An inmate who repeatedly bangs her head and strikes out at prison staff who try to stop her is not a dangerous offender, according to a ruling released today by a judge in Saskatchewan.

Marlene Carter, 43, has spent the past five years in federal custody in Saskatoon, almost all of it in solitary confinement.

Instead of declaring Carter a dangerous offender, Saskatoon Judge Sheila Whalen found the woman guilty of assaulting guards and staff. The consequence is that Carter will spend two more years in custody.

During Thursday's court proceeding Carter appeared via video link, strapped in a chair to keep her from harming herself. There was also a square patch of gauze covering her forehead. At one point, Carter used a free hand to remove the gauze. Beneath it there was a large red sore.

Carter, who is mentally ill, has spent almost all of the last five years tied to a chair or bed in a segregation cell because staff can’t stop her from hurting herself.

'Health care providers, not guards'

Attempts have been made to have Carter transferred from prison to a mental health centre for treatment but the Correctional Service of Canada has so far refused.

In the ruling, Whelan expressed hope that authorities would now place her in a more appropriate setting.

"Ms. Carter should be in a facility where a clinical approach governs, where there are sufficient resources to best respond to her mental health needs and where she would be surrounded by health care providers, not guards," Whelan said.

Carter's lawyer, James Scott, said he was happy with Whelan's findings.

"I’m really pleased," Scott said after court. "This is something I was hoping for."

Scott said he, and others, will follow up to ensure Carter gets the treatment she needs.

"Myself and others will be monitoring the situation," he said. Advocates believe an Ontario facility, the Brockville Mental Health Centre, is a more appropriate setting for Carter.

Carter has a long history of mental illness, which is now complicated by brain damage from her head banging.

The wound on her forehead is from regularly thrusting herself forward and banging her head on the floor or any nearby hard surface. A sound her social worker, Jennifer Balicki, described it as “like a watermelon hitting the concrete repeatedly.”

In one incident, Carter banged her head 152 times in less than two minutes. Other times, staff report wrestling her to the ground and using pepper spray to try to get her to stop. But Carter would frequently strike back and assault those staff.

Some then moved to have her charged criminally. Those charges have prolonged her stay in prison and prompted an application to have her declared a dangerous offender.

“I’ve never come across anyone like her,” said Dr. Shabehram Lohrasbe, a forensic psychiatrist with 30 years of experience, who assessed Carter for her dangerous offender hearing. He called her case both “sad” and “unique.”

“I personally have never encountered an individual who has struck her head so often and with so much force as Ms. Carter has,” he told the hearing. Lohrasbe said Carter told him she bangs her head because she believes hurting herself helps others.

Abandoned at birth, sexually abused

Born in Alberta, Carter is a member of the Onion Lake First Nation. She was abandoned at birth by her mother and sexually abused as a child. At 13, she tried to shoot herself. Since then, she has attempted suicide several times, once by stabbing herself in the stomach. She has spent much of her life in prison and has a history of drug and alcohol abuse.

Regional Psychiatric Centre officials say efforts to control the woman’s outbursts with anything other than restraints and sometimes pepper spray have failed. Prison staff testified that they have no specific programs to help women who severely harm themselves. Experts have said she belongs in a hospital, not a prison where security is considered more important than therapy.

“It’s a travesty, it’s an outrage,” said Kim Pate, executive director of the Canadian Association of Elizabeth Fry Societies. Pate said Carter’s illness has become worse in prison, where security concerns take precedence over therapy. She has been pushing for years to have Carter moved to a mental health centre where she can be treated.

Pate said Carter pleads guilty to most of the charges laid against her because “she wants to please people,” including prison staff.

“I think it’s questionable that she has any kind of criminal intent, so she should not be held responsible for many of the charges,” Pate said.

After the ruling Pate also expressed hope that Carter would be taken out of a prison setting.

"We need to move immediately to ensure she is transferred to Brockville as soon as possible,” Pate said. “As soon as I heard the decision, I sent a message to Corrections asking how I could assist and how we could move things and have her transferred."

Parallels with Ashley Smith case

Pate drew parallels between Carter’s case and that of Ashley Smith, the teenager who choked to death after tying a piece of cloth around her neck in a Kitchener, Ont., prison cell while guards stood outside her cell and watched. Smith, like Carter, was severely mentally ill. A coroner’s jury issued 104 recommendations in that case, including one that said inmates who are severely mentally ill should be transferred to mental health hospitals. 

“This situation, it’s just not fair and it’s not right,” said Jim Scott, Carter’s lawyer. “It’s an emergency situation ... she needs treatment right away. My worst fear is that she will find a way to harm herself and that harm could end her life.”

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An inquest into the death of Ashley Smith prompted a coroner's jury to issue more than 100 recommendations, including one that said inmates who are severely mentally ill should be transferred to mental health hospitals. (Photo courtesy of Ashley Smith's family)

Scott pointed out that inmates are sent to hospital when they have serious physical ailments, so the same should happen in cases of mental illness.

“I don’t think that people with a mental illness are children of a lesser god,” he said. Recently a team from Ontario's Brockville Mental Health Centre, which is not part of the prison system, travelled to Saskatchewan to assess Carter. They recommended she be transferred there. George Weber, CEO of the Royal Ottawa Mental Health Centre, which oversees the Brockville site, told CBC News the facility is willing to accept her. But so far, he said, Corrections Canada has refused to move Carter.

Her case has also drawn the attention of Howard Sapers, Canada’s correctional investigator and ombudsman for prisons. His office has written several letters to senior correctional service officials and to the public safety minister asking that Carter be sent to a hospital.

Carter’s case was also included in a special report issued by Saper’s office last year entitled Risky Business. It cited concerns about the treatment of female inmates who are mentally ill and harm themselves. In particular, it pointed to the unauthorized use of a boxing helmet and the construction of a padded cell to deal with Carter. Both methods have since been discontinued.

“I’m very concerned that we are going to see more deaths in custody, partly as a result of suicide or self-injury, because the individuals are not being managed according to their health needs,” Sapers told CBC News. Officials with  Corrections Canada declined to comment on Carter’s case, citing privacy concerns.

Last year, Commissioner of Corrections Don Head told the Ashley Smith inquest that his agency doesn’t have the staff or resources to handle complex cases such as Smith’s and at least a dozen other women.

Carter finished her sentence in federal custody two years ago, but has remained at the Regional Psychiatric Centre pending the disposition of new assault charges involving staff and awaiting the decision on whether to declare her a dangerous offender.

A dangerous offender status could have led to Carter being in prison indefinitely.

With files from CBC's Kathy Fitzpatrick