The upcoming Ontario election poses a difficult problem for those of us advocating for improved services for mental illnesses. It would seem that none of the parties care about this issue. That is most certainly the case for the ruling Liberal party as I've pointed out in recent blog posts.
The Liberals inherited an excellent report on bringing about improvements when they took office in 2003 and ignored it despite assurances that they would not. They then put together and all party committee which brought in another excellent report in 2010 which they have also ignored. The last time any reform was passed was in 2000 under the Conservative government.
That was Bill 68 commonly referred to as Brian's Law and named for Ottawa sportscaster Brian Smith who was killed by a man with untreated schizophrenia. Only 10 legislators voted against that bill of whom six were members of the NDP including their former leader, Howard Hampton. That piece of legislation introduced deterioration in health as a criterion for involuntary admission rather than just dangerousness and implemented community treatment orders.
One Liberal party official mentioned to me recently that the government would like to do more but money is scarce. He said they are slowly working through priorities and will eventually effect change. But, two of the most significant changes that were recommended in the 2010 report will not cost more money and may actually save money. Those changes are improving the committal criteria and changing the privacy laws.
The concept of involuntary committal can be a red flag for many as there are those who consider this to be akin to imprisonment. It is something that should be rarely used but unfortunately some people with brain illnesses, such as schizophrenia and bipolar disorder, are unable to understand that they are ill and pose a threat to themselves or others or will deteriorate significantly without medical intervention. This lack of understanding can lead to refusing treatment.
In fact, the law in Ontario is so absurd that people who are potentially dangerous because of their mental illness have been incarcerated in hospital but refuse to be treated and thus remain there for years.
Dr. John Gray of Victoria is an internationally known expert on mental illness and the law and he testified at the Select Committee on December 9, 2009. In his presentation, he cited "Treatment Delayed--Liberty Denied" published in the Canadian Bar Review which he co-authored with Robert Solomon, a law professor at Western University and Dr. Richard O'Reilly, a professor of psychiatry at Western. That paper cites examples of people being detained without treatment for five, and two at 20 and one at 25 years. Yes, 25 years locked up in a hospital because they were a danger but Ontario law allowed them to refuse the treatment that would have improved their illness so they could be discharged.
Gray calculated that at $600 a day in hospital, or $219,000 a year, the taxpayers forked over and wasted $5.475 million for 25 years for just one patient.
That paper, Gray said, could not have been written about any other province in Canada or most other countries because "they would treat people in these circumstances and they would be discharged."
Ontario legislation lags behind other provinces and many other countries as we deny people the right to be well. And, for those who will object on the basis of the Charter of Rights and Freedoms being violated, Gray pointed out that "Attorneys General and the Legislatures of six provinces obviously don't agree with that, and a number of courts have also found for broad committal criteria."
As a result of Dr. Gray's testimony and that of other people who said similar things, the committee recommended that laws on involuntary treatment be investigated and changed and that "the changes should ensure that involuntary admission criteria include serious harms that are not merely physical, and that involuntary admission entails treatment. This task force should report back to the Ministry within one year of the adoption of this report by the Legislative Assembly."
That was recommendation 21 and was never done.
The other improvement that would not be expensive is changing privacy laws. Dr. Gray told the committee that "In Ontario, if clinicians want to include families in their circle of care, it cannot be done because of the law, basically. The only way you could get that is if the person gave permission or they're found incapable and then somebody else gives permission."
Dr. Gray contrasted Ontario with B.C. and said that in B.C. "The act there recognizes that families must have information, without consent if necessary, to serve the needs of the client and to enhance their health care." That is, after all, sensible. Just because a sick child is over the age of 18 does not mean that the family does not care about them and should be shut out of treatment by doctors. I seriously doubt if that happens when a child over 18 suffers from cancer or some other ailment.
And again, the committee agreed with Dr Gray and the others who said the same thing and recommended that a task force be set up to reform the privacy legislation. These changes "should ensure that family members and caregivers providing support to, and often living with, an individual with a mental illness or addiction have access to the personal health information necessary to provide that support, to prevent the further deterioration in the health of that individual, and to minimize the risk of serious psychological or physical harm."
That was recommendation 22 which is logical and would save money for the health care system by improving the efficiency of treatment. The Liberals have ignored this as well.
And I for one, do not believe they will ever do any of this based on their record in office. And that is my dilemma. The NDP do not seem interested as their former leader voted against the last reform bill as did 6 of the 10 who voted against it. The Conservative party were the ones who introduced the last reform and it was the current Conservative health critic, Christine Elliott, who pushed for the all party legislative committee and was its co-chair. But, I am not alone in not wanting a Mike Harris clone in Tim Hudak, as premier of this province.
According to the Toronto Star chart on where the parties stand on various issues, the Liberals want to build more hospitals, the Tories want to break down barriers and the NDP wants to eliminate ambulance fees and Local Health Integration Networks. On labour, Hudak is still union bashing.
And that is the problem for those of us trying to bring about improved services for the seriously mentally ill. Their is no choice and there should be.
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