May 17, 2016
Hon. Yasir Naqvi
Minister of Community Safety and Correctional Services
18th Floor, George Drew Building
25 Grosvenor Street
Toronto, Ontario M7A 1Y6
Dear Minister,
Re: Request to cancel the federal-provincial agreement that permits the incarceration of immigration detainees in Ontario’s prisons
We are doctors, nurses and other healthcare providers practicing in the province of Ontario. We are writing to bring to your attention our shared concerns around immigration detention in this province. While there are many concerns in this arena, we specifically wish to raise the ongoing incarceration of immigration detainees in provincial prisons. This worrisome practice is adversely impacting the health of a very vulnerable population in our province, and we call on you to bring this practice to a stop immediately.
Prisons are part of the criminal justice system. Individuals awaiting resolution of their immigration or refugee matters in Canada should not be transferred to, and detained in, these institutions. We are alarmed that Ontario would agree to confine any person in a provincial prison who is not serving a criminal sentence or awaiting trial.
The Canada Border Services Agency (“CBSA”), detains thousands of individuals each year under the authority of the Immigration and Refugee Protection Act. Many immigration detainees are held in dedicated immigration holding centres across the country, including in Ontario. Nonetheless, CBSA also routinely transfers immigration detainees to medium-maximum security provincial prisons, where they are held in the custody of the Province. This includes refugee claimants, survivors of severe trauma or persecution, and other vulnerable non-citizens including many who are dealing with mental health challenges. These transfers take place under the agreement between the federal and Ontario governments signed by yourself on October 1, 2014.
A leading justification for CBSA transfers of immigration detainees to provincial prisons is the presence of physical or mental health concerns. This can include people with heart disease, respiratory concerns and various types of cancers. It also routinely involves persons with mental illness, such as schizophrenia and bipolar disorder, or those who are perceived to be suicidal while at the immigration holding centres. Indeed, an expression of suicidal ideation to a CBSA officer may even lead to a person’s arrest and immediate detention in a provincial prison.
Simply put, prisons are not healthcare facilities. Ontario should not be accepting transfers to its prisons of persons detained by CBSA who require medical or mental health intervention. The practice is profoundly inhumane and inconsistent with the values of Ontarians.
It goes without saying that imprisonment in a penal institution is generally bad for a person’s health. The harms include increased exposure to tuberculosis, HIV and Hepatitis C, which exist at epidemic rates in some provincial prisons; the possibility of assaults or other injury; and a lack of access to ample nutritious food and recreational opportunities.
Furthermore, imprisonment of people suffering pre-existing mental health issues, including those seen among survivors of trauma and persecution, is particularly troublesome and likely to lead to worse outcomes. Refugee claimants and other migrants are especially vulnerable to the toxic stress of incarceration, as many have already experienced prolonged and repeated trauma, including torture, in their countries of origin.
Incarceration in prisons often has a profound and debilitating impact on persons with suicidal ideation. In fact, the standard procedure for dealing with persons with suicidal ideation in custody is placement in near or complete isolation and sometimes in solitary confinement. These placements may indeed cause a suicide rather than prevent it. We note the most recent case of Melchioro Gahungu, the Burundian man who hung himself while on immigration hold at the Toronto East Detention Centre on March 7, 2016.
We call on the Government of Ontario to bring an end to this harmful practice immediately. We urge you to cancel the federal-provincial agreement that permits the incarceration of immigration detainees in Ontario’s prisons, and in the interim, during the one-year cancellation notice period, to immediately stop accepting transfers of any immigration detainee with a documented and serious medical illness, including suicidal ideation or other mental health disorders.
We would be very pleased to meet with you soon to discuss these concerns, and look forward to your prompt reply.
Yours sincerely,
Dr. Michaela Beder, MD, FRCPC Psychiatrist Lecturer, University of Toronto
Dr. Ritika Goel, MD, MPH, CCFP Family Physician Lecturer, University of Toronto
Dr. Rachel Kronick, MD, FRCPC, MSc Psychiatrist, Child Youth and Family Service
Elia Abi-Jaoude, MD Staff Psychiatrist, The Hospital for Sick Children, University of Toronto
Sasha Adler, RSW
Parul Agarwal, MD, FRCPC, Child and Adolescent Psychiatrist
Yusra Ahmad, MD, FRCPC, Psychiatrist, Affiliated with Women’s College Hospital & St. Michael’s Hospital
Tarak Ahmed MSW, RSW
Amy Alexander, MD, MHSc, CCFP, Psychosocial Oncology and Palliative Care, Stronach Southlake Cancer Centre
Zenita Alidina, MD, Psychiatry Resident
Lisa Andermann, MPhil, MD, FRCPC, Mount Sinai Hospital, Associate Professor, Equity, Gender and Populations Division, Department of Psychiatry, University of Toronto
Alison Arnot, MD, CCFP, FCFP, Addictions & Concurrent Disorders Centre, Credit Valley Hospital Site of Trillium Health Partners
Alison Ashamalla, MD, CCFP, Family Physician
Lucy Barker, MD, Psychiatry Resident
Adrienne Batke, MD, Psychiatry Residentm, University of Toronto
Ahmed Bayoumi, MD, MSc, FRCPC, Professor, Department of Medicine and The Institute of Health Policy, Management and Evaluation, University of Toronto
Imaan Bayoumi MD, MSc, FCFP, Napanee Area Community Health Centre
Marianne Belau, MD, CCFP (PC), FCFP
Shree Bhalerao, MD, Psychiatrist
Neha Bhuptani, MD, Inner City Family Health Team
Anne Biringer, MD, CCFP, FCFP, Associate Professor, Department of Family and Community Medicine, University of Toronto
Jill Blakeney, MD, PhD, Family Physician, Parkdale Community Health Centre
Gary Bloch, MD, Family Physician, St. Michael’s Hospital
C. Braidek, MD, FRCP(C), Geriatric Psychiatrist, Royal Ottawa Mental Health Centre
Jessica Braidek, MD, Psychiatry Resident
Katherine Burress, RN
June C Carroll, MD, CCFP, Professor, Department of Family & Community Medicine, Sinai Health System, University of Toronto
Adriana Carvalhal, MD, PhD
Alexander Caudarella, MD
Patricia Cavanagh, MD, FRCPC, Centre for Addiction and Mental Health
Aline Chhun, RN
Nate Charach, Psychiatry Resident, University of Toronto
Alison Charlebois, MD, Inner City Health Associates and Village Family Health Team
Laura Clark, MD, CCFP
Gregory Cohen, MD, Psychiatry Resident, PGY2, University of Toronto
Cathy Crowe, RN
David Daien, MD, CCFP, Family Physician – Summerville Family Health Team, Division Head Primary Care – Trillium Health Partners, Co-Lead – East Mississauga Health Link
James Deutsch, MD, Department of Psychiatry, University of Toronto
Gerald M. Devins, Ph.D., C.Psych., Consulting & Clinical Psychologist
Neil Dilworth, MD, Women’s College Hospital, Clinical lecturer, University of Toronto
Katie Dorman, MD, MSc, CCFP, Moose Factory, ON
Naheed Dosani, MD, CCFP(PC), BSc, Family Physician Project Lead & Palliative Care Physician, Palliative Education And Care for the Homeless [PEACH], Inner City Health Associates, FCJ Refugee Centre,
Kathleen Doukas, MD, Family Physician, Inner City Health Associates
Cheryl Eadie, MSW, RSW, Social Worker – Mental Health, Inner City Family Health Team
Gail Erlick Robinson, MD, DPsych, FRCPC, O.Ont., Director, Women’s Mental Health Program, Univ. Health Network, Professor of Psychiatry, University of Toronto
Andrea Evans MDCM FRCP
Temi Firsten, MSW, Women’s College Hospital
Olivia Flaherty, RN, Inner City Family Health Team
Kenneth Fung, MD, FRCPC, MSc, Clinical Director, Asian Initiative in Mental Health, Associate Professor, Equity, Gender, and Populations Division, Department of Psychiatry, University of Toronto
Amy Gajaria, MD, Senior resident, Department of Psychiatry, University of Toronto
Miriam Garfinkle, MD
Sharon Gazeley, MD
Natalie Gdyczynski, RN
Samantha Green, MD, Family Physician, St. Michael’s Hospital, Lecturer, University of Toronto
Tim Guimond, MD, FRCPC
Gord Guyatt, MD, Distinguished Professor, McMaster University
Elise Hall, MD, FRCPC
Laura Hanson, BN, MN, NP-PHC, Health Providers Against Poverty
Ken Harrison, MD, Centre for Addiction and Mental Health RECONNECT – South Toronto Links team
Brittany Hart, RN
Robyn Hartley, RN
Kate Hayman MD, MPH, FRCPC, Emergency Physician, University Health Network
Julie Henderson, MD, FRCPC, Centre for Addiction and Mental Health, Inner City Health Associates
Meghan Henderson, Nurse Practitioner
Abby Hershler, MD, FRCPC
Julianna Hobbs, RN
Beverley Jackson MD CCFP, Lecturer, University of Toronto Community Physician
Gaiathry Jeyarajan, MD, University of Toronto, Department of Psychiatry
Sofia Khan, SJHC
Sumeet Khanna, MD
Sean A. Kidd, Ph.D., Associate Professor, Department of Psychiatry, University of Toronto
Tara Kiran, MD, MSc, CCFP
Christopher Kitamura, MD, University of Toronto
Linda Klapwyk, MD, CCFP, FCFP, Family Physician
Diana Kljenak, MD, Ontario Psychiatric Association President
Nicole Kozloff, MD, FRCPC, Centre for Research on Inner City Health
Li Ka Shing Knowledge Institute, St. Michael’s Hospital
Dorothy Kuk, MD, Resident in Psychiatry, PGY2, Treasurer, Psychiatry Residents Association of Toronto, University of Toronto Rep., Coordinators of Psychiatric Education
Joanne Laine-Gossin, MD, CCFP, FCFC
June Lam, Psychiatry Resident, University of Toronto
Wiplove Lamba, MD, FRCPC
Samuel Law, MD, FRCPC
Jessica Leah, MD, Family Medicine Resident, St. Michael’s Hospital
Lorainne Lee, MD, Yorktown Family Medicine
Janet Lee-Evoy, MD, Psychiatry Resident, University of Toronto
Bernadette Lettner, RN, Multi-disciplinary Outreach Team
Matthew Levy, MD, FRCPC, Staff Psychiatrist, St. Michael’s Hospital
Joel Lexchin, MD, Emergency Department, University Health Network
Ted Lo, MD, Psychiatric Consultant, Hong Fook Mental Health Association, Across Boundaries Ethnoracial Mental Health Centre
Julie Maggi, MD, FRCPC, Assistant Professor of Psychiatry, University of Toronto, St. Michael’s Hospital
Minoo Mahmoudi, MD, Psychiatrist, Youthdale Treatment Centre
Arfeen Malick, MD, Resident, University of Toronto
Jessica Mangan, RN, BScN, Kingston General Hospital
Danielle Martin, MD, Family Physician, Toronto
Azad Mashari, MD, FRCPC
Lisa McCarthy, PharmD, MSc, Assistant Professor, Leslie Dan Faculty of Pharmacy and DFCM, Pharmacy Clinician Scientist, Women’s College Hospital
Rosemary Meier, MD, Psychiatric Consultant, Canadian Centre for Victims of Torture, Quaker Committee on Refugees, Senior Fellow, Massey College, University of Toronto
Rachel Mitchell MD, FRCPC, Staff physician, Division of Youth Psychiatry, Sunnybrook Health Sciences Centres
Soraya Mumtaz, MD, BSc (Hons), Psychiatry Resident, PGY5, University of Toronto
Alpna Munshi, MD, Centre for Addiction and Mental Health, University of Toronto
Arash Nakhost, MD, Psychiatrist
Erika North, CCPA
Catherine Oliver, MD
James R. M. Owen, MD, CCFP, St. Michael’s Hospital, Department of Family and Community Medicine, University of Toronto
Donald E. Payne, MD, Psychiatrist, Toronto
Suvercha Pasricha, MBBS, FRCPC, Lead Psychiatrist Women’s inpatient service,Centre for Addiction and Mental health
Llijah Pearce, RN
Dr Nav Persaud, MD, MSc, CCFP, Staff Physician, Department of Family and Community Medicine,St Michael’s Hospital, Associate Scientist, Keenan Research Centre in the Li Ka Shing Knowledge Institute, Assistant Professor, Department of Family and Community Medicine, University of Toronto
Andrew Pinto, MD, CCFP, FRCPC
Jane Pritchard, MD, CCFP, FCFP, Family Physician
Cheryl Proc, Registered Social Worker
Priyadarshani Raju, MD, FRCPC, Hincks-Dellcrest Centre
Linda M. Rapson, MD, CAFCI, Assistant Professor, DFCM, University of Toronto, Affiliate Scientist, Toronto Rehabilitation Institute, Medical Director, Rapson Pain and Acupuncture Clinic
Meb Rashid, MD, Assistant Professor,Department of Family and Community Medicine
Paula Ravitz, MD, FRCPC, University of Toronto
Danyaal Raza, MD, MPH, CCFP
Daniel Rosenbaum, MD, Psychiatry Resident, University of Toronto
Jennifer Rosser, Peer Support Specialist, Registered Social Service Worker
Marlee Rubel, Registered Psychotherapist
Andrea Sadler, O.t. Reg. (ONT), Occupational therapist
Debra Stein, MD, FRCPC, Hincks-Dellcrest Centre, Toronto
Vicky Stergiopoulos, MD, Psychiatrist in Chief, St. Michael’s Hospital
Jeff Straw, CCPA, PA-C, University of Toronto, Department of Family and Community Medicine
Jim Sugiyama, MD
Nadiya Sunderji, MD, FRCPC, Psychiatrist, St. Michael’s Hospital
Tomislav Svoboda, MD, PhD, FRCPC, Associate Scientist Li Ka Shing Knowledge Translation Institute, Associate Professor, Department of Family and Community Medicine, University of Toronto
Verjinder Ubhi, MD, CCFP, Family Physician Mississauga, Lecturer DFCM, UFT, Medical consultant to Punjabi Community Health Services (PCHS) Mississauga
Paul Uy, MD, Resident in Psychiatry, PGY5, University of Toronto
Ketan Vegda, MD, Psychiatrist, Centre for Addiction and Mental Health
Diane Versace, Mental Health Nurse, Montserrat Villanueva Barbolla, RN
Priya Watson, MD, Staff Psychiatrist, Child Youth and Family Service, Education Scholar, Centre for Addiction and Mental Health, Assistant Professor, Department of Psychiatry, University of Toronto
Jennifer Wellman, RN
Karen Weyman, MD, Chief and Family Physician, Department of Family and Community Medicine, St. Michael’s Hospital, University of Toronto
David White, MD, CCFP, FCFP, Professor & Interim Chair, Family & Community Medicine, University of Toronto, Community Teacher, North York General Hospital
Kimberly Wintemute, MD, Family Physician, Assistant Professor, University of Toronto
Angela Wong, MD, Family Physician, South Riverdale Community Health Centre
Susan Woolhouse, MD, MClSc, CCFP, FCFP
Edward Xie, MD, Clinical lecturer, University of Toronto
Mary Yang, MD
Joseph Yu-Kai Wong, C.M., MD., D.SC.(Hon.), Founder and Chair, Yee Hong Foundation, Founder and Chair Emeritus, Yee Hong Centre for Geriatric Care
Marcia Zemans, MD, FRCPC, Child and Adolescent Psychiatrist, Assistant Professor, University of Toronto, Centre for Addiction and Mental health
Carrol Zhou, MD, Resident in Psychiatry, PGY1, University of Toronto
CC: Hon. Ralph Goodale, PC, MP, Minister of Public Safety and Emergency Preparedness; Renu Mandhane, Chief Commissioner, Ontario Human Rights Commission
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