On August 2 and 3, a man suffering from mental health issues shot dead three people in the streets of Montreal. A few hours later, Prime Minister François Legault, offering his condolences to the families of the victims, nevertheless said he was “glad that we got rid of this individual” and wondered about the relevance of “having released him “. He then wonders if a tightening of the measures on the detention of individuals suffering from mental health disorders is necessary.
As part of my research in bioethics, I am particularly interested in the influence of neoliberal social policies on psychiatry and on the perception of mental health in the broader sense. In this regard, I find it interesting to analyze the Prime Minister’s statements as testifying to a certain perception of mental illness that seems to have taken up more space in public debate in recent years.
To better understand this idea, we must go back to a turning point in the history of psychiatry. While since the birth of the discipline, mental illness was largely treated by coercion (both care, but also individuals in detention facilities), the 1960s were marked by a vast movement of deinstitutionalization. The aim is therefore to reintegrate individuals suffering from mental health disorders into the community, by strongly limiting the use of involuntary detention and treatment.
However, like many social reforms at that time, the States failed to allocate the resources necessary for their ambitions. Deinstitutionalization has become synonymous with abandonment rather than treatment transformation. This logic was also greatly exacerbated in the 1980s and 1990s with the rise of neoliberal policies and the gradual disintegration of welfare state structures and public services in favor of the private sector.
We have seen in recent years the result of this political rationality on the most vulnerable individuals in our society. On the other hand, what is regularly singled out is deinstitutionalization itself. That is to say that the public debate on these questions operates in a purely binary way. People with mental health problems are either locked up in detention institutions or left to fend for themselves.
A response to the events of the last week therefore seems quite natural: we must return to coercion since deinstitutionalization was a failure. This is precisely what François Legault and others seem to be asking, saying, for example, that tighter regulation is necessary, or questioning the fact of having “released” the individual.
We also see it in the publication, in recent days, of numerous texts and editorials presenting the regulations limiting the use of coercion and involuntary treatments in psychiatry as responsible for the tragic events of the past week.
Not only does this response risk increasing the stigmatization of individuals with mental health disorders (reinforcing the idea that they are all potentially dangerous and violent), but it misses the crux of the problem, namely that deinstitutionalization does not never obtained the means of his ambitions. In short, the problem is not in itself having “released” individuals suffering from mental health disorders, the problem is having done so by refusing to support them with suitable resources.
The response which then seems the most coherent in the face of the observation of the failure of the support and care offered in psychiatry is not more coercion, but more resources. The Prime Minister must take note, in this case as in others, of the failure of deregulation, privatization and market logic.
It is necessary to reinvest massively in community organizations, social workers or psychotherapy and psychiatry teams. It is also essential, more broadly, to question the way in which neoliberal public policies responsible for the lack of resources in mental health can also be at the origin of psychic suffering.
Individualization, socio-economic precariousness or the injunction to absolute competitiveness between individuals are the driving forces of neoliberalism, but are also, perhaps, the source of our distress.