of the medical emergency department of a city hospital exhibited levels of fearless dominance similar to university undergraduates and federal inmates; their levels of impulsive antisociality fell between those of federal and state inmates. Both psychopathy factors were correlated with male gender, younger age, and more frequent average alcohol consumption. Fearless dominance was associated with agentic success (e.g., being employed, higher household income), fewer psychological problems, and less use of psychotropic medications, including anxiolytics. Impulsive antisociality was negatively related to both agentic and communal (e.g., ever being married) success and positively correlated with substance use and self-reported bipolar, ADHD, and psychotic psychiatric conditions. Further, only impulsive antisociality was associated with presenting to the emergency department for physical injury or psychological disturbance.

Field Inter-Rater Reliability of the Psychopathy Checklist–Revised

Strong inter-rater reliability has been established for the Hare Psychopathy Checklist–Revised (PCL-R), specifically by examiners in research contexts. However, there is less support for inter-reliability in applied settings. This study examined archival data that included a sample of sex offenders ( n = 178) who entered federal custody between 1992 and 1998. The offenders were assessed using the PCL-R on two occasions. The first assessment occurred at Millhaven Institution, the intake unit for federally incarcerated offenders in the province of Ontario. The second assessment took place upon inmates’ transfer to the Regional Treatment Center, which admits federal inmates with intense psychological and psychiatric needs. Intra-class correlation coefficients (ICCs) were calculated for item, total, factor, and facet scores. The ICC absolute agreement for the PCL-R total and factor scores from raters across both settings was slightly better than what has been previously reported by Hare. Results of this study show that the reliability of PCL-R scores in field settings can be comparable to those in research settings. Authors conclude by highlighting the importance of training, consultation, considering different scores for a given item, following the guidelines of the manual in addition to considering measures that enhance neutrality and reliability of findings in the criminal justice system.

Prévenir le VIH et l’hépatite C dans les prisons fédérales canadiennes : l’apport de la recherche et du militantisme dans l’instauration des programmes d’échanges de seringues en prison

RÉSUMÉ:Les auteurs souhaitent faire le point sur la santé des détenus sous responsabilité fédérale, se centrant plus spécifiquement sur les épidémies de virus de l’immunodéficience humaine (VIH) et d’hépatite C qui s’y propagent. Ils exposeront d’abord le portrait sociodémographique des prisonniers, en focalisant sur les problèmes de toxicomanie qui y prévalent. S’appuyant ensuite sur des études canadiennes et internationales, ils argumenteront pour la mise en place de programmes d’échanges de seringues en prison, démontrant du même coup ses bienfaits pour la société dans son ensemble. Finalement, ils discuteront de l’engagement communautaire des scientifiques et des chercheurs comme une modalité pouvant engendrer leur implantation dans les milieux carcéraux. ABSTRACT:The authors wish to review the health of federal inmates, focusing more specifically on the epidemics of human immunodeficiency virus (HIV) and hepatitis C. They first expose the sociodemographic portrait of prisoners, focusing on substance abuse issues. Then, based on Canadian and international studies, they argue for the introduction of prison needle exchange programs, at the same time demonstrating its benefits to society as a whole. Finally, they will discuss community involvement of scientists and researchers as a modality to lead to the implementation of such programs in prison settings.