Examining the use of the recovery model with individuals found not criminally responsible on account of mental disorder

Revealing tensions between risk management strategies and recovery


  • Michael Gulayets MacEwan University
  • Ashlyn Sawyer




NCRMD, not criminally responsible on account of mental disorder, recovery model, risk management, outpatient setting, qualitative, forensic mental health


In providing the care and control of individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD), forensic psychiatry attempts to balance the protection of society with the treatment of mental illness. A new approach in mental health care is the recovery model, which centers on the understanding that there should be a ‘recovery in’, not a ‘recovery from’ serious mental illness. In clinical practice, this means that treatment decisions should be made in collaboration with patients and include their personal circumstances, such as criminality and aspirations. Concepts that intersect with these goals are elements like choice, hope, personal responsibility, and empowerment. This paper examines the implementation of the recovery model in forensic mental health settings and provides an in-depth exploration and evaluation of the model as it is practiced at a forensic psychiatric outpatient clinic with individuals found NCRMD. Ten participants, including both individuals found NCRMD and psychiatric professionals, took part in semi-structured interviews. The paper examines the experiences, perceptions and challenges of implementing the recovery model in a forensic psychiatric setting and compares its strategies to the predominant risk-based forensic practices. The analysis suggests that it is difficult to implement the recovery model in a forensic setting without compromising either the recovery model or the risk management approach.

Keywords: NCRMD, recovery model, risk management, outpatient setting, qualitative, forensic mental health


[1] Smandych R, Verdun-Jones SN. Catch-22 in the nineteenth century: the evolution of therapeutic confinement for the criminally insane in Canada, 1840-1900. Crim Justice Hist 1981;2:85-108
[2] Canadian Criminal Code, 55-56 V., c.29, s.736
[3] Verdun-Jones SN. Criminal law in Canada: cases, questions, and the code. Toronto, ON: Nelson Education, 2015
[4] LaJeunesse RA. Political asylums. Edmonton, AB: The Muttart Foundation, 2002
[5] Porter R. Madness: a brief history. Oxford, UK: Oxford University Press, 2003
[6] Canadian Criminal Code, 1968-69 (Can.) c.38, s.48
[7] Canadian Criminal Code, 972 (Can.), c.13, s.45)
[8] Verdun-Jones SN. (1994). The insanity defence in Canada: setting a new course. Int J Law Psychiatry 1994;17(2):175–89
[9] Canadian Criminal Code, s. 672.72
[10] Canadian Criminal Code, RSC 1985, c C-46
[11] Beck U. Risk society: towards a new modernity. London, UK: Sage Publications, 1992
[12] Glancy GD, Chaimowitz G. The clinical use of risk assessment. Can J Psychiatry 2005;50(1):12-17
[13] O’Malley P. Risk, power and crime prevention. Economy and Society 1992;21(3):252-275
[14] O’Malley P. Risk, uncertainty and government. Portland, OR: Glasshouse, 2004
[15] Winko v. British Columbia (Forensic Psychiatric Institute) [1999] 2 S.C.R. 625
[16] Crocker AG, Seto MC, Nicholls TL, Côté G. Description and processing of individuals found not criminally responsible on account of mental disorder accused of “serious violent offences”. Ottawa: Research & Statistics Division, Department of Justice: 2013
[17] Not Criminally Responsible Reform Act, S.C. 2014, c. 6
[18] Dupuis T. Bill C-14: An act to amend the Criminal Code and the National Defence Act (Mental Disorder). Library of Parliament (41), 2014
[19] Goossens I, Nicholls TL, Charette Y, Wilson CM, Seto MC, Crocker AG. Examining the high-risk accused designation for individuals found not criminally responsible on account of mental disorder. Can Psychol 2019;60(2):102-114
[20] Grantham L. Bill C-14: A step backwards for the rights of mentally disordered offenders in the Canadian criminal justice system. Appeal 2014;19:63-81
[21] Hilton NZ, Simpson AI, Ham E. The increasing influence of risk assessment on forensic patient review board decisions. Psychol Serv 2016;13(3):223-231
[22] Crocker AG, Nicholls TL, Charette Y, Seto MC. Dynamic and static factors associated with discharge dispositions: the national trajectory project of individuals found not criminally responsible on account of mental disorder (NCRMD) in Canada. Behav Sci Law 2014;32(5), 577-595
[23] Penney SR, Marshall LA, Simpson AIF. The assessment of dynamic risk among forensic psychiatric patients transitioning to the community. Law Hum Behav 2016;40(4):374-386
[24] Wilson CM, Crocker AG, Nicholls TL, Charette Y, Seto MC. The use of risk and need factors in forensic mental health decision-making and the role of gender and index offense severity. Behav Sci Law 2015;33(1):19–38
[25] Crocker AG, Nicholls TL, Côté G, Latimer EA, Seto MC. Individuals found not criminally responsible on account of mental disorder: are we providing equal protection and equivalent access to mental health services across Canada? Can J Commun Ment Health 2010;29(2):47-54
[26] Mann B, Matias E, Allen J. Recovery in forensic services: facing the challenge. Adv Psychiatr Treat 2014;20(2):125-131
[27] Clossey L, Mehnert K, Silva S. Using appreciative inquiry to facilitate implementation of the recovery model in mental health agencies. Health Soc Work 2011;36(4):259-266
[28] Simpson AIF, Penney SR. The recovery paradigm in forensic mental health services. Crim Behav Ment Health 2011;21(5):299-306
[29] Slade M. Personal recovery and mental illness: a guide for mental health professionals. New York, NY: Cambridge University Press, 2009
[30] Longden E, Slade M. Empirical evidence about recovery and mental health. BMC Psychiatry 2015;15:285-298
[31] Kaliski SZ, de Clercq HG. When coercion meets hope: can forensic psychiatry adopt the recovery model? Afr J Psychiatry 2012;15(3):62-166
[32] Lukens JM, Pouncey CL. Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry. In Sisti DA, Caplan AL, Rimon- Greenspan H. (Eds.). Applied ethics in mental health care: an interdisciplinary reader. Cambridge, MA: MIT, 2010:237-253
[33] Corlett H, Miles H. An evaluation of the implementation of the recovery philosophy in a secure forensic service. British Journal of Forensic Practice 2010;12(4): 14-25
[34] Shepherd A, Doyle M, Sanders C, Shaw J. Personal recovery within forensic settings – systematic review and meta-synthesis of qualitative methods studies. Crim Behav Ment Health 2016;26(1):59-75
[35] Barnao M, Ward T, Casey S. Looking beyond the illness: forensic service users’ perceptions of rehabilitation. J Interpers Violence 2015;30(6):1025-1045
[36] Clarke C, Lumbard D, Sambrook S, Kerr K. What does recovery mean to a forensic mental health patient? A systematic review and narrative synthesis of the literature. J Forens Psychiatry Psychol 2016;27(1):38-54
[37] Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. BJPsych 2011;199(6):445-452
[38] Mezey GC, Kavuma M, Turton P, Demetriou A, Wright C. Perceptions, experiences and meanings of recovery in forensic psychiatric patients. J Forens Psychiatry Psychol 2010;21(5):683-696
[39] Tapp J, Warren F, Fife-Shaw C, Perkins D, Moore E. What do the experts by experience tell us about ‘what works’ in high secure forensic inpatient hospital services? J Forens Psychiatry Psychol 2013;24(2):160-178
[40] Aga N, Vander Laenen F, Vandevelde S, Vermeersch E, Vanderplasschen W. Recovery of offenders formerly labeled as not criminally responsible: uncovering the ambiguity from first-person narratives. Int J Offender Ther Comp Criminol 2017;63(6):919-939
[41] Askola R, Nikkonen M, Paavilainen E, Soininen P, Putkonen H, Louheranta O. Forensic psychiatric patients’ perspectives on their care: a narrative view. Perspectives in Psychiatric Care 2018;54(1):64-73
[42] Livingston JD, Nijdam-Jones A, Lapsley S, Calderwood C, Brink J. Supporting recovery by improving patient engagement in a forensic mental health hospital: results from a demonstration project. J Am Psychiatr Nurses Assoc 2013;19(3):132-145
[43] Davidson L, Drake RE, Schmutte T, Dinzeo T, Andres-Hyman R. Oil and water or oil and vinegar? Evidence-based medicine meets recovery. Community Ment Health J 2009;45(5):323-332
[44] Livingston JD. What does success look like in the forensic mental health system? Perspectives of service users and service providers. Int J Offender Ther Comp Criminol 2018;62(1):208-228
[45] Le Boutillier CL, Chevalier A, Lawrence V, Leamy M, Bird VJ, Macpherson R, … Slade M. Staff understanding of recovery-orientated mental health practice: a systematic review and narrative synthesis. Implementation Science 2015;10(87):1-14
[46] Davidson L, O’Connell M, Tondora J, Syron T, Kangas K. The top ten concerns about recovery encountered in mental health system transformation. Psychiatr Serv 2006;57(5):640-645
[47] Bouman YHA, Schene AH, de Ruiter C. Subjective well-being and recidivism in forensic psychiatric outpatients. Int J Forensic Ment Health 2009;8(4):225-234
[48] Gudjonsson GH, Webster G, Green T. The recovery approach to care in psychiatric services: staff attitudes before and after training. The Psychiatrist 2010;34(8):326-329
[49] Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2): 77-101
[50] Neergaard MA, Olesen F, Sand Andersen R, Sondergaard J. Qualitative description – the poor cousin of health research? BMC Med Res Methodol 2009;9(52):1-5




How to Cite

Gulayets, M., & Sawyer, A. (2020). Examining the use of the recovery model with individuals found not criminally responsible on account of mental disorder: Revealing tensions between risk management strategies and recovery. International Journal of Risk and Recovery, 3(1), 3–22. https://doi.org/10.15173/ijrr.v3i1.4079



Original Article