Provisions in British Columbia's Mental Health Act that protect people with severe mental illnesses are currently under attack.
A challenge filed in B.C.'s Supreme Court argues that both inpatient and outpatient involuntary treatment are violations of people's human rights. The plaintiffs are two individuals who have received involuntary treatment as well as the Council of Canadians with Disabilities.
While not fighting against involuntary hospitalizations, the proposed changes would mean that people can avoid involuntary treatments no matter how ill they are.
They will be able to do this because either they or a substitute decision maker they have previously selected have signed documents preventing treatment. As well, once they are released, the same documents could prevent mandated treatment that could help them remain stable in the community. It won't matter how often they have been unable to maintain necessary outpatient treatments and have ended up involuntarily hospitalized to protect themselves or others.
"Readers may conclude that the most morally responsible position is always to allow people to choose whether they want to be treated. But this easy conclusion ignores essential information about psychotic disorders."
In Ontario this kind of legislation has led to prolonged hospitalizations when very ill people refuse treatment. Current B.C. legislation requires treatment decisions to be made by physicians.
Safeguards include the right of patients to have a second opinion and/or a Review Panel reconsider their admission and treatment. As well, unintentional safeguards include the reality of an underfunded mental health system that understandably discourages unnecessary hospitalizations and treatments.
The perspectives of the plaintiffs have been well represented by various human rights lawyers. Readers may conclude that the most morally responsible position is always to allow people to choose whether they want to be treated. But this easy conclusion ignores essential information about psychotic disorders.
Psychosis is a mental state in which someone loses the ability to differentiate between what is real and what isn't. Even as some of its symptoms begin to subside, people can be left with anosognosia, a brain based inability to understand that they are or have been ill. Proponents of this legislative change argue that stigma and the possibility of involuntary treatment are what prevent people from seeking treatment. But for people in psychosis, it's anosognosia that is the biggest problem.
Just talk to families desperate to get a psychotic family member the treatment they are too ill to understand that they need. Or read accounts like Joseph Bowers' recent article "Involuntary Treatment Made A Decent Life Possible for Me." Mr. Bowers, whose illness started when he was seventeen and who experienced numerous involuntary admissions before his illness was stabilized, writes:
I'm near seventy, healthy, a husband and father who is retired with enough money coming in. None of this could have happened without involuntary treatment. My civil liberties were not taken away when force medicated and treated. I was instead liberated from the tyranny of serious psychosis.
As the mother of a daughter who has lived with schizophrenia for sixteen years, I know how crucial brief involuntary hospitalizations have been in helping her enjoy years of stability. Schizophrenia involves much more than psychosis; the associated cognitive difficulties which my daughter developed, and which began appearing long before the introduction of medications, means that she lives with significant disabilities.
Simple daily tasks can be extremely challenging for her and she relies on us for assistance including reminders about medication. My daughter tells other families that she never wants to be left in untreated psychosis in the future.
I want my daughter's best interests to be represented by the numerous disability rights organizations that have appeared in recent years. Sadly, these organizations, like the Council of Canadians with Disabilities, too often promote policies that pose real dangers to her. It's important to understand why a group like this would decide to hold these positions.
"Mental illness policies developed by individuals in organizations who lack basic information about these disorders can be harmful."
A good place to look for answers is investigating the beliefs espoused by the Mad Studies programs which have been proliferating in Canadian and other universities. "Mad" people and "psychiatric survivors" are usually people who have experienced great mental distress and who have survived encounters with psychiatry and medications that they didn't need.
A leader in developing Mad Studies programs is Professor Bonnie Burstow who fights to have the field of psychiatry abolished. Burstow teaches at the Ontario Institute for Studies in Education (OISE).
OISE is the University of Toronto's school for training teachers and educational leaders. In this article, Burstow explains how Mad Studies have become a standard part of the curriculum in disability studies programs.
Burstow helpfully calls attention to egregious practices in the pharmaceutical industry. But students at OISE and elsewhere, who will become leaders in education, health care policy, and disability rights should also know about the progress that neuroscientists have made in recent decades. Here's a link to help them discover the science-based US National Institute of Mental Health (NIMH).
And because students influenced by Mad Studies go on to make decisions impacting people with schizophrenia, here is useful research-based information offered by NIMH. NIMH is funded by the federal government, not the pharmaceutical industry.
Mental illness policies developed by individuals in organizations who lack basic information about these disorders can be harmful. None of the statements from advocates for the challenge to the B.C. Mental Health Act discuss the consequences of the changes they propose. Canada has experienced a growing number of people with severe mental illnesses who remain untreated and who end up homeless and, increasingly, incarcerated.
Melanie Benard of the Council of Canadians with Disabilities is a lawyer and argues that current legislation is "reinforcing harmful stereotypes that equate mental illness with incapacity." Psychotic illnesses can, at times, incapacitate the people who live with these disorders.
Perhaps when disability rights advocates understand this, they will stop trying to dismantle laws that help people achieve stability and avoid encounters with the criminal justice system.
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