Bloodbound Bus7. NCR: My Sec 1-7. #VincentLi #NCR #Schizophrenia

Bloodbound Bus7

NCR: My Sec 1-7

June 10, 2015

The Criminal Code of Canada contains laws that govern how we decide who is guilty of a crime, and who is not.  The most relevant Section for our discussion today is 16. (1).

It states;

No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong.

Marginal note: Presumption

(2) Every person is presumed not to suffer from a mental disorder so as to be exempt from criminal responsibility by virtue of subsection (1), until the contrary is proved on the balance of probabilities.

Marginal note: Burden of proof

(3) The burden of proof that an accused was suffering from a mental disorder so as to be exempt from criminal responsibility is on the party that raises the issue

If that seemed like a bit too much legalese, let me try to break it down into my 21 easy steps, with editorial comments about the issues along the way.

1- If you have a mental disorder or illness

2- Like Schizophrenia

3- An illness well known to cause many symptoms

4- Distorting the environment with hallucinations

5- Disorganizing reality with cognitive symptoms

6- And/or with strong delusions sometimes ruling over thoughts

7- Any of the above 3 types of symptoms capable

8- In the correct circumstances

9- Of clouding what one thinks is right or wrong

10- To the extent that if you killed someone

11- Even in a horrific manner that no person ever deserved

12- Especially Tim

13- While in a severe psychotic state of mind at the time

14- And could prove it with reasonable evidence

15- And it made probable sense

16- Then you cannot be found guilty of a crime

17- You can still be isolated, to protect society

18- And detained in a hospital

19- To ensure you received treatment

20- Until you were able to rejoin society

21- In specific, monitored steps

The rest of this essay will address each of my subjective interpretations, from Sec. 16. (1), of the Criminal Code in more detail, and hopefully as respectfully as possible.

1, 2 

We should start with the question of whether or not Li was suffering from a mental illness at any time before the tragedy.

By now, this is one of the easiest questions to answer.  Although Li has technically committed no crime, his essential right to privacy and confidentiality about his medical condition has been waived, and we are provided with updates through the media of his progress.

We now know, through various sources, that Li suffers from Schizophrenia, which is a mental illness due to a disease of the brain.

3, 4, 5, 6

See Bloodbound Bus3, 4, and 5.

7

There are many people, living very productive lives, who experience residual psychotic symptoms, despite medications and other treatments.  There may be episodes of paranoia brought on by stress or medication non-compliance.

In others, there may be a subtle leftover disorganization in thinking that the person learns to work around.

Hallucinations may re-occur when using alcohol, marijuana or other drugs, and last for days.

While many people with Schizophrenia live with mild psychotic symptoms, very few ever become overwhelmed enough to engage in significant aggression or homicidal behavior.

It is very hard to locate this tipping point along the illness timeline in specific individuals.

That is one of the reasons many people with Schizophrenia are monitored closely by mental health professionals, often on a weekly basis.

But there are still times, when those living with these symptoms are overcome; and hallucinations, delusions, or fear, lead to aggression.

Any single symptom of psychosis, or even several at once, can elevate the risk.

It is hard to tell in general, when a person goes insane.

There is a PRODROME before this stormy diagnosis, where behaviors change, and it may be noticeable to loved ones or loving strangers.

The mark of frank psychosis is Shirley Evan Dent to Annie Tom, Dick, or Harry.

But with eyes on our screens, instead of on the people in our communities, sometimes we miss what is right in front of us.

In the first darkening clouds of this diagnosis, it is common to socially withdraw, or lose the ability to function effectively at school, or while at work.  The probability of thought’s precipitation reaches new HI’s and LO’s.

The beginnings of disorganization start to make the daily forecast confusing.

Sometimes a developmental stressor can light the genetic fuse; rapidly leading to Stahl’s wildfire of psychosis.

Such stressors may include:  moving to college, relationship conflicts or breakups, the death of a loved one, school or work responsibilities, or using illicit drugs.

This ‘pre-Schizophrenia’ stage can smolder even several years before the illness is sparked, fanned each time, by stress’ headwinds.

Once the illness is diagnosed, roughly 65% respond well, or fairly well, to medication and other treatments.  These people are often able to build productive and meaningful lives, with infrequent episodes or hospitalizations.

There is another roughly third that struggle much more, due to poor responses to treatment.

Schizophrenia is likely a heterogeneous disorder, and may one day be re-classified into sub-types responding to divergent treatments.

For the treatment resistant third however, who have a version of the illness that does not diminish enough with medications, life is difficult.  It is usually these individuals who require the most support, and there are community based PACT teams to meet them where they live, in cities like ours.

The risk of aggression in those with Schizophrenia has already been discussed, in BBB5.

It is my hope that we continue to provide the resources necessary to monitor those individuals in high risk categories, without impinging on liberties.

Having said that, there should be a mechanism whereby an individual who is mentally deteriorating, or is an obvious risk to themselves, or someone else, can be brought to Mental Health Professionals.

Even in situations where it is against their will.

It is at these difficult crossroads, where society’s well-being must trump any one individual’s.

This would be an important step to ensuring that anyone afraid of living in a community with Li, or someone else they feared for whatever reason, would have some legal mechanism to ensure their own safety.

As well as to ensure the individual who is suffering receives the attention they require, before the condition worsens.

This may seem a firm stance, however, at worst, an individual would be assessed in an Emergency Department; if things were okay, that individual most often would be ‘freed’ to go home, hopefully with some follow-up.

Or if there was no home, arrangements can be made to contact shelters, or Crisis Stabilization Units, here in the city.

Luckily such a safety net already exists, within a system reliant on ‘FORM’s, supported by the Mental Health Act of Canada.

We will discuss this more in the next chapter, NCR Sec 8-14.

Simon Trepel, MD

Simon Trepel, MD FRCPC, is a practicing Child and Adolescent Psychiatrist, in Winnipeg, Canada.  He is an Assistant Professor, at the University Of Manitoba, in the Faculty of Medicine, and the Co-founder of the GDAAY Clinic.  He is, more importantly, the proud Father of 2 beautiful Daughters.  He writes in his spare time about things he knows something about, and occasionally about things he doesn’t; like Yoga, and Italian flavored coffees.  He was not referring to coffee that tastes like an Italian person.

Check out his Blog, called Simon Says Psych Stuff

http://wp.me/67ZVU

🙂

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4 thoughts on “Bloodbound Bus7. NCR: My Sec 1-7. #VincentLi #NCR #Schizophrenia

    1. 5imon5ez says:

      Hey Brett, thanks for your comment. It could be my writing style that is causing the confusion. I don’t think merely causing fear should be grounds for incarceration. Nor do I think active Schizophrenia should be grounds for incarceration. I believe the courts and Review Board in the Vincent Lee case were correct in finding him NCR, and I am glad he is recovering and regaining his freedom. Since My post was so misconstrued by you, could you point out which part of my post made you think I was in favour of incarcerating Mr. Li?

      Like

  1. 5imon5ez says:

    Ahhh, I see where it seems confusing.

    The context of that I was talking about there is as follows:
    If you are afraid of someone hurting you, there already is a mechanism of addressing this in Canada, which is calling the police. If you are wrong about that person actually being specifically dangerous to you, the police will investigate, but ultimately leave that falsely accused person alone. It is important we have such a system, which I am sure you would agree.

    What I was not saying is as follows:
    If you are afraid of someone, they should be locked up immediately and have conditions forever placed on their lives.

    The facts are that Li was psychotic at the time of the incident and thus was rightly found to be NCR.

    He has since recovered and remained symptom free for an extended period of time, thus establishing that treatment is effective if undertaken correctly.

    He has demonstrated a sustained improvement in his functioning and has not demonstrated any aggression to anyone.

    He behaves as a completely different person while non psychotic- which would be the same finding for myself or any other human being incidentally- and thus has followed the necessary protocols to gain his freedom back again.

    The only conditions that have been imposed upon him are related to his medical treatment of SCZ.

    If someone is afraid of him now, the burden of proof is on the accuser to demonstrate a current and specific risk, for the police or anyone else to intervene.
    Based upon how Li has done, it is likely the police won’t have a problem with him living in Winnipeg, or anywhere else for that matter, and hopefully, he can continue to live his own life and find meaning in relationships, occupation, hobbies, and the rest of the stuff we all find meaning in.

    Like

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