Risk Factors in Reports for People found Not Criminally Responsible: Has Clinical Practice Kept Up with Evidence-Based Practice?

Abstract

If someone cannot appreciate the nature/quality of their actions or know they were wrong, the Canadian Criminal Code requires they are found Not Criminally Responsible on Account of Mental Disorder (NCRMD). In Canada, Review Boards (RBs) determine whether individuals found NCRMD receive an absolute discharge (released without conditions), conditional discharge (released with conditions), or custodial disposition (custody in hospital) based on their risk to public safety. To determine risk, RBs use reports written by the patient’s treatment team that should consider empirically-supported risk factors, including Historical-Clinical-Risk Management-20 items (Webster et al., 1997). Previous research concluded few HCR-20 items were mentioned in reports; however, report audience (RB vs. court) may have influenced findings. This study examines how often HCR-20 items were mentioned in reports sent to courts versus RBs for patients found NCRMD residing at a secure forensic facility. The necessity of maintaining public safety and the patient’s rights is discussed.