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Segregation room
Acute stabilization room
People with complex and acute mental health needs face a treatment gap in correctional settings compared with the community. They are often placed in segregation or solitary confinement to reduce risk to themselves and others, which may make recovery more difficult.
St. Joseph’s Healthcare Hamilton is testing a new model of care to reduce that treatment gap. Treatment in the acute stabilization unit is improving patient engagement in therapeutic programs and routine care and contributing to symptom remission and recovery in some patients. Afterward, the correctional mental health team receives the recommendations and support they need to continue patients’ care.
The unit was the focus of Dr. Andrew Olagunju’s presentation to the International Forensic Psychiatry Lecture Series.
Old Problem: Mental Health, Incarceration, and Segregation
Mental health issues are two to three times more prevalent in Canadian correctional facilities compared with the general population, according to the John Howard Society. In Ontario, 41 per cent of people experience at least one severe mental health issue while being incarcerated.
These mental health needs often go unmet. This results in persistent behavioural problems and mental health symptoms, increasing the risk to the person and others. Segregation and solitary confinement are often used to manage that risk. In fact, about a third of people in segregation in Ontario in 2022–2023 had a mental health alert. Fewer than a quarter had a suicide risk alert.
In corrections, the term segregation refers to a placement decision to separate a person from others. It often results in solitary confinement with minimal human contact for 22 or more hours a day. This raises concerns about human rights, dignity, mental health and general well-being, and care and monitoring.
Following human rights complaints and a class action lawsuit, the Ontario government appointed an independent advisor on corrections reform to review the use of segregation and solitary confinement in provincial correctional facilities. Three reports provided advice and 167 recommendations, focusing on both segregation and adult corrections.
New Solution: Acute Stabilization Unit
In response to one of the recommendations, the Ministry of Health and Long-Term Care and the Ministry of the Solicitor General agreed to pilot acute stabilization units with two aims. The first aim was to provide mental health and liaison services to detained individuals with complex and acute mental health needs in an efficient and timely manner. The second was to provide short-term stabilization services, with individuals being returned to the detention centre when they became stable.
St. Joseph’s (male patients), the Centre for Addiction and Mental Health, and Ontario Shores (female patients) established these units.
At St. Joseph’s, when a person is referred to the unit, a multidisciplinary meeting is held with the mental health team from the Hamilton-Wentworth and Niagara detention centres and unit staff. An admission assessment includes a nurse practitioner completing a thorough physical and medical evaluation and Dr. Olagunju completing a mental health assessment.
Patients are transferred for psychiatric evaluation on a mental health form completed by a psychiatrist at the detention centre due to safety concerns and/or impaired capacity to care. They are admitted involuntarily based on assessment of their mental health status and having threshold/criteria required in the Ontario mental health laws for involuntary admission. Also, Dr. Olagunju assesses the person’s ability to consent to treatment, which is often impaired, albeit a proportion are okay.
Most patients receive psychopharmacological treatment with long-acting injectable or oral medications and other medical treatments. Neither of these treatments would be possible at the detention centres.
Collaborative, Linked, and Stepped Care
Dr. Olagunju said the eclectic model of care used in the acute stabilization unit blends collaborative, linked, and stepped care.
As part of the collaborative approach, twice-weekly meetings are held with staff from the detention centres and the unit about the patients’ progress and needs. Patients may need social and psychological services when they return to the detention centre.
Using the service linkage model of care, the unit can connect patients with legal aid should they need it. Patients also have support to attend court, either virtually or in person, when they are ready.
As part of stepped care, support for follow-up care is provided as needed when the unit discharges the person back to the detention centre. Recommendations could include the mental health team at the detention centre conducting another psychiatric assessment to determine whether an existing community treatment order should be lifted.
Results
A retrospective review of data collected between 2021 and 2024 included 118 men admitted to the four-bed unit at St. Joseph’s. The most common diagnoses were schizophrenia (69 per cent), substance use disorder (49 per cent), and antisocial personality disorder (48 per cent). The most common reasons for their referral were active psychotic symptoms, impaired ability to care for themselves, refusing treatment, and risk of harm to themselves and others. Thirty-nine had community treatment orders.
On average, people stayed about a month (34 days), but the length of stay varied widely. Some patients experienced a remission in their symptoms and some recovery.
Patients had better engagement in therapeutic programs and routine care.
The detention centre’s mental health team could continue care and receive recommendations or support as needed.
For more details, watch the recording of the October 30, 2025, lecture, “Piloting an Eclectic Model to Address Complex and Acute Mental Health Needs in Correctional Settings in Ontario” on our website.
Written by Virginia St-Denis and approved by Dr. Andrew Olagunju.
