Fatality inquiry recommends more mental health resources at Edmonton Remand Centre after inmate died begging for addictions treatment

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Warning: this story deals with suicide. If you need help, the AHS Mental Health Help Line can be reached at 1-877-303-2642. The Canada Suicide Prevention Service can be contacted at 1-833-456-4566.

A judge is recommending an overhaul of how prisoners at the Edmonton Remand Centre receive mental health care after an inmate died by suicide pleading for addictions treatment.

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Alberta Court of Justice Justice Olugbenga Shoyele on Friday released the results of a fatality inquiry into the death of Timothy “T.J.” McConnell, who was in pretrial custody for allegedly stealing airsoft guns in Grande Prairie.

Corrections officials found the 23-year-old dead in his cell Jan. 11, 2021.

As is the case in nearly all deaths in custody, a fatality inquiry was called to determine what happened and steps that might be taken to prevent similar deaths.

Shoyele found McConnell — who repeatedly requested mental health and addictions treatment — did not receive adequate help because of an “overwhelmed” system.

“Presently, the ERC operates with three clinics serving approximately 1,500 inmates and are ‘packed to the brim,’ ” Shoyele said.

“In essence, the current system is overwhelmed because it faces limitations in terms of staffing and resources, leading to long wait times and inadequate care, with the potential for some inmates who are not as acutely unwell to fall through the cracks.”

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Lana Greene, McConnell’s mother, said she is pleased with Shoyele’s recommendations — which include reorganizing the remand’s mental health clinic to operate more like a hospital psychiatric unit.

She remains skeptical, however, whether authorities will make the changes, given the raft of reports on health-care deficiencies at the remand — Canada’s largest jail.

Dozens of former remand inmates and their families have contacted Greene since she went public about her son’s death.

“People reach out to me,” said Greene. “I had someone who just got out of there. He was in there for 5 1/2 months, and he experienced the same thing.”

Pleas for treatment, medication

McConnell was arrested by Edmonton police on Sept. 3, 2020, and jailed in the remand. Over the course of his stay, he bounced between general population and administrative segregation following disciplinary issues.

Inmates seeking medical attention are required to submit health services request forms to the AHS staff working in the facility.

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Two months after his admission, McConnell submitted multiple forms complaining of pain, difficulty sleeping, anxiety and depression. Later that month, he submitted three requests asking to see a psychiatrist, as well as for Suboxone — used to treat opioid addiction — and Seroquel — an antipsychotic drug.

A mental health nurse met with McConnell in his cell Nov. 17, 2020. He was later told he would receive a followup with a psychologist. Dr. Curtis Woods planned to meet with McConnell Dec. 14, 2020, but for reasons that were not explained, McConnell did not attend.

McConnell made further requests Jan. 1, 2021, complaining he was “having trouble living day to day” without his mental health medication, which AHS said it had no record of him being prescribed in the community. McConnell again pleaded to start Suboxone treatment, telling officials he had overdosed 16 times in the community and feared he would die when released.

McConnell died 10 days later. He was on the waiting list for opioid dependency treatment but had not been prescribed the medication he sought.

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‘A whole different world’

At last year’s fatality inquiry, Woods said he was one of three forensic psychiatrists offering weekly clinics at the remand. He and his colleagues typically review 40 files during a clinic and see 10-15 patients, he said.

Woods said those working in the system are “extremely competent people who are very busy, with limited resources.” He confessed to being “surprised” more people in remand don’t die by suicide, given the risk factors.

Shoyele concluded the problems at the Edmonton remand are “not necessarily budgetary,” given the clinics are billed through Alberta Health.

“Professional opinion confirms that the current setup — where only three mental health clinics are available for 1,500 inmates — is inadequate,” he said. “The inevitable result that flows from this present regime is that mental health units are overcrowded.”

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One issue, he said, is the difficulty recruiting psychiatrists to work in correctional facilities.

Shoyele recommended the remand hire a full-time forensic psychiatrist position, which would be staffed round the clock. He suggested that person work as part of a “hospital-grade” mental health and addictions unit, which would be better equipped to handle overcrowding and surges in population.

Such a system would improve response times to health service requests, facilitate better treatment at intake and improve monitoring, the judge said. He also recommended a “general expansion” of mental health services and staffing at the jail.

Greene said Shoyele’s recommendations make sense, but she’s concerned whether they will actually be acted upon.

She urged the system to reassess whether people like her son need to be in the custody in the first place.

“T.J. never belonged there,” she said. “He isn’t some hardened criminal, and there’s a lot of T.J.s in there right now. They’re there because they have addiction issues, have done petty crime and are, I feel, being punished for using drugs and being poor.”

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In an email, ministry of mental health and addiction spokesperson Hunter Baril said Shoyele’s recommendations will be taken “into consideration.”

Since McConnell’s death, the government has expanded same-day access to opioid agonist therapy medications “including Suboxone in corrections through the virtual opioid dependency program,” he said.

Recovery Alberta, the province’s new addictions agency, has also added health care and mental health staff to police arrest processing and detainee management units to improve screening for mental health and addictions issues, Baril said.

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