Edited by: Barna Konkolý Thege, Waypoint Centre for Mental Health Care, Canada
Reviewed by: Cindy Stern, University of Adelaide, Australia; Kyrsten Grimes, Waypoint Centre for Mental Health Care, Canada
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In recent years, there has been a global advancement in the offering of canine-assisted interventions (CAI) in prisons. However, these programs have focused primarily on the benefits to the dogs involved and not on the impact on the participants. The authors of this perspective study have been running a CAI program with therapy dogs, called PAWSitive Support, in a Canadian federal prison since 2016. Thoughts from the program facilitators and interviews with prison staff indicate that the program, and specifically the therapy dogs, provides a unique and integrated source of comfort, support, and love for participants. These benefits are consistent with those seen in CAI programs outside of prisons. Unique to the prison setting appears to be an improvement in participant–staff relations. The therapy dogs have helped participants to experience comfort and consequently express their emotions. This seems to contribute to their recognition of support within the prison system and specifically developing trust with staff. Additionally, the dogs have helped to create an experience of the feeling of love within the prison, interpreted as the feeling of being cared for, which is rare for this population. The authors suggest that the integration of a therapy dog intervention in prison could be a novel harm reduction strategy to address issues related to prisonization and associated mental health concerns, including substance use. This consideration can offer unique insight into the field of forensic psychiatry about providing compassionate care to patients.
During a presentation on canine-assisted interventions (CAIs) for the International Forensic Psychiatry Lecture Series in 2022 (
There is evidence to suggest that interacting with animals can have a positive impact on human health (
Therapy dogs involved in CAIs are friendly companion animals who, alongside a human handler, have passed a test enabling them to visit with individuals who do not have regular access to a dog and can benefit from their comfort, support, and love (
Program evaluation research has demonstrated that CAIs implemented in correctional facilities can have a positive effect on both the institutional atmosphere and participant behavior (
In the realm of substance use research, companion animals and CAIs have been found to increase clients' experiences of connection and care with another being. These feelings of connection, support, love, and comfort can be seen to influence addiction and mental health outcomes including benefiting positive thinking patterns, improved emotional states, and positive attachments and style of attachment (
Historically, prisons in Canada, as in many other places, have been designed with a focus on punishment rather than rehabilitation (
A CAI that involves therapy dogs has the potential to provide prisoners with a distinctive form of comfort, support, and love. Although there is no standard definition of compassionate care at present in healthcare, there seem to be important elements including an aim to reduce the pain, suffering, and harm experienced by a patient and treating patients with compassion, kindness, respect, and dignity (
PAWSitive Support is a canine-assisted learning program that aims to improve the wellbeing of participants through human–canine interaction. It was first delivered at the request of the Warden of Drumheller Institution in response to an increasing number of illicit drug overdoses. The program was developed by Dr. Colleen Dell from the University of Saskatchewan and Dr. Darlene Chalmers from the University of Regina and is grounded in an evidence-based experiential learning approach (
The program is offered over 4 intensive days and includes a follow-up session 6 months later. The 4-day program was designed around space availability. The follow-up sessions were less structured in nature than the initial program and allowed the program participants to reconnect with the program dogs, facilitators, and each other. After completing the program, the participants were invited to return and act as peer mentors. In this role, the peer mentors guided new program participants through the process, offered their insights or ideas on interacting with the program dogs, and supported the current participants in reflecting on the impact of the program on their experiences within prison. The first group of participants consisted of five individuals with a history of substance use, most of whom were serving life sentences. All participants liked dogs, were assessed as non-violent and non-aggressive at the time of the intervention, and had no history of animal abuse. The dogs involved in the program—Kisbey, a loving mature boxer, Subie, an emotionally attuned boxer, and Anna-Belle, a stubborn but affectionate English bulldog—were selected for their friendly personalities and ability to provide comfort, support, and love to those they interact with. They also worked as therapy dogs in their local community. The dogs were assessed for their health, they had basic obedience skills, and their welfare was paramount throughout the program's offering. Two program facilitators, Dr. Colleen Dell and Dr. Darlene Chalmers, led the program activities.
The two program facilitators conducted eight interviews and a focus group with five prison staff members (including administration, front-line, and programming staff) who were associated with the case files of the first five PAWSitive Support participants. The eight individual interviews were conducted between one staff member and one facilitator, with the focus group having both facilitators present. These took place immediately after the program began and then approximately every 6 months over a 2-year period after the program ended to determine program impacts. The interviews and focus groups were semi-structured to allow for insights from the staff members to be collected beyond the experiences or knowledge of the facilitators and varied in length from 24 min to 89 min. The transcripts of these interviews were analyzed using flexible inductive coding methods to identify the program's overall impacts, following the methods outlined by Deterding and Waters (
Three main themes emerged from the analysis, which were described as prison-specific therapy dog-facilitated experiences of comfort, support, and love. This was not surprising, given that these are common therapy dog program outcomes outside of a prison context. Unique here is that these are staff-identified insights, whereas the majority of the extant literature focuses on participant experiences. Thus, focusing our perspective article on how these three concepts are perceived uniquely within a prison-specific context by staff can be a potentially important contribution to forensic psychiatry and allied professions.
According to the staff, the program has a temporary impact on the prison environment for the participants. They explained that the prison environment is typically characterized by hypervigilance, fear, and projected strength as participants feel the need to hide any signs of vulnerability to stay safe and maintain status. However, the presence of the program dogs helped ease these tensions and alter the prison environment. Staff observed that participants were able to “let their guard down” and “show vulnerability” without fear of judgment. One staff member shared the following:
Staff 2: So this morning when we were sitting outside, Participant 1 and Participant 2 were sitting chatting and Participant 1 said, and it was just something that came out, and he said “I don't even feel like I am in prison right now…I feel like I am cured.”
Another staff member similarly shared the following:
Staff 1: Same with Participant 5. He's like, he's got gang affiliations, he's quite high ranking in his gang, so for him to let that down [his guard] a little bit, is big.
Additionally, the staff observed that the sense of comfort facilitated by the non-judgmental comforting presence of the dogs allowed participants to experience and express emotions that they would not normally, and for some, had not done in a very long time.
Staff 3: So that's some empathy, which again would be huge for Participant 4. Cause that's a big issue for him. Cause he can't show it, you know, you get so used to being that, you know look at me, the big tough guy… he probably, probably a place he hasn't been since I would say he was a child.
Participating in the program offered participants a sense of comfort to explore their emotions and feelings with reduced fear of judgment. The culture and norms within the prison, alternatively, can create a disconnection between a participant and their emotions. This is especially important to substance-using individuals as disconnection from emotions and difficulty regulating them can lead to increased substance use (
In forensic psychiatry, comfort is a key element to build rapport and trust with patients and is crucial for effective treatment (
Our team has developed a Top 10 Resource for service providers, including in forensic psychiatry, to access evidence-informed outcomes that recognize the beneficial role of animals in the lives of individuals facing substance use concerns. Recognition of the positive benefits of human–animal interaction by service providers is a key, although under-recognized, way to build comfort with program clients. The resource is available at
The staff members observed that having PAWSitive Support therapy dogs in the prison contributed to creating a supportive environment, which resulted in stronger relationships between the participants and prison staff. One staff shared (Staff 1) “More than anything probably [the program] is what motivated him but like, I think this helped him, like I said with his anxiety and with probably staying sober… and definitely helped with his relationship with staff.”
The staff members noted that the presence of therapy dogs during the program increased the participants' recognition of being supported within the institution, which in turn facilitated the development of trusting relationships between the participants and the staff.
Staff 1: He seemed to have more trust with me. Like cause when he came to me about getting out of the gang, it was like he came to the door… then he closed the door and “what do you think about maybe a transfer, so I can maybe distance myself, you know?”
Staff also thought that the program participants' trust with them was strengthened when they saw that prison staff supported the program, such as when one of the therapy dogs was permitted to visit a participant in the segregation unit.
Facilitator 1: Instead of fighting the institution… [the participants began] seeing it as something that was supporting them, and even… taking [therapy dog] to see [Participant 4] in] Seg yesterday,
Staff 1: You took [therapy dog]? Oh my gosh, that must have been so big for [Participant 4] …. I can't believe you got in there, that is amazing.
The therapy dogs provided a positive and supportive alternative to the traditional prison environment. This had a positive impact on the participants' relationships with the institutional staff. Research has shown that supportive relationships and strong therapeutic alliances can reduce the risk of substance use for patients in recovery (
Our team has created a resource in collaboration with the Canadian Centre on Substance Use and Addiction to help professionals incorporate animals into their practice to create a more supportive and client-centered environment. This resource includes common definitions in the field, a video series, and a resource guide on how to become animal-informed as a practitioner. This resource also incorporates the voices of people with lived experience of substance use whose animals supported them in their recovery, reflecting the harm reduction tenant of respecting the expertise of people with lived and living experience (
The staff reflected that participants in the PAWSitive Support program expressed gratitude for being a part of it and had positive feelings toward the prison for allowing them to take part in it. They felt that the institution cared for them and that they mattered. This is not a common sentiment within the broader culture of prisons.
Facilitator 1: One thing that came out really strong from everybody… was that they saw [Correctional Service Canada] as supporting and caring about them. Which was surprising to me, is not how I was really thinking about it but to allow the program into here, and to allow them to participate in it, they saw as, maybe CSC really does care.
Additionally, the staff observed that the program participants' interactions with the therapy dogs were non-judgmental, trusting, and loving. It provided them with an opportunity to see themselves beyond the externally and internally imposed labels of “criminal,” “lifer,” or “gang member.”
Staff 4: [Participant 4] was very surprised, somebody would do that for him, because he's a bad guy, he's in prison, “well those dogs don't know that I've done bad things, and they still love me,” they're jumping on them, they're licking them, they're hugging them, and to have that love with no strings attached, because they can't do anything for you, they can't do anything for the dogs, and they know that, but still the dogs love them. And you guys took time out of your world and your life, but there's a lot of other things you could be doing, and they see that too, like “wow, they actually came in here, and wanna spend this time with us, wow, maybe I'm not so bad. Maybe I am okay.”
Evidence-based literature tends to avoid discussing the concept of love. However, within the context of the PAWSitive Support program, institutional staff identified love as the participants' feeling of being cared for and valued. The concept of “mattering” is explored more commonly in literature than love. Research indicates that not feeling like one matters can contribute to increased criminal activity, mental health issues such as depression and suicidal tendencies, and a greater likelihood of substance use (
Our team is active on social media platforms (@PAWSitiveCanineConnections) and the Internet (
Offering compassionate care in a prison setting is challenging, and establishing trust between participants and staff and within an institutional environment can seem impossible. One possible way to enhance the quality of care in forensic psychiatry is to take into account the insights of the Drumheller Institution staff and thoughts from PAWSitive Support facilitators who work with participants in this prison canine-assisted intervention program. According to the staff, the program's therapy dogs create a distinct and integrated sense of comfort, support, and love for participants—all elements of compassionate care. This, in turn, helps to establish some trust between participants and staff as well as the institution. Improving staff-participant relations is beneficial to creating a therapeutic alliance that supports participants' overall wellbeing and addresses the negative impacts of prisonization, such as substance use. By integrating this knowledge about human–animal interaction and insights into compassionate care into its practice, forensic psychiatry may be able to create a more positive and supportive environment for its patients, leading to better therapeutic outcomes, harm reduction for prisonization, and an improved standard of care.
It must also be noted that ensuring the welfare of the participating program dogs is crucial to a program's success. This is central to the offering of the PAWSitive Support program. Future research should consider collecting data over a longer term and include pre- and post-intervention measures, including mental health and substance use-specific outcome indicators. At the same time, moderating factors on outcomes need to be fully accounted for, such as participants' mental health symptoms and length of incarceration.
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
The perspective study involving human participants was reviewed and given ethics exemption by the University of Saskatchewan Human Research Ethics Board given its evaluation focus. The patients/participants provided their written informed consent to participate in this study. The animal study was reviewed and approved by University of Saskatchewan Animal Research Ethics Board. Written informed consent was obtained from the owners for the participation of their animals in this study.
MG wrote the original draft of this manuscript. MG and CD contributed to the conceptualization and editing of the manuscript. CD, DC, GR, and MM all contributed sections of the manuscript. All authors contributed to manuscript revisions and approved the submitted version.
The authors would like to acknowledge funding support from the Office of One Health and Wellness, Department of Sociology, University of Saskatchewan, and the Canadian Research Initiative in Substance Misuse.
The authors of this manuscript would like to acknowledge the prison staff members and participants who took part in this project. Without their willingness to work with us and share their experience, this study would not be possible. Furthermore, the authors would like to acknowledge the therapy dogs, Anna-Belle, Kisbey, and Subie, who provided their expertise to the intervention outlined in this study. While you have now passed, your impact will never be forgotten.
The authors declare no financial conflict of interest but wish to note that they acted as the program facilitators for the project presented in this manuscript.
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