Imagine your family member is experiencing a mental health crisis, but instead of being treated at a mental health facility, they are locked inside a notorious provincial jail. You go to help by bringing their medication and medical records but are turned away again and again. Days later, a knock at the door brings the devastating news that your loved one is dead.
The Faqiri family has been living this nightmare for the last seven years. They had come to Canada as refugees from Afghanistan in the early 1990s hoping for a better life.
On Dec. 15, 2016, 30-year-old Soleiman Faqiri died at the Central East Correctional Centre, a “super jail” in Lindsay, Ont.
He had been repeatedly struck by guards, pepper sprayed twice, his face covered in a “spit hood” and forced onto his stomach in a prone restraint position. He had earlier been arrested for allegedly stabbing a neighbour during a mental health episode.
The coroner’s inquest into Faqiri’s death is concluding with Ontario coroner’s counsel calling his death a homicide and making 55 recommendations for jurors to consider to prevent further deaths. The inquest saw graphic and disturbing video evidence and witness testimony of the final days and moments of his life, and the brutal force used against him by corrections officers.
Coroner’s counsel Prabhu Rajan told jurors at the inquest that Faqiri’s death was a “preventable tragedy” and that evidence points in the direction of homicide.
In 2022, the Ontario Provincial Police told Faqiri’s family they would not be laying any charges against the guards involved in his death, saying there was “insufficient evidence” to do so.
The inquest has reignited concerns surrounding the use of force and deaths in custody of people experiencing mental health distress. This tragic case serves as a poignant reminder that our current approach to dealing with mental health issues within the prison system is deeply flawed, and demands immediate attention and reform from federal, provincial and territorial governments.
Elevated risk of death in custody for people with mental health issues
Faqiri’s death in custody is not an isolated incident. Studies have shown that a significant number of deaths in custody involve mental health issues. Tragically, federally incarcerated individuals are eight times more likely to die from homicide and suicide than the general population.
In one study, researchers examined 478 deaths in custody in Ontario between 1996 and 2010. They found that around “half of all deaths in custody occurred among those with a history of mental illness or substance use and those deaths disproportionately occurred in local police or provincial custody.”
Canada has formally abolished the death penalty as a legal sanction, yet it effectively remains in place for many people with mental illness who are incarcerated.
Individuals with mental health issues face elevated risks in correctional facilities, where force is often used to control inmates. From restraint equipment to pepper spray, the arsenal of tools employed by corrections officers can exacerbate the trauma and distress of those already struggling with mental health disorders.
Moreover, the conditions of incarceration, including overcrowding and double-bunking, contribute to heightened stress, anxiety and incidents of self-harm and suicidal behaviour.
The 2020-21 annual report by the federal correctional investigator, Ivan Zinger, revealed that a staggering 41 per cent of use-of-force incidents in federal prisons involve individuals with documented mental health conditions. However, this likely underestimates the true extent of the problem, as reliable data from the Correctional Service of Canada on mental health indicators is lacking.
Another disturbing aspect highlighted by Zinger is the overuse of pepper spray, a practice particularly cruel and traumatic for individuals with serious mental health conditions. He recounted a case where a certified individual undergoing a health procedure was subjected to two bursts of pepper spray, handcuffs and “physical handling.”
A report from the John Howard Society found that common behaviour and symptoms of severe mental health disorders (like bipolar or schizoaffective disorder) can be misinterpreted by corrections staff, leading to increased disciplinary sanctions and use of segregation.
Independent investigators
While we have an independent corrections investigator for federal institutions, there is no comparably empowered independent watchdog for provincial jails. This must change.
Additionally, Canada has so far refused to join 90 other countries that have ratified the United Nations Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment. The protocol requires countries to open up all places of detention to independent national and international inspections. We need greater transparency and accountability, and to fundamentally change how incarcerated people are treated.
Faqiri’s death is a haunting example of the fatal consequences of the criminal justice system being used to address mental health issues. Despite the coroner’s report detailing the severe mistreatment leading to his death, the lack of accountability so far is deeply troubling.
The systemic issues plaguing our correctional facilities need to be addressed and the mental well-being of those in custody must be prioritized. Reform should focus on providing medically and culturally-appropriate trauma-informed treatment, medication and therapies in a supportive environment, rather than in prisons that exacerbate the challenges faced by individuals with mental health issues.
Evidence-based community mental health services are also vital to better meet the needs of people with mental health issues while protecting society. Where such services are not provided, there is an elevated risk of harm. Prevention is key.
“People who have a psychotic illness who are treated have the same or lower rates of violence than the general population,” Sandy Simpson, chair in forensic psychiatry at the University of Toronto’s Centre for Addiction and Mental Health, explained in an interview for my book Indictment: The Criminal Justice System on Trial. “So, it’s treatable if care is available and acceptable and delivered in the right way to people in need.”
The tragic stories of those like Faqiri demand that we reevaluate our approach to mental health in the community and in prisons as we strive for a system that promotes healing rather than perpetuating harm. Faqiri’s death must not be in vain. His family deserves answers, justice and accountability.