April 19, 2016

Not Criminally Responsible

When the commission of a crime is related to the person's mental condition, a court may declare him not mentally responsible, NCR for short. Section 16 of the Criminal Code sets out the condition:

“No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong.”

On December 15 the Royal Ottawa Hospital presented a panel of mental health professionals and persons found to be not criminally responsible.  The title of the program was “When mental illness leads to crime: Stigma and recovery for the forensic client.” 

Someone with this kind of diagnosis is able to appreciate the nature and quality of his acts and knows when he commits an act which is wrong, morally and legally.  That person is not psychotic and hence is not NCR, she explained.

Her explanation may describe the legal state of affairs, but the whole concept of NCR and the nature of personality disorders is highly controversial. 

Some have attached onto the concept the principle that it should also apply to people who know that an act is wrong but are nevertheless driven to do it.  And the view that someone with an anti-social personality is not mentally ill is far from universally accepted in the mental health community.  Nevertheless, she described the legal situation now for who is NCR and who is not.

Therapists and society as a whole face the problem of reintegrating people who have been declared NCR back into the community, a task made more difficult because of stigma.  Yellow journalism feeds on graphic accounts of offenses.

Dr. Anik Gosselin, a forensic neuropsychologist attached to the Brockville Mental Health Centre and who is on the faculty of the University of Ottawa, addressed the issue of stigma. 

She pointed to negative public attitudes toward mental illness and stressed that if we add the forensic factor the negativity is increased.  As well, the person in question is likely to identify with the public characterization.  As a result of accepting the stigma label, he may tend to give up trying to recover and may see himself as beyond help. 

As a result of stigma, she observed, the patient may suffer depression, demoralization, and shame.  Symptoms may be intensified, and he may avoid social interactions. 

This is an observation for someone with mental illness.  When the stigma relates to someone who is NCR, the self-image can be devastating: “I am violent and mentally ill.”  The therapist faces the challenge of building trust and moving the patient beyond learned helplessness and resistance to therapy.  She also spoke of difficulty in convincing landlords to accept NCR tenants.  Yet, on the basis of her experience she declared, “They are reliable tenants.” 

Landlords and others who discriminate against them would put themselves in violation of the law. 

Illness, including mental illness, joins such grounds as race and religion as illegal under anti-discrimination legislation.  She noted that there has been progress in attitudes of acceptance.  As well, she sees a positive movement away from the medical model to a recovery model, focusing not on cure but on management. 

One promising approach to promoting patient involvement in movement toward recovery is the use of peer support workers in multi-disciplinary teams.

It is not just the person labeled NCR who is stigmatized.  The stigma is shared by the family. 

Royal Ottawa social worker Raphaela Fleisher addressed this aspect of the problem. 

She noted that most who have been found not criminally responsible live with family members, leading to ongoing stress on the family.  Family caregivers are potentially at risk of challenges to their mental and physical health and are apt to face emotional turmoil.  Coping may be difficult, and they may feel trapped.  Being guilty by association, they are confronted by law enforcement and an often sensationalizing media.

Families are often faced, she said, with a lack of a support network and of knowledge of services. 

Beyond their knowing of services, services may be difficult to reach, especially because of waiting lists.  The Royal Ottawa Hospital develops support groups for family members as a way of alleviating the feeling of being alone and at a loss.  Family members have needs of their own.  They need help in getting over being afraid to ask.