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Sean Clifton now understands the seriousness of his actions and is deeply remourseful.Lars Hagberg/The Canadian Press

When the stranger with wild hair and wilder eyes plunged a knife into the young woman's chest outside a Wal-Mart, screaming as he continued stabbing, she thought she was going to die.

In that terrifying moment, the 22-year-old victim didn't know much about mental illness or the delusions that whipped Sean Clifton, a local oddball in Cornwall, Ont., into a violent frenzy.

When he was found not criminally responsible and sent to a mental hospital, those close to his victim wanted to know why he wasn't going to prison.

She has an answer for them now: "He was very ill."

"I can't imagine in a daily life having to go through all that," she said in a recent interview.

"So I understand that why that happened to me that day was because he was sick. It wasn't personal, it was just being there at the wrong place at the wrong time."

While the woman who gives her first name as Julie no longer lives in fear, enough trauma lingers from the attack 13 years ago that she does not want her last name used.

Remarkably, though, she feels no anger toward Mr. Clifton. In fact, she feels empathy for the man. She is angry, however, at the mental health system that failed to catch him on his downward spiral.

Julie has been given a glimpse into the life and mind of her mentally ill attacker that most victims, and the general public, rarely get.

Mr. Clifton, 46, is at the centre of a new documentary, NCR: Not Criminally Responsible, which illustrates an often misunderstood system now under scrutiny due to some high-profile cases and changes proposed by the Conservative government.

The film, from Emmy-winning Canadian director John Kastner, shows the process people go through from the time of an NCR finding to their release into the community.

In an interview with The Canadian Press, Mr. Clifton reflected on his life before and after the stabbing, on his anxieties about how he will come across in the film and on the politics of the issue. He hopes the documentary helps destigmatize mental illness.

Mr. Clifton was sent to the Brockville Mental Health Centre in Ontario in 2000 after his NCR finding, which meant his mental illness rendered him incapable of knowing what he did was wrong.

With a dual diagnosis of obsessive compulsive disorder and schizophrenia, Mr. Clifton was one of the sickest patients the staff had ever encountered, they say in the documentary.

After years of treatment he is capable again of rational thought, of reflection and of remorse. He has rediscovered old interests and is an avid CBC radio listener, eager to discuss the news of the day.

He lives in Brockville, closely monitored under strict conditions from the hospital. He says he is no threat.

"I had a crazy compulsion," Mr. Clifton says. "It was a … break with reality, but I think I'm getting back to where I was before I went insane, with the help of the medication, I guess."

Mr. Clifton wants to debunk the misconception that not criminally responsible verdicts flood the streets with the criminally insane soon after their trials.

"It's been a very slow, gradual process," he said. "They've been very cautious. I have not shown any violence since my index offence, but every review board I have, they mention I'm a threat to society or something."

Those found not criminally responsible are managed by review boards – independent tribunals made up of at least five people, including one psychiatrist.

Each year, people in most NCR cases go before their province's review board, which can order that they remain in hospital, with varying levels of privileges, release them on a conditional discharge or order an absolute discharge.

Absolute discharges are granted only when the board finds the person is not a "significant threat" to public safety.

Few NCR cases get an absolute discharge at the first hearing, according to a government-commissioned study of review boards in Canada between 1992 and 2004. About 35 per cent of people in NCR cases spend more than 10 years in the system, the study found.

Mr. Clifton is one of them. At his last hearing, the review board noted his significant progress, but still kept him on a tight leash. He is under a detention order, but allowed to live outside the hospital in an apartment.

He doesn't have "sufficient insight" to recognize early symptoms of deterioration, the board found.

The review board system lets NCR people into the community – once they're deemed ready – for short periods under close supervision to see how well they cope. If they do well, they can be granted more privileges at subsequent hearings, step by step. If they don't, the review board pulls the reins of supervision a little tighter.

Mr. Clifton was in the most secure ward of the mental hospital for several years. Eventually, he was allowed to go into the yard escorted by two staff members. Then he was allowed to leave the grounds with a staff member. Later, he could go downtown by himself for an hour, then as many hours as he wanted.

One year, Mr. Clifton didn't take his medication for a few weeks and at his next review board hearing he was granted no new privileges.

Thousands of people have already gone through the review board system and are living in our cities and towns after getting absolute discharges, says Chris Summerville, CEO of the Schizophrenia Society of Canada.

"[They're] out here living amongst us and you're not reading about them every day in the paper," he said. "What you're reading about are the high-profile cases."

The federal government introduced the Not Criminally Responsible Reform Act after some of those cases. Bill C54 seeks to create a "high-risk" designation for people found NCR in cases of serious personal injury.

The Crown would apply to the court for such a designation, and only a court could lift it. "High-risk" people would not be allowed to leave hospital unescorted and could go three years between review board hearings.

It would affect a few people, Justice Minister Rob Nicholson said in an interview.

"We're making changes that are all reasonable to ensure that public safety is the paramount consideration when a decision is being made with respect to whether an individual will be released," he said.

"We're adding the extra protection for everyone involved by a high-risk designation and …we are responding to what victims have told us."

Review board officials and mental-health organizations say the bill is a politicized, "knee-jerk" response to three particularly reviled cases: Vince Li, who beheaded Tim McLean on a Greyhound bus in Manitoba, Allan Schoenborn, who killed his three children in B.C., and Guy Turcotte, a Quebec cardiologist who killed his two children.

But rates of reoffending are starkly lower for those released by a review board in NCR cases than those released from jails and prisons.

For people released from the penal system, the recidivism rate is about 40 per cent, according to various government statistics.

Three years after an NCR verdict, about 10 to 14 per cent of those people had reoffended, fewer violently, according to research recently submitted to the Department of Justice.

The Trajectory Project, led by Anne Crocker, a psychiatry researcher and professor at McGill University, tracked 164 people over several years who were found NCR for serious violent offences, which included murder, attempted murder and sexual offences.

That represents about 8 per cent of the total NCR population in that time.

The study's authors said their results should be interpreted with caution. But the findings are in line with the government-commissioned study, which discovered that 90 per cent of people found not criminally responsible had no previous NCR verdict.

However, the study found, more than half of those people had a criminal conviction. Many mentally ill people cycle through the correctional system for years, not getting the treatment they need.

"The jails are our biggest mental hospitals," says B.C. Review Board chairman Bernd Walter.

Mr. Clifton had a couple of assault and mischief convictions before his attack on Julie. He has not been violent since.

Mr. Clifton once spent several months in a psychiatric ward after his obsessive compulsive disorder spun out of control. His brother had found him holed up in a hotel room, where he had become so afraid of germs that he didn't eat or drink for six days.

After he was discharged from the psychiatric ward, Mr. Clifton was sent to a "rest home," a facility for people who can't look after themselves.

Mr. Clifton's OCD behaviours about stairs particularly controlled him. He would have to practice climbing each stair, he says. Sometimes he would crawl on his hands and knees. A trip to the bathroom in the middle of the night could take 45 minutes.

He tried to get help just hours before he attacked Julie, but was told the psychiatrists were too busy to see him that day, he says.

It is not people who have been treated and deemed well enough to be released back into their communities who pose the highest risk to the public, mental health lawyer Anita Szigeti said, adding it is people in the community who are not receiving proper help and support for their mental illness.

Mr. Walter of the B.C. Review Board said people tend to spend much more time in review board custody than they would have with a jail sentence and are fully released only after experts have deemed them well enough.

"The government's own research indicates that (NCR) rate of reoffending and recidivism is a fraction of what it is for those people who do the time and come back out on the street after jail. So to me it sounds like the system is working," he said.

That doesn't sit well with Carol de Delley, whose son was beheaded by Mr. Li in 2008.

"If he's released into the public, I will be afraid," she says. "I don't trust that this man should be released …Why would I? He ate my son's heart and his eyes. Why would I think it's a good idea for him ever to be free?"

A public outcry erupted when Mr. Li was granted escorted passes last year. People were similarly outraged when Mr. Turcotte was released after only 18 months in psychiatric care. Combined with his time in jail awaiting trial, Mr. Turcotte spent less than four years in custody.

Ms. De Delley doesn't think not criminally responsible verdicts should exist since the system left no one responsible for the horror inflicted on her son. She thinks someone who commits as violent an act as Li should be locked in a secure facility for the rest of his life.

Schizophrenia, as Li has, is treatable with medication, but isn't curable. De Delley worries about what would happen if Li does well enough on medication to be released, then stops taking it.

"We know what he is capable of doing when he's not in treatment," she says. "We may not know what he's going to do in the future, but we know what he has done in the past."

She does hope Li gets better. It will be easier for the psychiatric hospital staff to manage him. She just wants him to stay there.

"I hope that he comes to a place in his mind where he can understand the devastation he wreaked upon another family," she says.

"I don't know how he lives with that, but he has to live with that. I have to live with that."

It's true, says Walter, that the only way to guarantee 100 per cent safety from people with mental disorders is to lock them all up indefinitely.

"But we have a constitution and a charter of rights," he says.

The goal of the not criminally responsible system is rehabilitation, not punishment. But de Delley says she is appalled that people found NCR have so many rights.

"The system concentrates its efforts and resources and funding on the rehabilitation of the offender and the victim is left to themselves," she says.

It's an exercise that leaves de Delley feeling like the horror her family experienced goes unacknowledged.

"The entire focus becomes on how to best meet the needs of the offender and the victim is forgotten," she says.

Nicholson says that's why the government wants to bring in enhanced provisions in the system for victims.

"It's certainly consistent with our program over the last seven years that we've been in government and that is to make sure that victims' concerns are heard and that they're represented."

The bill would let victims know, if they wish, when an NCR person is discharged. It would also ensure victims' safety is considered by review boards and allow for non-communication orders between the NCR person and victims.

Communication has helped Mr. Clifton and Julie move forward with their lives. In a watershed moment in the documentary, Mr. Clifton writes a letter of apology to Julie and her family.

"I want you to know how deeply sorry I am about what I did to Julie and for the pain I have caused you and your family," he writes. "I accept that I have a mental illness. I know I need medications. I know I will have to take them for the rest of my life."

Julie, now a married mother of three, not only accepted his apology, but replied after watching the documentary.

"I can't begin to imagine all that you have suffered through this mental illness but commend you for the way you have turned this around," she wrote. "I do appreciate the letter of apology and the way you have helped me understand why this had happened. I wish nothing but the best for you in your recovery and hope that you will continue to take your medication."

Mr. Clifton was pleased to receive Julie's note.

"I care, you know, that I hurt somebody, and it's not something I take lightly," he said.

"I'm sorry for what I did. Maybe some people found NCR are too mixed up to feel they're sorry, but I've been scratching and clawing my way back to mental health. …I've rediscovered old interests and things, things I couldn't care about while I was climbing up the stairs on my hands and knees at the rest home in Cornwall.

"I did a terrible thing. I hurt somebody really bad. But I am capable of leading a peaceful, quiet, somewhat normal life."

This content appears as provided to The Globe by the originating wire service. It has not been edited by Globe staff.

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