title: The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 2: the people behind the label.
abstract: OBJECTIVE
  To examine the psychosocio-criminological characteristics of not criminally responsible on account of mental disorder (NCRMD)-accused people and compare them across the 3 most populous provinces. In Canada, the number of people found NCRMD has risen during the past 20 years. The Criminal Code is federally legislated but provincially administered, and mental health services are provincially governed. Our study offers a rare opportunity to observe the characteristics and trajectories of NCRMD-accused people.
  
  
  METHODS
  The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia (n = 222), Quebec (n = 1094), and Ontario (n = 484) between May 2000 to April 2005, followed until December 2008.
  
  
  RESULTS
  The most common primary diagnosis was a psychotic spectrum disorder. One-third of NCRMD-accused people had a severe mental illness and a concomitant substance use disorder, with British Columbia having the highest rate of dually diagnosed NCRMD-accused people. Most accused people (72.4%) had at least 1 prior psychiatric hospitalization. Two-thirds of index NCRMD offences were against the person, with a wide range of severity. Family members, followed by professionals, such as police and mental health care workers, were the most frequent victims. Quebec had the highest proportion of people with a mood disorder and the lowest median offence severity. There were both interprovincial differences and similarities in the characteristics of NCRMD-accused people.
  
  
  CONCLUSIONS
  Contrary to public perception, severe violent offenses such as murder, attempted murder or sexual offences represent a small proportion of all NCRMD verdict offences. The results reveal a heterogeneous population regarding mental health and criminological characteristics in need of hierarchically organized forensic mental health services and levels of security. NCRMD-accused people were well known to civil psychiatric services prior to being found NCRMD. Risk assessment training and interventions to reduce violence and criminality should be a priority in civil mental health services.
authors.affiliation: Associate Professor, Department of Psychiatry, McGill University, Montreal, Quebec; Associate Director, Policy and Knowledge Exchange, Douglas Mental Health University Institute Research Centre, Montreal, Quebec.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Crocker
authors.affiliation: Associate Professor, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Senior Research Fellow, Forensic Psychiatric Services Commission, BC Mental Health & Substance Use Services, Coquitlam, British Columbia.
authors.forename: Tonia L
authors.initials: TL
authors.lastname: Nicholls
authors.affiliation: Director of Forensic Rehabilitation Research, Royal Ottawa Health Care Group, Brockville, Ontario.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Seto
authors.affiliation: Post-doctoral Fellow, Department of Sociology, Yale University, New Haven, Connecticut; Student, Department of Criminology, Université de Montréal, Montreal, Quebec.
authors.forename: Yanick
authors.initials: Y
authors.lastname: Charette
authors.affiliation: Professor, Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec; Director, Philippe-Pinel Institute Research Centre, Montreal, Quebec.
authors.forename: Gilles
authors.initials: G
authors.lastname: Côté
authors.affiliation: National Coordinator, National Trajectory Project, Douglas Mental Health University Institute Research Centre, Montreal, Quebec.
authors.forename: Malijai
authors.initials: M
authors.lastname: Caulet
mesh_terms: D000328:Adult; D000550:Amblyopia / Q000453:epidemiology*; D001955:British Columbia / Q000453:epidemiology; D057237:Criminals / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D008607:Intellectual Disability / Q000453:epidemiology*; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence / Q000523:psychology*; D028642:Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011792:Quebec / Q000453:epidemiology