Lessons from the pandemic for the treatment of serious mental illness

COVID-19 has two lessons for serious mental illness we need to embrace. The first is from an editorial in the British medical journal the Lancet. They state that before the pandemic “the wants and needs of people with diagnoses such as schizophrenia rarely entered into increasing public discussion of mental health issues.” During the pandemic, little consideration has been given to the needs of those with serious mental illness.

Their lesson is that “Those who wish to build fairer societies and health systems after the pandemic ends must learn about and prioritize the needs of people living with severe mental illness as a matter of urgency.”

One way to accomplish that is to revise the very controversial involuntary treatment guidelines. One thing that we have learned from this crisis is that the vast majority of people are willing to sacrifice some of their freedom through lockdowns, masks, and living with furloughs and closed public places for the better good of slowing the spread of the virus. That is not dissimilar to involuntary treatment.

When someone is in the midst of a full-blown psychosis with all its delusions and paranoia, they have difficulty understanding that they are ill and refuse treatment. While those with serious mental illness are no more violent than others (when treated), they can be when not treated.

Over the years, I have written about numerous cases of what can be called preventable tragedies. In my book on schizophrenia, I wrote about a young man whose family desperately tried to get him treated only to fail until he killed his parents. He was found “not criminally responsible” and put into a forensic treatment facility where he thrived on medication. I met him years later and he was a clean cut, polite, gentle person.

In one of my articles, I accused the Ontario government of being complicit in a murder when a young man’s untreated schizophrenia was being ignored by the medical system. He got treatment after being found not criminally responsible for killing his father and I’m told is doing well in hospital.

Erin Hawkes, a neuroscientist with schizophrenia, had been involuntary treated over a dozen times until a drug was found that worked. She wrote in the National Post that forced treatment saved her life and said “The right to live supercedes the ‘right’ to not be involuntarily treated for mental illness. Those who are suicidal when ill but want to live when not, should have the safety of having another person decide to give us the chance to return to our lives and be well.”

Today, Erin is well on her medication, married and works in the mental health field in Vancouver.

Herschel Hardin, a former director of the Civil Liberties Association who has worked with Amnesty International wrote that “Here is the Kafkaesque irony: Far from respecting civil liberties, legal obstacles to treatment limit or destroy the liberty of the person” and that “Medication can free victims from their illness — free them from the Bastille of their psychosis — and restore their dignity, their free will and the meaningful exercise of their liberties.”

In 2013, a charter challenge in Ontario

to the use of one form of involuntary committal called community treatment orders (CTO’s) was dismissed. This enables doctors to treat someone in the community as an alternative to hospital when they have a history of lack of compliance and multiple hospitalizations. If the person does not comply, they can be returned to the hospital.

The Empowerment Council’s witness (the plaintiff) was actually a model for the success of the program. The witness considered herself a survivor of psychiatry. She had been hospitalized numerous times, had twice attacked her mother (once with a large knife) and had assaulted a doctor in the emergency room. After five hospitalizations, she was put on a CTO in 2009. Justice Belobaba commented “Since being placed on a CTO, Ms. Ness has not been admitted to a psychiatric facility, either voluntarily or involuntarily.” She has maintained her housing, volunteers with community organizations, has a job and takes classes.

He said her situation works for many. The Ontario all-party Task Force on Mental Health and Addictions (2008), recommended that involuntary treatment be reviewed and improved but the Liberals refused. Christine Elliot, the current health minister, was co-chair and strongly supported that but has done nothing.

Once this current crisis is over, Ontario should take some action but I am doubtful based on past performances. It is high time they do though.