Many offenders arrive at a federal institution with physical and psychological conditions that could pose a risk to themselves, staff and others.The following is an overview of the conditions that are most prevalent in the correctional setting.

Within the institutions there are some offenders who are considered a high risk for infectious disease such as HIV/AIDS, Hepatitis A, B and C, and Tuberculosis (TB). Research shows that many offenders have substance abuse problems and some have serious mental disorders that require specialized treatment.

Infectious Diseases

In 2002, CSC data indicated that almost 2%of the general offender population was known to have HIV. In the same year, roughly 24% of the offender population had hepatitis C.

Many offenders are vulnerable to these diseases due to high-risk lifestyles, both before they arrive in prison and while incarcerated. High-risk behaviours include injecting drugs, sharing needles, body piercing, tattooing and unprotected sex. In the institutions, there are people who are at high risk for TB infection, particularly Aboriginal Canadians, foreign-born individuals and injection drug users. TB is transmitted through the inhalation of airborne organisms. Shared air space and a large number of people living in a confined location, such as an institutional environment, increases the potential for transmission of this airborne disease.

Treatments and Responses to Infectious Diseases by CSC

CSC entered into a partnership with Health Canada through the Canadian Strategy on HIV/AIDS. CSC’s HIV/AIDS programming focuses on education, prevention, care, treatment and support.All offenders have access to medication and specialists are available for assessment and monitoring. CSC has a voluntary Hepatitis A and B immunization program, and for Hepatitis C and HIV, voluntary testing is performed. For TB, CSC offers a voluntary 2-step TB skin test on newly admitted offenders and annual TB skin testing of all offenders. Each CSC region has a designated number of facilities/rooms to which an inmate suspected of having, or confirmed to have active TB disease, may be transported in order to implement respiratory precautions.

TB screening and surveillance of CSC staff is the responsibility of Occupational Health and Safety, CSC. The Workplace Health and Public Safety Programme (WHPSP), Health Canada, provides advice and staff to conduct screening and surveillance activities on behalf of CSC.Staff screening participation is voluntary. The assessment includes a TB history, risk factor and symptom inquiries, as well as a Tuberculin Skin Test (if indicated).

Volunteers and contractors may be required to provide documentation of their baseline TB status to CSC prior to starting work in a CSC institution. Further assessment, i.e. annual screening, may also be required if these individuals have direct and extended contact with offenders.

Substance Abuse

Substance abuse is a serious problem for federal offenders. Roughly 79 percent of Canadian offenders have some problem with drugs and/or alcohol. All correctional jurisdictions around the world have a problem with drug use among offenders. CSC has “zero-tolerance” for the presence or use of drugs in its institutions because drugs have a negative impact on reintegration efforts; they threaten the security of an institution and contribute to the spread of infectious diseases.

In the community, this issue raises serious concern for the safety of the public as it is often related to the carrying out of a crime and the transmission of infectious diseases.

CSC’s drug strategy is based on the “National Canada Drug Strategy” and the intent is to eliminate drug use in correctional facilities by reducing the supply of and demand for drugs. This will then affect the spread of disease among offenders. The intent is to assist the offender to successfully re-enter society as a law-abiding citizen. With the decrease in substance abuse, the offender has a much higher chance of living in the community productively.

These initiatives are ongoing by CSC to try and reduce the supply of drugs:

• Non-intrusive searching of all visitors entering institutions using metal detectors, ion scanners and drug detection dogs
• Searching of cells, grounds and buildings and offenders are carried out regularly
• National random urinalysis program that tests urine samples of five percent of the offender population each month

These initiatives are ongoing by CSC to try and reduce demand for drugs:

• Substance abuse programs for offenders (intermediate and low intensity)
• High intensity substance abuse programs for those offenders with the most severe problems
• Provision of Intensive Support Units for those who want to live drug-free while incarcerated
• Methadone maintenance treatment
• Opening of the Addiction Research Centre to provide a focal point for all drug and alcohol research conducted by CSC

Mental Disorders

Offenders with mental disorders have difficulty adjusting to life in prison. They have a higher risk of suicide or self-injury. They usually require more assistance in the reintegration process and may need more support services in the community, including such things as alternative housing and additional counselling. Unfortunately, there are limited community supports for these offenders and this adversely affects their eligibility for conditional release.

Roughly 19 percent of the inmate population suffers from a mental disorder that may require specialized intervention. Upon entering a CSC facility, inmates are assessed to determine where they should be placed.

Treatments and Responses to Mental Disorders by CSC

• Intensive (acute) care is provided for acutely mentally disordered offenders such as psychotics and schizophrenics at regional treatment/psychiatric centres
• Intermediate and chronic care is given to offenders with mental disorders who need crisis intervention and transitional care.Programs and services of mental health units are located in regular facilities and delivered by mental health professionals

Ambulatory care is provided to those who have had episodes of mental disorder within the past year but are not in an acute phase of illness.