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' REPORT ON VISITS

TO THE

SOCIAL THERAPY UNIT (OAK RIDGE),

PENETANGUISHENE MENTAL HEALTH CENTRE

AND THE

THERAPEUTIC COMMUNITY UNIT, SPRINGHILL INSTITUTION.)

CANADIAN PENITENTIARY SERVICE //

LIBRARY MINISTRY OF THE SOLICITOR

16 1982

BIBLIOTHÈQUE MiNISTÈRE DU SOLLICITEUR GÉNÉRAL

Prepared by: R.E. Watkins, M.Sc. Chief, Psychological Services Living Unit and Human Relations Directorate Offender Program Branch Canadian Penitentiary Service

Report on Visits to the Social Therapy Unit (Oak Ridge), Penetanguishene

Mental Health Centre, and the Therapeutic Community Unit, Springhill

Institution, Canadian Penitentiary Service.

Baqkground: In December of 1977, Acting DCIP requested

that I visit the Social Therapy Unit at Oak Ridge in order to famil-

iarize myself with the program in place there. This request Was in

response to Recommendation #45 of the Parliamentary Sub-Committee

Report on the Penitentiary System in Canada (1) WhilP the main

responsibility of responding to Recowiendation /14!", was subsequetly

given to the Medical and Health Care Services Branch by SMC, it was

thought appropriate by senior officers qf the Offender Programs Branch

that this Branch prepare a position paper in response to the recom-

mendation from its own perspective as well. With this in mind, a visit

to the Oak Ridge Complex at the Penetanguishene Mental Health Unit was

scheduled for January 23-27, 1978.

Similarly, and subsequently, a visit to assess the Therapeutic Community

Unit program at Springhill Institution was planned. The Parliamentary

Sub-Committee Report commented upon this program. (2) This assessment

was to be done in the light of my examination of the Oak Ridge Social

Therapy Unit. (The theoretical underpinnings of both of these program

may be seen as arising from the same base.) A visit to Springhill

Institution was scheduled for April 4-7, 1978, for this purpose.

...2

2.

Social Therapy Unit, Oak Ridge

The Oak Ridge Complex for the criminally insane at the Penetanguishene

Mental Health Centre is comprised of two units - the Social Therapy

Unit (STU) and the Activity Therapy Usait (ATU). Each of these two

units consists of four wards or ranges. The wards contain thirty-eight,

cell-like, individual rooms with open-barred doors. Patients assigned

to ATU are generally those who have been assessed to be of lower intel-

ligence (i.e., mentally retarded) and therefore not capable of bene-

fitting from the STU program. Other types of patients to be found there

are those who are judged to be unsuitable candidates for STU (for

various reasons), the physically disabled, the chronically ill and the

elderly. The program in this unit is centred around occupational

training and therapy for the patients. No further attention will be

paid to the Activity Therapy Unit as it does not fall within the scope

of this report.

The four wards of the Social Therapy Unit (STU) represent a progression

in an individual's treatment program. The wards are symbolized by

letters and treatment progression is related inversely to letter juxta-

position in an alphabetic sense. To illustrate: H Ward - this ward

serves two purposes: 1) it acts as a reception unit (M.A.P. program)

for all newcomers to STU; and 2) it acts as a dissociation/isolation

unit (Time-Out program) for those patients who are judged to be

regressing in terms of commitment to, and/or participation in, the

treatment programs; G Ward - the initial therapeutic community

...3

3.

experience entered into upon successful completion of the M.A.P.

program (i.e., M ,-. motivation, A = attitude, and P = participation)

of H Ward and where the emphasis is placed upon developing communication

skills, group solving of community problems and improving an individ-

ual's ability to relate to the community as a whole and to its members

individually; this is achieved through a series of patient committee

structures; F Ward - the second community experience of a more intense

nature than G Ward and featuring a "tribal system" where the emphasis

is placed upon the person as an individual and the discovery of self

in relation to a freer community organization; E Ward - the work ward

where patients, who have graduated successfully through H, G and F

Wards, now reside while engaging in work activities during the day. A

general progression of patient autonomy is noted - virtually no

autonomy on H Ward to a maximized amount of autonomy (given the insti-

tutional context) on E Ward.

Patients on STU come from three basic sources. One of these sources

is the courts which refer those wbo bee- n found 1W. .L Guilty by

Reason of Insanity", those who have been found "Unfit to Stand Trial"

and those who are remanded for observation for periods of thirty or

sixty,days. The federal and provincial correctional institutions

provide a second source of patients for STU. It is important to note

that certification is a requirement of admission in these cases, as

well as in other cases. The third source of patients consists of

other mental health centres in the province.

.. .4

4.

The STU program, in its inception, was based upon five major assump-

tions: 1) sickness as the failure of communication; 2) dialogue as

therapy; 3) the patient as the agent of therapy; 4) total experience

(i.e., total immersion into group 'structures and processes and the

consequent requirement to communicate and explore inter and intra-

personal relationships); and 5) coercion as the goal to freedom. (3)

Major components of the program are confrontation, anxiety arousal,

analysis, community (in the sense of fellow patients) support and

feedback (both from staff and fellow patients). Much of the thera-

peutic process is carried out by the patients themselves within the

group, tribal and dyad structures. The professional staff is small in

number, consisting of seven persons altogether during my visit to Oak

Ridge: a psychiatrist, a psychologist, a psychometrist, an occupational

therapist and three nurses. The roles of these seven staff members were

virtually indistinguishable with the exception of a few medical functions

(performed by the psychiatrist and the nurses) and in the staff feed-

back sessions which were led by the psychiatrist who is the Unit

Director. The remaining staff component consists of custodial officers.

The Parliamentary Sub-Committee Report makes reference to the fact that

the "inmate code" is absent on the STU and that "undesirables"

(e.g., sexual offenders) are accepted by the other patients. My obser-

vations supported these comments to a large degree. However, I feel I

must offer the following qualifying remarks. There remains evidence

of a "we-they" reference structure on the part of the patients vis-à-vis

...5

5.

the professional staff and particularly vis-à-vis the custodial staff.

There exists evidence of varying degrees of acceptance of the so-called

"undesirables", however the threat of violence appears to be completely

absent. There is also evident a tension between professional staff and

custodial not unlike that present in federal penitentiaries. Attempts

to deal with this problem are made through weekly meetings between

professional staff and custodial unit supervisors. However, and not

unexpectedly, some communication problems remain. Acceptance of the

STU program is not universal by the custodial staff particularly at the

lower levels.

The STU program comes under the heading of "coercive programs" in a

classification schema of treatment programs. It warrants this classi-

fication on several counts; to begin with, there is the fact of

certification - most, if not all, of the participants in the program

have been certified as being mentally ill (and thus committable to

the institution), decertification (and therefore release) depends upon

performance and participation in the program. Needless to say, this

fact lends a fair degree of externally generated motivation to the

patient to initially participate in the program. Coercion also is

applied in ensuring the patient's continued participatinn and interest

in the program. This is illustrated by the fact that patients can be

removed from any aspect of the program and sent to the Time-Out

program (i.e., dissociation/isolation). One might also argue that

...6

6.

some forms of individual therapy utilized in the program (i.e., certain

of the drug and alcohol treatment programs) are of a coercive nature.

The fixed, step-by-step nature of the program with no allowance for

variation and individual preference is another example.

The coercive nature of the program points out essential qualitative

differences between the STU setting at Oak Ridge and federal peniten-

tiaries in general (with the possible exception of the Regional Psy-

chiatric Centres), differences which are of significance to the

Offender Programs Branch. In the federal penitentiary context, it has

been argued by some that incarceration is the sole penalty of law-

breaking and that participation in institutional programs of a reha-

bilitative nature is purely a voluntary option for the offender. In

other words he has the "privilege" (or "right"?) to refuse "treatment"

(or conversely, under the "opportunities model", the Service provides

program opportunities to incarcerates which may, or may not, involve

attempts to motivate the individual to participate but certainly does

not encompass the element of coercion).

Such considerations anticipate problems such as the following: peni-

tentiary sentences are usually determinate, therefore why should one

undertake a commitment (and personal emotional risk) to a very inten-

sive program such as the STU program when one's eventual release is

not dependent upon such participation. Even were such a commitment

to be given, how does one hold an individual to that commitment when

...7

7.

the going gets tough if participation is supposedly voluntary. There-

in lies a very difficult problem when considering the implementation of

the STU program in a non-psychiatric, medium or maximum security

institution.

Another point of interest concerns a perceived relationship between the

STU program of Oak Ridge and the Living Unit programs of CPS, in con-

junction with the environments in which each program is applied. Many

of the basic tenets of the STU program are shared with other "Thera-

peutic Community" types of programs. In philosophy, orientation and

theory they all share a common base. Thus the Living Unit (LU) program

of CPS and the STU program can be considered as variations on a theme

in relation to the Therapeutic Community model in the abstract. The

major difference between the STU program and the LU program is one of

degree in terms of "therapy" or "treatment" offered, the model through

which this service is delivered and the environment in which it is

applied. STU patients are certified as mentally ill; a medical model

is applied in a mental hospital (maximum security) environment and

through therapy a "cure" is strived for (albeit with a strong emphasis

on social and interpersonal interactions - i.e., a predominantly social

psychiatry medical model). The "cure" calls for very intensive therapy

at a deep emotional level. Penitentiary inmates, on the other hand,

constitute a "normal" population (in the psychiatric sense); a medical

model does not necessarily apply, nor is the environment of program

application that of a mental hospital. An approach which stresses a

social learning (or relearning) approach in a non-mental hospital

...8

8.

environment would seem more appropriate. The concepts of open communi-

cation, a supportive atmosphere, the learning of more adaptive social

skills and problem solving behaviors and the selective reinforcement of

positive and negative behaviors (which are common to both approaches)

can be applied through a program (4) which encompasses a social learning

model in its application and is adapted to, and incorporated into, a

penitentiary environment. The LU program, in its "pure" form, is an

attempt to meet these conditions.

The question of the so-called "right" to refuse treatment does not arise

with the Living Unit approach to therapeutic community principles.

Because the inmate is not considered "ill" or "abnormal" in a medical or

psychiatric sense, psychiatric therapy is not warranted. Rather, a

program, which is basically socially oriented and which operates as part

and parcel of the institutional environment, would seem more appropriate.

Thus the program is built into the institutional regime and becomes part

of normal institutional life (e.g., range meetings). The question of

forced or coercive treatment simply does not arise. This fact would

seem to render a program such as the LU program as being more conducive

to the non-psychiatric, federal institutions.

In the foregoing, while comparing the STU and LU programs, I have used

the terms "therapy" and "treatment". This was done for illustrative

purposes only. It should be remembered in this context that the LU

program eschews the use of these terms. A social learning model or

approach is applied. No attempt is made to deal with deep-seated

emotional problems in a psychiatric sense. The objective is to

...9

9.

provide "normal" individuals with social learning opportunities so

that a more socially acceptable and adaptative responsP rPpertoirP

may be acquired by the incarcerate. Insight into emotional problems

may result from this approach as well as better control of emotional

impulses. The primary aim however is of a "social adjustment" nature

and not therapeutic intervention in a psychiatric sense.

The Parliamentary Sub-Committee Report on the Penitentiary Service in

Canada states that the use of the term "patient" in the text of the

Report when discussing the STU program does not "imply any specifically

medical treatment" (5) . This statement should not, on the other hand,

be misinterpreted to mean that the STU program is not, basically, a

medical program. The program deals with the treatment of certified

individuals under medical direction. A medical (social psychiatric)

model is applied in the treatment program. The individualited drug and

alcohol "immersion" therapy techniques specifi ,ally require the presence

of medical consultation if not outright medical direction.

In conclusion, it is suggested that the adoption of the STU model

presents serious theoretical and practical problems for non-medical,

non-psychiatric institutions and thus for the Offender Program Branch.

As a first step in the implementation of Recommendation #45 of the

Parliamentary Sub-Committee Report it is recommended that the Regional

Psychiatric Centres (RPC) be the focus of attention where conditions

10.

and models of treatment more closelyapproemate_those of the STU

program at Oak Ridge.

Once this has been achieved and the benefits of the program made

evident to other incarcerates, perhaps the problems of motivation,

participation and commitment can be overcome in non-psychiatric

institutions and pilot projects (i.e., programs) can be instituted in

these institutions for those individuals who either need or wish to

participate in such a program. Furthermore, a pool of trained inmate

therapists will then be available from the RPC programs. These individ-

uals, in turn, will greatly aid in the introduction of pilot projects

in other medium and maximum security institutions. It is projected,

however, that universal participation of federal inmates in STU-like

programs will never be realized (if that ever was the goal) and that

the LU program will be crucial in serving a similar function for what

is seen as the non-participating "normal" majority. That is, will

provide the opportunity for social learning and .social adaptation

experiences to those "normal" individuals who neither require nor wish

a "treatment" or "therapy" program in the psychiatric sense. In my

view, the STU and LU programs should not be perceived as competing

and/or mutually exclusive programs. Rather, they should be perceived as

being complementary in nature; each being of value and benefit in the

particular environments within which they function best.

...11

THERAPEUTIC COMMUNITY UNIT, SPRINGHILL INSTITUTION

Springhill Institution, a medium security institution, has four

residential units. Three of the residential units are designated

as living units and are operated in accordance with Living Unit

program guidelines. The fourth residential unit, Unit #10, has

been designated as the "Therapeutic Community Unit" (TCU). The TCU

program was instituted in July, 1969.

The following rationale was recently offered as the basis for the

operation of TCU. The therapeutic community is composed of a group

of inmates and staff working together toward a therapeutic goal.

This goal consists of the creating of an environment which will

induce the inmate to learn non-delinquent alternatives to those

behaviour patterns that placed him in his present predicament (i.e.,

incarceration). (6) One of the essential differences between the TCU

program and the LU program is that the notion of therapy is stressed

in TCU whereas therepeutic intervention, per se, is not an element

of the LU program. The latter, as noted above, stresses an environ-

mentally-structured approach to social learning (or relearning) and

social adaptation.

The physical structure of TCU is similar to most medium security,

living unit program penitentiaries. There are three wings of cells,

two ranges per wing, with approximately 17 cells per range. A fourth

and smaller range of cells located over the main entrance to the unit

12.

was renovated to provide space for what is now the community meeting

room. The staff complement consists of two Living Unit Development

Officers (LUDO's), one Living Unit Supervisor (LU-2) and fifteen

Living Unit Officers (LU-1's). The terminology used for, and

classification of, staff in STU are identical to that utilized for

regular living unit residences in CPS. TCU differs from other

residential units under the Living Unit program in that all three

work shifts are covered by LU 'staff (as opposed to other residential

units where the night shift is manned by a security officer - i.e.,

CX staff - only). Other institutional personnel are available to

TCU in a resource capacity. Such personnel include the institutional

psychiatrist, psychologists, chaplains, etc. A NPS officer is

assigned to TCU from the Truro NPS office and participates in staff

meetings, inmate interviews, and community meetings as much as is

possible given his schedule and travel demands.

One observer commented that the essential differences between the

TCU program and the LU program at Springhill Institution consisted of

the following: 1) more frequent community meetings in TCU (thus

intensifying contacts); 2) availability of TCU staff on a twenty-

four hour basis; and 3) cells are not locked thereby giving the

unit residents more control over their daily lives in terms of

allowing them to determine their own hour of retirement for the

night and the ability to seek the privacy of their cell as they see

fit. (7) One should comment here that the nature of the aforementioned

3

13.

community meetings are different than the range meetings of the

traditional LU program. On TCU an attempt is made, during these

meetings, to assume a therapeutic, insightful approach to discussions

concerning matters affecting the functioning of the community and,

in particular, to behaviour considered detrimental to the community.

Also staff "wash-up" (i.e., feedback) meetings were recently

reinstituted. All available staff attend these meetings which are

led by the institutional psychiatrist.

The TCU program then, may be thought of as falling somewhere between

the STU program on the one hand, and the LU program on the other. It

might be useful, for illustrative purposes, to pursue a continuum

analogy in a rudimentary comparative analysis of the three programs.

One continuum would be of a theoretical, conceptual nature. On this

continuum the TCU program would fall, let us say, mid-way between the

STU and LU programs. The TCU program is not a medical program in the

manner of the STU program though it does borrow some elements from a

medical model such as that of therapeutic intervention, yet it adopts

as well a social learning approach similar to that of the LU program.

The second comparative continuum would consider the practical aspects

of the programs, i.e., its operation. On this continuum the TCU

program would again be located between the other two programs but, in

this case, much more closely aligned with the LU program than with

the STU program. There are many reasons for this placement, the

majority of which are environmental, administrative and organizational

14.

in nature. In terms of therapeutic intervention the main instruments

for this are the TCU daily community meetings. Therefore the

emphasis and practice of therapeutic intervention at Springhill

differs markedly from the STU program at Oak Ridge, particularly on

the dimensions of intensity and depth.

The Parliamentary Sub-Committee Report makes reference to the TCU

program. It indicates that the program has fallen short of "... reaching

a satisfying therapeutic climate..." (8) and therefore its goals. Two

reasons for this may be extracted from a reading of the Report: 1) too

large a "community" population, particularly in relation to partici-

pation in community meetings where the group meets en masse; and 2) the

fact that "... the prison sub-culture had not been fractionalized..."

again seemingly due to the numbers problem as well as to the intake

philosophy of the unit (i.e., lack of a slow integration process of

new inmates into the unit). I interpret this to mean that the "inmate

code" had not been successfully broken down.

Yet a recent review (9) of the TCU program unearthed the following

information: 1) TCU had fewer disciplinary offences and less use of

dissociation than the other three units; 2) inmates who had been

behaviour problems in other units adjusted well in the TCU environ-

ment; 3) inmates in TCU have consistently refused to participate

in planned incidents of collective action initiated by inmates on

other units and have thus proved to be a stabilizing factor within

the institution; 4) a former policeman (now an inmate) was placed

...15

15

on TCU and was accepted there with no special arrangements being

necessary for his protection, indicating perhaps a greater degree

of acceptance on this unit of so-called "undesirable" inmates;

5) relationships between staff and inmates appear to be of a

closer nature on TCU as compared with the other units; and 6) the

incidence of damage to property in the unit is lower in TCU than in

the remainder of the institution.

What does one conclude from these findings? Notably, that there

seems to be a qualitative difference between the TCU and LU programs

at Springhill Institution. To what can one attribute the difference?

Presumably to the four or five basic differences pointed out earlier

in this section, that is: 1) more frequent community meetings;

2) TCU (LU) staff "counsellor" availability on a twenty-four hour

basis; 3) allowing inmates the autonomy to determine their own

individual bedttmes and privacy needs; 4) a willingness by staff

and inmates alike to discuss mutual problems in depth in the open

forum of the community meeting; and 5) the opportunity for the TCU

staff to receive and to give feedback. Does this mean that the LU

program in the other three residential units is failing? Not neces-

sarily, as an in-depth study of those units was not undertaken. It

perhaps can be said however that range meetings in these units should

be held with greater frequency; that more emphasis must be put into

staff training programs particularly for the LU "counsellors". Those

latter two points are fairly generally perceived as needs indigenous

to most LU programs throughout the Service.

...16

16.

Perhaps the TCU program more closely approximates the ideal LU

operation despite its emphasis on so-called "therepeutic intervention".

Perhaps there are aspects of the TCU program that could be usefully

adapted to the LU program such as the five noted above. Lastly, a

close look should be taken at the functioning of these units in

relation to the LU program guidelines to ensure the guidelines are

being adhered to. The findings do indicate, as well, that the TCU

program has not been a total and dismal failure; a conclusion that

one might extract from the Parliamentary Sub-Committee Report. In-

sofar as the "inmate code" is concerned, while one could not claim

a total breakdown of the code (nor would one expect it), I did

witness events that certainly indicated a partial breakdown of the

"code" ( cf., also inmate statements appended to Report of Visit to

00)% the Atlantic Region ).

I .did not find evidence of any undue amount of conflict between

custodial staff and professional staff as mentioned in the Parlia-

mentary Sub-Committee Report.(11)

I did see evidence of tension

between TCU staff in general and the administration. Such tension

I perceived as being due to the dynamic of attempting to operate the

TCU program within the administrative confines of the institution, of

the Service and within a system with a basic LU program orientation.

All these factors, at times, override the perceived needs of TCU. •

Many people have commented upon the fluctuating nature of TCU over

its nine-year history in terms of the vivacity and viability of the

.. .17

17.

program. There seems to be periods when interest and motivation

flag. During my visit the program seemed to be in an up-swing

phase, having been examined only recently as to its needs and its

viability. A similar phenomenon of phasic fluctuations in program

vivacity was reported during my visit at Oak Ridge and is often

reported in the program evaluation literature. I strongly felt

that the professional resource staff at Springhill Institution

must take a renewed interest in TCU.

Another area of comment concerned the number of inmates in the TCU

program (i.e., sixty-eight or more). This number seems a bit unwieldy

to deal with in a therapeutic manner. One is overwhelmed with the

idea of sixty-eight individuals participating in a therapy-oriented

community meeting. Yet there is a trade-off involved were one to

fractionalize the population. This occurs through the loss of a

"one community" identity and its being replaced by several sub commu-

nity identities (e.g., wings or ranges). It was the considered

opinion of the TCU staff that it would be a mistake to attempt to

fractionalize the community. Such fractionalization (and subsequent

loss of community identity) was cited as one reason why the other

three residential units at Springhill Institution seemed to be

functioning less effectively than TCU. I attended two community

meetings where upwards of sixty-five inmates were in attendance (plus

staff and resource persons). The quality of the meetings, given the

numbers, was surprisingly good. However, content tended to be as

much informational in nature as therapeutic.

,..18

18.

A comparative study of the LU and TCU programs at Springhill Insti-

tution was conducted by a research team from the University of

Moncton in 1975. (12) The research findings were inconclusive in

terms of program superiority but did find many areas of overlap

in the two programs as has been alluded to earlier in this report.

The report also commented that the quality of the therapeutic

intervention attempts left much to be desired, generally because the

staff lacked the necessary training in the skills required for such

intervention.

Part of the reason for my visit to Springhill Institution was to

assess the TCU program in the light of the STU program. However,

I soon found any attempt at such a comparison to be of an "apples

and oranges" nature. The TCU program does not, nor cannot, attempt

therapeutic intervention in the manner of a program such as the STU

program. However, as has been noted above, the TCU program does

possess many positive features which, in the Springhill experience,

renders it seemingly somewhat superior to the other residential

units at that institution. As suggested earlier, perhaps the LU

program could benefit from examining those aspects in which TCU

Offers with a possible view to their incorporation in the LU program.

FOOTNOTES

(1) Report to Parliament by the Sub-Committee on the Penitentiary System in Canada. Minister of Supply and Services, Canada, 1977. pp.119-122.

(2) Ibid. p.121.

(3) Maier, G.J. and Hawke, T.J. Penetang: People and Paradox. Penetanguishene Mental Health Centre, undated. 26 pp.

(4) Henriksen, S.P. Guidelines to the Living Unit Program in Medium Security Institutions. Unpublished Document. Ministry of the Solicitor General, 1976. 245 pp. plus appendices.

(5) Report to Parliament ... Op.cit. p.120, para. 570.

(6) Garneau, M.L.J. Therapeutic Community. Unpublished Document. Ministry of the Solicitor General, 1976. 3 pp.

(7) Garneau, M.L.J. Report of Visit to the Atlantic Regiun. January 23-25, 1978. Unpublished Document. Ministry of the Solicitor General, 1978. 8 pp. plus addenda.

(8) Report to Parliament ... Op.cit. p.121, para. 581.

(9) Garneau, M.L.J. 1978. Op.cit.

(10) Garneau, M.L.J. 1978. Op.cit.

(11) Report to Parliament ... Op.cit. p.121, para. 581.

(12) Desjardin, L. and Loubert, C. Comparative Study of the Therapeutic Community and Living Units at Springhill. Unpublished Document. Ministry of the Solicitor General and the University of Moncton, 1975. 9 pp. (translated summary).

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