An unpublished Federal Department of Justice study released only through Freedom of Information provisions and two recent research studies explain why the abysmal treatment we see for the mentally ill rest with governments, particularly in Ontario.
A paper entitled "The Mentally Ill: How They Became Enmeshed in the Criminal Justice System and How We Might Get Them Out" by Justice Richard D Schneider outlines why so many people with mental illness wind up in jail when they should not be there. Schneider presided over the mental health court in Toronto. The main fault, he says, rests with the Ontario Mental Health Act and the provisions for involuntary treatment.
Under the current legislation, someone who is exhibiting all the signs of illness, listening to the voices of Martians in his head while denying he is ill, cannot be hospitalized without consent. Neither the police nor the Justice of the Peace will help hospitalize that person if they do not believe there is "clear evidence that he is dangerous to himself or others." And, even if he is admitted, he is "discharged before he is stable" and "his condition deteriorates."
But, as Schneider says, if he punches a policeman when the family calls them for help and he is charged with assault, he will be remanded for a psychiatric evaluation by the courts because he will likely appear totally disorganized and ill. He will then remain in hospital and be stabilized until his trial so that he will be mentally well enough to participate and understand the proceedings. At his trial, he will be found Not Criminally Responsible at the time the offence took place, and he will then be sentenced to treatment; treatment that he should have received months or even years earlier when his family first attempted that.
As Schneider says, treatment in a forensic system is far more costly than in a civil system. "One learned colleague suggested," he said, "that up to 20 civil patients would have been accommodated and treated in the bed space allocated to a single forensic patient."
Thus, we have a situation where those with mental illness are over-represented in the criminal justice system, and that representation has more than doubled between 1997 and 2008. A recent one day snapshot, Schneider says, found that 63 per cent of female Federal inmates were prescribed psychotropic medications.
The 1967 Ontario Mental Health Act allowed for someone to be admitted to hospital involuntarily if they were suffering from a mental disorder severe enough to warrant treatment in hospital for their own or others safety, and they could be held for one month. That was changed in 1978 thanks to the civil libertarians to involuntary treatment only if the person had threatened or attempted to do harm to himself or others. The time held was lowered to 14 days.
Further, the 1967 Act considered that hospitalization meant treatment, and people being held were treated. That changed in 1978, and someone could be held involuntarily but they did not have to agree to treatment. As Schneider said, "If the individual is not seen as dangerous to himself or others he is free to roam the streets 'madder than a hatter.'" And, in many cases, the person will come into conflict with the law and wind up in the vastly more expensive forensic psychiatric system.
Attempts have been made to change the Mental Health Act in Ontario. That was one of the recommendations of the 2008 all party Select Committee on Mental Health and Addictions Report. Recommendation 21 in that report states that the Ontario government should set up a task force within one year to "investigate and propose changes to Ontario's mental health legislation and policy pertaining to involuntary admission and treatment."
It is 2018, and the Liberal government still has not acted.
The members of the Select Committee also commented that they were impressed with the British Columbia Mental Health Act, which they considered superior. Sadly, some groups in B.C. are trying to change that act to make it more like the Ontario Act, while others are defending it, myself included.
Schneider also talks about the lack of proper funding for mental illness treatment. That was the subject of two recent research reports in the Canadian Journal of Psychiatry. The first "Public Expenditures for Mental Health Services in Canadian Provinces," looked at provincial spending between 2003 and 2013. What they found was that, "Nationally, the portion of total public spending on health that was spent on mental health decreased from FY 2003 to FY 2013 from 5.4 per cent to 4.9 per cent."
The second paper called "Temporal Trends in Mental Health Service Utilization across Outpatient and Acute Care Sectors: A Population-Based Study from 2006 to 2014," found that in Ontario, "The increasing acute care service use coupled with the reduction in outpatient visits suggest, overall, an increase in demand for mental health care that is not being met in ambulatory care settings."
There is an election in Ontario this year and this is one issue that the incumbent Liberals need to be grilled about.
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