A rare public letter from The Royal, an Ottawa mental health care and research facility, about how society "failed" an incarcerated Indigenous patient could be a catalyst to get better treatment for women with mental health issues, a Canadian senator says. 

Dr. A.G. Ahmed, The Royal's associate chief of forensic psychiatry, said Monday that Marlene Carter's hope for recovery was stripped from her when she was sent back to a correctional facility in Saskatchewan after spending two years at The Royal's Brockville, Ont. facility.

It was there in 2014, in a state of psychosis, that Carter repeatedly stabbed a nurse with a pen, seriously injuring her.

The Royal was fined $75,000 last week under the Occupational Health and Safety Act for failing to properly assess the risk associated with Carter. 

"The Royal's ability to treat Carter was severely limited by the lack of a dedicated unit for treating female offenders; the funding for a pilot program of only two beds wasn't enough to adapt the environment and bring in the interdisciplinary team that someone with extremely complex needs requires," wrote Ahmed, who treated Carter.  

"Our society fails people living with mental illness, especially women, by locking them up instead of getting them the care they need."

The case of Marlene Carter is now reigniting a debate about how to care for incarcerated women who have significant mental health issues. 

The Royal operated a 100-bed secure unit for male patients at the Brockville facility, but no such setup exists for women.

"Clearly many people believed there should have been much more than just those two beds in Brockville. Much more than just one unit, even," Sen. Kim Pate told CBC News on Tuesday. 

Senator Kim Pate

Sen. Kim Pate has built her career as an advocate for prisoners' rights, and currently sits on the Standing Senate Committee on Human Rights to examine human rights issues related to the prisoner experience in the correctional system. (Amanda Pfeffer)

Pate is a longtime advocate for prisoners and is now on the standing committee for human rights, which examines issues facing Canadian prisoners.

She recently visited the unit where Marlene had been staying in Brockville. 

She said she hopes the fine and Dr. Ahmed's public statement will provide an opportunity to move forward on improving care for mentally ill patients, not just in Ontario but across Canada. 

"I think we've let down lots and lots of individuals who are in this situation. Ashley Smith, Terry Baker, Marlene Carter. Those are names that have been in the public, I won't name all the other women who continue to be struggling with those issues," she said. 

"We have an obligation as a country to ensure that those supports and services are provided and I think we would see far fewer people victimized, far fewer people criminalized, and far fewer people in prison if we actually develop those resources in our communities."

Brockville Mental Health Centre

Carter was in custody at the Brockville Mental Health Centre from August 2014 until April 2016. (Waubgeshig Rice, CBC News)

Better facilities needed in Saskatchewan, Carter's sister says

Carter has spent most of her adult life — 28 years — incarcerated. Now 41, she continues to live with complex psychiatric problems and has history of violence and self-harm. 

She's back in the correctional institution in Saskatchewan where she spend the previous two years restrained from head to toe on a board, according to Ahmed. She was returned to her hometown to be closer to her family.

Carter's older sister, Peggy Harper, told CBC she is happy that her sister is closer to her home. She echoes calls from Sen. Pate that correctional services across Canada need to be better equipped to treat and rehabilitate patients with complex mental health issues. 

"I think they need to consider that we have mental health issues here in Saskatchewan, that it's not just down in Ontario," Harper said. "I would be in support to say there should be a facility here."

With files from Amanda Pfeffer