Ashley Smith could have been treated with more time: psychologist

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Ashley Smith is shown in an undated handout photo released at the inquest into her prison cell death, in Toronto, Wednesday, Feb.20, 2013. THE CANADIAN PRESS/HO

TORONTO - Troubled young inmate Ashley Smith wanted to work on her behaviour to get out of her near-constant segregation, but before any real progress could be made she was shipped off to yet another institution, an inquest heard Monday.

Smith had been in secure isolation at a youth facility before she was transferred to the Nova Institution for Women in Truro, N.S., on Oct. 31, 2006.

In all, Smith was transferred 17 times between various institutions over the last 11 months of her life — most of that time spent in segregation.

She was a notoriously difficult inmate, frequently hurting herself, most often by tying ligatures around her neck, the inquest has heard.

Smith died at age 19 after strangling herself at Grand Valley Institution in Kitchener, Ont., in October 2007. Guards had been instructed not to enter her cell to remove the ligatures if she was still breathing, the inquest has heard.

Smith would tie the strips of cloth around her neck in part for attention and in part for the "almost sexual" sensation it gave, psychologist Allister Webster told the inquest Monday.

The isolation took its toll on her, he suggested.

"(She was) an adolescent who over the years had developed very maladaptive ways of approaching life," said Webster, who worked at Nova while Smith was there.

"My belief was that she had been largely locked away from her peers for many years...She had not been provided with an opportunity to really develop an identity."

Webster only ended up spending a total of 21 days assessing or treating Smith. In the few months — broken up over two stints — she was at Nova she self-harmed and otherwise acted out a lot, but had also signed off on a therapy plan to get out of segregation, Webster said.

"There wasn't much time to do anything beyond trying to set some groundwork that we might be able to build on, and then she was gone," he said.

She eventually withdrew her consent for treatment, but Webster still believed she could be helped, he said.

A psychiatrist at the institution identified Smith as having a number of personality issues such as borderline personality disorder and sadism, but did not diagnose her as having any psychotic mental illness, Webster said.

The correctional staff who dealt with Smith at Nova expressed a lot of frustration with her behaviour — particularly when she would smear or throw her feces — and said she was "crazy" and belonged in a hospital, Webster said.

"Health-care staff said, 'This woman is not psychotic.'" he said. "She's not out of her mind. The behaviour has a purpose. She's trying to accomplish something."

Smith was lonely in segregation and when she "tied off" it was to get attention, she told Webster. It was a power struggle with, as a psychiatrist called her, "a large, tyrannical child who can't tolerate limits," Webster said.

When Smith self-harmed staff at Nova were told not to engage her in conversation, and if they had to, to keep it "matter of fact and without warmth," Webster said. The idea was not to reinforce self-harming behaviours, he said.

Webster went on vacation at the end of December 2006 and when he came back Smith had been transferred, unbeknownst to him, to the Regional Psychiatric Centre in Saskatoon, he said.

Smith was transferred many more times between institutions before she died in Kitchener, including one more stay of several weeks at Nova. Staff there were not happy about getting the difficult inmate back and a prison-wide "awareness session" about Smith was held, Webster said. Even maintenance staff attended, he said.

Webster explained Smith's behaviour to staff by likening her relationship with correctional staff to that of a child and a parent, he said.

"She felt that if she tied off and she was in trouble, she felt that (Correctional Service Canada) had to save her," Webster testified. "That was the game...She expected that CSC would always be the adult and come in and help."