Thoughts on NCR

Periodically, notorious cases such as those of Vince Li, or Allan Schoenborn come up for review, and we hear that some manner of excursion into the community has been requested, or granted.  Outrage ensues, and fear and anxiety, for we know these men for the tragic, horrific acts they committed.  The surviving families renew and relive their loss and anguish.

But, on careful examination, competent courts determined that by reason of mental illness these men were then not capable of understanding the nature and consequences of their actions, nor that they were wrong, so they are Not Criminally Responsible by reason of Mental Disorder (NCRMD).  Instead of a criminal conviction and a finite prison sentence they’ve been committed to forensic hospitals on an open-ended basis, and this requires periodic review.

Then, in sharp criticism of the NCR system, we worry:  How can we risk ever letting them out?  They’ve killed — what guarantee have we that they won’t “relapse,”  or go off their meds, and do it again?

It’s a double standard, of course, for we don’t demand such guarantees of others who have committed manslaughter and served their sentences.  They’ve shown a capacity, too, to kill, even while responsible for their actions.  We’re generally not worried that they‘ll “snap” one day — though the recidivism rate for people who have served criminal sentences is five times higher than for NCR.

According to the Canadian Mental Health Alliance (CMHA):  “People who are found not criminally responsible stay, on average, far longer in hospital than convicted offenders do in prison.”  Had they not been judged NCR, these men might well have served a sentence for involuntary manslaughter and now be back on the street, free and clear, having had no treatment for their illnesses.  A far more dangerous scenario, indeed! — we need to appreciate the NCR regime as the safest course in such cases.

Even though a person might be not criminally responsible, however, at a gut level we still want to punish;  we still want to see time in treatment as time-served, and gauge it as if a prison sentence.  But NCR is not a finding of criminal guilt;  it is not a sentence;  it is not about punishment;  and it is not about how long it lasts but until, and how well, the treatment works.

Again from the CMHA:  “Treatment and rehabilitation is monitored closely by clinical teams and the Review Board system.  Members of the review board teams take their roles very seriously, and have the knowledge and expertise to address each situation.  Review Boards are not likely to give an absolute discharge to someone who endangers the life or safety of another person” — Nor are they likely to grant excursions where public safety is at risk!

But mental illness makes us nervous.  When the delicate mechanism that is the mind goes off the rails it doesn’t show up on X-rays, or CAT scans or MRI.  There’s nothing to which to point to say:  There!  There it is!  And so it is difficult to trust mental health practitioners about this mysterious, inscrutable, condition that we can’t actually see.  We can’t see it when it’s there, and we can’t see if it’s gone, or under control, and in this fundamental mistrust we can’t fathom how such people can possibly be allowed on the street again?

We who understand mental illness from Psycho, or The Shining, and all the genres that exploit mental illness for sensationalist thrills, and without knowledge of the patients’ prognoses, we nevertheless “know” that the clinical teams and review boards are just flat-out wrong, and without hesitation and without any real foundation publicly denounce them as recklessly irresponsible.

Those clinical teams, however, have medical and advanced degrees in this field, extensive practical training, and years of clinical experience dealing on a day to day basis with illnesses of these specific kinds.  They know all the tricks about patients off their meds, and are intimately aware of the histories, and specific prognoses of their patients — which makes them at least as competent as we are to have an opinion on the matter!

In the end it’s up to the review board to decide, bringing to bear its own high expertise, as well, to conscientiously weigh the good of the patients against full care and concern for public safety.  The evidence shows that the NCR regime works extremely well, and that we have experienced, competent people at the helm who take their jobs seriously.  I’m good with that.

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