In April, the California Supreme Court handed down its verdict that Governor Gavin Newsom could move forward with his CARE (Community Assistance, Recovery and Empowerment) plan to force people with mental health issues to cure.
Earlier this year, a coalition of people with disabilities asked the Supreme Court to declare the CARE project unconstitutional because it exceeded procedures and jeopardized the protection of the rights of individuals.
With the CARE project, a new civil court will see the light of day. A court whose mandate will be to direct people with mental health problems and the homeless who refuse treatment to care and accommodation.
Patients who may be referred by the police, mental health workers, doctors and family members.
The introduction of the CARE system means that the court will be able to order a clinical evaluation of the individual and, if his condition meets certain criteria, require follow-up with health care workers. Failure to cooperate will lead to further hearings and court actions up to and including conservatorship.
Adrift, careless
For the past twenty years, we have seen patients with mental health problems transferred to supervised residences or to communities in order to put an end to systematic institutionalization practices. We all know people with mental health issues and families with sick children. Psychiatric services are overwhelmed and communities lack the resources to help and care for patients.
The vast majority of people with mental health problems, homeless or not, pose no danger and these people live their lives in complete freedom under the same legal constraints as others. Except that big cities are also grappling with more and more people with mental health problems and homeless people who are left adrift without care, without supervision, without shelter.
In some cases, people with mental health conditions may be temporarily admitted to psychiatric facilities on a voluntary or involuntary basis, i.e. whether or not they consent, depending on whether they pose a danger to their safety or that of others.
Provincial mental health laws specify that a person can be detained as an involuntary patient if a doctor finds the patient meets the law’s criteria or if a court orders a psychiatric assessment. Detention is only 24 to 96 hours, depending on the province. A patient can be detained longer, but in this case he is entitled to a review. The court must take into consideration the freedom and dignity of people with mental disorders, their safety and that of others.
Marked increase
A study of psychiatric hospitalizations in British Columbia shows that involuntary hospitalizations are still very present. If, in 2008, involuntary hospitalizations represented 44.6% of all hospitalizations, 10 years later, they were down to 57%. A jump that corresponds to a 65.7% growth in involuntary hospitalizations between 2008 and 2018.
For the researchers of the study, it is not so much the involuntary hospitalization which must be privileged, but the system of voluntary care.
Among patients who had visited the emergency department in 2017-2018, 25% of patients with mental health problems and 75% of substance abuse patients (of which 50% had co-occurring mental health problems) had not had a psychiatric visit in the year. And 25% of patients with mental health and substance use problems had no mental health problems at their last annual visit. The increase in hospitalizations would, for the researchers, be the result of care and follow-up not rendered and insufficient.
Additionally, 75% of all hospitalizations for schizophrenia patients were involuntary. People with schizophrenia may be at higher risk for rehospitalization given the link between involuntary hospitalization and not taking medication. The clinician-patient relationship is important to prevent involuntary hospitalizations.
More homeports
The Government of Quebec has announced that it will review Bill 38 on the protection of persons whose mental state presents a danger to themselves or to others. Quebec is particularly concerned about the revolving door of patients leaving an institution to be readmitted shortly after for lack of care in the community.
Certainly, the mental health system must be reviewed. Patients with mental health disorders need more care, follow-up and accommodation resources. Forcing patients to seek treatment is an option that should not overshadow the need to have sufficient resources to do so.
In addition, the community must be part of the development of the solution.
Currently, the community provides a large share of mental health accommodation in the community, without too many financial resources.
It is important to improve care, to better support patients with mental health and drug addiction problems with adequate local services, to support families and not to abandon these people adrift who need care. , supervision and above all a roof.
British Columbia announced investments of $1 billion over three years to address mental health and addiction issues. Quebec should follow the example, prioritize mental health and invest more.