Addressing and treating mental health disorders among offenders is a challenge CSC faces on a regular basis.
But thanks in part to some fresh voices and new initiatives in the organization, progress is continually being made.
CSC recently launched a new National Medical Advisory Committee to better integrate physicians’ expertise into operational and policy discussions. The first meeting was in November of last year and the plan is for the committee to meet twice a year in person and twice by video conference.
We recently had an opportunity to speak with two members of that committee: CSC national medical advisor Dr. James Worthington and new senior psychiatrist Dr. Colin Cameron.
Here’s what they had to say about working at CSC, the committee, and goals and challenges moving forward.
Dr. James Worthington
Dr. Worthington is CSC’s national medical advisor. He did his initial training at Birmingham Medical School in the United Kingdom before taking on junior hospital positions in the area. He moved to Canada and practiced as a Family Physician in Northwestern Ontario and then in Northern Saskatchewan. He returned to England, and worked as a Family Physician before returning to the University of Ottawa to train as an Emergency Physician. After graduating from the residency program he joined the medical staff of the Civic Hospital which subsequently became The Ottawa Hospital, TOH. During his time at TOH, he was Head Department Emergency Medicine and was subsequently promoted to various executive positions. He retired from his position as Executive Vice President Medical Affairs, Quality and Performance at the hospital in 2016, and has been the CSC National Medical Advisor since.
Q: For someone who isn’t totally familiar with the structure, can you tell me what the national medical advisor does and what your responsibilities are?
James Worthington: I’d say, overall, it’s to bring the voice of the physician and the experience and knowledge of the physician into the development and delivery of health services for CSC patients. So my focus has been on developing a governance model for physicians.
We’ve developed, over the past 18 months, a National Medical Advisory Committee, which composes regional physician leaders of primary care and psychiatry, together with senior administrated/management leadership that will look at, essentially, how physicians can work together with the leadership of CSC in a collaborative, constructive relationship to enhance the quality of health care provided to CSC patients.
On a day-to-day basis, I look at many things. I support the pharmacy team by being a member of the national pharmacy and therapeutics committee … I provide advice on incidents, board of inquiry, whether the incident involved serious bodily injury that occur within the prison institution, and I’m also involved in many initiatives quality of care including the present strategy around aging persons within CSC, Hepatitis management, HIV, chronic disease, hypertension … I basically cover everything that would be regarded as involving a physician.
Q: What are the challenges and most pressing issues that the National Medical Advisory Committee will be dealing with?
JW: Well, I think there’s many. We did a specific physician engagement survey to understand how the physicians feel about their involvement within health services at CSC, so the results of that survey are in, we’re going to be discussing that and that’s really going to inform the development of the relationship between the physicians and Correctional Service Canada. So that’s a really important aspect we’re going to have to deal with, front and centre.
The second thing is I think there are many pressing issues that really do need physician involvement. First and foremost is clinical seclusion, what is the role of the physician, how can we compare ourselves to community mental health hospitals in the care that we provide? Clinical seclusion, the new framework around suicide prevention, the strategy around elderly persons in corrections – I’d say those are the three of the significant issues coming up.
Plus, the development of an agreed, what I would have called in my previous role, a scorecard, so that we understand the outcomes of the initiatives we’re undertaking. What are the strategies, what metrics can we use to measure our success in reaching our goals. Then we can understand how our work is impacting those metrics and ultimately inform how we reach our goals.
Q: What are some of the most unique variables you have to deal with in corrections, and is there anything surprising or interesting that you’ve learned about medical care in institutions that you’ve learned since joining CSC?
JW: I can’t say I’ve been surprised about anything from a medical care perspective. I think the issues that I’ve found is that mental health is such a factor within the prison system - the management of addiction and effectively supporting the inmates to approach their issues with addiction.
HIV and Hepatitis C, once again, that’s a major issue – especially Hepatitis C, which I think CSC has done an excellent job of being really aggressive and pro-active in its management.
I think one thing that’s really impressed me has been the commitment of the physician leaders and the physicians who I’ve had the pleasure of meeting – and really of all the health team members. Their openness and commitment to the patients and doing the best they can for their patients.
What I really enjoy and I really see is that, at the end of the day, it’s really going to make a difference. That’s what motivates me to be doing this work. I’m very optimistic that things will change and the issues before health services can be approached, managed and improved.
Dr. Colin Cameron
Dr. Colin Cameron joined CSC in the role of senior psychiatrist last month. He had been clinical director of the Integrated Forensic Program - Secure Treatment Unit, Royal Ottawa Health Care Group (St. Lawrence Valley Correctional and Treatment Centre), a 100 bed facility for mentally disordered adult male offenders serving a provincial sentence in Brockville, Ontario, for the previous 10 years. As Clinical Director, he led the development of this first-of-its-kind hybrid mental health/correctional centre with a clinical staffing model similar to a forensic hospital setting where the day to day supervision of offenders is done by mental health staff rather than correctional officers – a model more and more recognized as the best practice model to care for seriously mentally-ill offenders.
Q: You’ve said that you had never anticipated mental health in corrections being your specialty area. Is there anything in particular that appealed to you about it or you just kind of fell into it?
Colin Cameron: I tell people that correctional psychiatry is the best-kept secret in psychiatry. When you go through psychiatry residency training, often the kinds of people that wind up in corrections, when they show up in your emergency room, often the needs are so overwhelming that you feel kind of helpless. Often patients have ongoing substance abuse issues and are high on drugs, and you’re really not able to provide the kind of services warranted. So most young psychiatry residents who haven’t worked in corrections would say “that’s the last field I want to work in. People are difficult, you can’t help them.”
What surprised me when I first went, with some hesitation, to do consultations at the St. Lawrence Valley Correctional Treatment Centre was that in such a setting, where there really isn’t access to street drugs and you have people with you for a good chunk of time, you can actually do therapeutic work that’s very rewarding. Unlike hospitals, where people are admitted and they have to be discharged as quickly as possible because there’s big lineups in the emergency rooms, there is time to provide people more comprehensive help.
In a controlled setting where there’s no drugs and you have people for several months, people are able to receive a whole complement of care – individual psychotherapy to various group psychotherapies to school to work programs – you can develop a real therapeutic milieu that can transform lives.
Surprisingly, it’s in correctional psychiatry that I came to feel the greatest sense of job satisfaction and like I’m doing something of value to help people.
Q: Obviously you’ve only recently started at CSC, but if you could take a wider view, what do you see your role being and is there anything in particular you’d like to accomplish while you’re here?
CC: I’m fairly new to the organization, but my understanding is that most physicians and psychiatrists within CSC are contractors, many of whom are part-time, so as a result, the physician voice and psychiatrist voice hasn’t been as integrated into CSC development of clinical services, policies and treatment guidelines as it might be.
So the last few years there’s been a whole reform in the governance structure at CSC and health care in particular that is now formalizing the integration of the physician voice into those areas. It’s at the early stages, so it’s kind of an exciting time, and part of my role is to help that process along.
We now have the National Medical Advisory Committee, which is becoming very central in terms of representing and tapping into the physician voice and expertise so that it gets taken into account within the broader organization.
I come in at an exciting time because I think the profile of health and mental health in particular is being raised, and I think there’s now a genuine desire and willingness to invest in developing services and raising the bar.
Q: How much do you think the societal acceptance of mental health issues and the willingness to bring it out of the shadows and talk about it openly contributes to something like improving services in corrections?
CC: I finished my residency in psychiatry in 1994, and since that time, I think there’s been huge progress in terms of reducing stigma, in terms of mental illness particularly. Correctional mental health might be the last big vestige of stigma, because it’s sort of a double stigma – there’s criminality and mental illness. Sometimes there’s this attitude in terms of getting tough on crime and that people who’ve committed offences don’t deserve access to care. So we’ve still got some work to do there.
There’s issues also when people are released back into the community when they finish their sentence and sometimes barriers are put up to accept people with serious mental illness into community programs because people assume there’s going to be safety issues or disruptions to their services. So there is still work to be done on that front, particularly when it comes to people that have been involved in the criminal justice system.