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Cindy Presse, chief psychologist at the Regional Psychiatric Centre in Saskatoon, is pictured outside the Ashley Smith inquest in Toronto on April 15, 2013. Presse testified Smith told her that self-strangulation felt good.Colin Perkel/The Canadian Press

A troubled teenager liked to choke herself because it felt good and alleviated boredom, an inquest into her death heard Monday.

In her testimony, psychologist Cindy Presse told jurors that self-strangulation can be auto-erotic, but Smith didn't do it for that reason.

"She was quick to say, 'It's not sexual, Cindy'," Presse testified. "She said it just made her feel good."

Presse, chief psychologist at the Regional Psychiatric Centre in Saskatoon, saw Smith, then 18, at the psychiatric prison to which she transferred on Dec. 20, 2006, from another facility in Nova Scotia.

Presse said she arranged for the inmate to call home and gave her some magazines.

Within hours, however, the teen began showing the same acting-out behaviour that had driven staff at other prisons to distraction.

She covered her segregation-cell camera and window with pages from the magazine. She dismantled the sprinkler head.

"A little TLC didn't go very far in controlling her behaviour," Presse told the inquest.

In her testimony, the psychologist drew a clear distinction between "parasuicidal" or self-harming behaviour and suicidal behaviour.

The former, which includes cutting or choking oneself, she said, is a form of addictive self-stimulation that's not intended to be lethal.

However, Presse said, it is important to ensure parasuicidals don't actually kill themselves in their quest for a more intense sensation in the way a drug addict might take increasingly powerful doses.

"You've got to keep the patient safe, but you don't really want the big commotion."

Smith, the jurors heard, didn't like her small bare isolation cell at RPC, where the little external stimulation she had – such as a radio – was removed when she misbehaved.

Presse conceded the punishment made little sense since the acting out was often a way to relieve boredom.

At RPC, the "fresh-faced" Smith stood out from other inmates, who were more likely to be hardened street people or drug addicts.

"She wasn't from a deprived background," Presse said.

As she did with others she encountered, Smith talked to Presse about her concerns and suspicions about her parentage.

Smith believed her sister, who was 19 years older and had a son two years older, was really her mother, and her nephew really her brother, jurors heard.

The view appeared to have been reinforced when she first went into the provincial jail system as a 15 year old.

"A guard said, 'Oh, my God: You must be [his] sister'," Presse said Smith told her. "'You look exactly like him'."

While others have testified that Smith believed her adoptive mother, Coralee Smith, was really her grandmother, presiding coroner Dr. John Carlisle ruled questions around the parentage issue were off-limits.

Presse's notes at the time indicate the difficulty dealing with Smith's erratic behaviour.

"Ashley impresses as extremely immature; she seems to see her non-compliance as a game," Presse wrote at one point.

But at another point she wrote that Smith "certainly can present as bright and reasonable when she chooses."

Smith, who constantly self-harmed, choked herself to death at a prison in Kitchener, Ont., in October, 2007 when she was 19.