After involuntary mental health treatment, many patients feel afraid to seek more help. A constitutional challenge could change the way patients consent to treatment in BC.
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Golok Buday jokes that he's an instinctively paranoid person, so when plainclothes cops showed up at his home one night back in 2001, he was already thinking the worst.
According to Buday, the cops brought his aunt and a social worker, and asked his roommate to put his dog in another room. He didn't fully understand it at the time, but under BC's Mental Health Act, Buday had been deemed potentially harmful to himself or others, and would be given emergency anti-psychotic treatment that night regardless of his own consent.
Buday, who has developed a local reputation in media circles as a frequent mayoral candidate and prolific commenter, says his mind was racing with skepticism and ulterior motives. He recalls asking why the cops had entered his home without permission, and demanded to see a warrant or credentials. When he picked up his own phone and began dialing police, Buday says he was then dragged away and sedated.
This is a standard medical procedure when it comes to dealing with schizophrenia and bi-polar disorders. British Columbia has provisions in its mental health legislation that allows doctors to order patients be detained by police and brought into care. In Vancouver, the number of cases where police detain mental health patients has grown steadily over the past several years. On average, Vancouver police do a handful of these house calls every day.
Since his time as an involuntary patient, Buday has grown a strong distrust for both cops and most mental health treatment. He claims he's never been firmly diagnosed with schizophrenia, but sometimes experiences the symptoms, and has taken anti-psychotic drugs on and off in the past. He now maintains a local chapter of Mindfreedom, a small online group that advocates for patients' rights to refuse strong anti-psychotic meds.
Buday isn't alone in developing an antagonistic relationship with doctors following involuntary treatment. The last time Irit Shimrat was hospitalized, in 2007, she says it was a neighbour who called police.
When cops arrived with an attending nurse, Shimrat says she was in a state of delusion, confused about who she was and what was happening. She told them she doesn't react well to anti-psychotic drugs; instead of bringing delusions under control, she says they intensify the experience. Shimrat claims she was restrained and injected with them anyway, and woke up days later in seclusion at a Comox Valley psychiatric hospital. Since then, she's avoided psychiatrists "like the plague."
Dr. Michael Krausz, MD and psychiatry researcher at the University of British Columbia, says in most circumstances it is up to patients like Shimrat and Buday to choose their own treatment and dosage—even if their wishes go against scientific consensus. "Just like if you have cancer and don't want any more treatment, because it's too painful or you don't trust it, you have the ability to reject that treatment," he said.
The tricky part comes when doctors choose to "certify" patients under the Mental Health Act, which deems them unable to consent to treatment voluntarily. In rare circumstances it's a necessary tool, says Krausz, but in the face of rising mental health crises filling up emergency rooms, he sees the practice becoming more common.
"Capacity is very limited, the available specialists are decreasing, and demand is increasing," he told VICE, adding the number of certifications at St. Paul's, one of Vancouver's two major hospitals, has increased about 50 percent over the last few years. When involuntary treatment is used unnecessarily, Krausz says it can sometimes push patients like Buday and Shimrat away from seeking alternative or low-dose treatment on their own.
A recent constitutional challenge filed in BC's Supreme Court argues that the Mental Health Act as its written denies patients "the right to give, refuse or revoke consent to psychiatric treatment, regardless of those patients' actual capability to do so." Plaintiff Mary Louise MacLaren claims that she was not properly assessed for her ability to give consent, nor was she able to leave important health decisions to her next of kin. MacLaren was given anti-psychotics and electroshock therapy. The suit notes anti-psychotic drugs come with some serious side effects, including risk of diabetes.
Local schizophrenic advocacy organizations have come out against the constitutional challenge, and in support of the Mental Health Act, but critics say the law's consent mechanisms could be improved.
"In other provinces, all adult patients—afflicted with mental illness or not—are presumed to be capable of making decisions related to their own treatment until they are evaluated and proven incapable," lawyer Sarah Leamon wrote in the Georgia Straight following the civil claim. "Our province is therefore the only jurisdiction in which patients with mental illness are considered to be legally incompetent solely on the basis of their medical condition."
In court filings, the province defended the act, denying the legislation is discriminatory. Failing to treat with anti-psychotics can increase risk of suicide, self-harm, deterioration and social withdrawal, reads part of the filing, and doctors must complete paperwork that acknowledges the patient's ability to consent. If rights are violated, according to the government, it's "in accordance with the principle of fundamental justice."
Krausz says there is ongoing rigorous debate about the effectiveness and side effects of anti-psychotics, and that new research aims at minimal dosing. Because people like Shimrat and Buday reject treatment, their only interactions with doctors tend to be in crisis situations.
"Unfortunately, because accessibility of mental health services is very limited, most people show up in emergency rooms, brought by family or ambulance, and there is a crisis response," Krausz told VICE. "That's not a good way to start a relationship and start treatment… If you want to create a therapeutic relationship, you have to make sure patients are convinced and on board."
According to Krausz, there are good reasons to bring down the number of patients being "certified" under the Mental Health Act, and a need for more early community-based outreach. That way, people like Buday and Shimrat, who are independent and functioning, can avoid future hospital stays.
Both Shimrat and Buday say they take care of their minds through non-medical means. Shimrat relies on physical activities like yoga, while Buday claims being a dog owner has helped more than an anti-psychotic prescription. They both pride themselves on being "psychiatry-free" and say those views have grown out of real trauma.
"The way it works now, if you act strange everyone panics," Shimrat said. "It's dehumanizing to be brutalized by people who have all the power—to get stripped down, and often tied down and locked in seclusion."
Shimrat rejects the concept of mental illness and mainstream treatment. But if she could choose her own response to a crisis situation, Shimrat would prefer anti-anxiety or sleep drugs, along with talk therapy—preferably from someone who has had a similar experience. "I'd like to be asked how I'm feeling instead of being told that I'm sick."
Krausz says the mental health treatment situation in Vancouver may improve if doctors and police to listen more to patients like Shimrat and Buday. "Not feeling comfortable, feeling imprisoned, you would absolutely take that as important feedback, and try to find alternatives," he said. "That's the main basis of any good treatment."
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