Prisons Are Not Hospitals, But Some Inmates Are Patients

Jeff Johnson (2L)

On November 23, the Health Law Institute presented “A Legacy of Missed Opportunities: The Case of Ashley Smith” as part of the Health Law Seminar Series. Howard Sapers, the Correctional Investigator of Canada, delivered a sobering yet informative lecture on his work addressing the challenges of delivering mental health care to and preventing death of those in custody. The lecture was focused around the tragic story of Ashley Smith, a young woman who committed suicide while incarcerated in a federal correctional facility.

Mr. Sapers spoke of how marginalized groups are over-represented in federal institutions and how offenders with mental health concerns represent a growing percent of the prison population, a number of whom have a history of self-harm and attempted suicide. Segregation, one of the traditional and common methods of dealing with those who have mental health concerns, does nothing to treat the inmates or address their problems, and can instead cause an additional list of concerns or exacerbate pre-existing conditions.

Mr. Sapers stated that there are up to 60 deaths per year of those incarcerated in federal facilities, including about one suicide per month. Prevention of these suicides is hindered by lack of communication between mental health providers, such as psychologists, and the facility security staff, as well as inadequate emergency response procedures. Deaths occur that could have been prevented had staff intervened faster and the inmate received prompt care. Unfortunately, Ashley Smith was one of those who slipped through the cracks.

Ms. Smith’s experience with the youth correctional system was, as the title of this lecture suggests, filled with missed opportunities to assist her and prevent her untimely death. Her run-ins with the law began at an early age and instead of being properly diagnosed and treated, she was shunted off to and transferred between various correctional institutes. She was known to engage in self-harm activities, but no treatment plan was ever developed. At the age of 18 she committed suicide while being kept in a segregation cell. A contributing factor to her death was the failure of correctional staff to respond to her actions immediately.

Since Ms. Smith’s death, changes have been made to policy and procedure regarding inmates with mental health concerns. New initiatives have been created to prevent this from happening again, including reviews of long-term segregation. Offenders with mental health concerns are one of the most at-risk groups in the prison system, and their safety and access to treatment needs to be ensured. The fact is that there are likely many more Ashley Smith’s currently in the system, and one can only hope that the changes made and the increased attention given to inmates with mental health concerns will prevent them from meeting the same tragic end.

The most recent report from the Office of the Correctional Investigator on the state of access to mental health services in federal correctional facilities and the prevention of deaths in custody can be found at the Office’s website: http://www.oci-bec.gc.ca.