#AbolishNCR: A Qualitative Analysis of Social Media Narratives around the Insanity Defense

This article presents an analysis of social media posts by laypersons regarding a finding of Not Criminally Responsible on Account of Mental Disorder (NCRMD) for Matthew de Grood after a high-profile trial in 2016 in Canada. From trial to verdict, a total of 4,991 tweets relating to the case were harvested from Twitter. Qualitative content analysis of 365 tweets by laypersons revealed three themes – largely equating the insanity defense to a legal loophole: (1) The case exemplified a misappropriation of the legal defense (e.g., due to privilege, due to the seriousness of the offence); (2) The perception existed that the NCRMD defence is a miscarriage of justice; (3) Many comments reflected a search for answers and justice. These embodied the ABCs of NCRMD: advocating, blaming, and clarifying. A need for public education about the forensic psychiatric system is evident; misconceptions about the insanity defence appeared pervasive. Further research could focus on the efficacy of knowledge translation over new media channels, such as Twitter.

Alberta not criminally responsible project: Rates of persons found NCRMD and absolute discharges in Alberta following the Not Criminally Responsible Reform Act

In 2014, then-Canadian Prime Minister Stephen Harper passed the Not Criminally Responsible Reform Act into law, which gave Canadian courts and Review Boards new powers to protect the public from particularly dangerous mentally ill offenders. The most controversial change to the law included the designation of the High-Risk Accused. Once designated by the courts as a High-Risk Accused, that individual is barred from leaving a forensic hospital except for urgent medical reasons. In this article, the authors assess the impact of the Not Criminally Responsible Reform Act on the forensic mental health system in Alberta, Canada. The findings indicate that the legislation did not lead to any meaningful changes in the Alberta forensic mental health system in terms of absolute discharges and incoming persons found not criminally responsible.

“Trapped in their Shame”: A Qualitative Investigation of Moral Injury in Forensic Psychiatry Patients

Individuals who engage in criminal behavior for which they are found not criminally responsible (NCR) may be at increased vulnerability to experience moral pain and, in extreme circumstances, moral injury after regaining insight into the consequences of their behavior. Yet, almost no research exists characterizing the nature, severity, or impact of moral pain in this population. Semi-structured interviews were conducted with nine forensic psychiatric patients and 21 of their care providers. Narratives were explored using thematic analysis. Findings demonstrate that NCR patients endorse symptoms consistent with moral injury, including feelings of guilt toward victims, shame for one’s behavior, and a loss of trust in one’s morality. Moral pain is a strong driver of behavior and must be understood as part of a constellation of factors influencing criminality, risk, and recovery. Future research must develop adequate tools to measure and characterize offense-related moral injury to understand its impact on this population.

The Ontario Forensic Mental Health System: A Population-based Review: Le système ontarien de services psychiatriques médico-légaux: Une étude dans la population

Objective: The purpose of this study was to increase the understanding of the Canadian forensic psychiatry system by providing a population-based overview of the Ontario forensic mental health system. Methods: Data were collected on 1,240 accused adults who were subject to the jurisdiction of the Ontario Review Board (ORB) between 2014 and 2015. Archival data were retrieved from annual ORB hearing hospital reports for accused supervised by all nine adult forensic psychiatry facilities across Ontario. Results: The sample included not criminally responsible (NCR; 91.6%) and unfit to stand trial (UST; 8.4%) accused. The majority of the sample was male (85.7%), single (70.1%), unemployed (63.6%), with a high school education (48.8%). Most were on a detention order (78.5%) and almost half were living in the community at the time of the report (48.8%). The majority had prior contact with psychiatric services (83.1%) and/or the criminal justice system (70.6%) before entering the forensic system. A history of elopement (31.5%) and inpatient aggression was high (60.6%). Most had a psychotic spectrum disorder (81.6%) and over half had a substance use disorder (57.2%) in the reporting year. A range of index offences was observed (69.9% violent, 20.3% general, 9.8% sexual), and the majority of the sample (61.0%) had an index offence that resulted in no injury or a minor injury to the victim. Conclusion: The Canadian forensic psychiatry system is comprised of a unique subset of justice-involved individuals. This study provides a detailed examination of accused who are subject to the jurisdiction of the ORB and provides key insight into risk factors associated with offending behaviour in this population. The results of this study will provide a framework for future studies examining the association between mental disorder and violence and the treatment trajectories for those in the forensic psychiatry system.

Persons found not criminally responsible on account of mental disorder (NCRMD) for sexual offences: characteristics, risk factors, and Review Board decision making

This thesis examined the characteristics of persons found NCRMD for sexual offences, their offences, and the degree to which empirically supported risk factors predicted Review Board decisions. Reasons documents dated from 2006 to 2015, and examining index sexual offences were collected from LawSource ©. Search terms were derived from the Canadian Criminal Code (1985, c. C-46), and commonly accepted terminology for sexual offending. Findings suggest that persons found NCRMD for sexual offences present with general and sexual offence specific risk factors for recidivism. However, Review Board decisions were only predicted by factors related to clinical functioning and risk management factors. These findings suggest that further research is needed to examine risk assessment, decision making, and forensic mental health outcomes of persons found NCRMD for sexual offences. Implications for treatment of persons found NCRMD and knowledge dissemination to Review Boards are also discussed.

Persons found not criminally responsible on account of mental disorder (NCRMD) for sexual offences: characteristics, risk factors, and Review Board decision making

This thesis examined the characteristics of persons found NCRMD for sexual offences, their offences, and the degree to which empirically supported risk factors predicted Review Board decisions. Reasons documents dated from 2006 to 2015, and examining index sexual offences were collected from LawSource ©. Search terms were derived from the Canadian Criminal Code (1985, c. C-46), and commonly accepted terminology for sexual offending. Findings suggest that persons found NCRMD for sexual offences present with general and sexual offence specific risk factors for recidivism. However, Review Board decisions were only predicted by factors related to clinical functioning and risk management factors. These findings suggest that further research is needed to examine risk assessment, decision making, and forensic mental health outcomes of persons found NCRMD for sexual offences. Implications for treatment of persons found NCRMD and knowledge dissemination to Review Boards are also discussed.

Describing the recovery experiences of not criminally responsible clients living in the community

This study describes the recovery experiences of persons who have been found not criminally responsible on account of a mental disorder (NCRMD). A qualitative descriptive methodology was used to elicit the recovery experiences of five participants. The overarching theme that arose from the data was ‘Experiencing and understanding recovery in the forensic mental health system (FMHS) as a dynamic process of change,’ and the major themes that emerged out of the overarching theme are: ‘Recovering in the FMHS,’ ‘the Critical Role of Medication,’ ‘the Significance of Relationships,’ ‘the Importance of Helping Yourself,’ and ‘Navigating Challenges.’ The results of this inquiry reveal that the participants’ experiences of recovery are greatly influenced by their involvement in the FMHS. This study offers a preliminary understanding of how recovery is experienced by NCRMD clients who reside in the community and suggests implications for clinical practice and education, as well as future research and theory.