The news of the past few days has painted a rather gloomy portrait of psychiatry in Quebec. It presents the shortage of psychiatrists, the slowness of the courts responsible for hearing cases relating to involuntary treatment, as well as the lack of beds as being the main challenges facing mental health services. Without denying these problems, it is clear that once again, psychiatry is represented under the biomedical prism, where institutional treatment (hospital and legal) is favored over collective and community solutions.
In addition to ignoring the essential contribution of various health professionals (nurses, psychologists, social workers, occupational therapists, peer helpers, to name a few), this perspective contributes to perpetuating the representation of people living with mental health as dangerous and to reinforce societal acceptance of coercion (isolation, restraint, confinement in an institution, judicial authorization of care) as a treatment. In this context, there is reason to question the overuse of the courts to alleviate the difficulties of access to mental health services that correspond to people’s needs.
In the report presented by Radio-Canada (SOS hospitals for dozens of psychiatrists), the angle of approach is that of the difficult work of psychiatrists due to the shortage of manpower and the slowing down of legal processes. One evokes as a consequence the overcrowding of hospitals and as solutions an increase in the number of psychiatrists and the creation of more beds available to accommodate sick people.
Other angles of approach are systematically neglected in this report. In recent years, several reforms have been deployed to maximize the contribution of other stakeholders working in mental health, whether it concerns access to services, prescription powers, the assessment of mental disorders or even the practice of psychotherapy. Today, simple access to psychotherapy is dramatically difficult, while it can be practiced by nine different types of health professionals under certain conditions, in addition to psychologists, who also claim better access to their services. in the public network.
Remember that it is estimated that 1.5% of people have specialized mental health needs. However, resources on the front line and within the community itself are not presented as possible solutions, when it has been clear for years that more investment in prevention is needed.
human rights
The fact that people are kept in hospital for several months against their will because of the slowness of the courts to hear their case should arouse indignation because of the violation of human rights that this represents. In the public sphere, we have to consider the impacts this can have on the people concerned. The scientific literature on the subject presents many negative consequences of judicial authorization of care. It is particularly a question of feelings of fear, humiliation and dehumanization, of contested effectiveness, in addition to a loss of identity and control over several facets of his life.
In addition, it is important to emphasize that judicial authorizations for care and control measures (isolation, restraint) are coercive tools. These are last resort measures which can have serious consequences for the person and which represent morally difficult work for the interveners responsible for applying them. The trivialization of these coercive measures is worrying. Internationally, specialists — including the World Health Organization — are calling for approaches based on respect for mental health rights, which inevitably involves a reduction (some would even say an abolition) of coercion and even of hospitalization.
The image of the “dangerous psychiatric patient” proposed in the report and that conveyed by the media only confirms the prejudices and stigmatization towards people living with a mental health problem. The dissemination of disturbing images and the use of terms evoking a climate of dangerousness in psychiatric care units encourage the belief that people living with a mental health problem are violent.
In addition to having the effect of confirming the need for recourse to coercion (via the courts) and of dissuading people and their loved ones from seeking the help they need, this belief is erroneous. The majority of people with mental health problems are not violent and we must repeat here that they are more likely to be victims of violent acts themselves than to initiate them.
Above all, it is the lack of access to adequate services based on the mental health condition and the psychosocial context of the person and their loved ones, in a timely manner and in an appropriate place, which constitutes the heart of a problem that deserves to be explored from another angle than that of dangerousness. Responsibility for mental health issues is collective and leads to solutions that respect people’s needs, rights and ability to act.
*Also co-signed this letter:
Myreille Bédard, certified trainer, Health and Recovery Learning Center (CASR), author, speaker and patient partner
Vincent Billé, doctoral student at the Faculty of Nursing at the University of Montreal
Etienne Boucher, clinical nurse in front-line mental health, CIUSSS de l’Est-de-l’Ile-de-Montréal
Catherine Briand, Professor in the Department of Occupational Therapy at the University of Quebec at Trois-Rivières, Researcher at the Research Center of the University Institute of Mental Health in Montreal
Anne Crocker, Department of Psychiatry and Addiction and School of Criminology, University of Montreal and Director of Research and University Teaching National Institute of Forensic Psychiatry Philippe Pinel
Audrey-Anne Dumais Michaud, Professor, School of Social Work and Criminology, Laval University
Christine Genest, Associate Professor, Faculty of Nursing, University of Montreal
Caroline Larue, Full Professor, Faculty of Nursing, University of Montreal
Marichelle Leclair, PhD candidate – Psychology and School of Public Health, University of Montreal
Bernard Saulnier, person in recovery, certified trainer at the Health and Recovery Learning Center, writer
Luc Vigneault, patient-partner in research and teaching, author, speaker and trainer in mental health