Opinions

Potential changes to Alberta Mental Health Act cause concern

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The recently proposed changes to Alberta's Mental Health Act are causing controversy in the province--well, as much as anything without the words "royalty" and "oil" can these days.

In Nov., the Provincial Legislature will vote on whether or not to adopt Bill 31. The bill proposes changes to the Mental Health Act that would increase capacity to commit patients against their will, and even mandate them to take their medicine while not in hospital. Though seen as a step in the right direction by some, it is viewed with a particularly violent disdain by civil liberties groups.

The expansion of the capacity to admit patients to hospital against their will involves the amending of the current act, which allows for the committing of individuals representing a threat to themselves or others, to those "likely to cause harm to [themselves] or others or to suffer substantial mental or physical deterioration or serious physical impairment." Thus, a person may be committed when they are felt to be on the verge of a decline in wellbeing, mental or physical. How is an impending deterioration to be appraised? It seems that this criterion is quite open to interpretation.

The second facet of Bill 31 is the addition of the Community Treatment Orders. These are mandates for a particular individual to comply with their prescribed medicinal treatment. In order for an individual to qualify for these, they must have spent a minimum of 60 days in hospital in the past two years, been admitted on three or more occasions in that two-year period, or have been previously subject to such an order. In addition, two doctors must sign off on the order. While the bill seemingly has safeguards against misuse built in, concerns remain over the issue of requiring a person to take medicine. Medicine, though often able to provide a person with the opportunity to participate in society, is not always an appealing prospect for individuals. Certainly there are a variety of reasons an individual may not be taking their medicine though it is beneficial, but individuals do not like the way medicine affects them, and should not have it forced on them except in cases where a threat is posed.

Unfortunately, this proposed legislation stems from a case where a police officer and his assailant, a schizophrenic, were killed. The contention is that added capacity to force individuals to comply with treatment could have avoided this situation. This reasoning, though, fails to recognize the real problem--insufficient personnel and infrastructure to help the mentally ill.

Some argue that current legislation, providing capacity to deal with those deemed dangerous to themselves or others, is not enough, and further powers will allow issues to be addressed before they bottom out, thus decreasing the damage such instances cause. It does not seem, though, that in the absence of a threat there exist sufficient grounds for violating a person's rights. The idea that a supposed deterioration is all that is needed to warrant such action is going too far. Forcing medicine on a person against their will is a drastic measure, not unlike imprisoning someone, and should not be predicated on a subjective judgment made by a member of the medical community. The existing legislation already allows for acting in situations where danger is imminent, and should not be extended.

Instead of expanding the capacity to act on people against their will, the province should focus on providing the resources necessary for people seeking treatment to receive it. Indeed, if this treatment were readily available in a manner which preserved the dignity of the individual and were operated in a comfortable, discreet manner, perhaps the efficacy of treating the mentally ill would be drastically increased.

This, at least, should be attempted before legislation imposes severe limits on individuals' freedoms. The province has admitted that more resources are required to implement this scheme. This being the case, they should try providing adequate resources with the current system before imposing this new bill on the population. The conservatives are interested in limited government, right?

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Comments

While some of your points are valid, and legislation such as that proposed in bill 31 poses a risk to individual automony, I believe that it is very difficult to comment on these issues without firsthand experience in mental health. Although I am a staunch supporter of civil liberties, my experiences with schizophrenic patients forces me to reframe my thinking arond this particular issue. In this condition mental illness itself can prevent an individual from recognizing that they have a mental illness or need treatment. So the times when they need medication the most may be the times that they are most reluctant to take it. It is unlikely that those who do not feel themselves ill would seek treatment, especially given the serious adverse side-effects of many of these treatments.

Mental health is a subjective field. Human lives do not boil down nicely into objective measurement instruments. There simply is not a practical alternative to a subjective judgement in determining which patients require assertive community treatment. Unfortunately the resources for forced community treatment are not present, and will not be created by this act.