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Indigenous individuals are vastly over-represented among people incarcerated in Canada. We collected extensive clinical information and outcome data from Review Board (RB) files and obtained lifetime criminal records for 1800 individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD) in BC (n = 222), ON (n = 484), and QC (n = 1094). Indigenous and non-Indigenous people were compared on (a) socio-demographic, clinical, and criminal histories; (b) index offenses; (c) processing by the RB; and (d) recidivism. Compared to published rates of the disproportionate incarceration of Indigenous people in prisons in Canada (30%), just 3.9% of people in custody with an NCRMD finding were identified as Indigenous. Compared to non-Indigenous people, Indigenous people had higher rates of substance use disorders, personality disorders, and lower rates of mood disorders at verdict and came from low population density neighborhoods but high population density homes. Indigenous individuals were detained in custody longer and remained under supervision longer than non-Indigenous individuals but recidivated at similar rates. Criminal histories, mental health characteristics, and index offenses of Indigenous people found NCRMD were similar to non-Indigenous people found NCRMD. Further research is required to determine if seriously mentally ill Indigenous people who come into contact with the justice system are considered for the NCRMD defense similarly to non-Indigenous people and to explore why Indigenous individuals receive more restrictive dispositions, yet time to reoffending is similar. [ABSTRACT FROM AUTHOR]