The key to helping those with serious mental illness is, first of all, to make sure they get treatment when they need it. This is particularly important for those who need help the most – those who are psychotic or falling into psychosis, with little or no relative insight into their own condition and spurning treatment as they fall into the abyss. This is where involuntary committal is needed. For this “access to treatment” to be timely and to forestall the worst effects of the illness, especially the damage caused by prolonged psychosis, one needs, in turn, mental health legislation that allows this help to be given.
Pathways has been in the forefront of defending provisions in our legislation that do allow for such help. Members of the Pathways, knowing from first-hand experience the tragedy of leaving the seriously mentally ill untreated to deteriorate on the streets, have been among those most active in these advocacy efforts.
Fortunately, as it happens, British Columbia has relatively good legislation for helping those with mental disorders. The B.C. Mental Health Act is based on medical need (“the need for care and supervision,” as it is worded in the act) and provides for involuntary committal where appropriate, after careful assessment. There are also checks and balances, most particularly review panels, to prevent abuses.
In the last few decades of the 20th century, however, an anti-treatment lobby surfaced. It began in the United States and then spilled over into Canada, notably Ontario. It was based on the false notion that involuntary committal was, in effect, a conspiracy against people’s rights when, in fact, by freeing those suffering from schizophrenia and other serious mental illness from their psychoses, it returned their humanity to them. The anti-treatment lobby, nevertheless, to justify itself, simply denied the reality of serious mental illness.
The whole sordid and tragic story of the havoc they wreaked, with those with serious mental illness as their victims, is told in a 1990 book entitled Madness in the Streets, by American authors Rael Jean Isaac and Virginia Armat.
This is where the B.C. Schizophrenia Society came in. It fought incipient efforts to undermine the B.C. Mental Health Act during a review of the legislation in 1992. BCSS North Shore (now the Pathways) was represented on the provincial society’s fledgling Advocacy Committee that drafted its original pro-active treatment document, Response to the Discussion Paper on Mental Health Legislation, submitted to the provincial government for the occasion. At the same time, the Branch, for lack of a concise readable leaflet explaining the need for treatment, drafted one itself, entitled simply Mental Health Act Review . Because it put the case for a realistic appreciation of the realities of mental illness so cogently, it later came to be known as the Manifesto. It was widely circulated and cited.
In 1993, member and author Herschel Hardin wrote a landmark article articulating the civil liberties case for involuntary committal, entitled “Uncivil Liberties.” The article, which first appeared in the Vancouver Sun, was widely reprinted in Canada and the United States and as far away as Australia and used in advocacy efforts by sister organizations in those other jurisdictions. It is as relevant today as the day it was first published.
Pathways members also played a key role in ensuring that, for those with serious mental illness, the Mental Health Act took precedence over new guardianship legislation that would have placed inappropriate administrative and legal obstacles in the way of timely treatment. We were similarly active in supporting “Bill 22,” an amendment to the Mental Health Act, which made the Act more explicitly pro-treatment for people in serious decline (“to prevent substantial mental or physical deterioration” is the relevant wording).
Two other areas of legislative and government advocacy, led by the B.C. Schizophrenia Society, also deserve to be noted. The first is the defence of Riverview Hospital or, in more general terms, of a tertiary hospital facility in the Lower Mainland with the specialization and expertise that Riverview has provided for the mentally ill, especially the most difficult cases. This has included a defence of the unique Riverview grounds.
The second additional area is advocacy for adequate spending on treatment and services for those with serious mental illness – sufficient acute care beds, outpatient services, rehabilitation and housing. The Pathways, as well as speaking to the issue directly, buttresses mental health spending by its educational work and its sheer presence, taking schizophrenia out of the closet and helping the public to appreciate the needs of those with serious mental illness.
Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill, by Rael Jean Isaac and Virginia Armat, New York: Free Press, 1990. The book is also available in selected libraries (West Vancouver Memorial, North Vancouver District, and Vancouver) or may be consulted at the Family Support Centre.
“The Manifesto: Commentary on the Mental Health Act Review,” BCSS North Shore (now the Pathways), 1992.
“Uncivil Liberties” by Herschel Hardin, Vancouver Sun, July 22, 1993.
Guardianship and the B.C. Mental Health ActAn explanation of how the B.C. Mental Health Act takes precedence over other legislation, to safeguard those with serious mental illness and their need for treatment.
Right to Treatment and Care
The rationale for involuntary committal and its provision in the B.C. Mental Health Act.
Highlights of the McCorkell decision
The findings of Justice Ian Donald of the B.C. Supreme Court in a famous 1993 case upholding the provisions of the B.C. Mental Health Act dealing with involuntary committal and helping to ensure the mentally ill are not abandoned
A Vision for Renewing Riverview
December 2015 report describing the new development of the Riverview Lands.