Global Courant 2023-05-13 02:00:00
WARNING: This story is about mental distress and suicide.
The jury overseeing the inquest into Moses Beaver’s death has ruled the means of his death undetermined – which was the find his family hoped for.
The inquest into the death of the 56-year-old Oji-Cree Woodlands artist began on April 17, more than six years after he became unresponsive in Thunder Bay District Jail. Investigations are required under the Ontario Coroners Act when a person dies in custody.
A jury of three white women, a white man and a native woman heard from 32 witnesses about the mental health crisis Beaver went through in Nibinamik First Nation, and the crisis he continued to go through in the Thunder Bay District Jail prior to his death.
Deliberations began Wednesday, and the jury delivered its verdict on Friday: Moses Beaver died just after 10 p.m. on Feb. 13, 2017, at the Thunder Bay Regional Health Sciences Center, labeled “undetermined.”
While closing the statements, one of the family’s attorneys, Caitlyn Kasper of Aboriginal Legal Services, explained why the family believes a finding of undetermined is most appropriate.
“In this case, the family says there is evidence of suicide, but also much that points against it,” Kasper told the jury on Wednesday. “It is both the family’s submission and our interpretation of the evidence before you that Moses would not have chosen to end his life had it not been for the severity of his illness.”
Caitlyn Kasper, one of the attorneys representing Moses Beaver’s family, explains why his family sought an indefinite determination in the death of the 56-year-old Woodlands artist from Nibinamik First Nation. (Marc Doucette/CBC)
The jury heard testimony that Beaver attempted suicide twice in Nibinamik before being taken to Thunder Bay District Jail on January 18, 2017.
But they also heard from Beaver’s eldest sons that their father was against suicide. Writings found in his cell also indicated he understood the devastating impact of suicide, the jury heard.
“It is a very unsatisfactory verdict in some respects, because it does not provide the certainty we hoped for. On the other hand, however, it is a fair and fair verdict, and one that may well push the limits of the evidence you have up to at your disposal,” said Kasper.
“What we do know is that his life was priceless and his loss had a profound impact on those who loved him.”
The jury made 63 recommendations to prevent future deaths similar to Beaver’s — including ways to ensure that someone in his condition is transported to the hospital, not jail.
Improving mental health care for indigenous peoples
It is not required for an investigative jury to make recommendations, but the jury received more than 50 suggestions from counsel before deliberations began.
The very first recommendation serves as a legacy for Beaver, who taught art workshops in schools. It is asking the provincial and federal governments to fund an arts program at the Nibinamik Education Center, and an additional school in the Nishnawbe Aski Nation area on a rotational basis, where an artist helps students create work that expresses traditional knowledge .
The rest of the recommendations focused on improving mental health care within remote First Nations and correctional facilities such as the Thunder Bay District Jail and the new Thunder Bay Correctional Complex scheduled to be completed in the fall of 2026.
They include providing more resources for mental health treatment within First Nations, making mental health transports more direct and dignified, and ensuring that all parties involved follow a common protocol so that everyone knows their role and can be held accountable for it. held.
We are all deeply touched and will carry a piece of him with us.— Statement from the jury overseeing Moses Beaver’s investigation
That would prevent situations like Beaver’s, where the jury heard that delays, misinformation, and miscommunication between the community, Ornge, and the police ultimately led to Beaver being transported to prison instead of a hospital.
The jury also recommends that Indigenous Services Canada work with First Nations on how to build safe or secure rooms – while ensuring there is adequate physical space, staff and training to facilitate them – so someone like Beaver, who was shifted between a small, outdated and understaffed nursing station and his family’s home, have a place where they cannot harm themselves or others.
In addition, the jury recommended that Nishnawbe Aski Nation, which oversees 49 First Nations in Treaty 9 and 5, receive funding to develop a culturally safe mental health plan for remote First Nations in northwestern Ontario.
Better care, conditions in corrections
Ongoing training in mental health and cultural awareness was another big demand, especially for frontline workers in correctional facilities.
Especially when it comes to Indigenous inmates, who according to witnesses make up up to three quarters of the population of the Thunder Bay District Jail and experience more frequent and more complex mental health and addiction problems.
There was a big focus on Native-led, Native-led solutions. The jury recommended improving detainees’ access to Indigenous liaison officers, elders and other Indigenous service providers.
At the new correctional complex, they proposed building a special outdoor cultural space and a mental health unit, with cells that do not lend themselves to self-harm.
After hearing repeated testimony about the overcrowded and understaffed prison, the jury also recommended at least five hours of stimulating activity a day for inmates and an hour outside.
In terms of accountability, recommendations were also made around health accreditation to improve standards of care in correctional facilities for Indigenous peoples, along with the suggestion of an Indigenous Advisory Committee on the provision of health care and correctional services.
The recommendations have been made to various parties, including:
Governments of Canada and Ontario. Indigenous Services Canada. Nishnawbe Aski Nation. Nishnawbe-Aski Police Service and OPP. Ministries of Health, Attorney General and Solicitor General.
NAN welcomes the jury’s recommendations
Nishnawbe Aski Nation issued a release on Friday following the jury’s verdict, in support of the recommendations made.
“In recent weeks, this inquest has revealed systems designed with fatal flaws that ignored the realities of the people and communities they were supposed to serve. Under-resourced systems left an entire community with only two nurses and no police officer.
“In the last weeks of Moses’ life, he was imprisoned, though innocent, by a justice system that did not care about his life or treat his illness,” Deputy Chief Anna Betty Achneepineskum said in the release.
While the jury’s verdict is not legally binding — meaning no one is obligated to follow the recommendations — the chief coroner’s office is asking those who received recommendations to respond within six months to whether they have been implemented and if not why.
Nishnawbe Aski Nation Deputy Grand Chief Anna Betty Achneepineskum commends the recommendations of the jury overseeing the inquest into the death of Moses Beaver and calls on the government to take action to implement them. (Nishnawbe Aski Nation)
Perhaps the most sensible recommendation, No. 63, is that the Office of the Chief Coroner for Ontario conduct an annual review of previous investigations related to mental health and addiction problems experienced by First Nations people – looking at past and present recommendations. the patterns in between that are not implemented.
“We urge the governments of Canada and Ontario to review the recommendations and make it a priority to implement the recommendations so that no First Nations person is denied required care in an extreme crisis,” said Achneepineskum.
The jury also issued a statement following the verdict.
“While we were not privileged to meet Moses in person, we are honored to learn who he was, how important he was to so many and what an asset he was to his community,” read one of the judges. tears to Beaver’s family.
“We are all deeply affected and will carry a piece of him with us. Our hearts are heavy with the events Moses endured and the tragedies you all experienced. We hope these recommendations honor his memory for you. .”
If you or someone you know is struggling, get help here:
