Call to reform involuntary care under Mental Health Act

Proposals from British Columbia’s premier to expand involuntary mental health treatment in British Columbia are renewing debate around the state power to hospitalize someone against their will. That power has shaped journalist Rob Wipond’s family for more than 20 years since his father was detained in Kelowna after seeking mental health support for the first time in early retirement. Interview continued from Wednesday’s Daily Courier.

Wipond: We don’t often hear from the people who are being subjected to those laws and to that forced treatment. We’re not talking about people just being gently coerced. And when you do, you discover this is having an enormous impact on people’s lives. It’s a very brutal process. We’re talking about the use of security guards, four-point restraints, people being stripped against their will, people crying out and pleading that they can’t tolerate the effects of a drug and being given a monthlong dosage with a needle. So understandably, those people come out of that experience, very outspoken against that and very traumatized by it. Question: Do I hear you saying that serious conditions like schizophrenia aren’t medical and there aren’t medical options that can help people with such conditions? If so, is that really accurate? Wipond: There is no definitive test to determine if someone has a particular mental disorder like there are for many other medical conditions. The most recent DSM edition Diagnostic and Statistical Manual of Mental Disorders and the American Psychiatric Association have acknowledged that there is no scientific consensus on whether mental illnesses like schizophrenia have a genetic component, or are related to chemical imbalances in the brain, or to something else. Pharmaceutical options tend to be more helpful to people who take them voluntarily and have agency over the dosage and combination that works for them. If someone takes an anti-psychotic drug and it helps them and they want to keep taking it, that’s great. If they don’t find it helpful and the side-effects are too great, what are we doing trying to make them take it? We need to be honest that if that’s the case, we’re not correcting that person’s medical problem by giving them sedative anti-psychotic drugs. We are just giving them a chemical restraint without other solutions to support them to live a good life as they see it. Question: The premier and leader of the opposition in B.C. have both floated increasing involuntary treatment powers under the Mental Health Act to respond to public safety concerns and people being killed by the toxic drug poisoning crisis. Are those proposals part of the solution and does evidence support them? Wipond: There’s no body of credible medical scientific evidence out there that says involuntary psychiatric treatment helps people in the long-term. Most studies measure short-term “effectiveness” of hospitalization in terms of adherence to medications and reduction of delusion, for example. But we haven’t measured how that person is actually doing, or the impacts on their relationships and trust with family and health-care providers, or their willingness to seek future voluntary care after being involuntarily detained, in a systematic, holistic way. This lack of evidence has now been recognized by the World Health Organization and the European Union of Medical Specialists such that they’re strongly advocating reduction, and ultimately, the end of coercion in mental health care. I think it’s important that we contextualize it and actually talk about the issues of forced treatment, not only in relation to those vulnerable segments of the population. Some people may see more homeless people or hear someone shouting on the street and think they should be gotten rid of, which is a very problematic and kind of reactionary response. And unfortunately, politicians from left to right across North America seem to get some traction out of supporting it. It’s being sold to people with liberal sentiments as true compassion and care and to people who are more conservative as an effective policing initiative, when it’s really neither and it doesn’t help these people. B.C. has some of the highest rates of forced treatment and the broadest laws in North America, and they’ve got the same problems everyone else has. It’s not solving anything and it hasn’t been solving anything for decades. Question: Your book discusses how workplace and institutional wellness initiatives have led to some people who are not in crisis being involuntarily detained when they ask for help. Is this a case of good intentions going wrong or overreach in those settings? Wipond: My concern is the different forms of power and leverage that are used against people. There is massive cultural buy-in to the concept of mental health, but it means all things to all people right now. Suddenly, when we say “mental health,” everybody who is grieving or who is feeling anxious about something has mental health issues. As I show in the book, there’s power relationships in workplaces where this coercion can play out and coerce somebody into treatment for experiencing conflict or distress in the workplace. Workplaces need to get out of this dynamic. And we’ve got to take away these really powerful laws that allow it to occur and rewrite them altogether. Question: In the book, you don’t argue for ending involuntary treatment as a whole. Instead you call for increasing data collection, evaluation and oversight over involuntary detention. What could improving accountability in involuntary mental health care look like? Wipond: I don’t think abolition is going to be seen as realistic by a lot of people, and we’re actually heading in the opposite direction because all the numbers across North America show more people are being forcibly treated. So then we back up to ask: What are some of the things we could do that should already be happening? And one of those is to be clear with the data and find out who is being forcibly treated, how often and what are the outcomes according to them, to their family and to their healthcare providers. Let’s be open about that and make sure lots of different points of view are at the table. Because right now, a fundamental part of this system is that it operates in the darkness. Then the next level is accountability for the fact that a large proportion of detentions don’t follow the laws as they’re written now in B.C., according to the Ombudsperson. Nothing’s changing, and I expect the moment the Ombudsperson is not watching anymore, we’re going to fall back to very, very low levels of accountability. And then we haven’t even got to the issue of abuse, harm and trauma and lack of positive outcomes for people. The data we do have shows it’s bad, and the complaints process is a mess. It’s virtually impossible to hold a mental health practitioner to account because it is impossible to say with certainty someone has one mental health issue over another or would have been slightly less worse-off if they hadn’t received a specific treatment. Question: Throughout the book, you mention your involvement with efforts to reform and improve involuntary treatment, as well as friendships with anti-involuntary detention activists. How does that experience inform your book and how do you navigate those relationships in your reporting? Wipond: I’ve never really believed in this term “objectivity,” but I do believe fairness is absolutely vital. I try to legitimately understand other points of view, and integrate those and reflect on those. As journalists, we write about things that we think are important, and that we care about. In this case, I’ve seen the level of damage that’s being done, and that’s the side that’s not being reported nearly as much. On the other hand, the mental health industry is really dominating the discussion right now, and we are so over-biased in the other direction right now as a culture. I don’t consider myself in the end as a fullon activist on this issue, but I don’t think there’s any mystery to anyone who reads my writing where I’ve landed in my conclusions and the lens that I’m bringing. In fact, I try to be upfront about that so that people can evaluate what they’re reading from that perspective. I would love to see more people who’ve been through forced treatment writing and speaking out and being able to report on these issues because their voices are desperately underrepresented in our society. This is becoming a trend and I think that’s important for everybody to understand and care about.