By Marvin Ross
For years, we’ve had a small group of very vocal people who call themselves psychiatric survivors — people who have had psychiatric treatment, do not agree with it and consider that they have survived it. Now, thanks to CBC radio, we have someone dubbed a psychiatric refugee — a woman who fled British Columbia for Ontario to escape her involuntary status in a B.C. hospital. And, it was said, she is not the only so-called refugee.
Comparing yourself to people who survived a genocide like the Holocaust or saying that you are comparable to Syrians and others fleeing in leaky, dangerous boats from war is absurd. But what is also absurd is the story that this anonymous person called Sarah by the CBC told. It is just not logical but it is being used to justify the Charter challenge to the B.C. Mental Health Act that I suggested was misguided.
People deserve to know and to understand what the Mental Health Act is about. They deserve to know the processes that are in place to commit someone against their will and to treat them. And they need to know the safeguards that are in place to prevent excesses and protect the rights of the individual. These are never explained.
First, I encourage you to listen to the interview. To begin with, Sarah said that she went to the emergency at a hospital with her mother because of troubling life events and she wanted help. She was admitted, she said, voluntarily but then her status was changed to involuntary.
Now, for her to have been declared involuntary, she would have had to have satisfied all four of these criteria (page 18 of the guide):
- Is suffering from a mental disorder that seriously impairs her ability to react appropriately to her environment or to associate with others;
- Requires psychiatric treatment in or through a designated facility;
- Requires care, supervision and control in or through a designated facility to prevent her substantial mental or physical deterioration or for her own protection or the protection of others; and
- Is not suitable as a voluntary patient.
If she was involuntary, a licensed physician must have assessed her and certified that she met the criteria. Then, another independent physician conducted an examination with the same criteria to extend the stay beyond 48 hours.
( See form 4 where the reasons for the involuntary decision must be listed.)
At the end of one month, she would be examined again to determine if she still met the involuntary admission criteria and the proper form would be filled out to extend her stay a further month (page 20 of the guide). If she no longer needed to be involuntary during this period, the doctor can cancel it and she can always appeal her status to a review board at any time.
Once a patient has been deemed involuntary, they are given a form 5 (consent to treatment) (page 173), which explains to them what treatment is being given. Note that Sarah told the CBC that no one ever discussed treatment with her. They had to.
In addition, Sarah’s rights would have been explained to her and she would be given a form 13 to sign (page 182). She did say she had to sign something but she was not sure what it was. The person having her sign would have told her that she had a right to a lawyer, that she would be regularly examined by a doctor to ensure she was being held appropriately, informed that she could apply to a review board to assess her capacity, go to court to challenge the doctor’s decision and/or request a second opinion from a different doctor.
Next, she would be given a form 15 (page 186) to fill out so that she could nominate a near relative to be informed of her status. She did say that her mother went to the emergency with her so I have to ask where her mother was in all this. Surely she would have been liaising with the hospital staff over diagnoses and treatments. While her mother would have no authority under the act, most doctors do encourage family participation. During the CBC interview, Sarah said that she wished her mother could be involved in her treatment and there is nothing in the act that says she can’t be.
Sarah told the CBC that she absconded during a smoke break and that a form 21 (page 193) had been filled out. That form obligates a peace officer to return her to hospital. Sarah said she went to police in Calgary and told them, and that they called her psychiatrist but they did not hold her for return. The form 21 is only valid within British Columbia, but if 60 days had expired, it would not be valid and she would be deemed discharged.
There are so many holes in what she told the CBC that cast doubt on all she said. It is important for people to understand, particularly in light of the court challenge, what protections there are for an individual who is involuntary. This is not something that anyone takes lightly and is done for the best interest of the patient and for society.
The infamous Vince Li, who beheaded Tim McLean on a Greyhound bus, was initially picked up by Toronto Police in 2004 and taken to hospital. He left hospital against medical advice as there was no mechanism with which to keep him.
Imagine what would have happened if he had been treated initially? Tim McLean would be alive, his family would not have suffered the pain and anguish they did, and the first Mountie on scene might not have developed severe PTSD and eventually taken his own life.
As for Vince Li, he has done so well on treatment that he is now living in a halfway house. I can only guess at the pain he must feel knowing what he did while psychotic and that he would not likely have done if he had been properly treated at the outset.
Vancouver resident Erin Hawkes has written extensively on how the so-called forced treatment had saved her life. She has written in the National Post, numerous times in the Huffington Post and in the Tyee.
The CBC should interview her as well on the court challenge and they should do better fact-checking. If the plaintiffs in this Charter challenge call Sarah as a witness, we will see how well her story holds up to cross-examination.
Note: this first appeared in the Huffington Post on September 26. One person criticized me for attacking mothers which is not what I intended. I pointed out that Sarah’s mother has gone to the ER with her and I likely had input. When I asked where she was, it was a comment directed towards Sarah who said that she wished her mother could have been involved and I suspect she was. I realize that not all doctors and mental health staff are open to families but enough are. My own experience as a family member is that I have always been involved.