 My name is Adelina Yutene, I am a law professor at Schulich School of Law at Dalhousie. So we traveled from Halifax to be here tonight. Thank you so much to the community college for hosting out. Thank you, Heather, for making Daliso and making sure everything goes smoothly. And thank you to Elisabeth from Dell, who's arranged everything. She's also my support system too. As I said, I'm a law professor and my area is quite interdisciplinary. I mostly work in criminal law. I do a lot of criminal justice issues, social justice issues. And I specialize in what we now call prison law. So an area that looks at particular needs and rights, avenues, access to justice for prisoners. But the research that I do, as I said, is quite interdisciplinary. It goes beyond the limits of the law into health sciences, social sciences, criminology, and so forth. For the last about seven years of my career, I've been specializing in looking into the healthcare needs and access to justice for vulnerable groups of prisoners. With specific emphasis on aging prisoners. And that's something that I'm going to address tonight. I'm going to go over some of the healthcare issues and availability of healthcare resources in prisons for aging individuals. Now, I don't want to be understood as saying that younger prisoners do not have health problems or that the treatment of younger prisoners is significantly different or much better. It's just that as it happens in the community, as we age, we tend to have more problems. So if there is a gap in terms of treatment, it's going to be more obvious within the groups of people that have heightened needs. So I think the aging population is a fairly interesting group to make a case study out of and to look at how different resources within the Correctional Service Canada are being distributed and utilized. Now I'm only talking about the Federal Correctional System. I do not talk about the Provincial System. The Federal Correctional System is the one that's running penitentiaries across the country and is where individuals who have been sentenced to two years or more are serving their sentence. So there may be more people in the Provincial. We have each province has its own correctional system where people sentenced to under two years are serving their time. And there are obviously a lot of people there, but they focus on the Federal system because it's there where people serving life are incarcerated, so growing, old in prison. People serving indeterminate sentences are serving very long sentences or are in and out in and out of prison. So for the point of view of aging, it's definitely a more important place to look at, I would say. Now I'm going to do two things tonight. First of all, I'm going to try to provide a rundown of what the Federal Correctional System looks like, what's the legal framework that is governing the rights of prisoners, the different activities that take place in prison, basically the whole prison construct. There is a framework behind it and we're going to talk a bit about it. And we're going to see that actually on paper that legal framework is quite progressive and it's actually one of the better ones that exist around the world. Now in the second part of my talk, it's not going to be as optimistic. That one looks at how the law is being applied in practice within the Federal system. And I'm going to present you with some of the results of my study, I've been based on interviews with 200 older prisoners in Texas. And I'm going to try to offer you the image of the older prisoners, an individual that is aging in prison, the treatment that he is getting, and the resources that are available, and the potential legal problems that occur when the law in terms of their rights is not applied to its fullest meaning. And I'm going to inquire into what it means for our community in terms of resupplying the law or not always considering the constitutional rights of prisoners. So that's just a bit overview of what I'm going to be doing. The pictures that you're seeing are actually of actual individuals incarcerated in Canada and in the US. There are courtesy of photographer Roble being the photographer in the US. And he's kind of dedicated his life to taking, to going into prison and putting a face to the process of aging. His beautiful photo album is called Prisoners of Age. It's a wonderful, wonderful collection. So the Federal Correctional System, as I mentioned, is the Canadian system that is bringing together all the penitentiaries across Canada. And it's governed by a governmental agency called Correctional Service Canada, which is responding directly to the Ministry of Public Safety. And they have penitentiaries of old levels from minimum, medium, and maximum security and multi-level for women. And they exist from coast to coast. We have one here in Springfield. And there is another one through road, which is for women. And there are also some other institutions, such as the Regional Treatment Center. In each region, there is one, which is basically a psychiatric institution where people, prisoners that are having acute medical disorders are being sent there for treatment. It's still a Correctional Institution, but it has this psychiatric angle to it. Now, basically, prison is what we call a total institution. So it's an institution where the people that are in it are under full control of the state. So the state is the one that has to provide everything for them because their autonomy and possibility of choice have been completely taken away by way of the state intervening and taking away their liberty. So we need a very robust framework in order to ensure that we are maintaining the kind of tension between the needs of security of the institution and the needs of the Correctional System to fulfill its purpose and the rights that these individuals have, including, for instance, to healthcare. People grow old in prison, people get sick in prison and they don't have the option of going elsewhere and seeking for help even if they have money to pay for it, right? So there is the need for the institution to provide for that kind of treatment and obviously a lot of time there is a tension between the provision of services and ensuring that the security of the institution is running smoothly, right? So for that we have a very big federal piece of legislation which is called Correctional and Conditional Release Act and it has its companion Correctional and Conditional Release Regulation. Now these pieces are regulating absolutely every aspect of life in prison. Everything from the intake of prisoners, how you're supposed and they are mandatory, how you are supposed to treat prisoners upon intake, how you are going to assess their risk, in what institution you're going to place them, what are their healthcare entitlements, when do they go to solitary confinement, how they are being disciplined, what kind of visitation they take, everything, every single moment from the moment when they wake up to the moment when they are going to be released later on, it's governed by this piece of legislation, that part of it is to ensure that that tension I was talking about between rights and security is kind of maintained and it's not at the whim of whoever is at the political will, let's say, right? So, as I'm going to focus when I'm talking about this piece of legislation on a number of issues, but first I would probably mention the fact that at the moment there are 13,000 people incarcerated in federal tenturies across Canada. This number changes from year to year, it's been fairly steady within the last decade or so. 2,000 of these people are over the age of 50. Now, why am I saying 50? In prison research we use 50 as the lower limit of seniority. I know it's very young, but the reason we do that is because empirical data shows that any given prisoner tends to have the problems of a person to stand to 15 years older than them in the community. It's kind of lower the age of seniority to correspond to that reality, right? So, there are about 2,000 people that are incarcerated over the age of 50 in these penitentiaries. Again, at all levels of security. And I'm going to talk to you about that more when I get to the portion when I'm discussing my study. Now, I just want to point out from the big framework of legislation a number of provisions. A number of provisions that I think are particularly impacted by what my study brought out or brought up. And I'm going to kind of link them to the finding of my study. So, just bear with me a little bit. One of the very important articles in the Corrections and Traditional Release Act is section 81. Section 80 and 81 are talking about the health care provision. So, they are guaranteeing the fact is very clearly stated that individuals that are in federal correction in the federal correctional system are entitled to unlimited access to primary health care at the same levels as in the community. And they should have access to a reasonable amount to non-primary health care. And mental health care, the legislation says, is a primary health care issue. So, they should be having access to that. Two issues, an issue of access and issue of quality should be at comparable levels to those in the community. So, we have that on one part. And we also have that coupled with some of the rights in the constitution. Obviously, there are a number of issues that can be linked to health care in terms of constitutionally protected rights, such as the right to be free from cruel and unusual treatment and punishment, for instance. When does the lack of health care make tilt into that field? So, those are some of the questions that I'm going to go into a little later. The other provisions that I think are important because I'm going to come back to them are the regulation of security measures. Again, remember I was saying the other end of the tension is the security needs and the obligation to ensure that there will not be a lot of security incidents and that people are going in to get rehabilitated and come out rehabilitated. So, one of those issues is the disciplinary system. There is a whole disciplinary system that is put in place. And the provisions are regulating every kind of aspect of the disciplinary moment from the reasons why you would get a disciplinary action against you to how you can challenge it, to who's going to present you and so forth. And I think the important point for this talk is the reason why there is a disciplinary system in prison and the legislation says very clearly in section 38 and onwards for those who came that the reason why we have a disciplinary system is to ensure that the individuals are motivated to behave properly and that is in turn going to ensure their rehabilitation and successful reintegration in the community upon return to community. So, there is that idea that everything that disciplinary is is a behavioral trigger, right? And that includes disciplinary solitary confinement that's kind of like the bigger form of action. Disciplinary segregation, for instance, when you're completely isolated for 23 and a half hours a day because you have... And there is a cap in the legislation of no more on paper than 30 days in disciplinary segregation. Now, we also have what we call administrative segregation, which is also a form of security. And the legislation says that the reason we have this is also means sending somebody to solitary confinement, keeping them isolated from 23 to 23 and a half hours a day, no access to other people, no access to programs, and so forth. And the reason the legislation says is because you want to ensure that people that continue to present risk for the security of the institution are not associated with other individuals that are sort of incompatible. So, it's not necessarily behavior trigger, it's more preventive to ensure that the security is running kind of loosely. And then the other issue that has some security connotations is the actual level of the security. So, we have minimum security institutions, medium security and maximum security. And make no mistake, the difference between them is enormous, is very big. To begin with, people that, you know, there is a lot of way more freedom as we go down the security scale, right? Individuals are able to associate more freely. A lot of times they are not locked up. A lot of times they are living in house kind of settings where they can cook their own food. And there is definitely a different quality in services as we go down the security level. The emphasis kind of shifts from security, investing money in security to investing money in more rehabilitative activities such as programs, such as visitation, escorts to community and so forth. Normally, and that's a principle that's governing the legislation, is that an individual should not be overclassified. Overclassification means when you are placing them in a higher level of security than they should based on their actual risk. And there are a whole bunch of factors into how we are assessing the risk of an individual. But for them, and both of them have to do, in general it has to do with the crime they had committed at that point and with their personal history, right? Once an individual has been classified, you're normally not moving them to a higher form of security for any other reason than behavioral trigger. So, if you cannot manage them in minimum security and they are acting out and they are, that's when you're going to move them out. There are many other reasons. Now we're going to see how these, all of the security issues that I've talked about and which in theory sound like there is actually some reason behind them can actually be very easily manipulated to respond to other concerns than security or to other things that are not behavior but they can be in terms of health care and it's all a cycle in the end. And I wouldn't want to be understood as saying necessarily Correctional Service Canada's fault or fully Correctional Service Canada's fault or fully the government's. I think we're in a bad situation where prisons are becoming nursing homes and prisons are becoming increasingly places where we see mentally ill people, chronically ill, terminally ill people. We do not have a sound mechanism of releasing these people and integrating them back into the community. So we are left with simply security tools to deal with medical issues and so many fronts wrong. It's wrong in terms of law. It's in terms of potential for reintegration and it's wrong in terms of community safety ultimately and we're going to go through that a bit. The final thing that I want to mention before I get into the more juicier part of the actual study is the constitutional rights. Now we have a Canadian Charter of Rights and Freedoms which is part of the Constitution of Canada and which ensures that the prisoners have or guarantees that the prisoners have the same rights as any of us have as long as they are compatible with a limitation in their freedom, right? So, especially important here, I've already mentioned the right to be free from cruel and unusual treatment and punishment but also things like the right to life and security of the person in certain, you know, as long as it's compatible with the principle of fundamental justice and so forth, those are things that are going back to the needs of the individuals, the most primary needs of the individuals, right? So, we're going to see how that may be affected. Let's talk about the study now. It's interesting because the issue of aging in prison has been a very frequent topic of discussion over the last 10 years or so in the American literature because there is definitely an aging of the population worldwide, not just prison, like just worldwide. Well, obviously this is being mimicked in the prison settings, right? And obviously there has been a significant understanding of the fact that aging where the image of the young, strong, prisoner in 25, 30, you know, very healthy who needs to go to school and better himself and come out and be a productive member of society is being completely shifted with the aging of the prison population and the demographic worldwide generally, right? So, there has been an understanding that maybe what we used to do for a population that was mostly formed out of healthy 30-year-olds might actually not be as suitable for 75-year-olds who are chronically ill and they might see their end of life in prison. So, Americans who also have, you know, life without possibility of release and so they have been way faster than we are in researching these issues and looking at that. Now, when I started my doctoral work back in 2012 there was no work whatsoever done on the aging of the prison population in Canada. No. Despite the fact that it was becoming clear that the rate of individuals aging has doubled within the previous decade and was at that point at 20% of the whole federal prison population. By the time I finished my doctoral work four years later the number of people aging in prison had gone to 25% and were now headed towards 30%. And it's interesting because the overall rate of incarceration in Canada has remained steady. So, it's interesting because it shows that within the steadiness of the group of people the only ones that are increasing it means that the number of young people is decreasing and the number of old people is very rapidly increasing, right? And again, there has been no particular changes to how prisons are operated based on this demographic and we're going to see what that means based on the study that I conducted. So, what I did, I interviewed 200 prisoners that was roughly 10% a very significant portion statistically speaking of the individuals who are aging in prisons and they were from seven federal penitentiaries in Canada all of them were based in Ontario and they were at all levels of security so minimum, medium, maximum and an assessment unit. All of them were male I did not receive access to females and that's a whole lot of categories so all of them were males. I talked to them based on structured interviews I administered some 72 questions of the fairly structured and they all had to respond to them and then I quantified them using SPSS and then I qualified them as well so I had a number of methods of analysis and the results that have resulted from my quantitative and qualitative work is what I'm going to briefly go over with you tonight and see how that kind of fits with the framework the legal framework that I've introduced. So, let's see let's start with how the older individual looks like so the individual over the age of 15 Now, if you're over the age of 15 chances are that you have about 50% chance that you have grown old in prison so 50% of the sample either were serving a life sentence or were indeterminate sentences which means that you don't have an end to your sentence your word doesn't expire because you've been and that happens when you've been chopped when you've been convicted of two or more dangerous violent offenses and the prosecutor has requested that designation that the designation means that you will you're basically saving a life sentence it's just that the possibility of clearly release may be a little different than for actual life sentences If you are over 50 you have a 99% chance of suffering from at least one chronic condition the majority of them being arthritis, diabetes, cancer heart problems things that are very common within our aging community as well the particularity was that the majority of these individuals were suffering from between four and seven chronic conditions 52% were suffering from debilitating disability so that meant that it was impacting their abilities of daily living whether that was walking, going up and down the stairs getting into bed, washing and what's not it also meant it was interesting because their disability was statistically correlated with a number of other problematic issues such as ability to sleep at night it was correlated with chronic pain and it was correlated with alcohol abuse and that brings to chronic pain as I mentioned the majority of people suffering from a disability were also reporting chronic pain but there were also people not suffering from a disability that reported chronic pain over 50% of them and when I say chronic pain for the purpose of this study I was referring to people whose symptoms were not managed by over-the-counter medication so they needed prescription medication These issues were particularly problematic and there are some other issues for instance one of them reported and probably this one under-reported were incontinent and also 5% of them were suffering from a terminal illness so terminal illness for the purpose of connection of Canada means within six months of living and I'm going to go back to this category but just to put it out there if you're in this five category chances are you don't have access to a hospice and you don't have access to palliative care Now chronic pain, disability, incontinence were in a very peculiar category of their model and that category was that of fear for placing them in the category of very vulnerable individuals so there was a lot of peer abuse registered about 70% of them reported some form of peer abuse and the rate was doubled in the people that were suffering from high number of chronic illnesses or from incontinence or from disability then people who did not so that was a significant rate of abuse and we're going to see what that means for security reasons in a second but I'll just put it out there for now So let's see how the guy over 50 looks like mentally once not great and again this is probably under-reported some 45% or the 8% were suffering from at least one chronic mental illness and the majority of them were in the category of chronic depression significant anxiety, PTSD, schizophrenia and what was probably one of the most disturbing of them was that there were 5% of my sample reported either stage one dementia or reported significant cognitive impairment and this is an interesting and sad group because it's the moment when you look at them and you know that there is nothing that anybody can do and I'll tell you why in maximum security it was one of the guys who was Milhaven maximum security and he had been in for about one year at the point when I was interviewing him now he was in for murders so he was serving life the thing about murder is that no matter how much personal history it looks like no matter how you know how your risk other risk factors are you know they might be at the very low bottom murder itself has such a high risk factor that it's automatically going to send you for two years to maximum security regardless of anything else just the offense committed right so clearly this guy would have started regardless of anything else he would have started his sentence in maximum security and then he kind of goes down the problem with him and he was in maximum was that by the time his trial was done and he finally got into the what they call the mother institution the institution where you start your sentence he finally was seen in a step by psychiatrist and the psychiatrist said yeah well this guy has a state one dimension which is you know we've kind of treated as alcohol withdrawal for the last four years but well you know there it is it's actually state one dimension and there is nothing to do so this guy sits there in front of me and he cries for the whole hour of the interview he was particularly panicked and he said you know by the time I'm even done in maximum security I'm not going to remember my name let alone what I've done and the problem is that there was no way he was going to be released why he was serving like the early possibility of release was after 25 years so there is no way you can apply for early release before your period of parole eligibility comes in that's 25 years for him dementia even when it takes a while it doesn't take 25 years to set it and the second issue in Canada we do not have a functioning mechanism of compassion so we have a thing that's called parole by exception if you are serving life you are not eligible to apply for parole by exception unless you're suffering from a terminal illness and guess what he mentions not a terminal illness so we have 5% of our people who cannot remember their name or what they've done and they are incarcerated but they're not penitentiaries and there is no way they can be there is just no legal mechanism that can be used to be released we're going to talk in a second about the vulnerability that these individuals are presenting but I'm going to address them in the terms of treatment and accommodation because I think that's particularly important I mean the rates of disease and the rates of illnesses and I could go on I have pages and pages of that they are not particularly different than we see in the community maybe a little higher because of the previous lifestyles and regards of incarceration again, it's not spectacular we see that in the community as well what is spectacular and what is of concern is the availability or the responses that are available for this kind of issues and I'm going to start with simple things with the accommodation and the infrastructure now, a lot of these institutions are old institutions they have been built in the 19th century they have been built in some of them they have been built in the 20th century and they are not many of them are not having disability ramps many of them are not having working elevators many of them have very long distance in between the buildings so the individuals are having to walk a very long distance in a record time under threat of punishment to get from their house for instance to the programming building or the kitchen or what not and they have to go over these very long yards which explains what 72% of them reporting falling within the last winter on unclean or improperly DI's pathways because they have to rush through it and they are not properly taken care of the yards double banking is a significant problem these individuals double banking is currently over 30% in federal institutions and it doesn't matter how old you are the rule is the newcomer is taking the upper bank so if you are new to the cell no matter whether you are 20 or you are 75 you are going to be taking the upper bank now it also doesn't it might matter because if you have what they call a young banking if you have somebody who is 20 and he is in a gang perhaps he might not want even if he is the old person even if he is the new person in the room he might not want to go on the top of the bank so between a 20 year old and a 75 year old who do you think is going to spend the most time on the top bank a lot of the top banks don't even have rails so you have to and in one institution they didn't even have stairs so this guy had to jump up and down the stairs he broke his leg twice it was pretty intense and in some of the other institutions the better institutions the double banking happens in beds that are side by side as opposed to one on top of the other the problem is that because they are made for one person as opposed to two people you could get in and into your bed but you couldn't get your wheelchair in so remember I was telling that they have like 54% rate of disability many of them are in wheelchairs so that would mean you have to leave your wheelchair in the door and you kind of crawl your way into the bed so that's how double banking looks like for a 50 year old devices and medical supplies now a lot of times in the community if you don't get them from your doctor you can go and buy them from shoppers very easy things that are managing an extra bank with an extra pillow, heating pads braces, knee braces orthopedic shoes different kind of things that are sort of elevating the different symptoms that you might be having in most institutions so we have a very long list of things that can be prescribed with the permission of the warden such as wheelchair and cane in many institutions even those ones are prohibited and there is a whole list of items that are prohibited in all institutions for instance, heating pads braces and stuff like that you cannot get, that's not an option which makes things significantly difficult in terms of monitoring systems, symptoms the other issue had to do with the fact that there weren't any peer caregivers so again, 52% rate of people who are suffering from a disability that's impairing their activity of daily living and yet there were only two institutions that were having peer caregivers so 16% of the individuals benefited from somebody was helping them kind of base or wheeling them around or stuff like that the problem was that those peer caregivers did not receive a training so it meant that a lot of times they would be still in their food they would be still in their medication they would kind of like forget to go pick them up from where they had to be picked up they misplaced their wheelchairs a lot of the incidents of that so sometimes you're wondering whether you're not better off without a peer caregiver another issue was medication over 90% of this group was taking prescription medication excite for maximum security you have to go pick up your medication in person every day at 7 in the morning so that meant that you have to line up you wait for an hour until you get it in line with everyone else, in half of the institutions the lines were formed outside you had to line up to pick up your medication now these were people that were suffering were picking up their antibiotics for pneumonia raining, pouring outside minus 10 doesn't matter you have to stand and pick it up nobody else can pick it up for you not your peer caregiver, nobody else you have chronic pain, doesn't matter you have to stand to pick up your tile and all three for instance and this is something that's happening at NOVA for instance, in the prison for women the same thing, the lines but I know at NOVA for sure it's the same thing, you have to line up and pick it up in the morning now the other problem is, if you're old and slow and you have to pick up your medication sometimes you don't make it for breakfast now imagine that you're a diabetic by the way high rates of diabetes especially in people that have been in prison for like the last decade or so what you have to do is to have to choose if you go to pick up your insulin medication or if you're eating your breakfast the problem is, you cannot get your insulin without your breakfast so that was, in one of the institutions I talked about 10 of the guys and there was no conclusion no outcome to their complaints in that terms and this seems to be seemingly a very simple thing very easy to fix and the other big issue was the fact that there was no accommodation for dying people whatsoever again 5% individuals were in a terminal stage of life a lot of times they would not be close to their parole eligibility date so they wouldn't be at a time where they could actually be released with a regular parole mechanism the early release mechanism and for some whatever reason nobody has ever heard of parole by exception they would seem to fit squarely within people whose health is not compatible with incarceration and yet nobody has heard of it based on my research in the last 10 years that particular provision has been used two times in Canada so despite this huge numbers of people that should not be in prison the only quasi-compassionate release mechanism that we have is not actually function so there are options where there is no palliative care there is no systematic and life care in prisons so you just take the care that you can get you're being housed together with any brandy else say medication restrictions and so forth now for the most part they were kind of trying to for the most part they were kind of trying to keep them in lower security institutions there was this one particular institution that was called a death camp because they would have somebody die in natural causes every six months or something so 70% were over 50 in there it was definitely with a better conditions for sure so they transferred this one guy that everybody in that institution was telling me about they transferred him within the month that I was there and they said he's going to have better access to care and medication and what not the problem is that when you get transferred your paper record doesn't immediately follow you because that's bureaucracy so the paper was his medical record was about the months behind him this guy was in stage 4 cancer he was in unreal pain for one month he was one house together with everyone else and he didn't receive any medication forget morphine forget anything else he was yelling in pain every night the guys in his house put money together to buy him a bottle of regular Tylenol from the canteen now a bottle of Tylenol is worth one week of work for a regular prisoner so they all put money together and they didn't know what to do with him he finally did get some because I followed up with what happened to him so he finally his paper did follow he got some morphine and then he got two weeks of chemotherapy and then he died so that was his outcome not to mention that it was absolutely devastating on the guys that were witnessing that the guys were terrified by what they were seeing these were very very tough people and they were saying living in prison I've lived in prison for 40 years living in prison is not an issue I don't even have who to go outside to but dying in prison I don't want to die in prison I don't want to get sick in prison so it was that terrifying rampant fear of what will happen that was clearly having significant effects on their mental health and well-being interesting topic because the only painkillers available in prison according to the drug formulary are Tylenol-3 and morphine between them nothing so everybody the default rule is that everybody who has a pain that in his prescription gets Tylenol-3 now if you were on something else in the community good for you still get Tylenol-3 in the community Tylenol-3 is used for mild to moderate pain or two substance or some mild to surgery thing here guys that were in stage 4 cancer were getting Tylenol-3 because that's what they had and that was secure to use in some institutions they would have morphine there wasn't a particular rhythm to whether they would prescribe morphine or Tylenol-3 even though the difference between them is absolutely huge one person was in maximum security he was having a significant concussion after a car accident he had been in very devastating headaches he got morphine good he took them two weeks to figure out even though it was in his record why morphine was not working he was a heroin addict so what did they do they take him off morphine and they put him on Tylenol-3 because that's what's available and it's not surprising that pain efficiency was reported in these people in 20% of the cases so we have over 50% of people reporting chronic pain horrible pain caused of disability and statistically correlated to diseases and to physical disabilities and their efficiency record was 20% of course there were a lot of problems regarding the access to specialists and you know for the most part the waiting times were not different in the community there is also a long waiting time in terms of specialists so you know that was just that there were other issues that were different from the community for instance there was one psychiatrist available for 600 people in one institution right so the question was if you wanted to see a psychiatrist the question was are you suicidal and if you said no then you wouldn't be seen if you said yes you would be seen at the place in solitary confinement sorry observation cell so that was basically you know the trajectory now they had also one psychologist and you were entitled to three sessions with the psychologist for the duration of the stay this was a medium security that means that most people stayed there for like 15 years and the duration of your stay you got three visits most other specialists you would see by going to community so you get an appointment in the community you wait like everybody else in the community can be a long time that's normal unfortunately for Canada in general the problem was that being a prisoner you need somebody to escort you to your community visit to your doctor and it has to be an officer normally so in this particular institution where I told you that it was a death camp lots of people had community visits to go and see the doctor outside they had three officers available every day to take them out so what happened was that if you were the fourth guy having meeting an escort that day for which you waited for like I don't know two years you'd be bumped back to the end of the line because there was nobody to take you back to your community visit so what it meant is that you were going to wait to go back and wait for another two years to see the same doctor if you make it that far right so it was just a simple matter of institutional organization in how those things are going to it wasn't even a matter of actual access it was the matter of actually getting there and then of course there is a chronic shortage of it half of the institution did not have 20 or 7 pairs available like the working hours were between 8 and 5 and if you have a heart attack outside working hours then you are like he's not there one of the guys was describing an heart attack he had a heart attack in the yard at 8 in the evening so outside working hours he had a heart attack one of his fellow inmates went and grabbed the officer who was at the other end the officer had no idea how to do CPR by the way on paper, policy everybody of course responded and they know CPR every single one of them so they didn't, they were not able to perform CPR on this person one of the inmates tried, attempted like desperately to perform some CPR the problem was that he was not even allowed to call the ambulance so he went and called the keeper first and asked for the permission to call the ambulance he got the permission to call the ambulance then he called the ambulance, the ambulance this was a remote location it's about 45 minutes drive from Kingston so the ambulance came so all of these took about an hour now the thing is when the ambulance arrived and this was something that was happening all the time in that institution because it was a lot of walking to do and the ambulance couldn't get through so you get there, the ambulance stopped and they forced the guy to walk he made it, because he made it to tell the story but it puts his perspective why they had that every six months in that place it might not have all been cancer let's put it like that and there is many many stories that I could tell you about that because I had to stop here for time considerations the thing that I do want to talk to you about and that's the last piece that I want to address is the issue of ok, so not only that a lot of these issues are not community standards like as bad as healthcare is in the community there are still some common sense things that don't happen waiting life for an hour to pick up your medication they're not sent to solitary confinement there are a lot of other things that are slightly different, you know even though access again and that's acknowledging that in many parts of the country, access to healthcare is not necessarily wonderful but the other thing the other piece that's different and is significant is the fact that not only that the access to treatment may not be readily available but it is being supplemented by security tools so basically all the security measures that we talked about are actually taken to control behavior that is triggered by health issues so one of the things is disciplinary incidents disciplinary incidents were double the amount in people who reported a mental illness comparing to people who did not report a mental illness so why and that was also for disciplinary segregation and it also goes for any kind of other disciplinary action so I thought it was particularly interesting why would you discipline somebody who's sick probably they were healthier, probably they were complaining more probably they were louder but I think the big piece was the fact that a lot of time around the behavior was that their sick behavior was misinterpreted as being around the behavior so a lot of times because they have such a shortage of psychiatrists and such a problem in even correctly diagnosis diseases they would fail to have that piece in and they would have the correct diagnosis and they would simply be treating it as around the behavior and hence they were disciplining them now remember that we said that the disciplinary action is supposed to help with the rehabilitation and the reintegration of the individual in the community because you're giving this incentive to them this penalty that if you misbehave, you're going to be penalized and you're not going to have all these things that are helping you to get back to the community individuals who are mentally ill and the cause is internal and this is not working for them on the contrary, you're sending them to solitary confinement which is now known to have devastating effects on mental health problems you are not helping them rehabilitate on the contrary, disciplinary actions are going on the record so what it means is that it's in your way of accessing early release like it's actually a factor that's against you if you have disciplinary tickets it's going to count against you in going to a lower level of security you might have access to better doctors you might have access to better programs and all of those things that are sort of getting you closer to the goal of rehabilitation and release but by the fact that it's treated as disciplinary action you're actually moving them away from that goal the same thing with administrative segregation and this is interesting because administrative segregation was used not only double in the people that were suffering from a mental illness but also administrative segregation was statistically more used for people who were suffering from more chronic conditions physical chronic conditions so it was not only associated statistically with mental issues but also with chronic issues again the question why well with mental illness probably because they were misbehaving probably because again they were misdiagnosed but with chronic illness it wasn't clear to me for a while and I think the reason is because they are high in vulnerability so people with mental illnesses for instance were 70% of people reporting mental illnesses are also reporting significant periods compared to 40% who didn't report mental illness right so they were significantly at higher risk of abuse and the same with people reporting 4 to 7 chronic conditions compared to those who reported less than that were double the risk of opinions and it was probably the reason their vulnerability they were placed in solitary confinement to kind of protect them from that abuse to kind of ensure that they are not being attacked now the problem with that remember we talked about administrative segregation as being you're isolating the person who's doing something to kind of protect the rest of them and to kind of pre-emptive any kind of you know misbehavior to ensure that there's more security because also administrative segregation has a lot of negativity effects on the mental health itself but you're also deprived of programs you're also deprived of visitation it also goes on your record and you cannot access the early release opportunities as well so it is essentially even though it's called administrative segregation it is a form of punishment for sure so what you do you take the most vulnerable person that you have in your institution that is vulnerable to being attacked by the solitary confinement with all these effects that it's having and again it's deterring them from accessing the programs that health care and everything else that they are needing so again you have that opposite effect as opposed to what you would be wanting to achieve by treating that and there are a number of other forms of hidden forms of solitary confinement one of them is protective custody for instance, protective custody we only find it at high forms of security for the pulmonary nervous of the world so there is protective custody that's called no contact and contact no contact is really very significant a lot of the the most horrific for the most horrific crimes that would really not survive a day in prison because they have a target on their back they are going to be placed in protective custody for the duration pulmonary nervous never came out of protective custody like he's there, he's in no contact nobody he only talks to the officer in charge and that's all there have been many attempts to kill him he's not very surprising and if you put him in contact he's going to die there is no way about it so you kind of put them there because of the crimes they committed and to protect them very stigmatizing even if you're not a well known person if you are placed in protective custody they are automatically going to assume you're akin to pulmonary nervous and all those guys about it now a lot of the guys I was telling you about in maximum security they end up in maximum security after years of trial because of the crimes they committed not necessarily because of their risk level such as murder for instance not particularly stigmatized in the whole Bernardo kind of category but they get placed in protective custody because they are very vulnerable because they suffer from dementia or what not right they are automatically assumed to be in the same category so they will never be released so most of the guys I talked to 70% incidents of mental illness they are going to spend the next 25 years in protective custody even though they may have nothing to do with the horrific crimes that some other individuals have committed it's simply a matter of fact that there is no other way to protect them and there is no other way to release them never too high of forms of security that's the last point quite an issue the legislation is fairly clear that you shouldn't be transferring people to higher forms of security than the ones that they were initially classified unless you cannot manage that behavior right and let's say that the correctional service applies is very literal so I'll give you one example this fella was suffering from dementia he was probably no more advanced stage than stage 1 but he worked his way through all the way to minimum this time he's been in for a long time so he developed dementia while in prison and he worked his way all the way from maximum to minimum security so he was like kind of like Comoran, right? when his dementia was flaring up really badly so he got really confused that at night he was a wanderer so he became really confused he didn't remember what he was doing he was going from room to room he was bothering everybody else he was still quite a bit away from his release time there was really nothing to be done for him so what they did they opt him to maximum security so that they can lock him up and that way they could put him in solitary confinement and they don't have to worry about it so a very significant increase in the transfer to higher forms of security used in response to mental illness or in response to dementia in particular because it is a way of managing behavior because you have in minimum security there is no solitary confinement it's a very open living concept everybody is living like people are living in houses and they can move around it's kind of mimicking the community so they can ease their integration you don't have fancies or anything like that also people don't have a lot of incentive to run because they get brought back and back to medium or max it's a pretty open environment so that's why they are using transfers not because their actual risk has increased or because they are more likely to offend but rather because they cannot manage their behavior they cannot treat it they cannot release them so there is no other way than use security tools to control it and I think the thing that I've done most work with is release and I don't have time this is a different topic for a different day because I think that for me the biggest issue is the issue of use because correctional institutions are not nursing home not should they be they are not hospices there are some common things that should be changed to reflect the population I mean it's actually not that hard to put some disability ramps and to change the infrastructure and to put the lines to form insides and then outside and a lot of other examples that would make a lot of difference but I think ultimately the question becomes why are we continuing to incarcerate these people in the first place in the moment when they are so brought down like when their own mental state and physiology is making them incompatible to be offended with ever again and the answer is simply the fact that we don't have mechanism to release them and we seem to be comfortable with that we don't seem to mind that there is a gap between the risk of people that we have in prison and their ability to be released so there is a very important study that has been conducted by one of my members in Toronto a few years ago and it was showing he is a statistician criminologist and it was showing that if early release was abolished altogether in Canada right now the prison population would increase by only 4% early release is extremely little used so that image when people get really upset in the media saying like what is only getting like you know life with 25 years before being released that's not true most people don't get released after 25 years I've seen people in prison for 45 years so they say no life should mean life actually you know what life kind of means life some people get released it's not the norm they will get released eventually yes some of them most of them will eventually get released unless they die in prison but it's not going to be after 25 years the first parole eligibility is going to take quite a long time and the reason is because for instance and I think it's actually working against older people because the conditions that you have to meet on your first parole eligibility or second parole eligibility or whatever you have to prove that you have been you know you are taking responsibility that you're rehabilitating and you're ready to be integrated which in theory they sound really good and I think yes that's a great goal the problem is that they are being and the initial the factors that they are considering to see that have to do with have you done all your programs what you're sociable do you have a plan after your release do you have a job lined up for you do you have community support and again that might have been great for a healthy 30 year old that might work really well when you're 75 year old and dying completing a correctional plan might not really be your main priority for your release so a lot of those criteria and those are the set of criteria that parole boards are taking into account so a lot of times these people are not actually available not have this avenue even when they reach parole eligibility date the other issue is that the very things that are making them incapable of being girls such as the fact that they are I don't know they are bedridden they cannot move at all or they have dementia they are not factoring in at all and the other issue of course is the fact that we don't have a compassionate release system sure maybe all of these criteria we could keep them for younger, healthier individuals probably with quite a bit of reform as well but still and have a better compassionate release system in place that is taking into account only health and issues like that well we don't have that again none of the guys in my study actually would be an option so very significant issues in terms of their possibility of release so I think the question becomes why what does it mean I mean it's horrific when you hear about it it sounds really bad and it is really bad other than the moral and the ethical considerations for this there are also a lot of legal implications but there are also legal implications not necessarily for the correctional service Canada or for the individuals who are incarcerated but there are a lot of implications for us as a community and if prisoners are not a sympathetic group of people it's always very hard to advocate on behalf of prisoners and it's always very hard to make the public sympathetic because they are not many of them are actually harder criminals and you see them in the news and they are people who wouldn't want to hang out with but how I like to explain this you know for instance the law and the chart there are think of what the constitutional is meant to do right the constitution is not necessarily meant to protect is not in place to protect the persons who are the majority at the moment in time because that's what the parliamentarily elected people are doing that's why your democratic process it's always going to reflect the values and what the individuals that have put them in power the majority that's what you know is ensuring that the reason why we have a Charter of Rights in a democracy is to protect the people we don't like and that's what's speaking about the quality of the democracy you don't have to like them like a lot of the people that I've seen but it's not about that it's about protecting fundamental and ultimate values that are guaranteed by constitution because if their rights are being breached any of our rights can be breached because it means they don't mean anything whether we're winning whether we are people of color whether we are LGBTQ plus community whether we are elderly whether we are young whether we are on the wrong side of the politics at the moment in time it means that if one group of people can be deprived of rights and basically nobody is looking that can happen to anyone so the strengths of a democracy comes essentially from using the laws to be respected and applied appropriately even when we don't believe in that cause necessarily even when we don't care about that cause necessarily that's what democracy is the other issue that has to do is the fact that and people don't think about it is that the failure to apply the law appropriately in prisons means that people are not being diagnosed it means that they are not really receiving the programming and the rehabilitation they need to make them functional citizens and many of them will come back into the community like a decreasing number I would say with the increase of terminal illnesses but still a good 90% at some point in their life are going to come out of prison and they are going to be our neighbors and we want our neighbors to be stable people who have rehabilitated productive members of the society if you are putting them in a prison environment that it's actually failing to diagnose the problem that they have failing to provide them with the treatment they have fail to take their rights into consideration you are actually producing more in a stable way you are producing you are having exactly the opposite effect of what the system is supposed to be doing so again people think through a lot of vengeance a lot of times the public opinion is very vengeful and you know they think a lot well you know if you can do the time you shouldn't have done the crime well great but the thing is that they will come back and that you mistreated them significantly in prison and they are not going to be better they are not going to be better individuals in the community and you kind of just shoot yourself in the leg with that you've just invested a lot of money making somebody you think is bad works so it's not a sound decision and certainly and I don't like to talk about money because coincidentally I do believe in this cause so I do believe in the human and moral dimensions of these issues I've also met wonderful people in prison wonderful wonderful prisoners aside from you know so the image of that beast is not necessarily accurate but that being said and that's I guess a different conversation but that being said there is also a very pragmatic dimension to this and do you know how much it costs to keep somebody in a federal prison healthy no health care, no solitary confinement it's $100,000 a year to keep somebody who is sick in prison in solitary confinement either sick or in solitary confinement it's $300,000 a year do you know who's paying for that to keep somebody in a nursing home it costs $50,000 a year again you're keeping somebody who's not sick who has a very low risk of reoffending and you're basically keeping that because your mechanisms your laws are not functioning properly and because the public opinion is against any kind of reforms and a lot of the tough on crime agenda had to do with the situation in which we are now because it was scattering to that outright of keeping community safe and guess what we're not we're not keeping the community safe at all in fact we are doing that and we're doing that at the cost of significant mental human well-being and we are kind of devaluing ourselves and our rights in the process as well so I'm going to stop here and welcoming any comments, any thoughts on that I'm happy to expand on any of the things that I've talked about saying that there's 2000 across Canada do you think that's probably going to increase oh it already has increased 2000 was at the time when in 2012 when I was looking at that and that was roughly 20 or 21% so right now if we're at like and when I finished it was 25% now it's about 26-27% so that would be yeah that would be 2500 something like that right now so it definitely would have increased since then and it's definitely increasing because they were heading towards 30% and the reason why that happened like it cannot stop and the reason why it cannot stop is because the tough on crime agenda and bills many of them are still in place so we're still doing that the release system is not any better than it was in 2012 and the other the demographic continues to age worldwide right so there is no way that this can stop unless something is being done actively about it there's some European country I don't remember which one offhand that has been showing that they have a whole different way of treating prisoners have you looked into that and is that possible to bring that kind of system here that they're doing that we're treating them like humans so I mean yes the first part of your question is yes I did look into it because that's actually I did my master in comparative prison also I'm originally from Europe so I did a lot of work with the European Court of Human Rights and they actually do have a lot of the understanding of what as it applies specifically to conditions of confinement we have not really done that in Canada even though the provision sounds the same we don't do it in the same manner there's definitely it's interesting because and that's a bit apparel I think the thing that should be done that's the most comparable to you that should be done in the same manner it's to actually maintain the same service within the justice system as it is for the non-prisoners I don't think I've seen any other area of law or any other category of people where a double standard is used more than with prisoners when it comes to the application of charter rights and that's another area of research that I'm looking at so it's a bit beyond the scope of today's talk but definitely the way their charter rights are being applied and upheld in court is very different than if they are not prisoners and there are also other implications in terms of the access to justice and other issues like that so that would already be a very significant change in terms of can you transplant conditions of confinement I think it's hard because a lot the countries that you're talking about are more of the countries they are significantly smaller in number like they have the last population their sentencing system is very different and also they are more homogeneous there isn't as much of a diversity and as many other issues that are kind of impacting the way the system is set up so I think that it's difficult it's probably not fully transplantable because of these all different considerations but can there be can there be things that we can learn from them? Absolutely and it has to do especially with the ability to compassionate release and do the ability to reshape our sentencing system in a different manner and I mean ultimately I think that what those examples are standing for is the fact that you can have a more humane system you can have a system that's more focused on incarceration and reintegration in the community without actually putting in danger the safety of the community because that's the rhetoric that we're hearing from politicians that they are saying that this is it has to be done like this because it's making us safer well research is showing that it's actually not making us safer and in the meanwhile the other countries are doing a much better job at keeping their community safe and instilling respect for everyone's rights Do you think it's part of moving it to a for profit model that this rhetoric is at the basis of like it is in the states? I hope not I don't think so even in the states the for profit model has started to decline and it's actually starting to reduce in numbers significantly and the reason for that is because they had a very significant issue in applying a lot of the regulations that would apply to state actors including constitutional considerations would not apply to this for profit so it was really hard to this for profit organization for private reasons so it was actually significantly difficult to control them but what was also more difficult was that the standards in some of them were significantly lower and without any kind of legal accountability so the movement it's interesting because we're seeing in the states a movement of kind of moving more towards a more humane process they're still very far away in the current political regime where in Canada we're seeing exactly the opposite you may have answered this question but did you in your research notice differences in the level of care given provided and maximum security? yes absolutely so that was also another issue a lot of times actually and not only depending on security levels sometimes simply some institutions were purely better they had better staff the correctional officers were just nicer people in general I appreciate the work that correctional officers have to do it's a hard work you know some of them are really nice people but in some institutions it's you make you it makes you wonder how did somebody lose their humanity like that to a certain degree it's better because clearly the rule of law has made significant progress in the 80s but you see a lot of abuse still going on and again in some other institutions like the one that I was telling you that's called the death camp the quality of the people that were there was even better the quality of there were more acts to medical care the officers themselves the way officers treat you they're the first responders it's making such a big difference either they became the same under peer pressure or they quit because there was no changing that environment and in other institutions they thought there were 600 people again and they would say I would ask them that was a specific question how are your guards treating you and many of them said you know what most of them are just mean by negligence they just ignore you they don't care sometimes it's better and you have two bad apples that are really horrible people but they are going to make all your life miserable and you're hitting that blue wall of silence and you cannot get past because nobody is going to speak against them right and these guys in the institution where it was a medium high there were 600 people a lot of people had wheelchairs and what the officers would do they would play pranks on the individuals and they would tie the wheelchairs to the table so when the guy was sleeping for instance he would go in and he would tie the wheelchair and the guy would not access his wheelchair or he would take the wheelchair and he would put it in somebody else's cell and you'd know where it was just things like that so I mean certain things did not depend from one institution to another for instance access to that and all for it that was all it was like that's a national regulation that's all you get how many psychiatrists you have employed that's a national regulation that already did people employed and the environment is significantly different and it did make a difference in the quality of their life and it did make a difference proximity to town that was an important part because the closer you are to town the faster the ambulance arrives it's a different kind the more volunteers you get that kind of thing it's not unlike here Springhill is very far from Halifax very few volunteers in Springhill because it's closer and it's also in a scent in a more urban center right? so the same it depends on so many other factors right? Is there anybody within the system who advocates for better healthcare for prisoners? I mean you know I'm sure there is there are great people working with Correctional Service Canada I work with a lot of great people with Correctional Service Canada and again sometimes it's not just about them per se it's also more like the governmental bureaucracy the funding that is available and simply not a well thought system that needs to be rethought completely there definitely have been people there is a lot of individual workers that you know occupational therapies that I've met or like nurses or doctors that are wonderful compassionate people and they do the best that they can with it but again their hands are tied like a doctor cannot prescribe what he or she wants a doctor prescribe what's available and if you prescribe something else there's something else tough luck that's that you know like you're not going to have their hands are tied from so many points of view right? so there are people who are advocating and there is we see them all the time and for instance there is in BC that's a provincial institution though it's Ruth Martin who was a prison hospital who's now one of the biggest prison advocates and she's created amazing programs for the women there again so that's not federal but similar people do exist when they are trying the problem is that I think one of the biggest issues is the fact that you're working with a machinery in which everything is covered up a lot of it is covering them the first response is always very defensive when you're trying to face them with some limitations so you're trying to show them the results of the study and try to sit them down and talk to them the first response is always defensive and you don't know it's security you have no idea you know it's always that response first and a lot of the communication gets lost in the paper trail so again it's not one individual it's a system and I think the bigger problem comes with the lack of access to justice for many prisoners and the lack of legal resources to self represent or have a representation in prison and to actively challenge the conditions in which they are incarcerated or lack of access to release or things like that I mean I think we're past the moment and we're hoping for the parliament to change something I think we're past that moment I think that there is a need for a bit more active intervention and that's the other part of the work that I'm doing a bit more active courts and lawyers and all of that because I think I don't see a huge swamp being legislated before I mean we keep waiting for it but there does seem to have been I don't know what you would call it that listening for a bit of a wink of change maybe a breeze of change since the government changed that's I mean from a modern limited experience no I think you're right that seems to be what people would want to get within the correction no I think you're right I agree with you I mean I think that there is a lot with the obligation that you're setting on people I think that the again even the current government has inherited a very flawed system so it's only so much you can do to be in terms of an overwhelming reform I do think things have changed and things can change in terms of who are you hiring who are you hiring in key positions so I have also seen quite a bit of change in terms of the relaxation in terms of side-behaving more allegations of abuse that are coming out from officers either against their fellow officers so a lot of things like that are actually starting to to shape up and there have been also some more successful cases so I think the combination of the government and there is a bit more prison advocacy lately in the last 10 years 5-10 years I would say so definitely there is a wind of change definitely people are starting to understand more to be engaged more a lot of advocacy groups so I do see that a lot and I do think that it's a better time than it has ever been in terms of pushing for recognition in terms of what we're doing to others also the current government is doing the criminal justice reform so again I'm always cautious let's say I'm cautiously optimistic I definitely think it's better than when I started the study that's not just no comparison you're right and it's all you can hope in terms of what can be done I think it's more about changing and shifting attitudes that's going to be really hard Professor, you mentioned in your presentation that the only opportunity for a life sentence to be commuted would be a criminal illness at least so it's not about not about being commuted it's not about the compassionate for the system so we have a number of options of release and you mentioned about 5% of the population at prison at any time is currently ill so what would be the criteria or what point in the criminal illness would lead to criteria for an early release right so for the early release in the sense of parole, the regular parole system their terminal illness is not counting at all so the regular system where you have to have for instance, parole eligibility or ineligibility of 5 years when you met the 5 years, you can apply for your parole and then you have to show signs that you are taking responsibility that you're rehabilitating and ready to integrate your terminal illness counts very little they may look at it but it's not something that's generally affected now if you wanted to count like if you want to be otherwise released you have to apply through section 121 like exception so that section is broad that it says if you're suffering from a terminal illness or if your health is incompatible with incarceration or it's likely going to significantly deteriorate while you're in prison you may be eligible to try and apply to be released by this parole by exception which is mostly based on health but then it goes on and it says now if you are serving a life sentence the only way you can benefit from this is if you are actually terminal and then you look at your guidelines and your guidelines say you have to be like basically they are adopting a lot of the language from nursing homes you know they are not nursing homes and they are saying you know if you are within 6 months of that so basically then here's the difficulty because let's say you meet otherwise the criteria you're within 6 months of that and a lot of these guys do not get them it's because when they knew about it and they applied because they were you have to apply the moment when you start like when a doctor says this guy is really terminal ill probably he doesn't have more than 6 months to live so you have to have the prison physician you might have a second opinion and then you apply so it has to be at a moment the problem is that it takes forever so a lot of the guys that did apply died during the application like it never happened it takes more than 6 months that's another issue in the system like you have to be within 6 months of dying but there is no expediency so the parole board doesn't have a different section that only deals with parole by exception they deal with all of them together and there is no emergency procedure for parole by exception you just get all your parole applications and when you get to it you get to it and it might take a little longer because like oh really are you really within 6 months maybe we need another opinion where are you going to go who's the nursing home that's going to take you all of this guy really lets you hear from your family lets hear from this this paper wasn't filled right so all of those things they are also not very used to this system because they haven't done a lot of that there is no clear guidelines or how to deal with that so when a particular parole board faces it's like oh my god what are we doing now with this guy so a lot of issues like that arise which are ending them like they die that's another flaw and I think what's very interesting in terms of this is because now we have assisted dying in community and in prison as well and what we're pushing for now me and some of my colleagues we're looking at trying to get them to consider terminal illness and the various or conditions for release to be similar to the language that is being used for medical assistance in dying which are talking about foreseeable death and that's definitely longer than six months I mean you are eligible to apply for assisted death there was a recent case in Ontario where the guy was ten years away from death but he was in horrible pain and he was bred by court permission to get assisted dying even though by a strict interpretation of the current legislation ten years would be too long so there is definitely this movement towards having very broad periods of time in which you can apply for assisted dying and yet if you are in prison you have to be with six months of death so what you're eligible for assisted dying but you're not eligible to be released because you're sick so it doesn't make a lot of sense at all right so that's you know that's a very big disconnect between the different legislations I was wondering if I could ask you a question about dementia dementia typically the measure is result of Alzheimer's progressive disease and a senior prisoner who is suffering from dementia will eventually reach a point where they are no longer aware of why they were incarcerated or even that the fact they are incarcerated may not know where they are could not the argument be made at that point that the point of incarceration at least the punitive point of incarceration is now moot because the person who doesn't know where they are or why they're there what's the point of incarceration because the part of it is punitive no exactly and that's something that you know part of the work that I've done saying that the principles for release should mirror the principles for sentencing so you know if you're taking these factors into consideration when you're sending somebody to prison and their life circumstances change during that and it's interesting because one of my studies I was looking at what happens when an individual goes before a judge during sentencing and he presents exactly this criteria that they are being brought by some other people before the parole court and as it turns out according to that study that I've done judges are significantly more likely to take into account issues such as already ongoing dementia or other chronic illnesses so if you are lucky enough to have been diagnosed with dementia at the time of sentencing the judge will take that into account if there isn't a minimum sentence mandatory minimum sentence of course but if there isn't one your sentence is going to look significantly different because you have those factors and yet if you develop them during the prison time the parole court is not going to take that into account so the problem is yes I think you're absolutely right and I do think you hit the nail in the head with that the fact that there is a problem and I do believe that it's actually new to the issue is new and I do think that there is a strong argument to make that the purpose of incarceration are no longer the problem is that nobody is listening a friend of mine in Alberta had a bad stages of Alzheimer's he murdered his wife he was shown to be incompetent but he still in a locked up facility charged with criminal charges so he went through the whole court system not knowing what the hell went on and doesn't know that he murdered his wife which is a good thing upstanding citizens in the community these two were joined at the hip and he's in the system and again it goes back to the fact that obviously you cannot just release people randomly like you need to have a system on how to do it and we do have a system on how to do it it's just not reflecting the realities that we're facing so conclusion is that the system needs to be reformed now we'll see what will happen at the moment to talk about the reform the senate's human rights committee is actually looking specifically into the vulnerable groups of people I appeared before them two weeks ago and they seemed very interesting in this issue they asked me to provide more details and to provide them with a draft of a new compassionate release provision so they are interested in it and it's going to make its way into their reform I do believe that now what happens with their report it's anyone's chance definitely more this government has been more willing to appoint independent senators that are more willing to go into these committees and to look at these issues the legacy of what will happen is to be assessed