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Literature review finds Canadians in jails and prisons have poor health

The vast majority of Canadians in correctional facilities have mental health and substance abuse issues as well as a high rate of suicide attempts and completions compared to the general population, a comprehensive review of studies on detainees’ health has found.

The study led by Dr. Fiona Kouyoumdjian, a post-doctoral fellow with the Centre for Research on Inner City Health of St. Michael’s Hospital, also found that more than half the people incarcerated in federal prisons or provincial jails have experienced childhood abuse.

“The health of this population is poor compared to the general Canadian population with respect to socioeconomic status, deaths in custody, mental health, substance use, communicable diseases and sexual and reproductive health,” said Dr. Kouyoumdjian. “The time in custody could provide a unique opportunity to intervene to improve their health.”

Dr. Kouyoumdjian, a public health physician, examined studies on prisoner/inmate health conducted between 1993 and 2014, as well as websites of relevant government and non-government organizations, and published the results today in the journal Canadian Family Physician.

Among the findings:

  • The vast majority of people in correctional facilities have mental health and substance abuse issues. (For example, 91.7 per cent of men in provincial custody in Edmonton had mental health or substance abuse issues in their lifetime in one study compared to 43.7 per cent of the general population.)
  • More than one in five people in custody have attempted suicide.
  • More than two-thirds of adults and youth in custody are smokers, compared to 16 per cent of Canadians. Alcohol use is common in this population, and many people begin using drugs and alcohol at a young age.
  • Injection drug use is common, with about one in 10 adults reporting having injected in the months prior to admission and one in 20 youth reporting ever injecting. People continue to use drugs in custody, including by injection.
  • A large number of persons report prior hospitalization for psychiatric illness -30.1 per cent of women and 14.5 per cent of men admitted to federal custody in 2007 and 2008.

“As the United Nations Committee on Torture and the Correctional Investigator of Canada have called for the prohibition of segregation for people with serious mental illness or acute mental illness, the use of segregation is likely inappropriate for the majority of people in custody,” Dr. Kouyoumdjian said.

Most people in custody experienced major adverse events in childhood, such as witnessing family violence, having one or more parents absent, or being involved with the child welfare system. At least half report a history of childhood physical, sexual, or emotional abuse. About 15 per cent to 20 per cent of Aboriginal persons in federal facilities have attended residential schools.

The socioeconomic status of this population is low, as indicated by a lack of housing, low employment rates, low educational achievement, and low income status. One fifth of men in provincial custody in Toronto in 2009 and 2010 reported being homeless at the time of admission and more than half of youth in custody in British Columbia in 2012 and 2013 had ever been homeless. The majority of adults in custody have not completed high school.

In Canada, there are more than 250,000 adult admissions each year to correctional facilities, about 8,000 of which are to federal custody, and 14,000 youth admissions each year. On an average day, there are about 40,000 people in correctional facilities.