The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 2: The People behind the Label

Abstract

Objective: To examine the psychosocio-criminological characteristics of not criminally responsible on account of mental disorder (NCRMD)–accused people and compare them across the 3 most populous provinces. In Canada, the number of people found NCRMD has risen during the past 20 years. The Criminal Code is federally legislated but provincially administered, and mental health services are provincially governed. Our study offers a rare opportunity to observe the characteristics and trajectories of NCRMD–accused people. Method: The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia ( n = 222), Quebec ( n = 1094), and Ontario ( n = 484) between May 2000 to April 2005, followed until December 2008. Results: The most common primary diagnosis was a psychotic spectrum disorder. One-third of NCRMD–accused people had a severe mental illness and a concomitant substance use disorder, with British Columbia having the highest rate of dually diagnosed NCRMD–accused people. Most accused people (72.4%) had at least 1 prior psychiatric hospitalization. Two-thirds of index NCRMD offences were against the person, with a wide range of severity. Family members, followed by professionals, such as police and mental health care workers, were the most frequent victims. Quebec had the highest proportion of people with a mood disorder and the lowest median offence severity. There were both interprovincial differences and similarities in the characteristics of NCRMD-accused people. Conclusions: Contrary to public perception, severe violent offenses such as murder, attempted murder or sexual offences represent a small proportion of all NCRMD verdict offences. The results reveal a heterogeneous population regarding mental health and criminological characteristics in need of hierarchically organized forensic mental health services and levels of security. NCRMD—accused people were well known to civil psychiatric services prior to being found NCRMD. Risk assessment training and interventions to reduce violence and criminality should be a priority in civil mental health services.

Dynamic and Static Factors Associated with Discharge Dispositions: The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder (NCRMD) in Canada

“…Also, our study addressed files from 2000 to 2005; therefore, practices may have changed in recent years (e.g., as young mental health professionals enter the field we would expect to see shifts in practice reflecting research developments). Furthermore, there are differences across jurisdictions in the comprehensiveness of available information in the files (Crocker et al, in press‐b). We also did not consider the specific HCR‐20 items in the prediction model for dispositions, but rather the number of factors that were mentioned.…”

Factors Associated with Review Board Dispositions following Re‐hospitalization among Discharged Persons found Not Criminally Responsible

“…The NTP (https://ntp-ptn.org, ) was an archival, longitudinal study examining a cohort of Canadian individuals found NCRMD in British Columbia (BC), Ontario (ON), and Québec (QC). The full methodology is described in detail by Crocker and colleagues (Crocker et al, ; see also Charette et al, ; Crocker et al, ; Crocker et al, 2015a–c; Nicholls et al, ; Salem et al, ; Wilson et al, ). Details relevant to the current analyses are presented here.…”

The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 3: Trajectories and Outcomes through the Forensic System

“…Our research revealed provincial differences in forensic patient characteristics. 4 It follows that the trajectories of people found NCRMD through the forensic mental health and RB systems may also vary from province to province. 5 …”