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Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services

  • A.G. Crocker (a1) and G. Côté (a1)


Following psychiatric deinstitutionalization and changes in involuntary civil commitment laws, many individuals with severe mental disorders have been receiving mental health services through the back door, that is, the criminal justice system. Significant changes to the section of Criminal Code of Canada dealing with individuals with mental disorders have led to significant annual increases in the number of individuals declared Not criminally responsible on account of mental disorder (NCRMD), many of whom are directed to civil psychiatric settings. The goal of the present study was to describe the psychosociocriminological and risk characteristics of individuals found NCRMD remanded to civil psychiatric hospitals (CPH) compared to a forensic psychiatric hospital (FPH). This study was conducted between October 2004 and August 2006 in the sole FPH of the province of Québec and two large CPH in the Montréal metropolitan area. The final sample for the current study consisted of 96 men: 60 from the FPH and 36 from the two CPH. Results indicate that individuals in both settings have similar psychosociocriminal profiles, including PCL-R scores, but that individuals in CPH have higher scores in the Risk subscale of the HCR-20 than do their counterparts in the FPH. This difference is due to a higher score on two items: exposure to destabilizing factors and noncompliance with remediation attempts. Results are discussed in terms of the need for civil psychiatric settings to implement risk assessment and management programs into their services, and the need for further research into forensic mental health services.


Corresponding author

*Corresponding author. Tel.: +(514) 761-6131 ext. 3361; fax: +(514) 762-3049. E-mail address: (A.G. Crocker), E-mail address: (G. Côté).


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[1]Arboleda-Florez, J.Crisanti, A.Holley, H.L.The effects of changes in the law concerning mentally disordered offenders: The Alberta experience with Bill C-30. Canadian Journal of Psychiatry 1995;40:225233
[2]Arboleda-Florez, J.Nussbaum, D.Ohayon, M.M.Roesch, R.Research on the impact of the 1992 criminal code amendments on remands for fitness to stand trial and criminal responsibilityEaves, D.Ogloff, J.R.P.Roesch, R.Mental disorders and the criminal code: Legal background and contemporary perspectives Burnaby, BCMental Health, Law, and Policy Institute, Simon Fraser University 2000 101160
[3]Balachandra, K.Swaminath, S.Litman, L.C.Impact of Winko on absolute discharges. The journal of the American Academy of Psychiatry and the Law 2004;32:173177
[4]Bassuk, E.L.Gerson, S.Deinstitutionalization and mental health services. Scientific American 1978;238:4653
[5]Canadian Charter of Rights and Freedoms. Constitution Act B; 1982.
[6]Canadian Criminal Code. L.R.C. C-46; 1992.
[7]Cardinal, C.Côté, G.La clientèle psychiatrie-justice au Centre de détention Rivières-des-Prairies et à l’Institut Philippe-Pinel de Montréal MontréalCentre de Recherche de l’Institut Philippe Pinel de Montréal 2003
[8]Cohen, J.A power primer. Psychological Bulletin 1992;112:155159
[9]Crocker AG, St-Onge B, Caulet M, Ohayon MM. Implementation of Bill C-30 in the Province of Québec: Progress report. A Report submitted to the Federal department of Justice Canada. 1995.
[10]Desmarais, S.Hucker, S.J.DeFreitas, K.A.A Canadian example of insanity defense reform: Accused found not criminally responsible before and after the Winko decision. International Journal of Forensic Mental Health 2008;7:114
[11]Drake, R.E.McLaughlin, P.Pepper, B.Minkoff, K.Dual diagnosis of major mental illness and substance disorder: An overview. New Directions for Mental Health Services 1991;50:312
[12]Drake, R.E.Osher, F.C.Noordsy, D.L.Hurlbut, S.C.Teague, G.B.Beaudett, M.S.Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin 1990;16:5767
[13]Drake, R.E.Wallach, M.A.Substance abuse among the chronic mentally ill. Hospital Community Psychiatry 1989;40:10411046
[14]Dubreucq, J.-L.Joyal, C.C.Millaud, F.Risk of violence and serious mental disorders. Annales Medico-Psychologiques 2005;163:852865
[15]First MB, Gibbon M, Spitzer RL, Williams JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I). New York: Biometrics Research Department; 2001.
[16]First, M.B.Spitzer, R.L.Gibbon, M.Williams, J.B.W.Lorna, B.Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). (Version 2. 0) New YorkBiometrics Research Department 1996
[17]Hare, R.D.The Hare psychopathy checklist-revised TorontoMulti-Health Systems 1991
[18]Hare, R.D.The Hare psychopathy checklist-revised (3rd edition) TorontoMulti-Health Systems 2003
[19]Hare, R.D.Jutai, J.W.Criminal history of the male psychopath: Some preliminary dataVan Dusen, K.T.Mednick, S.A.Studies of crime and delinquency Boston, MAKluwer Nijhoff Publishing 1983 225236
[20]Hare, R.D.McPherson, L.M.Violent and aggressive behavior by criminal psychopaths. International Journal of Law and Psychiatry 1984;7:3550
[21]Hart, A.Psychopathy and violenceHays, J.R.Roberts, T.K.Soloways, K.S.Violoence and the violent individual Jamaica, NYSpectrum 1981 5374
[22]Hart, S.D.Dempster, R.J.Impulsivity and psychopathyWebster, C.D.Jackson, M.A.Umpulsivity: Theory, assessment, and treatment New York, NYGuilford 1997 212232
[23]Hodgins, S.Alderton, J.Cree, A.Aboud, A.Mak, T.Aggressive behaviour, victimisation and crime among severely mentally ill patients requiring hospitalisation. British Journal of Psychiatry 2007;191:343350
[24]Hodgins, S.Müller-Isberner, R.Allaire, J.-F.Attempting to understand the increase in the number of forensic beds in Europe: A multi-site study of patients in forensic and general psychiatric services. International Journal of Forensic Mental Health 2006;5:1731984
[25]Hodgins, S.Müller-Isberner, R.Freese, R.Tiihonen, J.Repo-Tiihonen, E.Eronen, al.A comparison of general adult and forensic patients with schizophrenia living in the community. International Journal of Forensic Mental Health 2007;6:
[26]Hodgins, S, Toupin, J, Fiset, S, Moisan, D. Soins communautaires pour patients souffrant de troubles mentaux graves et ayant une histoire d’actes illégaux: Une comparaison de l’efficacité des soins spécialisés et non-spécialisés. Montréal : Rapport de recherche soumis au Conseil québécois de la recherche sociale; 1998.
[27]Kiesler, C.A.McGuire, T.Mechanic, D.Mosher, L.R.Nelson, S.H.Newman, al.Federal mental health policy making: An assessment of deinstitutionalization. American Psychologist 1983;38:12921297
[28]Latimer, J.The Review Board Systems in Canada: Overview of Results from the Mentally Disordered Accused Data Collection Study OttawaDepartment of Justice Canada 2006
[29]Lecomte, Y.De la dynamique des politiques de désinstitutionnalisation au Québec [From the dynamics of deinstitutionalization politics in Québec]. Santé mentale au Québec. 1997;12:724
[30]Livingston, J.A.Wilson, D.Tien, G.Bond, L.A follow-up study of persons found not criminally responsible on account of mental disorder in British Columbia. Canadian Journal of Psychiatry 2003;48:408415
[31]Ministère de la Santé et des Services Sociaux. Plan d’action en santé mentale 2005–2010: La force des liens. Québec: Gouvernement du Québec; 2005.
[32]Mueser, K.T.Drake, R.E.Comorbidity: What have we learned and where are we going?. Clinical Psychology: Science and Practice 2007;14:6469
[33]Mueser, K.T.Drake, R.E.Clark, R.E.McHugo, G.J.Mercer-McFadden, C.Ackerson, T.H.Evaluating substance abuse in persons with severe mental illness Cambridge, MAHuman Services Research Institute 1995
[34]Mueser, K.T.Yarnold, P.R.Bellack, A.S.Diagnostic and demographic correlates of substance abuse in schizophrenia and major affective disorder. Acta Psychiatrica Scandinavica 1991;85:4855
[35]Mueser, K.T.Yarnold, P.R.Levinson, D.F.Singh, H.Bellack, A.S.Kee, al.Prevalence of substance abuse in schizophrenia: Demographic and clinical correlates. Schizophrenia Bulletin 1990;16:3156
[36]Mueser, K.T.Yarnold, P.R.Rosenberg, S.D.Swett, C.Miles, K.M.Hill, D.Substance use disorder in hospitalized severely mentally ill psychiatric patients: Prevalence, correlates, and subgroups. Schizophrenia Bulletin 2000;26:179192
[37]Ohayon, M.M.Crocker, A.G.Impact of Bill C-30 in the province of QuébecEaves, D.Ogloff, J.R.P.Roesch, R.Mental disorders and the Criminal Code: Legal background and contemporary perspectives Burnaby, BCMental Health Law and Policy Institute, Simon Fraser University 2000 118128
[38]Ohayon, M.M.Crocker, A.G.St-Onge, B.Caulet, M.Fitness, responsibility and judicially ordered assessments. Canadian Journal of Psychiatry 1998;43:491495
[39]Paquet, J.Crocker, A.G.Ohayon, M.M.Côté, G.La mise en application et les répercussions de la Loi C-30 : les personnes ayant reçu une ordonnance d’évaluation psychiatrique entre le 4 février 1992 et le 31 mars 1993 sous la responsabilité administrative de l’Institut Philippe-Pinel de Montréal. Rapport préliminaire soumis au ministère de la Justice du Canada MontréalCentre de recherche de l’Institut Philippe-Pinel de Montréal 1993
[40]Pham, T.H.Évaluation psychométrique du questionnaire de la psychopathie de Hare auprès d’une population carcérale belge. L’Encephale 1998;24:435441
[41]Priebe, S.Badesconyi, A.Fioritti, A.Hansson, L.Reinhold, K.Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. British Medical Journal 2005;330:123126
[42]Quinsey, V.L.Harris, G.T.Rice, M.E.Cormier, C.A.Violent offenders: Appraising and managing risk Washington, DCAmerican Psychological Association 1998
[43]Robertson, R.G.Gupton, T.McCabe, S.B.Bankier, R.G.Clinical and demographic variables related to fitness to stand trial assessments in Manitoba. Canadian Journal of Psychiatry 1997;42:191195
[44]Roesch, R.Ogloff, J.R.P.Hart, S.D.The impact of Bill C-30 on remands and assessments of fitness to stand trial and criminal responsibility: A Report Department of Justice 1993
[45]Roesch, R.Ogloff, J.R.P.Hart, S.D.Dempster, R.J.Zapf, P.A.Whittemore, K.E.The impact of Canadian criminal code changes on remands and assessments of fitness to stand trial and criminal responsibility in British Columbia. Canadian Journal of Psychiatry 1997;42:509514
[46]Schneider, R.D.Forestell, M.MacGarvie, S.Statistical survey of provincial and territorial review boards 2002 Department of Justice Canada
[47]Haris, G.T.Rice, M.E.Seto, M.C.The criminogenic, clinical, and social problems of forensic and civil psychiatric patients. Law and Human Behavior 2004;28:577586
[48]SPSS Inc. Sample power. 2.0 ed: Author; 2003.
[49]Sreenivasan, S.Kirkish, P.Eth, S.Mintz, J.Hwang, S.Van Gorp, al.Predictors of recidivistic violence in criminally insane and civilly committed psychiatric inpatients. International Journal of Law and Psychiatry 1997;20:279291
[50]Swain RV. 63C.C.C. (3d) 481; 1991.
[51]Webster, C.D.Douglas, K.S.Eaves, D.Hart, S.D.HCR-20: Assessing risk for violence Version 2 VancouverMental Health Law and Policy Institute, Simon Fraser University 1997
[52]White, P.A.Chant, D.C.Whiteford, H.A comparison of Australian men with psychotic disorders remanded for criminal offences and a community group of psychotic men who have offended. Australian and New Zealand Journal of Psychiatry 2007;40:260265
[53]Williams, D.H.Bellis, E.C.Wellington, S.W.Deinstitutionalization and social policy: Historical perspectives and present dilemmas. American Journal of Orthopsychiatry 1980;50:5464
[54]Winko v. British Columbia (Forensic Psychiatric Institute); June 17, 1999.
[55]Zapf, P.A.Roesch, R.Fitness to stand trial: Characteristics of remands since the 1992 Criminal Code amendments. Canadian Journal of Psychiatry 1998;43:287293


Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services

  • A.G. Crocker (a1) and G. Côté (a1)


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Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services

  • A.G. Crocker (a1) and G. Côté (a1)
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