Too many tools, not enough expertise. The assessment of the dangerousness of people whose criminal record resulted in a verdict of not criminal responsibility and the absence of standards to ensure their monitoring are singled out by various experts consulted by The duty. Our investigation reveals that more than 70% of the verdicts of not criminal responsibility handed down in 2023 were outside the mainland and that 11 regions have no forensic psychiatrist with in-depth expertise in this type of case.
” That presents a problem […] There are still places where there are no psychiatrists working at the moment. If you are in a remote region of Abitibi, there may not be psychiatrists in the community for the NCR patient. [NCR]. It is a doctor who will follow the patient with his conditions [de libération formulées par la Commission d’examen des troubles mentaux, la CETM] », confirms the Dr Pierre Bleau, physician-psychiatrist and national director of mental health and forensic psychiatry services at the Ministry of Health and Social Services.
The duty contacted the 45 hospitals designated to perform the custody, treatment or evaluation of a defendant found not criminally responsible to find out if they had forensic psychiatrists on their team. We found a significant disparity. More than half of the forensic psychiatrists work at the Philippe-Pinel National Institute of Forensic Psychiatry in Montreal. Eleven regions have none, even though a significant number of not criminally responsible verdicts have been rendered in these same places.
The assessment of a patient’s risk of dangerousness is decisive. The CETM relies on it to decide on the terms of release of NCR people.
Carl Gauthier-Beauregard is accused of killing his mother in November 2023 in Sainte-Anne-de-la-Rochelle. Two years earlier, he was released unconditionally by the CETM after being found not criminally responsible for charges of assault and death threats against his mother. According to the account of the facts, the man experienced a first psychotic episode on October 9, 2020. Feeling threatened, he took an ax, which slipped from his hands and injured him. He bandages his wound himself, smokes a joint and loses consciousness. When he wakes up the next day, he no longer recognizes his mother. Frightened, she tries to call 911, but her son pushes her, hits her on the head and shouts at her that he is going to “go get a gun for the gunshooter. Fourteen knives and swords were seized preventively by the police that day, in addition to two imitation weapons, a pellet rifle and a pellet gun. During a first hearing, in January 2021, although the accused’s psychiatrist mentioned that his delusions could have been exacerbated by cannabis consumption, he maintained “not seeing any risk for the mother”, in whom the 37-year-old man had returned to live.
When Carl Gauthier-Beauregard’s file was reviewed 11 months later, the CETM released him unconditionally, considering that “the offenses which brought him before the Commission were isolated events”. The lifeless body of his 64-year-old mother, bearing traces of violence, was found two years after the decision. The murder was allegedly committed in the preceding days, according to the police. Carl Gauthier-Beauregard is today accused of the unpremeditated murder of his mother. A psychiatric evaluation was requested to determine whether his mental state was disturbed at the time he allegedly killed his mother.
In a brief filed as part of the public inquiry into the deaths of Maureen Breau and Isaac Brouillard Lessard, the Professional Order of Criminologists of Quebec (OPCQ) insists on the importance of agreeing on a limited number of tools for assessing dangerousness in order to prevent tragedies like this from happening again. Especially since some tools used do not take into account factors such as the use of drugs or alcohol, which have an influence on the risk to public safety.
“Often, we just evaluate medical stabilization [l’état mental perturbé]but we must assess the risk of violence once [la personne] reintegrated into society,” indicates Josée Rioux, president of the OPCQ.
Just like criminologists, forensic psychiatrists have expertise used in the legal framework and use sophisticated assessment tools with patients who have committed serious crimes, which they learn during their training, i.e. an additional year of residency sanctioned by a Royal College of Canada examination.
However, the absence of such specialists in certain regions leads general psychiatrists and doctors who do not have this subspecialization to evaluate patients. The OPCQ also points out the lack of standardization of the assessment of the risk of violence. “At the CETM, the report of the psychiatrist treating the user is the only mandatory report to be produced at the hearing. The doctor is called upon to decide on the risk of violence represented by his patient and to make recommendations on the terms of release or detention. This psychiatrist is not necessarily a forensic psychiatrist with specialized experience in assessment, treatment and management of the risk of violence,” we read in the brief.
The Dr Mathieu Dufour, head of the psychiatry department at the National Institute of Forensic Psychiatry Philippe-Pinel, also believes that a limited number of evaluation tools by forensic psychiatrists and criminologists should be used with patients monitored by the CETM , and this, systematically. “That would be a quick fix. It’s not that hard. »
“Right now, every psychiatrist [légiste ou non] uses the tool he wants to assess the dangerousness of his patient. We should choose one or two for NCR people and systematically use them so that we can measure apples to apples,” argues Josée Rioux.
There is currently no standardized assessment tool for assessing risk and dangerousness.
Variable monitoring
Throughout her son’s journey before the CETM, the mother of Isaac Brouillard Lessard, the man shot dead by the police who stabbed Sergeant Maureen Breau in Louiseville in March 2023, observed a variable quality in the follow-up of his son, from Montreal to Louiseville via Saint-Jérôme and Trois-Rivières. “When he was in Pinel, he recovered. They brought my son back to me,” says Sandra Lessard. “They were able to control it with medication. He worked hard, it went really well […] There are some psychiatrists who are better than others,” adds the mother. ” They [certains psychiatres] are not sufficiently aware of their rights. Because I was surprised to know that the doctor could simply say to immediately send the police and then take him away. In the past, during the first psychosis, this had been done,” recalls Mme Lessard. Her son’s last psychiatrist did not take advantage of this power.
“The tragedies that are unfolding demonstrate that surveillance is lacking,” says Josée Rioux.
“The observation is that it is the treatment team which ensures surveillance. They [les individus déclarés NCR] cannot be monitored at the correctional level, they are not found criminally responsible. What we see is the lack of rigor in monitoring,” she explains.
Psychiatrist Pierre Bleau considers that the medical team “acts as a probation officer”. “Doctors have a medical responsibility for follow-up, but if the patient does not respond or does not respect his conditions, it is not doctors who are going to knock on the door and look for the patients […] It is up to the police to intervene in the face of danger. »
“Deficient surveillance”
The CETM can decide to release a patient who is not criminally responsible provided that he is followed in one of the 45 designated hospitals in Quebec. It is then up to the hospital manager to ensure that the patient respects his conditions of release.
Otherwise, the hospital manager “must assess to what extent the accused’s conduct increases the significance of the risk he represents for public safety,” indicates the CETM on its website.
For Sandra Lessard, the release of her son, even under certain conditions, was destined to end in a serious event. “The conditions, if they don’t want to respect them, they just have to not follow them. There are virtually no consequences for breaching these conditions,” she laments.
The duty asked the 45 designated hospitals in Quebec who plays the role of “hospital manager” in each establishment. The answers were very different from one hospital to another, although this role must be entrusted to a specialist who has medico-legal knowledge.
According to data compiled by The duty, in Bas-Saint-Laurent, for example, it is a liaison nurse who plays the role of responsible person. “ Since we do not have forensic psychiatrists, requests reach the liaison nurse and are subsequently transmitted to the attending psychiatrist,” indicated the CISSS du Bas-Saint-Laurent.
In Laval, “medical care for users found not criminally responsible is provided in turns by psychiatrists [généralistes] “.
“I’m not sure how well known it is that we have a surveillance warrant. The delegation of authority allows me to take the patient back to the hospital right away with the police. To apply the delegation of authority, I must believe that there is a change in his mental state that increases his risk of violence. Sometimes, I’m not sure, I bring it back the same,” explains the Dr Mathieu Dufour, according to whom the surveillance mandate of designated hospitals does not seem to be understood by all establishments.
“Many designated hospitals are also general hospitals which are not used to to see an NCR clientele. And there are some who are not even aware that they have a delegation of power to bring individuals back,” adds Anne Crocker, director of research and university teaching at the National Institute of Forensic Psychiatry Philippe- Pinel.
Prioritization project
The Ministry of Health and Social Services has been working since spring 2023 on a project to prioritize forensic psychiatry in Quebec. A project which should only be completed in 2027.
“What we want to include, at the ministry, is a culture of measurement which will ensure that, depending on the degree of dangerousness, the patient will be followed by people who perhaps have a little more expertise compared to this degree”, mentions the Dr Pierre Bleau.
The ministry is also studying the possibility of reducing the number of designated hospitals to allow better coordination in the monitoring of NCR patients.
According to Anne Crocker, a solution to compensate for the lack of forensic doctors would be to limit the number of hospitals where these patients can be supported. “If we started by cutting it in half [le nombre d’hôpitaux désignés], we would already be in a better position. In Ontario, there are ten for a population twice as high,” recalls the researcher, who estimates that each hospital could thus have a forensic psychiatrist in its treating team.