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The challenge of the Canada Act, 1982 to existing mental health legislation : implications for planning,… Geddes, Beatrice Ann 1984

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THE CHALLENGE OF THE CANADA ACT, 1982 TO EXISTING MENTAL HEALTH LEGISLATION: IMPLICATIONS FOR PLANNING,MENTAL HEALTH LEGISLATION AND RIGHTS IN CANADA BY BEATRICE ANN GEDDES B.S.N., The U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1959 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE i n THE FACULTY OF GRADUATE STUDIES ( D e p a r t m e n t o f H e a l t h C a r e and E p i d e m i o l o g y H e a l t h P l a n n i n g and A d m i n i s t r a t i o n Programme) We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA APRIL 1984 © B E A T R I C E ANN GEDDES 1984 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an advanced degree a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e head o f my department o r by h i s o r h e r r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department O f Health Care and Epidemiology The U n i v e r s i t y o f B r i t i s h C o l u m b i a 1956 Main Mall V a n c ouver, Canada V6T 1Y3 D a t e April 26, 1984. ABSTRACT W i t h t h e p r o c l a m a t i o n o f t h e Canada A c t , 1982 t h e r e has begun i n Canada a q u e s t i o n i n g o f l e g i s l a t i o n t h a t i s r e s t r i c t i v e o f human r i g h t s . M e n t a l h e a l t h l e g i s l a t i o n i s an example o f a r e s t r i c t i v e a c t i n t h a t i t d e f i n e s p r o c e d u r e s f o r e n f o r c e d o r c o m p u l s o r y t r e a t m e n t p r o c e d u r e s t h a t remove c e r t a i n human r i g h t s . T h i s s t u d y e x a m i n e s m e n t a l h e a l t h l e g i s l a t i o n i n t h e l i g h t o f t h e c h a l l e n g e p o s e d by t h e C h a r t e r o f R i g h t s and Freedom's e n t r e n c h e d i n t h e Canada A c t by u s i n g a d e s c r i p t i v e a n a l y s i s o f l e g i s l a t i o n . L e g i s l a t i o n i n Ca n a d a , a n d m e n t a l h e a l t h l e g i s l a t i o n i n E n g l a n d and C a n a d a a r e e x a m i n e d a c c o r d i n g t o t h e i r a d m i n i s t r a t i o n and s u b j e c t d e v e l o p m e n t . The m e n t a l h e a l t h a c t s f o r f i v e C a n a d i a n p r o v i n c e s a r e u s e d f o r t h e s a m p l e . The f r amework o f t h e s t u d y i s t h a t o f a p l a n n e r commencing w i t h p r o b l e m d e f i n i t i o n , a n a l y s i s and r e s u l t a n t s o l u t i o n s o r r e c o m m e n d a t i o n s . The p l a n n e r i n t h i s c o n t e x t a d v i s e s on l e g i s l a t i o n , a nd on t h e i m p l e m e n t a t i o n o f l e g i s l a t i o n . From t h e a n a l y s i s o f t h e s t u d y i t was f o u n d t h a t l e g i s l a t i o n i s i n t e r a c t i v e w i t h t h e e c o n o m i c , t e c h n o l o g i c a l and s o c i a l v a l u e i s s u e s w i t h i n s o c i e t y . F o r m e n t a l h e a l t h i t was n o t e d t h a t t h e l e g i s l a t i o n does n o t a d d r e s s h e a l t h o r t r e a t m e n t b u t r a t h e r c o m p u l s o r y t r e a t m e n t o f i n d i v i d u a l s deemed t o be " m e n t a l l y d i s o r d e r e d " and i n n e e d o f t r e a t m e n t f o r t h e i r own o r s o c i e t y ' s p r o t e c t i o n . As w e l l , i t was f o u n d t h a t t h e l a b e l " m e n t a l d i s o r d e r " , d e f i n e d d i f f e r e n t l y i n e a c h p r o v i n c e , - r e s u l t s i n t h e a p p l i c a t i o n o f r e s t r i c t i o n s on an i n d i v i d u a l so d e f i n e d , i n t h e c o n t e n t s o f o t h e r p r o v i n c i a l a c t s . As C a n a d i a n s a r e n o t a s k i n g f o r t h e r e m o v a l o f c o m p u l s o r y t r e a t m e n t p r o c e d u r e s b u t f o r a r e c o g n i t i o n o f r i g h t s a n d f r e e d o m s , t h i s s t u d y makes r e c o m m e n d a t i o n t o a d d r e s s t h e l i m i t i n g i t e m s i n m e n t a l h e a l t h a c t s so t h a t i n j u s t i c e s i n p r o v i n c i a l s t a t u t e s do n o t c o n t i n u e . i v TABLE OF CONTENTS page ABSTRACT i i TABLE OF CONTENTS i v LIST OF TABLES v i i ACKNOWLEDGEMENTS v i i i C hapter I . INTRODUCTION 1 F o o t n o t e s 7 I I . WHY EXAMINE MENTAL HEALTH LEGISLATION AND THE RIGHTS ISSUE? 8 I m p l i c a t i o n s f o r M e n t a l H e a l t h L e g i s l a t i o n ... 10 Reasons f o r Choosing t o Study M e n t a l H e a l t h L e g i s l a t i o n 11 S e l e c t i o n of P r o v i n c i a l A c t s 13 I I I . METHOD OF ANALYSIS 15 M a t e r i a l s and I n f o r m a t i o n C o l l e c t e d 17 The Scope o f the Study 18 L i m i t a t i o n s of the Study 19 F o o t n o t e s 20 IV. THE DIVISION OF LEGISLATIVE AUTHORITY BETWEEN FEDERAL AND PROVINCIAL GOVERNMENTS AND THE PROBLEMS RAISED . . . 21 F e d e r a l Government R e s p o n s i b i l i t y 22 P r o v i n c i a l Government R e s p o n s i b i l i t y 27 Changes I m p a c t i n g Upon Mental H e a l t h L e g i s l a t i o n 31 E f f e c t of S o c i a l Change on L e g i s l a t i o n 31 E f f e c t of Economic Change on L e g i s l a t i o n 33 V E f f e c t of T e c h n o l o g i c a l Change on L e g i s l a t i o n .. 34 Fo o t n o t e s 37 V. DESCRIPTIVE ANALYSIS OF MENTAL HEALTH LEGISLATION 38 Content of M e n t a l H e a l t h L e g i s l a t i o n 38 H i s t o r i c a l E v o l u t i o n of Concepts R e l a t i n g t o Me n t a l H e a l t h i n England . 39 Development of E n g l i s h L e g i s l a t i o n 44 Development of Canadian M e n t a l H e a l t h L e g i s l a t i o n 48 P r e s s u r e s o f Change 50 F o o t n o t e s 54 V I . DESCRIPTIVE ANALYSIS OF FIVE PROVINCIAL MENTAL HEALTH ACTS AND THE IMPINGEMENT UPON THE CHARTER OF RIGHTS AND FREEDOMS 55 The D e f i n i t i o n s of Mental D i s o r d e r 55 P l a c e of Treatment 57 Compulsory Treatment and R i g h t s 58 B r i t i s h Columbia 60 Saskatchewan 61 O n t a r i o 61 Quebec 62 Nova S c o t i a 63 R e s t r i c t i o n s on M e n t a l l y D i s o r d e r e d i n Other P r o v i n c i a l S t a t u t e s 65 F o o t n o t e s 69 V I I . CONCLUSIONS AND IMPLICATION AND PLAN FOR CHANGE 70 P l a n f o r Change 73 Recommendations 73 v i R o l e of P a r t i c i p a n t s 74 Method of P r o c e e d i n g 76 BIBLIOGRAPHY 79 Appendices APPENDIX A: B r i t i s h N o r t h America A c t , 1867, S e c t i o n 91-92 86 APPENDIX B: C h a r t e r o f R i g h t s and Freedoms, C o n s t i t u t i o n A c t , 1982 88 APPENDIX C: D e f i n i t i o n s Found In F i v e P r o v i n c i a l M e n t a l H e a l t h A c t s f o r "Mental D i s o r d e r " , " D i r e c t o r " , " P a t i e n t " , " F a c i l i t y " , " P h y s i c i a n . " 90 v i i LIST OF TABLES page Table 1: P r o c e d u r e s f o r Compulsory Treatment i n 5 Canadian P r o v i n c e s 93 ACKNOWLEDGEMENTS The p r e p a r a t i o n and w r i t i n g o f t h i s t h e s i s , a l t h o u g h p r i m a r i l y an independent t a s k , has been done l a r g e l y due t o the s u p p o r t , encouragement and d i r e c t i o n p r o v i d e d by f r i e n d and c o l l e a g u e s . To my t h e s i s committee--Dr. Ann C r i c h t o n , C h a i r p e r s o n , Dr. Nancy (Waxier) M o r r i s o n , and Mr. John F o r r e s t e r - - i s extended a s p e c i a l word o f thanks f o r the sound c r i t i c a l comments g i v e n t o me as the work p r o g r e s s e d . The weaknesses i n t h i s s t u d y I accept as a r e f l e c t i o n o f my a b i l i t y . 1 Chapter I INTRODUCTION In 1982, w i t h the p r o c l a m a t i o n by the f e d e r a l government of the C o n s t i t u t i o n A c t , the c o n t e n t s of e x i s t i n g s t a t u t e s i n Canada assumed a new s i g n i f i c a n c e . The C o n s t i t u t i o n A c t , 1982, w i t h the C h a r t e r of R i g h t s and Freedoms e n t r e n c h e d w i t h i n i t , was de v e l o p e d by a l l the p r o v i n c i a l governments j o i n t l y w i t h the f e d e r a l government. The former c o n s t i t u t i o n a l document, the B r i t i s h N o r t h America A c t , 1867, (BNA A c t ) r e f l e c t e d the B r i t i s h t r a d i t i o n of c o n s t i t u t i o n a l l e g i s l a t i o n i n t h a t i t d i d not address r i g h t s and freedoms e x p l i c i t l y . Now v a l u e s t h a t i n d i v i d u a l s have r e c o g n i z e d as i n t e g r a l and e s s e n t i a l t o a n a t i o n , l i k e t he r i g h t t o l i f e , l i b e r t y and s e c u r i t y of p e r s o n , are p r o t e c t e d , not i n p r o v i n c i a l s t a t u t e s but i n an a c t f o r Canada. These v a l u e s are no l o n g e r r e s t r i c t e d by p l a c e of r e s i d e n c e o r j u d i c i a l i n t e r p r e t a t i o n o f r e l e v a n t s t a t u t e s . The C h a r t e r of R i g h t s and Freedoms l i s t s t he r i g h t s and freedoms t h a t are gua r a n t e e d i n t w e n t y - f o u r of the t h i r t y s e c t i o n s making up the C h a r t e r . These v a l u e s are p r o c l a i m e d s u b j e c t o n l y t o such r e a s o n a b l e l i m i t s p r e s c r i b e d by law as can be demonstrably j u s t i f i e d i n a f r e e and d e m o c r a t i c s o c i e t y . The s e c t i o n headings i n which the freedom o r r i g h t s a re p r o c l a i m e d a r e : ( i ) Fundamental Freedoms ( i i ) D emocratic R i g h t s 2 ( i i i ) M o b i l i t y R i g h t s ( i v ) L e g a l R i g h t s (v) E q u a l i t y R i g h t s ( v i ) O f f i c i a l Languages of Canada ( v i i ) M i n o r i t y Language E d u c a t i o n a l R i g h t s ( v i i i ) Enforcement ( i x ) G e n e r a l (x) A p p l i c a t i o n of C h a r t e r ( x i ) C i t a t i o n A l l of the C h a r t e r has r e l e v a n c e f o r s t u d y of mental h e a l t h l e g i s l a t i o n but p a r t i c u l a r l y i m p o r t a n t are the s e c t i o n s r e g a r d i n g fundamental freedoms; d e m o c r a t i c , m o b i l i t y , l e g a l and e q u a l i t y r i g h t s , and"enforcement. Those s e c t i o n s guarantee t h a t the freedom of c o n s c i e n c e , r e l i g i o n , thought or o p i n i o n , and e x p r e s s i o n t h e r e o f , i n c l u d i n g freedom of the p r e s s or o t h e r media of communication w i l l not be based upon p r o v i n c i a l r e s i d e n c y or membership of a m a j o r i t y group but are t o be e n j o y e d by a l l Canadians. The r i g h t t o l i f e , l i b e r t y and s e c u r i t y of p e r s o n and the r i g h t not t o be d e p r i v e d t h e r e o f e x c e p t a c c o r d i n g t o the p r i n c i p l e s of fundamental j u s t i c e ; t o g e t h e r w i t h the r i g h t not t o be s u b j e c t t o any c r u e l and u n u s u a l t r e a t m e n t or punishment; and the r i g h t not t o be a r b i t r a r i l y d e t a i n e d or i m p r i s o n e d are examples of m a t t e r s t h a t pose a c h a l l e n g e t o e x i s t i n g mental h e a l t h l e g i s l a t i o n . The C o n s t i t u t i o n A c t , 1982 ( C o n s t i t u t i o n A c t ) i s a f e d e r a l s t a t u t e d e v e l o p e d over a p e r i o d of t e n y e a r s of b a r g a i n i n g a t f o r m a l f e d e r a l - p r o v i n c i a l c o n f e r e n c e s and a t d i s c u s s i o n s of b u r e a u c r a t s and p o l i t i c i a n s h o l d i n g t h i s assignment. The response of the p r o v i n c i a l governments t o t h i s o v e r r i d i n g f e d e r a l a c t has been guarded and i s o n l y now b e g i n n i n g t o be worked t h r o u g h . With the p r o v i n c i a l governments i n d i c a t i n g t h e i r commitment t o the p r o c l a m a t i o n of the C o n s t i t u t i o n A c t a t the C o n s t i t u t i o n a l Conference of November, 1981, t h e r e i s re a s o n f o r t h e s e governments t o make t h e i r own s t a t u t e s conform t o t h i s r e c e n t s t a t u t e . The p r o v i n c i a l governments, i n t h e i r e f f o r t s t o a t t a i n congruence between f e d e r a l and p r o v i n c i a l a c t s , r a i s e the i s s u e of r e s p o n s i b i l i t i e s a s s i g n e d t o the two l e v e l s of government by the e a r l i e r " c o n s t i t u t i o n a l " document, the BNA A c t . H e a l t h , c i v i l and p r o p e r t y r i g h t s are examples of mat t e r s g i v e n t o p r o v i n c i a l governments t o a d m i n i s t e r . However, s i n c e the p r o c l a m a t i o n of the BNA A c t , t h e r e has been a change i n the r e s p o n s i b i l i t y assumed by the f e d e r a l government r e g a r d i n g r i g h t s and freedoms and r e g a r d i n g h e a l t h , i n p a r t i c u l a r , the f i n a n c i n g of h e a l t h s e r v i c e s . Over the y e a r s the government has r e c o g n i z e d t h a t v a l u e s and b e l i e f s such as freedom, human r i g h t s , h e a l t h and a v a i l a b i l i t y of t r e a t m e n t are not bounded by the g e o g r a p h i c s t r u c t u r e of p r o v i n c e s . H e a l t h l e g i s l a t i o n i s the g e n e r a l d e s i g n a t i o n f o r s t a t u t e s t h a t p r o v i d e f o r the a d m i n i s t r a t i o n of s e r v i c e s 4 l i k e h o s p i t a l s and f o r compulsory t r e a t m e n t of d i s e a s e s ; examples are h o s p i t a l a c t s , v e n e r e a l d i s e a s e a c t s , t u b e r c u l o s i s c o n t r o l a c t s and mental h e a l t h a c t s . In t h i s s t u d y i t i s proposed t o examine one component of h e a l t h l e g i s l a t i o n , the p r o v i n c i a l mental h e a l t h a c t s , t o determine whether t h e r e i s concordance w i t h the C o n s t i t u t i o n A c t and, i n p a r t i c u l a r , w i t h the e n t r e n c h e d C h a r t e r . M e n t a l h e a l t h l e g i s l a t i o n has been chosen because of the c o n c e r n s r a i s e d by the r e s t r i c t i v e n a t u r e of the c o n t e n t s i n the a c t s . In p r o v i d i n g f o r the t r e a t m e n t of the m e n t a l l y d i s o r d e r e d , t h e s e s t a t u t e s i n c l u d e s e c t i o n s t o apprehend and c o n t a i n c e r t a i n o f the d i s o r d e r e d i n o r d e r t o p r o v i d e compulsory t r e a t m e n t . T h i s p r o c e s s may be compared w i t h a c r i m i n a l p r o c e d u r e i n t h a t a p p r e h e n s i o n and containment are s i m i l a r , but f o r the c r i m i n a l , u n l i k e the d i s o r d e r e d , t h e r e i s a p r o c e s s t o e s t a b l i s h t h e g u i l t and the punishment t o be g i v e n . M e n t a l h e a l t h a c t s , w r i t t e n t o promote mental h e a l t h as an outcome of the compulsory treatment,". l a c k s i m i l a r p r o c e d u r e s t o e s t a b l i s h i l l n e s s and a p p r o p r i a t e c a r e and t h e r e f o r e may be r e s t r i c t i v e i n the c u r r e n t Canadian scene. I t i s t i m e l y f o r the e x a m i n a t i o n of e x i s t i n g p r o v i n c i a l s t a t u t e s g i v e n the r e c e n t enactment of a "new" C o n s t i t u t i o n . The q u e s t i o n under study f o r t h i s paper i s t o determine whether the c o n t e n t s of t h e p r o v i n c i a l mental h e a l t h a c t s are r e s t r i c t i v e of the r i g h t s and freedoms t h a t are now p r o t e c t e d i n the Canadian C o n s t i t u t i o n and the i m p l i c a t i o n s of the f i n d i n g s f o r a p l a n n e r of p r o v i n c i a l mental h e a l t h s e r v i c e s . T h i s study w i l l examine and a n a l y z e the c o n t e n t s of f i v e p r o v i n c i a l mental h e a l t h a c t s s e l e c t e d t o r e p r e s e n t : ( i ) a l l t h e r e g i o n s of Canada; ( i i ) t h e F r e n c h and E n g l i s h l e g i s l a t i v e r o o t s ; ( i i i ) r e c e n t and e a r l y p r o c l a m a t i o n ; and ( i v ) l a r g e and s m a l l p r o v i n c i a l p o p u l a t i o n s . The s e l e c t i o n of f i v e p r o v i n c i a l mental h e a l t h a c t s from the t e n p r o v i n c e s was made w i t h t h e s e v a r i a b l e s i n mind. The method used t o a n a l y z e and d i s c u s s the q u e s t i o n f o l l o w s g e n e r a l l y a q u a l i t a t i v e approach d e s c r i b e d by G l a s e r and S t r a u s s . 1 T h i s method of a n a l y s i s i s p a r t i c u l a r l y s u i t e d f o r s u b j e c t s t h a t are i n a c o n t i n u o u s s t a t e of change l i k e s o c i a l i s s u e s . In Chapter I I , the method of a n a l y s i s f o r t h i s s tudy i s d e s c r i b e d . In Chapter IV the d i v i s i o n of a u t h o r i t y between the f e d e r a l and p r o v i n c i a l governments i s r e v i e w e d . However, the emphasis i s on governmental r e s p o n s i b i l i t i e s f o r h e a l t h and mental h e a l t h and the problems t h a t have a r i s e n from t h i s s t r u c t u r i n g . Next f o l l o w s the a n a l y s i s of the c o n t e n t s of the mental h e a l t h l e g i s l a t i o n t o r e v e a l the s e c t i o n s t h a t are impacted by the C h a r t e r o f R i g h t s and Freedoms. The l e g i s l a t e d a u t h o r i t y a s c r i b e d t o a f e d e r a l or p r o v i n c i a l i n s t r u m e n t i s c o n s i d e r e d a l o n g w i t h the r i g h t s and freedoms w r i t t e n i n the C h a r t e r . The c o n c e p t s of mental i l l n e s s w r i t t e n i n t o laws are r e v i e w e d v i s a v i s the r e s t r i c t i o n s embodied i n t h e - a c t s . In Chapter V I , the d i f f e r e n c e s i n the c o n t e n t s between the f i v e p r o v i n c i a l mental h e a l t h a c t s w i l l be d e s c r i b e d , n o t i n g e s p e c i a l l y t h o s e s e c t i o n s t h a t impinge upon the i s s u e s o f r i g h t s and freedoms. I n c l u d e d i n t h i s c h a p t e r are t h e l i m i t a t i o n s the m e n t a l l y d i s o r d e r e d s u f f e r because of the c o n t e n t s of o t h e r p r o v i n c i a l a c t s . T h i s s t u d y f i r s t c o n s i d e r s the c h a l l e n g e c r e a t e d by the C o n s t i t u t i o n A c t on the e x i s t i n g p r o v i n c i a l mental h e a l t h a c t s and s u b s e q u e n t l y proposes a p l a n f o r change. A p l a n n i n g framework d e f i n e s a problem, examines and a n a l y z e s the v a r i a b l e s of the problem, then d e v e l o p s a s e t of s o l u t i o n s or recommendations. In t h i s c o n t e x t , the r e s t r i c t i o n s c o n t a i n e d i n mental h e a l t h l e g i s l a t i o n c r e a t e a problem f o r those who are m e n t a l l y d i s o r d e r e d and f o r t h o s e who a d m i n i s t e r the a c t . The outcome of the a n a l y s i s of t h i s problem i s s t a t e d i n the f i n a l c h a p t e r . 7 F o o t n o t e s ^Barney G. G l a s e r and Anselm L. S t r a u s s , The D i s c o v e r y of Grounded Theory: S t r a t e g i e s f o r Q u a l i t a t i v e R e s e a r c h , A l d i n e P u b l i s h i n g Company, New York, 1967. 8 Chapter I I WHY EXAMINE MENTAL HEALTH LEGISLATION AND THE RIGHTS ISSUE? For much o f Canadian h i s t o r y t h e r e has been no p i e c e o f l e g i s l a t i o n s p e c i f i c a l l y w r i t t e n t o p r o t e c t r i g h t s and freedoms '. These v a l u e s were r e g a r d e d by t h e e a r l y p o l i t i c a l l e a d e r s t o be s o c i a l m a t t e r s and s u f f i c i e n t l y p r o t e c t e d by the t r a d i t i o n s o f the j u d i c i a r y and government. However, a g e n e r a l i n t e r e s t i n r i g h t s and freedoms has been emerging s i n c e World War I I . T h i s i n t e r e s t was g i v e n shape and r e c o g n i t i o n i n 1960 when the f e d e r a l government pass e d a B i l l of R i g h t s . As w e l l , i n the y e a r s t h a t f o l l o w e d , many p r o v i n c i a l l e g i s l a t u r e s e n a c t e d human r i g h t s l e g i s l a t i o n . The e n a c t i n g of the f e d e r a l and p r o v i n c i a l i n s t r u m e n t s t o a s s u r e t h e p r o t e c t i o n of r i g h t s and freedoms was not the end r e s u l t o f the i s s u e . These governmental a c t i v i t i e s were p a r t of the p r o c e s s t h a t c u l m i n a t e d i n 1982 w i t h t h e p r o c l a m a t i o n o f the C o n s t i t u t i o n A c t . T h i s f e d e r a l a c t was a r e c o g n i t i o n a t the n a t i o n a l l e v e l o f the n e c e s s i t y t o w r i t e i n t o l e g i s l a t i o n and make e x p l i c i t t h e r i g h t s and freedoms o f Canadians a l o n g w i t h o t h e r c o n s t i t u t i o n a l m a t t e r s . These s o c i a l v a l u e s are not l i m i t e d by l e g i s l a t i v e or g e o g r a p h i c b o u n d a r i e s but are p a r t of the s o c i a l f a b r i c of p e o p l e , wherever they may r e s i d e . C o n s i d e r e d i n the development of t h i s p a r t i c u l a r enactment were the demands of m i n o r i t y e t h n i c groups, s p e c i a l i n t e r e s t groups and t h e handicapped. Each p r e s e n t e d t h e i r c o n cerns about r e s t r i c t e d 9 r i g h t s t o the p u b l i c g e n e r a l l y and g o v e r n i n g b o d i e s e s p e c i a l l y . These i s s u e s were not d i s c u s s e d i n Canada o n l y but were r e c o g n i z e d i n t e r n a t i o n a l l y . The I n t e r n a t i o n a l Year of D i s a b l e d P e r s o n s , 1981, or the U n i t e d N a t i o n s Decade f o r Women, 1975 t o 1985, f o r example, gave f o c u s t o the pr o m o t i o n of a c t i o n t a k e n on b e h a l f of the p a r t i c u l a r group. A major t h r u s t i n the twenty y e a r s f o l l o w i n g the passage of the B i l l o f R i g h t s was the f e d e r a l - p r o v i n c i a l c o n s t i t u t i o n a l d i s c u s s i o n s . These meetings p r o v i d e d a forum t o address the i s s u e s of r i g h t s , freedoms and l e g i s l a t i v e r e s p o n s i b i l i t y . The event o f i n v o k i n g t h e War Measures A c t by the Prime M i n i s t e r i n the p r o v i n c e of Quebec i n 1970 gave prominence t o the v a l u e s of freedom of speech, of the r i g h t t o a s s o c i a t e i n groups and not t o be d e t a i n e d w i t h o u t j u s t cause. As w e l l , t h i s a c t i o n i n d i c a t e d the a u t h o r i t y of the f e d e r a l government i n r e l a t i o n t o a p r o v i n c i a l government m a t t e r . The assignment o f v a r i o u s s u b j e c t s e i t h e r t o f e d e r a l o r p r o v i n c i a l b o d i e s was e s t a b l i s h e d i n s e c t i o n s 91 and 92 of the BNA A c t , and w i l l be d i s c u s s e d more f u l l y i n Chapter IV of t h i s s t u d y . At t h i s p o i n t , s u f f i c e i t t o mention t h a t p r o p e r t y and c i v i l r i g h t s were m a t t e r s t h a t appeared t o be a s s i g n e d t o the p r o v i n c e s . C o n s e q u e n t l y , t h e p a s s i n g of l e g i s l a t i o n by the f e d e r a l and p r o v i n c i a l governments on the same s u b j e c t can c r e a t e j u r i s d i c t i o n a l problems. Thus, i n r e g a r d t o r i g h t s and freedoms, the f e d e r a l government became i n v o l v e d i n what had e a r l i e r been a p r o v i n c i a l m a t t e r . So, 10 from 1970 t o 1982 t h e r e was c o n f u s i o n r e g a r d i n g governmental r e s p o n s i b i l i t y f o r r i g h t s and freedoms and, as w e l l , new i m p l i c a t i o n s were c r e a t e d r e g a r d i n g the r e s t r i c t i o n of t h e s e v a l u e s i n many p i e c e s of l e g i s l a t i o n , mental h e a l t h s t a t u t e s b e i n g one example. I m p l i c a t i o n s f o r M e n t a l H e a l t h L e g i s l a t i o n With the p r o c l a m a t i o n o f t h e C o n s t i t u t i o n A c t , the c o n t e n t s o f v a r i o u s f e d e r a l and p r o v i n c i a l s t a t u t e s r e q u i r e s tudy t o ensure t h a t p o t e n t i a l l y c o n f l i c t i n g items are c l a r i f i e d . I n the BNA A c t , h e a l t h m a t t e r s g e n e r a l l y and mental h e a l t h s p e c i f i c a l l y were a s s i g n e d t o the p r o v i n c i a l l e g i s l a t u r e s . At the time o f w r i t i n g t h a t i n s t r u m e n t (1867), mental i l l h e a l t h was d e f i n e d as i n s a n i t y and t r e a t e d o r c o n t a i n e d i n an asylum. S i n c e the A c t was w r i t t e n l o n g b e f o r e governments became i n v o l v e d i n t a k i n g much -r e s p o n s i b i l i t y f o r s o c i a l w e l f a r e , i n c l u d i n g h e a l t h , the wording i s not s p e c i f i c and s u b j e c t t o i n t e r p r e t a t i o n . I t s t a t e s i n s e c t i o n 92(7) t h a t the p r o v i n c e i s t o p r o v i d e and m a i n t a i n asylums. As many h e a l t h t r e a t m e n t m o d a l i t i e s have changed i n the y e a r s s i n c e 1867, so t o o have the s e r v i c e s f o r t h e m e n t a l l y i l l . "Asylum" i s no l o n g e r a word used g e n e r a l l y by the p u b l i c o r h e a l t h p r o f e s s i o n a l s . Now an asylum i s r e p l a c e d by a p s y c h i a t r i c f a c i l i t y or h o s p i t a l t h a t o f f e r s a t r e a t m e n t program, not j u s t c u s t o d y . S i n c e each p r o v i n c e has t h e a u t h o r i t y t o l e g i s l a t e f o r and a d m i n i s t e r s e r v i c e s f o r mental i l l n e s s , .there have been many changes i n the a c t s r e g u l a t i n g the f a c i l i t i e s and s e r v i c e s n e c e s s a r y t o t r e a t the d i s t u r b e d . However, the changes i n t r e a t m e n t p r o c e d u r e s have not caused major changes i n the c o n t e n t s of mental h e a l t h l e g i s l a t i o n . The m a t t e r of compulsory t r e a t m e n t s t i l l remains an e s s e n t i a l i s s u e o r c o r e m a t t e r w r i t t e n i n a l l the p r o v i n c i a l a c t s . I t i s t h i s p a r t of a l l the s t a t u t e s t h a t i s r e s t r i c t i v e of i n d i v i d u a l r i g h t s and freedoms p r o c l a i m e d i n t he e n t r e n c h e d C h a r t e r of R i g h t s and Freedoms and t h a t may be p e r c e i v e d t o c o n f l i c t w i t h the C h a r t e r . (The C h a r t e r was d e s c r i b e d i n Chapter I and i s p r e s e n t e d i n f u r t h e r d e t a i l i n Appendix A.) Reasons f o r Choosing t o Study M e n t a l H e a l t h L e g i s l a t i o n The l e g i s l a t i o n g o v e r n i n g an a s p e c t of h e a l t h c a r e o r the r e g u l a t i o n of p r o f e s s i o n a l p r a c t i c e i s not always e v i d e n t t o a l l t h e p r o f e s s i o n a l s w o r k i n g i n h e a l t h s e r v i c e s . Nurses, p s y c h o l o g i s t s and o t h e r h e a l t h p r o f e s s i o n a l s may ca r e f o r i n d i v i d u a l s i n h o s p i t a l s o r community c l i n i c s f o r a l o n g time b e f o r e t h e c o n t e n t s o f a h o s p i t a l a c t or o t h e r r e l e v a n t a c t s are brought t o t h e i r n o t i c e . However, mental h e a l t h p r o f e s s i o n a l s u s u a l l y have r e a s o n a b l y good knowledge of the s e c t i o n o f t h e mental h e a l t h a c t t h a t d e s c r i b e s compulsory t r e a t m e n t . T h i s knowledge i s a n e c e s s a r y a s p e c t of any p s y c h i a t r i c program. With a background of many y e a r s i n community p s y c h i a t r y , the w r i t e r a l r e a d y had an i n t e r e s t i n mental h e a l t h 12 l e g i s l a t i o n , e s p e c i a l l y the e f f e c t s of the compulsory a s p e c t s of i t upon the m e n t a l l y i l l . T h i s i n t e r e s t was g i v e n f o c u s and shape d u r i n g a s t u d e n t c l e r k s h i p i n 1980. One of the t a s k s i n t h e c l e r k s h i p was t o r e v i e w a l l the p r o v i n c i a l mental h e a l t h a c t s and t o document or c a t a l o g u e t h e i r c o n t e n t s . At t h i s time the t a s k was r e g a r d e d as i m p o r t a n t because t h e r e had been d i s c u s s i o n s by the p r o v i n c i a l d i r e c t o r s of mental h e a l t h s e r v i c e s r e g a r d i n g the d i f f i c u l t i e s of a d m i n i s t e r i n g a p r o v i n c i a l l y bounded s e r v i c e w i t h the j u r i s d i c t i o n a l problems c r e a t e d by the m o b i l i t y o f the d i s o r d e r e d . The o t h e r c o n c e r n was t h e r e c o g n i t i o n t h a t r i g h t s and freedoms l e g i s l a t i o n might a f f e c t e x i s t i n g mental h e a l t h a c t s . The m o b i l i t y of Canadians c r e a t e d t h e s p e c i a l c o n c e r n of t h e s e d i r e c t o r s , t h a t of a p p l y i n g t h e mental h e a l t h a c t ' o f : o n e p r o v i n c e i n the p r o v i n c e where the " i n v o l u n t a r y p a t i e n t " had r e l o c a t e d . To t a k e an example, i f a p h y s i c i a n had completed a c e r t i f i c a t e i n B r i t i s h Columbia s t a t i n g t h a t a p e r s o n r e q u i r e d " c o m p u l s o r y t r e a t m e n t f o r mental d i s o r d e r and w i t h i n 15 days of t h e s i g n i n g of t h a t c e r t i f i c a t e t h a t p e r s o n took a bus t o O n t a r i o , would th e O n t a r i o h e a l t h a u t h o r i t i e s be o b l i g e d t o apprehend and t r e a t the p e r s o n or apprehend and t h e n r e t u r n him t o B r i t i s h Columbia f o r t r e a t m e n t ? The r e s o l u t i o n of problems of t h i s k i n d r e q u i r e s time and e x p e n d i t u r e o f mental h e a l t h program f u n d s . The d i r e c t o r s were q u e s t i o n i n g whether a s t a n d a r d a c t a p p l y i n g t o a l l Canadians might be 13 n e c e s s a r y ; c o n s e q u e n t l y , t h e y wanted t o know whether each o f the p r o v i n c i a l a c t s g o v e r n i n g t h e i r d e c i s i o n s needed t o be brought i n t o l i n e w i t h the o t h e r t e n a c t s . In l o o k i n g a t the c o n t e n t s of the t e n p r o v i n c i a l a c t s more c l o s e l y , i t became e v i d e n t t h a t the problem was complex and t h a t more stu d y o f mental h e a l t h l e g i s l a t i o n needed t o be done. The f o l l o w i n g q u e s t i o n s had become ap p a r e n t : 1. Were a l l mental h e a l t h a c t s r e s t r i c t i v e i n t h a t they have s e c t i o n s r e g a r d i n g e n f o r c e d t r e a t m e n t and c u s t o d y w i t h o u t v o l u n t a r y c o n s e n t ? 2. Have t h e s e i s s u e s always been i n a c t s f o r the m e n t a l l y i l l and i s t h e r e a l i k e l i h o o d t h a t t h e y may remain? 3. Many r e s t r i c t i v e a c t s have r e v i e w and a p p e a l p r o c e d u r e s . Were s i m i l a r p r o c e d u r e s l a i d down i n a l l the mental h e a l t h a c t s ? 4. Was the wording l o o s e and s u b j e c t t o i n t e r p r e t a t i o n and, i f so, what changes needed t o be made? Some of the q u e s t i o n s had no immediate answer but s e r v e d as a s t i m u l u s f o r t h i s p r o j e c t . S e l e c t i o n of P r o v i n c i a l A c t s D u r i n g the i n i t i a l r e v i e w of a l l the t e n p r o v i n c i a l mental h e a l t h a c t s , i t was noted t h a t i n t h e c o n t e n t s of a l l were s e c t i o n s t h a t now c o n f l i c t w i t h the f e d e r a l C h a r t e r of R i g h t s and Freedoms. But f o r the purpose of t h i s s t u d y , o n l y f i v e o f t h e p r o v i n c i a l s t a t u t e s were s e l e c t e d . The s e l e c t i o n was made c o n s i d e r i n g the v a r i a b l e s of g e o g r a p h i c r e p r e s e n t a t i o n , l a r g e and s m a l l p r o v i n c i a l p o p u l a t i o n v a r i a t i o n , F r e n c h and E n g l i s h l e g i s l a t i v e t r a d i t i o n s , and r e c e n t and e a r l i e r d a t e s of enactment. The p r o v i n c i a l a c t s s e l e c t e d a re from the p r o v i n c e s of B r i t i s h Columbia, Saskatchewan, O n t a r i o , Quebec, and Nova S c o t i a . These a c t s do r e f l e c t mental h e a l t h l e g i s l a t i o n i n Canada. 15 Chapter I I I METHOD OF ANALYSIS In t h i s c h a p t e r , t he w r i t e r w i l l d e s c r i b e the method of a n a l y s i s used t o develop the recommendations f o r change r e g a r d i n g p r o v i n c i a l mental h e a l t h l e g i s l a t i o n . T h i s study i s not one of q u e s t i o n i n g t he n e c e s s i t y o f mental h e a l t h l e g i s l a t i o n nor of t h e i m p l i c a t i o n s of imple m e n t i n g the s t a t u t e nor i f i t s h o u l d have a m e d i c a l o r s o c i a l f o c u s , but r a t h e r i t examines t h e c o n t e n t o f the mental h e a l t h a c t s t o l e a r n i f t he r i g h t s of t h e m e n t a l l y i l l a re not r e s t r i c t e d . The s u b j e c t i s mental h e a l t h l e g i s l a t i o n and t h e s e c t i o n s of the l e g i s l a t i o n t h a t are c o n s i d e r e d r e s t r i c t i v e . S i n c e s t a t u t e s are not s t a t i c but s u b j e c t t o t h e p r e s s u r e s of the s o c i e t y and the government f o r whom and by whom th e y are w r i t t e n , q u a l i t a t i v e a n a l y s i s u n d e r l i e s t he approach. As D a v i d W e i s s t u b , a l e a d i n g Canadian a u t h o r i t y on the law, s t a t e s : "Law i s a p r o d u c t o f the s o c i e t y i n which i t i s f o r m u l a t e d and e n f o r c e d as w e l l as b e i n g a d e r i v a t i v e o f antecedent s o c i e t i e s . I t remains s u b j e c t t o c o n t i n u o u s p r e s s u r e f o r a l t e r a t i o n by s o c i e t y . " 1 With the dynamic n a t u r e of s t a t u t o r y i n s t r u m e n t s , an a n a l y s i s t h a t i n c o r p o r a t e s t he changes o c c u r r i n g p r e s e n t l y and over time i s needed. As w e l l , l e g i s l a t i o n f i t s i n t h e c o n t e x t of t h e s o c i a l environment of a n a t i o n o r p r o v i n c e and r e q u i r e s e x a m i n a t i o n t h a t i s s e n s i t i v e t o t h i s . Some of the elements of q u a l i t a t i v e a n a l y s i s d e s c r i b e d by G l a s e r 16 2 and S t r a u s s i n The D i s c o v e r y of Grounded Theory were e s p e c i a l l y s u i t e d t o t h i s s t u d y . The a n a l y s i s can be o r d e r e d i n t o f o u r a r e a s , as f o l l o w s : ( i ) a c o m p a r a t i v e / d e s c r i p t i v e approach t o p r o v i n c i a l m ental h e a l t h l e g i s l a t i o n ; ( i i ) an h i s t o r i c a l e v o l u t i o n a r y / c o m p a r a t i v e approach to E n g l i s h and Canadian mental h e a l t h l e g i s l a t i o n ; ( i i i ) a c o m p a r a t i v e / d e s c r i p t i v e approach t o f e d e r a l and p r o v i n c i a l l e g i s l a t i o n ; and ( i v ) an a n a l y t i c a l approach t o t h e i s s u e o f r i g h t s i n the mental h e a l t h l e g i s l a t i o n o f f i v e p r o v i n c e s . F o l l o w i n g the a n a l y s i s , recommendations w i l l be made f o r change i n a c t s o f t h e s e f i v e p r o v i n c e s i n t h e l i g h t o f t h e powers and r e s p o n s i b i l i t i e s of the p r o v i n c i a l m ental h e a l t h a d m i n i s t r a t o r s . The q u e s t i o n o f the study i s : "Do t h e c o n t e n t s o f the mental h e a l t h a c t s , now i n e f f e c t i n Canada, c o n f l i c t w i t h the c o n t e n t s of t h e C h a r t e r of R i g h t s and Freedoms?" The answer t o the q u e s t i o n w i l l be d e v e l o p e d from the p e r s p e c t i v e of a p l a n n e r . A p l a n n e r i n mental h e a l t h has, f o r t h i s s t u d y , two f u n c t i o n s : t o a d v i s e on l e g i s l a t i o n and t o a d v i s e on t h e i m p l e m e n t a t i o n o f i t . The l e g i s l a t i o n i s the t o o l t h a t s e t s out the a u t h o r i t y and b o u n d a r i e s of a s u b j e c t . In the f i e l d of h e a l t h , f o r example, t h e r e are a c t s f o r mental h e a l t h , v e n e r e a l d i s e a s e c o n t r o l , and p u b l i c h e a l t h . The w r i t t e n document becomes a t o o l of s o c i a l o r d e r 17 when i t s c o n t e n t s are implemented. The p l a n n e r , i n a n a l y z i n g a q u e s t i o n , w i l l t a k e i n t o account a l l the f a c t o r s t h a t are r e l e v a n t t o the problem and i t s i m p l e m e n t a t i o n of a s o l u t i o n . The framework used i n t h i s s tudy f o l l o w s the p r o c e s s of problem d e f i n i t i o n , a n a l y s i s of t h e v a r i a b l e s , c o n s i d e r a t i o n of t h e i m p l i c a t i o n s and c o n c l u s i o n s w i t h recommendations. To do t h i s , i n f o r m a t i o n and m a t e r i a l had t o be g a t h e r e d , r e v i e w e d , and used a c c o r d i n g t o the v r e q u i r e m e n t s of t h i s s t u d y . M a t e r i a l s and I n f o r m a t i o n C o l l e c t i o n The f i r s t s t e p i n the p r e p a r a t i o n o f t h i s paper was t o o b t a i n a copy of the mental h e a l t h a c t o r a c t s f o r each of the t e n p r o v i n c e s . As w e l l , a l i t e r a t u r e s e a r c h f o r j o u r n a l a r t i c l e s u s i n g the key words " h e a l t h l e g i s l a t i o n " , "mental h e a l t h l e g i s l a t i o n " and " r e s t r i c t i o n s found i n mental h e a l t h l e g i s l a t i o n " was done. The next s t e p was t o conduct a l i b r a r y s e a r c h i n t h e g e n e r a l f i e l d of l e g i s l a t i o n , law-making and l a w - w r i t i n g . T h i s was done i n the g e n e r a l l i b r a r y as w e l l as the l e g a l l i b r a r i e s o f the U n i v e r s i t y of V i c t o r i a and U n i v e r s i t y o f B r i t i s h Columbia. The a d m i n i s t r a t o r s of the p r o v i n c i a l mental h e a l t h s e r v i c e s were w r i t t e n t o determine i f t h e r e were any changes p l a n n e d f o r t h e mental h e a l t h a c t s . I f changes were p l a n n e d , the s e c t i o n o r s e c t i o n s t o be amended was r e q u e s t e d . At the time of c o n t a c t , t h e r e were no changes b e i n g p l a n n e d f o r the a c t s i n t h i s s t u d y . 18 F o l l o w i n g the i n i t i a l c o l l e c t i o n of m a t e r i a l and i n f o r m a t i o n on mental h e a l t h l e g i s l a t i o n , a d d i t i o n a l m a t e r i a l was g a t h e r e d on the p r o c e s s of law-making i n Canada, the C o n s t i t u t i o n A c t , and o t h e r p r o v i n c i a l a c t s t h a t p l a c e r e s t r i c t i o n s on t h e m e n t a l l y d i s o r d e r e d . The Scope o f the Study For a s u b j e c t t o be w r i t t e n i n t o law t h e r e a re b a s i c r e q u i r e m e n t s t o be met. The t o p i c must be w i t h i n the j u r i s d i c t i o n o f the government making t h e law and i f t h a t c r i t e r i o n i s s a t i s f i e d t he c o n t e n t s are s e t out a c c o r d i n g t o the e s t a b l i s h e d f o r m a t . The format i n t h i s c o n t e x t means or i n c l u d e s t h e d e s c r i p t i v e t i t l e , a d m i n i s t r a t i v e a u t h o r i t y of p r o c l a i m i n g government, d e f i n i t i o n of terms, g e n e r a l and s p e c i a l p r o v i s i o n s , and t h e date of enforcement. C o n s i d e r i n g t h e s e f a c t o r s and the purpose o f t h i s s t u d y , mental h e a l t h l e g i s l a t i o n had s e c t i o n s t h a t were r e s t r i c t i v e , r a t h e r than the e n t i r e a c t b e i n g r e s t r i c t i v e . The st u d y i s l i m i t e d t o the f o l l o w i n g s e c t i o n s i n the p r o v i n c i a l mental h e a l t h a c t s : t h e t i t l e , t h e d e f i n i t i o n s , the compulsory t r e a t m e n t and ap p e a l p r o c e d u r e s and the s e c t i o n s t h a t r e c o g n i z e p a t i e n t r i g h t s . Each o f t h e s e s e c t i o n s of the a c t are a n e c e s s a r y p a r t of t h e a n a l y s i s u s i n g a p l a n n i n g framework. T h i s model i n c l u d e s the f o r c e s t h a t a f f e c t the i m p l e m e n t a t i o n and development o f an a c t , such as the a l l o c a t i o n of human and f i n a n c i a l r e s o u r c e s r e q u i r e d f o r a d m i n i s t r a t i o n and t h e 19 v a r i o u s groups w i t h a s p e c i a l i n t e r e s t s e e k i n g t o i n f l u e n c e t h e enforcement of t h e law. L i m i t a t i o n of the Study The s t u d y does not i n c l u d e d a t a on the a p p l i c a t i o n of the mental h e a l t h a c t s . There are no f i g u r e s on the number of p e o p l e t r e a t e d c o m p u l s o r i l y i n each of the p r o v i n c e s i n t h e s t u d y . T h i s i n f o r m a t i o n , a l t h o u g h most u s e f u l f o r comparing th e use o f compulsory t r e a t m e n t p r o c e d u r e s between p r o v i n c e s or w i t h i n a p r o v i n c e , i s not e a s i l y o b t a i n e d . The i n f o r m a t i o n t h a t i s a v a i l a b l e may not be g a t h e r e d i n the same way and from th e same s o u r c e s , thus a f f e c t i n g the v a l i d i t y of the c o m p a r i s o n s . The-scope of the study i s l i m i t e d t o the s e c t i o n s of the f i v e p r o v i n c i a l mental h e a l t h a c t s d e s c r i b e d above, and i s done i n the framework of a p l a n n e r t o p r o v i d e a d v i c e on mental h e a l t h l e g i s l a t i o n and i t s a d m i n i s t r a t i o n . 20 F o o t n o t e s "^David N. W e i s s t u b , Law and P s y c h i a t r y i n the Canadian  C o n t e x t , Pergamon P r e s s , T o r o n t o , Canada, 1980, p. 50. 2 Barney G. G l a s e r and Anselm L. S t r a u s s , The D i s c o v e r y  of Grounded Theory: S t r a t e g i e s f o r Q u a l i t a t i v e - R e s e a r c h , A l d i n e P u b l i s h i n g Company, New York, 1967. 21 Chapter IV THE DIVISION OF LEGISLATIVE AUTHORITY BETWEEN FEDERAL AND PROVINCIAL GOVERNMENTS AND THE PROBLEMS RAISED The l e g i s l a t i v e s t r u c t u r e was f o r m a l l y s e t out f o r Canada i n 1867 when f o u r independent Canadian p r o v i n c e s t o g e t h e r r e q u e s t e d the B r i t i s h ; g o v e r n m e n t t o g r a n t them a " c o n s t i t u t i o n " when th e y j o i n e d i n a C o n f e d e r a t i o n . The BNA Act e s t a b l i s h e d t h e two l e v e l s o f government and s e t out t h e i r powers and r e s p o n s i b i l i t i e s , p a r t i c u l a r l y i n s e c t i o n s 91 and 92 (see Appendix A ) . The w r i t i n g and the c o n t e n t s of t h a t document r e f l e c t t h e v a l u e s and b e l i e f s h e l d by the peop l e o f t h a t day. The F a t h e r s of C o n f e d e r a t i o n adopted the t r a d i t i o n s o f the E n g l i s h p a r l i a m e n t a r y government and j u d i c i a r y system f o r Canada. One i m p l i c a t i o n of t r a n s p l a n t i n g t h e s e t r a d i t i o n s was not w r i t i n g i n t o the BNA A c t a s e c t i o n on r i g h t s and freedoms. Other c o u n t r i e s , the U n i t e d S t a t e s f o r example, had w r i t t e n documents or b i l l s on r i g h t s and freedoms as p a r t of t h e i r c o n s t i t u t i o n s l o n g b e f o r e 1867. But, E n g l a n d and i t s l o y a l c o l o n i e s guarded the v a l u e s much l e s s e x p l i c i t l y i n the p a r l i a m e n t a r y p r o c e s s and j u d i c i a l p r o c e d u r e s . P r i o r t o t h e s i g n i n g of the BNA A c t , t h e r e s i d e n t s o f the v a r i o u s s e p a r a t e c o l o n i a l j u r i s d i c t i o n s of Upper and Lower Canada, P r i n c e Edward I s l a n d and Nova S c o t i a had been a d m i n i s t e r e d o r managed by a p p o i n t e e s of the r e i g n i n g monarch and p a r l i a m e n t of England. These c o l o n i e s o r p r o v i n c e s d e v e l o p e d t h e i r systems of government from the c o l o n i a l e x p e r i e n c e s of the predominant group of s e t t l e r s , so t h a t Lower or F r e n c h Canada f o l l o w e d the t r a d i t i o n s of F r a nce w h i l e Upper Canada and t h e m a r i t i m e p r o v i n c e s adhered t o t h o s e of E n g l a n d and S c o t l a n d . The c o n c e r n s about i m m i g r a t i o n and q u a r a n t i n e , l a n d c l e a r i n g and development of the economy and the maintenance of o r d e r and j u s t i c were o r g a n i z e d s e p a r a t e l y f o r each a r e a . The BNA A c t e s t a b l i s h e d the government f o r a l l t h e areas j o i n i n g i n c o n f e d e r a t i o n i n 1867 and f o r a d d i t i o n a l p r o v i n c e s t h e r e a f t e r ; e.g., B r i t i s h Columbia j o i n e d i n 1871 f o l l o w e d by M a n i t o b a , t h e n Saskatchewan and A l b e r t a i n 1905 and Newfoundland i n 1949. In j o i n i n g w i t h the c o n f e d e r a t i n g p r o v i n c e s , t h e more r e c e n t p a r t i c i p a n t s were committed t o govern a c c o r d i n g t o the n a t i o n a l a u t h o r i t y p r o c l a i m e d i n 1867. M a t t e r s such as f i n a n c i n g s e r v i c e s , d e v e l o p i n g the economy, and managing e l e c t i o n s t h a t f o r m e r l y had been the s o l e r e s p o n s i b i l i t y of a p r o v i n c e were now, f o l l o w i n g c o n f e d e r a t i o n , a d m i n i s t e r e d a c c o r d i n g t o t h e assignment of f u n c t i o n s d e c l a r e d p r i m a r i l y i n s e c t i o n s 91 and 92. F e d e r a l Government R e s p o n s i b i l i t y The m a t t e r s w i t h i n the r e s p o n s i b i l i t y of the f e d e r a l government o t h e r t h a n the s p e c i f i c s of e l e c t i n g and o r g a n i z i n g government are n o t ed i n s e c t i o n 91 o f the BNA A c t and n o t e d i n Appendix A. G e n e r a l l y , the f e d e r a l government was t o be r e s p o n s i b l e f o r p r o t e c t i o n from f o r e i g n i n v a s i o n , 23 i n t e r n a t i o n a l t r a d e and t a r i f f s , n a t i o n a l t r a n s p o r t a t i o n , communication, b a n k i n g and the monetary system. The o n l y h e a l t h m a t t e r s t h a t f e l l i n t o the f e d e r a l j u r i s d i c t i o n were q u a r a n t i n e , the e s t a b l i s h m e n t and maintenance of marine h o s p i t a l s and h e a l t h s e r v i c e s t o t h e n a t i v e p o p u l a t i o n as p a r t o f t h e o v e r a l l r e s p o n s i b i l i t y t o n a t i v e p e o p l e s . The management or a d m i n i s t r a t i o n o f h e a l t h by the f e d e r a l and p r o v i n c i a l governments i s i n t e r e s t i n g . H e a l t h s e r v i c e s i n 1867 m a i n l y c o n s i s t e d of p r o v i d i n g uncontaminated f o o d , water and m i l k s u p p l i e s and i s o l a t i n g t h o s e p e o p l e who had r e c o g n i z e d d i s e a s e s . As w e l l , the s o c i a l norms of the day were f o r f a m i l i e s , the churches and c h a r i t a b l e groups t o c a r e f o r t h e i r s i c k and poor, l i m i t i n g the government i n v o l v e m e n t t o a minimum, e s p e c i a l l y the n a t i o n a l government. So from 1867 t o 1919, f e d e r a l h e a l t h r e s p o n s i b i l i t i e s f o r q u a r a n t i n e and p u b l i c h e a l t h were a d m i n i s t e r e d by the Department of A g r i c u l t u r e . I t i s of i n t e r e s t t o note where h e a l t h was p l a c e d i n the f e d e r a l o r g a n i z a t i o n a l s t r u c t u r e from 1867 t o now. As s t a t e d , f o r f o r t y y e a r s i t was i n the Department of A g r i c u l t u r e . Then, f o l l o w i n g the swine f l u e p i demic of 1919, h e a l t h was t r a n s f e r r e d from A g r i c u l t u r e t o a s e p a r a t e Department of H e a l t h u n t i l 1928. In 1928, the Department of H e a l t h was j o i n e d w i t h the S o l d i e r s C i v i l R e - e s t a b l i s h m e n t S e c t i o n t o form the Department of P e n s i o n s and N a t i o n a l H e a l t h . T h i s s t r u c t u r e remained u n t i l 1944, when two 24 departments were c r e a t e d : the Department of V e t e r a n s ' A f f a i r s and the Department of N a t i o n a l H e a l t h and W e l f a r e . The l a t t e r department s t i l l e x i s t s and has w i t h i n i t the f o l l o w i n g d i v i s i o n s : - h e a l t h s e r v i c e s t o I n d i a n s , n o r t h e r n r e s i d e n t s , t h e f e d e r a l p u b l i c s e r v i c e , immigrants and c i v i l a v i a t i o n p e r s o n n e l - q u a r a n t i n e s e r v i c e s - f o o d and drug i n s p e c t i o n , N a r c o t i c s C o n t r o l - e n v i r o n m e n t a l h e a l t h ( r a d i a t i o n p r o t e c t i o n ) - h o s p i t a l and m e d i c a l c a r e i n s u r a n c e w i t h the p r o v i n c e s - p o i s o n c o n t r o l - a i d t o the b l i n d - m e d i c a l r e s e a r c h - h e a l t h p r o m o t i o n , f i t n e s s and amateur s p o r t ( r e p o r t i n g t o a s e p a r a t e m i n i s t e r of s t a t e ) . The o r g a n i z a t i o n a l changes o u t l i n e d above, i n p a r t m i r r o r the e v e n t s o c c u r r i n g t h r o u g h o u t a l l p a r t s of the n a t i o n such as t e c h n o l o g i c a l advances, economic c y c l e s , p o p u l a t i o n i n c r e a s e s , wars and t h e r i s e of p r e s s u r e groups f o r the handicapped or d i s a d v a n t a g e d . N a t i o n a l l y , mental h e a l t h was a s u b j e c t r e c o g n i z e d i n the o r g a n i z a t i o n a l s t r u c t u r e of the Department of H e a l t h from 1922. A l t h o u g h the Department had no a u t h o r i t y t o d e l i v e r s e r v i c e s f o r the m e n t a l l y i l l , t he D i v i s i o n o f M e n t a l H e a l t h was c e n t r a l i n the a s s e m b l i n g , c o - o r d i n a t i n g 25 and d i s s e m i n a t i n g Canadian i d e a s about the o r g a n i z a t i o n of s e r v i c e s and t r e a t m e n t f o r t h e m e n t a l l y i l l . The A d v i s o r y Committee on M e n t a l H e a l t h was an a c t i v e p a r t of the D i v i s i o n f o r twenty y e a r s from 1946 t o 1966. The j o u r n a l Canada's M e n t a l H e a l t h , i n i t s t h i r t i e t h y e a r of p u b l i c a t i o n , i s one example o f the o u t p u t from the D i v i s o n of M e n t a l H e a l t h . B e f o r e t u r n i n g t o the r e s p o n s i b i l i t i e s of the p r o v i n c i a l governments f o r h e a l t h , a b r i e f comment on the f i s c a l a c t i v i t i e s of the f e d e r a l government i s n e c e s s a r y i n a r e v i e w of l e g i s l a t i v e development. The BNA A c t s p e c i f i e d the a u t h o r i t y o f the n a t i o n a l and p r o v i n c i a l governments t o t a x so as t o r a i s e t h e funds n e c e s s a r y t o implement the v a r i o u s programs. The p r o v i n c e s c o u l d a p p l y d i r e c t t a x a t i o n on i n d i v i d u a l s and b u s i n e s s e s f o r p r o v i n c i a l p u r p o s e s , whereas t h e f e d e r a l government a p p l i e d t a r r i f s and any mode of t a x a t i o n a c c o r d i n g t o the BNA A c t . T h i s system was s a t i s f a c t o r y f o r the e a r l y y e a r s a f t e r C o n f e d e r a t i o n but w i t h World War I and t h e d e p r e s s i o n y e a r s t h e s e o r i g i n a l f i s c a l arrangements became s t r a i n e d . In o r d e r t o reduce t h e f i n a n c i n g p r e s s u r e s t h e government was e x p e r i e n c i n g , the f e d e r a l government i n s t i t u t e d a p e r s o n a l t a x a t i o n , p r i m a r i l y t o a s s i s t w i t h t h e war expenses. With t h e p a s s i n g o f t h e Income Tax A c t , t h i s p r e l i m i n a r y arrangement became a permanent t a x and f e d e r a l government i n v o l v e m e n t i n t h e p r o v i n c i a l f i s c a l arena g r a d u a l l y i n c r e a s e d . 26 The government programs l i k e p u b l i c h e a l t h and v e t e r a n s s e r v i c e s r e q u i r e d i n c r e a s e d f u n d i n g because of demands a r i s i n g from a growing p o p u l a t i o n and new t e c h n o l o g y . With the s o c i a l , t e c h n o l o g i c a l and economic changes i n Canada from 1867 t o 1935, t h e f e d e r a l government r e c o g n i z e d t h a t a„ thorough i n v e s t i g a t i o n of f e d e r a l - p r o v i n c i a l r e s p o n s i b i l i t e s was needed and t o t h a t end a p p o i n t e d a commission. The R o y a l Commission on D o m i n i o n - P r o v i n c i a l R e l a t i o n s ( r e f e r r e d t o as the R o w e l l - S i r o i s Commission) was a p p o i n t e d i n 1937 and r e p o r t e d t o P a r l i a m e n t i n 1940. T h i s was the f i r s t o b j e c t i v e assessment s i n c e 1867 of t h e economic and f i n a n c i a l b a s i s o f Canada and t h e d i s t r i b u t i o n o f f e d e r a l and p r o v i n c i a l powers. T h i s was an i m p o r t a n t document f o r the f u t u r e d i r e c t i o n o f f i n a n c i a l arrangements of the f e d e r a l government. The recommendations from t h i s r e p o r t were not a l l implemented i m m e d i a t e l y but many of them, e s p e c i a l l y r e g a r d i n g t a x i n g and f e d e r a l g r a n t s t o the p r o v i n c e s , were e v e n t u a l l y a c t e d upon. Thus, the Dominion a c c e p t e d r e s p o n s i b i l i t y f o r o l d age p e n s i o n s , unemployment a s s i s t a n c e (now i n s u r a n c e ) , h e a l t h i n s u r a n c e and a i d i n n a t u r a l r e s o u r c e development. These new u n d e r t a k i n g s i n r e s o u r c e a l l o c a t i o n were assumed by agreement w i t h t h e p r o v i n c e s f o l l o w i n g n e g o t i a t i o n s r a t h e r t h a n by c o n s t i t u t i o n a l entrenchment. The f e d e r a l government then passed a number of a c t s t h a t i n d i c a t e d i t s new r o l e i n t h e h e a l t h c a r e system. With the H e a l t h G r a n t s A c t , 1948; the H o s p i t a l I n s u r a n c e and D i a g n o s t i c S e r v i c e s A c t , 1957; and the M e d i c a l Care A c t , 1966 each of the s t a t u t e s gave more v i s i b i l i t y t o t h e f e d e r a l government on a s o c i a l p o l i c y m a t t e r v i a f i n a n c i n g h e a l t h programs. The cha n g i n g r o l e of the f e d e r a l government i n h e a l t h f o l l o w e d a l o n g w i t h the change w i t h i n the p o p u l a t i o n t h a t i s , h e a l t h no l o n g e r was a p r i v a t e c o n c e r n but a s e r v i c e a v a i l a b l e t o a l l . To f u l l y d e s c r i b e t h e changes i n f e d e r a l f i n a n c i n g , e s p e c i a l l y t h a t of h e a l t h , would r e q u i r e much more space than i s p o s s i b l e i n t h i s s t u d y . For t h i s s tudy i t i s n e c e s s a r y t o note t h a t f u n d i n g s e r v i c e s i s an e s s e n t i a l p a r t of t h e p o l i c y e n a c t e d by government. P r o v i n c i a l Government R e s p o n s i b i l i t y H e a l t h has been one o f the m a t t e r s a s s i g n e d t o the p r o v i n c i a l governments i n s e c t i o n 92(7) of t h e BNA A c t t h a t s t a t e s : "the E s t a b l i s h m e n t , maintenance, and managements of H o s p i t a l s , Asylums, C h a r i t i e s and Eleemosynary I n s t i t u t i o n s i n and f o r t h e P r o v i n c e , o t h e r than Marine H o s p i t a l s . " At the time of c o n f e d e r a t i o n , i n d i v i d u a l s and t h e i r f a m i l i e s were used t o c a r i n g f o r t h o s e members who were i l l . I m m unization a g a i n s t communicable d i s e a s e s had not been g r e a t l y d e v e l o p e d and c e r t a i n l y m e d i c a l knowledge l i m i t e d t r e a t m e n t t o a few s u r g i c a l p r o c e d u r e s , a minor pharmacopeia and t o r e s t i n bed. The m e n t a l l y i l l were p l a c e d i n asylums t h a t d i d l i t t l e more th a n p r o v i d e c u s t o d i a l c a r e . The o r g a n i z a t i o n a l s t r u c t u r e of t h e p r o v i n c e s under st u d y w i l l be d e s c r i b e d now f o r mental h e a l t h r a t h e r than 28 f o r h e a l t h g e n e r a l l y . B r i t i s h Columbia p l a c e d p u b l i c h e a l t h , mental h o s p i t a l s , homes f o r the aged and v i t a l s t a t i s t i c s w i t h i n the Department of the P r o v i n c i a l S e c r e t a r y u n t i l 1947. With h e a l t h c a r e f o r t h e most p a r t c o n s i d e r e d t o be t h e r e g u l a t i o n of p r o f e s s i o n s and c o n t r o l of communicable d i s e a s e s by t h e government, i t i s r e a s o n a b l e t o have h e a l t h so p l a c e d i n t h e a d m i n i s t r a t i v e s t r u c t u r e . The I n s t i t u t e f o r t he Insane o f B r i t i s h Columbia was l o c a t e d i n V i c t o r i a from 1872 t o 1877 when i t was r e l o c a t e d t o New We s t m i n s t e r . T h i s one p s y c h i a t r i c s e r v i c e was expanded i n 1947 w i t h the C h i l d Guidance C l i n i c i n Vancouver, f o l l o w e d by c o n t i n u e d development of community mental h e a l t h s e r v i c e s . W ith the e s t a b l i s h m e n t o f a Department o f H e a l t h and W e l f a r e , 1946, p u b l i c h e a l t h and a l l community h e a l t h m a t t e r s were removed from the a d m i n i s t r a t i o n of t h e P r o v i n c i a l S e c r e t a r y , who r e t a i n e d mental h e a l t h and h o s p i t a l i n s p e c t i o n . M e n t a l h e a l t h was f i n a l l y p l a c e d w i t h i n the a d m i n i s t r a t i o n o f the Department o f H e a l t h i n 1959. Saskatchewan, e n t e r i n g i n t o c o n f e d e r a t i o n i n 1905, had a f a i r l y w e l l d e v e l o p e d a d m i n i s t r a t i v e s t r u c t u r e f o r h e a l t h s e r v i c e s . I n 1905 p s y c h i a t r i c s e r v i c e s c o n s i s t e d of two p r o v i n c i a l mental h o s p i t a l s , one a t N o r t h B a t t l e f o r d and one a t Weyburn, and a p s y c h o p a t h i c ward i n the Re g i n a H o s p i t a l . The Department o f P u b l i c H e a l t h a d m i n i s t e r e d the l a t t e r s e r v i c e s i n Re g i n a as w e l l as m e d i c a l and g e n e r a l h o s p i t a l s e r v i c e s . The Department o f P u b l i c Works a d m i n i s t e r e d the two p r o v i n c i a l h o s p i t a l s u n t i l 1950 when t h e a d m i n i s t r a t i o n was t r a n s f e r r e d t o the Department of P u b l i c H e a l t h , P s y c h i a t r i c S e r v i c e s Branch. I t was i n t e r e s t i n g t o note i n the e a r l y d e s c r i p t i o n o f the f u n c t i o n s of the Department o f P u b l i c H e a l t h t h a t t h e r e was t o be an e v a l u a t i o n of the t r e a t m e n t s a v a i l a b l e . R esearch and development was an acknowledged r e s p o n s i b i l i t y of the Department. The development o f the a d m i n i s t r a t i o n o f h e a l t h programs i n O n t a r i o i s i n t e r e s t i n g . From 1864 t o 1930 h o s p i t a l s and p r o v i n c i a l asylums were under the j u r i s d i c t i o n o f the I n s p e c t o r o f P r i s o n s and P u b l i c C h a r i t i e s who report e c t o the P r o v i n c i a l S e c r e t a r y . In 1930 the Department o f H e a l t h e s t a b l i s h e d a d i v i s i o n t o s u p e r v i s e and l i c e n s e p r i v a t e h o s p i t a l s , t o i n s p e c t and a d m i n i s t e r g r a n t s t o p u b l i c h o s p i t a l s and t o m a i n t a i n the mental h o s p i t a l s known as the O n t a r i o H o s p i t a l and mental h e a l t h c l i n i c s . T h i s was a new d i v i s i o n added t o t h e d i v i s i o n a l r e a d y a d m i n i s t e r i n g p u b l i c h e a l t h m a t t e r s . I n 1950, the Department p l a c e d mental h e a l t h i n a d i v i s i o n f o r t h a t purpose a l o n e . P u b l i c H e a l t h a d m i n i s t e r e d by t h e P r o v i n c i a l Board of H e a l t h from 1882 s u b m i t t e d i t s r e p o r t s t o the P r o v i n c i a l S e c r e t a r y , then the M i n i s t e r of Labour, then i n 1924 t o the M i n i s t e r f o r t h e newly c r e a t e d Department o f H e a l t h . In Quebec, t h e P r o v i n c i a l S e c r e t a r y had h e a l t h m a t t e r s as p a r t of t h e p o r t f o l i o u n t i l 1936. H e a l t h was a s e p a r a t e department u n t i l 1972 when h e a l t h was l i n k e d w i t h s o c i a l 30 s e r v i c e s . M e n t a l h e a l t h came under the d i v i s i o n of h e a l t h r e s p o n s i b l e f o r i n s p e c t i o n of p r i s o n s and asylums. P s y c h i a t r i c h o s p i t a l s managed or a d m i n i s t e r e d by r e l i g i o u s o r d e r s l i k e the Grey Nuns appeared t o r e p o r t d i r e c t l y t o s e n i o r managers i n the Department of the P r o v i n c i a l S e c r e t a r y p r i o r t o 1936. In Quebec the r e l i g i o u s o r d e r s of t h e Roman C a t h o l i c Church p r o v i d e d h o s p i t a l and c h a r i t a b l e s e r v i c e s . With t h i s r e s o u r c e i n the p r o v i n c e , a d m i n i s t e r i n g h e a l t h s e r v i c e s took a d i f f e r e n t form from t h a t o f the r e s t o f the p r o v i n c e s . The c h u r c h p r o v i d e d an i m p o r t a n t s e r v i c e by e n c o u r a g i n g i t s members t o g i v e d o n a t i o n s t o i n s t i t u t i o n s and i n some cases t o e n t e r r e l i g i o u s o r d e r s t o p r o v i d e c a r e t o the s i c k . For t h i s s t u d y , the a d m i n i s t r a t i o n o f mental h e a l t h s e r v i c e s by government i s of prime i n t e r e s t and t h e s o c i a l c o n t e x t of t h i s p r o v i n c e i s r e f l e c t e d i n i t s a d m i n i s t r a t i o n of t h e s e s e r v i c e s . The s e r v i c e s managed by r e l i g i o u s o r d e r s were not a major p a r t of government a d m i n i s t r a t i o n and m ental h e a l t h was p r i m a r i l y a governmental s e r v i c e . In Nova S c o t i a , the l a s t p r o v i n c e i n c l u d e d i n t h e r e v i e w of t h e assignment of h e a l t h w i t h i n t h e government s t r u c t u r e , the Board of Commissioners of P u b l i c C h a r i t i e s e s t a b l i s h e d i n 1878 was r e s p o n s i b l e f o r the Nova S c o t i a H o s p i t a l f o r the Insane and the V i c t o r i a G e n e r a l H o s p i t a l i n H a l i f a x . The Board of Commissioners was t h e n put under the Commission of P u b l i c Works and Mines from 1884 t o 1910. Then, 31 f o r n i n e t e e n y e a r s t h e s e f a c i l i t i e s were a d m i n i s t e r e d by the Department of P u b l i c C h a r i t i e s . F o l l o w i n g a two-year p e r i o d i n t h e M i n i s t r y o f P u b l i c Works and Mines, Humane I n s t i t u t i o n s , Nova S c o t i a S a n a torium, V i c t o r i a G e n e r a l H o s p i t a l and the Nova S c o t i a H o s p i t a l were a s s i g n e d t o the Department of P u b l i c H e a l t h i n 1931. Community h e a l t h m a t t e r s l i k e the c o n t r o l o f t u b e r c u l o s i s and v e n e r e a l d i s e a s e s had been the r e s p o n s i b i l i t y of the P r o v i n c i a l Board of H e a l t h under the P r o v i n c i a l S e c r e t a r y from 1893 t o 1931. Thus, In 1931, the P u b l i c H e a l t h Department had i n one department b o t h community h e a l t h and h o s p i t a l c a r e , i n c l u d i n g mental h e a l t h . Changes I m p a c t i n g Upon M e n t a l H e a l t h L e g i s l a t i o n I t has been s a i d t h a t "an a c t of law i s the p r o d u c t of t h e s o c i e t y i n ' which i t i s f o r m u l a t e d and e n f o r c e d as w e l l as b e i n g a d e r i v a t i v e o f a n t e c e d e n t s o c i e t i e s and i t remains s u b j e c t t o c o n t i n u o u s change.""'* Canadian l i f e s t y l e has changed d r a m a t i c a l l y s i n c e 1867 w i t h t h e advancement of t r a n s p o r t a t i o n and communication systems and expanded m e d i c a l knowledge r e g a r d i n g t r e a t m e n t . These s o c i a l , economic and t e c h n o l o g i c a l changes have s e p a r a t e l y and c o l l e c t i v e l y had an impact upon l e g i s l a t i o n but w i t h t h e r e c o g n i t i o n t h a t the l e g i s l a t i v e changes o c c u r a f t e r a l a p s e o f t i m e . L e g i s l a t i v e changes and s o c i a l s t r u c t u r a l changes are i n t e r a c t i v e . E f f e c t of S o c i a l Change on L e g i s l a t i o n The s o c i a l s t r u c t u r e of Canadian s o c i e t y has moved from b e i n g based upon an extended f a m i l y u n i t c a r v i n g out a l i v e l i h o o d on a homestead o r farm t o a "blended" m o b i l e f a m i l y w o r k i n g i n urban c e n t r e s . More c h i l d r e n now grow and dev e l o p i n a f a m i l y w i t h o n l y one n a t u r a l p a r e n t o r a s t e p -p a r e n t and s t e p - s i b l i n g s t h a n was the case t h i r t y y e a r s ago. The move t o t h e c i t i e s began i n the 1930's f o l l o w i n g the f i r s t World War and d u r i n g the D e p r e s s i o n which d r a m a t i c a l l y a f f e c t e d the p r a i r i e f a r m e r s . T h i s t r e n d c o n t i n u e d so t h a t now the a g r a r i a n p o p u l a t i o n has d i m i n i s h e d and the urban-suburban p o p u l a t i o n p r e d o m i n a t e s . Now c a r e f o r the s i c k and h e a l t h c a r e g e n e r a l l y i s p r o v i d e d by p r o f e s s i o n a l s funded by government i n a c o n t e x t of absent extended f a m i l y members and of h i g h l y t e c h n i c a l and complex t r e a t m e n t p r o c e d u r e s . Responding t o t h e s e s o c i a l changes were changes i n t h e mental h e a l t h l e g i s l a t i o n i n the t h i r t i e s and a g a i n i n the l a t e 1960's and t h e r e a f t e r . Another p e r s p e c t i v e on laws s t a t e d by B l o n d e l i s t h a t "the s t a t u t e s a re always t o a g r e a t e r o r l e s s e r degree behinc the r e a l i t y , t he s t a t u t e s c h a n g i n g i n p e r i o d i c jumps i n a 2 v a i n e f f o r t t o keep up." The law i s p a r t o f the s t r u c t u r e of s o c i e t y so t h a t a l l the i n t e r a c t i o n s of s o c i a l groups impinge upon the making and maintenance of s t a t u t e s . Thus, the change i n f a m i l y s t r u c t u r e and p l a c e of r e s i d e n c e has had an impact upon h e a l t h l e g i s l a t i o n i n t h a t l e s s c a r e can be p r o v i d e d by f a m i l y members and governments are urged t o p r o v i d e more s e r v i c e s . 33 E f f e c t of Economic Change on L e g i s l a t i o n The f i r s t World War f o l l o w e d by the D e p r e s s i o n i n the 1930's were s i g n i f i c a n t e v e n ts i n the r e c e n t h i s t o r y of Canada and moved the governments, p r o v i n c i a l and f e d e r a l , t o c o n s i d e r o f f e r i n g more or d i f f e r e n t s o c i a l s e r v i c e s , i n c l u d i n g m e d i c a l c a r e . I n s u r e d h e a l t h or m e d i c a l c a r e was d i s c u s s e d and d e s c r i b e d i n 1935 i n B r i t i s h Columbia governmental v : " ~ r e p o r t s but not p r o c l a i m e d i n l e g i s l a t i o n . H e a l t h f u n d i n g was put a s i d e f o r the y e a r s of the war u n t i l 1948 when the H e a l t h G r a n t s A c t p a s s e d by the f e d e r a l government i n j e c t e d funds i n t o the p r o v i n c e s f o r h e a l t h c a r e . M e n t a l h e a l t h s e r v i c e s b e n e f i t e d from the s t a t u t e by b e i n g r e c o g n i z e d as a component of the m e d i c a l c a r e system, not as a s e p a r a t e o r g a n i z a t i o n o u t s i d e t h e mainstream of h e a l t h c a r e . Two a d d i t i o n a l p i e c e s o f l e g i s l a t i o n t h a t had a d i r e c t e f f e c t on the h e a l t h c a r e system were the H o s p i t a l I n s u r a n c e and D i a g n o s t i c S e r v i c e s A c t , 1957, and the M e d i c a l Care A c t , 1966. A l l t h e s e a c t s , p r i m a r i l y f i n a n c i a l i n purpose, a f f e c t e d h e a l t h l e g i s l a t i o n and m e d i c a l p r a c t i c e i n a l l o f the p r o v i n c e s . The f e d e r a l government, t h r o u g h i t s f i s c a l r e s p o n s i b i l i t y , began t o p l a y a major p a r t i n t h e h e a l t h c a r e system. I t s p a r t was not t o remain s m a l l but g r a d u a l l y assumed s i g n i f i c a n t l y l a r g e p r o p o r t i o n s . P r o v i n c i a l l y , mental h e a l t h s e r v i c e s were a l l a d m i n i s t e r e d by Departments of H e a l t h by 1959 t h r o u g h l e g i s l a t e d measures. E f f e c t o f T e c h n o l o g i c a l Change on L e g i s l a t i o n Knowledge about d i s e a s e and i t s t r e a t m e n t has expanded d r a m a t i c a l l y s i n c e 1867. New t e c h n i c a l d e v i c e s and c h e m i c a l d i s c o v e r i e s have a i d e d b o t h the d i a g n o s i s and t r e a t m e n t of d i s e a s e . New t h e r a p i e s have been added t o the p h y s i c i a n ' s armamentarium f o r t h e t r e a t m e n t of i n f e c t i o n s , c a n c e r and mental d i s o r d e r s . M e n t a l i l l n e s s t r e a t m e n t p r o c e d u r e s w i t h the advent of chemotherapies have changed from c u s t o d y i n an asylum t o community based t r e a t m e n t p r o v i d e d by p s y c h i a t r i s t s and o t h e r p r o f e s s i o n a l c l i n i c i a n s , thus a l l o w i n g the d i s o r d e r * t o remain a t home and, when f e a s i b l e , c o n t i n u e employment. Most of t h e s e changes i n p s y c h i a t r i c t r e a t m e n t took p l a c e a f t e r 1960 w i t h the d i s c o v e r y of p s y c h o t r o p i c m e d i c a t i o n . With more p e o p l e b e i n g t r e a t e d w h i l e a t home, t h e r e has been a change i n the p e r c e p t i o n o f mental i l l n e s s by the g e n e r a l p o p u l a t i o n . The mystique s u r r o u n d i n g the m e n t a l l y i l l has l e s s e n e d and u n u s u a l b e h a v i o r a s s o c i a t e d w i t h i t i s more t o l e r a t e d . T r e a t e d i n d i v i d u a l s have p a r t i c i p a t e d i n group a c t i o n s on b e h a l f of t h e m e n t a l l y i l l c o n f i n e d i n u n i t s p r i m a r i l y used f o r c u s t o d y . L e g i s l a t i o n f o r mental i l l n e s s w r i t t e n s i n c e 1960 does i n d i c a t e t h a t t r e a t m e n t i s p r o v i d e d i n community f a c i l i t i e s as w e l l as i n - p a t i e n t f a c i l i t i e s . A n o ther t e c h n i c a l development t h a t has had an e f f e c t on our way o f l i f e as w e l l as our a t t i t u d e s towards mental i l l n e s s i s improved d i s t a n t communication. With r a d i o , t e l e v i s i o n and computer t e c h n o l g o y , new i d e a s are s h a r e d and v a l i d a t e d amongst a w i d e r audience w i t h ease. I t i s more d i f f i c u l t now t o i g n o r e s i t u a t i o n s o r proven hypotheses when the i n f o r m a t i o n i s made a v a i l a b l e so b r o a d l y . For the m e n t a l l y i l l t he asylum i s no l o n g e r remote. M e n t a l h o s p i t a l s are now r e a d i l y a c c e s s i b l e t o . t h e p u b l i c w i t h the use of t e l e v i s i o n cameras, r a d i o d o c u m e n t a r i e s , t e l e p h o n e s , or s i m p l y w i t h a u t o m o b i l e s . More peopl e can v i s i t p s y c h i a t r i c i n s t i t u t i o n s . With more open communication the p u b l i c can be exposed t o media p r e s e n t a t i o n s of t r e a t m e n t g i v e n i n mental h o s p i t a l s . S p e c i a l i n t e r e s t groups concerned about the m e n t a l l y i l l made use of t h e s e o p p o r t u n i t i e s t o p u b l i c i z e the i n j u s t i c e s i n the t r e a t m e n t of the m e n t a l l y i l l . I n summary, h e a l t h l e g i s l a t i o n has changed i n Canada w i t h the f e d e r a l government assuming a more a c t i v e p a r t i n the f i n a n c i a l arrangements f o r h e a l t h s e r v i c e s . T h i s change i n f u n d i n g arrangements has not removed the r e s p o n s i b i l i t y f o r p r o v i d i n g h e a l t h s e r v i c e s d e l e g a t e d t o p r o v i n c e s i n 1867. The r o l e of government, i n p a r t i c u l a r , t he p r o v i n c i a l government, has i n c r e a s e d i n the l a s t 100 y e a r s w i t h i n d i v i d u a l s and t h e i r f a m i l i e s b e i n g r e s p o n s i b l e f o r purchase of c a r e r a t h e r t h a n g i v i n g c a r e . M e n t a l h e a l t h l e g i s l a t i o n has r e t a i n e d the compulsory t r e a t m e n t i t e m p r e s e n t i n a l l t h e e a r l i e r s t a t u t e s . With new t e c h n o l o g y , changed economy, and an i n c r e a s i n g l y m o b i l e s o c i e t y , the s t a t u t e s have not removed the e n f o r c e d t r e a t m e n t a s p e c t s of p s y c h i a t r i c c a r e . The l e g i s l a t i o n has merely added t o the c o r e element of c u s t o d y , o p p o r t u n i t i e s f o r a d m i n i s t e r i n g t r e a t m e n t s e r v i c e s o u t s i d e t h e h o s p i t a l . 37 F o o t n o t e s """David W e i s s t u b , Law and P s y c h i a t r y i n the Canadian  C o n t e x t , Pergamon P r e s s , T o r o n t o , Canada, 1980, p. 50. 2 J . B l o n d e l , Comparative L e g i s l a t u r e s , P r e n t i c e H a l l , New J e r s e y , 1973, p. 13. 38 Chapter V DESCRIPTIVE ANALYSIS OF MENTAL HEALTH LEGISLATION In the p r e c e d i n g c h a p t e r , d i s c u s s i o n of the assignment m a t t e r s t o f e d e r a l and p r o v i n c i a l governments i n d i c a t e d t h a t h e a l t h and mental h e a l t h r e g u l a t i o n was the r e s p o n s i b i l i t y of the p r o v i n c e s . As w e l l , the i n t e r a c t i o n between s o c i a l , economic, and t e c h n i c a l developments and t h i s r e g u l a t o r y l e g i s l a t i o n was d e s c r i b e d b r i e f l y . In t h i s c h a p t e r , mental h e a l t h l e g i s l a t i o n w i l l be a n a l y z e d b e g i n n i n g w i t h the b a s i c c o n t e n t of an a c t , the e v o l u t i o n of the s t a t u t e s f o r mental h e a l t h i n Great B r i t a i n and Canada, and the p r o c e s s of development of l e g i s l a t i o n i n the f e d e r a l and p r o v i n c i a l governments. In the next c h a p t e r a comparison of the c o n t e n t s of the c u r r e n t p r o v i n c i a l mental h e a l t h a c t s w i l l be u n d e r t a k e n . Content of M e n t a l H e a l t h L e g i s l a t i o n In Canada a c t s of P a r l i a m e n t have a format t h a t i s c o n s i s t e n t no m a t t e r what the s u b j e c t . The a c t i s t i t l e d and numbered by c h a p t e r a c c o r d i n g t o the p r o v i n c i a l or f e d e r a l governments r e v i s e d s t a t u t e s . For example, i n the R e v i s e d S t a t u t e s of B r i t i s h Columbia 1979 (R.S.B.C. 1979), the c u r r e n t M e n t a l H e a l t h A c t i s Chapter M. 13, 1978 and i n Nova S c o t i a mental h e a l t h i s found i n the R e v i s e d S t a t u t e s of Nova S c o t i a , 1967 (R.S.N.S. 1967) Chapter 249, 1978, t h e H o s p i t a l s A c t . F o l l o w i n g the t i t l e , the c o n t e n t s of t h e a c t are s e t 39 o u t , f i r s t w i t h an i n t r o d u c t o r y s t a t e m e n t ; f o l l o w e d by the d e f i n i t i o n of terms and of t h e a u t h o r i t y g i v e n t o a d m i n i s t e r The body of the a c t i n c l u d e s g e n e r a l p r o v i s i o n s and s p e c i a l or e x c e p t i o n a l p r o v i s i o n s . T h i s i s f o l l o w e d by a l i s t o f t h e r e g u l a t i o n s and, f i n a l l y , the date t h a t the a c t comes i n t o e f f e c t . In 1915, Canadian Bar A s s o c i a t i o n e s t a b l i s h e d a committee w i t h r e p r e s e n t a t i v e s from a c r o s s the c o u n t r y t o promote u n i f o r m i t y of the l e g i s l a t i o n i n Canada. From th e n on, t h i s group has r e v i e w e d th e l e g i s l a t i o n on many s u b j e c t s however, mental h e a l t h l e g i s l a t i o n was o n l y r e c e n t l y r e v i e w e d , i n 1980. But t h e i r r u l e s of d r a f t i n g l e g i s l a t i o n have e s t a b l i s h e d a b a s i c o u t l i n e t h a t i n s u r e s c e r t a i n t y and c l a r i t y of meaning and c o n c i s e n e s s of e x p r e s s i o n i n a l l a c t s Thus, b o t h f e d e r a l and p r o v i n c i a l s t a t u t e s are w r i t t e n i n the same manner but i t i s the t r e a t m e n t of t h e s u b j e c t t h a t r e f l e c t s a p r o v i n c i a l p e r s p e c t i v e . For example, the e x t e n t or comprehensiveness of d e f i n i t i o n s i n t h e s t a t u t e can r e s u l t i n v a r i a t i o n between p r o v i n c e s , or i f i n a mental h e a l t h s t a t u t e , mental r e t a r d a t i o n , a l c o h o l and drug a d d i c t i o n are i n c l u d e d i n the d e f i n i t i o n s , p r o v i n c i a l d i f f e r e n c e s can be n o t e d . The d e f i n i t i o n s of terms, f o l l o w i n g the statement of i n t r o d u c t i o n or s h o r t t i t l e , a re of prime importance i n the a p p l i c a t i o n or i n t e r p r e t a t i o n of the l e g i s l a t i o n . The d e f i n i t i o n s s t a t e who i s t o implement the a c t and t o whom the c o n t e n t s a p p l y . In mental h e a l t h i n s t r u m e n t s " p h y s i c i a n 40 " d i r e c t o r " , " a d m i n i s t r a t o r " , "mental h e a l t h worker", and " p a t i e n t " are d e f i n e d a c c o r d i n g to the purposes of each p a r t i c u l a r a c t . " D i r e c t o r " , f o r example, may mean the i n d i v i d u a l i n charge of a l l the p r o v i n c i a l mental h e a l t h s e r v i c e s i n one act or of one i n - p a t i e n t or o u t - p a t i e n t f a c i l i t y i n another. The government department or m i n i s t r y r e s p o n s i b l e f o r the a d m i n i s t r a t i o n of the act i s noted i n the d e f i n i t i o n of " M i n i s t e r . " As noted i n the p r e v i o u s chapter, h e a l t h and mental h e a l t h acts would have named the M i n i s t e r of Mines and P u b l i c Works i n Nova S c o t i a i n the d e f i n i t i o n s f o r the p e r i o d of time 1890 to 1919 and the P r o v i n c i a l S e c r e t a r y i n B r i t i s h Columbia i n the 1930's and 1940's. F o l l o w i n g the d e f i n i t i o n i s a short s e c t i o n s t a t i n g the p r i n c i p l e or i n t e n t i o n of the a c t . And t h i s s e c t i o n enunciates i n a c o n c i s e form who has the a u t h o r i t y to administer the a c t . I t i s t h i s statement t h a t , i n e f f e c t , commits the government to r e g u l a t e the procedures, s e r v i c e s or a c t i o n s proclaimed i n the s t a t u t e . Although the a u t h o r i t y i s s t a t e d i n a s h o r t , simple .sentence, the i m p l i c a t i o n s r e s u l t i n g from e x e r c i s i n g the a u t h o r i t y can be complex and f a r - r e a c h i n g . Some of the i m p l i c a t i o n s of these mental h e a l t h laws are r e s t r i c t i o n of r i g h t s , l o s s of freedom to communicate and others to be noted l a t e r i n t h i s chapter. The general and s p e c i a l p r o v i s i o n s which f o l l o w next make up most of the content of an a c t . For mental h e a l t h , 41 the main c o n s i d e r a t i o n i s the p r o v i s i o n f o r and p r e s c r i b e d p r o c e d u r e s r e g a r d i n g compulsory t r e a t m e n t . The method by which compulsory t r e a t m e n t i s t o be put i n t o e f f e c t i s s e t down; i . e . , t h e p r o c e s s t o be f o l l o w e d by one or two p h y s i c i a n s i s e s t a b l i s h e d w i t h i t s l i m i t a t i o n s and the n e c e s s a r y documentation; a l t e r n a t i v e l y , the nonmedical commitment p r o c e s s v i a m a g i s t r a t e 1 or judge i s d e s c r i b e d . As w e l l , i n the g e n e r a l p r o v i s i o n s are m a t t e r s such as a p p e a l a g a i n s t compulsory t r e a t m e n t , absence from t r e a t m e n t f a c i l i t i e s w i t h o u t a u t h o r i z e d l e a v e , c o n f i d e n t i a l i t y of r e c o r d s and r e l e a s e of i n f o r m a t i o n . In a l l p r o v i n c i a l mental h e a l t h a c t s i s a s e c t i o n p r o v i d i n g f o r i n d i v i d u a l s who f a c e c harges under the C r i m i n a l Code of Canada and are deemed t o be m e n t a l l y i l l . The f i n a l s e c t i o n of the a c t i s the statement g i v i n g the date t h a t the s t a t u t e comes i n t o e f f e c t . A l i s t o f the r e g u l a t i o n s may be a t t a c h e d a f t e r the statement of the e f f e c t i v e date or j u s t p r i o r t o i t . T h i s l i s t of r e g u l a t i o n s o u t l i n e s o r , r a t h e r , s p e c i f i e s items t h a t may be d e l e g a t e d t h r o u g h the a u t h o r i t y o f the L i e u t e n a n t -Governor i n C o u n c i l . By t h i s mechanism, the government can a d m i n i s t e r w i t h i n the a u t h o r i t y o f the a c t w h i l e a d d r e s s i n g the c h a n g i n g r e q u i r e m e n t s of the p r i n c i p a l purpose of the s t a t u t e . L e g i s l a t i o n i s w r i t t e n i n terms t h a t are somewhat g e n e r a l . R e g u l a t i o n s are more s p e c i f i c but can be amended as needed t o meet the c u r r e n t s i t u a t i o n , w h i l e l e g i s l a t i o n 42 i s r e v i s e d i n f r e q u e n t l y and through p a r l i a m e n t a r y p r o c e d u r e i n t h e l e g i s l a t u r e . Some c i t i z e n groups have q u e s t i o n e d governments t h a t a d m i n i s t e r m a i n l y by t h e use of d e l e g a t e d l e g i s l a t i o n , v i e w i n g t h i s as g o v e r n i n g o u t s i d e the p a r l i a m e n t a r y system, r e l y i n g i n s t e a d upon e x e c u t i v e a c t i v i t y of t h e g o v e r n i n g p a r t y . An a n a l y s i s o f the c o n t e n t s and o r d e r of the s t a t u t o r y i n s t r u m e n t s r e l a t i n g t o mental h e a l t h i n Canada i n d i c a t e t h a t t h e r e i s c o n s i d e r a b l e u n i f o r m i t y i n the w r i t t e n l a w s . The Canadian Bar A s s o c i a t i o n r u l e s of d r a f t i n g l e g i s l a t i o n have c l e a r l y s e r v e d as a guide t o the p r o v i n c i a l w r i t e r s of t h e s e l a w s . For t h i s p a r t i c u l a r s t u d y , the s e c t i o n s of the mental h e a l t h a c t s t h a t are under s c r u t i n y are the d e f i n i t i o n s , compulsory t r e a t m e n t p r o c e d u r e s , a p p e a l and r e v i e w p r o c e s s e s , and statements of r i g h t s . A l l but the d e f i n i t i o n s are p a r t of the g e n e r a l p r o v i s i o n s of the mental h e a l t h l e g i s l a t i o n and r e l a t e t o the i s s u e o f r i g h t s and the impact of t h e new C o n s t i t u t i o n A c t . The remainder of t h i s c h a p t e r w i l l f o c u s on the c o n c e p t s of mental i l l n e s s and how they were a d d r e s s e d i n l a w s . T h i s i n f o r m a t i o n i s u s e f u l p r i o r t o the a n a l y s i s o f s e c t i o n s of s t u d y i n t h e p r o v i n c i a l a c t s . H i s t o r i c a l E v o l u t i o n of Concepts R e l a t i n g t o M e n t a l H e a l t h i n England In E n g l a n d , p r i o r t o the mid-1800's, mental i l l n e s s had been viewed as demon or s p i r i t p o s s e s s i o n , not an i l l n e s s . 43 The r e l i g i o u s groups were charged w i t h c a s t i n g out the e v i l w i t h i n p e r s o n s . T h i s was a time when w i t c h e s were o s t r a c i z e d and sometimes burned by the community. A s i d e from t h a t group of " n u i s a n c e s " , o t h e r s who were a problem f o r the community, i n p a r t i c u l a r , the v a g r a n t s , were s u b j e c t t o the benevolence of the government, l o r d o r k i n g . The m e n t a l l y i l l , who were o f t e n v a g r a n t poor, have had a l o n g h i s t o r y of b e i n g the o u t c a s t s of the community and s u b j e c t s of r e s t r i c t i v e l a w s . At t h i s p o i n t , i t i s i m p o r t a n t t o add a comment about the l i n k between mental i l l n e s s and p o v e r t y . At t h e p e r i o d when the l e g i s l a t i o n was f i r s t w r i t t e n , the E n g l i s h s o c i a l s t r u c t u r e was o r g a n i z e d on a f e u d a l system. The l o r d and o v e r s e e r s c a r e d f o r o r managed the p r o p e r t y and b u s i n e s s a s s o c i a t e d w i t h t h e i r h o l d i n g s . The pe o p l e who d i d not work or p r o v i d e a u s e f u l s e r v i c e because of weakness f o r any reason were a n u i s a n c e t o t h e i r f a m i l i e s , g u a r d i a n s o r ma s t e r s . In some a r e a s , c h a r i t a b l e o r g a n i z a t i o n s p r o v i d e d s h e l t e r as d i d r e l i g i o u s groups but elsewhere the community had t o c a r e f o r i t s r e s i d e n t s who were poor and w i t h o u t i d e n t i f i a b l e s u p p o r t . The o t h e r " n u i s a n c e " group needing c a r e were the d i s o r d e r e d w i t h o u t f a m i l i e s . So the f a c i l i t y , a poorhouse/asylum, was b u i l t away from the town t o house the unwanted members of the community. Some of the b e h a v i o r s of t h e poor were s i m i l a r t o the d i s t u r b e d so i t seemed r e a s o n a b l e t o d e a l w i t h a l l t h e s e p e o p l e i n one p l a c e . As paupers d i d not c o n t r i b u t e t o the w e a l t h o f the community, t h e i r s o c i a l r i g h t s were o f no consequence and so were d i s r e g a r d e d . L e g i s l a t i o n f o r the poor and the m e n t a l l y i l l i n c o r p o r a t e d t h e s e s o c i a l v a l u e s of w o r t h l e s s n e s s a t t h e time when the two were t r e a t e d under one law. These c o n c e p t s no l o n g e r c o - e x i s t as t h e y d i d i n the 18th and 19th c e n t u r i e s but v e s t i g e s of t h o s e s o c i a l v a l u e s remain. In the a p p l i c a t i o n of to d a y ' s mental h e a l t h l e g i s l a t i o n , more people i n the lower s o c i o - e c o n o m i c c a t e g o r y are c o m p u l s o r i l y t r e a t e d i n l a r g e p r o v i n c i a l mental h o s p i t a l s and fewer by 2 p s y c h i a t r i s t s i n t h e i r o f f i c e s . T h i s i s c i t e d as an example t o c l a r i f y t he r e l a t i o n s h i p of l e g i s l a t i o n t o s o c i a l v a l u e s , not of the use of a p p l i c a t i o n of l e g i s l a t i o n . M e n t a l h e a l t h l e g i s l a t i o n has had a l o n g h i s t o r y . Not always have the s t a t u t e s been w r i t t e n i n the p r e s e n t form nor was the c o n t e n t t h e same as i t i s now. S t a t u t e s have r e f l e c t e d the contemporary view of mental d i s o r d e r f o r a s o c i e t y . The f o c u s of the law a t any p a r t i c u l a r t ime was l i m i t e d t o the needs t h a t the government o f the day was p r e p a r e d t o address and the e v o l u t i o n of l e g i s l a t i o n has been dependent on the e v o l u t i o n of i d e a s about c u s t o d y , t r e a t m e n t and s o c i e t y ' s t o l e r a n c e of d e v i a n t s . Development o f E n g l i s h L e g i s l a t i o n The essence of e a r l y r e s t r i c t i v e laws was the p r o t e c t i o n o r containment o f the d i s o r d e r e d p e r s o n and c a r e of h i s p r o p e r t y . I n the 18th c e n t u r y England t h e r e was c o n s i d e r a b l e c o n c e r n about the e x p l o i t a t i o n of h e i r s and h e i r e s s e s by t h e i r l e g a l g u a r d i a n s who c o u l d have them c o n f i n e d as l u n a t i c s a l t h o u g h , i n f a c t , t h e y may have not been m e n t a l l y i l l . I n t he mid-19th c e n t u r y , England began t o enact new k i n d s of l e g i s l a t i o n from i n s t r u m e n t s r e g u l a t i n g i n s t i t u t i o n s t o ones c o n t r o l l i n g p e o p l e . Among the s o u r c e s of p r e s s u r e f o r change were concerns about the t r e a t m e n t of K i n g George I I I who was known t o have s u f f e r e d g r e a t l y from the r e s t r a i n t s put upon him because of a mental d i s o r d e r . P a r l i a m e n t had i n q u i r e d i n t o the n e c e s s i t y f o r t h i s form of " c a r e . " At t h a t t i m e , as i n the p r e s e n t , the s o c i a l , t e c h n o l o g i c a l and p o l i t i c a l i s s u e s a f f e c t e d t h e c o n t e n t of l e g i s l a t i o n . New t r e a t m e n t mothods deve l o p e d i n France by P i n e l , who removed the c h a i n s from h i s asylum p a t i e n t s , l e d t o the development of the moral t r e a t m e n t i d e a s of E n g l i s h Quakers and t h e subsequent r e f o r m of p r i v a t e mental h o s p i t a l s . Poor law i n s t i t u t i o n s and, l a t e r , asylums l a g g e d b e h i n d i n t h e use' of newer forms o f t r e a t m e n t . G r a d u a l l y , however, the m e n t a l l y i l l were s e p a r a t e d out from the paupers and were sent t o s p e c i a l i n s a n e asylums b u i l t f o r t h e i r c u s t o d i a l c a r e . These were i n t e n d e d t o p r o v i d e moral t r e a t m e n t and l i m i t e d r e h a b i l i t a t i v e c a r e . With t h e s e changes i n c o n c e p t s of t r e a t m e n t , l e g i s l a t i v e changes were made between 1845 and 1891. The t h r u s t o f the new a c t s was the r e c o g n i t i o n t h a t the d i s o r d e r e d needed 46 t r e a t m e n t and might b e n e f i t from i t and t h a t c u s t o d y a l o n e was o f l i t t l e v a l u e . In t h i s p e r i o d , the l e g i s l a t i o n had p h y s i c i a n s named as the t r e a t e r s of t h e i l l . C u s t o d i a l a s p e c t s of t r e a t m e n t were not removed from t h e s e s t a t u t e s , but c u s t o d y now meant c o n t a i n m e n t - w i t h - t r e a t m e n t , not s o l e l y c o n t a i n m e n t . The r e c o g n i t i o n t h a t p o v e r t y and i n s a n i t y were not synonymous ( a l t h o u g h i n i t i a l l y p r o v i d e d f o r under one act ) took time t o be acknowledged s e p a r a t e l y i n the l a w s . S o c i e t y ' s view of mental i l l n e s s problems i s shown by the changes i n t h e t i t l e s of the A c t s from L u n a t i c t o I d i o t t o M e n t a l Treatment and f i n a l l y t o M e n t a l H e a l t h A c t . A l i s t of t h e a c t s passed between the y e a r s 1845 and 1959 by the P a r l i a m e n t of England i n p a r t i n d i c a t e s the change i n f o c u s from merely r e s t r i c t i v e c u s t o d y t o such t r e a t m e n t as c o u l d be made a v a i l a b l e a t the t i m e : 1845 L u n a t i c A c t 1853 Lunacy R e g u l a t i o n A c t 1853 L u n a t i c s Care and Treatment Amendment A c t 1853 L u n a t i c Asylum Amendment A c t 1862 L u n a t i c ' s Law Amendment A c t 1886 I d i o t s A c t 1889 L u n a t i c Law Amendment A c t 1890 Lunacy ( C o n s o l i d a t e d ) A c t 1891 Lunacy A c t 1921 L o c a l Government A c t 1930 M e n t a l Treatment A c t 47 1946 M e n t a l H e a l t h S e r v i c e A c t 1959 M e n t a l H e a l t h A c t . Many items i n the a c t s c o n t i n u e d t o be s e t out as b e f o r e l i k e the a d m i s s i o n c r i t e r i a , the p l a c e of c o n f i n e m e n t , who gave the l a b e l o f "mad" or " i n s a n e " and what t h a t meant at t h a t t i m e . There was a l s o i n c l u d e d a p r o c e d u r e t o remove i n d i v i d u a l s from the community t o the asylum and a d e f i n i t i o n of the worker d e s i g n a t e d or a u t h o r i z e d t o implement the p r o c e d u r e . However, the l a b e l s d e s c r i b i n g the a f f l i c t e d d i d change from l u n a t i c and i d i o t t o m e n t a l l y i l l and m e n t a l l y d e f e c t i v e . P h y s i c i a n s assumed r e s p o n s i b i l i t y f o r l a b e l l i n g and p r e s c r i b i n g t r e a t m e n t . I n v o l v e d w i t h some removals from open s o c i e t y i n t o h o s p i t a l (and l a t e r r e t u r n t o the community) were th o s e known as Poor or R e l i e v i n g O f f i c e r s whose t i t l e s became Duly Q u a l i f i e d O f f i c e r , then Duly A u t h o r i z e d or M e n t a l W e l f a r e O f f i c e r . A l s o , the p o l i c e s t i l l c o n t i n u e d t o have a f u n c t i o n i n removing some of the d i s t u r b e d from t h e i r communities t o mental h o s p i t a l s , though many were brought i n by f a m i l i e s and f r i e n d s . As mentioned above, t h e r e were changes i n the o r g a n i z a t i o n and f i n a n c i n g of t r e a t m e n t i n s t i t u t i o n s , though not a t f i r s t i n the f i n a n c i n g of p a t i e n t payment systems. G r a d u a l l y , however, as the s e p a r a t i o n of the i n d i g e n t , t h e m e n t a l l y i l l and t h o s e w i t h i l l n e s s and p o v e r t y was done, t r e a t m e n t f o r the d i s t u r b e d was d e f i n e d w i t h i n a m e d i c a l c o n t e x t . With the i n t r o d u c t i o n of the N a t i o n a l H e a l t h S e r v i c e i n 1946, the 48 next s t e p was t o r e v i e w the l e g i s l a t i o n w i t h i n t h i s o r g a n i z a t i o n a l c o n t e x t . A R o y a l Commission on M e n t a l I l l n e s s and M e n t a l D e f e c t 1955-1958 r e s u l t e d i n the M e n t a l H e a l t h A c t , 1959, which p r o v i d e d a model f o r o t h e r c o u n t r i e s t o f o l l o w . One comment made r e g a r d i n g the commission was t h a t v a r i e d r e s e a r c h i n v e s t i g a t i o n s were not i n i t i a t e d nor were the major p o l i c y changes accompanied by p l a n s f o r 3 r e s e a r c h d e s i g n e d t o a s s e s s t h e i r e f f e c t s . The Commission was used, r a t h e r , t o t e s t t h e " g e n e r a l w i l l " f o r change. I t seems t h a t , d e s p i t e c o n s i d e r a b l e moves f o r w a r d a t t h a t t i m e , mental h e a l t h l e g i s l a t i o n c o n s i s t e n t l y c o n t i n u e s t o r e t a i n p r o c e d u r e s f o r compulsory c u s t o d i a l t r e a t m e n t even when o t h e r t r e a t m e n t a l t e r n a t i v e s e x i s t . Development of Canadian M e n t a l H e a l t h L e g i s l a t i o n In Canada, mental i l l n e s s d i d not come w i t h i n the j u r i s d i c t i o n of the f e d e r a l government, but from the o u t s e t , i n 1867, i t was a p r o v i n c i a l m a t t e r . As d e s c r i b e d b e f o r e , the e a r l y s t a t u t e s were pass e d t o p e r m i t the p r o v i n c i a l governments t o p r o v i d e and manage asylums. But the u n d e r l y i n g purpose of t h e s e l e g i s l a t i v e i n s t r u m e n t s was much more complex than s i m p l y p r o v i d i n g a f a c i l i t y t o s e g r e g a t e the i n s a n e . They a d d r e s s e d the problems of h o u s i n g the poor, and p r o t e c t i n g the community from b i z a r r e , u n a c c e p t a b l e b e h a v i o r i n l e g a l p h r a s e s t h a t were w r i t t e n i n g e n e r a l terms. For mental i l l n e s s , t h i s format was w e l l s u i t e d as d i a g n o s i s i s not s p e c i f i c and p r e c i s e . 49 A f t e r the 1930's, each of the p r o v i n c e s began t o w r i t e about t r e a t m e n t of the m e n t a l l y i l l r a t h e r than about i n s t i t u t i o n s i n t h e i r s t a t u t o r y i n s t r u m e n t s . The t i t l e changes are s i m i l a r t o t h o s e found i n E n g l a n d , f o r the Insane Asylum A c t s or Insane H o s p i t a l s A c t s were now r e t i t l e d M e n t a l H e a l t h A c t s and M e n t a l H o s p i t a l A c t s . In the 1930's or t h e r e a f t e r , t h e a d m i n i s t r a t i o n of the mental h e a l t h s t a t u t e s became p a r t of h e a l t h department r e s p o n s i b i l i t y a f t e r y e a r s of b e i n g i n a department l i k e P u b l i c Works and Mines i n Nova S c o t i a and i n the I n s p e c t o r of P r i s o n s and P u b l i c C h a r i t i e s d i v i s i o n of the P r o v i n c i a l S e c r e t a r y i h O n t a r i o . The p r o t e c t i o n of t h e d i s o r d e r e d p e r s o n ' s p r o p e r t y remains p a r t of some of the p r o v i n c i a l mental h e a l t h a c t s , namely th o s e of Nova S c o t i a , O n t a r i o and Saskatchewan and i n t h r e e o t h e r p r o v i n c i a l s t a t u t e s not i n c l u d e d i n t h i s s t u d y . E l s e w h e r e , the m a t t e r of e s t a t e s and p r o p e r t y i s a d d r e s s e d i n s e p a r a t e l e g i s l a t i o n t o ensure t h a t t h e p r o p e r t y of p a t i e n t s and o t h e r s , c o n s i d e r e d or deemed incompetent, are managed as l o n g as t h e i r mental competency i s i n q u e s t i o n . But even w i t h o r g a n i z a t i o n a l , a d m i n i s t r a t i v e and -w ording changes i n mental H e a l t h l e g i s l a t i o n , compulsory t r e a t m e n t t o p r o t e c t the i n d i v i d u a l s and t h o s e around them has remained unchanged; so have the assessment p r o c e d u r e s and d e c i s i o n making by p h y s i c i a n s , p o l i c e , and m a g i s t r a t e s t o e n f o r c e p r o t e c t i v e c u s t o d i a l t r e a t m e n t . But now t h e a c t s 50 f o c u s p a r t i c u l a r l y on the m e n t a l l y i l l who r e q u i r e t r e a t m e n t i n a m e d i c a l s e t t i n g and p a r t i c u l a r l y on th o s e who are c o m p u l s o r i l y t r e a t e d . P r e s s u r e s f o r Change Changes i n l e g i s l a t i o n are brought about by t h e a c t i o n s of p o l i t i c i a n s , a d m i n i s t r a t o r s , p h y s i c i a n s , l a w y e r s , s t a f f o f mental f a c i l i t i e s , d i s o r d e r e d i n d i v i d u a l s and t h e i r f a m i l i e s . Another s t r o n g f o r c e i n the s o c i e t y i s the media: r e p o r t e r s f o r t e l e v i s i o n , newspapers o r r a d i o . I t i s n e c e s s a r y t o r e c o g n i z e t h a t i n t e r e s t groups do have t o be c o n s i d e r e d when changes are p l a n n e d i n e x i s t i n g s t a t u t e s , f o r i t was and i s t o the p o l i t i c i a n s t h a t p r e s s u r e groups d i r e c t t h e i r views r e g a r d i n g l e g i s l a t i o n and, i n t h i s c a s e , mental h e a l t h l e g i s l a t i o n . While the t r a d i t i o n a l groups w i t h i n t h e p r o v i n c e s u p p o r t i n g o r c o n f r o n t i n g the r e v i s e d l e g i s l a t i o n are p h y s i c i a n s , l a w y e r s and a d m i n i s t r a t o r s , new groups which b r i n g p r e s s u r e t o bear are the consumers and human r i g h t s a d v o c a t e s . However, t h e g e n e r a l i n t e r e s t of the p u b l i c seems t o be p r o t e c t i o n from dangerous, u n p r e d i c t a b l e o r b i z a r r e " a c t s w i t h t h e l e a s t e x p e n d i t u r e of t a x d o l l a r s , r a t h e r than p r o m o t i n g the use o f n o n r e s t r i c t i v e t r e a t m e n t s . The i n t e r e s t of t h e m e d i c a l and l e g a l p r o f e s s i o n s i s t o c a r e f o r and t r e a t o n l y t h o s e r i g h t f u l l y r e q u i r i n g i t . In the l e g i s l a t i v e p r o c e s s t h e s e have been the c e n t r a l i s s u e s . The l e g i s l a t i o n has s e r v e d as a f o c u s p a r t i c u l a r l y f o r the i n t e r e s t s of p o l i t i c a l , c l a s s , and p r o f e s s i o n a l groups r e g a r d i n g mental i l l n e s s and i t s t r e a t m e n t . In B r i t i s h Columbia, the m e d i c a l group w i t h a major c o n c e r n are t h e p s y c h i a t r i s t s . For the M e d i c a l A s s o c i a t i o n , t h e S e c t i o n o f P s y c h i a t r y p r o v i d e s the forum i n which i s s u e s of c u r r e n t p s y c h i a t r i c t r e a t m e n t p r a c t i c e s are d i s c u s s e d . As w e l l , t h i s group may be r e q u e s t e d t o r e v i e w p r o p o s a l s o r t o o f f e r recommendations on d r a f t l e g i s l a t i o n o r an amendment t o l e g i s l a t i o n a f f e c t i n g mental h e a l t h s e r v i c e s . Other p r o f e s s i o n s a c t i v e i n mental i l l n e s s t r e a t m e n t such as p s y c h o l o g y , p s y c h i a t r y , s o c i a l work and p s y c h i a t r i c n u r s i n g p r o v i d e i n p u t i n t o mental i l l n e s s p o l i c y development t h r o u g h t h e i r p r o f e s s i o n a l a s s o c i a t i o n s . The p o i n t of view e x p r e s s e d by o t h e r groups, even th o s e w o r k i n g i n the f i e l d of mental i l l n e s s , may not s u p p o r t the view e x p r e s s e d by p h y s i c i a n s o r p s y c h i a t r i s t s , and t h e r e f o r e i s n e c e s s a r y i n o r d e r t o have more complete i n f o r m a t i o n on the s u b j e c t . S i n c e t h e l a t e s i x t i e s , we have seen the development of an a c t i v e consumer group i n B r i t i s h Columbia, the M e n t a l P a t i e n t s A s s o c i a t i o n . The membership of t h i s group i n c l u d e s t r e a t e d i n d i v i d u a l s as w e l l as those s t i l l i n t r e a t m e n t . I t has f o c u s e d upon the i s s u e of compulsory t r e a t m e n t and the r e s t r i c t i o n s imposed by t h i s t r e a t m e n t . Other t y p e s of i n t r u s i v e t r e a t m e n t such as ele c t r o - ^ s h o c k t r e a t m e n t and p s y c h o s u r g e r y have been denounced by t h i s group. The M e n t a l P a t i e n t s A s s o c i a t i o n s u p p o r t s the concept t h a t a p p e a l p r o c e s s e s a g a i n s t compulsory t r e a t m e n t as w e l l as f r e q u e n t r e v i e w p e r i o d s s h o u l d be w r i t t e n i n t o l e g i s l a t i o n . As a l l the members have e x p e r i e n c e d p s y c h i a t r i s t s ' s e r v i c e s as r e c i p i e n t s , t h i s c o h e s i v e group has deve l o p e d a method of p r e s s u r i n g f o r change of t r e a t m e n t s they c o n s i d e r u n d e s i r a b l e . An example o f the group's a c t i o n was a t the World Congress of M e n t a l H e a l t h h e l d i n Vancouver i n 1978 when spokespersons made t h e i r demands f o r change more b r o a d l y known. A c r o s s Canada t h e r e are s i m i l a r groups e s t a b l i s h e d . In Saskatchewan, t h e r e i s the S c h i z o p h r e n i c s Anonymous, i n O n t a r i o the F r i e n d s of S c h i z o p h r e n i c s S o c i e t y - - e a c h of t h e s e w i t h groups i n o t h e r p a r t s of Canada. The l o n g e r - e s t a b l i s h e d Canadian M e n t a l H e a l t h A s s o c i a t i o n founded i n O n t a r i o has branches i n a l l the p r o v i n c e s . T r a d i t i o n a l l y , the l a w y e r s have had t h e i r p a r t i n d e v e l o p i n g mental h e a l t h l e g i s l a t i o n and i n c r e a s i n g l y some may become advocates f o r r i g h t s . At t h e B r i t i s h Columbia p r o v i n c i a l mental h o s p i t a l one lawye r e s p e c i a l l y has had c o n s i d e r a b l e i n f l u e n c e i n the e s t a b l i s h m e n t o f a mental p a t i e n t s ' advocacy o f f i c e . At the p r e s e n t t i m e , the l e g a l p r o f e s s i o n may have r e q u e s t s t o r e p r e s e n t p a t i e n t s i n c o u r t on c a s e s r e g a r d i n g an u n f a i r p r o c e d u r e of compulsory t r e a t m e n t . A l l of t h e s e groups, p r o f e s s i o n a l and consumer, a p p l y p r e s s u r e on government i n t h e i r own g e o g r a p h i c areas as w e l l as n a t i o n a l l y , f o r changes t o the l e g i s l a t i o n . Now w i t h a C h a r t e r of R i g h t s and Freedoms p r o c l a i m e d by the f e d e r a l government and w i t h the a s s e n t o f the p r o v i n c i a l governments the " i n t e r e s t s of the p a t i e n t s ' r i g h t s " groups w i l l have a new f o c u s , t h a t of e n s u r i n g t h a t mental h e a l t h l e g i s l a t i o n i s not i n c o n f l i c t w i t h the new A c t . 54 Fo o t n o t e s "'"Magistrates i n Canada are the i n d i v i d u a l s a p p o i n t e d t o hear cases f o r a d e f i n e d a r e a of the law. The c o u r t s i n which th e s e o f f i c i a l s p r e s i d e are e n t i r e l y under p r o v i n c i a l c o n t r o l . I n t h e e a r l y days, the incumbent may not have had e d u c a t i o n i n law but was c o n s i d e r e d t o m e r i t the p o s i t i o n because of demonstrated a b i l i t y i n the community. In some c a s e s , the appointment was made t o reward p o l i t i c a l o r o t h e r s o c i a l f a v o r s . I n c l u d e d i n the d u t i e s of m a g i s t r a t e s were thos e of J u s t i c e of the Peace. Now m a g i s t r a t e s , almost u n i v e r s a l l y , are l a w y e r s . S t i p e n d a r y m a g i s t r a t e i s a term no l o n g e r used i n Canada. The Northwest T e r r i t o r y was the l a s t p l a c e t o use the term, d i s c o n t i n u i n g i t i n 1955. 2 Donald M i l l e r , Community M e n t a l H e a l t h , D. C. Heath and Company, Canada, 19 74, p. 41. 3 G. F. Re h i n and F. M. M a r t i n , P a t t e r n s o f Performance  i n Community Care, A Report of a Community Me n t a l H e a l t h S e r v i c e s Study, O x f o r d U n i v e r s i t y P r e s s , London, 19 68, p. 2 2. Chapter VI DESCRIPTIVE ANALYSIS OF FIVE PROVINCIAL MENTAL HEALTH ACTS AND THE IMPINGEMENT UPON THE CHARTER OF RIGHTS AND FREEDOMS In t h i s c h a p t e r , the M e n t a l H e a l t h A c t s of B r i t i s h C olumbia, Saskatchewan, O n t a r i o , Quebec and Nova S c o t i a are t o be compared r e g a r d i n g the d e f i n i t i o n , the compulsory t r e a t m e n t p r o c e d u r e , the a p p e a l o r r e v i e w p r o c e d u r e and r i g h t s and freedoms. The D e f i n i t i o n s o f M e n t a l D i s o r d e r As s t a t e d e a r l i e r i n t h i s s t u d y , the terms used f o r the m e n t a l l y i l l have changed over the y e a r s . The d e f i n i t i o n s . o f t h e s e terms are i m p o r t a n t i n o r d e r t o c l a r i f y t he i n t e n t and a p p l i c a t i o n o f the l e g i s l a t i o n . The r e l e v a n t terms d e f i n e d i n the a c t s are " d i r e c t o r " , "mental d i s o r d e r " , " p a t i e n t " , " p h y s i c i a n " , " p r i v a t e mental h o s p i t a l " , " p r o v i n c i a l h e a l t h f a c i l i t y " , and " i n v o l u n t a r y p a t i e n t . " The d e f i n i t i o n s o f the s e terms as they appear i n the f i v e p r o v i n c i a l s t a t u t e s are n o t ed i n Appendix C. The d e f i n i t i o n of mental d i s o r d e r v a r i e s from no d e f i n i t i o n i n the Quebec A c t t o the b r o a d one of "any d i s e a s e or d i s a b i l i t y o f the mind, i n c l u d i n g a l c o h o l o r drug a d d i c t i o n " i n the Nova S c o t i a A c t . A l l of the A c t s r e q u i r e p h y s i c i a n s t o determine the presence o f mental d i s o r d e r . However, i n Quebec the d e t e r m i n i n g p h y s i c i a n must be a p s y c h i a t r i s t and i n t h a t r e g a r d the a c t f o r Quebec i s an e x c e p t i o n t o the o t h e r s . In 56 Nova S c o t i a , any p h y s i c i a n can determine the presence of mental d i s o r d e r but a p s y c h i a t r i s t must d e c i d e i f compulsory t r e a t m e n t i s needed. In Nova S c o t i a , the c e r t i f i e d p a t i e n t i s c a l l e d a " f o r m a l p a t i e n t " or " f o r m a l a d m i s s i o n . " The d e t e r m i n a t i o n of the l a b e l "mental d i s o r d e r " i s a s u b j e c t i v e one s i n c e an o b j e c t i v e , w e l l d e v e l o p e d p r o c e d u r e t h a t has proven i n f a l l i b l e i s not a v a i l a b l e a t t h i s t i m e . The d e f i n i t i o n of mental d i s o r d e r i n a l l the a c t s has i n h e r e n t i n i t compulsory t r e a t m e n t . M e n t a l i l l n e s s and compulsory t r e a t m e n t are not g e n e r a l l y c o n s i d e r e d t o g e t h e r by p h y s i c i a n s , p s y c h i a t r i s t s and p s y c h o l o g i s t s i n the d a i l y p r a c t i c e o f t h e i r p r o f e s s i o n . T h i s i s s u e of e n f o r c e d t r e a t m e n t o c c u r s i n f r e q u e n t l y but when i t does i t i s incumbent upon the p h y s i c i a n or p s y c h i a t r i s t t o e x e r c i s e a judgment and l a b e l the p a t i e n t " m e n t a l l y d i s o r d e r e d . " When t h i s s u b j e c t i v e p r o c e s s o c c u r s , the i n d i v i d u a l i s s u b j e c t t o the r e s t r i c t i o n s a t t e n d a n t w i t h e n f o r c e d t r e a t m e n t . In the a n a l y s i s of the f i v e a c t s , i t i s e v i d e n t t h a t t h e r e i s extreme v a r i a t i o n i n the p r o v i n c i a l d e f i n i t i o n s . In B r i t i s h Columbia the d e f i n i t i o n of mental d i s o r d e r i s so broad or i m p r e c i s e t h a t i t c o u l d i n c l u d e i n d i v i d u a l s who are m e n t a l l y r e t a r d e d or i m p a i r e d from e x c e s s i v e a l c o h o l consumption. The a p p l i c a t i o n of the d e f i n i t i o n depends upon the a s s e s s i n g p h y s i c i a n and h i s judgment of the i n t e n t o f the a c t r e l a t i v e t o the c o n d i t i o n of the i n d i v i d u a l . A Canadian l i v i n g i n Nova S c o t i a can be d e f i n e d " m e n t a l l y d i s o r d e r e d " due t o an a l c o h o l i s m problem and th e n p l a c e d i n a f a c i l i t y f o r e n f o r c e d t r e a t m e n t . T h i s same i n d i v i d u a l c o u l d move t o any o t h e r p r o v i n c e and not be so d e f i n e d , o r c o n v e r s e l y , one who moves t o Nova S c o t i a would be s u b j e c t t o the l a b e l l i n g of the l e g i s l a t i o n t h e r e . The d e f i n i t i o n o f "mental d i s o r d e r " i n a l l the p r o v i n c i a l mental h e a l t h a c t s l a c k s s p e c i f i c i t y . Or r a t h e r , the p r e c i s e i n t e r p r e t a t i o n depends upon the judgment of the i n d i v i d u a l a p p l y i n g the d e f i n i t i o n . For example, i n Nova S c o t i a , a t what p o i n t i s a l c o h o l o r drug a d d i c t i o n d e t e r m i n e d t o be "mental d i s o r d e r " ? Or, i n B r i t i s h Columbia, i s an i n d i v i d u a l d r i v i n g a v e h i c l e i n a dangerous manner then " m e n t a l l y d i s o r d e r e d " r e q u i r i n g p r o t e c t i o n f o r h i m s e l f o r o t h e r s ? The d i f f e r e n t d e f i n i t i o n s f o r "mental d i s o r d e r " i n the p r o v i n c i a l a c t s as w e l l as the d i s c r e t i o n g i v e n p h y s i c i a n s p r o v i d e s the o p p o r t u n i t y f o r unequal a p p l i c a t i o n o f the l e g i s l a t i o n w i t h i n a p r o v i n c e and a c r o s s the n a t i o n . P l a c e of Treatment G e n e r a l l y , a l l the a c t s p r o v i d e f o r t r e a t m e n t w i t h i n a f a c i l i t y and tho s e f o r the p r o v i n c e of B r i t i s h Columbia, Saskatchewan and Quebec i n c l u d e community f a c i l i t i e s such as mental H e a l t h c l i n i c s d e s i g n a t e d as c e n t r e s f o r p s y c h i a t r i c t r e a t m e n t . The f a c i l i t y i s the p l a c e where most o f t e n v o l u n t a r y t r e a t m e n t of p s y c h i a t r i c d i s o r d e r s i s o f f e r e d but where compulsory o r i n v o l u n t a r y t r e a t m e n t may be g i v e n . There are o t h e r a c t s t h a t have a s e c t i o n r e g a r d i n g compulsory 58 t r e a t m e n t f o r d i s e a s e ( e . g . , v e n e r e a l d i s e a s e and t u b e r c u l o s i s ) but the d i f f e r e n c e between th o s e a c t s and the mental h e a l t h a c t s i s t h a t the compulsory t r e a t m e n t f o r t h e s e d i s e a s e s does not i n c l u d e c u s t o d i a l c a r e . The t r e a t m e n t f o r t h e s e d i s e a s e s do not n o r m a l l y r e q u i r e c onfinement i n a f a c i l i t y . Compulsory Treatment and R i g h t s A l l o f the p r o v i n c i a l mental h e a l t h a c t s i n c l u d i n g t h a t of Quebec have a p r o c e d u r e t o p l a c e an i n d i v i d u a l i n h o s p i t a l f o r compulsory t r e a t m e n t . T h i s p r a c t i c e o f removing an i n d i v i d u a l from the community has a l o n g h i s t o r y d a t i n g back t o the Roman code of 450 B.C. The p r o c e d u r e has not been removed from the laws 2400 y e a r s l a t e r . The l a b e l s of the d i s o r d e r or b e h a v i o u r r e q u i r i n g removal have changed but c u s t o d y has remained e n t r e n c h e d . Compulsory t r e a t m e n t p r o c e d u r e s have two r o u t e s t o be completed; one i s the m e d i c a l r o u t e and the o t h e r i s the j u d i c i a l o r l e g a l r o u t e . Each method r e q u i r e s t h a t the d i s o r d e r e d p e r s o n be seen e i t h e r by a p h y s i c i a n or a law o f f i c e r . The p h y s i c i a n or a judge then w r i t e s or s i g n s o r d e r s , o f t e n c a l l e d c e r t i f i c a t e s , t o have the i n d i v i d u a l t a k e n t o a f a c i l i t y o r h o s p i t a l t h a t p r o v i d e s compulsory t r e a t m e n t . The judge does not n e c e s s a r i l y have t o see the d i s o r d e r e d p e r s o n but the p h y s i c i a n does. One t a b l e has been used t o p r e s e n t the m e d i c a l r o u t e g r a p h i c a l l y . The p r o c e d u r e f o l l o w e d by one or two p h y s i c i a n s i n c l u d e s the time a l l o w e d f o r v a r i o u s s t e p s t a k e n t o c o n f i r m compulsory t r e a t m e n t , the p e o p l e needed t o complete the p r o c e s s and the t i m e s of r e v i e w and renewal of compulsory t r e a t m e n t (see T a b l e 1 ) . T a b l e 1 s c h e m a t i c a l l y p r e s e n t s t h e v a r i a t i o n i n t h e p r o v i n c i a l p r o c e d u r e s of compulsory t r e a t m e n t . The time between the i n d i v i d u a l b e i n g seen and the v a l i d i t y o f the p h y s i c i a n ' s r e p o r t , and the time the p e r s o n may be h e l d i n the f a c i l i t y u n t i l a s s e s s e d by the f a c i l i t y ' s o r o t h e r s p e c i a l i s t s t a f f are two a r e a s of d i f f e r e n c e between the p r o v i n c e s . In B r i t i s h Columbia, the c e r t i f i c a t e s s i g n e d by two p h y s i c i a n s are v a l i d t o h o l d a p e r s o n i n a f a c i l i t y f o r compulsory t r e a t m e n t f o r one y e a r . The p r o c e d u r e s i n Quebec a l l o w l e s s time t o pass w h i l e the v a r i o u s s t e p s are b e i n g t a k e n compared t o the o t h e r p r o v i n c e s . Another d i f f e r e n c e between the p r o v i n c e s i s the p e r i o d of time l a p s e d b e f o r e a r e v i e w and renewal of compulsory t r e a t m e n t i s made. A g a i n , the B r i t i s h Columbia a c t i s the most r e s t r i c t i v e , w i t h a year as t h e time f o r the f i r s t and subsequent r e n e w a l s . Most o t h e r p r o v i n c e s have a t l e a s t t h r e e r e v i e w s f o r renewal i n one y e a r . The p r o v i n c i a l mental h e a l t h a c t s do have wide v a r i a t i o n s i n the way i n which they address a common m a t t e r , compulsory t r e a t m e n t . The f i v e p r o v i n c i a l a c t s have a s e c t i o n t h a t d e f i n e s the r e v i e w p r o c e s s . The one from the B r i t i s h Columbia i n s t r u m e n t i s the l e a s t d e v e l o p e d . There, a c t i o n depends 60 upon the p a t i e n t r e q u e s t i n g a r e v i e w , and t o make a r e q u e s t i m p l i e s t h a t the p a t i e n t comprehends what i s meant by compulsory t r e a t m e n t and a l s o u n d e r s t a n d s t h a t an a p p e a l or r e v i e w can be r e q u e s t e d . The o t h e r p r o v i n c e s ' s t a t u t e s d e s c r i b e t h e p r o c e d u r e , who p a r t i c i p a t e s and w i t h what f r e q u e n c y so t h a t the p a t i e n t does not i n i t i a t e the a c t i o n . In the mental h e a l t h a c t s of the p r o v i n c e s i n c l u d e d i n t h i s s t u d y , the i s s u e of r i g h t s i s not u n i f o r m l y a d d r e s s e d . Those r i g h t s t h a t are i n c l u d e d r e l a t e t o consent t o t r e a t m e n t , t o c o n f i d e n t i a l i t y of r e c o r d s , t o a p p e a l s o r r e v i e w s of i n v o l u n t a r y t r e a t m e n t , t o s e n d i n g or r e c e i v i n g communication and t o h a v i n g v i s i t o r s . A g a i n , each of the p r o v i n c i a l a c t s i s d i f f e r e n t i n what i s i n c l u d e d r e g a r d i n g the m a t t e r of r i g h t s . For each p r o v i n c e , t h e r i g h t s t h a t are mentioned w i l l now be n o t e d . B r i t i s h Columbia The M e n t a l H e a l t h A c t f o r B i r i t s h Columbia c o n t a i n s l i t t l e s p e c i f i c i n f o r m a t i o n on r i g h t s . There i s no s e c t i o n on c o n f i d e n t i a l i t y of r e c o r d s or consent f o r t r e a t m e n t . What i s s t a t e d i s t h a t : the D i r e c t o r of the f a c i l i t y s h a l l send i n w r i t i n g t o the next of k i n of the p a t i e n t a n o t i c e s t a t i n g f o r t h the r i g h t s of the p a t i e n t under S e c t i o n 27. In the event t h a t t h e r e i s no next of k i n known t o t h e D i r e c t o r , n o t i c e may be sent t o the P u b l i c T r u s t e e t o comply w i t h the A c t . l The r i g h t s s t a t e d i n S e c t i o n 27 are the r i g h t t o a p p l y t o t h e c o u r t f o r a d i s c h a r g e . As w e l l , i n S e c t i o n 27 i t s t a t e s : " Nothing i n t h i s s e c t i o n a f f e c t s the r i g h t o f a 61 p e r s o n t o a p p l y f o r a w r i t of habeas corpus or o t h e r p r e r o g a t i v e w r i t . " I n r e g a r d t o t r e a t m e n t , the A c t s t a t e s : t h a t a p e r s o n over the age of 16 a p p l y i n g on h i s own b e h a l f t o be a d m i t t e d i s deemed t o have the c a p a c i t y t o make a p p l i c a t i o n and an agreement f o r payment f o r maintenance and t r e a t m e n t i n the f a c i l i t y and t o a u t h o r i z e h i s t r e a t m e n t i n the f a c i l i t y . 2 Saskatchewan In the Saskatchewan A c t f o r M e n t a l H e a l t h t h e r e i s no s e c t i o n on consent t o t r e a t m e n t or c o n f i d e n t i a l i t y o f r e c o r d s . S e c t i o n s 29, 30 and 31 of t h e A c t d e a l w i t h appeal a g a i n s t i n v o l u n t a r y a d m i s s i o n p r o c e d u r e s . The A c t , however, does s t a t e : Communications may be w r i t t e n by or s e n t t o a p a t i e n t i n an i n - p a t i e n t f a c i l i t y w i t h o u t b e i n g opened, examined o r w i t h h e l d , and the d e l i v e r y of the communication not o b s t r u c t e d i n any way or d e l a y e d e x c e p t when t h e r e are r e a s o n a b l e and p r o b a b l e grounds t o b e l i e v e t h a t the c o n t e n t s of t h e communication w r i t t e n by t h e p a t i e n t would be o f f e n s i v e o r p r e j u d i c e h i s b e s t i n t e r e s t ; o r t h a t the c o n t e n t s r e c e i v e d by a p a t i e n t would i n t e r f e r e w i t h h i s t r e a t m e n t and cause unnecessary d i s t r e s s . 3 In t h i s manner the Saskatchewan A c t r e c o g n i z e s the r i g h t of an i n d i v i d u a l t o e x p r e s s or communicate i d e a s or w i s h e s . O n t a r i o The M e n t a l H e a l t h A c t f o r O n t a r i o has e x p l i c i t c o n t e n t r e g a r d i n g r i g h t s . The r i g h t of consent t o t r e a t m e n t i s i n c l u d e d i n t h i s A c t by t h e f o l l o w i n g s t a t e m e n t : The p s y c h i a t r i c t r e a t m e n t s h a l l not be g i v e n t o an i n v o l u n t a r y p a t i e n t w i t h o u t the consent of t h e p a t i e n t , o r , where th e p a t i e n t has not r e a c h e d the age o f m a j o r i t y or i s not m e n t a l l y competent, the consent of the n e a r e s t r e l a t i v e of the p a t i e n t , e x c e p t under the 62 a u t h o r i t y of an o r d e r of a R e g i o n a l Review Board made on an a p p l i c a t i o n of t h e o f f i c e r i n charge.4 There i s the a d d i t i o n a l p r o v i s o r e l a t e d t o p s y c h o s u r g e r y and i n t h e A c t i t s t a t e s : The consent of the i n v o l u n t a r y p a t i e n t o r the n e a r e s t r e l a t i v e o f an i n v o l u n t a r y p a t i e n t t o t r e a t m e n t w h i l e an i n v o l u n t a r y p a t i e n t does not i n c l u d e and s h a l l not be deemed t o i n c l u d e p s y c h o s u r g e r y . 5 In the O n t a r i o A c t , c o n f i d e n t i a l i t y o f the p a t i e n t ' s r e c o r d i s c o v e r e d i n S e c t i o n 26a. G e n e r a l l y , no pers o n s h a l l d i s c l o s e , t r a n s m i t o r examine a c l i n i c a l r e c o r d . Those who can, as w e l l as s i t u a t i o n s t h a t w a r r a n t i t , are d e s c r i b e d . R e g a r d i n g freedom t o communicate, the a c t s t a t e s : No communication w r i t t e n by a p a t i e n t o r sent t o a p a t i e n t s h a l l be opened, examined o r w i t h h e l d , and i t s d e l i v e r y s h a l l not i n any way be o b s t r u c t e d or delayed.6 However, t h e r e i s a s e c t i o n o f the a c t t h a t p u t s l i m i t s t o the above statement by w i t h h o l d i n g o r o b s t r u c t i n g t h o s e p i e c e s of communication t h a t may i n t e r f e r e w i t h the t r e a t m e n t o r cause u n n e c e s s a r y d i s t r e s s . To t h i s end: The o f f i c e r i n charge of t h e f a c i l i t y has t h e a u t h o r i t y t o open and examine the c o n t e n t s of w r i t t e n communication, w i t h the e x c e p t i o n of t h a t from a 7 B a r r i s t e r and S o l i c i t o r o r a member o f the Review Board. Appeal a g a i n s t i n v o l u n t a r y t r e a t m e n t i s w r i t t e n i n s e c t i o n 27 and 28 p r i m a r i l y . Quebec For the p r o v i n c e of Quebec, t h e r e i s no i t e m r e g a r d i n g c o n s e n t t o t r e a t m e n t and c o n f i d e n t i a l i t y of r e c o r d s i n t h e M e n t a l P a t i e n t s ' P r o t e c t i o n A c t . However, the i n d i v i d u a l s g r e c e i v i n g compulsory o r c l o s e t r e a t m e n t are p r o v i d e d w i t h 63 more i n f o r m a t i o n about the r i g h t s a t the o u t s e t than o t h e r p r o v i n c i a l a c t s would i n d i c a t e . P a t i e n t s ' r i g h t s are i n c l u d e d i n t h i s l e g i s l a t i o n w i t h a s e c t i o n s t a t i n g t h a t : e v e r y h o s p i t a l c e n t r e or r e c e p t i o n c e n t r e t o which a p erson i s a d m i t t e d i n c l o s e t r e a t m e n t must i n f o r m such p e r s o n i n w r i t i n g , i n accordance w i t h the r e g u l a t i o n s of the r i g h t s and r e c o u r s e s g r a n t e d t o him by t h i s A c t ; i t must a l s o i n f o r m him i n w r i t i n g t h a t h i s c l o s e t r e a t m e n t i s t e r m i n a t e d as soon as i t i s ended.^ Some of the r i g h t s i n c l u d e d i n t h e r e g u l a t i o n s are the r i g h t s t o have the f a m i l y n o t i f i e d of the measures b e i n g t a k e n t o h a s t e n the i n d i v i d u a l ' s r e c o v e r y . The p a t i e n t must a l s o be i n f o r m e d of such measures u n l e s s i t i s not i n h i s b e s t i n t e r e s t a t t h a t t ime t o be i n f o r m e d . There i s a comment on the r e q u i r e m e n t s of the exchange of c orrespondence w i t h an a d v o c a t e , a p h y s i c i a n , a n o t a r y , t h e p u b l i c c u r a t o r , the Board of Review or one of i t s members. The a p p e a l p r o c e d u r e i s i n c l u d e d i n the w r i t t e n i n f o r m a t i o n on r i g h t s g i v e n t o a p a t i e n t . The mechanisms f o r e n d i n g i n f o r m a l or c l o s e t r e a t m e n t are a l s o b r i e f l y s t a t e d i n the n o t i c e of r i g h t s g i v e n t o a p a t i e n t a d m i t t e d under c l o s e t r e a t m e n t . Nova S c o t i a Nova S c o t i a has the most r e c e n t p r o c l a m a t i o n of an a c t f o r mental d i s o r d e r , the H o s p i t a l s A c t , 1978. The Nova S c o t i a l e g i s l a t i o n has a r a t h e r l e n g t h y s e c t i o n , S e c t i o n 62, d e a l i n g w i t h p a t i e n t r i g h t s . W i t h i n t h i s s e c t i o n are t h e " r i g h t s t o communicate by l e t t e r and how the m a i l s h a l l be d e a l t w i t h , i n p a r t i c u l a r , communication t h a t may have a d e t r i m e n t a l e f f e c t on the a d d ressee. In r e g a r d t o l e t t e r s 64 o r w r i t t e n communication t h e r e i s i n c l u s i o n of a c c e s s t o w r i t i n g m a t e r i a l s , i n c l u d i n g stamps. The s e c t i o n on communication a l s o d e a l s w i t h the use of the t e l e p h o n e . V i s i t i n g of a p a t i e n t s h a l l be p e r m i t t e d a t a l l r e a s o n a b l e t i m e s and c i r c u m s t a n c e s . The f a c i l i t y i s r e s p o n s i b l e f o r p o s t i n g c o p i e s of the r i g h t s o f p e o p l e under o b s e r v a t i o n or of p a t i e n t s i n a p l a c e w i t h i n the h o s p i t a l where t h e y are v i s i b l e t o t h e s e groups of p e o p l e . A l l p a t i e n t s or persons a d m i t t e d f o r o b s e r v a t i o n are t o r e c e i v e w r i t t e n i n f o r m a t i o n on t h e i r r i g h t t o send and r e c e i v e l e t t e r s , t h e i r r i g h t t o make and r e c e i v e t e l e p h o n e c a l l s , v i s i t i n g r i g h t s , the r i g h t t o c o u n s e l , the r i g h t t o have a f i l e r e v i e w e d by a Review Board or a C o u r t , and the r i g h t t o have a d e c l a r a t i o n of competency or c a p a c i t y r e v i e w e d by a Review Board or a Court.- A v e r b a l e x p l a n a t i o n , and a s s i s t a n c e i s t o be p r o v i d e d t o a p a t i e n t or a p e r s o n a d m i t t e d f o r o b s e r v a t i o n t o c o n t a c t a B a r r i s t e r and t o a p p l y f o r a r e v i e w by the Review Board.10 S e c t i o n 63 a ddresses c o n f i d e n t i a l i t y of r e c o r d s s t a t i n g terms and c o n d i t i o n s o f r e l e a s e of i n f o r m a t i o n w i t h c o n s e n t . I f c o n s e n t by the p a t i e n t i s not p o s s i b l e because of i n a b i l i t y o r i n c a p a c i t y , then the g u a r d i a n , spouse, next of k i n or P u b l i c T r u s t e e i s d e s i g n a t e d t o a c t . Consent t o t r e a t m e n t i s s t a t e d s p e c i f i c a l l y i n the l e g i s l a t i o n i n t h e s e words: "No p e r s o n a d m i t t e d t o a h o s p i t a l s h a l l r e c e i v e t r e a t m e n t u n l e s s he c o n s e n t s t o such treatment." 1"'" And the p e r s o n may be a d m i t t e d t o a f a c i l i t y f o r o b s e r v a t i o n w i t h h i s consent and upon th e r e q u e s t of a q u a l i f i e d m e d i c a l p r a c t i t i o n e r . I f t h e i n d i v i d u a l i s found t o be i n c a p a b l e of c o n s e n t i n g t o t r e a t m e n t , then the d e s i g n a t e s of t h a t p e r s o n may g i v e c o n s e n t . 65 The c i t a t i o n s from t h e p r o v i n c i a l s t a t u t e s r e v e a l t h a t , on t h e m a t t e r o f r i g h t s f o r the mental p a t i e n t , t h e r e i s no c o n s i s t e n c y o r agreement between p r o v i n c e s . These r i g h t s as s e t down a p p l y t o t h e p e r s o n d e f i n e d as a p a t i e n t . A g a i n , i n t h e d e f i n i t i o n s , a p a t i e n t i s , f o r the most p a r t , one r e c e i v i n g compulsory t r e a t m e n t a l t h o u g h o c c a s i o n a l l y i t may mean one v o l u n t a r i l y a d m i t t e d t o h o s p i t a l . L i t t l e i s s p e l t out about r i g h t s i n t h e B r i t i s h Columbia A c t compared t o the more e x t e n s i v e c o n t e n t on r i g h t s i n the Nova S c o t i a A c t . R e s t r i c t i o n s on M e n t a l l y D i s o r d e r e d  i n Other P r o v i n c i a l S t a t u t e s In t h e f i r s t p a r t of t h i s s e c t i o n , compulsory t r e a t m e n t was noted t o be r e s t r i c t i v e of r i g h t s and freedoms. The r e s t r i c t i o n s were i n h e r e n t i n the a c t of t a k i n g a p a t i e n t i n t o c u s t o d i a l c a r e i n a mental h o s p i t a l . As w e l l , t h e r e are r e s t r i c t i o n s p l a c e d on t h e m e n t a l l y i l l i n o t h e r p r o v i n c i a l s t a t u t e s . For example, i n t h e B r i t i s h Columbia Land (Wife P r o t e c t i o n ) A c t s e c t i o n 9(1) s t a t e s : where she i s a m e n t a l l y d i s o r d e r e d p e r s o n or p e r s o n o f unsound mind . . . the Supreme C o u r t may, on a p p l i c a t i o n by p e t i t i o n d i s p e n s e w i t h the conse n t o f the w i f e . 1 2 The M a r r i e d Woman's P r o p e r t y A c t i n t h i s p r o v i n c e s t a t e s i n s e c t i o n 23(c) whose husband i s a m e n t a l l y d i s o r d e r e d p e r s o n w i t h o r w i t h o u t l u c i d i n t e r v a l s s h a l l have as her s e p a r a t e p r o p e r t y . . . .13 The S u p e r i n t e n d e n t of Motor V e h i c l e s i n B r i t i s h Columbia i s g i v e n wide d i s c r e t i o n a r y powers. In c a r r y i n g out h i s 66 r e s p o n s i b i l i t i e s he c o u l d c o n s i d e r mental d i s o r d e r as a cause t o r e s t r i c t an i n d i v i d u a l from d r i v i n g . The a c t p r o v i d e s t h e a u t h o r i t y i n the f o l l o w i n g c l a u s e : . . . f o r any o t h e r reason t h a t the S u p e r i n t e n d e n t i n h i s d i s c r e t i o n deems r e a s o n a b l e from t h e i n s p e c t i o n of the person's d r i v i n g r e c o r d or any o t h e r i n f o r m a t i o n the S u p e r i n t e n d e n t has r e s p e c t i n g the person's a b i l i t y t o d r i v e , and w i t h o u t f o r m a l p u b l i c o r o t h e r h e a r i n g may c a n c e l or suspend. . . .14 The m e n t a l l y d i s o r d e r e d have r e s t r i c t i o n s p l a c e d upon them by o t h e r B r i t i s h Columbia s t a t u t e s ; c o n s e q u e n t l y , l a b e l l i n g as a c o m p u l s o r i l y t r e a t e d mental p a t i e n t c a r r i e s heavy p e n a l t i e s . S i m i l a r examples of r e s t r i c t i o n s on the m e n t a l l y d i s o r d e r e d p e r s o n w r i t t e n i n t o o t h e r p r o v i n c i a l a c t s can be found i n t h e s t a t u t e s of O n t a r i o , Nova S c o t i a and Saskatchewan. In the p r o v i n c e of O n t a r i o , the E l e c t i o n A c t P a r t I I s e c t i o n 13 s t a t e s : p e r s o n s who are p r i s o n e r s . . . or who are p a t i e n t s i n mental h o s p i t a l s . . . are d i s q u a l i f i e d from v o t i n g . 1 5 The M a r r i a g e A c t o f O n t a r i o s e c t i o n 7 s t a t e s : . . . no pe r s o n s h a l l i s s u e a l i c e n s e t o or s o l e m n i z e t h e m a r r i a g e of any pe r s o n whom he knows or has r e a s o n a b l e grounds t o b e l i e v e . . . by re a s o n of b e i n g m e n t a l l y i l l . 1 6 The Law S o c i e t y A c t s e c t i o n 35 s t a t e s : . . . i f a member has been found p u r s u a n t t o any A c t t o be m e n t a l l y incompetent o r m e n t a l l y i l l o r . . . C o n v o c a t i o n may by o r d e r l i m i t o r suspend h i s r i g h t s and p r i v i l e g e s as a member f o r such t i m e . . . .1' The Nova S c o t i a Motor V e h i c l e A c t , c h a p t e r 251 s e c t i o n 1(c) s t a t e s : 67 . . . revoke d r i v e r s l i c e n s e when r e g i s t r a r has such r e a s o n t o b e l i e v e t h a t such a pers o n i s incompetent t o d r i v e a motor v e h i c l e o r a f f l i c t e d w i t h mental o r p h y s i c a l i n f o r m a t i e s o r d i s a b i l i t y r e n d e r i n g i t u n s a f e f o r such a p e r s o n t o d r i v e a motor v e h i c l e upon the highways.18 The M a r r i e d Woman's P r o p e r t y A c t i n c h a p t e r 176 P r o t e c t i o n Orders s e c t i o n 26 (c ) s t a t e s : . . . any m a r r i e d woman (1) whose husband i s a l u n a t i c , w i t h o r w i t h o u t l u c i d i n t e r v a l s may a p p l y t o a judge f o r an o r d e r f o r p r o t e c t i o n e n t i t l i n g her t o have and en j o y a l l the e a r n i n g s of her i n f a n t c h i l d r e n and any a c q u i s i t i o n t h e r e f r o m f r e e from the debts o r o b l i g a t i o n s of her husband and from h i s c o n t r o l o r d i s p o s i t i o n . In summary, the p r e s e n t mental h e a l t h s t a t u t e s and o t h e r l e g i s l a t i o n f o r f i v e p r o v i n c e s have shown v a r i a t i o n i n t h e i r c l a u s e s and wording f o r t h o s e deemed t o need compulsory c a r e . F o r Canadians who are " m e n t a l l y d i s o r d e r e d " , t h e r e s t r i c t i o n s t h e y f a c e depend upon the p r o v i n c e i n which they l i v e . The r e s t r i c t i o n s o r l i m i t a t i o n s are not c o n f i n e d t o the mental h e a l t h a c t s but are found i n o t h e r p r o v i n c i a l a c t s . Most i m p o r t a n t i s the v a r i a t i o n found i n the d e t e r m i n a t i o n of mental d i s o r d e r a r i s i n g from the d e f i n i t i o n p r o c e d u r e based upon the s u b j e c t i v e o p i n i o n of the p h y s i c i a n . T h i s c o n f i n e m e n t p r e s c r i b e d by a p h y s i c i a n i s w i t h o u t adequate s a f e g u a r d s and may c o n s t i t u t e c r u e l and un u s u a l t r e a t m e n t . The C h a r t e r p r o t e c t s f o r a l l Canadians t h e i r r i g h t s and freedoms. I t i s t h i s document t h a t poses a c h a l l e n g e t o t h e r e s t r i c t i v e c o n t e n t s of p r e s e n t mental h e a l t h a c t s . The l i m i t a t i o n o f r i g h t s and freedoms are p r e s e n t i n each of the p r o v i n c i a l a c t s a l t h o u g h not i n e x a c t l y the same form. Thus 68 mental h e a l t h l e g i s l a t i o n i s i n need of r e v i s i o n t o r e d r e s s the r e s t r i c t i o n • p l a c e d on t h e d i s o r d e r e d and the a d m i n i s t r a t i v e c o m p l e x i t i e s a r i s i n g w i t h a m o b i l e p o p u l a t i o n . 69 F o o t n o t e s "" " B r i t i s h Columbia: R.S.B.C. 1979, c. 256, Men t a l H e a l t h A c t , 1964, s e c t i o n 30. 2 I b i d . , s e c t i o n 22. 3 Saskatchewan: R.S.S. 1978, c. M. 13, M e n t a l H e a l t h A c t , 1978, s e c t i o n 29. 4 O n t a r i o : R.S.O. 1980, c. 262, Men t a l H e a l t h A c t , 1978, s e c t i o n 3 1 a ( 2 ) . 5 I b i d . , s e c t i o n 3 1 a ( 3 ) . * ~ I b i d . , s e c t i o n 1 9 ( 1 ) . 7 Ibid . . , s e c t i o n 1 9 ( 3 a ) . g C l o s e t r e a t m e n t i s the term used i n Quebec l e g i s l a t i o n t o mean compulsory o r c e r t i f i e d t r e a t m e n t . 9 Quebec: R.S.Q. 1977, c. P. 41, Men t a l P a t i e n t ' s P r o t e c t i o n A c t , 1974, s e c t i o n 27. 1 0 N o v a S c o t i a : R.S.N.S. 1967, c. 249, H o s p i t a l s A c t , 1978, s e c t i o n 6 2 ( 8 ) . """"""Ibid. , s e c t i o n 4 6 ( 1 ) . 12 B r i t i s h C olumbia: R.S.B.C. 1979, c. 223, Land (Wife P r o t e c t i o n ) A c t , s e c t i o n 9 ( 1 ) , ( 3 ) . 13 B r i t i s h C olumbia: R.S.B.C. 1979, c. 252, M a r r i e d Woman's P r o p e r t y A c t , s e c t i o n 2 3 ( 3 ) . 14 B r i t i s h Columbia: R.S.B.C. 1979, c. 288, Motor V e h i c l e A c t , s e c t i o n 88. 1 5 O n t a r i o : R.S.0. 198 0, c. 133, E l e c t i o n A c t , P a r t I I , s e c t i o n 93. "" ^ O n t a r i o : R.S.O. 1980, c. 256, M a r r i a g e A c t , s e c t i o n 7. 17 O n t a r i o : R.S.O. 1980, c. 233, Law S o c i e t y A c t , s e c t i o n 1 8 Nova S c o t i a : R.S.N.S. 1967, c. 191, Motor V e h i c l e A c t , c h a p t e r 251, s e c t i o n 1 ( c ) . 19 Nova S c o t i a : R.S.N.S. 1967, c. 176, M a r r i e d Woman's P r o p e r t y A c t , c h a p t e r 26(c) 70 C hapter V I I CONCLUSIONS AND IMPLICATION AND PLAN FOR CHANGE T h i s s t u d y has examined the mental h e a l t h l e g i s l a t i o n of f i v e Canadian p r o v i n c e s and the development of t h e s e s t a t u t e s from e a r l i e r a c t - passed i n E n g l a n d and Canada. The s t u d y has shown t h a t t h e s e a c t s are t o o l s t o apprehend some of the m e n t a l l y d i s o r d e r e d i n the community, t o t r a n s p o r t them t o a t r e a t m e n t f a c i l i t y and t o d e f i n e the a u t h o r i t y t o implement the compulsory t r e a t m e n t . These a c t s were s t u d i e d i n the Canadian c o n t e x t w i t h r e f e r e n c e t o r i g h t s and freedoms as p r o c l a i m e d i n the Canadian C h a r t e r of R i g h t s and Freedoms. I t was s t a t e d e a r l i e r i n t h i s s tudy t h a t t h e r e are i n t e r - p r o v i n c i a l v a r i a t i o n s i n the s e c t i o n s of the mental h e a l t h a c t s under r e v i e w ; and i t was n o t e d t h a t each p r o v i n c i a l mental h e a l t h a c t has r e s t r i c t i o n s of r i g h t s and freedoms i n i t s c o n t e n t s . The d e f i n i t i o n of "mental d i s o r d e r " v a r i e s and may be i n t e r p r e t e d d i f f e r e n t l y w i t h i n each p r o v i n c e because of the i m p r e c i s i o n of the d e f i n i t i o n . Compulsory t r e a t m e n t , the p r o c e s s of i m p l e m e n t a t i o n , and a p p e a l a g a i n s t t h i s t r e a t m e n t i s a l s o r e s t r i c t i v e . Communication w i t h t h o s e not i n a f a c i l i t y by the p e r s o n h a v i n g e n f o r c e d t r e a t m e n t i s not open but r e s t r i c t e d and s c r u t i n i z e d . F i n a l l y , i t i s c o n c l u d e d t h a t t h e s e a c t s do not address th e i s s u e s of t r e a t m e n t f o r t h e " m e n t a l l y d i s o r d e r e d " or t h e p r o m o t i o n of mental h e a l t h . They are l e g i s l a t i v e documents t h a t d e f i n e a p r o c e d u r e t o p l a c e r e s t r i c t i o n s on c e r t a i n m e n t a l l y d i s o r d e r e d i n d i v i d u a l s , and t h a t p r o v i d e f o r the a d m i n i s t r a t i o n of mental h e a l t h s e r v i c e s w i t h i n a p r o v i n c e . These s t a t u t e s do not address t h e s e i s s u e s u n i f o r m l y i n a l l p r o v i n c e s ; r a t h e r t hey have d e f i n i t i o n s and p r o c e d u r e s t h a t meet l o c a l r e q u i r e m e n t s . The essence of each of the p r o v i n c i a l a c t s i s t o p l a c e a p e r s o n who i s p o s i n g a danger t o h i m s e l f or t h o s e around him i n a p l a c e where t r e a t m e n t may be e n f o r c e d . F u r t h e r , i t was found t h a t the r e s t r i c t i o n s o f e n f o r c e d t r e a t m e n t w r i t t e n i n t o the a c t were of w i d e r impact i n t h a t o t h e r p r o v i n c i a l s t a t u t e s p l a c e d l i m i t a t i o n s on the " m e n t a l l y d i s o r d e r e d . " The r e s t r i c t i o n s on r i g h t s t o v o t e , manage p r o p e r t y and d r i v e were examples of the l i m i t i n g e f f e c t s o f o t h e r l a w s . The s o u r c e s of the r e s t r i c t i o n s i n the mental h e a l t h a c t s were the s u b j e c t i v e n a t u r e of d e f i n i n g "mental d i s o r d e r " and the a p p e a l p r o c e s s t o c h a l l e n g e the e n f o r c e d t r e a t m e n t and c o n f i n e m e n t . Even though i t was shown t h a t the c o n t e n t s and a d m i n i s t r a t i o n of a c t s f o r mental h e a l t h changed over the l a s t f i f t y o r more y e a r s , the " m e n t a l l y d i s o r d e r e d " are s t i l l s u b j e c t t o i n j u s t i c e s of the law. With a g e n e r a l l y more m o b i l e p o p u l a t i o n , i n c l u d i n g the " d i s o r d e r e d " , the escape from one s e t of p r o v i n c i a l r e s t r i c t i o n s are met w i t h new or d i f f e r e n t ones i n a n other p r o v i n c e . An added problem, t h a t of a d m i n i s t r a t i n g the a c t t o a m o b i l e p o p u l a t i o n a t a time when t h e r e i s a n a t i o n a l C h a r t e r of R i g h t s and Freedoms was a l s o n o t e d . To answer the q u e s t i o n s r a i s e d by t h i s s t u d y , i t was shown t h a t mental h e a l t h a c t s , as w i t h a l l l e g i s l a t i o n , are i n t e r a c t i v e w i t h s o c i a l , economic and t e c h n o l o g i c a l c o n d i t i o n s o f the n a t i o n or p r o v i n c e . Thus, s o c i e t a l b e l i e f s about mental i l l n e s s and the s t i g m a a t t a c h e d t o the d i s o r d e r , economic a f f l u e n c e or d e p r e s s i o n , and new advances i n t e c h n o l o g y , e s p e c i a l l y i n d i s e a s e p r o c e s s e s and t r e a t m e n t , a l l must be c o n s i d e r e d when d e v e l o p i n g l e g i s l a t i o n . With t h i s u n d e r s t a n d i n g and the p o s s i b i l i t y of d i s c o v e r i n g new t r e a t m e n t s f o r mental i l l n e s s i n the f u t u r e , t h e r e i s r e a son t o amend the e x i s t i n g s t a t u t e s and t r u l y change the c o n t e n t from confinement t o t r e a t m e n t . The c o n t i n u a t i o n of v a l u e s or p e r c e p t i o n s of the " d i s o r d e r e d " from the i n d i s c r i m i n a t e law t h a t was w r i t t e n t o c o n t r o l the poor and the i n s a n e needs t o be a l t e r e d i n new."'acts. From t h i s s tudy i t has been shown t h a t p r o v i n c i a l mental h e a l t h a c t s i n Canada do impose r e s t r i c t i o n s upon the " m e n t a l l y d i s o r d e r e d " and t h a t the r e s t r i c t i o n s are d i f f e r e n t f o r each p r o v i n c e as w e l l as how t hey are a p p l i e d by each p h y s i c i a n i n the p r o v i n c e . I t i s p o s s i b l e t o make changes i n the s t a t u t e s i n an o r d e r l y manner even though the p r e s s u r e s f o r change come from w i d e l y d i v e r s e s o u r c e s . The p l a n f o r change w i l l address the c o n t r i b u t i o n s made by the v a r i o u s i n t e r e s t e d groups, the a d m i n i s t r a t i v e and economic i s s u e s , t o g e t h e r w i t h t e c h n o l o g i c a l change. P l a n f o r Change The p l a n f o r c h a n g i n g mental h e a l t h l e g i s l a t i o n w i l l i n v o l v e p r o f e s s i o n a l groups, p a t i e n t and s p e c i a l i n t e r e s t groups, and the government a d m i n i s t r a t o r s of mental h e a l t h . The p l a n , based On recommendations dev e l o p e d from t h i s study w i l l d e s c r i b e the r o l e of the p a r t i c i p a n t s and a method of p r o c e s s i n g . Recommendations From t h i s s t u d y i t i s recommended: 1. t h a t a n a t i o n a l s t a n d a r d be d e v e l o p e d f o r d e f i n i n g mental d i s o r d e r and a confinement p r o c e d u r e . 2. t h a t c u r r e n t p r o v i n c i a l mental h e a l t h s t a t u t e s be m o d i f i e d t o conform w i t h a n a t i o n a l s t a n d a r d r e g a r d i n g the d e f i n i t i o n of mental d i s o r d e r and a confinement p r o c e d u r e . 3. t h a t the t i t l e of t h e s e p r o v i n c i a l a c t s more a c c u r a t e l y r e f l e c t the c o n t e n t s ; e.g., M e n t a l D i s o r d e r Confinement A c t . 4. t h a t t h e d e f i n i t i o n of mental d i s o r d e r not i n c l u d e a d d i c t i v e o r h a b i t u a t e d s t a t e s as w i t h i n g e s t i o n of a l c o h o l or d r u g s . 5. t h a t the a p p l i c a t i o n of the d e f i n i t i o n o f mental d i s o r d e r f o r the purpose of confinement be made by two i n d i v i d u a l s from two p r o f e s s i o n a l groups such as p h y s i c i a n and p s y c h o l o g i s t , or p o l i c e and n u r s e . 6. t h a t the confinement procedure be d e f i n e d s e p a r a t e l y on a d m i s s i o n from the community and f o r t h a t from 74 w i t h i n a f a c i l i t y . 7. t h a t r e v i e w and ap p e a l p r o c e d u r e s r e g a r d i n g ~ confinement be developed n a t i o n a l l y f o r i n c l u s i o n i n p r o v i n c i a l s t a t u t e s and t h a t t h e s e not be dependent or based upon the v i c t i m i n i t i a t i n g t he p r o c e s s . 8. t h a t s e c t i o n s r e g a r d i n g communication, c o n f i d e n t i a l i t y , consent and n o n - i n t r u s i v e t r e a t m e n t p r o c e d u r e s be w r i t t e n i n t o the a c t . 9. t h a t o t h e r c u r r e n t s t a t u t e s w i t h s e c t i o n s t h a t s e t r e s t r i c t i o n s on the c o m p u l s o r i l y t r e a t e d m e n t a l l y d i s o r d e r e d be r e v i e w e d i n the l i g h t o f the recommendations and the C h a r t e r of R i g h t s and Freedoms. To implement t h i s o r any p l a n t o r e - w r i t e o r amend-l e g i s l a t i o n w i l l t a k e t i m e . However, t h e r e are a l r e a d y some e x i s t i n g mechanisms t o c o n s i d e r t h e s e recommendations and o t h e r s and then t o t a k e needed a c t i o n s . The time r e q u i r e d f o r the t a s k w i l l be s u b j e c t t o d e l a y o r urgency a c c o r d i n g t o the p o l i t i c a l p r e s s u r e s , s o c i a l p r e s s u r e s and o t h e r s e r v i c e d e l i v e r y i s s u e s . But as a p l a n n e r w i t h a r e s p o n s i b i l i t y t o a d v i s e on l e g i s l a t i o n and i t s i m p l e m e n t a t i o n , i t i s p o s s i b l e t o p l a n f o r n e c e s s a r y changes d e s p i t e o t h e r p r e s s u r e s . So, t h i s p l a n w i l l f i r s t d e s c r i b e the r o l e of the p a r t i c i p a n t s t o be f o l l o w e d by a method of p r o c e e d i n g . R o l e o f P a r t i c i p a n t s The government a d m i n i s t r a t o r s of mental h e a l t h s e r v i c e s w i l l t a k e t h e l e a d r o l e . T h i s group's response i s c e n t r a l i n r e v i e w i n g a l l the i m p l i c a t i o n s of p r e s e n t l e g i s l a t i o n , and s o c i a l , economic and i n t e r e s t group a c t i o n s f o r change. T h i s group can i n t e g r a t e the p r e s s u r e s f o r l e g i s l a t i v e change t h a t are o u t s i d e the view of each of the p a r t s of the system such as the m e d i c a l or governmental o r g a n i z a t i o n s . A d m i n i s t r a t o r s of p r o v i n c i a l mental h e a l t h s e r v i c e s are a b l e t o a d v i s e on p r o v i n c i a l s e r v i c e s as w e l l as r e p r e s e n t p r o v i n c i a l s e r v i c e s t o c o u n t e r p a r t s i n o t h e r p r o v i n c e s . These o f f i c i a l s can seek out and respond t o comments s u b m i t t e d by concerned groups from a l l p a r t s of s o c i e t y . The s p e c i a l i s t p h y s i c i a n s t o g e t h e r w i t h p h y s i c i a n s g e n e r a l l y w i l l need t o examine t h e i r c u r r e n t p r a c t i c e r e g a r d i n g the d e f i n i t i o n and t r e a t m e n t of the d i s o r d e r e d , e s p e c i a l l y as i t r e l a t e s t o the use o f compulsory t r e a t m e n t . These p e o p l e need t o c o n s i d e r the n e c e s s i t y of e n f o r c e d t r e a t m e n t p r o c e d u r e s f o r the m e n t a l l y i l l , p a r t i c u l a r l y i f t h e r e are a l r e a d y t o o l s a v a i l a b l e t o p r o v i d e t r e a t m e n t t o n o n - c o n s e n t i n g i n d i v i d u a l s ; e.g., the u n c o n s c i o u s t r a f f i c v i c t i m . F u r t h e r , t h i s group needs t o r e v i e w t h e i r e d u c a t i o n , b o t h f o r m a l l y and i n f o r m a l l y , as i t r e l a t e d t o mental d i s o r d e r , i t s d e f i n i t i o n , t r e a t m e n t and e s p e c i a l l y e n f o r c e d t r e a t m e n t . T h i s p e r s p e c t i v e has r e l e v a n c e t o the p h y s i c i a n knowing t h a t i n t e r - and i n t r a - p r o v i n c i a l d i f f e r e n c e s may o c c u r . The o t h e r p r o f e s s i o n a l groups w i l l be asked f o r t h e i r 76 o p i n i o n s r e g a r d i n g the t r e a t m e n t of the m e n t a l l y d i s o r d e r e d . But i t i s not o n l y the t r e a t m e n t t h a t i s s i g n i f i c a n t but a l s o the d e f i n i t i o n or d e t e r m i n a t i o n of a mental d i s o r d e r t h a t i s e q u a l l y i m p o r t a n t . The e d u c a t i o n t h e s e p r o f e s s i o n a l s have r e g a r d i n g t h e i r r e s p o n s i b i l i t y towards the e x i s t i n g l e g i s l a t i o n needs t o be responded t o as i t may need t o be c o n s i d e r e d w i t h a new s t a t u t e b e i n g w r i t t e n . The p r o f e s s i o n s sought out t o p r o v i d e e v i d e n c e are l a w y e r s , l e g i s l a t i v e w r i t e r s , p o l i c e , p s y c h o l o g i s t s , s o c i a l w o r k e r s , n u r s e s and academics. One i n t e r e s t e d group not mentioned above are the consumers. T h e i r e v i d e n c e i s n e c e s s a r y r e g a r d i n g i s s u e s ~ w i t h c u r r e n t l e g i s l a t i o n and the p o s s i b l e e f f e c t s o f proposed a c t s . Method of P r o c e e d i n g The method of p r o c e e d i n g has f o u r p a r t s : f i r s t , r e v i e w of c u r r e n t a c t s t o g e t h e r w i t h r e l e v a n t d a t a ; second, r e v i s i o n and w r i t i n g of the amendments or new a c t ; t h i r d , i m p l e m e n t a t i o n of the s t a t u t e ; and l a s t , an e v a l u a t i o n o f the a d m i n i s t r a t i o n of the a c t . Some of t h e s e a c t i v i t i e s are ongoing w i t h i n each of the p r o v i n c i a l mental h e a l t h departments but may r e q u i r e changes so t h a t the i s s u e of r i g h t s and mental d i s o r d e r i s a d d r e s s e d . The l e a d group can b e g i n r e v i e w s of the mental h e a l t h l e g i s l a t i v e i tems w i t h l e g i s l a t i v e w r i t e r s w i t h i n the p r o v i n c e and n a t i o n a l l y . For a b e g i n n i n g , t h o s e items t h a t can be changed q u i c k l y s h o u l d be c o n s i d e r e d a t the o u t s e t , f o l l o w e d by tho s e items t h a t r e q u i r e r e f i n e m e n t and development over a l o n g e r p e r i o d of t i m e . To t a k e an example, a l t h o u g h compulsory t r e a t m e n t i s r e s t r i c t i v e , p r e s e n t l y s o c i e t y views i t as a needed c o n t r o l mechanism, but appeal and r e v i e w p r o c e d u r e s are not a d e q u a t e l y addressed or p r o t e c t e d i n t h e s t a t u t e s and peopl e g e n e r a l l y want r e d r e s s . Thus, work can commence i n the ap p e a l and r e v i e w s e c t i o n s o f t h e p r o v i n c i a l a c t s t o ensure t h a t any changes are c o m p a t i b l e w i t h the Canada A c t . Other l e s s complex items can be worked on; the " t i t l e " mentioned i n Recommendation 3; and communication, c o n f i d e n t i a l i t y , consent and n o n - i n t r u s i v e t r e a t m e n t p r o c e d u r e s mentioned i n Recommendation 9 above. The next and more complex t a s k of r e f i n i n g the d e f i n i t i o n o f mental d i s o r d e r needs t o be ad d r e s s e d by each p r o v i n c i a l a d m i n i s t r a t i v e group and i n t e r p r o v i n c i a l l y as w e l l . The c r i t e r i a f o r d e t e r m i n i n g d i s o r d e r need t o be s p e l l e d out so they are made l e s s dependent upon s u b j e c t i v e judgements. The f a c t o r o f danger may r e q u i r e c o n s i d e r a t i o n t o be a p p r o p r i a t e as p a r t of the d e f i n i t i o n of mental d i s o r d e r . W ith a c l e a r d e f i n i t i o n f o r mental d i s o r d e r then the pro c e d u r e f o r compulsory t r e a t m e n t , i f n e c e s s a r y , needs t o be worked o u t . Or two procedures--one t o apprehend and convey, and one t o f o r c i b l y g i v e treatment--may be r e q u i r e d . 78 These t a s k s do not have s i m p l e s o l u t i o n s and w i l l r e q u i r e c o n s i d e r a b l e time t o c omplete. Time i s needed so t h a t the s t a t u t o r y changes are made based upon adequate, w e l l d eveloped i n f o r m a t i o n . In summary, f o r mental h e a l t h l e g i s l a t i o n , . f i r s t i t i s n e c e s s a r y t o r e - d e f i n e mental d i s o r d e r and confinement p r o c e d u r e s by e xamining the e v i d e n c e s o l i c i t e d from the v a r i o u s groups mentioned above and then f o l l o w e d w i t h the p r o c e s s of r e - w r i t i n g the l e g i s l a t i o n so t h a t the c o n t e n t s are t r e a t m e n t not c u s t o d y o r i e n t e d . Once the new or amended a c t i s p r o c l a i m e d , a r e v i e w of the a p p l i c a t i o n or i m p l e m e n t a t i o n of the s t a t u t e w i l l complete the p r o c e s s e n s u r i n g the needs of s o c i e t y are r e f l e c t e d i n the law. 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The Law and M e n t a l D i s o r d e r , A Comprehensive E d i t i o n of  the Report of the Committee on L e g i s l a t i o n and  P s y c h i a t r i c D i s o r d e r . Committee of the N a t i o n a l S c i e n t i f i c P l a n n i n g C o u n c i l o f the Canadian M e n t a l H e a l t h A s s o c i a t i o n , Canada, 1973. Sz a s z , Thomas S. Law, L i b e r t y and P s y c h i a t r y . The M a c M i l l a n Company, New York, 1963. S z a s z , Thomas S. P s y c h i a t r i c S l a v e r y . C o l l i e r M a c M i l l a n Canada L t d . , 1977 . T a n c r e d i , Lawrence R. "The R i g h t s of M e n t a l P a t i e n t s : Weighing the I n t e r e s t s . " J o u r n a l o f H e a l t h P o l i t i c s , P o l i c y and Law, v o l . 5, no. 2 (Summer 1980): pp. 190-203. 85 Townsend, F. R., and Lorne E. Rozovsky. "The New H o s p i t a l s A c t and P h y s i c i a n s . " The Nova S c o t i a M e d i c a l B u l l e t i n , ( F e b r u a r y 1979): pp. 13-14. We i s s t u b , D a v i d N. Law and P s y c h i a t r y i n the Canadian C o n t e x t . Pergamon P r e s s , T o r o n t o , Canada, 1980 . 86 APPENDIX A B r i t i s h N o r t h America A c t , 1867  S e c t i o n 91-92 P a r t V I . D i s t r i b u t i o n of L e g i s l a t i v e Powers Powers of the P a r l i a m e n t S e c t i o n 91. I t s h a l l be. . . . of such House, l a The P u b l i c Debt and P r o p e r t y . 2 The R e g u l a t i o n of Trade and Commerce. 2a Unemployment I n s u r a n c e . 3 The r a i s i n g of Money by any Mode or System of T a x a t i o n . 4 The b o r r o w i n g o f Money on the P u b l i c C r e d i t . 5 P o s t a l S e r v i c e . 6 The Census and S t a t i s t i c s . 7 M i l i t i a , M i l i t a r y and Nav a l S e r v i c e , and Defence. 8 The f i x i n g of and p r o v i d i n g f o r the S a l a r i e s and A l l o w a n c e s o f C i v i l and o t h e r O f f i c e s of the Government of Canada. 9 Beacons, Buoys, L i g h t h o u s e s , and Sab l e I s l a n d . 10 N a v i g a t i o n and S h i p p i n g . 11 Q u a r a n t i n e and the E s t a b l i s h m e n t and Maintenance of Marine H o s p i t a l s . 12 Sea Coast and I n l a n d F i s h e r i e s . 13 F e r r i e s between a P r o v i n c e and any B r i t i s h o r F o r e i g n C ountry o r between Two P r o v i n c e s . 14 C u r r e n c y and Coinage. 15 B a n k i n g , I n c o r p o r a t i o n of Banks, and the Is s u e of Paper Money. 16 S a v i n g s Banks. 17 Weights and Measures. 18 B i l l s o f Exchange and P r o m i s s o r y Notes. 19 I n t e r e s t . 20 L e g a l Tender. 21 B a n k r u p t c y and I n s o l v e n c y . 22 P a t e n t s of I n v e n t i o n and D i s c o v e r y . 23 C o p y r i g h t s . 24 I n d i a n s , and Lands r e s e r v e d f o r the I n d i a n s . 25 N a t u r a l i z a t i o n and A l i e n s . 2 6 M a r r i a g e and D i v o r c e . 27 The C r i m i n a l Law, ex c e p t the C o n s t i t u t i o n of C o u r t s of C r i m i n a l J u r i s d i c t i o n , but i n c l u d i n g the Procedure i n C r i m i n a l M a t t e r s . 28 The E s t a b l i s h m e n t , Maintenance, and Management of P e n i t e n t i a r i e s . 29 Such C l a s s e s o f S u b j e c t s as are e x p r e s s l y e x c e p t e d i n the Enumeration o f the C l a s s e s of S u b j e c t s by t h i s A c t a s s i g n e d e x c l u s i v e l y t o the L e g i s l a t u r e s of the P r o v i n c e s . And any M a t t e r coming w i t h i n any of the C l a s s e s of S u b j e c t s enumerated i n t h i s S e c t i o n s h a l l not be deemed t o come w i t h i n 87 the C l a s s of M a t t e r s of a l o c a l or p r i v a t e Nature c o m p r i s e d i n the Enumeration of the C l a s s e s of S u b j e c t s by t h i s A c t a s s i g n e d e x c l u s i v e l y t o the L e g i s l a t u r e s of the P r o v i n c e s . E x c l u s i v e Powers bf P r o v i n c i a l L e g i s l a t u r e s S e c t i o n 92. In each P r o v i n c e the L e g i s l a t u r e may e x c l u s i v e l y make Laws i n r e l a t i o n t o M a t t e r s coming w i t h i n the C l a s s e s of S u b j e c t next h e r i n - a f t e r enumerated; t h a t i s t o say, 1 The Amendment from Time t o Time, n o t w i t h s t a n d i n g a n y t h i n g i n t h i s A c t , o f the C o n s t i t u t i o n of t h e P r o v i n c e , except as r e g a r d s the O f f i c e of L i e u t e n a n t Governor. 2 D i r e c t T a x a t i o n w i t h i n the P r o v i n c e i n o r d e r t o the r a i s i n g of a Revenue f o r P r o v i n c i a l P u r poses. 3 The b o r r o w i n g of Money on the s o l e C r e d i t of the P r o v i n c e 4 The E s t a b l i s h m e n t and Tenure of P r o v i n c i a l O f f i c e s and the Appointment and Payment of P r o v i n c i a l O f f i c e r s . 5 The Management and S a l e o f the P u b l i c Lands b e l o n g i n g t o the P r o v i n c e and o f the Timber and Wood t h e r e o n . 6 The E s t a b l i s h m e n t , Maintenance, and Management of P u b l i c and R e f o r m a t o r y P r i s o n s i n and f o r the P r o v i n c e . 7 The E s t a b l i s h m e n t , Maintenance, and Management of H o s p i t a l s , Asylums, C h a r i t i e s , and Eleemosynary I n s t i t u t i o n s i n and f o r the P r o v i n c e , o t h e r than Marine H o s p i t a l s . 8 M u n i c i p a l I n s t i t u t i o n s ' , i n the P r o v i n c e . 9 Shop, S a l o o n , Tavern, A u c t i o n e e r , and o t h e r L i c e n c e s i n o r d e r t o t h e r a i s i n g of a Revenue f o r P r o v i n c i a l , L o c a l , o r M u n i c i p a l P u r p o s e s . 10 L o c a l Works and U n d e r t a k i n g s o t h e r than such as are of the f o l l o w i n g C l a s s e s : (a) L i n e s of Steam or o t h e r S h i p s , R a i l w a y s , C a n a l s , T e l e g r a p h s , and o t h e r Works and U n d e r t a k i n g c o n n e c t i n g t h e P r o v i n c e w i t h any o t h e r or o t h e r s o f the P r o v i n c e s , or e x t e n d i n g beyond the L i m i t s of the P r o v i n c e ; (b) L i n e s o f Steam S h i p s between the P r o v i n c e and any B r i t i s h o r F o r e i g n C o u n t r y ; (c) Such Works as, a l t h o u g h w h o l l y s i t u a t e w i t h i n the P r o v i n c e , are b e f o r e or a f t e r t h e i r E x e c u t i o n d e c l a r e d by t h e P a r l i a m e n t o f Canada t o be f o r the g e n e r a l Advantage of Canada or f o r t h e Advantage of Two or more of t h e P r o v i n c e s . 11 The I n c o r p o r a t i o n of Companies w i t h P r o v i n c i a l O b j e c t s . 12 The S o l e m n i z a t i o n of M a r r i a g e i n the P r o v i n c e . 13 P r o p e r t y and C i v i l R i g h t s i n the P r o v i n c e . 14~" The A d m i n i s t r a t i o n of J u s t i c e i n the P r o v i n c e , i n c l u d i n g the C o n s t i t u t i o n , Maintenance, and O r g a n i z a t i o n o f P r o v i n c i a l C o u r t s , b o t h of C i v i l and of C r i m i n a l J u r i s d i c t i o n , and i n c l u d i n g P r o c e d u r e i n C i v i l M a t t e r s i n t h o s e C o u r t s . 15 The I m p o s i t i o n of Punishment by F i n e , P e n a l t y , or Imprisonment f o r e n f o r c i n g any Law of t h e P r o v i n c e made i n r e l a t i o n t o any M a t t e r coming w i t h i n any of the C l a s s e s of S u b j e c t s enumerated i n t h i s S e c t i o n . 16 G e n e r a l l y a l l M a t t e r s of a merely l o c a l o r p r i v a t e Nature i n t h e P r o v i n c e . 88 APPENDIX B C h a r t e r o f R i g h t s and Freedoms, C o n s t i t u t i o n A c t , 1982 R e l a t e d t o mental i l l n e s s , the f o l l o w i n g s e c t i o n s from P a r t One of t h e Canadian C h a r t e r o f R i g h t s and Freedoms, C o n s t i t u t i o n A c t , 1982 are r e l e v a n t t o t h i s s t u d y . 6. (2) E v e r y c i t i z e n o f Canada and e v e r y p e r s o n who has the s t a t u s o f a permanent r e s i d e n t of Canada has the r i g h t : (a) To move t o and t a k e up r e s i d e n c e i n any p r o v i n c e ; and (b) To pursue t h e - g a i n i n g of a l i v e l i h o o d i n any p r o v i n c e . (3) The r i g h t s s p e c i f i e d i n s u b s e c t i o n (2) are s u b j e c t t o : (a) Any laws o r p r a c t i c e s of g e n e r a l a p p l i c a t i o n i n f o r c e i n a p r o v i n c e o t h e r than t h o s e t h a t d i s c r i m i n a t e among pers o n s p r i m a r i l y on the b a s i s of p r o v i n c e of p r e s e n t o r p r e v i o u s r e s i d e n c e ; and (b) any laws p r o v i d i n g f o r r e a s o n a b l e r e s i d e n c y r e q u i r e m e n t s as a q u a l i f i c a t i o n f o r t h e . r e c e i p t of p u b l i c l y p r o v i d e d s o c i a l s e r v i c e s . 7. Everyone has t h e r i g h t t o l i f e , l i b e r t y and s e c u r i t y of the p e r s o n and t h e r i g h t not t o be d e p r i v e d t h e r e o f e x c e p t i n a ccordance w i t h the p r i n c i p l e s of fundamental j u s t i c e . 8. Everyone has the r i g h t t o be secu r e a g a i n s t u n r e a s o n a b l e s e a r c h o r s e i z u r e . 9. Everyone has the r i g h t not t o be a r b i t r a r i l y d e t a i n e d or i m p r i s o n e d . 12. Everyone has the r i g h t not t o be s u b j e c t e d t o any c r u e l and u n u s u a l t r e a t m e n t o r punishment. 15. (1) Eve r y i n d i v i d u a l i s e q u a l b e f o r e and under the law and has t h e r i g h t t o t h e e q u a l p r o t e c t i o n and e q u a l b e n e f i t o f the law w i t h o u t d i s c r i m i n a t i o n and, i n p a r t i c u l a r , w i t h o u t d i s c r i m i n a t i o n based on r a c e , n a t i o n a l o r e t h n i c o r i g i n , c o l o r , r e l i g i o n , sex, age or mental o r p h y s i c a l d i s a b i l i t y . (2) ; S u b s e c t i o n (1) does not p r e c l u d e any law, program o r a c t i v i t y t h a t has as i t s o b j e c t the a m e l i o r a t i o n o f c o n d i t i o n s of d i s a d v a n t a g e d i n d i v i d u a l s o r groups i n c l u d i n g t h o s e t h a t are d i s a d v a n t a g e d because of r a c e , n a t i o n a l o r e t h n i c o r i g i n , c o l o r , r e l i g i o n , sex, age or mental o r p h y s i c a l d i s a b i l i t y . 24. (1) Anyone whose r i g h t s or freedoms, as gua r a n t e e d by t h i s c h a r t e r , have been i n f r i n g e d o r d e n i e d may a p p l y t o a 89 c o u r t of competent j u r i s d i c t i o n t o o b t a i n such remedy as the c o u r t c o n s i d e r s a p p r o p r i a t e and j u s t i n the c i r c u m s t a n c e s . 32. (1) T h i s c h a r t e r a p p l i e s : (a) To t h e P a r l i a m e n t and government of Canada i n r e s p e c t of a l l m a t t e r s w i t h i n the a u t h o r i t y of P a r l i a m e n t i n c l u d i n g a l l m a t t e r s r e l a t i n g t o the Yukon T e r r i t o r y and Northwest T e r r i t o r i e s ; and (b) To the l e g i s l a t u r e and government of each p r o v i n c e i n r e s p e c t o f a l l m a t t e r s w i t h i n the a u t h o r i t y o f the l e g i s l a t u r e o f each p r o v i n c e . 90 APPENDIX C D e f i n i t i o n s Found i n F i v e P r o v i n c i a l M e n t a l H e a l t h A c t s  f o r "Mental D i s o r d e r " , " D i r e c t o r " , " P a t i e n t " , " F a c i l i t y " , " P h y s i c i a n . " The d e f i n i t i o n s t h a t appear i n the f i v e p r o v i n c i a l mental h e a l t h a c t s a re as f o l l o w s . BRITISH COLUMBIA (R.S.B.C. 1979, c. 256, Me n t a l H e a l t h A c t , 1964) D i r e c t o r - means a p e r s o n who i s a p p o i n t e d i n charge of a p r o v i n c i a l mental h e a l t h f a c i l i t y and i n c l u d e s a person a u t h o r i z e d by a D i r e c t o r t o e x e r c i s e power o r c a r r y out a duty c o n f e r r e d o r imposed on the d i r e c t o r under t h i s A c t . M e n t a l l y D i s o r d e r e d Person - means a p e r s o n who i s s u f f e r i n g from a d i s o r d e r of the mind t h a t s e r i o u s l y i m p a i r s h i s a b i l i t y t o r e a c t a p p r o p r i a t e l y t o h i s environment o r t o a s s o c i a t e w i t h o t h e r s ; and t h a t r e q u i r e s m e d i c a l t r e a t m e n t o r makes c a r e , s u p e r v i s i o n and c o n t r o l o f the pe r s o n n e c e s s a r y f o r h i s p r o t e c t i o n o r w e l f a r e o r f o r the p r o t e c t i o n of o t h e r s . P a t i e n t - means a p e r s o n who under t h i s A c t : ( i ) i s r e c e i v i n g p s y c h i a t r i c c a r e and t r e a t m e n t ; o r ( i i ) i s r e c e i v e d , d e t a i n e d o r t a k e n charge of as a m e n t a l l y d i s o r d e r e d p e r s o n o r as an a l l e g e d l y m e n t a l l y d i s o r d e r e d p e r s o n . P h y s i c i a n - means a m e d i c a l p r a c t i t i o n e r . P r i v a t e M e n t a l H o s p i t a l - means an e s t a b l i s h m e n t l i c e n s e d under S e c t i o n 5. P r o v i n c i a l H e a l t h F a c i l i t y - means a p r o v i n c i a l mental h e a l t h f a c i l i t y d e s i g n a t e d under t h i s A c t . SASKATCHEWAN (R.S.S. 1978, c. M. 13, Me n t a l H e a l t h A c t , 1978) P h y s i c i a n o r P r a c t i t i o n e r - means a d u l y q u a l i f i e d m e d i c a l p r a c t i t i o n e r on the r e g i s t e r of t h e C o l l e g e o f P h y s i c i a n s and Surgeons of Saskatchewan. F a c i l i t y - means an i n s t i t u t i o n , p s y c h i a t r i c c e n t r e , p s y c h i a t r i c ward, mental h e a l t h c l i n i c o r any o t h e r b u i l d i n g o r p o r t i o n t h e r e o f s e t a s i d e f o r t h e c a r e , t r e a t m e n t o r t r a i n i n g of m e n t a l l y d i s o r d e r e d p e r s o n s . M e n t a l I l l n e s s - means a d i s o r d e r of mind o t h e r than psycho-p a t h i c d i s o r d e r o r mental r e t a r d a t i o n , t h a t r e s u l t s i n 91 a d i s t u r b a n c e i n a person's b e h a v i o u r o r f e e l i n g s or th o u g h t s and c o n v e r s a t i o n and t h a t r e s u l t s i n mental d i s t r e s s o r i m p a i r e d a b i l i t y t o a s s o c i a t e w i t h o t h e r s or r e s u l t s i n a person's i n a b i l i t y t o r e a c t a p p r o p r i a t e l y or e f f i c i e n t l y t o h i s environment and i n r e s p e c t of which m e d i c a l t r e a t m e n t i s a d v i s a b l e ; and m e n t a l l y i l l p e r s o n has c o r r e s p o n d i n g meanings. P a t i e n t - means a p e r s o n r e c e i v i n g p s y c h i a t r i c c a r e o r t r e a t m e n t o r d i a g n o s t i c s e r v i c e s f o r the purpose of d e t e r m i n i n g the e x i s t e n c e of mental d i s o r d e r . ONTARIO (R.S.O. 1980, c. 262, Me n t a l H e a l t h A c t , 1978) P h y s i c i a n - means a l e g a l l y q u a l i f i e d m e d i c a l p r a c t i t i o n e r . M e n t a l D i s o r d e r - means any d i s e a s e o r d i s a b i l i t y o f the mind. P s y c h i a t r i s t - means a p h y s i c i a n who h o l d s a s p e c i a l i s t , ' s c e r t i f i c a t e i n p s y c h i a t r y i s s u e d by the R o y a l C o l l e g e of P h y s i c i a n s and Surgeons of Canada o r e q u i v a l e n t q u a l i f i c a t i o n s a c c e p t a b l e t o the M i n i s t e r . P a t i e n t - means a p e r s o n who i s under o b s e r v a t i o n , c a r e and t r e a t m e n t i n a f a c i l i t y . I n v o l u n t a r y P a t i e n t - means a pers o n who i s d e t a i n e d i n a p s y c h i a t r i c f a c i l i t y under c e r t i f i c a t e of i n v o l u n t a r y a d m i s s i o n o r a c e r t i f i c a t e of r e n e w a l . P s y c h i a t r i c F a c i l i t y - means a f a c i l i t y f o r the o b s e r v a t i o n , c a r e and t r e a t m e n t of persons s u f f e r i n g from mental d i s o r d e r and d e s i g n a t e d as such by the r e g u l a t i o n s . QUEBEC (R.S.Q. 1977, c. P. 41, M e n t a l P a t i e n t s ' P r o t e c t i o n A c t , 1974) H o s p i t a l C e n t r e - a h o s p i t a l c e n t r e w i t h i n the meaning of the s a i d A c t - r e s p e c t i n g h e a l t h s e r v i c e s and s o c i a l s e r v i c e s , e quipped t o admit and t r e a t p e r s o n s s u f f e r i n g from mental d i s o r d e r s . L o c a l Community S e r v i c e C e n t r e - a l o c a l community s e r v i c e c e n t r e w i t h i n the meaning of t h e s a i d A c t r e s p e c t i n g h e a l t h s e r v i c e s and s o c i a l s e r v i c e s , e quipped t o admit and t r e a t p ersons s u f f e r i n g from mental d i s o r d e r s . P s y c h i a t r i c E s t a b l i s h m e n t f o r D e t a i n e d Persons - any e s t a b l i s h m e n t c o n t e m p l a t e d i n S e c t i o n 58. P s y c h i a t r i c C l i n i c a l E x a m i n a t i o n - an e x a m i n a t i o n h e l d t o determine i f t h e s t a t e of mental h e a l t h o f a pers o n r e q u i r e s t h a t he be p l a c e d under c l o s e t r e a t m e n t . 92 P s y c h i a t r i s t - a p h y s i c i a n h o l d i n g a s p e c i a l i s t ' s c e r t i f i c a t e i n p s y c h i a t r y i n f o r c e i s s u e d by the C o l l e g e of P h y s i c i a n s and Surgeons o f t h e P r o v i n c e of Quebec. There i s no d e f i n i t i o n of mental d i s o r d e r i n the Me n t a l P a t i e n t s ' ^ P r o t e c t i o n A c t . There i s a minor r e f e r e n c e t o mental d i s o r d e r s i n the A c t R e s p e c t i n g H e a l t h S e r v i c e s and S o c i a l S e r v i c e s . H o s p i t a l c e n t r e i s d e f i n e d i n t h a t a c t as a f a c i l i t y t o which persons are a d m i t t e d f o r p r e v e n t i v e p u r p o s e s , m e d i c a l d i a g n o s i s , m e d i c a l t r e a t m e n t , p h y s i c a l o r mental r e h a b i l i t a t i o n e x c l u d i n g , however, a p r o f e s s i o n a l ' s p r i v a t e c o n s u l t i n g o f f i c e and an i n f i r m a r y where a r e l i g i o u s o r e d u c a t i o n a l i n s t i t u t i o n r e c e i v e s i t s s t a f f and s t u d e n t s . NOVA SCOTIA (R.S.N.S. 1967, c. 249, H o s p i t a l s A c t ) P a t i e n t - means a p e r s o n who r e c e i v e s d i a g n o s i s , l o d g i n g o r t r e a t m e n t a t or i n a h o s p i t a l . P e r s o n Under O b s e r v a t i o n - means a p e r s o n who i s i n a h o s p i t a l pusuant t o S e c t i o n 27. P s y c h i a t r i s t - means a p h y s i c i a n who i s r e c o g n i z e d as a s p e c i a l i s t i n p s y c h i a t r y by the P r o v i n c i a l M e d i c a l Board, o r who, on or b e f o r e the 31st day of December, 1977, i s e l i g i b l e t o w r i t e f o r a Canadian F e l l o w s h i p i n P s y c h i a t r y o f the R o y a l C o l l e g e o f P h y s i c i a n s and Surgeons (Canada). F a c i l i t y - means a h o s p i t a l o r t h a t p a r t o f a h o s p i t a l so d e s i g n a t e d by the M i n i s t e r f o r the o b s e r v a t i o n , c a r e and t r e a t m e n t of persons s u f f e r i n g from p s y c h i a t r i c d i s o r d e r . M e n t a l D i s o r d e r - means any d i s e a s e o r d i s a b i l i t y of the mind and i n c l u d e s a l c o h o l i s m and drug a d d i c t i o n . Table 1 Procedures f o r Compulsory Treatment i n 5 Canadian P r o v i n c e s Stage of B r i t i s h Nova procedure Columbia Saskatchewan O n t a r i o Quebec S c o t i a P a t i e n t seen 2 p h y s i c i a n s 2 p h y s i c i a n s 1 p h y s i c i a n 1 p s y c h i a t r i s t 2 p s y c h i a t r i s t s Order W i t h i n w r i t t e n 14 days Conveyed t o f a c i l i t y Assessment C e r t i f i c a t e ( s ) good t o completed a n n i v e r s a r y date of ad m i s s i o n Renewals 1s t y e a r 2nd 2 y e a r s good f o r 14 days from when 1st seen 1st 3 Mon. 2nd 6 Mon, a l l r e s t 12 Mon. W i t h i n 7 days "'. W i t h i n 7 days Not more than 120 hours 1 c e r t i f i c a t e (1 p h y s i c i a n ) good f o r 2 weeks 1st 1 Mon. 2nd 2 Mon. 3rd 3 Mon. W i t h i n 24 hours With 96 hours 1 c e r t i f i c a t e (1 p s y c h i a t r i s t ) good f o r 21 days 1 s t 2 Mon. 2nd 3 Mon. 3r d 6 Mon. 4th 12 Mon. . s i 1 W i t h i n 4 8 hours W i t h i n 24 hours by p h y s i c i a n W i t h i n 3 days by p s y c h i a t r i s t 1 s t 3 Mon. 2nd 3 Mon. 3 r d 6 Mon. Re s t 12 Mon. 

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