Benefits of Involuntary Treatment for Severe Mental Illnesses.
Background
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Untreated, the symptoms of severe mental illnesses such as schizophrenia, bipolar
disorder and psychotic depression can cause great harm to the person, their family and
society. Symptoms include delusions, hallucinations, thought disorder and anosognosia.
Anosognosia (see statement “Addressing the Challenges of Anosognosia) is a symptom
that does not allow the person to recognize they have an illness, let alone a treatable
illness.
Untreated symptoms of mental illness cause great harm. Harm to the person often
includes suicide, self-mutilation, poor physical health, mental suffering, social isolation,
unemployment and school failure. The families of people who have untreated
psychosis are often disrupted by delusional beliefs, bizarre behaviour and occasional
violence. Society is harmed by untreated symptoms leading to homelessness, excessive demand on
social and health services and, occasionally, severe violence. For example, Vince Li had a
history of successful treatment of his psychotic illness but when this did not continue in
the community he decapitated a fellow bus passenger. But with subsequent involuntary
admission under the provisions of the Criminal Code and treatment he again recovered
and is living in the community under psychiatric supervision. Tragic and unnecessary incidents like this
contribute to stigma against people with a severe mental illness.
Most people with a severe mental illness seek treatment voluntarily. But some with harmful
symptoms do not accept voluntary treatment because of their anosognosia: “I’m not
sick, I don’t need help”. For these cases, the only alternative is involuntary admission
and treatment under the applicable provincial or territorial Mental Health Act.
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To be admitted as an involuntary patient all jurisdictions in Canada require a person with a severe
mental disorder to pose a risk of harm to themselves or others. Ontario and
Quebec limit the definition of harm to “serious bodily harm”. We believe that definition should be
broader and that involuntary admission should be for the purpose of treatment. However, Ontario and some other provinces allow patients found to be capable, either through an advance directive or in hospital, to refuse the treatment necessary for their recovery and release resulting in prolonged detention and family disruption. Safeguards against wrongful admission are available such as renewal examinations, and review boards. To help people stay on their medications and out of hospital, Community Treatment Orders must be part of all provincial and territorial Mental Health Acts.
Families are often involved in initiating the process of obtaining involuntary treatment
when their loved one does not recognize they have a treatable mental illness. Families
are also often involved in providing information and support to their hospitalized
family member and especially in the discharge and community follow up phase. Information
exchange with clinicians is essential to support the person with the severe mental illness.
Position
ï‚· When hospitalization is needed it is always preferable that it is provided on a
voluntary basis with the agreement of the patient
ï‚· Involuntary admission and treatment is necessary when the symptoms of a severe
mental illness preclude the person from accepting needed voluntary treatment.
ï‚· All Mental Health Acts should have a broad serious harm criterion rather than
restricting the criterion to serious bodily harm.
ï‚· All Mental Health Acts should recognize involuntary admission is for the purpose
of treatment.
ï‚· Families should be consulted in all phases of voluntary and involuntary treatment, including
admission, hospital treatment and discharge and community treatment planning.