After spending 23 years in prison, Mario-Nelson Boucher arrived at a Montreal homeless centre with nothing but a prescription for antidepressants and a soon-to-be expired health insurance card.

With no bridge between the services Boucher received in prison, if any, and the help he required once released, the centre’s employees didn’t know the extent of his mental health needs. All they knew was that if they didn’t take him in, he had nowhere else to go.

Seven months later, in June 2016, an outreach worker and cable service employee found Boucher hanging behind his door. He was 44.

After hearing testimony during a public inquest last year, Quebec coroner Andrée Kronström has issued her investigation report and recommendations, exploring the cracks in the system that led to Boucher’s death.

In the 17-page report, Kronström calls for Quebec’s health authorities to establish a clear strategy to ensure a “continuum” of mental health services for inmates transitioning out of the prison system and to ensure they have a housing plan upon release.

She also says Quebec’s detention centres need to be better equipped with outreach teams to help inmates leaving the system.

“Mr. Boucher’s vulnerability, in my opinion, was exacerbated by the difficulties he encountered in re-entering society after 23 years in detention,” Kronström writes in the report. “The lack of support and absence of any medical follow-up failed to create the safety net needed to limit the chances of him (taking his own life).”

Boucher died at the NAHA Centre in Hochelaga-Maisonneuve, an organization focused on social reintegration. He had spent most of his adult life in provincial and federal prisons. With testimony from the centre’s employees, directors and his sister, the inquest examined how he struggled with the transition.

Boucher was overwhelmed by the smallest things, one worker said, like owning a set of keys or trying to learn how to send emails for the first time. He insisted on washing his own clothes in a bucket in his room and would often make a bed in his closet and sleep there instead.

Mostly, he spoke of missing life in prison. He had friends there, he would tell the staff, but none on the outside. One month before his death, he mentioned wanting to commit an armed robbery to be returned behind bars.

His mental health crises compounded everything.

From his arrival, Boucher would have fits of paranoia and hallucinations. He could also become violent. Having not received his medical history from prison, everyone knew he was struggling with mental health issues, but didn’t know to which extent or how to help.

The centre acknowledged it wasn’t the right setting for a case as heavy as Boucher’s, but also knew the alternative was worse.

“These men have nowhere else to go,” its general director, Sébastien Pageon, testified. “And being with us is still better than nothing.”

“Mario was like a baseball,” outreach worker Marie-Claude Naud told the inquest.

“We would send him to the hospital, then they would send him right back to us,” she said. “He shouldn’t have been with us. But then the question became, ‘where was he supposed to be?’”

Kronström said Boucher’s case underscores the importance of having continuous, streamlined services for inmates suffering from mental health issues in order to avoid the “revolving door phenomenon.”

“It is clear that Mr. Boucher’s needs were not limited to finding a place to stay when he left prison,” Kronström wrote. “The challenge was more to follow-up with him to try to treat his mental health and addiction problems.

“If he didn’t receive care in prison, it becomes extremely difficult to bridge the gap with the health care system once released.”

The coroner called on Quebec’s public security department, health and social services department and integrated health and social services centres to work together to solve the issue.

Kronström also noted that the issue is not new  —  she had raised similar concerns in a 2001 investigation and was surprised to see efforts to address the failures only began in 2015.

The public hearings portion of the inquest had ended with Boucher’s sister, Carole, being asked if there was anything she wanted to tell Kronström after hearing all of the testimony.

She approached the witness box and stood before the coroner. Her bother’s entire life had been difficult, she said, but she was encouraged by what she heard during the hearings.

“I want to thank everyone on behalf of Mario,” she said. “He always said the people in prison were his family, so I know he’ll be happy if changes come from this.”

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