Introduction 

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On a quiet evening in April 2014, five university students were viciously stabbed to death at a house party in Calgary. The attacker, Mathew de Grood, had no criminal history. However, he had recently become consumed by delusions about the Illuminati, werewolves, and Medusas. He was later diagnosed with schizophrenia. In May 2016, de Grood was found Not Criminally Responsible Due to Mental Disorder (NCRMD). Ultimately, he was placed not in prison, but in a psychiatric institution and later transferred to a group home in Calgary (Hixt, 2024). This verdict served as the catalyst for a national debate: Was justice served? 

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In Canada, while the success rate of the NCRMD defence is not dramatically high, the impact on public perception, legal debates, and the justice system is significant. There is no national data on how often the NCRMD defence is raised; however, the Department of Justice Canada (2022) found that the number of individuals processed as NCRMD roughly doubled across seven provinces, from 1.2 to 1.8 cases per 1,000 adult court cases between 1994-2004. Though this represents a 50% increase in NCRMD-related outcomes, it does not necessarily reflect a proportional increase in the number of claims made. What was once considered to be a rare mechanism for only the most extreme psychiatric cases, NCRMD is now being considered for a wider range of diagnoses (Charette et al., 2015). As courts increasingly rely on psychiatric testimony to determine criminal responsibility for the actions of the accused, a necessary question arises: are we witnessing the ‘medicalization’ of justice?  

While the NCRMD defence succeeds in fewer than 1% of cases, it has become gradually more successful. Its reach has expanded in more subtle but significant ways: through increased diagnostic inclusivity, growing reliance on psychiatric expertise in the courtroom, and widening disparities in how it is implemented across jurisdictions (Miladinovic & Lukassen, 2015; Department of Justice Canada, 2022). Although relatively rare in its successes, the NCRMD defence has become structurally embedded and medically authoritative within the Canadian justice system. This can be shown by tracing the evolving use and implications of the NCRMD defence along three intersecting axes: (1) the horizontal expansion across psychiatric diagnoses included in NCRMD eligibility; (2) the vertical growth in psychiatry’s influence on legal determinations of responsibility and punishment; and (3) the structural inequality in NCRMD implementation across Canadian jurisdictions. Together, these will illustrate how the medicalization of justice, while progressive in theory, risks creating new forms of inequality and inconsistency in practice. 

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The concept of “medicalization” was popularized by Ivan Illich (1976) in his book, Medical Nemesis. Illich (1976) argued that the medical profession had begun to define and treat aspects of life that were previously considered normal experiences or social problems as medical conditions. In the context of the courtroom, the increasing use, and expanding definitions of what is considered NCRMD reframes the actus reus (criminal act) as something that is not punishable in the traditional sense because they are symptoms of a diseased mind, requiring treatment. While this shift may reflect advances in psychiatric understanding and a more enlightened approach to mental illness, it also risks distorting core legal principles like individual culpability, proportionality, public accountability, and the legitimacy of the system itself.  

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Law Meets Psychology  

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The NCRMD defence was established by Bill C‑30, enacted in 1992. It replaced the old “insanity” standard and set up provincial Review Boards. Since then, NCRMD has seen reform and now lies in Section 16 of the Criminal Code of Canada, which outlines the legal framework for determining when a mental disorder may absolve a person of criminal responsibility by creating reasonable doubt as to whether the defendant possessed the required mens rea (mental element), a necessary component of conviction. According to this section, for a successful NCRMD defence, there are two elements that must be met: First, the individual must be shown to have been suffering from a “mental disorder” at the time of the offence; second, that the disorder must have rendered the person either “incapable of appreciating the nature and quality of the act [...] or incapable of knowing that the act was wrong” (Criminal Code, RSC 1985, c C-46, s. 16(1)). Simply put, this criteria relies almost entirely on psychiatric interpretation to be satisfied, a task that is not as simple as stated. This is where the law meets psychology. 

 

A “mental disorder” is defined as “a disease of the mind,” a definition that has been labeled as a legal construct, rather than a medical one (Criminal Code, RSC 1985, c C-46, s. 2). Importantly, the burden of proof for an NCRMD claim lies with the defence, unless raised by the Crown in rare circumstances (Criminal Code, RSC 1985, c C-46, s. 16(3)). Once the issue is brought before the court, the trier of fact must decide whether the accused in fact had a “diseased mind.” In almost all cases reviewed in this analysis, the determination relies on the testimony of psychiatric experts, who have evaluated the mental state of the accused. Evaluations are done by conducting clinical interviews, psychological testing, clinical histories, and diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). These expert witnesses are tasked not only with identifying the presence of a disorder, but also with assessing its effects on the accused’s moral reasoning and self-control at the time of the offence. This reflects a (2) vertical deepening of psychiatry’s authority in courtrooms (R. c. Turcotte, 2013, para. 36-38; CAMH, 2024; Department of Justice Canada, 2022; Hixt, 2017; Supreme Court of Canada, 2025). 

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This dynamic where the line between legality and a person’s psychology is now presenting a distorted view of the relationship between clinical and legal authority. A psychiatric diagnosis is inherently probabilistic, interpretive, and often evaluated on a spectrum, while the law requires categorical judgments: guilty or not; responsible or not (American Psychiatric Association, 2013, p. 25; Criminal Code, RSC 1985, c C-46, s. 660, s. 661, s. 662, s. 663). As a result, the courtroom becomes a space in which clinical determination is translated and often simplified into legal decisions, primarily on psychiatric expertise in determining whether an individual should be held morally accountable for their actions. This gives room for more public scrutiny into how justice is defined and executed. 

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Rise of the Medicalized Mind 

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The idea that criminal behaviour can be medically or biologically explained is not a new development. In the late nineteenth century, Italian physician and criminologist Cesare Lombroso introduced the now discredited theory known as ‘atavism’. This posed the idea that criminals were evolutionary throwbacks identifiable by physical traits such as overgrowth of hair, asymmetrical faces, or long arms. Lombroso’s work was one of the first attempts to frame criminality as a scientific-medical condition rather than a moral failing or rational choice (Henry & Lanier, 2006, pp. 34, 35). Though his conclusions have been rejected, Lombroso’s legacy lives on in the broader idea that biology, psychology, or mental illness can fundamentally alter, or even erase, personal culpability (Henry & Lanier, 2006, pp. 34, 35). 

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Today, this logic is embedded in psychiatric explanations of criminal responsibility. Now, instead of blaming the “born criminal”, we recognize the “diseased mind”, which shows the evolution in the medicalization of deviance (Henry & Lanier, 2006, pp. 33, 34; Criminal Code, RSC 1985, c C-46, s. 2). As discussed, the term “diseased mind” is simply a legal construct and must be translated into clinical language. A key tool in this transformation is the DSM-5-TR, the widely recognized guide used by mental health professionals to define and categorize mental illness. New editions of the DSM-5-TR have expanded to include a growing range of disorders, from Post-Traumatic Stress Disorder (PTSD) to borderline personality disorder to intermittent explosive disorder (American Psychiatric Association, 2013). This represents the (1) horizontal expansion of what constitutes a “disease of the mind” in a courtroom (Criminal Code, RSC 1985, c C-46, s. 2). Moreover, these psychiatric progressions mean that what qualifies as a “disease of the mind” in one point in time might not in another (Criminal Code, RSC 1985, c C-46, s. 2). As a result, introducing inconsistency into legal outcomes occurs. 

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Consequently, in the courtroom, the language of medicine has overtaken the language of law. Psychiatric experts are called not just to describe disorders, but to pronounce on legal thresholds: was the accused able to appreciate the nature and quality of their act? Could they distinguish right from wrong? These are legal questions answered by clinical professionals, whose assessments are often based on probabilities and interpretations turned into decisive decisions (Criminal Code, RSC 1985, c C-46, s. 672.11, s. 672.12, s. 672.13). As such, different mental health professionals may reach different conclusions. This occurrence can be seen in many cases where the issue of NCRMD has been raised.  

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For example, in the case of R v. Bharwani, the defendant had been accused of murdering his roommate and thus was charged with first-degree murder. According to the Supreme Court of Canada (2025): 

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At trial, Mr. Bharwani raised a defence of not criminally responsible on account of a mental disorder. The defence called two psychiatrists to testify as experts. They diagnosed the accused as having symptoms of schizophrenia and psychosis at the time of the offence, preventing him from understanding the moral wrongfulness of his actions. The Crown also called a psychiatrist, who diagnosed the accused with schizophrenia but concluded he was capable of appreciating the nature and quality of his actions. A jury convicted him of first-degree murder. (p. 1) 

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Crucially, all three psychiatric experts in R. v. Bharwani diagnosed the accused with schizophrenia and acknowledged the presence of psychotic symptoms. However, while the defence experts concluded that these symptoms rendered him incapable of appreciating the moral wrongfulness of his actions, the Crown’s expert disagreed, not with the diagnosis, but with its legal significance. This disagreement underscores the interpretive nature of psychiatric opinion in legal settings. Even when the clinical facts are agreed upon, their translation into legal thresholds (like one’s capacity to distinguish between right and wrong) remains subjective, inferential, and probabilistic. Unlike other experts who specialize on topics like deoxyribonucleic acid (DNA) analysis or fingerprint identification, which deal with quantifiable, replicable evidence. Psychiatric assessments rely on a narrative, interpretation of symptoms, and reconstruction of mental states during the prohibited act. The expert is not reporting a fact but inferring legal relevance from probabilistic clinical observations. This inherently makes psychiatric testimony uniquely vulnerable to variance, as demonstrated by the case of Bharwani (Supreme Court of Canada, 2025). 

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This expansion of psychiatric influence reflects the societal shift described by Illich (1976), warning that modern institutions tend to treat all degrees of pain and suffering as a domain of medical control. Illich (1976) argued that medicine had begun to colonize normal experiences, redefining them as conditions to be treated as opposed to “suffering [through] its inherent personal meaning” (p. 42). In the context of NCRMD, we see something similar: acts of criminal violence are no longer simply punishable wrongs. They are signs of clinical pathology that deserve to be fixed rather than punished. 

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While this development may reflect greater compassion and a more comprehensive understanding of the effects of mental illness, it also raises pressing concerns. A lack of consensus between psychiatric experts on diagnosis creates disagreement on legal consequence, which is a core danger of medicalization. As psychiatric authority grows in the courtroom, which illustrates (2) vertical expansion, it imports with it a framework that is interpretive and uncertain, yet must be forced into the rigid binaries of legal judgment. In doing so, we must ask: are courts still administering justice? Or is the mode of adjudication changing? 

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Case Studies – Medicalization in Action 

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To understand fully how the tensions surrounding NCRMD unfold in practice, it is necessary to examine specific cases. Real-world examples not only demonstrate how the law is applied but also show us the complexities and consequences that theoretical frameworks alone cannot capture. As previously discussed, a well-known NCRMD case in recent Canadian history is that of Matthew de Grood. In 2016, the judge ruled him NCRMD because of his schizophrenic diagnosis. He was placed in a psychiatric facility rather than sentenced to prison. De Grood’s case caused controversy due to the implications the NCRMD verdict carries rather than the diagnosis being incorrect or contested (Hixt, 2024).  

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Once the defendant is found NCRMD, the judge does not issue a sentence, but instead, the accused faces a disposition. The court typically makes a disposition referral to a provincial or territorial Review Board. From here, the Review Board is tasked with determining the individual's disposition, while being mindful of the public’s safety. The board has three choices: absolute discharge, conditional discharge, or detention in a facility where the individual can gradually earn certain privileges (Criminal Code, RSC 1985, c C-46. s. 672.54).  

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Many members of the public, including victims’ families, expressed concern that the verdict and disposition failed to hold de Grood accountable in any meaningful way. The case became a show of a broader discomfort with what some saw as the justice system's outsourcing of moral judgments to clinical diagnoses. Although de Grood remains under the supervision of the Alberta Review Board (ARB), annual hearings may lead to conditional discharge or an absolute discharge (Hixt, 2017). The case underscores how NCRMD, while legally and medically justified, can challenge public institutions about what it means to seek justice for all.  

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While de Grood’s case involved a clear and undisputed diagnosis of schizophrenia, not all NCRMD rulings rest on such firmly established psychiatric conditions that meet verdicts’ criteria. One such case is that of Guy Turcotte, where the psychiatric diagnosis that met the NCRMD verdict was viewed by many as insufficient to explain the severity of the crime. In 2009, Turcotte, a respected cardiologist from Quebec, killed his two children by stabbing them a combined total of forty-six times (R. c. Turcotte, 2012). As a result, he was charged with two counts of first-degree murder. Experts argued that Turcotte, in the midst of an emotional breakdown following the collapse of his marriage, had consumed windshield washer fluid in a suicide attempt and was in a dissociative state at the time of the killings. He understood he would die but did not want his children to find his body (R. c. Turcotte, 2013). As such, he decided to bring “[his children] with him” (para. 24). Turcotte survived and was found by the police the next morning, where he was brought to an Intensive Care Unit. While he had trouble remembering the events chronologically, he was still able to recall the events (R. c. Turcotte, 2013). After his trial, in 2011 Turcotte was ruled to be NCRMD, based on an expert testimony diagnosing him with major depressive disorder (R. c. Turcotte, 2012). 

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This verdict sparked immediate and widespread public backlash, primarily because the diagnosis of depression seemed insufficient. Unlike psychosis or schizophrenia, which triggers delusions, depression does not convincingly sever the understanding of the consequences of one’s actions. The notion that someone suffering from depression could lose all appreciation for the nature or impropriety of their actions proved difficult to accept for both the public and for legal professionals. Soon after, in late 2012, Turcotte was granted a conditional release, which intensified the controversy (CityNews Vancouver, 2013). The Quebec Court of Appeal later overturned the NCRMD verdict, citing an error in the trial judge’s jury instructions (The Canadian Press, 2016; R. c. Turcotte, 2013). At Turcotte’s second trial, he was convicted of two counts of second-degree murder and sentenced to life imprisonment without parole eligibility for seventeen years (The Canadian Press, 2016).  

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Turcotte’s case shows how disputed psychiatric diagnoses, or disagreements over whether they justify an NCRMD finding, can undermine public confidence in such verdicts. Courts may be forced to reassess the role of mental illness when it fails to convincingly align with public and legal standards of moral incapacity. While courts struggle with this internal tension, the media significantly compounds this issue. In both of the cases discussed, the media shaped the public’s understanding of the accused actions, the diagnosis, and the verdict. Rather than framing NCRMD as a medically and morally necessary protection embedded in law, media coverage often emphasizes it as a controversial loophole (The Canadian Press, 2016; CityNews Vancouver, 2013; Hixt, 2017). This framing of the accused, paired with emotional stories of the victims, reinforces a punitive logic that seems to undermine the rehabilitative intentions of NCRMD. This, in turn, feeds the misconception that the defence is frequently overused or exploited, particularly when high-profile NCRMD offenders, like Turcotte and de Grood, are later seen reintegrating into society. 

Here, the court of public opinion plays an exceptionally large role. Unlike the criminal courts, which are bound by law and internal regulations, public opinion operates through a far less structured system, shaped by the media’s framing, retributive instincts, social bias, and emotional reaction. Judgments are often based not on legal standards but on reputation, outrage, and perceived fairness, especially when mental illness lacks visible or easily understandable symptoms (Miller, 2016).   

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Depending on public outcry, these reactions can be so powerful that they may have the ability to reshape political will and drive legal reform. For example, after Turcotte’s release, there were calls for tighter NCRMD restrictions and pre-requisites, even though such proposals risk undermining the system’s flexibility and clinical focus (The Canadian Press, 2012). This dynamic reflects a circular relationship, where public outrage shapes media narratives, which then pressure the legislators and courts to respond, often with measures that prioritize punitive satisfaction over clinical accuracy. This cycle also risks a dangerous judicial overcorrection. In highly publicized cases, judges or juries may be less willing to accept valid NCRMD defences for fear of backlash, even when psychiatric evidence clearly supports the verdict. This undermines the very protections the NCRMD framework was designed to offer, thus shifting the balance away from just outcomes rooted in medical understanding, toward outcomes shaped by the populist. 

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Benefits of Medicalization vs. Risks and Consequences 

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The medicalization of criminal responsibility, as reflected in the birth and expansion of NCRMD, represents a shift toward a more compassionate, scientifically informed model of justice. Instead of retribution, NCRMD verdicts prioritize treatment by recognizing that individuals who genuinely lack the capacity to understand/control their actions, do not require punishment for such actions. NCRMD acknowledges the complex realities of mental illness, allowing courts and review boards to tailor outcomes that align more closely with medical ethics, the Canadian Charter of Rights and Freedoms, and evolving understandings of human behaviour. In many cases, individuals found NCRMD receive more appropriate and intensive care than they would if incarcerated (Miller, 2016).  

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Contrary to public perception, individuals found NCRMD are more strictly supervised than their convicted non-NCRMD counterparts. According to Martin et al. (2022), they are 3.8 times more likely to be detained, 4.8 times less likely to be released from detention, and 2.9 times less likely to be granted absolute discharge compared to convicted offenders, even after controlling for age, gender, province, and offense severity. It is also noteworthy that, “one year following a verdict, 42% of the NCRMD accused were still detained, while 1% of convicted offenders in the sample were still in custody”. 

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Not only are there tighter restrictions and more intensive rehabilitative efforts on those found NCR, the very structure of the review boards mandates a yearly re-evaluation of risk, prioritizing public safety and therapeutic need (Criminal Code, RSC 1985, c C-46, s. (672.81 (1)). This structure enables individualized dispositions and community monitoring that criminal courts cannot replicate with general population of offenders found guilty simply because of a Review Board’s ability to set aside “at least in part, the principles of proportionality and punitiveness governing the traditional sentencing practices” (Martin et al., 2022, pp. 1-2). This system’s reliance on individualized assessments, as opposed to fixed sentencing, may help explain the relatively low recidivism rates observed among NCRMD individuals. As Charette et al. (2015) note, people under the purview of Review Boards were significantly less likely to reoffend. In fact, their study found a three-year recidivism rate of 17%, compared to 34% for the general offender population and 70% for inmates with mental disorders in correctional facilities. This data shows that those found NCRMD are far less likely to reoffend, than both the general offender population and those mentally ill in prison, suggesting that the dispositions of the NCRMD are more effective at reducing recidivism than incarceration.

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However, the same features that make NCRMD humane also invite certain legal and ethical concerns. Diagnostic ambiguity remains a persistent issue; psychiatric categories evolve, overlap, and oppose binary conclusions, yet the law depends on clear thresholds of culpability. What qualifies as a ‘diseased mind’ is neither uniform across provinces and territories nor consistently applied, and emerging and evolving diagnoses push the boundaries of what courts are willing to accept as exculpatory. This introduces the risk of inconsistency in diagnoses and verdicts which undermine public confidence in the legal process. 

Moreover, while the absence of a criminal conviction with an NCRMD verdict avoids punitive incarceration, it is far from a ‘get out of jail free card’ as previously discussed. Individuals may face indefinite detention in psychiatric facilities under the authority of Review Boards, whose primary mandate is risk management rather than a fixed release date (Criminal Code, RSC 1985, c C-46, s. 672.121). In practice, this can result in longer detentions than a prison sentence would have warranted, especially when the person presents a persistent, though treatable, risk. The focus on public safety above all else means that liberty is contingent and can depend heavily on the availability of psychiatric resources, institutional discretion, and a physicians’ willingness to work with the patient. 

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Consider the following thought experiment:  

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Case A involves a person found NCR, after committing a serious assault during a psychotic episode. This individual lives in a remote, under-resourced jurisdiction where psychiatric beds are limited, and local community supervision programs are overburdened with underperforming psychiatric expertise. At his Review Board disposition, this individual is assessed as a low-to-moderate risk. However, the Board cannot authorize a conditional discharge due to the lack of available psychiatric monitoring in the community. As a result, they remain detained in a secure hospital setting solely because the resources for their release are not obtainable in the region. 

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Case B involves another person found NCRMD for a comparable offence under similar clinical circumstances. However, Case B occurs in a well-funded urban centre with extensive forensic psychiatric services, transitional housing options, and an interdisciplinary care team available to support reintegration. At this individual’s yearly review, the Review Board approves a conditional discharge with community supervision and access to outpatient care. Within eighteen months, this individual is living independently under periodic review and minimal restrictions.  

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These contrasting cases raise a fundamental concern: How much of an NCRMD individual’s liberty depends not on their risk level or diagnosis, but on their (3) geographic and institutional context? When freedom is dependent on the availability of services or the discretion of hospital staff, the system risks trading one form of justice for injustice: legal recognition of mental illness for unequal, resource-driven confinement. Across Canada’s very diverse population and large geography, this thought experiment can easily become the reality. This sheds light onto the structural disparities across Canada making justice dependent on geography. 

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The Centre for Addiction and Mental Health (CAMH) is a frontier for mental health services and operates one of Canada’s most advanced forensic psychiatric programs, providing interdisciplinary clinical input supervised leave privileges all under the Ontario Review Board’s (ORB) oversight (CAMH, 2024). However, this level of resourcing is not representative of all Canadian jurisdictions. By contrast, remote regions like Nunavut face significant limitations in forensic psychiatric capacity. Upfold et al. (2023), found that Nunavut had only fifteen forensic psychiatric patients, with just 47% receiving outpatient care. While only 37.1% of NCRMD individuals across Ontario, Québec, and British Columbia were granted conditional discharge at their initial hearing, longitudinal data show gradual increases in community reintegration. For example, after one year, only 42% of Québec’s NCRMD patients remained detained, compared to 57% in British Columbia and 90% in Ontario (Crocker et al., 2015). These trends suggest that over time, outpatient care becomes increasingly available in jurisdictions with the infrastructure to support such transitions.

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By contrast, Nunavut’s forensic population remains disproportionately confined, not due to higher clinical risk, but due to the absence of viable outpatient options. This suggests a system heavily reliant on institutional care and lacking community-based options for reintegration. In addition to minimal infrastructure for such an approach, Nunavut lacks data-driven evidence-based treatment planning. Both of these deficits hinder the kind of psychiatric treatment and reintegration planning available in better-resourced regions like Ontario, British Columbia, and Quebec. As a result, NCRMD individuals in regions with an inhibited ability to assess, treat, and transition their patients may face prolonged hospitalizations or may be transferred out-of-territory, uprooting their lives even when they pose little clinical risk (Upfold et al., 2023). It is disparities like these that raise serious concerns about equity in access to mental health justice across Canada. 

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Thus, the medicalization of justice, while progressive in many respects, operates along a precarious line. With the additions and modifications to the Criminal Code’s provision on NCRMD, Canada has embedded more humane and scientifically grounded ideals into its courts. However, in practice, these ideals cannot be applied equally across the country. The stark contrast between urban psychiatric centres and under-resourced remote jurisdictions reveals access to justice through NCRMD is determined not just by psychiatric need or legal merit, but by the infrastructure and geography of the system. A truly just system must strive to preserve the spirit of medicalization, compassion, nuance, and proper care, without allowing those principles to be undermined by resource disparities and clinical inconsistencies. If the NCRMD verdict is to maintain both its credibility and legitimacy within the courts, governments must ensure that fairness is not only present in law, but also in practice, nationwide. Anything less risks transforming a progressive legal tool into a system of unintended, and unjust confinement. 

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Conclusion 

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The use of NCRMD in Canada shows progress in how we, as a society, have come to understand crime versus culpability. By recognizing the role of mental illness in shaping behaviours, the legal system has embraced a model that recognizes when one needs treatment over punishment aimed at retribution and deterrence. At its best, NCRMD verdicts offer a humane, clinically-informed approach that protects both the rights of the accused and the safety of the public. Yet this evolution is not without consequence. If  psychiatric testimony continues to gain authority in the courtroom we are effectively changing the foundations of criminal responsibility, through clinical reasoning. While not inherently wrong, incorrect execution may create a system where liberty and justice can hang not only on diagnosis, but on the availability of psychiatric institutions, the discretion of medical staff, and the interpretive nature of experts on the matter. With this system, what was designed to be fair risks becoming unpredictable and unequal. 

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This danger is evident across Canada’s large geography, showing great inequities across the country. In dense areas like Toronto, Vancouver, and Montreal, NCRMD verdicts can lead to structured reintegration through interdisciplinary supervision and community-based care. However, in remote regions like Nunavut, Yukon, or Northwest Territories, the same verdict can result in prolonged confinement simply because of a severe lack of local infrastructure for any form of discharge or follow-up (Upfold et al. 2023; Crocker et al., 2015). In this way, a verdict designed to protect the mentally ill risks becoming an unintended tool of oppression: depriving liberty not on the basis of law or risk, but of postal code and concentrated institutional strength. 

 

In addition, public misunderstanding, shaped by media coverage and driven by emotional reaction, has the power to undercut the public’s confidence in NCRMD entirely. In high-profile cases, the backlash against NCRMD verdicts can shape political discourse, alter legal outcomes, and even discourage courts from applying the defence where it is warranted. The NCRMD verdict sits at the centre of a complex intersection between medical expertise, legal tradition, and public morality. 

If Canada seeks to better preserve the legitimacy and integrity of NCRMD, courts and the healthcare system must ensure that the ideals behind medicalization are upheld in theory and in practice. That means addressing the uneven geography of care, investing in forensic infrastructure across provinces and territories, and creating a better-informed public understanding of mental health and its effect on Canada’s interpretation of justice. Without this, we risk allowing a system rooted in progress to become one marked by inequality and contradiction. Justice cannot be determined by diagnosis alone, nor can it be left to the availability of hospital beds. It must be actively constructed through a system that sees mental illness not as an escape from the law, but as a condition that law must treat, not merely judge. 

 

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References 

 

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). 

2. The Canadian Press. (2012, December 13). Federal government trumpets victims rights in wake of Turcotte release. Global News. https://globalnews.ca/news/319305/federal-government-trumpets-victims-rights-in-wake-of-turcotte-release-4/

3. The Canadian Press. (2016, February 23). Guy Turcotte’s challenge of parole eligibility accepted by Quebec’s top court. CBC. https://www.cbc.ca/news/canada/montreal/guy-turcotte-murder-conviction-appeal-1.3459613 

4. Centre for Addiction and Mental Health (CAMH). (2024). Information about Forensic Mental Health. https://www.camh.ca/en/camh-news-and-stories/information-about-forensic-mental-health? 

5. Charette, Y., Crocker, A. G., Seto, M. C., Salem, L., Nicholls, T. L., & Caulet, M. (2015). The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 4: Criminal recidivism. The Canadian Journal of Psychiatry, 60(3), 127–134. https://doi.org/10.1177/070674371506000307 

6. CityNews Vancouver. (2013, September 29). Case of doctor who killed his kids, then walked free, returns to court. https://vancouver.citynews.ca/2013/09/29/case-of-doctor-who-killed-his-kids-then-walked-free-returns-to-court/ 

7. Criminal Code, RSC 1985, c C-46.  

8. Department of Justice Canada. (2022, August 26). Results - The Review Board Systems in Canada: An overview of results from the mentally disordered accused data collection study. Government of Canada. https://www.justice.gc.ca/eng/rp-pr/csj-sjc/jsp-sjp/rr06_1/p3.html 

9. Henry, S., & Lanier, M. M. (2006). Cesare Lombroso and the Origins of Criminology. In The Essential Criminology Reader (pp. 33–42). Routledge. 

10. Hixt, N. (2017, March 28). Families of Brentwood 5 victims want Matthew de Grood hospitalized indefinitely. Global News. https://globalnews.ca/news/3341207/families-of-brentwood-5-victims-want-matthew-de-grood-hospitalized-indefinitely/  

11. Hixt, N. (2024, April 9). Matthew de Grood back in Calgary 10 years after killing 5 at Brentwood house party. Global News. https://globalnews.ca/news/10412779/matthew-de-grood-living-calgary/ 

12. Illich, I. (1976). Medical nemesis: The expropriation of health. Marion Boyars. 

13. Martin, S., Charette, Y., Leclerc, C., Seto, M. C., Nicholls, T. L., & Crocker, A. G. (2022). Not a “Get out of jail free card”: comparing the legal supervision of persons found not criminally responsible on account of mental disorder and convicted offenders. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.775480 

14. Miladinovic, Z., & Lukassen, J. (2015). Verdicts of not criminally responsible on account of mental disorder in adult criminal courts, 2005/2006-2011/2012. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/85-002-x/2014001/article/14085-eng.htm?.com 

15. Miller, T. N. (2016). Framed: A Canadian news media analysis of accused persons found not criminally responsible on account of mental disorder [MA Thesis, Simon Fraser University]. Summit Institutional Repository. https://summit.sfu.ca/item/16395 

16. R. c. Turcotte, 2012 QCCS 5587 (CanLII), <https://canlii.ca/t/ftpjj>, retrieved on 2025-08-01.  

17. R. c. Turcotte, 2013 QCCA 1916 (CanLII), <https://canlii.ca/t/g30kv>, retrieved on 2025-08-01.

18. Supreme Court of Canada (2025). R. v. Bharwani. https://www.scc-csc.ca/judgments-jugements/cb/2025/40781/

19. Upfold, C., Jentz, C., Heilmann, P., Nathanielsen, N., Chaimowitz, G., & Sørensen, L. U. (2023). Forensic psychiatry patients, services, and legislation in Nunavut and Greenland. International Journal of Law and Psychiatry, 91. https://doi.org/10.1016/j.ijlp.2023.101921