Last June, Advancing Health scientist Dr. Amanda Slaunwhite was appointed as the Scientific Director, Correctional Health Services at BC Mental Health and Substance Use Services, which is part of the Provincial Health Services Authority. We sat down with her to discuss the scope of her research and the importance of her work as Canada navigates the ongoing overdose crisis.
As the Scientific Director for Correctional Health Services, Dr. Slaunwhite works with clinicians, operational leaders, and allied health professionals within the 10 provincial correctional centres to do research focused on the health of people incarcerated in the province. Her work answers the big picture questions like “Are our services making a difference in the lives of people who are incarcerated?” Her research also helps the government identify gaps in the services and evaluate the impact of the services on the population.
“Lived experience is key to informing research”, said Dr. Slaunwhite. “I work with people with lived experience of incarceration to be able to identify what types of research we should be doing. We also collaborate to analyse data on the health status of incarcerated people to understand what the data is showing us from the perspective of people who have experienced the system.”
She credits her time in Alaska with crystallizing her research pathway, where her work with the Alaska Department of Corrections revealed a pressing need for more research and evidence-based interventions focused on substance use in incarcerated populations.
She also connects some elements of her research with her own life. “I come from a family that is affected by mental health and substance use, and I have my own lived experience with depression. I’m aware that for some people, mental health and substance use can unfortunately lead to some intersections with police and the criminal legal system.”
Reintegration into community
For Dr. Slaunwhite, her interactions with people who have lived experiences of incarceration drove home the complexity of the significant stigma experienced by people who have been incarcerated. Along with the challenge of navigating mental health and substance use, involvement with the criminal legal system can compound vulnerabilities, especially when people are released from custody and attempt to reintegrate back into our communities.
Almost everybody who’s incarcerated in Canada will get released at some point back into their community in a supervised or unsupervised capacity. Dr. Slaunwhite believes that this highlights the importance of rehabilitation and health care in custody to ensure successful post-release outcomes.
“When people are incarcerated and they’re transitioning back to community, there’s an optimal window where we can invest in creating hope and providing care to help them build healthy, meaningful lives in and reduce the rate of reincarceration,” she added. Dr. Slaunwhite’s research over the past five years includes development of a peer health rep program in Matsqui Federal Correctional Centre in Abbotsford that was informed by a program in the State of New Mexico. This program, and peer-led programs such as Community Transition Teams and Unlocking the Gates, illustrate the potential to build capacity by partnering with people who are incarcerated within custody and post-release.
Busting misconceptions
People with lived experiences of incarceration, mental health, and substance use are often viewed through a lens of apathy. Dr. Slaunwhite hopes to dispel that through her work.
“There’s a common misconception that people with a history of substance use or interaction with the criminal justice system don’t want to get better,” said Dr. Slaunwhite. “From my experience, the majority of folks that are incarcerated want to have a better life. People want hope. They want to reconnect with their families and make positive contributions to society.”
Dr. Slaunwhite’s days are filled with meetings to connect with collaborators at Correctional Health Services, BC Corrections and the Canadian Collaboration for Prison Health and Education. Current projects include research on substance withdrawal, psychiatric care, peer-led programs and health inequities experienced by incarcerated people. She also meets monthly with PERCH-BC (Priorities and Engagement in Research in Correctional Health), a committee of people with lived experience of incarceration.
Dr. Slaunwhite is pictured with Debra Hanberg, Manager from the Canadian Collaboration for Prison Health and Education, during a 2020 visit to the University of New Mexico Peer Education Program. They were hosted by the University of New Mexico Project ECHO Peer Education Program. More info available here.
Robust social safety nets
Because much of the evidence points suggests that people want to become healthier and more valued members of their communities, Dr. Slaunwhite believes the solution to addressing recidivism lies in strengthening voluntary care and expanding in-custody health care and post-release services. Voluntary care enables people to seek treatment on their terms. Dr. Slaunwhite believes growing voluntary care with more robust safety nets for people once they’re in stable and in recovery is key.
Safety nets take into consideration several factors that can impact recovery, such as the cost-of-living crisis. “We need to think critically about how social determinants play into recidivism. I know of people who have lost their housing and then they go back to drugs and eventually are re-incarcerated, restarting the cycle over again”
“The public perceives that people don’t want to take their medication, but the evidence suggests often people stop because they start feeling better, which we know can lead to psychiatric distress,” she said. “Ensuring people have supports in place to gain insight into their mental health and recognize when they need additional support can reduce the need for involuntary care.”
“Our responses are frequently motivated by shock, sadness and distress, and they can be shaped by racism, discrimination, and a lack of knowledge and compassion.” Dr. Slaunwhite emphasizes the importance of approaching mental health, incarceration, and substance use through an evidence-based lens.
She adds that people in custody retain their fundamental rights under the Canadian Charter of Rights and Freedoms. Maintaining dignity and recognizing the promise and potential of incarcerated people is critical to fixing the issues we’re seeing today.
“It’s a case of everybody counts or nobody counts,” she concluded.
