Tag Archives: Not Criminally Responsible

The Absolute Discharge for Vince Li was wrong

By Dr David Laing Dawson

Vince Li has been treated now, for his schizophrenia, for 8 years. He has been living in the community and attending classes. The Review Board has given him an “absolute discharge”. He is, we are told, recovered, insightful, remorseful, and willing to take his medication regularly. Thus he is not a threat and qualified for absolute discharge.

He may well remain healthy and compliant with his medication for the rest of his life.

Perhaps the odds are slight that he will stop his medication and become ill again.

But, here are two realities about psychotic illnesses, schizophrenia in particular:It is hard to catch a relapse.

  1. When a patient stops his medication he will feel fine for a while. And when the relapse begins the first thing to become impaired is insight. One can monitor mood, but not one’s own cognitive processes. So very few people with schizophrenia who stop medication and feel good for a while, are then able to detect, on their own, the early signs of cognitive changes. As the illness worsens the prospect of insight lessens. It is the nature of schizophrenia. It affects thinking.
  2. When relapses of psychotic illnesses occur, the original delusion returns, if not exactly word for word, almost word for word. Thus if the original delusion was relatively harmless, in a relapse the patient’s returning delusion will be relatively harmless. “They are listening to my thoughts from the TV so I don’t ever turn it on.” “It is happening again.” But if the original delusion was dangerous: “I must kill to rid the world of the devil”, then when the relapse occurs the person in question will once again become dangerous.

Thus, even if the possibility of a relapse of illness for Mr. Li is small, such a relapse would be far more dangerous than for most people with this illness.

And if this occurs, if Mr. Li relapses and hurts or kills someone else, the cost will be much wider than Mr. Li and his victim. “Let’s talk about it” will certainly not be enough to reduce stigma then.

Such an occurrence will undermine the compassion and civility of the “not criminally responsible” finding.

The average citizen has trouble buying this defense now, for various reasons, especially when the crime is horrifying. If Mr. Li relapses and commits a crime, the community outcry will be very strong. A relapse and repeat by Mr. Li could thus do great harm to all mentally ill in Canada.

This could have been remedied simply: a discharge (though not absolute) that continued a lifetime of monitoring compliance with treatment. Not overly intrusive or restrictive. Simply making sure that Mr. Li continues his treatment, that he continue to take his pills every day or his injections every two weeks.

If Mr. Li stops taking his anti-psychotic medication, one year or ten years from now, the illness will relapse. And the delusions of this illness always return in the same form.

What is Wrong with Luka Magnotta? Reflections on Forensic Psychiatry

David Laing DawsonBy Dr David Laing Dawson

Does he have schizophrenia or not? And if he does suffer from schizophrenia, is it the cause of his terrible behaviour? (murder, cutting up his victim and mailing the body parts to various people)

Actually, I’m not going to try to answer that question. Our courts decided he was responsible for his actions, whether or not he suffered from a mental illness.

But this case highlights an absurd inequity in our system. Mental hospitals have been closed, psychiatric beds reduced, psychiatric services limited, but for the past 20 years Forensic Psychiatry has been a growth industry. In some instances our old, a little run down, but functional and humane mental hospitals have been simply converted into maximum secure jails for mentally ill offenders. If Dorothea Dix were alive today she would be writing outraged petitions to our legislators.

We have made it harder for the average family with a mentally ill member to access psychiatric service by excluding the family (privacy laws), by reducing the number of psychiatric beds and staff, and by making it far more difficult to get that family member to the hospital and have the hospital keep him long enough to assess, treat, and stabilize. (Mental health laws and modern hospital management practices).

If that average family with a mentally ill member does get to see me on referral from a family doctor, I will spend about one hour figuring things out, “making a diagnosis”, about one half hour explaining, discussing and instituting treatment, about fifteen minutes documenting all this, another ten minutes trying to get a social worker involved, and then have them come back for “follow up” in two weeks. If I think the ill person needs to be in hospital I will spend half a day, on and off, while they wait, trying to find a bed and negotiate an admission. If my first impressions prove correct, and the treatment starts to help, we will have a series of half hour appointments perhaps every second week to once per month over the next couple of years to get treatment and rehabilitation and recovery on solid ground.

That’s it. We do have other mental health services in many of our communities that are better resourced, but for the most part they specialize with strict criteria and long waiting lists.

Now Luke Magnotta. The only real decision being made so expensively was whether he would be spending the rest of his life in a Prison or a Maximum Security Forensic Psychiatric Hospital. He would probably be safer in the Forensic Hospital, require isolation within the Prison, and perhaps be allowed escorted leaves from the Forensic Hospital a decade from now. In either facility he would receive psychiatric medication, perhaps with a little more care and expertise in the secure Forensic Hospital.

And to make this decision we spent a small fortune. I don’t have a figure but I can guess. Courts and lawyers and psychiatrists. Hours and hours of time spent by more than one psychiatrist examining, writing, reporting and testifying. Twenty-five thousand, a hundred thousand dollars of psychiatric time? A million dollars to house, feed, monitor and treat Mr. Magnotta over the next twenty years?

Now I don’t know if Mr. Magnotta has a treatable psychiatric illness, and if consistent treatment over the past five years would have prevented this tragedy. But it would have been a hell of a lot cheaper.