The escalation which cost the lives of a Maureen Breau on duty and an Isaac Brouillard Lessard in crisis was the result of a series of failures which were documented in detail before coroner Géhane Kamel. We would have preferred that their alignment was the disastrous exception which confirms the rule in matters of non-criminal responsibility.A careful investigation by reporters Améli Pineda and Stéphanie Vallet shatters our illusions: the problem is systemic.
In light of this striking case of the Duty, it is literally the Quebec legal psychiatry system that we see faltering. Some of the flaws that allowed the worst to happen in the small apartment of Isaac Brouillard Lessard, in Louiseville, have in fact appeared so common on the ground that they are today an integral part of our thinned safety net. This is true for our health system. This is also true for our judicial system and for our police forces.
Something has clearly broken in recent years. In 2023, The duty calculated that almost a quarter (24%) of the hearings held by the Mental Disorders Review Commission (CETM) concerned individuals who had already received a verdict of not criminally responsible. In 2015, it was less than one in twelve patients (8%). This spectacular progression sounds like a thunderous call to order. The ease with which we turn to such a verdict to circumvent our mental health failings can be deadly.
Even more so when advanced expertise is as poorly distributed as it is in Quebec. Currently, more than half of the forensic psychiatrists work at the Philippe-Pinel Institute in Montreal. However, our investigation reveals that more than 70% of the verdicts of not criminal responsibility pronounced in 2023 were outside the metropolis, where eleven regions operate without any forensic psychiatrist. In these deserts, we do our best, but this best is far from perfect.
Canadian jurisprudence judges that a person declared not criminally responsible (NCR) is automatically presumed not to be dangerous. It is up to her treating psychiatrist to prove that she represents a risk for herself or others. In the event that the Commission chooses to prescribe follow-up for her, it will then be up to her care team to “monitor” her, which forces her to wear an additional hat that does not suit her at all: that of the health care agent. probation.
This weight is immense for those who are equipped with these far from exact materials. For those who are not, it becomes an unreasonable burden. Even more so when the judicial system appears indolent in agreeing to decide on the basis of such disparate analyses. There is currently no standardized assessment tool to judge the risk and danger posed by these patients. It is imperative to sort to keep only the best and systematize them.
It is good to know that the Legault government is already working on a project to prioritize legal psychiatry to come in 2027. According to the Criminal Code, 45 hospitals are responsible for carrying out the custody, treatment or evaluation of an accused recognized NCR. It’s too much: expertise is diluted, standards lowered. Minister Lionel Carmant was right to formally commit last week to reducing their numbers. But we expect more from him, and faster.
The police community will also have to do its own examination. His approaches may take on an increasingly social color, but we are amazed to see to what extent the mechanics surrounding non-criminal responsibility remain foreign to him. Intervening at human level requires the finest knowledge of tools and approaches. Police officers need to catch up, everywhere in Quebec.
That nothing of the sort is still being taught at Nicolet is beyond belief. The Quebec National Police Academy has a corpus to adapt, and quickly! The number of tragedies involving people who had already passed through the CETM has in fact increased abnormally in recent years, according to the D’s own admission.r Mathieu Dufour, head of the psychiatry department at Philippe-Pinel.
In our quest for a better system governing non-criminal responsibility, we will have to dare to go to the most difficult questions. What about compulsory medication? What about the place to give to drugs or alcohol in our risk analyses? Do we want a “Maureen’s Law” inspired by Brian’s Law, which opened the door to imposing mandatory community treatment on certain people with severe and persistent mental health problems in Ontario?
The status quo is impossible. According to the compilation of Duty, 73% of repeat offenders were able to resume their lives without obligation of follow-up in 2023. However, as we have seen, dangers flourish in the deserts of care and expertise. In the name of everyone’s safety, we must accelerate the hierarchy of forensic psychiatry in Quebec.