Early identification and assessment of mentally ill offenders as they enter the correctional system are an important part of their management, but they have yet to be satisfactorily achieved within the Ontario region of CSC. During renovation of RTC(O) in 1991-92, an experimental, satellite mental-health unit was in operation at the maximumsecurity reception facility at Millhaven, and this temporary unit has so sufficiently revealed the utility of early psychiatric assessment as part the reception process that resources for creation of a permanent unit were allocated from the fiscal year 1993-94.

Inmates frequently arrive to begin their sentences with little psychiatric...

The mentally ill are vulnerable to stigmatization and exploitation at the hands of fellow inmates,¹ and conditions in prison for this group are probably less humane than those in a modern psychiatric hospital, but the correctional environment offers some opportunities in terms stabilizing an MDO whose behaviour is unreliable or unpredictable most important, the continuity of care available. Over some years, depending on the offender’s sentence, treatment staff can get to know patient who in other settings would seldom stay for long, and a longterm perspective encourages them to adopt a tolerant and creative response to disturbed behaviour. As well,...

In preparing for release of a sentenced MDO, two quite different processes are dictated by the type of sentence the MDO has received.Those who are serving a fixed sentence must be released by the time their warrant of committal expires - the warrant-expiry date (WED). Beyond this date, the offender, having served his or her sentence, can be subject to no more constraints than the ordinary citizen. A special condition was required by the Ontario Ministry of Health in granting schedule-I status to RTC(0)¹ - that the Ontario Mental Health Act (OMHA) should under no circumstances be used to prolong...

Community support represents the least-well-developed of the services provided to the MDO. All too often a damaging and costly routine of relapse and reconviction is precipitated by a chain of circumstances that includes failure of mental-health care. Many failures arise from poor communication² between supervisory and clinical personnel, and remedial efforts have been directed at establishing effective liaison between parole and mental-health services. Better contact has been hampered by lack of resources, but enough progress has been made to make it clear that good liaison can help prevent relapses.

A 3O-year-old man was admitted for stabilization six months prior to...

“Can prison medicine be ethical?” asks one authority,² and he answers in the affirmative, provided that certain conditions are met. The conditions he would require are independence from the prison administration, freedom of decision making, equivalence with community health-care standards, freedom of access to medical services, and respect of basic principles of medical ethics, including informed consent to treatment and confidentiality. He observes that these conditions are seldom met. “Can prison medicine be ethical?” he concludes, casually impugning the integrity of hundreds, if not thousands of his colleagues. “It could be but isn’t.”

It might be argued that the conditions...

Personality-disordered offenders present a number of challenges to mental-health services within a correctional system. Psychopaths who, for whatever reason, place few constraints on the exercise of their most casual impulses towards self-gratification will behave in an exploitative and threatening way towards their weaker peers, and such behaviour can be very difficult for administrations to control. Adjustment disorders often take the form of brief regressive deterioration, accompanied by aggressive or self-mutilatory behaviour. Prison populations are recognized to be at high risk for suicide. The following chapters address some of these aspects of psychiatric practice that are pertinent in the prison context....

A 44-year-old Caucasian male and first offender is serving a life sentence, with a minimum of 15 years, for a double homicide. He was admitted to RTC(O) for psychiatric assessment following reattachment a local general hospital of an almost totally severed penis.

By his own account, after serving four years, he had transferred to present institution from a different region of the country two years ago, to be near relatives. He had been turned down for regular counselling with the prison psychologists. Frustrated by what he saw lack of awareness of the seriousness of his needs, with “no one careing...

Relative to the psychiatric centres of other regions of CSC,² RTC(O) has proportionately fewer psychiatric beds to service its catchment population - 67 beds for some 3,700 inmates. As a consequence, in-patient must always hold as a priority early return of the patient to his parent institution. An Ambulatory Services Programme was established 1987, with one - now three - full-time psychiatric nurses, who visit the major institutions to monitor the discharged patient at the parent institution, organize follow-up psychiatric care, and consult with the institution on the patient’s management.

The program has been successful in terms of reducing readmission...

Chronically psychotic offenders, the brain-damaged, the mentally retarded, or just the socially or physically inadequate pose a problem prison services in terms of their vulnerability to exploitation, their failure to conform to established norms of inmate social behaviour, and the particular difficulty they represent for release planning. These people, whose common characteristic appears to be “their inability to cope unaided with the ordinary problems of everyday life,”¹ are widely recognized.

A 39-year-old man was admitted from the reception unit (at entry into the correctional system), with reports of bizarre and withdrawn behaviour. He was starting a three-year sentence for sexual...

Despite proven flaws in any attempts at prediction, there exists a small population for which seriously violent recidivism seems certain.² The assessment reports in Appendix B are an example. Recent completion of an extended, prospective study of recidivism in patients released from the maximum-security Oakridge mental-health facility at Penetanguishene confirms the existence of a small group of offenders that can be predicted with confidence to recidivate dangerously.³

If a mentally disordered offender (MDO) is serving an indefinite or a life sentence and is considered predictably dangerous - reliably or demonstrably likely to commit another seriously violent offence - it is...

Despite periodic efforts to divert the mentally ill from justice systems, high levels of psychiatric morbidity in prisons will probably continue. the foreseeable future, the combination of a population predisposed by character and circumstance to be vulnerable to mental disorder, and a restrictive milieu that imposes great stresses on that population, will generate a need for psychiatric services of some kind. These services will encounter the full spectrum of mental illness, often complicated by coexistent personality disorder and multiple diagnoses, will have to cope with extremes of disturbed behaviour.

Prison psychiatric services, whether administered by the prison system itself, and...