Mental health law P-38 (Law on the protection of persons whose mental state presents a danger to themselves or to others) does not protect a large part of the most severely affected people. In the name of the right to the inviolability of the person, Bill P-38 allows incapacitated persons to evade the care required by their condition and causes irreversible deterioration.
According to studies, 60% of people with schizophrenia and 50% of people with manic depression (PMD) are unaware that they are sick. Their lack of self-understanding causes half of people with significant mental illness to skip treatment. They refuse medical follow-up, medication and/or hospitalization and slip through the cracks of the social and medical net.
Families struggle to obtain the required care and/or hospitalization for their loved one. Having a sick person hospitalized against their will is an ultimate battle whose outcome is more than uncertain. To obtain temporary confinement in the hospital, the family and the doctor must be able to prove that the person presents a serious and immediate danger within 24 to 48 hours for themselves or for others. During provisional confinement, if two psychiatrists come to the same conclusion of dangerousness, they can obtain from the court a “regular” confinement of 21 days.
One might think that it will be obvious for the judge to conclude that the person before him is sick and must be hospitalized, but this is not the case. The sick person often stays in complete silence and does not give access to his thoughts to the evaluating psychiatrists. She does not talk about her delusions, her hallucinations and her psychological distress. She gathers all her energy to look normal. Very often, relatives, who know the sick person and who are aware that the worst can happen, helplessly experience the revolving door syndrome. Their sick person, whom they struggled to hospitalize, came out a few hours later without having received the required care.
The family and relatives witness again, in fear, the descent into hell of the affected person, over hours, days or weeks, until another event testifies to the dangerousness of this person. .
Law P-38 must be amended. Preventive interventions with a law supporting them must be put forward. Adding money for these very severely affected clienteles will not solve the problem if the law is not amended. In some Canadian provinces (Ontario and Saskatchewan) and in several countries, preventive interventions are put forward. In Sweden, Norway, Scotland, New Zealand, Australia, Switzerland, UK, etc., community treatment orders exist. They make it possible to intervene earlier with the sick person to avoid hospitalizations and tragedies. In New Zealand, it is possible to impose community treatment without the person having been hospitalized previously. Appropriate housing resources, such as supervised apartments and adequate follow-up by mental health workers in the community, are part of the intervention strategies.
Some will oppose by brandishing the right to the inviolability of the person. Do not forget that people in psychotic crisis are temporarily in another reality and therefore unable to make an informed judgment about their situation. What do we do in Quebec with the right to be treated at the appropriate time before an irreversible deterioration of one’s capacities and before committing the irreparable? On Friday, March 17, a young man from Rosemont killed three of his relatives. Wouldn’t he have preferred to have his rights violated and temporarily hospitalized to protect him from his hallucinations? How will he live with the consequences of his actions? Isn’t he another victim, too?
