Mental Illness and Crime: Prison Versus Psychiatric Care

Author: University of Montreal
Published: 17 Dec 2014 - Updated: 6 Sep 2026
Publication Details: Peer-Reviewed | Findings

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research compares two groups of men living with severe mental disorders who committed crimes: those who were incarcerated and those declared not criminally responsible on account of mental disorder (NCRMD) and hospitalized in a forensic psychiatric unit. Conducted by researchers at the Institut universitaire en sante mentale de Montreal and the Institut Philippe-Pinel de Montreal, affiliated with the University of Montreal, and published in the peer-reviewed journal Issues in Mental Health Nursing, the study found that incarcerated participants tended to have lower levels of schooling, made less use of specialized mental health services, carried a heavier history of criminal activity, and showed higher rates of substance use disorders and psychopathy than their hospitalized counterparts. The findings matter to anyone concerned with mental health, disability, and the justice system - including families, clinicians, correctional staff, and policy makers - because they show that people who need psychiatric treatment can end up serving time without it, and they make a clear case for shared care models that connect the legal and health care systems to improve outcomes and reduce the risk of reoffending.*

At a Glance

• 1 - Only 25 percent of incarcerated participants had completed Secondary 5 schooling. Among those declared NCRMD, that figure rose to 54 percent.
• 2 - Suicide attempt histories were far more common in the incarcerated group at 66 percent. Hospitalized participants reported a rate of 34 percent.
• 3 - Bill C-30, adopted in 1992, reduced the number of people with severe mental disorders in federal detention. It also increased those entering the psychiatric network as not criminally responsible.
• 4 - The research compared 44 incarcerated men with 59 men hospitalized in a forensic psychiatry care unit after committing an offense. All participants suffered from serious mental disorders.

Topic Definition

Mental Illness and Criminal Responsibility

When a person living with a severe mental disorder commits a crime, the justice and health systems must decide whether that individual belongs in prison or in psychiatric care. The distinction rests largely on criminal responsibility. Some offenders are held accountable and incarcerated, while others are declared not criminally responsible on account of mental disorder (NCRMD) and hospitalized in a forensic psychiatric setting instead. Research from the University of Montreal shows these two groups look quite different from one another. Incarcerated individuals tend to have less schooling, use specialized mental health services less often, carry a heavier criminal history, and show higher rates of substance use and psychopathy. Those found NCRMD are more likely to have been under psychiatric care before the offense occurred. Understanding this divide matters because it points to a real gap: people who need treatment can end up serving time without it, which is why researchers argue for shared care models linking the legal and health care systems.

Overview

Mentally Ill: Who Goes to Prison? Who Goes to Psych Institutions?

People with a severe mental disorder who commit a crime and who are incarcerated have different characteristics compared to people who are hospitalized after committing an offense. These are the findings of a study by researchers at the Institut universitaire en sante mentale de Montreal (IUSMM) and the Institut Philippe-Pinel de Montreal (IPPM), affiliated with the University of Montreal.

"We found a clear difference between people with a mental illness who are incarcerated for a crime and those declared not criminally responsible for a crime and then hospitalized at a psychiatric institution," explained Dr. Alexandre Dumais, a researcher at the IPPM and the IUSMM and the study's first author.

"Since the adoption of Bill C-30 in 1992, federal detention centers have had a significant decrease in the number of people with severe mental disorders, such as schizophrenia. Conversely, there has been an increase in the number of people declared not criminally responsible on account of mental disorder (NCRMD) and who find themselves in the psychiatric network," added Dr. Dumais, who is also an assistant clinical professor in the University of Montreal's Faculty of Medicine and a psychiatrist at the IPPM.

Conducted in collaboration with the Center d'etudes sur les mesures de controle en sante mentale of the IUSMM, this research compared the characteristics of individuals who suffer from serious mental disorders and who were either incarcerated (I = 44) or declared NCRMD and hospitalized in a forensic psychiatry care unit (H = 59) after committing a crime. The researchers analyzed data from an extensive research program that explored the clinical and sociodemographic profiles of men who suffer from severe mental disorders.1

Results:

• The researchers found differences between people who are incarcerated and those declared NCRMD and who are hospitalized - Higher level of schooling among those declared NCRMD (equivalent of Secondary 5)
• 25% for people who are incarcerated versus 54% for those declared NCRMD - Greater use of specialized mental health services among those declared NCRMD
• 40% for people who are incarcerated versus 73% for those declared NCRMD - Greater history of suicide attempts among people who are incarcerated
• 66% for people who are incarcerated versus 34% for those declared NCRMD - Greater history of criminal activity with or without violence among people who are incarcerated
• 71-80% for people who are incarcerated versus 25-29% for those declared NCRMD - More concomitant drug or alcohol disorders and a higher level of psychopathy among incarcerated people

"This study confirms the work of my colleagues at the IPPM: incarcerated people with a severe mental disorder have particular characteristics, along with criminal behavior and psychopathic traits," stated Jean-Francois Pelletier, a researcher at the IUSMM and an assistant professor at the University of Montreal's Faculty of Medicine.

"People who are declared NCRMD and hospitalized use mental health services more, and they are often under psychiatric care before they commit the offense," explained Mr. Pelletier.

"The characteristics of incarcerated people put them on a path to criminal behavior and prevent them from getting the psychiatric care they need," stated Dr. Dumais. "People who commit an offense need to serve their time, but they also need care if they suffer from an illness. New shared care models between the legal and health care systems need to be implemented so that these patients can get better treatment and so that we can reduce their risk of violent and antisocial behavior. Some countries have launched initiatives in this area, but these programs haven't been formally tested with rigorous research methods. Further studies should look at these models to determine which are ones are effective."

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

What does NCRMD mean in Canadian law

NCRMD stands for not criminally responsible on account of mental disorder, a legal finding that a person could not appreciate the nature of their actions or know they were wrong due to mental illness at the time of the offense.

What was Bill C-30

Bill C-30, adopted in Canada in 1992, reformed how the justice system handles people with mental disorders and led to fewer such individuals in federal detention and more entering the psychiatric network as not criminally responsible.

Where are people found NCRMD sent instead of prison

People found not criminally responsible are typically placed in secure forensic psychiatric units where they receive treatment and are monitored by a review board rather than serving a fixed prison sentence.

Can someone be both incarcerated and receive mental health treatment

Yes, incarcerated people can access mental health services in prison, but the study found they use specialized services far less often, which is why researchers call for integrated care linking legal and health systems.

What is psychopathy and how does it relate to this research

Psychopathy is a personality construct marked by lack of empathy, impulsivity, and antisocial behavior, and the research found higher levels of psychopathy among incarcerated individuals with severe mental disorders.

Who decides whether a person goes to prison or psychiatric care

Courts make this determination based on assessments of criminal responsibility, often relying on forensic psychiatric evaluations that examine the person's mental state at the time the offense was committed.

Does a finding of NCRMD mean a person is released immediately

No, a person found not criminally responsible is usually detained in a forensic hospital and released only when a review board determines they no longer pose a significant risk to public safety.

Why do researchers recommend shared care models

Researchers recommend shared care models because many incarcerated people with mental illness serve time without adequate treatment, and coordinated legal and health approaches may reduce recidivism and improve outcomes.

1 Dumais, A., Cote, G., & Lesage, A. (2010). Clinical specificity and sociodemographic profiles of male inmates with severe mental disorders: A comparison with voluntarily hospitalized patients. Canadian Journal of Psychiatry, 55(3), 172-179.

About the Study

• Dumais, A., Cote, G., Larue, C., Goulet, M. H., & Pelletier, J. F. (2014). Clinical characteristics and service use of incarcerated males with severe mental disorders: a comparative case-control study with patients found not criminally responsible. Issues Ment Health Nurs, 35(8), 597-603. Pubmed
• Alexandre Dumais is a researcher at the Institut universitaire en sante mentale de Montreal (IUSMM) and a psychiatrist at the Institut Philippe-Pinel de Montreal (IPPM).
• Jean-Francois Pelletier is a researcher at the IUSMM and an assistant professor in the Department of Psychiatry in the Faculty of Medicine at Universite de Montreal. He is also Director of the International Program for Participatory-action Research (IPPAR) at the IUSMM.
• Gilles Cote is a researcher at the IUSMM and directs the Center de recherche de l'IPPM. He is a full professor in the Department of Psychology at Universite du Quebec A Trois-Rivieres.
• Caroline Larue is a researcher at the IUSMM and an associate professor in the Faculty of Nursing at Universite de Montreal. She directs the Center d'etudes sur les mesures de controle en sante mentale at the IUSMM.
• Marie-Helene Goulet is a doctoral student in nursing at the Center de recherche de l'IUSMM and is part of the team at the Center d'etudes sur les mesures de controle en sante mentale.

Insights, Analysis, and Developments

Editorial Note: What stands out in this comparison is how early access to care appears to shape where a person ends up: those declared NCRMD were frequently already under psychiatric care before their offense, while incarcerated participants were often on a path toward criminal behavior that kept them from getting the treatment they needed. The study drew on a sample of 44 incarcerated men and 59 hospitalized men, and it built on earlier work confirming that inmates with severe mental disorders carry a distinct profile marked by criminal behavior and psychopathic traits. For readers with disabilities, seniors, caregivers, and advocates, the takeaway is practical rather than abstract - the researchers note that while some countries have launched programs bridging the justice and health systems, those initiatives have yet to be rigorously tested, leaving a real opportunity for future research to identify which approaches actually work for people whose mental illness intersects with the law.*

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by University of Montreal and published on 17 Dec 2014, this content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.