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The ombudsman’s office for Canada’s correctional system has repeatedly identified serious problems with mental health care in its penitentiaries. However, Correctional Service Canada (CSC) has not implemented most recommendations for addressing the root causes of those problems.
Dr. Ivan Zinger was the speaker during a December 2026 session of the International Forensic Psychiatry Lecture Series. He discussed his most recent annual report of the Office of the Correctional Investigator (OCI), covering the 2024–25 fiscal year, which the OCI released weeks earlier.
“While we have achieved significant success in resolving individual complaints, many of our recommendations for systemic reform have too often been disregarded or dismissed by” Correctional Service Canada (CSC), Dr. Zinger wrote in that report.
When Recommendations Are Ignored
Dr. Zinger was appointed as Correctional Investigator of Canada in January 2017 and reappointed for another five-year term in January 2023. However, he retired at the end of January 2026, two years before the end of his term.
“What I’ve told the Commissioner of Correction is that if you dismiss my recommendation, it’ll eventually come back to bite you,” Dr. Zinger said during his lecture. “So we see it in individual litigation [and] in class action lawsuits. More and more of our reports get filed as evidence, and then we see some movement as a result of that.”
Canadian Corrections in Context
While the federal government is responsible for writing criminal law, the provinces and territories operate the courts.
CSC operates 43 penitentiaries across the country for people convicted and sentenced to two years or more. Provincial and territorial prisons and detention centres are for people who have been sentenced to less than two years or who are awaiting trial.
In contrast, the provinces and territories have almost full responsibility for health care delivery. “The federal government, for example, [has] only very few areas where they have the responsibility to deliver health care. And they don’t do [it] very well in any of those situations, and certainly including federal corrections,” Dr. Zinger said.
Office of the Correctional Investigator
The Government of Canada created the OCI more than 50 years ago to provide independent oversight of federal corrections. In 2024–25, the office received more than 4,000 complaints and inquiries, including 578 use-of-force reviews and 181 deaths in custody and serious bodily injury reviews.
“Our batting average is pretty good in terms of having wardens act upon our recommendations when they’re confronted with issues from our senior investigators,” Dr. Zinger said.
About 18 years ago, the OCI started conducting systemic investigations into recurring problems by theme, with a focus on legal and policy compliance and fairness. These investigations have prioritized:
- Physical and mental health care
- Conditions of confinement
- Indigenous corrections
- Women’s corrections
- Release and reintegration
- Equity, diversity, and inclusion
- Deaths in custody and mandated reviews
The investigations end with recommendations to resolve the root causes of the problems. However, the recommendations are not binding on CSC, the Minister of Public Safety, nor the Government of Canada.
“If we were successful, and the services take on those recommendations at heart, we would see, for example, a decrease in the number of individual complaints coming to the attention of our office,” Dr. Zinger said.
“That was the theory. Unfortunately, it hasn’t panned out that way… As I have said publicly many times, our batting average when it comes to making recommendations directly to the Commissioner of Corrections or the Minister of Public Safety or the Government of Canada, that batting average has been fairly poor.”
2024–2025 Annual Report
“Knowing that this would be my final report, I chose to highlight an issue that has defined much of my career: access to and the quality of mental health care in federal corrections,” Dr. Zinger wrote in the recent annual report.
It was the first time an entire report focused on a single theme. The report presents the findings of six investigations:
- Regional Treatment Centres in Crisis: The Erosion of Mental Health Care in Federal Corrections
- Falling Through the Cracks: Federally Sentenced Individuals with Cognitive Deficits
- Community’s Burden: The Discontinuity of Post-Release Mental Health Services
- An Update on Therapeutic Ranges and Intermediate Mental Health Care
- Assessing and Addressing Trauma in Federally Sentenced Women
- Mental Health Needs and Services for Indigenous Peoples in Federal Corrections
Together, they include 21 recommendations, 19 of which are directed at the Correctional Service of Canada. Four have already been rejected. While four have been accepted in principle, seven have been accepted in part. Only six have been accepted. It is unknown how many will be implemented.
For more details, watch the recording of the December 11, 2025, lecture, “Access to Mental Health Services in Federal Corrections: Perspectives of the Canadian Prison Ombuds” on our website.
Written by Virginia St-Denis and approved by Dr. Ivan Zinger.
