The percentage of people entering British Columbia’s prisons with both mental health needs and substance use disorders doubled over eight years, a new study finds.
But the percentage dropped for prisoners judged to be free of mental illness and simply grappling with substance use problems.
The study examined records of 47,000 inmates in 10 B.C. prisons between 2009 and 2017 and found that the proportion of people with a co-occurring disorder increased to 32 per cent from 14.5. People who have mental health and substance use disorders compose two to four per cent of the country’s population.
People in prison who had only mental health needs rose to 14.8 per cent from 9.9 per cent while those with no disorders fell to 25.4 per cent from 38.9.
People with only a substance use disorder dropped to 27.9 per cent from 36.7 per cent, found the study, which examined findings from an assessment tool used to rapidly identify the health needs of people entering prison.
The study also tracked over the period what drugs were heavily used by inmates with substance use disorders.
Methamphetamine use disorder more than tripled to encompass nearly 30 percent of the prison population and heroin use disorder more than doubled, afflicting one out of four inmates. The proportion of inmates who abused alcohol dropped from about one out of four to about one out of five.
The prison findings reflect the larger context of a deadly opioid crisis and a sustained deterioration of people’s mental health in the U.S. and Canada, noted the study’s lead author Amanda Butler, a criminologist and research associate at UBC’s department of psychiatry.
Butler told The Tyee that the prison numbers point to the lack of available resources in the community for people with mental health challenges which, in many cases, directly or indirectly, leads them to end up in the criminal justice system in the first place.
The researcher said such people generally face barriers to housing, secured employment and lack social and familial support. Since many basic mental health services are not covered by B.C.’s health-care system, their psychological well-being further deteriorates when they cannot afford to see a clinical counsellor or psychologist.
People who have both mental health needs and substance use disorders face further challenges in accessing treatment, Butler pointed out, because many treatment services exclude people with mental illness when providing care for a substance use disorder.
The study cites other research finding that 51 per cent of individuals in B.C. with a co-occurring disorder reported their mental health needs were unmet by the system. “And so it means that a lot of folks end up getting to a pretty severe place in their illness often before they're able to access resources,” Butler said. People shouldn't have to end up in prison before they have access to adequate care.”
Studies have shown that people in Canada who have mental illness are not arrested more frequently than others committing the same offences, but that when people with psychological disorders are detained, more force is used. Of the 461 people who were fatally shot by the police in Canada between 2000 and 2017, 70 per cent had a mental illness.
One lesson to draw from her study, said Butler, is the need to start early. She said “evidence-based therapies, including trauma therapy, treatments, counsellors and psychologists should be made available under a scheme where people can access it under provincial health care. Anybody with a card that has MSP could avail treatment.”
Butler said since psychological problems begin very young, schools should develop better tools to detect mental illness, linked to early intervention programs for students before their illness worsens or “their substance use becomes their trajectory.”
Another part of the solution could be to bolster specialized emergency response teams that are trained to handle mental health crises. There are such programs here and there in the province. Examples include Car 87 in Vancouver, Car 67 in Surrey and Integrated Mobile Crisis Teams in Victoria, all of which pair a police officer with a registered nurse or psychiatric nurse when responding to mental health crises.
Experts have pointed to a model adopted by Eugene, Oregon. A community-based public safety system called CAHOOTS fields calls related to mental health crises and sends a trained intervention worker to de-escalate difficult situations when no apparent public threat is involved. The service has reported saving an average of $8.5 million a year for the city in terms of police enforcement costs.
“We really just need some kind of bold political action in this area to change the way that we do business and to make high-quality services more accessible to folks,” Butler said.
The main reason why the study examined records until October 2017 is that on Oct. 1 of that year the responsibility of health care in the prisons was transferred to the Provincial Health Services Authority from BC Provincial Corrections.
Preliminary research shows the move has been beneficial for people in prison. Former inmates now are more likely, after their release, to access health-care services including treatment for substance use. The result, researchers found, is a “decreased hazard of non-fatal overdose.”
But Butler cautions that her research found a large and rising population of prisoners contending with mental health and substance use disorders during a recent period.
“I think that it is going to take time to disrupt these trends because, as we see, they’ve been increasing for nearly a decade,” she said. “But the hope is that we would see a really positive shift and that the prevalence of people with mental health challenges in prisons drops over time.”