Letter to Ontario Minister of Community Safety and Correctional Sevices

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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