Did Ashley Smith belong in a jail or a mental health facility?
It’s a pressing question that arose particularly during Smith’s time in the adult correctional system, and one that echoes throughout the ongoing coroner’s inquest into the 19-year-old’s death in a jail cell on Oct. 19, 2007.
In his 33-page, June 2008 report into the Smith case, “A Preventable Death,” Correctional Investigator Howard Sapers asserts that “most’’ of the senior managers and front-line Correctional Service of Canada staff responsible for Smith “lacked the specialized mental health training required to adequately assess or address’’ her needs.
Kim Pate, national director of the Canadian Association of Elizabeth Fry Societies, an advocacy group for women and girls in the justice system, and which has standing at the Smith inquest, recently told reporters in an interview that Smith shouldn’t have been in the prison system, but rather a mental health facility.
Some of the guards in prisons where Smith stayed voiced the same views, according to evidence at her inquest.
Sapers, who acts as an ombudsman for federal offenders, noted that management plans for Smith at the Grand Valley prison for women in Kitchener, where she choked herself to death in a segregation cell by tying a ligature around her neck, “were largely security-focused’’ and “lacked mental health components.’’
Smith presented significant security challenges as an inmate. She was kept in segregation during most of her three years in the youth system in New Brunswick, beginning in 2003, and went straight into segregation when she entered the adult prison system in late 2006.
The rationale for segregation was that Smith was at high risk of harming herself and others. She assaulted staff and hurt herself by scratching, banging her head on the floor, or tying ligatures around her neck. The latter was especially problematic because although she told some jail staff she enjoyed the sensation of asphyxiating, and while some staff felt she tied the ligatures to draw attention from guards, she was often despondent, talking and writing frequently about wanting to kill herself.
One prison staffer testifying at her inquest likened her drawn-out time in segregation to a Catch-22 situation — her confinement in solitary contributed to her severely acting out, but that same acting out kept her in segregation.
In the mental health context, views about the best treatment for Smith sometimes differed.
The best example of this occurred during her stay at the Nova Institution prison for women in Nova Scotia, where she was sent to serve her federal sentence in late 2006. At Nova, two mental health providers came up with vastly different evaluations and treatment recommendations for her within a one-day span.
That happened in mid-December 2006. At the time, Smith was causing a commotion at Nova, frustrating guards by smearing her feces in her cell, and other “maladaptive behaviours.’’ She wanted to be transferred to another institution.
Dr. Jeffrey Penn, a psychiatrist who saw Smith on Dec. 15, 2006, at Nova, described her his way: “She openly admits that she has some, but little capacity for remorse, often enjoying hurting others (sadistic) and also gets gratification in hurting herself (masochistic).’’
Penn later wrote: “She shared that even with consistent positive reinforcement, she just gets bored with her good behaviour and has to act out. She also cannot tolerate any prolonged lack of attention — has to periodically act out to get any kind of attention, generally negative.’’
He noted that Smith was at high risk for suicide.
Penn, who is set to testify when Smith’s inquest resumes Monday in Toronto, referred to her as a “fearful tyrannical child’’ who could not accept authority or limits, noting Ashley wasn’t making progress at the time — she was “deteriorating’’ in fact — and that morale among prison staff was low as a result.
Having diagnosed her as exhibiting a personality disorder, with borderline paranoid features, Penn recommended that Smith be transferred to a secure facility with a 24-hour behaviour modification program, something Nova didn’t have.
Days later she was sent to the Regional Psychiatric Centre in Saskatoon — a secure forensic centre that is part prison, part mental health facility — a move Smith volunteered for.
(Nova did seek psychiatric beds elsewhere in the province for Smith, the inquest has previously heard, but none was found at that time.)
Meanwhile, on Dec. 14, 2006, the day before Penn’s report, Dr. Allister Webster, then a psychologist at Nova, wrote a “management plan’’ for Smith based on his belief she could be treated at the jail.
He wrote, in part: “While Ms. Smith appears to be of average intelligence, her presentation is frequently consistent with that of a young adolescent.’’
In outlining his plan, Webster later wrote: “It remains my clinical opinion that Ms. Smith can be effectively managed and assisted towards the adoption of pro-social behaviour.’’
Further on he stated: “Her engagement in appropriate behaviour will result in opportunity to meet with (prison) staff, as her risk for aggression towards others will become reduced.’’ Webster recommended that prison staff “engage with her in a respectful and professional manner,’’ adding “we must model the behaviours that we want from her.’’
During the inquest Webster testified that he left for vacation after writing his management plan for Smith, and was surprised to learn upon his return that she’d been transferred to the Saskatoon centre.
Webster told the inquest he felt “undermined’’ by the decision to ship Smith out, though he has a high regard for Dr. Penn’s professionalism and judgment.
Webster also told the inquest he had concerns that the transfer negatively impacted the “therapeutic relationship’’ Smith was developing with him and others, including nurses, who were trying to help her at Nova.
Smith’s move to the Saskatoon centre was one of 17 institutional transfers she endured in the space of less than a year.
In his “Preventable Death” report, Sapers says this series of transfers “eroded Smith’s trust, escalated her acting-out behaviours’’ and made it increasingly more difficult for the correctional service to manage her. Attempts to get a full psychological assessment of her were thwarted by the constant moves, Sapers notes.
Smith stayed at the Saskatoon facility from Dec. 20, 2006, until April 12, 2007, when she was on the move again. Stops included the Grand Valley Prison in Kitchener, back to Nova in the summer of 2007, and finally Grand Valley again, where she died that fall in her segregation cell, right in front of her guards.
The inquest hasn’t yet been told the full story about her time at the Saskatoon facility, but the inquiry has heard it didn’t end well. She was moved out for her own safety.
Smith’s mother, Coralee Smith, went to the Saskatoon centre in February 2007 to visit her daughter and found her “reserved, stiff and withdrawn.’’
“She talked about how it was kind of scary in there,’’ Coralee Smith told the inquest. Ashley Smith later complained to her mother about being assaulted there.
A security supervisor at the Saskatoon facility was charged after Ashley Smith died. The allegations arose over an incident where Smith was restrained because of concerns she might harm herself. A nurse on duty testified she saw the man strike Smith, but a judge later acquitted him, ruling the nurse’s evidence was not credible.
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