Severely mentally ill criminals: who goes to prison and who goes to psych institutions?

"We found a clear difference between people with a mental illness who are incarcerated for a crime and those declared not criminally responsible for a crime and then hospitalized at a psychiatric institution," explained Dr. Alexandre Dumais, a researcher at the IPPM and the IUSMM and the study's first author.

"Since the adoption of Bill C-30 in 1992, federal detention centres have had a significant decrease in the number of people with severe mental disorders, such as schizophrenia. Conversely, there has been an increase in the number of people declared not criminally responsible on account of mental disorder (NCRMD) and who find themselves in the psychiatric network," added Dr. Dumais, who is also an assistant clinical professor in the University of Montreal's Faculty of Medicine and a psychiatrist at the IPPM.

Conducted in collaboration with the Centre d'études sur les mesures de contrôle en santé mentale of the IUSMM, this research compared the characteristics of individuals who suffer from serious mental disorders and who were either incarcerated (I = 44) or declared NCRMD and hospitalized in a forensic psychiatry care unit (H = 59) after committing a crime. The researchers analyzed data from an extensive research program that explored the clinical and sociodemographic profiles of men who suffer from severe mental disorders.

Results

• The researchers found differences between people who are incarcerated and those declared NCRMD and who are hospitalized.
• Higher level of schooling among those declared NCRMD (equivalent of Secondary 5)

25% for people who are incarcerated versus 54% for those declared NCRMD

• Greater use of specialized mental health services among those declared NCRMD

40% for people who are incarcerated versus 73% for those declared NCRMD

• Greater history of suicide attempts among people who are incarcerated

66% for people who are incarcerated versus 34% for those declared NCRMD

• Greater history of criminal activity with or without violence among people who are incarcerated

71-80% for people who are incarcerated versus 25-29% for those declared NCRMD

• More concomitant drug or alcohol disorders and a higher level of psychopathy among incarcerated people

"This study confirms the work of my colleagues at the IPPM: incarcerated people with a severe mental disorder have particular characteristics, along with criminal behaviour and psychopathic traits," stated Jean-François Pelletier, a researcher at the IUSMM and an assistant professor at the University of Montreal's Faculty of Medicine.

"People who are declared NCRMD and hospitalized use mental health services more, and they are often under psychiatric care before they commit the offence," explained Mr. Pelletier.

"The characteristics of incarcerated people put them on a path to criminal behaviour and prevent them from getting the psychiatric care they need," stated Dr. Dumais. "People who commit an offence need to serve their time, but they also need care if they suffer from an illness. New shared care models between the legal and health care systems need to be implemented so that these patients can get better treatment and so that we can reduce their risk of violent and antisocial behaviour. Some countries have launched initiatives in this area, but these programs haven't been formally tested with rigorous research methods. Further studies should look at these models to determine which are ones are effective."