[Opinion] Putting an end to the safe approach to mental health

The drama that took place in Amqui last week gave rise to reactions that were surprising to say the least. Affirming “that madness must not triumph over hope”, the Premier invited Quebecers to monitor and denounce their loved ones “who are showing worrying signs”.

The Minister of Public Security mentioned, before changing his mind, the possibility of revoking the driving licenses of people who have received certain psychiatric diagnoses. He nevertheless repeated in several forums that mental health is a public safety problem, relying in particular on the number of calls related to mental health received by the Montreal Police Service. However, the accused in the Amqui tragedy is neither known for any mental health problems nor has he requested an assessment of his capacity to stand trial or of his criminal responsibility.

The connection between mental health and public safety, which is increasingly common, has no basis in scientific research. On the contrary, research shows that people with mental disorders are more often victims of violence than perpetrators of violence. Stories like those told by Investigation last week are exceptional. However, they serve as a pretext for more control and coercion.

We hear too often, especially from psychiatrists, that it is complicated to treat someone against their will in Quebec. In the report ofInvestigation, it is explained that, since the 1960s, “we have given more rights to patients who suffer from mental disorders”, but also “the responsibility to seek care themselves”, which “poses a problem when the no one recognizes that they are ill, unless they represent a danger to themselves or to others”. This statement is simply false.

Consent to care and its corollary, refusal of care, are fundamental rights. It is however possible for a physician to obtain authorization from the court to impose treatment on a person who is incapable of consenting to his care, despite his refusal, if such care is required by his state of health. Being in denial about one’s illness is one of the criteria used to assess the capacity to consent to care. It is therefore not necessary, and above all not relevant, that the person presents a danger to himself or to others in order for treatment to be imposed on him. The danger to oneself or others is the criterion allowing hospitalization without consent (custody in an institution), and not the treatment.

These statements are disturbing on several levels. They constitute public misinformation that contributes directly to fueling fear and prejudice. They also demonstrate the lack of knowledge that some psychiatrists have of the exceptional legal mechanisms that they nevertheless use more and more regularly and which constitute significant violations of fundamental rights.

Indeed, the number of requests presented to the courts by hospitals to force hospitalizations and treatments increased respectively by 29% and 45% between 2015 and 2020, amounting to 7,030 requests for forced hospitalization and 3,244 requests for forced care. These requests are accepted in more than 95% of cases.

This increasingly common use of the civil courts to force people into hospitalizations and psychiatric treatment says more about the state of our public services than about any problems of public safety. For twenty years, following an international neoliberal trend, the Quebec government has systematically slashed public services, particularly support for individuals and families.

Health spending has held up, but a significant portion is drained by the titanic salary increases granted to doctors during the years of the Couillard government. During the same period, while the crime rate was falling, budgets related to public safety experienced increases far exceeding inflation, particularly for police services, whose budgets increased by 10%.

It is therefore not surprising, in a context where social and health services are moribund, that the police are seen as the “first responders” in mental health. It’s also easy to see how, with police cops dealing with mental health issues without any skill, the narrative about public safety and the “mental health crisis” builds. However, it is our social and health services that are in crisis and must be massively refinanced to finally free themselves from the security approach to mental health.

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