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The Minister of Health Doesn't Understand His Own Legislation

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Is it any wonder that mental illness care in Ontario is so bad? Dr. Eric Hoskins, our Minister of Health, does not even understand his own Mental Health Act.

Global News Toronto ran a piece on a woman with schizophrenia who has been missing for the past six weeks in bitterly cold weather, with no money, no ID and no cellphone. Eva Szeman of Mississauga, Ontario last saw her sister Judy on January 27. Judy Szeman was first diagnosed with schizophrenia in hospital in June 2009 and was discharged on what is known as a Community Treatment Order (CTO). Eva Szeman also spoke to Matt Galloway in a longer interview on CBC's Metro Morning.

A CTO is a method for ensuring that someone who is ill can live in the community provided that they comply with the rules of the order. According to S 33 (3) of the Mental Health Act:

The purpose of a community treatment order is to provide a person who suffers from a serious mental disorder with a comprehensive plan of community-based treatment or care and supervision that is less restrictive than being detained in a psychiatric facility. Without limiting the generality of the foregoing, a purpose is to provide such a plan for a person who, as a result of his or her serious mental disorder, experiences this pattern: The person is admitted to a psychiatric facility where his or her condition is usually stabilized; after being released from the facility, the person often stops the treatment or care and supervision; the person's condition changes and, as a result, the person must be re-admitted to a psychiatric facility.

And while there are a number of criteria for instituting this, the key requirement is:

if the person does not receive continuing treatment or care and continuing supervision while living in the community, he or she is likely, because of mental disorder, to cause serious bodily harm to himself or herself or to another person or to suffer substantial mental or physical deterioration of the person or serious physical impairment of the person.

Of course, these orders are issued by doctors are are subject to periodic review by review boards. In this case, it seems that the woman with schizophrenia may have had a lawyer argue for her at a Review Board hearing without the knowledge of her family and that CTO may have been lifted. As Eva Szeman said in her interview, the privacy legislation that prevented the family from knowing of this needs to be changed. Families need to be involved in the care of their relatives. That was recommended by an all-party committee of the Ontario Legislature in 2010 but has been ignored. It is also recommended by the Mental Health Commission of Canada.

Because the CTO has expired, the family has had to go to a Justice of the Peace and has had a form 2 executed that requires the police to search for, apprehend and return Judy to hospital.

If you listen to Eric Hoskins in the Global TV interview, you will hear him state that you cannot compel a person to accept a CTO. Well, with all due respect Dr. Hoskins, not only can you but that is the entire purpose of that order. It is designed to allow people to live in the community who would otherwise be held in hospital provided they comply with certain criteria. And, if they break the order, the police can return them to hospital.

The most recent study of treatment orders was published in February of 2015 and found decreased psychiatric hospitalizations. Hospital costs were 40 per cent of the average total per person costs in New York City, and 52 per cent of the average total per person costs in Ohio.

Hopefully, Judy Szeman will be returned to her family safe but the anguish that the family is going through and any consequences of her disappearance can be put onto the shoulders of Dr. Hoskins for not even understanding his own legislation.

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