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Earlier discussion

Mental health and the law

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John Gray: I too would like thank Mary Greene and her family for having the courage to tell their story. It should inform people and help people to change practices and the law. The law should be designed to help her son and many like him who have treatable brain illnesses. The trouble is that the troubled brain of many people with bi-polar and schizophrenia does not recognize the person is ill. Why would a logical person accept voluntary treatment if they were not ill. Mental health acts are the only alternative to abandonment.

It was said in the article featuring Mary Greene that adequate investment and commitment to the recovery model would "make it unnecessary to resort to involuntary commitment and forced treatment." No matter how good the services, some people who do not believe they are ill will not avail themselves of the services and compulsory admission and treatment will be required.

The irony is that treatment with medication, compulsory if necessary, is the only known scientific means of treating people sick enough to have been involuntarily admitted. For those who oppose compulsory treatment they are then depriving the detained person from a Charter right - liberty. Without treatment as Mr Starson's 7 years detention and Mr Sevel's 404 days in solitary confinement show, there is no liberty.

So just as a person who is psychotic is likely to refuse admission they are likely to refuse treatment. Some provinces recognize this and see that the reason for admission is to treat. If the person can't be treated the admission is for social control and not compatible with a hospital but with a jail.

Other provinces, including Ontario, allow an involuntary patient, in some circumstances, to refuse the very treatment required for their release. That is why compulsory treatment makes sense. Without treatment the problems of criminalization, homelessness, victimization become every present dangers for people with serious brain illness.

c.f. from not specified Canada writes: The mental health act in Ontario has a lot of silent, or grey areas that cause us who work in mental health, a lot of grief as we try to care for clients. For example, who is to transport the violent, agitated patient to a schedule one facility from a regular non schedule one emergency room? The act says any person may, but the ambulance doesn't do those transfers, the police say it isn't their mandate any more because it says ''any person,'' and private transport companies refuse because of violence. Am I the nurse, supposed to walk them across the city or take the city bus? That is just one of the areas that trips us up daily. When will the act be updated?

John Gray: I can certainly sympathize with the position this puts staff and patients in. However, the Ontario Mental Health Act is similar to most where "any person" may transport. Only Manitoba requires a police officer for every move. The reason "any person" is used is to cover the contingencies from relatives, staff, ambulance, police etc. The police certainly qualify as "any person."

The assumption is that the most "appropriate" person will be used although that is not stated in the Act. In practice in most provinces it is usually the ambulance. However, if the ambulance people think the situation may be dangerous, they do, and should, call on the police. Sometimes a police transport is entirely appropriate and indeed for someone else to do it where they or the patient may be injured negligence may be an issue.

I know that does not solve your problem which is solved in most communities by an agreement between the police and the local mental health centre/hospital etc. The Canadian National Police Mental Health Liaison Committee website may have some information which is relevant. There are several websites you can check: This one from CAMH, and this one from the liason committee.

Christine Diemert, globeandmail.com: Thanks for joining us today Dr. Gray.

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