When Pierre Ny St-Amand was found not criminally responsible last month for crashing a city bus into a Laval, Que., daycare in 2023, the verdict was met with anger, confusion and frustration by some parents of the children impacted by the incident.
Although there was no doubt Ny St-Amand was behind the wheel of the bus that killed two children and injured six others, Quebec Superior Court Justice Éric Downs found Ny St-Amand to be not criminally responsible — a recommendation made by both the Crown and defence. Downs said the evidence showed he was experiencing psychosis at the time.
“It’s shocking to us to see how they talk about him,” said Mélanie Goulet, following the verdict at the Laval courthouse.
Her daughter Emma survived after being trapped under the bus.
“It feels like he’s the victim,” said Goulet.
Ny St-Amand’s verdict is among a number of high-profile cases in Quebec where the accused was found not criminally responsible for their actions due to a mental disorder, often referred to as NCR.
Quebec has more NCR verdicts than anywhere else in Canada.
The verdict can elicit mixed reactions, questions and confusion. That’s particularly true in Quebec, which has more not criminally responsible verdicts than any other province.
In April, Emmanuel Gendron-Tardif was found NCR for the stabbing death of his mother. He was suffering from schizophrenia at the time.
Fabio Puglisi was also declared NCR earlier this month for killing his mother and a neighbour after he stopped taking his medication for schizophrenia.
Court documents show Puglisi had a long history of mental illness and was found NCR for other offences in 2012 and 2020.
“Some people think that when people are found not criminally responsible, it’s like they have been acquitted, which is not true,” said Dr. France Proulx, a forensic psychiatrist at Philippe-Pinel Institute, a psychiatric hospital in Montreal.
Proulx acknowledged that for families, an NCR verdict can feel like a denial of justice, but she said the judicial system in Canada specifies that “when you have a mental disorder that is serious, you should not be punished, you should be treated.”
But these cases have brought renewed attention to NCR verdicts, raising questions about the intersection of justice, public security and health, as well as the degree of support and followup in place for individuals after their release.
Isabelle Gaston, whose ex-husband Guy Turcotte was initially found NCR in 2011 for killing their two children, believes there should be stricter rules and greater oversight when it comes to these verdicts.
Gaston said a person found NCR should serve a minimum amount of time before they can be released.
Turcotte was released from a psychiatric institution after 18 months. He was later retried and found guilty of two counts of second-degree murder.
“Psychiatry remains an evaluation by a human based on criteria and you could have a person that is able to manipulate you,” Gaston said.
As it stands, when someone is released, the review board puts the least restrictive conditions in place to find a balance between protecting the public and respecting the individual’s rights.
“I think this is something that we should change,” said Gaston.
Access to care
While Quebec has more NCR verdicts, such decisions remain rare.
“It’s less than one per cent of all the verdicts we see,” said Dr. Mathieu Dufour, a forensic psychiatrist and head of psychiatry at the Philippe-Pinel Institute.
“Even so, Quebec has six to seven times more verdicts of not criminally responsible compared to other provinces.”
The latest data from Statistics Canada shows there were 44,337 cases in adult criminal and youth court in 2020-21.Of those, 24 cases had a decision of NCR by reason of a mental disorder.
According to the latest annual reports available, more than 2,100 people were under the jurisdiction of the province’s mental health review board in Quebec compared to just over 1,600 in Ontario and 260 people in British Columbia.
That’s not because Quebec has more people with psychiatric illnesses, Dufour said. “The prevalence of psychiatric disorders is the same across Canada,” he said.
“But it’s the use of this verdict that often leads to access to care.”
That’s because, in Quebec, the right to refuse medical care is a fundamental principle protected by the Civil Code of Quebec. This makes it more difficult to hospitalize someone without their consent.
Once a person has been handed an NCR verdict, they are under the control of the province’s mental health review board and offered treatment, said Emmanuelle Bernheim, a law professor at the University of Ottawa. She also holds the Canada Research Chair in mental health and access to justice.
The person can still refuse treatment, which is their right, but they typically agree, as it will help them be released, she said.
Bernheim said it’s a broken system and that police and the courts may not react until the person is already in crisis.
“The ordinary case is really the case of a person that has a history of mental illness and at the moment of the crime, they didn’t take their medication,” said Bernheim. “That’s something we see again and again.”
What happens after the verdict?
Unlike a prison sentence, the length of time a person is detained after a verdict of NCR is not known.
People found NCR often have schizophrenia, schizoaffective disorder, bipolar disorder or a manic or depressive relapse that triggers a psychosis, said Proulx.
About 200 people found NCR are detained at the Philippe-Pinel Institute, one of three maximum security hospitals in Canada. But not all of the people under the mental health review board need to be admitted to a hospital. Some are treated in the community.
A lot depends on their willingness to accept treatment.
That may include taking medication, psychotherapy and additional treatment if drugs or alcohol were involved.
“If they don’t co-operate, they will have more strict conditions,” said Proulx.
Goodwill is important, but the severity of the person’s mental illness is also a factor. Some people may show improvement in just a few months. For others, they may remain at the Philippe-Pinel Institute for decades.
Their case is evaluated by the review board every 12 months.
“We have to assess the level of security needed considering the mental state of the person and the risk of relapsing into violent acts,” said Proulx.
If the person’s mental state has improved, they may be transferred to a less restrictive psychiatric hospital. Others may be released with conditions, such as a requirement to have housing, abstain from drugs and alcohol and not to be in contact with the victims or the families of those victims.
People generally have a better prognosis when there is family support, they take their medication regularly and the person has gone through all the treatment options available.
“We have some nice success stories,” said Proulx.
Officer’s killing highlights flaws in followup
An individual will only be absolutely discharged once the board is confident they no longer pose a risk to society.
But these tools are not perfect. There is recidivism — and unpredictability.
When people are released conditionally, they can also struggle to maintain their mental health.
Representatives from the ministries of justice, health and social services, public security and the legal system are working together to find possible solutions and improve how people are taken care of following their release, Quebec Health Ministry spokesperson Marie-Claude Lacasse said in an email to CBC.
Part of that involves improving the organization and delivery of mental health and forensic psychiatric services to make sure the right services are offered to people based on their needs and risk level.
In March 2023, Sgt. Maureen Breau was stabbed to death by Isaac Brouillard Lessard, a man with a history of mental health issues. Brouillard Lessard was being followed by the province’s mental health board.
“Sad events such as the death of Sgt. Breau have highlighted shortcomings in the followup of people under the board’s care,” Lacasse said in an email.
Quality control
In addition to better oversight, Gaston, Turcotte’s ex-wife, has also been pushing for changes to some of the rules around NCR evaluations.
When a judge orders an NCR evaluation for a serious crime, the request is sent to the Philippe-Pinel Institute. There are four dedicated psychiatrists who can do the assessment. If there is no bed available at the institute, there are psychiatrists at other detention centres who are available, said Proulx.
But Gaston has questions about the quality of the assessments being done. In her ex-husband’s case, she filed a complaint about the psychiatric evaluation done at his trials. She later dropped the complaint, but thinks there should be an independent committee that audits a certain number of evaluations a year.
“When there are humans, there is imperfection and when there is imperfection, there is great danger that justice is not being served,” said Gaston.
Proulx is not aware of any jurisdiction that has this level of quality control and points out that forensic psychiatrists receive additional training to do these assessments.
“It’s up to the judge to evaluate the credibility and quality of the assessment from his legal point of view,” said Proulx. “That can be debated in court.”
But it can be difficult for the judge to question the evaluation because that’s not their role and they don’t have specialized expertise, said Bernheim, the law professor, who acknowledges some people may erroneously be labelled NCR.
Gaston says she’s OK with the concept of someone not going to prison because they were sick.
“But I think we have to also protect society from this happening again,” she said.
