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Mentally Ill: Who goes to Prison and Who Goes to Psych Institutions

  • Date : 2014-12-17 : Rev. 2017-09-30
  • University of Montreal : William Raillant-Clark - w.raillant-clark@umontreal.ca
  • Synopsis : Difference between people with mental illness incarcerated for crime and those declared not criminally responsible and hospitalized at psychiatric institution.

Main Document

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."

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.


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