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An image from a video taken just days before Ashley Smith died at the Grand Valley Institution for Women in Kitchener, Ont., in October, 2007.

Five years ago, there was a short burst of political will to change the way prisons deal with inmates with mental illness. The Correctional Investigator had penned a report on the death of 19-year-old Ashley Smith, who was watched by guards as she strangled herself to death in 2007.

The Public Safety Minister of the day, Peter Van Loan, launched federal-provincial discussions, and steered a national strategy. But Ottawa's attention drifted. Change moved slowly. Almost year ago, a coroner's inquest issued another report on Ms. Smith's death, with 104 recommendations. Correctional Service Canada has yet to respond.

There's still a depressing sameness to some of the deaths inside prisons. The case of Edward Snowshoe has highlighted failures, like the dangers of prison segregation, especially in the case of people suffering from mental illnesses. They aren't new warning signs.

Howard Sapers, the Correctional Investigator, who wrote the 2009 report about Ms. Smith, said he recently reviewed a still-unpublished Corrections Board of Inquiry report on another suicide last year, and found many of the same problems. "It's the same thing all over again," he said in an interview.

Ms. Smith's case was chilling. She strangled herself, even though guards were watching on video monitors. They didn't enter her cell until 45 minutes later.

She was a troubled teen whose mental-health problems led to a cycle of incarceration. She first went into youth detention for throwing crab apples at a postal worker, and her misbehaviour there led to longer terms and eventually, transfer to adult prison.

Her behaviour was, for prison officials, "extremely challenging," Mr. Sapers said. In difficult cases, the prison system often goes to default responses, and the default is security, he said: "She was almost perpetually segregated."

That happened because of a bureaucratic loophole. Inmates in segregation were supposed to have psychological assessments within 30 days. But Ms. Smith was moved from prison to prison, or to hospital and back, 17 times, and each time, the clock for psychological assessment was reset.

That policy was changed, so now the clock doesn't get reset every time an inmate is moved. But there are other recommended changes that aren't in place. Mr. Sapers believes there should be psychological screening within five days of an inmate being placed in segregation, and those with serious mental illnesses issues should never be in segregation.

Some positive things have been done. Mr. Van Loan opened discussions with provincial counterparts and developed a national strategy. It didn't revamp all policies, but it encouraged some change.

After Mr. Van Loan left the portfolio in 2010, there was less drive from the minister's office. Major changes were slow in coming. CSC has yet to conclude long-promised agreements with provinces to arrange for female patients with serious mental illnesses to be treated in medical facilities, rather than prisons.

Mr. Van Loan's successor, Vic Toews, held a conference with provincial counterparts. But he didn't seem particularly sympathetic. When the NDP asked about Ms. Smith's case, Mr. Toews accused them of caring more about prisoners than victims. But in theory, the Conservative government took the position that mentally-ill people should be treated in health facilities, not prisons.

That's true, of course. It's also true that the Corrections system has to deal with mentally-ill prisoners. "Prisons are not and should not be hospitals," Mr. Sapers said. "That said, some inmates are patients."

Almost a year ago, a coroner's inquest into Ms. Smith's death made 104 recommendations. Most fit into two categories: more resources, training, and facilities for dealing with mentally-ill female inmates and limits on segregation. Correctional Service Canada has yet to respond.

A spokesman, Véronqiue Rioux, said the CSC is taking the response seriously, and noted that there have been changes, including the fact that CSC has trained 10,800 staff on the basics of mental health, and now 90 per cent of women inmates complete mental health screening when they go into the system. In May, the current Public Safety Minister, Steven Blaney, introduced a new mental health "action plan" for federal inmates.

It's now up to Mr. Blaney to inject a little political will. Otherwise, there will be more deaths with the same pattern, after the same unheeded warnings.

Campbell Clark is The Globe's chief political writer in Ottawa.