TORONTO – A teenager who choked herself to death in her prison cell was extraordinarily challenging in light of her severe mental illness but she was not unique, a psychiatrist testified Tuesday.

Unlike many previous witnesses who said they had never encountered anyone so intense and bent on self-harming as Ashley Smith, Dr. Olajide (Jide) Adelugba was more sanguine.

“She was a difficult patient but there was no behaviour that she exhibited that I saw for the first time,” Adelugba told the five-women inquest jury.

“She was different, she was difficult, she was challenging. But she was not alone.”

Adelugba was clinical director at the Regional Psychiatric Centre in Saskatoon, a psychiatric prison operated by Correctional Service Canada and the only one in Canada to take females.

Smith, then 18, was sent there in December 2006 because staff at a prison in Nova Scotia couldn’t cope with her self-harming, disruptive behaviour.

Adelugba described the teen as a textbook case of antisocial personality disorder.

The “Diagnostic and Statistical Manual of Mental Disorders,” the official guide to diagnosing psychiatric illness, lists 10 criteria for antisocial personality disorder, among them a disregard for the safety of self and others.

Smith met all 10, Adelugba said.

During her stay at RPC, Smith was seen by psychiatrists on 117 occasion, but her behaviour showed few signs of improvement.

Smith, Adelugba agreed, was involved in “one long episode of disruptive behaviour that never completely abated.”

Nevertheless, he insisted she was making slow progress at RPC.

He noted she had been kept constantly in segregation at Nova in Truro, N.S., but was occasionally allowed out of isolation at RPC.

Also, guards used force on Smith 51 times in 61 days at Nova. At RPC, the relative incidence of force was cut in half to 45 in about four months, at which point she was transferred out.

At RPC, the troubled inmate wracked up about 30 institutional charges, many related to having ligatures she would use to choke herself.

In cross-examination, Smith family lawyer Meaghan Daniel noted the contradiction of guards charging the inmate for having self-harming objects while clinicians were trying to treat her for the same behaviour.

Adelugba said the clinical team had “no control” over the charges, but said he tried to mitigate their impact by noting the teen’s mentally illness.

Smith was moved to Philippe-Pinel Institute, a forensic psychiatric hospital in Montreal, in April 2007.

The transfer decision came from Correctional Service Canada national headquarters following an incident in which a supervising officer at RPC was charged with assaulting Smith.

Adelugba was adamant he would only let Smith go to another psychiatric hospital because prison guards don’t have training to deal with serious mental illness.

“I was concerned that she could not be managed in a prison setting,” Adelugba said.

After Smith, of Moncton, N.B., left RPC, no one ever consulted Adelugba about dealing with her even though he was the psychiatrist who had the most interaction with her, jurors heard.

After a dozen further transfers, Smith choked to death at Grand Valley Institute in Kitchener, Ont., in October 2007. She was 19.