The Vancouver Sun: Opinion: B.C.’s Mental Health Act is about treating mental illness


Original link to Letter to the Editor in The Vancouver Sun published January 12, 2018.

A response to Improving B.C.’s Mental Health Act is about respecting rights, Opinion, Jan. 2, by Mark Iyengar.

The purpose of the B.C. Mental Health Act is to help ill people receive the medical treatment they need and deserve so that they can regain their health.

Many people with schizophrenia and other mental illnesses resist hospitalization and treatment because they do not believe that there is anything wrong with them. Core features of brain illness — delusions, hallucinations, cognitive deficits — often lead a person who is unwell to “logically” conclude that, “I’m not sick; I don’t need help.”

The B.C. Schizophrenia Society (BCSS) strongly objects to Community Legal Assistance Society (CLAS) lawyers’ recent call for changes to the B.C. Mental Health Act. Rather than protecting patient “rights,” such proposals will instead result in depriving patients of the most important right of all: the right to safe, effective and timely medical treatment.

Our current Act provides for treatment so patients usually recover and are discharged within days or weeks. Involuntary treatment means not abandoning people with psychosis to continued suffering, homelessness and possible violence.

Involuntary patients are certified by two independent physicians as having a serious mental disorder that requires treatment because without it, the individual is likely to harm themselves or others or to suffer substantial deterioration.

In the name of civil liberties, CLAS insists that involuntary psychiatric hospital patients must be able to refuse treatment. This would make B.C.’s legislation like Ontario’s, where psychiatric patients can refuse the very treatment they need to get better. In our opinion, this makes no sense.

We believe this change would have the same catastrophic effects as in Ontario, where patients with psychotic illness are held in hospital for unreasonably long periods of time. Because treatment is withheld, patients with psychosis are trapped in their suffering by exercising their “rights” — in this case, the right to refuse the very treatment they need to get better.

Under Ontario law, a Mr. Sevels was hospitalized but refused psychiatric treatment. Mr. Sevels was extremely violent, and seclusion was the only way to protect him, the other patients and staff from harm. After 404 days in solitary confinement, Mr. Sevels’ case came before a court. The judge concluded that although psychiatric treatment was appropriate, Ontario legislation did not permit it.

However, that same judge strongly objected to legislation that allowed such a situation. He said surely it wasn’t the intended result of the Charter of Rights that patients who are trapped in their mental illness “… be for prolonged periods caged and warehoused in mental health facilities where the key to their necessary and involuntary seclusion is available with relatively likelihood of substantial risk.”

Nurses’ colleges and unions should know that while untreated, Mr. Sevels attacked and seriously injured a staff member. Studies show that this is not atypical. Untreated patients have much higher rates of harming staff. It took time, but two months after the attack, Mr. Sevels was finally treated with good results.

Was “the right to refuse treatment” good for Mr. Sevels? His suffering continued and he lost his liberty for at least five years, including over a year in solitary confinement. What about the right of nurses not to be injured at work? What about other patients’ rights not to be interfered with? What about the right of patients waiting in emergency because treatable but untreated patients are blocking beds? What about taxpayers’ rights not to pay hundreds of thousands of dollars for unnecessary hospitalization?

There are many other tragic examples of the effects of treatment refusal by Ontario patients. Because he refused treatment, Professor Starson was in hospital for over seven years. (He was treated over his objection when he nearly died from delusional-induced starvation. He did well.) Another patient has been detained in various psychiatric hospitals for over 25 years without ever receiving treatment. A young man who tried to eviscerate his eye because of a delusion remained untreated for over four months.

These are the kind of incidents that can occur if we accept CLAS’s recommendation to “improve patient rights.” BCSS strongly rejects this proposition.

The Saskatchewan Law Reform Commission considered the Ontario experience and concluded that “logically, legal authority to hospitalize a patient without their consent must entail authority of some form of treatment without consent.” We agree.

Improvements to the mental health system can be accomplished by improved staff training, health authority policy, review board policy, ministry-approved guidelines or regulation changes. But changing our B.C. Mental Health Act does not make sense.

It isn’t right. It isn’t fair. And it isn’t necessary.

David Halikowski is president of the British Columbia Schizophrenia Society


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