This article contains discussion of suicide. If you or someone you know is having a suicide crisis, please call the Canada Suicide Prevention Service (1-833-456-4566), which offers 24/7 support. There is also Kids Help Phone (1-800-668-6868), the First Nations and Inuit Hope for Wellness Help Line (1-855-242-3310), and 1-866-APPELLE (for Quebec residents).

In a frayed cardboard box, Lana Greene keeps a collection of important items, each in a clear plastic bag and labelled with a hasty scribble: there’s a lighter, a cloth face mask, a blue T-shirt, a black belt, socks, jeans, a pocket Bible with a crumpled front page, shoes with the backs ripped out and laces removed. It’s all Greene has left of her twenty-three-year-old son, Timothy James McConnell, or TJ as he is commonly known.

Inside her home in Terrace, British Columbia, Greene opens one bag, sent to her from the Edmonton Remand Centre, and presses the blue T-shirt to her nose. Instead of TJ’s familiar scent, pepper spray burns her nostrils, sends fire into her lungs. Her eyes burn, tears roll down her cheeks, and she screams over the death of her son.

Initially, Greene was relieved when TJ was arrested on charges of shoplifting and theft under $5,000 in September 2020. He’d spent months sleeping rough and stealing to pay for drugs. She thought the legal system would require him to get help for his mental health and addiction. Jail would be tough, she thought, but maybe this would give TJ the final push toward getting the help he needed, toward getting his life back on track. “When people get arrested, if they want the help, they can get it. That’s what I always thought,” Greene says. So when she got the call from his lawyer after he was placed in custody, Greene refused to act as TJ’s surety—a requirement often needed for a judge to grant someone bail. She knew that she couldn’t provide the environment to help stabilize TJ, that if he came to stay with her, he’d just slip back into his old ways. That decision, Greene says, has been hard to live with.

On January 11, 2021, the day that TJ died, Greene had a feeling that something wasn’t right. She’d had trouble focusing on her massage therapy job—she hadn’t heard from TJ for ten days, and the anxiety was gnawing away at her. TJ tended to call every week or so from the remand centre; that’s how she knew he was doing okay. When she finally got a call at 8:58 that evening, from an Edmonton phone number, she was relieved. Oh, my god, he’s out, she thought to herself. He’s calling me.

Instead, it was the RCMP. They had information about her son, information they couldn’t give her over the phone. “I know something is wrong. Please tell me what is going on,” she remembers saying. She thought maybe TJ had been hurt by another inmate and that he was in the hospital. But there was no answer forthcoming. It took until 11 p.m. for an officer to arrive at Greene’s door, and that’s when she was told that TJ had been found unresponsive and had died by suicide.

Before he died, TJ had spent four months in the sprawling Edmonton Remand Centre, Canada’s largest correctional facility. According to Statistics Canada figures, he was one of the 12,752 people held in remand centres at that time—provincial or territorial jails where people are held for two years or less—who were awaiting trial for charges they hadn’t yet been convicted of. People in jail awaiting trial have been growing in number year after year, and they face substantial risks. These individuals experience higher suicide rates than other Canadians, and their suicides accounted for 20.6 percent of all deaths in provincial correctional facilities between 2009 and 2019. The reasons for these figures are complex, but advocates say that there is a common thread: many on remand have substantial mental health needs that are going unmet, and until systemic changes are made, people will continue to die.

Across Canada, over the past decade, crime rates have been falling. So, too, have the numbers of people being handed jail sentences. While these figures suggest that there should be fewer people sitting in jails, the opposite is true: the number of adults on remand—those awaiting trial or sentencing and kept in provincial jails—has been on a staggering rise. From 2013 to 2019, the number of people in those jails without a sentence increased from 11,494 to 15,505. In fact, in every year since 2004, adults on remand have outnumbered adults serving sentences in provincial custody. In 2018 and 2019, on a given day, there were about 70 percent more people in jail without a sentence (14,778) than people in jail serving a sentence (8,708).

In Canada, anyone who is arrested and charged with a crime is either released by police or held for a bail hearing. In 2019, 40 percent of criminal charges never resulted in a finding of guilt, meaning that many people on remand will do time in jail without ever being found guilty of an offence. The remand population in nearly all of the provinces and territories accounts for more than half of those held in custody, and among the highest numbers are in Alberta and Ontario, where about 70 percent of the incarcerated population are those awaiting trial or sentencing.

Although there must be reasonable grounds for someone to be held in custody while awaiting trial, remanded individuals are disproportionately homeless, poor, experience mental health issues, or have a substance use disorder, in part because these populations tend to lack stable housing or employment, which are usually requirements for bail.

Today, nearly all jurisdictions are facing overcrowding in their correctional centres as a direct result of the numbers of those held in remand, and the problem is especially acute in dilapidated facilities that were designed to house much smaller populations. The problems correlating with overcrowding are grave: deteriorating conditions inflame tensions, which can lead to violence, creating a dangerous environment for both detainees and staff. Many stays on remand usually average a week or a month, but some people, like TJ, can be held for even longer. At the same time, the Canadian Charter of Rights and Freedoms guarantees both a speedy trial and a presumption of innocence until proven guilty. Even temporary stays can be challenging, as people on remand are under much stress and uncertainty because they do not know when or if they will be convicted. On top of this, they may still be dealing with challenges that contributed to their alleged crimes, such as mental health or substance abuse issues. And since they are not in jail serving a sentence of a set length, those on remand have limited access to community programming and mental health services during their time in a facility.

TJ, who had been officially diagnosed with bipolar disorder years before he ended up incarcerated, struggled to accept his diagnosis. Greene tried to encourage him to go for counselling or see a doctor. “He’d say, ‘I’m not crazy, mom.’” Just months before he was placed in the Edmonton centre, Greene had tried to find him a bed in an Alberta addiction treatment hospital that could help him with his drug use struggles as well as his bipolar symptoms.

Greene says TJ was charged by Edmonton police for allegedly breaking into a paintball store and stealing airsoft pistols. He was sent to the remand centre on September 4, 2020. “It was crushing,” Greene says. “But we just moved forward. He was vocally asking to see a psychologist in the remand centre, which I saw as a miracle because I had been trying to get him to ask for help for years.”

Leah MacIntyre, TJ’s long-time girlfriend, also thought that TJ would find the support he needed while awaiting his court date and that it would start him on a path toward a better life when he got out. “In NA [Narcotics Anonymous] meetings, they always say you end in three ways: you either get better, or you overdose, or you go to jail. That’s kind of the ending thing,” says MacIntyre. “So I thought in remand at least he’ll be stuck in one place, he’ll have the help there, and then he’ll start reaching out and probably get better.”

But TJ never got the chance to get better. Records from the remand centre obtained by Greene’s lawyer (Greene spent nearly a year and a half and worked multiple jobs to pay retainer fees) show that TJ was pleading with staff to help with his addiction and mental health struggles. He was desperately reaching out for help. TJ asked multiple times to be put on Suboxone, a medication that treats opioid dependence. “I’m scared I’m gonna lose my life when I get outside, back around even more pressure to use. I’ve overdosed 16 times and I really want to leave this life behind,” he wrote on a health services request form two months into his custody. After another month and a half went by without receiving help, TJ submitted another request: “I’m sorry to bug, I know I’m on the waiting list, but I’ve been here 4 months and soon I’ll be back on the streets, surrorned [sic] by drugs and hopeless addicts … please let me start my suboxone treatment. I won’t abuse this privilege.” But it’s unclear if TJ was even on the wait list. He would receive a letter notifying him that he had been put on the wait list for Suboxone on January 5, 2021. He died six days later.

TJ also made numerous requests to see a psychiatrist and asked to be put on Seroquel, an antipsychotic medicine that he had been prescribed in the past. Near the end of November 2020, a staff member wrote that TJ had threatened to “go suicidal” if he wasn’t prescribed the antidepressant Wellbutrin. One request, where TJ wrote that he was having trouble sleeping and was struggling with anxiety and depression, was met with the response that he had already been seen by someone from the centre’s mental health personnel and that his file had been referred to the psychiatrist. One of his requests for medication was met with the reply that there was no history of TJ having been on medication. But Greene says that her son had the medical history of his bipolar diagnosis and his Seroquel prescription, which was documented in hospitals in BC and Alberta.

Another reply from remand health staff suggested that TJ follow up with his family doctor when he got out of the remand centre. “I don’t even have a family doctor,” Greene scoffs when I read out that particular reply over the phone. “There he is in their care saying, ‘I want to function in society, I want medication to help me not be on drugs,’ and they frickin’ ignored him,” she says. TJ’s requests are now being used as part of a lawsuit, filed by Greene, against Alberta Health Services and the province, alleging that the lack of medical care ultimately led to TJ’s death.

TJ’s experience at the Edmonton Remand Centre is not a unique case. Health care has continued to be the most common complaint from incarcerated people from 2015 to 2020, according to the Office of the Correctional Investigator, the ombudsman for people serving federal sentences in Canada’s prisons. In addition, Ontario ombudsman Paul Dubé wrote in his 2020/21 annual report: “Year after year, access to health care is the most common complaint we hear from inmates, and the pandemic has only intensified this. . . . Treatments by doctors, dentists, psychiatrists and other specialists were often limited, cancelled or delayed.” The report cited instances where the correctional facility had stopped an inmate’s mental health medication and where an inmate had been referred to a psychiatrist for depression but had not been seen by mental health staff for months.

Heath care in jails is also a public health issue, especially for those held on remand who are often released back into the community after a short period of time. People who are held in jails and prisons tend to have more health issues than the general population. Studies of Canadian inmate populations have found increased prevalence of chronic illnesses, HIV, hepatitis C, mental illnesses, and substance use disorders. Certain conditions in jails, like overcrowding and lack of fresh air, can contribute to the spread of diseases, while isolation and lack of activities have the potential to worsen existing mental health issues.

“That their standard of health care in the jail is as good or better than the outside—that is complete bullshit,” says Tom Engel, a prison law lawyer in Alberta who is now representing Greene. He says many of his clients in the Edmonton Remand Centre struggle to access the medication they were on before they were taken into custody. When I spoke with him, he was helping a client who had been refused antidepressants and sleeping medications despite having a note from a doctor on the outside stating that the client must have these medications or he would become depressed and likely suicidal. Engel also says that the remand centre’s prohibition on in-person visits makes it challenging for people to access family supports. “You have this vulnerable population, you put them in those conditions—what do you think is going to happen to somebody who was depressed?” he says. “If they had any suicidal ideations before, it’s going to be more severe. If they didn’t have them before, they’re probably going to have them once they get in there.”

Alberta Health Services oversees health care for the province’s remand centres. In a statement provided to The Walrus, a representative said that they could not comment on TJ’s case due to privacy reasons but stated that “our primary goal is to ensure all inmates have access to health services, medications and support as required. When an individual is brought into the facility Alberta Health Services health care team reviews their health care needs, including any prescriptions that an inmate may require.”

Prior to 2013, the Edmonton Remand Centre had been located in the city’s downtown, where it had operated for over thirty-three years. Originally designed to house between 300 and 400 inmates, it became hopelessly overcrowded by the early 2000s. At one point, it held 800 people, including some double and triple bunked in basement storage rooms. According to the Edmonton Journal, conditions were so poor that some judges began giving inmates triple credit for time served there. In 2006, it was announced that a new facility would be built to alleviate the overcrowding, and in 2013, the new $568 million Edmonton Remand Centre was unveiled. Sprawling across sixteen hectares of land (the size of around twenty-seven football fields), the new centre has 1,952 beds and can hold nearly 3,000 inmates, according to another Edmonton Journal article. But the state-of-the-art building didn’t change the suicide risks that would continue to plague the facility.

Although the centre has a mental health policy—daily mental health checks when an inmate is in segregation, for example—what’s on paper often looks different in practice. “Every one of my clients has said, essentially, what they do is some version of knocking on your door and saying, ‘You okay?’ Or they’ll talk to you through your food slot and basically ask, ‘Do you want to kill yourself today?’ It’s not a private conversation, and it’s not really a meaningful conversation either,” Alberta lawyer Amanda Hart-Dowhun says. “Also, if you do say you want to kill yourself, things will get worse for you, not better.” Segregation for suicide risk in the remand centre and in most jails and prisons across the country requires inmates to be watched constantly by a camera while alone in a cell, often with nothing to do, and to wear a tear-resistant gown (dubbed the “babydoll”) instead of clothing. AHS did not respond directly to The Walrus’s emailed questions about mental health check practices at the remand centre. “A variety of health professionals depending on an individual’s needs including registered nurses, psychiatric nurses, social workers, nurse practitioners, physicians, psychiatrists, psychologists, and counsellors are available to assess patients’ medical and mental health needs,” the provided statement read.

“If you’re asking what [drives] people with mental illness coming into custody, a big chunk of that is structural poverty, housing instability, and poorly coordinated mental health services. If you want to stop the problem in the community, those are the things we have to address as well,” says Alexander Simpson, chair in forensic psychiatry at the Centre for Addiction and Mental Health. Simpson also works at CAMH’s Forensic Early Intervention Service at Toronto South Detention Centre, the country’s second largest correctional facility. The program is a collaboration between CAMH and multiple government ministries, and it provides mental health screening, triage, and interventions to those in the facility. He says that mental health services that bridge the transition in and out of custody are crucial—and these are the supports that are very poorly funded. “[The Ministry of Community Safety and Correctional Services] are experts in detention and supervision of people before the courts and with short-term sentences; that’s what they do,” says Simpson. “We do mental health services, we want to work together on many of the people coming in there, because mental health services fail people, social supports fail people, and corrections winds up being the place they get sent to. It’s our supports and health services that need to be better.”

After losing TJ, Greene found support from Moms Stop the Harm, a network of Canadian families who have lost loved ones to substance misuse and who advocate for harm reduction instead of criminalizing drugs and drug users. Willamena McCorriston, a board member with Moms Stop the Harm, says she thought her daughter would get treatment for substance use disorder and mental health when she ended up in Pine Grove, a women’s jail in Saskatchewan. When her daughter was instead left to go through withdrawal in a jail cell, McCorriston’s distrust of Canada’s prisons system was further confirmed. “We’re using punitive measures to treat sick people, and that shoe will never fit,” she says. “That conversation just absolutely has to be had—this is completely the wrong tool. And we’re spending millions and millions of dollars in corrections.” McCorriston says she’d like to see the correctional system have treatment options that are made collaboratively with an individual and support that individual’s transition through the system: from remand centre to sentencing, if they are convicted, and to their release back into the community.

Recent tragedies at Pine Grove lay bare the lack of support structures in place. In 2021, Kimberly Squirrel was found frozen to death three days after her release from remand. The Saskatoon StarPhoenix reported that Squirrel had a history of depression and substance use and had tried to go to jail as a way to get sober. Earlier, in June 2019, Ronalda Wescoup died of cardiac arrest in a medical observation cell at Pine Grove just four hours after arriving there. She was placed on remand after stealing alcohol. “It’s really unfortunate that the system has this opportunity to help people perhaps get on a pathway to wellness and they don’t take it,” McCorriston says. “In terms of whether or not people continue treatment after they get out of a facility, I think all of us are willing to say, ‘Well, at least they’ve been shown a path.’”

Since TJ’s death, Alberta Health Services has made some changes to how it approaches opioid disorder treatment. In July 2022, AHS expanded its online Virtual Opioid Dependency Treatment program into the Edmonton Remand Centre. In a statement provided to The Walrus, AHS said that there was currently no wait list for opioid treatment in the remand centre.

Greene is left knowing that her son wanted to live. “At the end of the day, nothing undoes what happened,” she says. She wants to see the criminal justice system make more of an effort to help people like her son. “I would just like to see people being treated like human beings,” she says. “If we look at someone’s crimes and determine they’re mentally ill or dealing with substance use, address it and give them an opportunity to heal.”

Geena Mortfield
Geena Mortfield is a court and crime reporter based in southwestern Manitoba.