Re: The triple burden experienced by incarcerated people in British Columbia

I read with interest the article “The triple burden experienced by incarcerated people in British Columbia: Mental illness, substance abuse, and poverty” in the April 2026 issue of the BCMJ.[1] As a physician, this subject has troubled me for years. The unrecognized elephant in the room is fetal alcohol spectrum disorder (FASD). The prevalence of FASD in the incarcerated adult population is disproportionately high, with estimates ranging from 17.5% to 46% depending on the setting and population studied, compared with general population estimates of 2% to 5% in Canada.[2]

An estimated 98% of individuals with FASD in Canada remain undiagnosed or misdiagnosed, and testing wait times range from 1 month to 4.5 years.[3] The barriers to diagnosis and treatment are overwhelming.

The estimated cost of a comprehensive FASD diagnostic assessment in Canada, as of 2013, was $3110 to $4570.[3] The cost of social welfare benefits for a person with a lifelong mental disability pension in BC is about $20 000 per year.[4,5]

The average cost per male prisoner in federal prison in 2020 was $126 000 per year; the average cost for women was 80% higher.[6]

One of my patients at a BC treatment centre was a pleasant, intelligent 35-year-old who had been in and out of prison since his mid-teens. He was an enforcer for a street gang. He thought he might have FASD, because he had trouble learning in school, he was illiterate, and his mother had alcohol use disorder. He asked me about FASD testing. He wanted to change his life, but the system was failing him. Upon release from prison, he attended Service BC as directed, where he was told to go to a computer and fill out forms for social assistance. He couldn’t read, and he didn’t know how to use a computer. Embarrassed, he left, and he again resorted to criminal behavior to survive and avoid homelessness. I explained to him that FASD testing was available but that it was expensive and not covered by the health care system. He didn’t have the money. The cycle was destined to repeat itself indefinitely.

There are two reasons the federal and provincial governments need to provide FASD testing at no cost:

• Financial: Our governments are wasting taxpayers’ money (i.e., spending $126 000 per prisoner for every year of incarceration versus approximately $5000 for a one-time FASD assessment and then $20 000 per year for social support).
• Legal: Universal access to health care in Canada is a fundamental tenet of our national and provincial health care systems. Citizens with FASD are being denied their rights.

What will change this unacceptable situation? Physicians putting strong pressure on politicians and our criminal justice system. There is no cure for FASD, but we can end the needless incarceration of citizens with FASD who have a lifelong disability through no fault of their own and who deserve timely assessment, kindness, and lifelong social support as first-line treatment, not incarceration.
—Murray Trusler, MD, MBA, FCFP, FRRMS
Peachland

This letter was submitted in response to “The triple burden experienced by incarcerated people in British Columbia: Mental illness, substance use, and poverty.”

References

1.    Slaunwhite AK, Rondeau K, Roth K, et al. The triple burden experienced by incarcerated people in British Columbia: Mental illness, substance use, and poverty. BCMJ 2026;68:100-104.

2.    McLachlan K, McNeil A, Pei J, et al. Prevalence and characteristics of adults with fetal alcohol spectrum disorder in corrections: A Canadian case ascertainment study. BMC Public Health 2019;19:43. https://doi.org/10.1186/s12889-018-6292-x.

3.    Popova S, Temple V, Dozet D, et al. Health, social and legal outcomes of individuals with diagnosed or at risk for fetal alcohol spectrum disorder: Canadian example. Drug Alcohol Depend 2021;219:108487. https://doi.org/10.1016/j.drugalcdep.2020.108487.

4.    Government of British Columbia. On disability assistance. Updated 1 December 2025. Accessed 29 April 2026. www2.gov.bc.ca/gov/content/family-social-supports/services-for-people-with-disabilities/disability-assistance/on-disability-assistance.

5.    Government of Canada. Canada Disability Benefit. Modified 23 April 2026. Accessed 29 April 2026. www.canada.ca/en/services/benefits/disability/canada-disability-benefit.html.

6.    John Howard Society of Canada. New data on crime, prisons, parole. 14 November 2023. Accessed 29 April 2026. https://johnhoward.ca/blog/new-data-on-crime-prisons-parole/.