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

Abstract

Objective: To examine the processing and Review Board (RB) disposition outcomes of people found not criminally responsible on account of mental disorder (NCRMD) across the 3 most populous provinces in Canada. Although the Criminal Code is federally legislated, criminal justice is administered by provinces and territories. It follows that a person with mental illness who comes into conflict with the law and subsequently comes under the management of a legally mandated RB may experience different trajectories across jurisdictions. 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 and April 2005, followed until December 2008. Results: We found significant interprovincial differences in the trajectories of people found NCRMD, including time detained in hospital and time under the supervision of an RB. The odds of being conditionally or absolutely discharged by the RB varied across provinces, even after number of past offences, diagnosis at verdict, and most severe index offence (all covariates decreased likelihood of discharge) were considered. Conclusions: Considerable discrepancies in the application of NCRMD legislation and the processing of NCRMD cases through the forensic system across the provinces suggests that fair and equitable treatment under the law could be enhanced by increased national integration and collaboration.

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

“…To facilitate interpretation, the reference category is always the more restrictive disposition: positive coefficients indicate a greater likelihood of a less restrictive decision. As observed in our previous work (Crocker, Charette, et al, in press), there is a difference across provinces in review board dispositions. Ontario and BC review boards are less likely to grant CDs than QC.…”

“…The present study builds on our previous research (Crocker et al, ; Crocker, Charette, et al, in press) to further examine how dynamic and static variables predict disposition decisions for NCRMD individuals across the three largest provinces in Canada.…”

“…Given that studies have shown that review boards rely on expert testimony for decision‐making and that there is high agreement between clinicians' recommendations and review board decisions (Crocker, Charette, et al, in press; Hilton & Simmons, ), it is important to consider what information is presented at review board hearings. We considered whether a structured risk assessment tool was used and mentioned in the expert report.…”

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.…”

Housing Trajectories of Forensic Psychiatric Patients

“…Thus, the 3‐year duration of the observation period of this study might have had an impact on the lack of variability in the trajectories of this sample. Longer follow‐up periods would allow us to see more variation over time in placement patterns, particularly for individuals who committed a severe index offense, for whom duration under Review Board is longer (Crocker et al, ) and for whom housing resources may be particularly difficult to access.…”