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Mental health and the law

Expert takes your questions

Globe and Mail Update

Mental-health services are in short supply, even for those who want care. But for those who refuse treatment, the situation can be dire and deadly. Many end up caught in the revolving door of the criminal justice system, their health — mental and physical — spiralling downward, Andre Picard writes in Friday's Globe and Mail.

In such cases people who care for a the person who refuses help end up in a situation that pits people's civil rights against their health and the safety of others.

There are about 60,000 admissions a year for involuntarily psychiatric care in Canada, and that doesn't include those in the criminal justice system, research by psychologist John Gray shows. Decades ago those peole were hospitalized indiscriminately and often treated in a horrific fashion.

Now, civil rights have swung to a point where involuntary hospitalization and treatment are next to impossible. Only those who pose an imminent danger to others can be held and treated, and an army of untreated people have taken to the streets or often ending up sleeping on cold slabs in prison.

"The fundamental problem is that we've deinstitutionalized the mental-health system, but we haven't deinstitutionalized mental-health law," Dr. Gray says.

Has your family struggled trying to help someone who has a mental illness? What would you like to know about mental-health laws in Canada?

We're pleased Dr. Gray will be joining us Monday at 2 p.m. ET to answer your questions about mental health and the law. Send them now and return Monday to read his answers, which will be posted below.

John Gray is the lead author of the recently published book Canadian Mental Health Law and Policy, 2nd Edition (with lawyer Margaret Shone of Edmonton and psychiatrist Peter Liddle formerly chair of Schizophrenia, University of British Columbia, published by LexisNexis).

John Gray has a PhD in psychology from the University of London, UK and a Masters from the University of New Zealand. He has worked in Saskatchewan as a clinician and executive director of that province's psychiatric hospital. For more than 20 years he was a program advisor on the British Columbia Mental Health Act while working in their Ministry of Health.

Dr. Gray has served on the boards of the Canadian Mental Health Association, in Saskatchewan and the Victoria and provincial BC Schizophrenia Societies' boards. He is a past president of the Canadian Schizophrenia Society.

Editor's Note: globeandmail.com editors will read and allow or reject each question/comment. Comments/questions may be edited for length or clarity. HTML is not allowed. We will not publish questions/comments that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions/comments that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Christine Diemert, globeandmail.com: Thanks for joining us today Dr. Gray. We've got a lot of questions so let's get started.

Michael Petrunik from Ottawa: Canada's provinces and territories each have different mental health laws that can have significant implications for how persons with serious mental disorder are treated. For example, an resident of Ottawa suffering a psychotic episode and at imminent risk to harm self or others who crosses the river to Quebec will face different laws and procedures there that can have major implications for himself and his family. Can the Charter of Rights and Freedoms be invoked to deal with the issue of disparities in treatment in different provincial and territorial jurisdictions? Are there serious attempts to establish more uniform mental health provisions across Canada that could deal with such disparities?

John Gray: Mental health acts are part of provincial jurisdiction and like almost all other acts dealing with health they differ between provinces.

I do not think the Charter can be used to force uniformity in mental health acts. There can be quite different provisions, for example, on the committal criterion and as long as they meet the requirements of the Charter then they would be legal and there is no Charter mechanism to make these or other provincial jurisdiction laws the same.

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