OTTAWA – Six years after teenage inmate Ashley Smith killed herself in a prison cell, Canada’s correctional system still struggles to manage mentally ill female offenders who chronically hurt themselves, says a new report from the country’s prison watchdog.
In some cases, prisoners are punished or put in isolation for self-harm, even though that makes it worse.
And even though prisons are “ill-equipped” to manage the complex needs of these inmates, the Correctional Service of Canada rarely transfers them to outside psychiatric facilities better able to help them, says Correctional Investigator Howard Sapers .
“Sadly for us to realize, some of the issues that we identified when we investigated the death of Ashley Smith have surfaced in this investigation as well,” Sapers said in an interview.
A lack of comprehensive treatment plans and use of security staff, isolation and restraints as first responses to problematic behaviour – all problems the prison system encountered with Smith, who choked herself to death at age 19 – are still problems today, Sapers said.
“It’s frustrating.”
At least one Conservative agrees. Tory Sen. Bob Runciman said the report is proof CSC needs outside help in coping with mentally ill female offenders.
Runciman has long advocated for a secure treatment unit for female offenders modeled after the St. Lawrence Valley Correctional and Treatment Centre in Brockville, operated by the Royal Ottawa Health Care Group.
“We’ve known for some time that federal prisons are an inappropriate place for seriously mentally ill offenders and this report reinforces that,” Runciman said in a statement.
“But it also talks about approaches that work, in places like Brockville. Now it’s up to CSC to listen and to take the appropriate action.”
The Correctional Service has yet to respond to the proposal. A spokeswoman did not answer the question in an email.
“CSC fully considers all recommendations it receives from external bodies such as the (Office of the Correctional Investigator),” wrote spokeswoman Veronique Rioux.
The report “Risky Business” was two years in the making and makes 16 recommendations, including that the CSC transfer the most chronic and complex cases of self-injury to external provincial health care facilities.
It also recommends 24/7 health care coverage, prohibiting segregation for the mentally ill and those at high risk of suicide, and patient advocacy inside treatment centres similar to what’s available in community hospitals.
“Security or control interventions are generally disproportionate to the risk presented and often inappropriate from a mental health needs perspective,” says the report.
“In most cases, these measures simply contain or reduce the immediate risk of self-injury; they are not intended to deal with the underlying reasons or symptoms of mental illness manifested in self-injurious behaviour.”
In a statement, Public Safety Minister Steven Blaney thanked Sapers for his report, “which encourages us to continue to implement our mental health strategy for inmates.”
“We believe that prisons are not the appropriate place to treat those with serious mental illness,” he said.
The government notes it created a mental health strategy for prisoners, improved staff training, and extended psychological counselling.
The strategy includes intake screening, assessment, counselling and “community partnerships.”
NDP public safety critic Randall Garrison said the Conservatives need to implement Sapers’ recommendations, or produce proof that their strategy is working.
“Let’s see the evidence,” he said.
And Liberal critic Wayne Easter says the government should carefully consider Sapers’ recommendations.
“It is increasingly evident that this Conservative government has ignored what is a significant problem for Correctional Services and most importantly the staff of those federal institutions,” he said in a statement.
The report also says prisons still manage injury incidents with security and punishment, such as isolation, seclusion and segregation – even though that makes behaviours worse.
“Such responses tend to exacerbate the frequency and severity of self-injury and/or escalate the resort to other resistive/combative behaviours,” says the report.
Investigators interviewed eight women – seven whom were aboriginal – deemed to be the most high-risk and “chronic self-injurious women” in the federal prison system. All had a history of psychiatric hospitalization prior to their convictions.
The average age of the women was 25. All were serving time for at least one violent offence. Most spent their childhood in group homes or foster care. All had been victims of physical abuse; seven of the eight had been sexually abused.
“The major problem is these chronic self-harming women all fit a profile, and it’s a profile of psychological distress, of mental health issues, and yet their behaviour is being responded to really as though they are security problems and not health problems,” Sapers said.
The report notes that two women in the entire prison system accounted for disproportionate use of restraints. One woman was restrained either in a bed or chair for up to 23 hours a day for a period of several months, it says.
The report says the restraint to a bed, known as the Pinel Restraint Sytem, was often applied after self-injurious behaviour escalated or following other interventions such as physical handling, pepper spray, and movements to observation cells.
One inmate describes being strip-searched, having her underwear cut off by guards against her will and being restrained in a bed while menstruating.
Sapers also said there are “very human consequences” for prison staff.
“It’s very difficult work, and it’s very emotionally straining to deal with somebody who’s constantly hurting themselves, who’s using ligatures, who’s banging their head. We are dealing with women now who are permanently disfigured because of chronic head-banging. We’re dealing with women who come back from the hospital only to open up sutures and insert foreign objects into the wounds,” said Sapers.
“There really are just a handful of the most high-risk, high-needs women who the Correctional Service of Canada can’t safely manage in a prison situation.”
Over the last five years the incidence of self-injury in federal correctional facilities has more than tripled.
The report says 14 per cent of federally sentenced women offenders (37 of 264) accounted for almost 36 per cent of all reported self-injury incidents, with aboriginal women accounting for nearly 45 per cent of those incidents. Some 33 per cent of female inmates are aboriginal (aboriginal people make up about 4 per cent of the Canadian population as a whole).
Meanwhile, the former warden at Grand Valley Institution is slated to testify Monday at an Ontario coroner’s inquest looking into Smith’s death in October 2007.
Cindy Berry was fired following Smith’s death but was subsequently rehired by the Correctional Service in June 2012, Global News revealed earlier this year.
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