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The march is high to review the legal psychiatry system, according to experts, in a context where Quebec is “champion”, they say, in terms of the number of individuals declared not criminally responsible.
A trio of experts added their point of view to the coroner's inquest into the death of Sergeant Maureen Breau, comparing the Quebec reality with the Ontario system, which is seen as avant-garde in the country.
The experts have insisted on verdicts of not criminal responsibility, which are twice as frequent in Quebec as in Ontario. Yet Ontario's population is twice as high.
Year in and year out, it produces between 450 and 500 new verdicts of not criminal responsibility each year in Quebec, which elevates it to the rank of champion, illustrates researcher Anne Crocker.
Forensic psychiatrist Mathieu Dufour, who has worked in both provinces, highlighted before the coroner that such verdicts are rendered in Quebec for less serious crimes than in Ontario, such as shoplifting or threats.
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Forensic psychiatrist Mathieu Dufour compared the systems of Quebec and Ontario.
Judicialization is seen as a means of having access to psychiatric care, according to the expert . A vision shared by Anne Crocker.
People who enter the forensic psychiatric system will receive good care. So that's not what's worrying. What is worrying is that this makes us criminalize more minor offenses, which could be handled differently, adds the director of the Justice and Mental Health Observatory.
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To support her point, the expert insists on the heaviness of the label affixed to individuals who live with a mental health problem.
Say that you have been transferred to forensic psychiatry or that you have been found criminally innocent responsible, that might not be the first thing you say to a future employer, she said.
So perhaps for more minor offenses, we could think of other ways than going through [the declaration of not criminal responsibility], even if it is perhaps true that the offense was associated to illness. Is the consequence of this statement worth it? I wonder, she specifies.
Dr Dufour also explained to the coroner that the two provinces have a single maximum security psychiatric establishment. In total, Ontario has 10 hospitals designated for forensic psychiatry, while Quebec lists 45, making it the most decentralized system in the country and in the world, adds Ms. Crocker.
There is something to be reviewed to ensure that we put the right people at the right time in the right places with the right resources and then that we do not overload stakeholders from other environments who could work with other clienteles. , she said.
Dr Dufour believes that having fewer designated hospitals would allow the establishment of specialized teams and the development of specific expertise devolved to each psychiatrist, although the patient is sometimes further from his or her living environment, he adds.
Bringing together psychiatrists has advantages, also believes Claire Gamache, president of the Association of Psychiatrists of Quebec (AMPQ) .
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Dr. Claire Gamache is president of the Association of Psychiatrists of Quebec.
The coroner deplores, without accusing him, that the last treating psychiatrist of Isaac Brouillard Lessard n' was not inclined to call on colleagues specializing in forensic psychiatry when psychosocial monitoring in the field was abandoned. You should never feel alone with your patient, commented Géhane Kamel, to which Dr. Gamache agreed.
Géhane Kamel recalls that psychiatrist seminars are organized every month at the Philippe-Pinel Institute to evaluate complex cases in groups.
The initiative could catch on in Quebec hospitals. I have difficulty understanding why this was not done in this case, says Dr. Gamache. There is a question of modesty, she suggests. It's as if we were caught in the hints of telling ourselves that being a psychiatrist means taking responsibility for things alone with the patient.
The protection of people whose mental state presents a danger to themselves or others is provided for by law P-38, which must be reviewed and corrected, according to Dr. Dufour.
In Quebec, the notion of serious, real and immediate danger must be observed to deprive a person of their freedoms, while the criteria are less restrictive in Ontario since a coroner's inquest in 2000.
In the minority of patients who show violence, it's a little easier in Ontario to provide them with care, explains the forensic psychiatrist .
The criteria are a little more permissive for certain patients to be hospitalized against their will, so that means there is perhaps less risk of violence, explains Dr Dufour.
A project to prioritize the forensic psychiatry has been underway since April 2023. The initiative of the Ministry of Health and Social Services of Quebec will be spread over a period of three years.
We will look at the type of care we give to patients both in the hospital and in the outpatient clinic, explains Dr. Dufour.
The forensic psychiatrist speaks of a major reform where the most complex and most dangerous patients will be directed to the Philippe-Pinel Institute, but where there will be a better pyramid of care for patients who do not do not represent a risk for society.
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Anne Crocker
In this ongoing reform, loved ones must not be forgotten, specifies Anne Crocker. It's the families who see the risk factors, it's the families who see things getting worse, she says.
Coroner Kamel, who will hear the testimony of members of Isaac Brouillard Lessard's family on Thursday, has repeatedly underlined the clarity and clarity of the information received from the three experts, and indicates that: she intends to draw inspiration from it in her recommendations.
Teilor Stone has been a reporter on the news desk since 2013. Before that she wrote about young adolescence and family dynamics for Styles and was the legal affairs correspondent for the Metro desk. Before joining Thesaxon , Teilor Stone worked as a staff writer at the Village Voice and a freelancer for Newsday, The Wall Street Journal, GQ and Mirabella. To get in touch, contact me through my teilor@nizhtimes.com 1-800-268-7116
