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Clinically Significant Differences Among Canadian Mental Health Acts John E Gray, PhD1, Richard L O'Reilly, MB, FRCPC2 |
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Objective: First, to highlight the major differences among mental health acts in different
Canadian jurisdictions as they relate to involuntary admission criteria,
treatment authorization, review and appeal procedures, and conditional leave and
community treatment orders. Second, to analyze the impact of these differences
on the care that individuals with mental illness receive. Methods: We examined the mental health act provisions of all Canadian jurisdictions to determine how the clinical management of a typical case would differ among jurisdictions. We used a statement of principles for mental health legislation endorsed by the Canadian Psychiatric Association to guide the analysis. We confirmed interpretation of each act and its implementation through key informant contact in each province and territory. Results: We found clinically significant differences among the provinces and territories on all major components of their mental health acts. Conclusions: Provisions that prevent patients receiving appropriate clinical care can be found in some Canadian mental health acts. Alternate provisions that support appropriate clinical care, that respect the human rights and personal dignity of patients, and that are consistent with the Canadian Charter of Rights and Freedoms can be found in the legislation of other jurisdictions. (Can J Psychiatry 2001;46:315-321) Key Words: mental health act, commited criteria, community treatment orders |
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Mental health legislation can be a critical factor in determining whether a person who is severely afflicted by mental illness does or does not receive psychiatric treatment and whether this treatment occurs in a timely fashion. To inform the debate on mental health law reform, it is helpful to compare provincial and territorial mental health acts in Canada to determine what differences exist and whether different provisions help or hinder the treatment of people with serious mental illnesses, such as schizophrenia and bipolar disorder. In recent years Saskatchewan (1), Manitoba (2), British Columbia (3), and Ontario (4) have made major amendments to their mental health acts, and reviews of mental health acts are occurring in other jurisdictions. These changes, and the policy implications of various options in Canadian mental health laws, have recently been described (5). In the US, many states Manuscript
received February 2000, revised, and accepted March 2001. |
have significantly broadened their physical dangerousness committal criteria (6). Various forms of outpatient committal have been introduced in more than one-half of the US states (7), in Australia, and in New Zealand (8); they are also being considered in the UK (9). This paper uses a typical but fictional case to discuss the clinical significance for an individual of different Canadian mental health laws. Method The provisions of the provincial and territorial mental health acts that are the focus of this study were the major topics addressed in a position paper on mental health legislation produced by the Canadian Psychiatric Association (10). We added the issue of outpatient committal because of its relevance to current law reform debates. Thus, we have studied involuntary admission criteria, treatment authorization, review and appeal procedures, and conditional leave and community treatment orders. We examined the provisions in the 12 Canadian mental health acts (10 provinces and 3 territories—Northwest Territories and Nunavut use the same act). We have created a fictional illustrative case as a framework in which to discuss the implications of various mental health act provisions for appropriate and timely psychiatric treatment. |
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