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Before Weighing In On Mental Illness, Know Your Stuff

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A recently released report on human rights, mental health and addictions from the Ontario Human Rights Commission (OHRC) ventures into areas that they have no expertise with: actual treatment for serious mental illness. By doing so without proper understanding, they confound the topic.

On p.93, the Commission talks about complaints from some respondents who had concerns about treatment methods used by doctors and hospitals for serious mental illness such as anti-psychotic medication. These respondents felt that they were not given access to non-medication therapies. The report even highlights a comment that describes the entire treatment model used today as being flawed.

Not surprising that some people are anti-psychiatry and anti-medication but should we not leave the actual practice of psychiatry to specialists? Science should be the definitive source for treatment and not the views of lay people who prefer unproven alternatives. Evidence-based research for schizophrenia treatment according to both the National Institute of Mental Health in the US and the Public Health Agency of Canada is that proper treatment involves anti-psychotics and various psychosocial treatments.

It is not discriminatory for doctors to recommend scientifically-based treatment rather than non-scientific treatment. An analogy would be to suggest that oncologists are discriminatory for recommending standard cancer treatment over untested alternative treatments. If you don't want to follow conventional psychiatric medicine that's fine provided it does not mean that you are a danger to yourself, to others, or that you will deteriorate to the point that you need to be in hospital. That is the law in Ontario. As I pointed out in an earlier post, a young man in BC went off his meds for an alternative treatment and killed his father.

The report then focuses on the alleged negative consequences of involuntary treatment. Involuntary treatment is not something that anyone wants to enforce unless it is absolutely necessary and it must have the proper controls in place to protect the rights of the individual and last for the least amount of time required to bring about meaningful improvements in the individual. And, Ontario does have such safeguards. These are the views of two who have been involuntarily committed although in other provinces.

Erin Hawkes wrote an article in the National Post stating that involuntary treatment saved her life. Had she not been hospitalized numerous times, she would have succeeded at her suicide attempts. She said:

"Despite my resistance, hospital staff kept me safe from myself when I could not do so on my own. Those whom I thought were my jailers were actually my caregivers. The insight into all of this eluded me; anosognosia -- the inability to recognize one's own disease -- plagued me, as is the case for many others who suffer from schizophrenia. As I recovered, however, I could start to see that I had been protected from myself. I was still alive."

She is now well enough that she was able to write a successful book about her experiences -- When Quietness Came: A Neuroscientist's Personal Journey With Schizophrenia.

Natasha Tracy, a young woman with bipolar disorder wrote a blog called "Doctors Should Treat Mentally Ill Without Consent." Her comment about those who want to protect the rights of the ill is they "are either well-intentioned people with little grasp of logic or just plain anti-psychiatry nutjobs." She ends with:

"So the next time someone spouts off against the evil doctors prescribing evil medications I suggest you ask them what they want the doctor to do after they have a heart attack and their heart has stopped. I mean, you wouldn't want hundreds of joules of electricity to be pumped into your chest without prior consent; that would just be inhumane."

The Commission then criticizes Community Treatment Orders -- directives enabling people to live in the community provided they continue with their treatment. The Commission says that some people find these to be coercive and then cite a 2005 report that an evaluation of their effectiveness "was divided" (p.96). They were referring to a study by Dreezer and Dreezer Inc called A report on the Legislated Review of Community Treatment Orders.

But, S 7.2.1 on p. 116 of that report states: "The qualitative data that we have gathered through our interviews provides a strong indication that clients who have been placed on a community treatment order in Ontario have experienced substantial improvement in a number of spheres."

Sounds like it works. In fact, other research done with Kendra's Law in New York State -- an assisted outpatient treatment law -- concluded that hospitalization, homelessness, arrest, and incarceration are all reduced and there is an increased adherence to treatment and overall quality of life for those on this program.

If the OHRC wants to help the mentally ill, they should advocate for improved access to treatment so that people with serious mental illness do not wind up homeless and/or incarcerated.