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A new study of thousands of inmates at BC Corrections facilities has found drug addictions were the single strongest predictor for someone to be sent back behind bars within three years of their release, a conclusion that experts say underscores the need to improve treatment options in and out of jail.

The research, by five academics from Simon Fraser University, University of British Columbia and Dalhousie University, tracked 13,109 people released from provincial correctional facilities between 2012 and 2014. They then analyzed the government’s prisoner database to see whether they had been reincarcerated within three years of getting out.

The study, published this week in the peer-reviewed Criminal Justice and Behavior journal, broke this population into four groups based on their responses in their structured intake interviews with trained staff: those with no mental-health or addiction problems, people with one or the other, and those battling concurrent mental-health and substance-use disorders.

Nearly three-quarters (72 per cent) of those who said they had concurrent mental-health and addiction problems returned to prison, compared to 54 per cent of those with mental illness and just under half the inmates who first entered without any of these issues. But, the research found, 70 per cent of people with addictions alone also returned to prison within three years of their release.

The study’s lead author, Amanda Butler, an SFU criminologist who co-wrote British Columbia’s 2022 report into repeat offenders and stranger violence, said the group’s hypothesis that concurrent disorders bring a higher risk of returning to custody was borne out by the data, but she was surprised the risk was not significantly different for those with substance-use disorders.

“What that shows is the co-occurrence of the mental illness really is negligible in terms of its impact on crime – it’s really the substance use disorder that is driving the risk,” she told The Globe and Mail.

Their epidemiological study challenges the perception that mental illness alone causes criminal behaviour, Dr. Butler said. It did not focus on the reasons addiction may drive crime, she noted, but criminologists have supported three main reasons: that users commit offences to get money to pay for their drugs, that the substances alter people’s behaviour and cause them to do things they normally wouldn’t and, finally, that people end up breaking the law because they’re using illicit drugs and associating with others who are doing the same.

“I spoke to somebody recently in my work and he just said to me, ‘You know, the only time I’ve ever really been aggressive is when I’ve experienced drug-use psychosis,’” Dr. Butler said. “And so, if you look at a situation like that and you say, okay, well, is this person inherently aggressive or violent? The answer is no.”

Dr. Butler said because the data set ends in 2017, just after fentanyl poisonings began spiking in the province and causing more brain injuries among users, she suspects outcomes are now worse. She said the provincial government needs to improve its policies to ensure people with substance use disorders have their needs met – “not just within correctional services but in the community.”

B.C.’s Ministry of Public Safety and Solicitor General, which oversees BC Corrections, said in a statement that nearly two-thirds of provincial inmates are diagnosed with “mental health and/or addiction challenges.” Corrections staff work with the B.C. Provincial Health Services Authority and place an emphasis on identifying those people as fast as they can, the statement said, noting every new inmate is seen by a nurse or mental-health screener within a day of entering the facility to assess their problems.

Those with a prescribed dose of safer-supply drugs or who are engaged in opioid agonist therapy are kept on this plan and other addicted inmates are assessed to see if they need similar prescriptions, the statement said.

As well, the statement said, all 10 provincial correctional centres have teams that help those with complex mental-health and substance-use disorders make a transition back into the community after their release.

Bill MacEwan, who is one of three psychiatrists treating patients for mental-health issues at the Surrey, B.C., pretrial jail, said most prisoners who enter with addictions are given prescription substitutes while behind bars but corrections officials know that much more drug and mental-health treatment options are needed.

He works each Wednesday and two other colleagues see patients less than a full day each week at the facility. Dr. MacEwan also works at Vancouver’s Downtown Community Court, a pilot project opened in 2008 to help chronic offenders in the city’s core with housing, mental health and addictions, in exchange for guilty pleas.

He estimated about 100 of the 400-odd inmates at the Surrey pretrial jail on any given day may need his mental-health care, with dozens of others taking methadone or other prescription drugs to manage their substance use disorders.

Editor’s note: This article has been updated to add that inmates who are engaged in opioid agonist therapies such as methadone, as well as those with a prescribed dose of safer-supply drugs, are kept on their prescribed plans.

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