Mental Health and the SIUs
An Update for the Structured Intervention Unit Implementation Advisory Panel

January 23, 2023

Isolation in prison is intimately intertwined with mental health issues. For decades, it has been well-established that almost all reputable research on this topic has concluded that being held in solitary conditions of confinement, especially for long periods of time, is harmful to prisoners' mental health^{Footnote 1}. More recently there is some important research suggesting that the causal arrow between solitary conditions of confinement and mental health issues may point in both directions^{Footnote 2}. Specifically, there are now data that suggest that even when controlling for the in-custody behaviour of prisoners, those prisoners with mental health challenges may be especially likely to be targeted for placement in solitary conditions of confinement. Our first Annual Report contained a section addressing mental health issues. This update builds on those initial findings.

We do not have data on 'mental health' indicators on the mainstream population in CSC facilities and therefore cannot directly compare those who have experienced SIUs with those who have not. But we do know that between 1 January 2020 to 31 July 2022, a total of 2,015 different prisoners experienced a total of 4,276 admissions to the SIUs. Fifty three percent (N=1,073) of these prisoners had experienced one SIU stay and the remaining 47% (N=942) had experienced more than one SIU stay (2 to 15 separate stays).

As shown in detail in Appendix Table 1, the CSC files for those with multiple stays were much more likely to have indicators that they had mental health needs, suggesting that the more times one is transferred into an SIU, the more likely it is that the prisoner will have identified mental health needs. For those with only one stay in the SIU during this period, “only” 25% were identified by CSC has having mental health challenges. For those with 5 or more stays, more than half – 59% – were identified as having mental health challenges.

But it is not just that those with many SIU stays are more likely to have mental health challenges. It is also that they are more likely to have experienced their multiple stays in multiple regions.

We looked at the 942 people who were in an SIU more than once (See Appendix Table 2). If they had mental health issues, they were more likely to have their multiple SIU stays happen in SIUs in different regions. Specifically, about 41% of those who experienced multiple stays in SIUs and were identified by CSC as having mental health needs experienced those multiple stays in different regions. If they were not identified as having mental health issues, “only” 31% had their multiple stays in different regions of Canada.

It is worth keeping in mind that prisoners who are identified as having mental health issues are somewhat more likely (than those not identified as having mental health issues) to be transferred to the SIU for their own safety. 47% for those with identified mental health issues were transferred because of concerns about the prisoner's own safety vs. 40% for those without identified mental issues (See Appendix Table 3). This finding may be important in understanding what happens to prisoners who experience stays in the SIU.

Once in an SIU, those with broadly defined mental health challenges that were identified by CSC do not appear to be staying in SIUs for longer periods of time than those without such challenges (see Appendix Table 4). The SIU stays of about 23% of each group lasted longer than two months.

The mental health “flag” indicator – that the prisoner faces mental health challenges – is a very broad indicator of characteristics of the prisoner. CSC has, however, indicators of change in the mental health status of the prisoner while in the SIU.

Looking at all admissions^{Footnote 3} into an SIU from 1 January 2020 to 31 July 2022, there is a relationship between the length of time in an SIU and a change in prisoner's mental health over time. CSC's more sensitive measure of mental health deterioration while in the SIU suggests (see Table A as well detailed data in Appendix Table 5) that those with deteriorating mental health are considerably more likely, when compared to those whose mental health is not deteriorating, to remain in the SIU for two months or more. While fewer than a quarter of those whose mental health was not deteriorating spent over two months in a SIU, 40% of those with deteriorating mental health stayed that long (Table A). Those with deteriorating mental health were also considerably less likely to have very short SIU stays. As mentioned above, it is unclear which way or ways the causal arrow should be pointing. But whatever the causal direction is – long stays causing mental health deterioration, or people being kept in an SIU because of behaviour related to their mental health deterioration, or both – it is hard to conclude that long stays in an SIU are desirable.^{Footnote 4}

CSC is no doubt aware of the research on the relationship between the deterioration of mental health and long stays in solitary conditions of confinement. This knowledge does not appear to be influencing practice. The relationship between deteriorating mental health and length of stay in the SIU is not improving over time (Appendix Table 6). In each of the three calendar years during which SIUs existed for which we have sufficient data, those with deteriorating mental health are substantially more likely to spend two months or more in the SIU.

CSC's decisions to place those with deteriorating mental health for long periods of time in an SIU appears to be fairly consistent across regions. Those with deteriorating mental health status are more likely, in each of Canada's five regions, to stay in the SIU for two months or more (see Appendix Table 7).

One of the key features of the SIU legislation that differentiates SIU stays from segregation (and experiences that can be considered to be the equivalent of torture under the Mandela Rules if the prisoner is held in these conditions for more than 15 consecutive days) is that prisoners are expected to get a minimum of four hours out of their SIU cells, two hours of which is supposed to involve meaningful human contact.^{Footnote 5}

CSC tends to focus not on whether prisoners actually get their minimum four hours, but rather on that they have been offered time out of cell^{Footnote 6}. As we explained in our Annual Report, an offer is an inadequate measure of statutory compliance given that the offer may be less attractive than experiencing solitary conditions of confinement (e.g., because of the presence of incompatibles in the location offered to them, unattractive facilities such as an underequipped yard on a very cold day or similar factors).

We expect, given the data suggesting that long periods of time in solitary conditions of confinement is not beneficial for one's mental health, that CSC would try especially hard to ensure that those with mental health needs would get the minimum of 'four hours' out of cell in order to help prevent their mental health from deteriorating. However, those identified by CSC as having mental health needs were more likely than other prisoners to miss getting their four hours out of cell on most of the days. Specifically, looking at the proportion of those in SIUs for 16 days or more^{Footnote 7}, 61% of those with mental health challenges missed getting their full four hours during more than three quarters of their SIU days.  The comparable figure for those without mental health issues was “only” 51%. This relationship held in each of Canada's five regions (See Appendix Table 8). There is no doubt that some of the missed time out of cell is a function of prisoner refusals of an offer. As mentioned, these refusals may be for very practical reasons (i.e., inclement weather) or could be directly related to the mental health issues the prisoner is experiencing. For many prisoners, simply asking them if they want to leave their cell is not enough to honour the intent of the legislation. In simple language, those with mental health needs that were identified by CSC are more likely to miss getting their minimum/expected hours out of their cells than those without identifiable mental health needs.

As noted in the commentary in the appendix associated with Appendix Tables 8 and 9, it would appear that the relationship is a bit more complicated: Those prisoners with high mental health needs but who are stable appear to be the group, in most regions, that is most likely to miss getting their four hours out of cell. This finding also hold across time (Appendix Table 10).

The key oversight body for SIUs are the Independent External Decision Makers (IEDMs). They serve a number of functions, perhaps the most important of which, in this context, is their review of long stays in the SIU. The data suggest that the results of reviews of time in the SIUs by IEDMs is unrelated to mental health measures.

IEDM reviews of time in the SIU do not seem to address issues related to mental health. Mental health status and change in mental health appears to be unrelated to the IEDM decision on length of stay in the SIU (Appendix Table 11).

Some of our earlier work has demonstrated that being “ordered out” of the SIU by an IEDM does not necessarily mean that the prisoner is transferred out of the SIU quickly. Having, or not having, identified mental health needs appears not to make much difference in terms of when one gets out (details in Appendix Tables 11 and 12).

Conclusion

Staying a long time in an SIU is related to deteriorating mental health. And while those with mental health issues generally do not appear to be staying much longer in SIUs than those without mental health issues, they do have more stays. Moreover, they are more likely to experience their stays in different SIUs in different regions – similar to what happened with Ashley Smith under the previous “administrative segregation” model^{Footnote 8}.

In focusing on mental health and the SIUs in this report, we don't want to imply that mental health issues aren't intertwined with other issues, most notably the treatment of Indigenous people. As we see in the Table B, prisoners whose mental health is deteriorating and who stay a very long time (62 days or more) are disproportionately Indigenous as are those who are getting worse but are “only” in the SIU for two months or less.

The SIU-IAP will be looking at special issues related to Indigenous prisoners and the SIUs in our next update.

Appendix Tables

When we looked at the more 'fine grained' scale that CSC has for change in mental health status, we see that it is a bit more complicated for those about whom there is most concern (the long stay prisoners). What we see (Appendix Table 9) is that those with high needs but who are not getting worse tend, if anything, to have a high number of days on which they don't get their four hours out of cell. There is some regional variation in this.

Those whose mental health is deteriorating appear to be somewhat less likely to miss getting most of their hours out of cells. This (overall significant) effect is largely an effect of the manner in which people are treated in Ontario and the Prairies. The relationships are not (statistically) significant in the other three regions.  Those identified as having deteriorated mental health – a non-trivial 13.5 % of the long stay prisoners (those in the SIU for at least 16 days) – tend, more than the other two groups, to get their “four hours” on at least half their days.

Date modified:

2023-03-08