The Quebec psychiatrists’ association (AMPQ) has come out in support of Bill 23, which aims to relax the criteria for the involuntary hospitalization of a person in crisis.
The government’s bill is, in fact, the promised overhaul of “P-38,” the Act respecting the protection of persons whose mental state presents a danger to themselves or to others, which was passed more than 25 years ago.
Currently, authorities can only involuntarily hospitalize a person if they pose a “serious and immediate” danger. This criterion is among the most restrictive in Canada.
Bill 23 proposes replacing this criterion with one of a “situation where there is a danger” to the person or to others.
The AMPQ believes it is necessary to move in this direction, noting that many people with mental illness are unaware of their condition.
“This greatly complicates clinical interventions. It complicates interactions with family members, because often these ill individuals do not understand at all that we want to treat them, nor the relevance of the treatment. They often see themselves as victims of a system that wants to force them into treatment,” explained AMPQ president Claire Gamache during consultations on the bill at the National Assembly on Wednesday.
However, “if treatment begins earlier, and if it is provided with great compassion and empathy, patients gradually come to accept that treatment improves their lives, even if they don’t always fully recognize that they have a mental illness or a diagnosis,” she continued.
According to Gamache, in this kind of context, “the use of P-38 is necessary to build an alliance against the illness and enable the patient to regain their autonomy and freedom.”
She also called for “extreme caution” regarding the conflation of mental illness and violence. “The statistics are clear: only three to five per cent of acts of violence in society are committed by people with mental disorders,” the psychiatrist stated.
Although it supports the bill, the AMPQ asserts that we must also consider optimizing alternatives to hospitalization.
“The right to freedom and autonomy is important, but we must also have the right to health and dignity, and ideally, these rights should be as well-balanced as possible,” argued Gamache.
Immediate danger
If the bill is passed, an individual with schizophrenia, for example, who is reported to be deteriorating but who does not necessarily pose an immediate danger, may be taken against their will to a hospital, where they will remain for seven days.
However, a police officer must first obtain authorization from a crisis intervention worker before proceeding. Quebec aims to increase the number of such workers from 484 to 1,025 within five years.
After the seven-day period, to keep the individual in the hospital, a request must be filed with the Quebec Administrative Tribunal (TAQ). A new division of the TAQ would be created, and 20 judges hired to handle these requests.
Another new development: individuals struggling with mental health issues will now have the option to complete an advance psychiatric directive specifying their wishes in the event of a major mental health crisis.
The Quebec provincial police officers’ association (APPQ) has already welcomed the proposed changes.
The murder in early March of Chong Woo Kim, the owner of a convenience store in downtown Montreal, reignited the debate over the application of Bill P-38.
It was reminiscent of the case of police officer Maureen Breau, who was killed by an individual in crisis whose aggressive behavior had been reported by members of his family.
The government hopes to have this bill passed before the end of the legislative session on June 12.
-With files from Caroline Plante, La Presse Canadienne
–This report by La Presse Canadienne was translated by CityNews
