“No one talks to each other. Everyone works alone. » With these few words, coroner Géhane Kamel well summed up the Kafkaesque ecosystem surrounding the Mental Disorders Review Commission1.
The shortcomings of this system translate into loss of human life…
Such is the life of Maureen Breau whose death was the subject of coroner’s hearings this week. The police officer was stabbed in 2023, while trying to arrest Isaac Brouillard Lessard, a repeat violent offender who had been released after being found not criminally responsible for various violent crimes. The man was shot dead during this disastrous evening.
The life of Elisabetta Caucci-Puglisi, allegedly stabbed to death by her own son, Fabio Puglisi, found not criminally responsible (NCR) in the past for several attacks. The man who lived with his mother is also accused of the murder of his neighbor Manon Blanchard. And he allegedly mutilated and disfigured a third victim during this bloody attack in February.
The lives of Mohamed Belhaj, André Lemieux and Alex Lévis-Crevier. One was walking on the sidewalk. The other was waiting for the bus. The third was skateboarding. All three were killed in 2022 by Abdulla Shaikh, who was hospitalized several times after being recognized as NCR. Carefully prepared, he opened fire on them, for no reason. The police ended up killing him.
These three recent tragedies cast serious doubt in the public mind on the process of the Commission for the Examination of Mental Disorders (CETM), which has the mandate to evaluate the degree of dangerousness of a person found not criminally responsible for a crime due to mental health issues.
It’s not an exact science. The assessment is complex and delicate. On the one hand, we cannot keep people in a psychiatric hospital forever, often for minor crimes. On the other hand, we do not want to return to the society of time bombs.
But one observation should worry us: in Quebec, patients hospitalized in psychiatry are kept for less time than in other provinces, and their recidivism rate is twice as high once they have been released, explains the report on the case. of Abdulla Shaikh, deposed by the coroner a few days ago2.
What’s wrong with us? The report raises several red flags.
You guessed it, it is seriously lacking in resources. In some hospitals, “code 33” rings over the intercom every week. This means that the establishment is overflowing and beds must be freed. Some patients are therefore discharged while still ill. Disturbing.
But it’s not just a question of money. Our poor organization is also to blame.
Quebec is scattered like nowhere else. Around 40 general hospitals are designated to accommodate NCR people. In British Columbia, there is only one center and in Ontario, barely four.
Psychiatry units, which are already short of beds, are ill-suited and unsafe for potentially more dangerous NCR patients. The police will tell you that some hospitals often let patients go outside to smoke a cigarette. The police then have to make a lot of effort to find them.
Conversely, other hospitals lock NCR patients in their rooms for many months, unable to let them insult other patients or issue death threats to staff, as Mr. Shaikh did.
The experts themselves say it: the psychiatry departments of general hospitals do not have the capacity to take care of patients of this complexity, of this level of dangerousness, with imposing legal mandates. It would be preferable to concentrate services in a few specialized centers, to avoid diluting expertise.
At the moment, monitoring is very uneven. Is the patient still dangerous? Can we let him out of the hospital? Under what conditions? To decide these crucial questions, the Review Commission sometimes receives reports of 20 pages, sometimes half a page.
On average, the reports submitted by psychiatrists only cover half of the elements of the globally recognized grid for assessing the risk of an individual judged NCR. It must be said that these specialists do not have medicolegal training in their academic curriculum… another gap to be corrected.
In fact, very few experts find their way through this labyrinth where everyone advances blindly: healthcare personnel who do not have all the required training, criminal prosecutors who do not take the time to come to the CETM hearings, police officers who lack information on NCR people…
During the hearings last week, a sergeant also indicated that he did not know the CETM, despite his supervisory duties and his 20 years of experience.
Unfortunately, the burden falls on the family, who are often the first victims. Caught in the woods, she hesitates to call the police so as not to break the bond of trust.
Is there a need for a pivotal person to better supervise NCR people when they leave the hospital? A 1 800 line to better inform the various stakeholders who deal with them?
If there is one element that emerges from recent tragedies, it is that we need to talk to each other instead of dispersing ourselves.
1. Read the article “Death of police officer Maureen Breau: “I didn’t know if I was going to die,” says a police officer”
2. Consult the investigation report from coroner Géhane Kamel