Webcast Recording - Review of the Involuntary Psychiatric Treatment Act by Stephen Ayer

Recording of the Webcast

Review of the Involuntary Psychiatric Treatment Act

by

Dr. Stephen Ayer

Executive Director

Schizophrenia Society of Nova Scotia

Presentation made during the February 10th, 2014, meeting of the HRM Chapter of the Schizophrenia Society of Nova Scotia

To view the webcast recording, please click here.

Royal Assent was given to Nova Scotia’s Involuntary Psychiatric Treatment Act on December 8, 2005. The Act came into effect on July 3, 2007. An independent review of the Act, conducted by the Honourable Justice Gérard La Forest and Professor William Lahey, was made public on December 12, 2013.

An overview of the Act and its application was provided, as was a review of some of the many important findings of the independent review. The availability of and access to a broad range of treatment and support options for people diagnosed with mental illnesses was also discussed.

Flawed reasoning

A letter to the editor published in today's edition of The Chronicle Herald:

There is a flaw in John Roswell’s reasoning when he writes (Jan. 17), “I believe that most people who have experienced psychosis would agree with me that people should be held responsible for their criminal acts, no matter what their state of mind was when they committed the crime.”

It is the accused who ultimately determines whether or not to proceed with a defence of not criminally responsible on account of mental disorder. Therefore, if the accused, once found fit to stand trial, believes that psychosis, for example, is the reason they should be found not criminally responsible, they will instruct their defence counsel to present this argument in court.

With regard to better access to mental health services, many people experiencing psychosis have lost contact with reality to such an extent that they do not believe they are ill. Therefore, they do not seek treatment for their mental disorder, despite the efforts of family and friends to assist them. This is one reason why the Nova Scotia legislature passed the Involuntary Psychiatric Treatment Act in December 2005.

Stephen W. Ayer, Executive Director, Schizophrenia Society of Nova Scotia

Tragic cases show how much we misunderstand mental illness

An opinion piece published in the January 8th edition of The Chronicle Herald:

By Lezlie Lowe (pictured)

How many times have I heard this?

"She had everything."

Last time was New Year’s Day, when a family member and I were chatting about the November suicide of Daron Richardson, the 14-year-old daughter of Ottawa Senators assistant coach Luke Richardson.

Daron was a top student and hockey ace. She had, as it goes, everything.

Well, sure she did. She had pools, private school and iPods, but not her health — not her mental health.

It’s not uncommon to hear this logic tossed around: the better off a person is, the less likely he or she will suffer from psychiatric disorders.

And it’s true; mental distress is more prevalent in lower income households in Canada. But wealth, by no means, acts as a prophylactic against depression or psychosis. Just ask the family of Ali Reza Pahlavi, the son of the former Shah of Iran, who suffered from depression and shot himself Tuesday.

Mental illness isn’t a plague of the underprivileged or the fate of those who aren’t smart enough or committed enough or canny enough to seek out help, take their medication and stay in treatment.

Mental illness can be tweaked by our actions, sure. But it isn’t a choice. Ask yourself: if your best friend developed pancreatic cancer, would you ever say, "I just can’t understand it. He had everything."

And what of convicted killer Glen Douglas Race?

Race was a normal Dartmouth kid. Did he have everything? Perhaps not yachts, ponies and private jets, but by all accounts he had all the things most of us need to get by. And more than many have. Nevertheless, Race faced steady psychotic episodes. He was diagnosed with paranoid schizophrenia in 2001 in his second year at Dalhousie University.

To say Race’s illness was debilitating is an understatement. Race has been sentenced to life in prison for the upstate New York killing of Darcy Manor, a husband and father of two. He also stands accused of the first-degree murder of two Halifax men, Michael Paul Knott and Trevor Charles Brewster. Race’s parents and brother spoke publicly Wednesday, offering condolences to the families of the victims and raising this issue: Race needed more help than his family could give. And, more importantly, Race needed more help than the Nova Scotia mental health care system could offer.

Several families are in mourning now, Glen’s mother Donna Race said, because her son didn’t get the care his illness required.

The Involuntary Psychiatric Treatment Act, which could have forced Race into care and kept him from harming others, didn’t become law until July 2007, two months after the then 26-year-old was arrested trying to cross the U.S.-Mexico border with a rifle.

That policy is in place now. And it’s something. But it’s not enough. Our financial commitment to mental health still demonstrates a grave misunderstanding of its pervasiveness and seriousness.

As the Race family pointed out this week, in a painful and oft-repeated reminder, the system needs cash.

One in five Nova Scotians suffers from mental illness and Nova Scotia spends less than five percent of its health care budget on mental health.

In June, auditor general Jacques Lapointe released a report saying the province was failing to meet mental health treatment standards. Moreover, those failures were inadequately unmonitored, with no plan for a fix.

In short? We treat mental health like a joke; like it’ll clear up on its own.

Especially, we imagine, when those suffering from it have everything.

(llowe@herald.ca)

Photo credit

Patients' rights frustrate families

An article published in the March 12th edition of The Globe and Mail:

By André Picard (pictured)

The trial of Vince Li, the so-called "Greyhound bus killer," garnered a lot of media attention. There is no need to rehash the gruesome details.

But let's linger on one aspect of the case, because much was made of the fact that Mr. Li suffers from a severe mental illness, schizophrenia.

This is the story of someone else who suffers from schizophrenia.

His name is Matt. Like most [people with schizophrenia], he has never harmed anyone physically - except himself.

But he and his illness have caused his family and friends untold pain - a pain made more searing by the coverage of Mr. Li's trial. The descriptions of him as "psycho," a "sicko," a "nutcase" and so on hurt profoundly; so, too, did the focus on Mr. Li's "crazy" symptoms and the lack of attention paid to the fact that he was untreated for a treatable condition.

"Nobody deserves to die like that young man on the bus. But seeing the way schizophrenia was reported made me sick," said Steve, Matt's father.

They have a last name, but have asked that it not be used. There is a lot of stigma surrounding mental illness, and vilification of the mentally ill. "I'm self-employed and I can't afford having people think of me as the father of a 'freak.' That's the sad reality," Steve says.

But, at the same time, Steve wants the public to see another side of schizophrenia, one that will never be front-page news.

It is a story of frustration with Canada's patchwork mental-health system, one in which care is not available until there is a crisis. It is the story of the devastated family of the person with schizophrenia.

It is a story of anger with a legal system that gives people with severe mental illness the right to refuse treatment, and affords families no right to help their loved ones get well.

The family has lost count of how many times Matt, who is only 20, has attempted suicide, how many times he has overdosed.

Matt will ingest any drug he can get his hands on, from NyQuil to ecstasy. When he does, the demons that haunt him recede into the shadows for a while.

Like many people with severe, untreated mental illness, Matt has an ever-lengthening criminal record, most of it related to shoplifting over-the-counter drugs at pharmacies and public intoxication.

He spends nearly as much time in prison as he does in hospital - essentially jailed for being ill.

Who could have imagined it would come to this?

At one time, Matt lived a comfortable middle-class existence in suburban Toronto. He was a star athlete, a gifted musician, an army cadet, a popular classmate. But things began to unravel in high school.

He became withdrawn. Smoked and drank and did drugs with a little more gusto than his peers. Began acting weird. Dropped out of school. At first, it was dismissed as the growing pains of adolescence, but his behaviour soon spiralled out of control.

Matt bounced around various group homes and court diversion programs. The stress and frustration were such that his parents' marriage almost collapsed.

Then the diagnosis came - schizophrenia.

"Finding an explanation for his behaviour was a relief," Steve says. After all, parents tend to blame themselves.

"But then you find out what it really means - a mind-altering disease destroying a person you love - and it's heartbreaking," Steve says.

Trying to get his son the care he needed was more heartbreaking still.

The wait to get Matt into a psychiatric bed in the region of Ontario where he lives was 12 weeks or more. He bounced from crisis to crisis. When there was a glimmer of hope and the young man was willing to be treated, care was not available.

After a suicide attempt, Matt was treated in the emergency room then sent home. Not because he didn't need help, but because all the hospital's psychiatric beds were full.

Matt has now deteriorated to the point where he is hospitalized against his will; he has been committed, or "formed" as they say in the jargon of the milieu.

But he can still refuse treatment and he can still wander away from hospital to shoplift and get high. "He has lost the capacity to make rational decisions, but he still has the legal right to make those decisions," Steve says.

He is exasperated by this paradox, as are many parents of adult children with severe mental illness.

"In the end, all I want is my son back," Steve says mournfully.

He has nothing but praise for the health professionals who have cared for his son. The nurses and doctors, he says, have been phenomenal. So are the volunteers and staff from the Canadian Mental Health Association.

"But their hands are tied by consent forms and legal nonsense," Steve says. "The Charter of Rights and the Mental Health Act give my son the right to be sick."

Vince Li, too, had the right to be sick, the right to be guided by psychotic visions, the right to refuse treatment. In that case, the tragic consequence was the senseless death of Tim McLean on a Greyhound bus.

Two more victims of untreated schizophrenia, of a mental-health system with screwed-up priorities.

But there are many more victims of untreated mental illness, of a profoundly flawed system.

Far from the headlines, they are dying deaths by a thousand cuts, deaths by a thousand pills, deaths by a thousand missed opportunities to treat.

Also see:

The mentally ill who break the law deserve 'all mercy and humanity'

Involuntary Psychiatric Treatment Act

The November 2007 issue of the Newsletter of the Kings County Chapter of the Schizophrenia Society of Nova Scotia contains a number of articles relating to the new Involuntary Psychiatric Treatment Act, including an interview with Dr. David Mulhall, Medical Director, Annapolis Valley Health, Mental Health Services (pages 2 and 3).

To view the newsletter, click here (downloads a PDF).

Involuntary Psychiatric Treatment Act

The Involuntary Psychiatric Treatment Act came into effect on Tuesday, July 3rd, 2007.

Fact sheets and links to other important information on the Involuntary Psychiatric Treatment Act are available from the Nova Scotia Department of Health. To view, click here.


I have serious concerns about the accuracy of some of the Nova Scotia Department of Health Fact Sheets, as well as the accuracy of the webpage itself.

For example, the criteria for involuntary admission are, in fact:

Section 17
Where a psychiatrist has conducted an involuntary psychiatric assessment and is of the opinion that

(a) the person has a mental disorder;

(b) the person is in need of the psychiatric treatment provided in a psychiatric facility;

(c) the person, as a result of the mental disorder,

(i) is threatening or attempting to cause serious harm to himself or herself or has recently done so, has recently caused serious harm to himself or herself, is seriously harming or is threatening serious harm towards another person or has recently done so, or

(ii) is likely to suffer serious physical impairment or serious mental deterioration, or both;

(d) the person requires psychiatric treatment in a psychiatric facility and is not suitable for inpatient admission as a voluntary patient; and

(e) as a result of the mental disorder, the person does not have the capacity to make admission and treatment decisions,

the psychiatrist may admit the person as an involuntary patient by completing and filing with the chief executive officer a declaration of involuntary admission in the form prescribed by the regulations.

Involuntary Commitment

From the PBS program, Religion & Ethics Newsweekly. To view, including a video, click here.

Involuntary Psychiatric Treatment Act: July 3, 2007

The new Involuntary Psychiatric Treatment Act will be proclaimed in effect in Nova Scotia on July 3, 2007. The regulations that accompany this Act can be found here (downloads a PDF file; note: parts of some pages are missing).