02/26/2015 10:14 EST | Updated 04/28/2015 05:59 EDT

Allan Schoenborn: a psychiatrist's view on patients' risks of re-offending

A forensic psychiatrist who works with patients found not criminally responsible for gruesome acts says people who commit them due to mental illness are not necessarily at high risk of re-offending.

"The well-treated, well-supported individual who is no longer actively psychotic is not any more of a risk on your city streets than the guy next to you at the bar," said Dr. Elizabeth Hoffmann.

​The psychiatrist has worked at the Port Coquitlam, B.C. hospital where Allan Schoenborn is being treated, after he stabbed and smothered his three children to death seven years ago.

The court ruled that Schoenborn was not sane at the time and could not be held criminally responsible. Now, he is asking the B.C. Review Board to take supervised trips into the community, 

Effective treatment needed

Hoffmann says she can't speak specifically to Schoenborn's case, but in her experience there's a reason why people who are held not criminally responsible for their acts are not locked up forever.

"They are, by and large, people with serious and persistent mental illnesses that can be treated," she said. "The nature of the crime has more to do with their mental state and their psychosis than who they are."

Hoffman says the untreated mental illnesses found at the hospital she worked at often included schizophrenia, bipolar disorder, and schizoaffective disorder, sometimes in combination with drug addiction.

"My direct experience is people who are treated with long-term, good treatment and who don't have any other risk factors associated with violence actually do quite well," said Hoffman.

She says treatment includes medication and abstaining from drug abuse. It also includes occupational therapy like helping patients understand risk factors, warning signs and the benefits of long-term treatment.

Patients are often then assessed for further risk of doing harm to others, she says, by using the HCR-20 form, a set of guidelines for violence risk assessment.

The issues considered within those guidelines, both for presence and relevance, are summarized below.

Risk assessment guidelines

Historical scale

Does the patient have a history of violence, antisocial behaviour, or substance abuse?

Have they previously been employed and had intimate and non-intimate relationships?

Clinical scale

How much insight does the patient have about their mental illness?

Do they still exhibit symptoms and how stable is their condition? How responsive have they been to treatment?

Risk management scale

What services and plans are in place for when the patient is released? Does he or she have access to housing and a social support system?

Will they continue to comply with treatment? How well are they able to cope with stress?