Vince Li, Allan Schoenborn, Richard Kachkar. All three notorious killers sought treatment for serious mental illness in Canadian hospitals and clinics before the high-profile acts of violence for which they were found not criminally responsible. None were successful.

A new study published online Thursday by the Canadian Journal of Psychiatry quantifies this troubling and widespread problem.

Seventy-two per cent of people found not criminally responsible, or NCR, on charges in Canadian courts had at least one psychiatric hospitalization before the offence, researchers found in a review of 1,800 cases in Ontario, Quebec and B.C.

“It is easier for people with serious mental illness to access treatment after they are charged with a crime than it is for them to get professional help before,” said Michael Seto, forensic research director at the Royal Ottawa Health Care Group and one of the study’s lead authors.

The findings suggest more can be done to prevent rare but tragic incidents from taking place, and the study underscores the need for provinces to bridge gaps between their civil mental health systems, where patients first seek help, and forensic systems, where they end up after committing an offence.

The National Trajectory Project — a joint study led by researchers at McGill, the Royal Ottawa and the University of British Columbia — is the first body of research to offer an in-depth look at the NCR population in Canada. Its findings counter pervasive myths about mentally ill accused and contradict assumptions upon which the Harper government last year introduced a new law that imposed tougher penalties on NCR offenders. It also highlights “considerable discrepancies” in the way the law is applied across the provinces.

Recidivism low, but twice as high in Quebec as Ontario

People who receive an NCR verdict are far less likely to reoffend than inmates released from the Canadian prison system, the study found.

Roughly 17 per cent of NCRs reoffended after three years. In comparison, previous research has pegged prison-system recidivism at 34 per cent and as high as 70 per cent for mentally ill offenders.

However, recidivism in Quebec was more than twice as high — at 22 per cent — as in Ontario (9 per cent) and B.C. (10 per cent).

The study found that NCR offenders in Quebec were released from review board restrictions faster than in the other two provinces, suggesting it is possible the Quebec board may let some people go too quickly. But Anne Crocker, the study’s lead at McGill, believes multiple factors are at play. For example, Quebec has a much higher proportion of offenders who were found NCR on minor charges, and research suggests they are the people most likely to reoffend.

Offenders like Vince Li, whose NCR verdict stemmed from a serious violent offence — in his case, beheading a man on a Greyhound bus — had the lowest recidivism rates, with 6 per cent for all types of offences and 1 per cent for new violent offences.

What type of offences do NCRs commit?

Killings by people with serious mental illness are rare, but they generate a disproportionate amount of public attention. The vast majority of NCR cases begin with much lesser charges — uttering threats, causing a disturbance, minor assaults. Homicide and attempted murder accounted for only 7 per cent of all first offences in the cases reviewed for the study.

“Contrary to public perception, we’re not talking about a group of people who are highly or uniformly dangerous,” said Seto.

Strangers an infrequent target

Similarly, random attacks against strangers draw much attention despite evidence that suggests most victims are family members (34 per cent) or other people known to the accused (21 per cent). Roughly 23 per cent were police officers, mental health workers or other authority figures, and a further 23 per cent were strangers.

These figures represent all types of offences. Only a small minority were charges of serious violence. The authors said more supports are needed for families who have loved ones dealing with serious mental illness.

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Absolute discharge

Recidivism rates were low when NCR offenders were under the review board’s watch, but rose slightly when they were released on absolute discharge — to 22 per cent for all offences — though still remained far below prison levels.

Seto said NCRs who are released from the review board system can end up facing the same problem accessing mental health services as they did before they were ever charged with a crime. A smoother transition is needed between the forensic and civil mental health systems, the authors suggest.

People found NCR in Ontario remained under review board supervision for longer than any other province, with 92 per cent still detained after one year and 58 per cent after five years. People are released faster in Quebec, where the study showed 74 per cent were detained after one year and all but 19 per cent were discharged after five years.

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