By Marvin Ross
Over the past few years, I’ve been writing about the attempts by what I consider an anti-psychiatry group in British Columbia to derail that provinces excellent mental health act. They are still at it. I first wrote about it in the Huffington Post back in 2016 and again later that same year when someone fled BC to Ontario claiming she was a refugee from the BC Act.
In 2019, Susan Inman did a guest blog on this site on the attempts in BC to do away with involuntary treatment for those who are hospitalized under the act. The initial challenge to the Act was tossed on a technicality but the attempts still persist as Susan wrote recently in a Vancouver newspaper. The latest assault on involuntary treatment is from a report by the Representative for Children and Youth (RCY) called Detained: Rights of Children and Youth Under the Mental Health Act.
The key to their complaints is that people who are involuntarily committed are assumed to be consenting to treatment and they are then treated even if they do not want to be treated. The RCY argues that BC is the only jurisdiction in Canada that treats involuntary patients. BC, in fact, has the best provision to enable treatment to start immediately. Ontario is the only jurisdiction that allows an involuntary patient the right to refuse treatment with dire consequences which I will get to.
In Nova Scotia and Manitoba, if a patient, while competent, instructs a substitute decision maker (SDM) to refuse treatment, the SDM must follow those requests when the patient is involuntary unless doing so will result in significant harm. If that becomes the case, the SDM must make decisions in the best interest of the patient. Nova Scotia and Saskatchewan have raised the bar for capability to fully capable in order to refuse treatment. In Alberta and the Yukon, review boards can overcome refusals to treatment. In New Brunswick, the review board can overturn a refusal to treatment if it means that no treatment will result in the patient remaining in hospital as an involuntary hold.
The purpose of involuntary treatment (or any treatment for that matter) is to help the patient get better. If they are involuntary, the point should be to get them better so they can get out of hospital. If you deny treatment for the person as the BC advocates want to, will they get out? The answer to that can be found in the stupidity of the Ontario Act which allows someone declared involuntary to then refuse treatment and to remain in hospital, ill, for years.
As John Gray said in a presentation he gave to an Ontario committee in 2009 studying this:
Treatment refusal leads to unnecessary loss of liberty, continued suffering, unnecessary health costs and harm to others (e.g. assaults on nurses)
Gray pointed out that on average, people can be discharged after about a month with treatment but refusal to allow treatment can result in years and years in hospital. He and two others wrote a paper called Treatment Delayed – Liberty Denied. In one case, Professor Starson was held untreated for 5 years in an Ontario hospital while his case made its way up to the Supreme Court. And those people who appealed a Review Board finding waited 253 days until the courts dismissed their appeals and the doctors could treat. The courts uphold the Review Boards so the patients wasted 253 days.
And one sidebar on the Professor. He was not a professor and his name was not Starson but he called himself that because he believed himself to be a son of the stars. He was always referred to as Professor Starson even by the Supreme Court of Canada so you really have to wonder who is crazy.
But what is worse are the examples given in that particular study. There were people being detained for 5, 10 and even 25 years because they refused treatment and so remained a danger to themselves or others. At $600 per day, or $219,000 for 1 wasted year and 4.38 million for 20 years that is a lot of taxpayer’s money not to treat people and to also deny them their liberty. That is the Province of Ontario but that is not something that could happen in BC with its mental health act which these anti-psychiatry types want to abandon in favour of Ontario’s flawed legislation.
Returning to the most recent BC report, it should be said that the study is not what anyone would call proper research. The conclusions the author made are invalid in my opinion.. They interviewed 14 young people about their experiences in the system – hardly a systematic evaluation. The report makes this statement:
Although the Mental Health Act features protective safeguards – including requiring the provision of information about rights, notification of a near relative, second medical opinions, re-assessments, Mental Health Review Board hearings and access to legal counsel for Review Board hearings – this report finds that young people are apparently not being informed of and certainly not being supported to exercise their rights under the Act.
And they are correct in that the Act states in its guide that:
the Act also contains protections to ensure that these provisions are applied in an appropriate and lawful manner. Safeguards for the rights of people involuntarily admitted to a psychiatric facility include rights notification, medical examinations at specified time periods, second medical opinions on proposed treatment and access to review panels and the court.
The report suggests that this is not happening or at least they say apparently and that seems to be based not on a review of the statistics kept on children and youth who go through the system but on the recollection of the young people themselves. It seems they did look for the data but found it to be inconsistent and/or missing. That is a relevant finding and they should insist that the departments involved get their acts together and ensure proper statistics. It does not mean they can come to the conclusion that these safeguards are ignored.
The one other thing that I want to mention is this comment that there is a:
“lack of opportunity for young people detained under the Mental Health Act to have a say in treatment options that are more trauma-informed, relational and diverse rather than exclusively medical, and to stay connected with family and culture to help deal with underlying causes of their symptoms.”
This reflects their anti-psychiatry stance particularly with the mention of the need to get away from treatments that are “exclusively medical”. These are treatments that are evidence based and ones that have demonstrated a level of efficacy. They go even further with the suggestion that treatment staff must “Ensure First Nations, Métis, Inuit and urban Indigenous children and youth detained under the Mental Health Act receive trauma-informed, culturally safe and attuned mental health services.”
All staff in whatever system need to be culturally sensitive to the above groups and to all racialized groups to help counter systemic racism. The attitudes of staff can be discriminatory unfortunately but evidence based treatment modalities or mental illness are non discriminatory. The one caveat to that might be the problem with drug trials not having sufficient representation from a diverse enough population.
The issue of traditional treatments for Indigenous people came up in Ontario a few years ago with disastrous results. Two young Indigenous girls insisted that their cancer be treated by traditional methods and not western medicine. Maykala Sault, an 11 year old from the New Credit First Nations was being treated with conventional therapy at McMaster Children’s Hospital in Hamilton. She was given a 75 per cent chance of survival when she was diagnosed with acute lymphoblastic leukemia (ALL). Doctors stated that no one survived this form of cancer without chemo but Maykala decided to stop in order to pursue traditional Indigenous medicine. She died. So much for the efficacy of traditional healing. But then again, some of her treatments were carried out by a clinic in Florida which was actually licensed as a massage establishment and is being sued – not exactly traditional culture.
In a similar case, another Indigenous child aged 11 from the Six Nations decided to forgo traditional medical treatment for Indigenous care. Doctor’s treating her appealed to court to be allowed to continue scientific therapy but the judge ruled that she and her family had the right to decide to have other therapy. The name of the child was withheld so I have not seen what the outcome was in that case. The so called traditional therapy was also carried out at the same facility in Florida.
That treatment cost the family $18,000 and involved being taught to “heal themselves” from cancer by eating raw, organic vegetables and having a positive attitude. You can read about this clinic in this article from the CBC.
I’ve digressed a bit with this description but the intent was to show how ludicrous it is to abandon evidence based therapy whether for mental illness, cancer or any other condition.
Sadly, this BC report is nothing but another anti-psychiatry, anti-science piece of fluff which gets far too much attention from the public and politicians. If I may be allowed, if you want to read a comprehensive refutation of all that anti-psychiatry holds dear, my book, Anti-psychiatry and the UN Assault on the Mentally Ill will be available shortly.