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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 C H A L L E N G E OF T H E CANADA A C T , 1 9 8 2 TO E X I S T I N G M E N T A L H E A L T H L E G I S L A T I O N : I M P L I C A T I O N S FOR P L A N N I N G , M E N T A L H E A L T H L E G I S L A T I O N AND R I G H T S I N CANADA  BY  BEATRICE B.S.N.,  A  ANN  GEDDES  The U n i v e r s i t y o f B r i t i s h  THESIS  SUBMITTED IN PARTIAL  THE  REQUIREMENTS MASTER  FOR  OF  Columbia,  FULFILLMENT  THE DEGREE  1959  OF  OF  SCIENCE  in  THE  FACULTY  OF GRADUATE  STUDIES  (Department o f H e a l t h Care and Epidemiology H e a l t h P l a n n i n g a n d A d m i n i s t r a t i o n Programme)  We  accept to  THE  this  thesis  the required  UNIVERSITY  OF  APRIL ©BEATRICE  ANN  as  conforming  standard  BRITISH  COLUMBIA  1984 GEDDES  1984  In presenting  this  thesis i n partial  f u l f i l m e n t of the  r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e of B r i t i s h Columbia, I agree that it  freely  the L i b r a r y s h a l l  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 .  agree that permission f o r extensive for  University  s c h o l a r l y p u r p o s e s may  for  financial  Health Care and Epidemiology  The U n i v e r s i t y o f B r i t i s h 1956 Main M a l l V a n c o u v e r , Canada V6T 1Y3 D  a  t  e  A p r i l 26,  1984.  Columbia  my  It is thesis  s h a l l n o t be a l l o w e d w i t h o u t my  permission.  Department O f  thesis  be g r a n t e d by t h e h e a d o f  copying or p u b l i c a t i o n of t h i s  gain  further  copying of t h i s  d e p a r t m e n t 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 . understood that  I  make  written  ABSTRACT With begun  the proclamation  i n Canada  restrictive an for  example  light  or compulsory  study  examines  entrenched  analysis  of legislation.  legislation to their  The  mental  for  t h e sample. The  health  solutions advises  treatment  with  mental  that i s legislation  i t defines  procedures  health  i s  procedures  that  remove  administration for five  of the study  and mental  a r e examined  Canadian  i s that  and  a descriptive  and s u b j e c t  definition,  or recommendations.  on l e g i s l a t i o n ,  A c t by u s i n g  and Canada  i n the  of Rights  L e g i s l a t i o n i n Canada,  i n England  problem  legislation  by t h e C h a r t e r  i n t h e Canada  acts  framework  commencing  health  act i n that  posed  Freedom's  according  Mental  has  rights.  of the challenge  health  A c t , 1982 t h e r e  of legislation  rights.  of a restrictive  human  This  a questioning  o f human  enforced  certain  o f t h e Canada  development.  provinces  of a  analysis  The p l a n n e r  are used  planner and r e s u l t a n t  i n this  and on t h e i m p l e m e n t a t i o n  context of  legislation. From  the analysis  legislation and it  social was  deemed  i s i n t e r a c t i v e with value  noted  treatment  of the study  that  issues  compulsory  "mentally  found  the economic, society.  the legislation  but rather  t o be  within  i t was  does  technological  For mental not address  treatment  disordered"  that  health health  or  of individuals  and i n need  of  treatment  for  their  found  own  that  in  each  on  an  or  the  label  province,-  individual  provincial As  society's  "mental  results so  protection.  in  defined,  disorder", the in  the  contents  are  not  asking  for  the  treatment  procedures  but  rights  freedoms,  this  makes  the  injustices  defined  application  compulsory  address  well,  i t  was  differently  of r e s t r i c t i o n s of  other  acts.  Canadians  and  As  limiting in  study  items  provincial  in  mental  statutes  do  for  removal a  of  recognition  recommendation health not  acts  so  continue.  of to that  iv TABLE OF CONTENTS page ABSTRACT  i i  TABLE OF CONTENTS  iv  L I S T OF TABLES  v i i  ACKNOWLEDGEMENTS  viii  Chapter I.  II.  INTRODUCTION  1  Footnotes  7  WHY EXAMINE MENTAL HEALTH LEGISLATION AND RIGHTS ISSUE?  THE  I m p l i c a t i o n s f o r Mental Health L e g i s l a t i o n Reasons f o r Choosing Legislation Selection III.  t o Study Mental H e a l t h  of P r o v i n c i a l Acts  METHOD OF ANALYSIS  ...  10 11 13 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 S c o p e o f t h e S t u d y  18  Limitations  19  of t h e Study  Footnotes IV.  8  THE D I V I S I O N OF L E G I S L A T I V E AUTHORITY BETWEEN FEDERAL AND PROVINCIAL GOVERNMENTS AND THE PROBLEMS RAISED ...  20  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 M e n t a l H e a l t h Legislation  31  Effect  o f S o c i a l Change on L e g i s l a t i o n  31  Effect  o f E c o n o m i c Change on L e g i s l a t i o n  33  V  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 Footnotes V.  ..  34 37  DESCRIPTIVE ANALYSIS OF MENTAL HEALTH LEGISLATION  38  Content of Mental  Health 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 Mental  Health  i n England  .  39  Development o f E n g l i s h L e g i s l a t i o n Development o f Canadian Mental  VI.  44  Health  Legislation  48  Pressures  50  o f Change  Footnotes DESCRIPTIVE ANALYSIS OF F I V E PROVINCIAL MENTAL HEALTH ACTS AND THE IMPINGEMENT UPON THE CHARTER OF RIGHTS AND FREEDOMS The D e f i n i t i o n s o f M e n t a l  Disorder  55 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  Ontario  61  Quebec  62  Nova S c o t i a 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 Provincial Statutes  63 i n Other  Footnotes VII.  54  CONCLUSIONS AND IMPLICATION AND PLAN FOR CHANGE  65 69 70  P l a n f o r Change  73  Recommendations  73  vi Role of P a r t i c i p a n t s  74  Method o f P r o c e e d i n g  76  BIBLIOGRAPHY  79  Appendices APPENDIX A: APPENDIX B: APPENDIX C:  B r i t i s h N o r t h A m e r i c a A c t , 1867, S e c t i o n 91-92  86  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  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 Mental H e a l t h A c t s f o r "Mental D i s o r d e r " , "Director", "Patient", " F a c i l i t y " , "Physician."  90  vii L I S T OF  TABLES page  T a b l e 1:  Procedures f o r Compulsory 5 Canadian Provinces  Treatment i n 93  ACKNOWLEDGEMENTS The primarily  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 ,  an i n d e p e n d e n t t a s k , h a s b e e n done l a r g e l y due t o  the support, and  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  colleagues.  To my t h e s i s  C h a i r p e r s o n , D r . Nancy Forrester--is sound c r i t i c a l The  c o m m i t t e e - - D r . Ann C r i c h t o n ,  (Waxier)  M o r r i s o n , a n d Mr. J o h n  e x t e n d e d a s p e c i a l word o f thanks comments g i v e n t o me a s t h e work  weaknesses i n t h i s study  ability.  although  I accept  for the progressed.  a s a r e f l e c t i o n o f my  1 Chapter  I  INTRODUCTION In  1 9 8 2 , w i t h t h e p r o c l a m a t i o n by t h e 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 , t h e contents 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 . 1982,  The C o n s t i t u t i o n A c t ,  w i t h t h e C h a r t e r o f R i g h t s a n d Freedoms  w i t h i n i t , was d e v e l o p e d  by a l l t h e p r o v i n c i a l  j o i n t l y w i t h t h e f e d e r a l government. constitutional (BNA  Act)  r e f l e c t e d the B r i t i s h  legislation explicitly. integral liberty  document, t h e B r i t i s h  governments  former  N o r t h A m e r i c a A c t , 1867,  t r a d i t i o n of c o n s t i t u t i o n a l  i n t h a t i t d i d not address  r i g h t s and freedoms  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  and e s s e n t i a l  to a nation, l i k e the right to l i f e ,  and s e c u r i t y o f p e r s o n ,  provincial  The  entrenched  are protected, not i n  s t a t u t e s b u t i n an a c t f o r C a n a d a .  These  values  a r e no l o n g e r r e s t r i c t e d by p l a c e o f r e s i d e n c e o r j u d i c i a l interpretation of relevant statutes. The  C h a r t e r o f R i g h t s a n d Freedoms l i s t s  freedoms t h a t a r e guaranteed  i n twenty-four  s e c t i o n s m a k i n g up t h e C h a r t e r . s u b j e c t o n l y t o such c a n be d e m o n s t r a b l y society.  reasonable  t h e r i g h t s and  of the t h i r t y  These v a l u e s a r e p r o c l a i m e d limits  p r e s c r i b e d by l a w as  j u s t i f i e d i n a f r e e and  democratic  The s e c t i o n h e a d i n g s i n w h i c h t h e f r e e d o m o r  rights are proclaimed are: (i)  F u n d a m e n t a l Freedoms  (ii)  Democratic  Rights  2 (iii)  Mobility  (iv)  Legal  (v)  Equality  Rights  (vi)  Official  L a n g u a g e s o f Canada  (vii)  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  (viii)  Enforcement  (ix)  General  (x)  A p p l i c a t i o n of  (xi)  Citation  All  Rights  Rights  o f t h e C h a r t e r has  Charter  relevance  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  f o r study of mental  important  are  the  s e c t i o n s r e g a r d i n g fundamental freedoms; democratic, l e g a l and  equality  guarantee  t h a t the freedom of c o n s c i e n c e ,  o r o p i n i o n , and  rights,  and"enforcement.  mobility,  Those s e c t i o n s  religion,  thought  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  p r e s s or o t h e r media of communication w i l l  n o t be b a s e d upon  p r o v i n c i a l r e s i d e n c y o r membership of a m a j o r i t y group a r e t o be e n j o y e d liberty  and  by  a l l Canadians.  s e c u r i t y of person  right to  be  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  and  and  cruel  t h e r i g h t n o t t o be  are examples of matters mental h e a l t h The  unusual  treatment  arbitrarily  or  punishment;  detained or  t h a t pose a c h a l l e n g e t o  imprisoned existing  legislation.  C o n s t i t u t i o n A c t , 1982  but  life,  the r i g h t not t o  deprived thereof except  and  The  the  ( C o n s t i t u t i o n Act)  is a  f e d e r a l s t a t u t e developed  over  a period of t e n years of  bargaining at formal f e d e r a l - p r o v i n c i a l conferences discussions of bureaucrats assignment.  The r e s p o n s e  and p o l i t i c i a n s h o l d i n g  and a t this  o f t h e 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 h a s been g u a r d e d a n d i s o n l y now beginning  t o be w o r k e d t h r o u g h .  With  the p r o v i n c i a l  g o v e r n m e n t s i n d i c a t i n g t h e i r commitment t o t h e 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 t h e C o n s t i t u t i o n a l Conference of November, 1 9 8 1 , t h e r e i s r e a s o n  f o r these  make t h e i r own s t a t u t e s c o n f o r m t o t h i s  governments t o  recent  statute.  The p r o v i n c i a l g o v e r n m e n t s , 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  acts, raise the  issue 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 t h e two l e v e l s o f  g o v e r n m e n t by t h e e a r l i e r  "constitutional"  Act.  Health, c i v i l  matters  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 . o f t h e BNA A c t , t h e r e h a s  been a c h a n g e i n t h e r e s p o n s i b i l i t y government  assumed  by t h e f e d e r a l  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  i n particular,  Over t h e y e a r s beliefs  t h e BNA  and p r o p e r t y r i g h t s a r e examples o f  However, s i n c e t h e p r o c l a m a t i o n  health,  document,  such  of treatment  the financing of health  services.  t h e government has r e c o g n i z e d t h a t v a l u e s and  as f r e e d o m , human r i g h t s , h e a l t h a n d a v a i l a b i l i t y a r e n o t b o u n d e d by t h e g e o g r a p h i c  structure of  provinces. Health l e g i s l a t i o n  i s the general designation f o r  statutes that provide f o r the administration of services  4  l i k e h o s p i t a l s and  f o r compulsory treatment of  examples are  h o s p i t a l acts, venereal  control acts  and  mental h e a l t h a c t s .  p r o p o s e d t o e x a m i n e one  concordance with the  the  entrenched  Mental health the  acts.  disordered, contain  l e g i s l a t i o n has  and,  the  been chosen because  restrictive  n a t u r e of the  treatment of the  these statutes  include  sections  disordered This  i n order  f o r the  p r o c e s s may  be  c r i m i n a l , u n l i k e the  i s a process to e s t a b l i s h the Mental health  as an outcome o f t h e  guilt  It i s timely  statutes given The  question  whether the are  the  compared w i t h  a  containment  are  disordered,  the  i n the  and  provide  there  punishment to  and  i n the  appropriate current  care  Canadian  be  health  and scene.  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  recent  e n a c t m e n t o f a "new"  Constitution.  under study f o r t h i s paper i s t o  determine  c o n t e n t s of the p r o v i n c i a l mental h e a l t h  restrictive  protected  mentally  compulsory treatment,". l a c k s i m i l a r  restrictive  f o r the  and  of  contents  a c t s , w r i t t e n t o promote mental  procedures to e s t a b l i s h i l l n e s s be  is  to apprehend to  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  may  the  in particular,  f o r the  c e r t a i n of the  therefore  legislation,  Charter.  compulsory treatment.  given.  study i t i s  In p r o v i d i n g  s i m i l a r , but  tuberculosis  a c t s , to determine whether there  C o n s t i t u t i o n Act  c o n c e r n s r a i s e d by  i n the  acts,  In t h i s  component o f h e a l t h  p r o v i n c i a l mental h e a l t h  with  disease  diseases;  of the  r i g h t s and  freedoms t h a t are  C a n a d i a n C o n s t i t u t i o n and  the  acts now  implications  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  services.  This  study w i l l  e x a m i n e and  of f i v e p r o v i n c i a l mental h e a l t h  The  (i)  a l l the  regions  (ii)  the  (iii)  recent  (iv)  l a r g e and  F r e n c h and and  of  acts  health  analyze the selected to  contents represent:  Canada;  English legislative  early proclamation; small p r o v i n c i a l  roots;  and  populations.  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  ten provinces The  was  made w i t h  and  Strauss.  for subjects social this  the  question  a q u a l i t a t i v e approach d e s c r i b e d  t h a t are  issues.  study i s  by  Glaser  i n a c o n t i n u o u s s t a t e of change  suited like  I n C h a p t e r I I , t h e method o f a n a l y s i s  for  described.  I n C h a p t e r IV t h e f e d e r a l and  discuss  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  1  the  these v a r i a b l e s i n mind.  m e t h o d u s e d t o a n a l y z e and  follows generally  from  d i v i s i o n of a u t h o r i t y between  p r o v i n c i a l governments i s r e v i e w e d .  the  e m p h a s i s i s on  and  mental h e a l t h  governmental r e s p o n s i b i l i t i e s and  the  the  However, for  problems t h a t have a r i s e n  health from  this structuring. Next f o l l o w s the  a n a l y s i s of the  health  l e g i s l a t i o n t o r e v e a l the  by  Charter  the  of Rights  authority ascribed considered Charter.  along The  and  c o n t e n t s of the  sections  Freedoms.  t h a t are  The  mental  impacted  legislated  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  with  the  r i g h t s and  freedoms w r i t t e n i n  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  reviewed v i s a v i s the In Chapter V I , the  the  r e s t r i c t i o n s embodied i n  d i f f e r e n c e s i n the  the-acts.  contents  f i v e p r o v i n c i a l mental h e a l t h acts w i l l  be  between  described,  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 i m p i n g e upon t h e o f r i g h t s and  freedoms.  Included  l i m i t a t i o n s the m e n t a l l y contents  of other  This  study  a c t s and  disordered  are  the  s u f f e r because of  the  provincial acts.  first  C o n s t i t u t i o n Act  i n t h i s chapter  on  considers  the  the  challenge  c r e a t e d by  e x i s t i n g p r o v i n c i a l mental  s u b s e q u e n t l y proposes a p l a n f o r change.  framework d e f i n e s  a p r o b l e m , e x a m i n e s and  or recommendations.  In t h i s context,  the  i n mental h e a l t h l e g i s l a t i o n create  t h o s e who  are mentally the  act.  The  problem i s s t a t e d i n the  and  final  chapter.  the  solutions  a problem f o r  f o r those  outcome o f t h e  planning  restrictions  contained  disordered  the  health A  analyzes  v a r i a b l e s of the problem, then develops a set of  administer  issues  who  a n a l y s i s of  this  7 Footnotes ^ B a r n e y G. G l a s e r and A n s e l m 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 Y o r k , 1967.  8 Chapter I I WHY EXAMINE MENTAL HEALTH LEGISLATION AND THE RIGHTS ISSUE? For  much o f C a n a d i a n h i s t o r y  legislation  s p e c i f i c a l l y written  t h e r e h a s b e e n no p i e c e o f to protect  r i g h t s and  f r e e d o m s '. T h e s e v a l u e s were r e g a r d e d by t h e e a r l y  political  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 t h e j u d i c i a r y and government.  general i n t e r e s t since  W o r l d War I I .  recognition Bill  i n rights  and f r e e d o m s h a s b e e n e m e r g i n g  T h i s i n t e r e s t was g i v e n shape a n d  i n 1960 when t h e f e d e r a l  of Rights.  However, a  As w e l l ,  government p a s s e d a  i n the years that  followed,  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  enacting of the federal  to assure the p r o t e c t i o n end  r e s u l t of the issue.  part of the process that  of rights  write  instruments  a n d f r e e d o m s was n o t t h e  These g o v e r n m e n t a l a c t i v i t i e s  were  c u l m i n a t e d i n 1982 w i t h t h e  proclamation of the Constitution a recognition  and p r o v i n c i a l  at the national  Act.  This federal  a c t was  l e v e l of the necessity  to  i n t o l e g i s l a t i o n a n d make e x p l i c i t t h e r i g h t s a n d  freedoms o f Canadians a l o n g w i t h o t h e r matters.  constitutional  T h e s e s o c i a l v a l u e s a r e n o t l i m i t e d by l e g i s l a t i v e  or geographic boundaries but a r e p a r t o f t h e s o c i a l o f p e o p l e , w h e r e v e r t h e y may r e s i d e .  fabric  Considered i nthe  d e v e l o p m e n t o f t h i s p a r t i c u l a r e n a c t m e n t were t h e demands o f minority  ethnic  handicapped.  groups, s p e c i a l  i n t e r e s t groups and t h e  Each p r e s e n t e d t h e i r concerns about r e s t r i c t e d  9 r i g h t s t o t h e 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 especially.  bodies  T h e s e i s s u e s were n o t d i s c u s s e d i n C a n a d a o n l y  b u t were r e c o g n i z e d  internationally.  of D i s a b l e d Persons,  The I n t e r n a t i o n a l Y e a r  1981, o r t h e U n i t e d N a t i o n s  Decade f o r  Women, 1975 t o 1 9 8 5 , f o r e x a m p l e , gave f o c u s t o t h e p r o m o t i o n of a c t i o n taken  on b e h a l f o f t h e p a r t i c u l a r  A major t h r u s t i n the twenty years of the B i l l  f o l l o w i n g t h e passage  o f R i g h t s was t h e f e d e r a l - p r o v i n c i a l  discussions.  These m e e t i n g s p r o v i d e d  issues of r i g h t s , The  group.  constitutional  a forum t o address the  freedoms and l e g i s l a t i v e  responsibility.  e v e n t o f i n v o k i n g t h e War M e a s u r e s A c t b y t h e P r i m e  Minister i n the province to the values  o f Quebec i n 1970 gave p r o m i n e n c e  of freedom of speech, of t h e r i g h t t o a s s o c i a t e  i n g r o u p s a n d n o t t o be d e t a i n e d w i t h o u t well,  this  j u s t cause.  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 The  matter.  assignment of 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 or  p r o v i n c i a l bodies  was e s t a b l i s h e d i n s e c t i o n s 91 a n d 92 o f  t h e BNA A c t , a n d w i l l of t h i s  As  study.  be d i s c u s s e d more f u l l y  At t h i s p o i n t , s u f f i c e  property  and c i v i l  r i g h t s were m a t t e r s  assigned  to the provinces.  i n C h a p t e r IV  i t t o mention  that  t h a t a p p e a r e d t o be  Consequently,  the passing of  l e g i s l a t i o n by t h e f e d e r a l a n d p r o v i n c i a l g o v e r n m e n t s on t h e same s u b j e c t c a n c r e a t e j u r i s d i c t i o n a l p r o b l e m s .  Thus, i n  r e g a r d t o r i g h t s a n d f r e e d o m s , t h e f e d e r a l g o v e r n m e n t became i n v o l v e d i n what h a d e a r l i e r b e e n a p r o v i n c i a l m a t t e r .  So,  10 f r o m 1970 t o 1982 t h e r e responsibility  was c o n f u s i o n  being  i n many p i e c e s  regarding  the r e s t r i c t i o n of these  of l e g i s l a t i o n , mental health  f o r Mental Health L e g i s l a t i o n  With the proclamation contents of various  of the C o n s t i t u t i o n Act, the  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  study t o ensure that p o t e n t i a l l y c o n f l i c t i n g clarified.  I n t h e BNA A c t ,  mental h e a l t h legislatures. mental i l l contained before  s p e c i f i c a l l y were a s s i g n e d  Since  t h e A c t was w r i t t e n  As  f o r social welfare,  long  including health, the  and s u b j e c t  to interpretation. I t i s t o provide  and  asylums. 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  years since  have changed i n t h e  1867, so t o o have t h e s e r v i c e s f o r t h e m e n t a l l y  " A s y l u m " i s no l o n g e r  a w o r d u s e d g e n e r a l l y by t h e  public or health professionals. a psychiatric facility  Now an a s y l u m i s r e p l a c e d  or h o s p i t a l that o f f e r s a  treatment program, n o t j u s t custody. has  (1867),  i n t a k i n g much -  s t a t e s i n s e c t i o n 92(7) t h a t the province maintain  instrument  as i n s a n i t y and t r e a t e d o r  g o v e r n m e n t s became i n v o l v e d  wording i s not s p e c i f i c  items are  to the p r o v i n c i a l  At the time o f w r i t i n g t h a t  i n an a s y l u m .  require  h e a l t h m a t t e r s g e n e r a l l y and  h e a l t h was d e f i n e d  responsibility  by  statutes  one e x a m p l e . Implications  ill.  governmental  f o r r i g h t s a n d f r e e d o m s a n d , a s 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 values  regarding  the authority to legislate  Since  each  f o r and a d m i n i s t e r  province services  f o r mental i l l n e s s , .there  h a v e b e e n many c h a n g e s i n t h e a c t s  regulating 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  disturbed.  However, t h e c h a n g e s i n t r e a t m e n t  procedures  have n o t c a u s e d major changes i n t h e c o n t e n t s o f m e n t a l health  legislation.  The m a t t e r o f c o m p u l s o r y t r e a t m e n t  still  r e m a i n s 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 t h e provincial acts. is restrictive  I t i s t h i s part of a l l the statutes  o f i n d i v i d u a l r i g h t s and freedoms  i n the entrenched Charter may be p e r c e i v e d was  described  detail  of Rights  that  proclaimed  a n d Freedoms a n d t h a t  to c o n f l i c t with the Charter.  (The C h a r t e r  i n C h a p t e r I and i s p r e s e n t e d i n f u r t h e r  i n A p p e n d i x 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 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 o f h e a l t h c a r e o r  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  evident  t o a l l the p r o f e s s i o n a l s working i n health  Nurses, p s y c h o l o g i s t s care  and o t h e r  services.  h e a l t h p r o f e s s i o n a l s may  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  long time before relevant  acts  f o ra  the contents of a h o s p i t a l a c t or other  are brought t o t h e i r n o t i c e .  However, m e n t a l  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 t h e s e c t i o n o f t h e mental h e a l t h compulsory treatment.  This  act that  describes  knowledge i s a n e c e s s a r y  aspect  o f any p s y c h i a t r i c p r o g r a m . W i t h a b a c k g r o u n d o f many y e a r s i n c o m m u n i t y the  w r i t e r already  h a d an i n t e r e s t i n m e n t a l  psychiatry,  health  12 legislation,  e s p e c i a l l y the e f f e c t s of the  o f i t upon t h e m e n t a l l y This clerkship review  i n t e r e s t was i n 1980.  focus  of the  and  tasks  shape d u r i n g  r e g a r d e d as  t h e i r contents. important  At t h i s time the  because there  a  had  difficulties  service with  the  m o b i l i t y of the  of a d m i n i s t e r i n g jurisdictional disordered.  task  r e c o g n i t i o n t h a t r i g h t s and  been d i s c u s s i o n s  the  a provincially  other  The  province  where t h e  the the  Canadians  province  " i n v o l u n t a r y p a t i e n t " had  an e x a m p l e , i f a p h y s i c i a n had  t r e a t m e n t f o r m e n t a l d i s o r d e r and s i g n i n g of t h a t c e r t i f i c a t e would the Ontario  a p p r e h e n d and  in  t h a t p e r s o n t o o k a bus h e a l t h a u t h o r i t i e s be  p r o b l e m s o f t h i s k i n d r e q u i r e s t i m e and mental h e a l t h program funds.  The  act applying  The  To  certificate  days of  t r e a t t h e p e r s o n o r a p p r e h e n d and  whether a s t a n d a r d  the  required"compulsory  w i t h i n 15  to B r i t i s h Columbia f o r treatment?  of  relocated.  completed a  i n B r i t i s h Columbia s t a t i n g that a person  him  bounded  s p e c i a l concern of these d i r e c t o r s , t h a t  the mental h e a l t h act'of:one  Ontario,  regarding  c o n c e r n was  m o b i l i t y of  applying  take  by  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 . created  was  p r o b l e m s c r e a t e d by  The  to  t o document  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 the  student  i n t h e c l e r k s h i p was  a l l t h 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 and  or catalogue  aspects  ill. given  One  compulsory  the to  obliged then  to  return  r e s o l u t i o n of  expenditure  d i r e c t o r s were  of  questioning  to a l l Canadians might  be  13 necessary;  consequently,  t h e y w a n t e d t o know w h e t h e r e a c h o f  the p r o v i n c i a l acts governing  t h e i r d e c i s i o n s n e e d e d t o be  brought i n t o l i n e with the other In l o o k i n g a t the contents more c l o s e l y , i t became e v i d e n t and be  t h a t more s t u d y done. 1.  The f o l l o w i n g q u e s t i o n s  voluntary  2.  h a d become  apparent:  enforced  i n that  t r e a t m e n t and c u s t o d y  consent?  Have t h e s e i s s u e s a l w a y s b e e n i n a c t s f o r t h e  mentally  ill  and i s t h e r e  Many r e s t r i c t i v e  procedures. mental h e a l t h  and,  t h a t t h e p r o b l e m was c o m p l e x  Were a l l m e n t a l h e a l t h a c t s r e s t r i c t i v e  without  4.  of the ten p r o v i n c i a l acts  o f mental h e a l t h l e g i s l a t i o n needed t o  t h e y have s e c t i o n s r e g a r d i n g  3.  ten acts.  a l i k e l i h o o d t h a t t h e y may a c t s have r e v i e w  Were s i m i l a r p r o c e d u r e s l a i d  remain?  and a p p e a l down i n a l l t h e  acts?  Was t h e w o r d i n g l o o s e  and s u b j e c t  to interpretation  i f s o , what c h a n g e s n e e d e d t o be made? Some o f t h e q u e s t i o n s  served  as a s t i m u l u s  h a d no i m m e d i a t e a n s w e r b u t  for this  project.  Selection of P r o v i n c i a l Acts During the i n i t i a l  review  of a l l the ten 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 , i t was n o t e d 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 t h e f e d e r a l C h a r t e r Rights only  and Freedoms.  But f o r t h e purpose of t h i s  of  study,  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 t h e v a r i a b l e s o f g e o g r a p h i c  representation, variation, recent  l a r g e and s m a l l p r o v i n c i a l  population  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 e a r l i e r  dates of enactment.  s e l e c t e d are from the p r o v i n c e s Saskatchewan, O n t a r i o ,  The p r o v i n c i a l  of B r i t i s h  legislation  acts  Columbia,  Quebec, and Nova S c o t i a .  do r e f l e c t m e n t a l h e a l t h  and  i n Canada.  These  acts  15 Chapter I I I METHOD OF ANALYSIS In t h i s chapter,  thewriter w i l l  describe  t h e method o f  a n a l y s i s used t o d e v e l o p t h e recommendations f o r change regarding  p r o v i n c i a l mental h e a l t h  This  legislation.  s t u d y i s n o t one o f q u e s t i o n i n g  mental h e a l t h  l e g i s l a t i o n nor of the implications of  implementing the s t a t u t e nor i f i t should social  focus,  mental h e a l t h ill  considered subject for  but rather  i t examines t h e c o n t e n t o f t h e  The s u b j e c t  i s mental  health  and t h e s e c t i o n s o f t h e l e g i s l a t i o n t h a t a r e restrictive.  t o the pressures  Since  statutes are not s t a t i c but  o f t h e s o c i e t y and t h e government  whom a n d b y whom t h e y a r e 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  underlies  t h e approach.  As D a v i d W e i s s t u b , a l e a d i n g  C a n a d i a n a u t h o r i t y on t h e l a w , the  have a m e d i c a l o r  acts t o learn i f the r i g h t s of the mentally  are not r e s t r i c t e d .  legislation  thenecessity of  states:  s o c i e t y i n which i t i s formulated  as b e i n g subject  "Law i s a p r o d u c t o f and e n f o r c e d  a d e r i v a t i v e o f antecedent s o c i e t i e s . t o continuous pressure  as w e l l  I t remains  f o r a l t e r a t i o n by s o c i e t y . "  W i t h t h e dynamic n a t u r e o f s t a t u t o r y i n s t r u m e n t s , analysis that and  incorporates  over time i s needed.  context  t h e changes o c c u r r i n g As w e l l , l e g i s l a t i o n  o f t h e s o c i a l environment o f a nation  and  requires  examination that  the  elements o f q u a l i t a t i v e a n a l y s i s described  1  an  presently  fits  i n the  or province  i ssensitive to this.  Some o f  by G l a s e r  16 and  Strauss  especially The  i n The  Discovery  suited to this  a n a l y s i s c a n be  (i)  of Grounded Theory  2  were  study. ordered  into four areas,  as f o l l o w s :  a c o m p a r a t i v e / d e s c r i p t i v e approach to  (ii)  mental h e a l t h  legislation;  an h i s t o r i c a l  evolutionary/comparative  to (iii)  E n g l i s h and  provincial  approach  Canadian mental h e a l t h  legislation;  a c o m p a r a t i v e / d e s c r i p t i v e approach to f e d e r a l and  (iv)  provincial  an a n a l y t i c a l  legislation;  and  approach t o the  i s s u e of r i g h t s  the mental h e a l t h l e g i s l a t i o n of f i v e F o l l o w i n g the a n a l y s i s , recommendations w i l l change i n a c t s of t h e s e p o w e r s and  five provinces  in  provinces.  be made f o r  i n the  light  of  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 mental h e a l t h  administrators. The  q u e s t i o n of the  m e n t a l h e a l t h a c t s , now the contents The  study  in effect  of the C h a r t e r  to  this  study,  a d v i s e on t h e  two  "Do  the contents  o f R i g h t s and  A planner  functions:  implementation  be  developed  from  t o a d v i s e on The  of h e a l t h , f o r example, t h e r e  health.  The  boundaries  disease c o n t r o l ,  w r i t t e n document becomes a t o o l  has,  legislation  subject.  acts f o r mental h e a l t h , venereal  the  legislation  t h e a u t h o r i t y and  field  with  i n mental h e a l t h  of i t .  the  Freedoms?"  the t o o l t h a t s e t s out In the  of  i n Canada, c o n f l i c t  answer t o the q u e s t i o n w i l l  p e r s p e c t i v e of a p l a n n e r . for  is:  of  and is  a  are  and  of s o c i a l  public order  17 when i t s c o n t e n t s a r e  implemented.  analyzing  will  t h a t are  a question, relevant  solution.  The  t o t h e p r o b l e m and  of the  recommendations.  do  this,  requirements of t h i s  obtain the  step  articles health  using  the  legislation"  legislation" library  search  m a k i n g and library Victoria The  was  used according  As  well,  key  done.  general  field  This legal  was  administrators  search  s e c t i o n or s e c t i o n s there  of l e g i s l a t i o n ,  health a  law-  general University  of  Columbia.  of the p r o v i n c i a l mental  were no  of  "mental  to conduct  done i n t h e  to  journal  found i n mental  l i b r a r i e s of the  t o be  for  legislation",  n e x t s t e p was  U n i v e r s i t y of B r i t i s h  study.  v  to the  f o r each  "restrictions The  as w e l l as t h e  in this  had  act or acts  a literature  planned f o r the mental h e a l t h a c t s .  acts  material  p a p e r was  words " h e a l t h  and  i n the  time of c o n t a c t ,  with  of t h i s  s e r v i c e s were w r i t t e n t o d e t e r m i n e i f t h e r e  the  the  Collection  preparation  mental h e a l t h  law-writing.  and  and  a  variables,  conclusions  Information  i n the  a copy of the  ten provinces.  factors  study.  M a t e r i a l s and first  a n a l y s i s of the  information  g a t h e r e d , r e v i e w e d , and  The  study f o l l o w s  i m p l i c a t i o n s and  To  in  i t s implementation of  framework used i n t h i s  consideration  planner,  take i n t o account a l l the  process of problem d e f i n i t i o n ,  t o be  The  health  were any  changes  I f changes were p l a n n e d ,  amended was  requested.  changes being  At  the  planned for  the  18 Following information  the i n i t i a l  c o l l e c t i o n o f m a t e r i a l and  on m e n t a l h e a l t h  legislation,  additional material  was g a t h e r e d on t h e p r o c e s s o f l a w - m a k i n g i n C a n a d a , t h e Constitution Act,  and o t h e r  r e s t r i c t i o n s on t h e m e n t a l l y The For  a subject  p r o v i n c i a l acts that  place  disordered.  Scope o f t h e S t u d y  t o be w r i t t e n i n t o l a w t h e r e  r e q u i r e m e n t s t o be met.  are basic  The t o p i c must be w i t h i n t h e  j u r i s d i c t i o n o f t h e government making t h e l a w and i f t h a t criterion the  i s s a t i s f i e d the contents are s e t out according  e s t a b l i s h e d format.  includes  The f o r m a t i n t h i s c o n t e x t  the descriptive t i t l e ,  proclaiming  means o r  administrative authority of  government, d e f i n i t i o n o f terms, g e n e r a l  s p e c i a l p r o v i s i o n s , and t h e d a t e o f e n f o r c e m e n t . t h e s e f a c t o r s and t h e purpose o f t h i s l e g i s l a t i o n had s e c t i o n s the  e n t i r e a c t being  the  following sections  the  title,  restrictive.  and  Considering  study, mental  t h a t were r e s t r i c t i v e ,  health  rather  than  The s t u d y i s l i m i t e d t o  i n the p r o v i n c i a l mental h e a l t h  the d e f i n i t i o n s ,  to  acts:  t h e c o m p u l s o r y t r e a t m e n t and  a p p e a l p r o c e d u r e s and t h e s e c t i o n s t h a t r e c o g n i z e  patient  rights. Each o f these s e c t i o n s of t h e a n a l y s i s u s i n g includes  of the act are a necessary  a planning  framework.  This  part  model  t h e f o r c e s t h a t a f f e c t t h e i m p l e m e n t a t i o n and  d e v e l o p m e n t o f an a c t , s u c h a s t h e a l l o c a t i o n o f human a n d financial  resources  required  f o r administration  and t h e  19 various the  groups w i t h  a s p e c i a l i n t e r e s t seeking  enforcement of the  s t u d y does n o t  the mental h e a l t h  include  acts.  study.  This  comparing the provinces  and  of the  a b o v e , and advice  a p p l i c a t i o n of  f i g u r e s on  the  number  provinces  a l t h o u g h most u s e f u l  in  for  of compulsory t r e a t m e n t p r o c e d u r e s between  same s o u r c e s ,  comparisons. of the  the  i n each of the  i s not  t h a t i s a v a i l a b l e may  from the  sections  d a t a on  or w i t h i n a p r o v i n c e ,  information way  information,  use  Study  T h e r e a r e no  of people t r e a t e d c o m p u l s o r i l y the  influence  law.  L i m i t a t i o n of the The  to  not  e a s i l y obtained. be  gathered i n the  thus a f f e c t i n g the  The-scope o f t h e  i s done i n t h e  on m e n t a l h e a l t h  acts  framework of a p l a n n e r t o  legislation  and  same  validity  study i s l i m i t e d to  f i v e p r o v i n c i a l mental h e a l t h  The  the  described provide  i t s administration.  20 Footnotes "^David N. W e i s s t u b , Law and P s y c h i a t r y i n t h e C o n t e x t , Pergamon P r e s s , T o r o n t o , C a n a d a , 1980, p.  Canadian 50.  2 B a r n e y G. G l a s e r and A n s e l m L. S t r a u s s , The Discovery 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 Y o r k , 1967. -  21 C h a p t e r IV THE D I V I S I O N OF L E G I S L A T I V E AUTHORITY BETWEEN FEDERAL PROVINCIAL GOVERNMENTS AND The l e g i s l a t i v e  THE PROBLEMS RAISED  s t r u c t u r e was f o r m a l l y  C a n a d a i n 1867 when f o u r  AND  s e t out f o r  independent Canadian  provinces  t o g e t h e r r e q u e s t e d t h e 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 t h e y j o i n e d i n a C o n f e d e r a t i o n . Act  91 and 92  (see Appendix A ) .  t h a t document  p a r t i c u l a r l y i n sections  The w r i t i n g and t h e c o n t e n t s o f  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 t h e  people of that  day.  The F a t h e r s o f C o n f e d e r a t i o n a d o p t e d  t r a d i t i o n s of the E n g l i s h parliamentary  judiciary  s y s t e m f o r Canada.  One  g o v e r n m e n t and  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 n o t w r i t i n g i n t o t h e BNA A c t a on r i g h t s a n d f r e e d o m s .  Other c o u n t r i e s ,  f r e e d o m s as p a r t  less e x p l i c i t l y  i n the parliamentary  States  on r i g h t s and  of t h e i r c o n s t i t u t i o n s long before  E n g l a n d and i t s l o y a l c o l o n i e s  section  the United  f o r example, had w r i t t e n documents o r b i l l s  But,  BNA  e s t a b l i s h e d t h e two l e v e l s o f g o v e r n m e n t and s e t o u t  t h e i r p o w e r s and r e s p o n s i b i l i t i e s ,  the  The  1867.  g u a r d e d t h e v a l u e s much p r o c e s s and  judicial  procedures. P r i o r t o t h e s i g n i n g o f t h e BNA A c t , t h e r e s i d e n t s the  various  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 o f Upper and  Lower C a n a d a , P r i n c e administered  of  E d w a r d I s l a n d and Nova S c o t i a h a d b e e n  o r managed by a p p o i n t e e s o f t h e r e i g n i n g  monarch a n d p a r l i a m e n t o f E n g l a n d .  These c o l o n i e s  or  provinces  developed t h e i r  c o l o n i a l experiences  systems of government from  of the predominant group of  the  settlers,  so t h a t Lower o r F r e n c h C a n a d a f o l l o w e d t h e t r a d i t i o n s F r a n c e w h i l e U p p e r C a n a d a and to those  o f E n g l a n d and  immigration  and  t h e economy and organized  Scotland.  quarantine,  and  The  l a n d c l e a r i n g and  s e p a r a t e l y f o r each area.  C o l u m b i a j o i n e d i n 1871  The  areas j o i n i n g  for a d d i t i o n a l provinces  S a s k a t c h e w a n and  concerns  the maintenance of order  the government f o r a l l the 1867  the maritime provinces  adhered  about  development justic  were  BNA  Act e s t a b l i s h e d  i n confederation  t h e r e a f t e r ; e.g.,  and  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 ,  then  to  national authority proclaimed  such  services, developing  e l e c t i o n s t h a t f o r m e r l y had a province according  were now, to the  Matters  t h e economy, and  been the  1949.  t h e more  p a r t i c i p a n t s were c o m m i t t e d t o g o v e r n a c c o r d i n g  financing  in  British  Newfoundland i n  i n 1867.  of  and  f o l l o w e d by M a n i t o b a ,  A l b e r t a i n 1905  of  recent  the as  managing  sole r e s p o n s i b i l i t y  following confederation,  of  administered  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  matters w i t h i n the  government o t h e r  than the  r e s p o n s i b i l i t y of the  s p e c i f i c s of e l e c t i n g  federal and  o r g a n i z i n g g o v e r n m e n t a r e n o t e d i n s e c t i o n 91 o f t h e and  n o t e d i n A p p e n d i x A.  was  t o be  G e n e r a l l y , the  BNA  Act  f e d e r a l government  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 trade  and  tariffs,  c o m m u n i c a t i o n , b a n k i n g and health matters that f e l l quarantine,  the  h o s p i t a l s and p a r t of the The  i n t o the  maintenance of  s e r v i c e s to the  w a t e r and  s u p p l i e s and  recognized  day  were f o r f a m i l i e s , t h e for their  diseases.  s i c k and  As  quarantine  the  t o 1919, and  Health  uncontaminated  i s o l a t i n g those people  w e l l , the  s o c i a l norms o f  c h u r c h e s and  poor, l i m i t i n g  who  the  c h a r i t a b l e groups the  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 t h e f r o m 1867  as  peoples.  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 milk  were  native population  p r o v i n c i a l governments i s i n t e r e s t i n g .  had  So  only  marine  management o r a d m i n i s t r a t i o n o f h e a l t h by  s e r v i c e s i n 1867  care  and  The  federal jurisdiction  o v e r a l l r e s p o n s i b i l i t y to native  f e d e r a l and  food,  the monetary system.  establishment  health  national transportation,  to  government  national  government.  federal health responsibilities  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  for  the  Department of A g r i c u l t u r e . It the  i s o f i n t e r e s t t o n o t e where h e a l t h was  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 f r o m 1867  s t a t e d , f o r f o r t y y e a r s i t was Agriculture. h e a l t h was  Then, f o l l o w i n g the  Section Health.  was  until  joined with  t o form the This  the  1928.  t o now.  Department  in As  of  swine f l u epidemic of  t r a n s f e r r e d from A g r i c u l t u r e to a  Department of H e a l t h Health  i n the  placed  I n 1928,  Soldiers C i v i l  separate  the  Department  Re-establishment  D e p a r t m e n t o f P e n s i o n s and  s t r u c t u r e remained u n t i l  1919,  1944,  National  when  two  of  24 d e p a r t m e n t s were c r e a t e d : Affairs The  and  latter  the  the  Department of  Department of N a t i o n a l  department s t i l l  e x i s t s and  Veterans'  Health has  and  Welfare.  w i t h i n i t the  following divisions: -health  services to Indians,  northern  residents,  f e d e r a l p u b l i c s e r v i c e , i m m i g r a n t s and  civil  the  aviation  personnel -quarantine -food  and  services drug i n s p e c t i o n , N a r c o t i c s  -environmental health -hospital -poison  and  Control  (radiation protection)  medical care  insurance  with  the  provinces  control  - a i d t o the -medical  blind  research  - 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  (reporting  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  the  events occurring  throughout a l l parts  of the  as t e c h n o l o g i c a l a d v a n c e s , e c o n o m i c c y c l e s , increases,  w a r s and  handicapped or  the  r i s e of pressure  deliver  Although the  s e r v i c e s f o r the  Mental Health  such  population  groups f o r  a subject  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  f r o m 1922.  nation  the  disadvantaged.  N a t i o n a l l y , m e n t a l h e a l t h was the  mirror  was  Department of  D e p a r t m e n t had mentally  c e n t r a l i n the  recognized  ill,  no the  in  Health  authority  to  D i v i s i o n of  assembling,  co-ordinating  25  and  d i s s e m i n a t i n g Canadian i d e a s about t h e o r g a n i z a t i o n o f  s e r v i c e s and t r e a t m e n t C o m m i t t e e on M e n t a l  f o r the mentally i l l .  H e a l t h was an a c t i v e p a r t o f t h e  D i v i s i o n f o r twenty years Canada's M e n t a l  The A d v i s o r y  f r o m 1946 t o 1966.  Health, i n i t s t h i r t i e t h  i s one e x a m p l e o f t h e o u t p u t  The j o u r n a l  year of p u b l i c a t i o n ,  from t h e D i v i s o n of Mental  Health. Before 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 g o v e r n m e n t s f o r h e a l t h , a b r i e f comment on t h e f i s c a l activities  o f t h e f e d e r a l government i s n e c e s s a r y  review of l e g i s l a t i v e  development.  in a  The BNA A c t s p e c i f i e d  t h e a u t h o r i t y o f t h e n a t i o n a l and p r o v i n c i a l governments t o tax  s o as t o r a i s e t h e f u n d s  v a r i o u s programs. on  individuals  necessary  t o implement t h e  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  and b u s i n e s s e s  for provincial  purposes,  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 o f t a x a t i o n a c c o r d i n g t o t h e BNA A c t . satisfactory  f o r the e a r l y years  T h i s s y s t e m was  a f t e r Confederation but  w i t h W o r l d War I a n d t h e d e p r e s s i o n y e a r s fiscal  a n d any mode  a r r a n g e m e n t s became s t r a i n e d .  these  original  In order t o reduce the  f i n a n c i n g p r e s s u r e s t h e g o v e r n m e n t was e x p e r i e n c i n g , t h e 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 to  a s s i s t w i t h t h e war e x p e n s e s .  With  the passing of the  Income Tax A c t , t h i s p r e l i m i n a r y a r r a n g e m e n t 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 provincial  fiscal  arena  gradually increased.  i n the  26 The  g o v e r n m e n t p r o g r a m s l i k e p u b l i c h e a l t h and  services required increased  funding  a r i s i n g from a growing p o p u l a t i o n the  social,  f r o m 1867  t e c h n o l o g i c a l and  t o 1935,  the  because of  and  new  veterans  demands  technology.  With  economic changes i n Canada  f e d e r a l government r e c o g n i z e d  that  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  n e e d e d and  t o t h a t end  appointed  a commission.  The  R o y a l C o m m i s s i o n on D o m i n i o n - P r o v i n c i a l  Relations  (referred  t o as t h e R o w e l l - S i r o i s C o m m i s s i o n ) was  appointed  in  and  reported  to Parliament  i n 1940.  o b j e c t i v e a s s e s s m e n t s i n c e 1867 b a s i s o f C a n a d a and powers.  T h i s was  an  the  The  federal grants  document f o r t h e  arrangements of the  to the p r o v i n c e s ,  pensions,  unemployment a s s i s t a n c e  insurance  and  f e d e r a l government.  i n resource  agreement w i t h the p r o v i n c e s t h a n by The  a l l implemented taxing  were e v e n t u a l l y a c t e d  (now  a i d i n n a t u r a l resource  undertakings  financial  future  many o f them, e s p e c i a l l y r e g a r d i n g  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  new  first  o f t h e e c o n o m i c and  r e c o m m e n d a t i o n s f r o m t h i s r e p o r t were n o t  i m m e d i a t e l y but  the  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  important  d i r e c t i o n of f i n a n c i a l  T h i s was  1937  for old  upon.  age  insurance),  health  development.  These  a l l o c a t i o n were assumed following negotiations  and  by rather  c o n s t i t u t i o n a l entrenchment. f e d e r a l g o v e r n m e n t t h e n p a s s e d a number o f  t h a t i n d i c a t e d i t s new  r o l e i n the h e a l t h care  the Health  1948;  Grants Act,  acts  system.  the H o s p i t a l Insurance  and  With  Diagnostic 1966  Services  A c t , 1957; and t h e M e d i c a l  e a c h o f t h e s t a t u t e s gave more v i s i b i l i t y  Care A c t , to the  f e d e r a l g o v e r n m e n t 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. in  health  The c h a n g i n g r o l e o f t h e f e d e r a l g o v e r n m e n t  followed  along  with  t h a t i s , h e a l t h no l o n g e r available to a l l .  t h e change w i t h i n t h e p o p u l a t i o n  was a p r i v a t e c o n c e r n b u t a s e r v i c e  To f u l l y  describe  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 more s p a c e t h a n i s p o s s i b l e it  i n this  i s necessary t o note t h a t funding  part  study.  much  For t h i s  study  s e r v i c e s i s an e s s e n t i a l  o f t h e p o l i c y e n a c t e d by g o v e r n m e n t . 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 Health  h a s b e e n one o f t h e 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 g o v e r n m e n t s i n s e c t i o n 9 2 ( 7 ) o f t h e BNA A c t t h a t states:  "the Establishment,  m a i n t e n a n c e , a n d managements o f  H o s p i t a l s , Asylums, C h a r i t i e s and E l e e m o s y n a r y I n s t i t u t i o n s in the  and f o r t h e P r o v i n c e ,  other  time of confederation,  than Marine H o s p i t a l s . "  i n d i v i d u a l s and t h e i r  were u s e d t o c a r i n g f o r t h o s e members who were Immunization against  communicable d i s e a s e s  At  families ill.  had n o t 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.  that d i d l i t t l e The  The m e n t a l l y  more t h a n p r o v i d e  i l l were p l a c e d custodial  care.  o r g a n i z a t i o n a l structure of the provinces  study w i l l  be d e s c r i b e d  i n asylums  now f o r m e n t a l h e a l t h  under  rather  than  28 for  health generally.  British  Columbia placed  public  m e n t a l h o s p i t a l s , homes f o r t h e aged a n d v i t a l  statistics  w i t h i n t h e Department o f t h e P r o v i n c i a l S e c r e t a r y With health care  f o r t h e most p a r t c o n s i d e r e d  regulation of professions diseases so p l a c e d for  u n t i l 1947.  t o be t h e  and c o n t r o l o f communicable  by t h e g o v e r n m e n t , i t i s r e a s o n a b l e t o h a v e i n the administrative structure.  t h e Insane o f B r i t i s h  health,  health  The I n s t i t u t e  C o l u m b i a was l o c a t e d i n V i c t o r i a  f r o m 1872 t o 1877 when i t was r e l o c a t e d t o New W e s t m i n s t e r . This  one p s y c h i a t r i c s e r v i c e was e x p a n d e d i n 1947 w i t h t h e  C h i l d Guidance C l i n i c  i n Vancouver, f o l l o w e d  development o f community m e n t a l h e a l t h  by  continued  services.  With the  establishment  o f a Department o f H e a l t h  and W e l f a r e , 1946,  public health  a n d a l l c o m m u n i t y h e a l t h m a t t e r s were r e m o v e d  from t h e a d m i n i s t r a t i o n o f t h e P r o v i n c i a l S e c r e t a r y , 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 .  h e a l t h was f i n a l l y p l a c e d Department o f H e a l t h  who  Mental  within the administration of the  i n 1959.  Saskatchewan, e n t e r i n g  into confederation  i n 1905, had  a f a i r l y w e l l developed 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 health services.  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 o f two  p r o v i n c i a l m e n t a l 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 a n d one a t Weyburn, a n d a p s y c h o p a t h i c w a r d i n t h e R e 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  administered  the l a t t e r  s e r v i c e s i n R e g i n a a s w e l l as m e d i c a l a n d g e n e r a l services.  hospital  The D e p a r t m e n t o f P u b l i c Works a d m i n i s t e r e d  the  two  provincial hospitals until  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 t h e D e p a r t m e n t o f P u b l i c Psychiatric  S e r v i c e s Branch.  Health,  I t was i n t e r e s t i n g t o n o t e i n  the e a r l y d e s c r i p t i o n o f t h e f u n c t i o n s o f t h e Department o f Public Health treatments  t h a t t h e r e was t o be an e v a l u a t i o n o f t h e  available.  R e s e a r c h a n d d e v e l o p m e n t was an  acknowledged r e s p o n s i b i l i t y o f t h e Department. The  development o f t h e 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 interesting.  h o s p i t a l s and p r o v i n c i a l of the Inspector to the P r o v i n c i a l Health  From 1864 t o 1930  a s y l u m s were u n d e r t h e j u r i s d i c t i o n  o f P r i s o n s a n d P u b l i c C h a r i t i e s who Secretary.  I n 1930 t h e D e p a r t m e n t o f  established a d i v i s i o n t o supervise  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 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  grants t o  t h e m e n t a l h o s p i t a l s known  as t h e O n t a r i o H o s p i t a l and m e n t a l h e a l t h c l i n i c s . a new d i v i s i o n  added t o t h e d i v i s i o n  public health matters.  Health 1882  administered  submitted  already  This  placed  f o r t h a t purpose alone.  Public  by t h e P r o v i n c i a l B o a r d o f H e a l t h  i t s reports to the P r o v i n c i a l  was  administering  I n 1950, t h e D e p a r t m e n t  mental h e a l t h i n a d i v i s i o n  reportec  from  Secretary,  then  t h e M i n i s t e r o f L a b o u r , t h e n i n 1924 t o t h e 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 . I n Quebec, t h e P r o v i n c i a l as p a r t o f t h e p o r t f o l i o u n t i l department u n t i l  Secretary 1936.  had h e a l t h m a t t e r s  H e a l t h was a  1972 when h e a l t h was l i n k e d w i t h  separate social  30 services.  Mental health  responsible  came u n d e r t h e  f o r i n s p e c t i o n of p r i s o n s  d i v i s i o n of  and  asylums.  P s y c h i a t r i c h o s p i t a l s managed o r a d m i n i s t e r e d o r d e r s l i k e the  p r i o r t o 1936.  Department of the  I n Quebec t h e  C a t h o l i c Church provided  Provincial  province,  charitable  The  church provided  e n c o u r a g i n g i t s members t o g i v e i n some c a s e s t o e n t e r  t o the  sick.  For  this  health  s e r v i c e s by  an  r e s t of  the  by  institutions  administration  of  care  mental  g o v e r n m e n t i s o f p r i m e i n t e r e s t and  the  is reflected in i t s  of these s e r v i c e s .  and  Roman  health  important service  donations to  study, the  r e l i g i o u s o r d e r s were n o t administration  Secretary  r e l i g i o u s orders to provide  s o c i a l c o n t e x t of t h i s province administration  to  services.  administering  took a d i f f e r e n t form from t h a t of the  provinces.  and  directly  r e l i g i o u s o r d e r s of the  h o s p i t a l and  With t h i s r e s o u r c e i n the services  by r e l i g i o u s  G r e y Nuns a p p e a r e d t o r e p o r t  s e n i o r managers i n t h e  health  The  a major p a r t  m e n t a l h e a l t h was  s e r v i c e s managed of  by  government  p r i m a r i l y a governmental  service. I n Nova S c o t i a , t h e r e v i e w of the s t r u c t u r e , the established Hospital Halifax.  included  assignment of h e a l t h w i t h i n the  in  f o r the  was  responsible  I n s a n e and  f o r the  the  government  Board of Commissioners of P u b l i c  i n 1878  The  l a s t province  Charities  Nova  Scotia  the V i c t o r i a General H o s p i t a l  B o a r d o f C o m m i s s i o n e r s was  C o m m i s s i o n o f P u b l i c Works and  then put  M i n e s f r o m 1884  under  t o 1910.  in the 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 Department of P u b l i c C h a r i t i e s . i n the  Following  M i n i s t r y o f P u b l i c Works and  a two-year  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 t h e i n 1931.  r e s p o n s i b i l i t y of the Provincial  Secretary  Public Health health  and  and  venereal  diseases  f r o m 1893  D e p a r t m e n t had  t o 1931. i n one  i n c l u d i n g mental  been s a i d t h a t  as b e i n g a d e r i v a t i v e o f  "an  act of  transportation  and  since  technological  c o l l e c t i v e l y had  an  recognition  the  of time.  that  1867  been  the  under  the  law  the  treatment.  i s the  product  e n f o r c e d as  style  advancement  well  has of  expanded  These  i m p a c t upon l e g i s l a t i o n b u t  social, and  with  the  l e g i s l a t i v e changes o c c u r a f t e r a social  of  i t remains  changes have s e p a r a t e l y  L e g i s l a t i v e c h a n g e s and  the  Legislation  Canadian l i f e with  the  health.  c o m m u n i c a t i o n s y s t e m s and  m e d i c a l knowledge r e g a r d i n g e c o n o m i c and  had  a n t e c e d e n t s o c i e t i e s and  t o c o n t i n u o u s change.""'*  changed d r a m a t i c a l l y  of  department b o t h community  s o c i e t y i n ' w h i c h i t i s f o r m u l a t e d and  subject  the  T h u s , I n 1931,  C h a n g e s I m p a c t i n g Upon M e n t a l H e a l t h  the  and  Department  P r o v i n c i a l Board of H e a l t h  h o s p i t a l care,  I t has  period  Community h e a l t h m a t t e r s l i k e  c o n t r o l of t u b e r c u l o s i s  the  M i n e s , Humane I n s t i t u t i o n s ,  Nova S c o t i a S a n a t o r i u m , V i c t o r i a G e n e r a l H o s p i t a l  Public Health  by  lapse  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 The  social  S o c i a l Change on L e g i s l a t i o n  s t r u c t u r e o f C a n a d i a n s o c i e t y has  moved f r o m  being  b a s e d upon an e x t e n d e d f a m i l y u n i t c a r v i n g  livelihood  out a  on a h o m e s t e a d o r f a r m t o a " b l e n d e d " m o b i l e  f a m i l y working i n urban c e n t r e s . develop i n a family with only  More c h i l d r e n now grow and  one n a t u r a l p a r e n t o r a  step-  p a r e n t a n d s t e p - s i b l i n g s t h a n was t h e c a s e t h i r t y y e a r s a g o . The  move t o t h e c i t i e s b e g a n i n t h e 1930's f o l l o w i n g t h e  first  W o r l d War a n d d u r i n g  affected the p r a i r i e now t h e a g r a r i a n  farmers.  population  suburban p o p u l a t i o n health care  generally  Now c a r e  late  f o r t h e s i c k and  by p r o f e s s i o n a l s f u n d e d by  o f a b s e n t e x t e n d e d f a m i l y members  legislation  procedures.  c h a n g e s were c h a n g e s i n t h e i n t h e t h i r t i e s and a g a i n  i n the  1960's a n d t h e r e a f t e r . Another perspective  "the  so t h a t  and t h e u r b a n -  o f 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  mental h e a l t h  dramatically  trend continued  has d i m i n i s h e d  i s provided  Responding t o these s o c i a l  the  This  predominates.  government i n a c o n t e x t and  the Depression which  on l a w s s t a t e d by B l o n d e l  s t a t u t e s are always t o a greater  i s that  o r l e s s e r degree behinc  r e a l i t y , t h e 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  vain effort  t o keep up."  The l a w i s p a r t o f t h e 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 t h e i n t e r a c t i o n s o f s o c i a l  groups  i m p i n g e upon t h e m a k i n g a n d m a i n t e n a n c e o f 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  has  had  an i m p a c t upon h e a l t h  be  provided  provide  legislation  of residence  i n that l e s s care can  by f a m i l y members a n d g o v e r n m e n t s a r e u r g e d t o  more s e r v i c e s .  33 E f f e c t o f E c o n o m i c Change on L e g i s l a t i o n The  first  W o r l d War  f o l l o w e d by  the Depression i n  1930's were s i g n i f i c a n t e v e n t s i n t h e C a n a d a and consider medical and  moved t h e  care.  described  put  Health  Insured  aside  h e a l t h or medical  proclaimed  f o r the  y e a r s o f t h e war  funds i n t o the p r o v i n c e s  component o f t h e m e d i c a l  the h e a l t h care Diagnostic All  responsibility, system.  Health  until  1948  1957,  medical  system, not  as  health  a  and  as  a  separate Two  a d i r e c t e f f e c t on  the Medical i n purpose,  and  Care A c t ,  1966.  affected  p r a c t i c e i n a l l of  the  f e d e r a l government, through i t s f i s c a l began t o p l a y a major p a r t  I t s p a r t was  not  i n the  t o remain s m a l l but  large proportions.  1959  through l e g i s l a t e d  health gradually  Provincially,  m e n t a l 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  the  recognized  s y s t e m were t h e H o s p i t a l I n s u r a n c e  assumed s i g n i f i c a n t l y  of H e a l t h  when  Mental  s t a t u t e by b e i n g  care  funding  f e d e r a l government i n j e c t e d  o f l e g i s l a t i o n t h a t had  h e a l t h l e g i s l a t i o n and  care  the  these acts, p r i m a r i l y f i n a n c i a l  The  discussed  the mainstream of h e a l t h c a r e .  Services Act,  provinces.  c a r e was  for health care.  s e r v i c e s b e n e f i t e d from the  additional pieces  services, including  in legislation.  G r a n t s A c t p a s s e d by  organization outside  f e d e r a l , to  i n B r i t i s h Columbia governmental v : " ~  i n 1935  not  h i s t o r y of  g o v e r n m e n t s , p r o v i n c i a l and  o f f e r i n g more o r d i f f e r e n t s o c i a l  r e p o r t s but was  recent  the  by  measures.  Departments  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 dramatically  d i s e a s e and i t s t r e a t m e n t has expanded  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 t h e d i a g n o s i s and t r e a t m e n t o f disease.  New t h e r a p i e s h a v e b e e n a d d e d t o t h e 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 o f i n f e c t i o n s , mental  disorders.  the advent  Mental i l l n e s s  of chemotherapies  asylum t o community based  remain  treatment procedures  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 thus a l l o w i n g the disorder*  a t home a n d , when f e a s i b l e , c o n t i n u e e m p l o y m e n t .  Most o f t h e s e c h a n g e s i n p s y c h i a t r i c after  with  h a v e c h a n g e d f r o m c u s t o d y i n an  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 , to  c a n c e r and  treatment took p l a c e  1960 w i t h t h e d i s c o v e r y o f p s y c h o t r o p i c m e d i c a t i o n .  W i t h 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 h a s b e e n a change i n t h e p e r c e p t i o n o f m e n t a l population.  The m y s t i q u e  illness  by t h e g e n e r a l  s u r r o u n d i n g t h e m e n t a l l y i l l has  l e s s e n e d a n d 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 tolerated.  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 o f 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 custody.  L e g i s l a t i o n f o r mental  illness  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 in  community f a c i l i t i e s Another  as w e l l as o u r a t t i t u d e s towards  i s improved  television  facilities.  t e c h n i c a l d e v e l o p m e n t t h a t h a s h a d an e f f e c t on  o u r way o f l i f e illness  as w e l l as i n - p a t i e n t  d i s t a n t communication.  With  mental radio,  a n d c o m p u t e r t e c h n o l g o y , new i d e a s a r e s h a r e d and  v a l i d a t e d amongst a w i d e r difficult the  audience w i t h ease.  I t i s more  now t o i g n o r e s i t u a t i o n s o r p r o v e n h y p o t h e s e s when  i n f o r m a t i o n i s made a v a i l a b l e s o b r o a d l y .  mentally  i l l t h e a s y l u m i s no l o n g e r r e m o t e .  For the Mental  h o s p i t a l s a r e 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 t h e use  o f t e l e v i s i o n cameras, r a d i o documentaries,  or simply w i t h automobiles. institutions. be  can v i s i t  exposed t o media p r e s e n t a t i o n s o f treatment  the m e n t a l l y  given i n  S p e c i a l i n t e r e s t groups concerned  i l l made u s e o f t h e s e  injustices In  psychiatric  W i t h more open c o m m u n i c a t i o n t h e p u b l i c c a n  mental h o s p i t a l s .  the  More p e o p l e  telephones,  i n the treatment  about  opportunities to publicize  of the mentally  ill.  summary, h e a l t h l e g i s l a t i o n h a s c h a n g e d i n C a n a d a  w i t h t h e f e d e r a l g o v e r n m e n t a s s u m i n g a more a c t i v e p a r t i n the f i n a n c i a l in  funding  arrangements f o r h e a l t h s e r v i c e s .  This  arrangements has n o t removed t h e r e s p o n s i b i l i t y  for  providing health services delegated  t o provinces  The  r o l e o f government, i n p a r t i c u l a r ,  the provincial  government, has i n c r e a s e d i n t h e l a s t individuals  and t h e i r  purchase of care  100 y e a r s  f a m i l i e s being responsible f o r  r a t h e r than  i n a l l the earlier  giving care.  statutes.  Mental  W i t h new  c h a n g e d economy, a n d an i n c r e a s i n g l y m o b i l e s t a t u t e s have n o t removed t h e e n f o r c e d p s y c h i a t r i c care.  i n 1867.  with  l e g i s l a t i o n has r e t a i n e d t h e compulsory treatment present  change  health item  technology,  society, the  treatment  aspects of  The l e g i s l a t i o n h a s m e r e l y a d d e d t o t h e  core element of custody, o p p o r t u n i t i e s treatment s e r v i c e s o u t s i d e the  for  hospital.  administering  37 Footnotes """David W e i s s t u b , Law and P s y c h i a t r y i n t h e C a n a d i a n C o n t e x t , Pergamon P r e s s , T o r o n t o , C a n a d a , 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 DESCRIPTIVE ANALYSIS OF In the preceding  that health  and  responsibility  MENTAL HEALTH L E G I S L A T I O N  chapter,  m a t t e r s t o f e d e r a l and  d i s c u s s i o n of the  mental h e a l t h of the  r e g u l a t i o n was  provinces.  e c o n o m i c , and  this regulatory  l e g i s l a t i o n was  with  mental h e a l t h  As  s t a t u t e s f o r mental health  t e c h n i c a l developments described  a c t , the  briefly.  be  the will  c o n t e n t s of the be  analyzed  i n Great B r i t a i n  In the  current  and In  and  this  beginning  e v o l u t i o n of  the p r o c e s s of development of l e g i s l a t i o n governments.  the  w e l l , the i n t e r a c t i o n  legislation will  t h e b a s i c c o n t e n t o f an  provincial  assignment  p r o v i n c i a l governments i n d i c a t e d  between s o c i a l ,  chapter,  V  the  Canada,  i n the  and  federal  and  next chapter a comparison  p r o v i n c i a l mental h e a l t h  of  acts  undertaken. Content of Mental Health 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 consistent and  no  m a t t e r what t h e  numbered by  have a format t h a t  subject.  chapter according  t o the  f e d e r a l governments r e v i s e d s t a t u t e s . Revised Statutes the  current  of B r i t i s h  Mental Health  Nova S c o t i a m e n t a l h e a l t h o f Nova S c o t i a , 1967 Hospitals  The  For  example, i n  (R.S.N.S. 1967)  the  (R.S.B.C. 1 9 7 9 ) ,  i s C h a p t e r M.  i s found i n the  titled  p r o v i n c i a l or  C o l u m b i a 1979  Act  act i s  is  13,  1978  Revised  C h a p t e r 249,  and  in  Statutes 1978,  the  Act.  Following  the  title,  the  c o n t e n t s of the  act are  set  39 out,  first  with  an  introductory  d e f i n i t i o n o f t e r m s and The  body o f t h e  or e x c e p t i o n a l the  act includes provisions.  regulations  into effect.  of the  and,  a committee w i t h  authority given  general This  finally,  I n 1915,  s t a t e m e n t ; f o l l o w e d by  of the  on,  reviewed the  t h i s g r o u p has  however, m e n t a l h e a l t h r e v i e w e d , i n 1980.  legislation  only  o f m e a n i n g and  T h u s , b o t h f e d e r a l and the  same manner b u t  reflects  the  treatment of the For  i n the  that extent  can  or i f i n a mental drug  noted.  d e f i n i t i o n s of terms, f o l l o w i n g the short  s t a t e who  contents apply.  subject  definitions, provincial  title,  are  statement  of prime importance i n  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  the  and  i n a l l acts  statute  s t a t u t e , m e n t a l r e t a r d a t i o n , a l c o h o l and  definitions  legislation  example, the  health  i n t r o d u c t i o n or  subjects  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  i n v a r i a t i o n between p r o v i n c e s ,  The  From t h e n  certainty  result  be  to  recently  insures  or comprehensiveness of d e f i n i t i o n s i n the  d i f f e r e n c e s can  country  c o n c i s e n e s s of e x p r e s s i o n  i t i s the  included  established  t h e i r r u l e s of d r a f t i n g  a provincial perspective.  a d d i c t i o n are  of  comes  l e g i s l a t i o n on many  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 clarity  act  i n Canada.  l e g i s l a t i o n was  But  special  a list  Association  from across  administer  and  date t h a t the  C a n a d i a n Bar  promote u n i f o r m i t y  provisions  i s f o l l o w e d by  the  representatives  to  the  legislation.  i s t o implement the In mental h e a l t h  a c t and  instruments  of the  The t o whom "physician  40 "director", "patient"  "administrator",  are  defined  according  particular  act.  individual  i n charge of  i n one  facility  i n another.  the  of  The  i n - p a t i e n t or  and  Minister  o f M i n e s and  As  the health  out-patient  act  ministry  i s noted  a c t s w o u l d have named  o f t i m e 1890  in British  in  previous  P u b l i c Works i n Nova S c o t i a i n  period  Secretary  mean  noted i n the  mental h e a l t h  f o r the  of the  and  each  government d e p a r t m e n t o r  "Minister."  health  Provincial  purposes of  p r o v i n c i a l mental  administration  chapter,  definitions  a l l the  a c t o r o f one  f o r the  definition  to the  worker",  " D i r e c t o r " , f o r example, may  services  responsible  "mental h e a l t h  t o 1919  Columbia  i n the  and  the  the the  1930's  and  1940's. Following principle  or  the  definition  i n t e n t i o n of the  enunciates  i n a concise  administer  the  commits t h e or  act.  i n the  And  has  section stating this  the  the  authority  far-reaching.  Although  s i m p l e .sentence,  mental h e a l t h  laws a r e  t o communicate and general  most o f t h e  restriction  others  and  Some o f t h e  t o be  in  procedures,  r e s u l t i n g from e x e r c i s i n g the  to effect, services  the the  a u t h o r i t y can  i m p l i c a t i o n s of  of r i g h t s , l o s s of  noted l a t e r  in this  of  an  act.  For  mental  be  these freedom  chapter.  s p e c i a l p r o v i s i o n s which f o l l o w content  the  section  statement t h a t ,  statute.  i s stated i n a short,  complex and  make up  f o r m who  government t o r e g u l a t e  implications  The  act.  It i s this  actions proclaimed  authority  i s a short  next  health,  41 the main c o n s i d e r a t i o n procedures regarding  i s t h e p r o v i s i o n f o r and  compulsory treatment.  w h i c h c o m p u l s o r y t r e a t m e n t i s t o be down; i . e . , t h e p r o c e s s t o be physicians  put  The  one  commitment p r o c e s s v i a m a g i s t r a t e w e l l , i n the  appeal against  general  and  release  face  information.  mentally  ill.  statement g i v i n g the  as  treatment  confidentiality  of  In a l l p r o v i n c i a l  i s a section providing  charges under the  deemed t o be the  of  the  described.  compulsory t r e a t m e n t , absence from  mental h e a l t h acts who  two  are matters such  leave,  by  nonmedical  or judge i s  1  provisions  f a c i l i t i e s without authorized records  or  i t s l i m i t a t i o n s and  necessary documentation; a l t e r n a t i v e l y , the  As  method  i n t o e f f e c t i s set  f o l l o w e d by  i s established with  prescribed  for individuals  C r i m i n a l Code o f Canada and The  final  date t h a t the  s e c t i o n of the  are  act  is  s t a t u t e comes i n t o  effect. A list  of the  statement of the list  r e g u l a t i o n s may  be  be  after  e f f e c t i v e date or j u s t p r i o r to i 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 ,  t h a t may  delegated  through the By  administer  a u t h o r i t y of the  w i t h i n the  the This  s p e c i f i e s items  a u t h o r i t y of the  Governor i n C o u n c i l .  the  attached  t h i s mechanism, the  Lieutenant-  government  act while  can  addressing  changing requirements of the p r i n c i p a l purpose of  the  statute.  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  general.  Regulations  amended  as n e e d e d t o meet t h e  a r e more s p e c i f i c b u t current  can  situation, while  be  legislation  42  i s r e v i s e d i n f r e q u e n t l y and i n the l e g i s l a t u r e .  through  parliamentary  Some c i t i z e n g r o u p s h a v e  procedure  questioned  g o v e r n m e n t s 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 o f legislation,  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 t h e  p a r l i a m e n t a r y system, of the governing An  delegated  relying  i n s t e a d upon e x e c u t i v e  party.  a n a l y s i s o f t h e c o n t e n t s and  instruments r e l a t i n g to mental  order of the  h e a l t h i n Canada  statutory  indicate  that there 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 The  activity  C a n a d i a n 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  laws.  legislation  have c l e a r l y  s e r v e d as a g u i d e t o t h e p r o v i n c i a l w r i t e r s  these laws.  For t h i s p a r t i c u l a r  mental  study, the s e c t i o n s of  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  definitions,  compulsory  r e v i e w p r o c e s s e s , and  treatment statements  procedures, of r i g h t s .  impact  o f t h e new  appeal  and  A l l but  the  chapter w i l l  f o c u s on t h e c o n c e p t s  t h e y were a d d r e s s e d  mental  r e l a t e t o t h e i s s u e o f r i g h t s and  Constitution Act.  i n laws.  The  remainder  of mental  the  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 h e a l t h l e g i s l a t i o n and  of  of  illness  the  this and  how  This information i s useful  p r i o r t o the a n a l y s i s of s e c t i o n s of study i n the  provincial  acts. 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 Mental in In England, been viewed  Health  England  p r i o r t o the mid-1800's, mental  as demon o r s p i r i t p o s s e s s i o n , n o t an  illness  had  illness.  43 The  religious  g r o u p s were c h a r g e d  w i t h i n persons.  with c a s t i n g out the e v i l  T h i s was a t i m e when w i t c h e s  were  o s t r a c i z e d a n d s o m e t i m e s b u r n e d by t h e c o m m u n i t y .  Aside  f r o m t h a t g r o u p o f " n u i s a n c e s " , o t h e r s who were a  problem  f o r t h e community, i n p a r t i c u l a r , to the benevolence mentally i l l ,  t h e v a g r a n t s , were s u b j e c t  o f t h e government, l o r d o r k i n g .  who were o f t e n v a g r a n t p o o r ,  The  have had a l o n g  h i s t o r y o f b e i n g t h e o u t c a s t s o f t h e c o m m u n i t y and s u b j e c t s of  r e s t r i c t i v e laws. A t t h i s p o i n t , i t i s i m p o r t a n t t o a d d a comment a b o u t  the l i n k between mental  i l l n e s s and p o v e r t y .  when t h e l e g i s l a t i o n was f i r s t  written,  At the p e r i o d  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 s y s t e m .  The l o r d a n d  o v e r s e e r s c a r e d f o r o r managed t h e p r o p e r t y and b u s i n e s s associated with their holdings. or  provide a useful  to their  families,  guardians or  I n 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 had  who d i d n o t work  s e r v i c e b e c a u s e o f w e a k n e s s f o r any  r e a s o n were a n u i s a n c e masters.  The p e o p l e  groups but elsewhere  t h e community  t o c a r e f o r i t s r e s i d e n t s who were p o o r and w i t h o u t  identifiable  support.  The o t h e r  c a r e were t h e d i s o r d e r e d w i t h o u t  "nuisance" group families.  needing  So t h e f a c i l i t y ,  a p o o r h o u s e / a s y l u m , was b u i l t away f r o m t h e town t o h o u s e t h e u n w a n t e d members o f t h e c o m m u n i t y . of  t h e p o o r were s i m i l a r  reasonable  Some o f t h e b e h a v i o r s  t o t h e d i s t u r b e d so i t seemed  t o deal w i t h a l l these people  i n one p l a c e .  As  paupers their  d i d n o t c o n t r i b u t e t o t h e w e a l t h o f t h e community,  s o c i a l r i g h t s were o f no c o n s e q u e n c e a n d s o were  disregarded.  L e g i s l a t i o n f o r t h e poor  and t h e m e n t a l l y  ill  incorporated these s o c i a l values of worthlessness at the t i m e when t h e two were t r e a t e d u n d e r one l a w .  These  concepts  no l o n g e r c o - e x i s t as t h e y d i d i n t h e 1 8 t h a n d 1 9 t h c e n t u r i e s but v e s t i g e s of those s o c i a l values remain. the a p p l i c a t i o n of today's mental people  In  health legislation,  i n the lower socio-economic  more  category are compulsorily  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 f e w e r b y  2 psychiatrists  i n their offices.  example t o c l a r i f y  T h i s i s c i t e d as an  the 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 o f t h e use o f a p p l i c a t i o n o f 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 . always have t h e s t a t u t e s been w r i t t e n i n t h e p r e s e n t n o r was t h e c o n t e n t t h e same as i t i s now. r e f l e c t e d the contemporary society.  view of mental  Not  form  S t a t u t e s have disorder f o r a  The f o c u s o f t h e l a w a t any p a r t i c u l a r t i m e was  l i m i t e d t o t h e n e e d s t h a t t h e g o v e r n m e n t o f t h e day was p r e p a r e d t o a d d r e s s and t h e e v o l u t i o n o f l e g i s l a t i o n has b e e n d e p e n d e n t on t h e e v o l u t i o n o f i d e a s a b o u t  custody,  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 o f d e v i a n t s . Development o f E n g l i s h The  essence  or containment property.  Legislation  of early r e s t r i c t i v e  l a w s was t h e p r o t e c t i o n  o f t h e d i s o r d e r e d p e r s o n and c a r e o f h i s  I n t h e 1 8 t h c e n t u r y E n g l a n d t h e r e was c o n s i d e r a b l e  concern their  a b o u t t h e e x p l o i t a t i o n o f h e i r s a n d h e i r e s s e s by  l e g a l g u a r d i a n s who c o u l d h a v e them c o n f i n e d as  lunatics although, i n fact,  t h e y may have n o t b e e n m e n t a l l y  ill. In t h e mid-19th kinds of l e g i s l a t i o n  century, England  began t o e n a c t  from i n s t r u m e n t s r e g u l a t i n g  t o ones c o n t r o l l i n g p e o p l e . f o r c h a n g e were c o n c e r n s  new  institutions  Among t h e s o u r c e s o f p r e s s u r e  about t h e t r e a t m e n t o f 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 f r o m t h e r e s t r a i n t s p u t upon h i m b e c a u s e o f a m e n t a l  disorder.  P a r l i a m e n t had  inquired into the necessity f o rthis  form o f " c a r e . "  t i m e , as i n t h e p r e s e n t , t h e s o c i a l ,  t e c h n o l o g i c a l and  political  issues a f f e c t e d the content of l e g i s l a t i o n .  t r e a t m e n t mothods d e v e l o p e d the c h a i n s from h i s asylum of t h e moral subsequent  treatment  patients,  l e d t o t h e development  i d e a s o f E n g l i s h Quakers and t h e  and, l a t e r ,  newer f o r m s o f t r e a t m e n t .  hospitals.  G r a d u a l l y , however, t h e m e n t a l l y  insane asylums b u i l t  a n d were s e n t t o  f o rtheir custodial  T h e s e were i n t e n d e d t o p r o v i d e m o r a l rehabilitative  Poor law  a s y l u m s l a g g e d b e h i n d i n t h e use' o f  were s e p a r a t e d o u t f r o m t h e p a u p e r s  special  New  i n F r a n c e by P i n e l , who r e m o v e d  reform of p r i v a t e mental  institutions  ill  At that  treatment  care.  and l i m i t e d  care.  With these changes i n concepts  of treatment,  c h a n g e s were made b e t w e e n 1845 a n d 1 8 9 1 .  legislative  The t h r u s t o f t h e  new a c t s was t h e r e c o g n i t i o n t h a t t h e d i s o r d e r e d n e e d e d  46 t r e a t m e n t and might was o f l i t t l e  b e n e f i t from i t and t h a t c u s t o d y  value.  alone  I n t h i s p e r i o d , t h e l e g i s l a t i o n had  p h y s i c i a n s named a s t h e t r e a t e r s o f t h e i l l .  Custodial  a s p e c t s o f t r e a t m e n t were n o t removed f r o m t h e s e  statutes,  b u t 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 , n o t s o l e l y containment.  The r e c o g n i t i o n t h a t p o v e r t y a n d i n s a n i t y  n o t synonymous ( a l t h o u g h i n i t i a l l y act)  t o o k t i m e t o be a c k n o w l e d g e d S o c i e t y ' s view of mental  the changes i n t h e t i t l e s to  Mental Treatment  list  were  p r o v i d e d f o r u n d e r one s e p a r a t e l y i n the laws.  i l l n e s s problems  i s shown by  o f t h e A c t s from L u n a t i c t o I d i o t  and f i n a l l y  t o Mental  Health Act.  A  o f t h e a c t s p a s s e d b e t w e e n t h e y e a r s 1845 and 1959 by  the P a r l i a m e n t of England focus from merely  i n p a r t i n d i c a t e s t h e change i n  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 t h e t i m e : 1845  Lunatic Act  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  1853  L u n a t i c A s y l u m Amendment A c t  1862  L u n a t i c ' s Law Amendment A c t  1886  Idiots Act  1889  L u n a t i c Law Amendment A c t  1890  Lunacy  1891  Lunacy A c t  1921  L o c a l Government A c t  1930  Mental Treatment A c t  and Treatment  (Consolidated) Act  Amendment A c t  47 1946  Mental Health  Service  1959  Mental Health  Act.  Many i t e m s i n t h e like  the  acts continued  admission c r i t e r i a ,  gave t h e  l a b e l of  that time.  Act  "mad"  T h e r e was  i n d i v i d u a l s from the  or  t o be  set out  the p l a c e  "insane"  a s y l u m and  of the worker d e s i g n a t e d  or a u t h o r i z e d  procedure.  l a b e l s d e s c r i b i n g the  c h a n g e f r o m l u n a t i c and defective. and  Physicians  who  what t h a t meant  a procedure to  community t o the  However, t h e  before  of confinement,  and  also included  as  remove  a  definition  t o implement  i d i o t to mentally  at  the  afflicted  did  ill  and  mentally  assumed r e s p o n s i b i l i t y  for  labelling  p r e s c r i b i n g treatment.  Involved  open s o c i e t y i n t o h o s p i t a l (and  with  some r e m o v a l s  l a t e r return to  from  the  c o m m u n i t y ) were t h o s e known as P o o r o r R e l i e v i n g O f f i c e r s whose t i t l e s Authorized  became D u l y Q u a l i f i e d O f f i c e r , t h e n D u l y  or Mental Welfare O f f i c e r .  A l s o , the  police  still  continued  t o h a v e a f u n c t i o n i n r e m o v i n g some o f  disturbed  from t h e i r communities to mental h o s p i t a l s , though  many w e r e b r o u g h t i n by As and  f a m i l i e s and  mentioned above, t h e r e  friends.  were c h a n g e s i n t h e  f i n a n c i n g of treatment i n s t i t u t i o n s ,  i n the  though not  f i n a n c i n g o f p a t i e n t payment s y s t e m s .  h o w e v e r , as t h e  separation  and  those with  illness  the  d i s t u r b e d was  the  i n t r o d u c t i o n of the  and  defined  the  of the  at  first  Gradually,  i n d i g e n t , the mentally  poverty  was  done, t r e a t m e n t  within a medical context.  National  organization  Health  Service  ill for  With  i n 1946,  the  48 n e x t s t e p was t o r e v i e w t h e l e g i s l a t i o n w i t h i n organizational context.  this  A R o y a l C o m m i s s i o n on M e n t a l  I l l n e s s a n d M e n t a l D e f e c t 1955-1958 r e s u l t e d i n t h e M e n t a l H e a l t h A c t , 1959, w h i c h p r o v i d e d a model f o r o t h e r to follow.  countries  One comment made r e g a r d i n g t h e c o m m i s s i o n  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 n o t i n i t i a t e d n o r were t h e m a j o r  p o l i c y c h a n g e s a c c o m p a n i e d by p l a n s f o r 3  research designed t o assess t h e i r e f f e c t s .  The C o m m i s s i o n  was u s e d ,  f o r change.  rather, t o test the "general w i l l "  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 mental  It  time,  health l e g i s l a t i o n consistently continues to retain  procedures  f o r compulsory  c u s t o d i a l t r e a t m e n t e v e n when  other treatment a l t e r n a t i v e s Development of Canadian In Canada, mental  exist. Mental Health  illness  Legislation  d i d n o t come w i t h i n t h e  j u r i s d i c t i o n o f t h e f e d e r a l government, b u t from t h e o u t s e t , i n 1 8 6 7 , i t was a p r o v i n c i a l m a t t e r . the e a r l y  As d e s c r i b e d b e f o r e ,  s t a t u t e s were p a s s e d t o p e r m i t t h e p r o v i n c i a l  g o v e r n m e n t s t o p r o v i d e a n d manage a s y l u m s . u n d e r l y i n g purpose  of these l e g i s l a t i v e  But t h e  i n s t r u m e n t s was much  more c o m p l e x t h a n s i m p l y p r o v i d i n g a f a c i l i t y the i n s a n e .  They a d d r e s s e d t h e p r o b l e m s  t o segregate  of housing the poor,  and p r o t e c t i n g t h e c o m m u n i t y f r o m b i z a r r e ,  unacceptable  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 t e r m s . For mental  illness,  i s not s p e c i f i c  this  f o r m a t was w e l l s u i t e d as d i a g n o s i s  and p r e c i s e .  49 A f t e r the  1930's, each of the  about t r e a t m e n t of the m e n t a l l y institutions changes are  in their  provinces  ill  rather than  statutory instruments.  or Insane H o s p i t a l s Acts  Mental Health  and  In the  Acts  1930's o r t h e r e a f t e r , t h e  mental health  a f t e r years of being  P u b l i c Works and  The  and ih  were now  a d m i n i s t r a t i o n of  long  i n the  like  Inspector  Ontario. disordered  person's  property  o f some o f t h e p r o v i n c i a l m e n t a l h e a l t h  p r o v i n c i a l s t a t u t e s not  and  and  considered  acts,  S a s k a t c h e w a n and  included  in this  property  study.  i s addressed i n of  patients  wording changes i n mental H e a l t h the  legislation,  i n d i v i d u a l s and  has  r e m a i n e d u n c h a n g e d ; so have t h e  and  d e c i s i o n m a k i n g by  to enforce  as  question.  e v e n 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  treatment to protect  in  o r deemed i n c o m p e t e n t , a r e managed  as t h e i r m e n t a l c o m p e t e n c y i s i n But  the  department  separate l e g i s l a t i o n to ensure t h a t the property others,  retitled  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  Elsewhere, the matter of e s t a t e s  and  the  i n a department  n a m e l y t h o s e o f Nova S c o t i a , O n t a r i o other  title  Acts.  M i n e s i n Nova S c o t i a and  p r o t e c t i o n of the  remains p a r t  three  The  s t a t u t e s became p a r t o f h e a l t h  responsibility  Secretary  Mental H o s p i t a l  write  about  s i m i l a r to those found i n England, f o r  Insane Asylum Acts  of P r i s o n s  began t o  -  compulsory  t h o s e a r o u n d them  assessment procedures  p h y s i c i a n s , p o l i c e , and  p r o t e c t i v e c u s t o d i a l treatment.  But  magistrates now  the  acts  50  f o c u s p a r t i c u l a r l y on t h e m e n t a l l y in  i l l who r e q u i r e  treatment  a m e d i c a l s e t t i n g a n d p a r t i c u l a r l y on t h o s e who a r e  compulsorily  treated. Pressures  Changes i n l e g i s l a t i o n of p o l i t i c i a n s ,  physicians,  disordered  families.  Another strong  reporters  for television,  necessary t o recognize  for  a r e b r o u g h t a b o u t by t h e a c t i o n s  administrators,  of mental f a c i l i t i e s ,  considered  f o r Change  staff  i n d i v i d u a l s and t h e i r  f o r c e i n the s o c i e t y i s the media: newspapers o r r a d i o .  Iti s  t h a t i n t e r e s t g r o u p s do h a v e t o be  when c h a n g e s a r e 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 ,  i t was a n d i s t o t h e p o l i t i c i a n s  d i r e c t t h e i r views regarding mental h e a l t h  legislation.  within the province legislation  lawyers,  that pressure  legislation  and, i n t h i s  While the t r a d i t i o n a l  supporting  are physicians,  groups which b r i n g pressure  groups  or confronting  case,  groups  the revised  l a w y e r s and a d m i n i s t r a t o r s ,  new  t o b e a r a r e t h e 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 o f t h e 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 with  or bizarre"acts  the l e a s t expenditure of t a x d o l l a r s ,  rather  p r o m o t i n g t h e 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 . i n t e r e s t o f 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 and  t r e a t only  those r i g h t f u l l y  requiring i t .  than The  i s t o care f o r 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 b e e n t h e c e n t r a l i s s u e s . 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  The  i n t e r e s t s of p o l i t i c a l , regarding mental  class,  illness  and p r o f e s s i o n a l  and i t s t r e a t m e n t .  In B r i t i s h Columbia,  t h e m e d i c a l group  concern are the p s y c h i a t r i s t s .  w i t h a major  For the Medical Association,  the 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 t h e forum of c u r r e n t p s y c h i a t r i c As w e l l ,  t h i s group  l e g i s l a t i o n o r an  a f f e c t i n g mental  Other p r o f e s s i o n s a c t i v e i n mental psychology, psychiatry,  health  illness  services.  t r e a t m e n t s u c h as  s o c i a l work a n d p s y c h i a t r i c n u r s i n g  provide i n p u t i n t o mental  i l l n e s s p o l i c y development  their professional associations.  The p o i n t o f v i e w  even those w o r k i n g  i n the f i e l d  through expressed  of mental  may n o t s u p p o r t t h e v i e w e x p r e s s e d by p h y s i c i a n s o r  psychiatrists, more c o m p l e t e  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 i n f o r m a t i o n on t h e s u b j e c t .  Since the l a t e  sixties,  an a c t i v e c o n s u m e r g r o u p Patients Association.  we have s e e n t h e d e v e l o p m e n t o f  i n B r i t i s h Columbia,  f o c u s e d upon t h e i s s u e o f c o m p u l s o r y  restrictions  the Mental  The m e m b e r s h i p o f t h i s g r o u p  t r e a t e d i n d i v i d u a l s as w e l l as t h o s e s t i l l has  issues  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  amendment t o l e g i s l a t i o n  illness,  i n which  treatment p r a c t i c e s are discussed.  t o o f f e r r e c o m m e n d a t i o n s on d r a f t  by o t h e r g r o u p s ,  groups  i m p o s e d by t h i s t r e a t m e n t .  includes  i n treatment.  It  t r e a t m e n t and t h e Other  types of  i n t r u s i v e t r e a t m e n t such as e l e 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 h a v e b e e n d e n o u n c e d by t h i s g r o u p . P a t i e n t s A s s o c i a t i o n supports the concept  that  The M e n t a l  appeal  processes  against compulsory treatment  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 . t h e members h a v e e x p e r i e n c e d recipients,  t h i s cohesive  psychiatrists'  s e r v i c e s as  group has d e v e l o p e d  p r e s s u r i n g f o r change o f t r e a t m e n t s  As a l l  a method o f  they c o n s i d e r u n d e s i r a b l e .  An e x a m p l e o f t h e g r o u p ' s a c t i o n was a t t h e W o r l d C o n g r e s s of Mental  H e a l t h h e l d i n V a n c o u v e r i n 1978 when  spokespersons  made t h e i r demands f o r c h a n g e more b r o a d l y known. Across  Canada t h e r e a r e s i m i l a r groups e s t a b l i s h e d .  In  S a s k a t c h e w a n , t h e r e i s t h e S c h i z o p h r e n i c s Anonymous, i n Ontario the Friends of Schizophrenics Society--each of these w i t h groups i n o t h e r p a r t s o f Canada. Canadian Mental  The l o n g e r - e s t a b l i s h e d  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 . Traditionally,  the lawyers  have h a d t h e i r p a r t i n  d e v e l o p i n g m e n t a l 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 may become a d v o c a t e s  for rights.  At the B r i t i s h  p r o v i n c i a l m e n t a l h o s p i t a l one l a w y e r  advocacy o f f i c e .  At the present  p r o f e s s i o n may h a v e r e q u e s t s on c a s e s  Columbia  e s p e c i a l l y has had  considerable influence i n the establishment patients'  some  of a mental time, the l e g a l  to represent patients i n court  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  treatment. All pressure  of these  groups,  p r o f e s s i o n a l and consumer,  on g o v e r n m e n t i n t h e i r own g e o g r a p h i c  as n a t i o n a l l y ,  f o r changes t o t h e l e g i s l a t i o n .  areas  apply as w e l l  Now w i t h a  Charter  of Rights  and Freedoms p r o c l a i m e d  g o v e r n m e n t and w i t h t h e a s s e n t  by t h e f e d e r a l  of the p r o v i n c i a l  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 "  new  focus, that of ensuring  groups w i l l  that mental h e a l t h  i s n o t i n c o n f l i c t w i t h t h e new A c t .  governments have a  legislation  54 Footnotes "'"Magistrates i n C a n a d a a r e t h e i n d i v i d u a l s a p p o i n t e d t o h e a r c a s e s f o r a d e f i n e d a r e a o f t h e l a w . The c o u r t s i n which these o f f i c i a l s p r e s i d e a r e e n t i r e l y under p r o v i n c i a l control. I n t h e e a r l y d a y s , t h e i n c u m b e n t may n o t h a v e h a d e d u c a t i o n i n l a w b u t was c o n s i d e r e d t o m e r i t t h e p o s i t i o n because o f d e m o n s t r a t e d a b i l i t y i n t h e community. I n some c a s e s , t h e a p p o i n t m e n t was made t o r e w a r d 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 t h e d u t i e s o f m a g i s t r a t e s were those of J u s t i c e of t h e Peace. Now m a g i s t r a t e s , a l m o s t u n i v e r s a l l y , are lawyers. S t i p e n d a r y m a g i s t r a t e i s a t e r m no l o n g e r u s e d i n C a n a d a . The N o r t h w e s t T e r r i t o r y was t h e l a s t p l a c e t o u s e the term, d i s c o n t i n u i n g i t i n 1955. 2 D o n a l d M i l l e r , Community M e n t a l H e a l t h , D. C. H e a t h and Company, C a n a d a , 19 74, p. 4 1 . 3 G. F. R e h i n a n d F. M. M a r t i n , P a t t e r n s o f P e r f o r m a n c e i n Community C a r e , A R e p o r t o f a Community M e n t a l H e a l t h S e r v i c e s S t u d y , O x f o r d U n i v e r s i t y P r e s s , L o n d o n , 19 68, p. 2 2.  Chapter VI DESCRIPTIVE ANALYSIS OF F I V E 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 Mental H e a l t h A c t s of B r i t i s h Columbia, Saskatchewan,  O n t a r i o , Quebec a n d Nova S c o t i a a r e  t o be c o m p a r e d r e g a r d i n g t h e 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 , t h e 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 mentally i l l  i n this  s t u d y , the terms used f o r t h e  have c h a n g e d o v e r t h e y e a r s .  The  these 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 a p p l i c a t i o n of the l e g i s l a t i o n . i n the acts are " d i r e c t o r " , "physician", facility",  "mental d i s o r d e r " ,  and " i n v o l u n t a r y p a t i e n t . "  are noted i n Appendix  t h e i n t e n t and  The r e l e v a n t t e r m s  " p r i v a t e mental h o s p i t a l " ,  t h e s e t e r m s as t h e y a p p e a r  definitions.of  defined  "patient",  "provincial  health  The d e f i n i t i o n s o f  i n the f i v e p r o v i n c i a l  statutes  C.  The d e f i n i t i o n o f m e n t a l d i s o r d e r v a r i e s f r o m no definition  i n t h e Quebec A c t t o t h e b r o a d one o f "any d i s e a s e  or d i s a b i l i t y addiction" All  o f t h e mind, i n c l u d i n g a l c o h o l o r drug  i n t h e Nova S c o t i a A c t .  of the Acts r e q u i r e p h y s i c i a n s t o determine the  presence of mental d i s o r d e r .  However, i n Quebec t h e  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 t h e a c t f o r Quebec i s an e x c e p t i o n t o t h e 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  mental d i s o r d e r but  The  t h a t has The  I n Nova S c o t i a , t h e p a t i e n t " or  determination  s u b j e c t i v e one  of the  proven i n f a l l i b l e  i s not  p r a c t i c e of t h e i r p r o f e s s i o n .  a v a i l a b l e at t h i s i n a l l the  i n c u m b e n t upon t h e  This  patient  there  attendant with  a n a l y s i s of the  Columbia the  broad or i m p r e c i s e mentally  retarded  that  i s s u e of  and  together  i n the  daily  enforced  the  The  the  assessing  physician  the  act r e l a t i v e to the  disordered."  enforced  that  provincial definitions.  include  h i s judgment of the  i n Nova S c o t i a c a n  be  are  d e p e n d s upon intent  individual.  defined  so  alcohol  definition  c o n d i t i o n of the  is  i n d i v i d u a l s who  from e x c e s s i v e  a p p l i c a t i o n of the and  to  treatment.  d e f i n i t i o n of mental d i s o r d e r i t could  a  When  i n d i v i d u a l i s subject  f i v e acts, i t i s evident  or impaired  consumption.  Canadian l i v i n g  has  when i t does i t i s  i s extreme v a r i a t i o n i n the  In B r i t i s h  time.  Mental i l l n e s s  "mentally  subjective process occurs,  In the  is a  p h y s i c i a n or p s y c h i a t r i s t to e x e r c i s e  l a b e l the  restrictions  acts  psychologists  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  the  admission."  generally considered  p h y s i c i a n s , p s y c h i a t r i s t s and  this  patient  l a b e l "mental d i s o r d e r "  i n i t compulsory treatment.  j u d g m e n t and  certified  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  compulsory t r e a t m e n t are not by  "formal  d e f i n i t i o n of mental d i s o r d e r  inherent  of  a p s y c h i a t r i s t must d e c i d e i f c o m p u l s o r y  t r e a t m e n t i s needed. i s c a l l e d a "formal  determine the presence  of A  "mentally  disordered" a facility  due t o an a l c o h o l i s m p r o b l e m and t h e n p l a c e d i n f o r enforced  treatment.  c o u l d move t o any o t h e r p r o v i n c e conversely, the  This  same  individual  and n o t be so d e f i n e d , o r  one who moves t o Nova S c o t i a w o u l d be s u b j e c t t o  l a b e l l i n g of the l e g i s l a t i o n  there.  The d e f i n i t i o n o f " m e n t a l d i s o r d e r " i n a l l t h e p r o v i n c i a l mental h e a l t h acts l a c k s s p e c i f i c i t y .  Or r a t h e r ,  t h e p r e c i s e i n t e r p r e t a t i o n d e p e n d s upon t h e j u d g m e n t o f t h e individual Scotia, to  applying the d e f i n i t i o n .  a t what p o i n t i s a l c o h o l o r d r u g a d d i c t i o n d e t e r m i n e d  be " m e n t a l d i s o r d e r " ?  individual "mentally others?  driving  O r , i n B r i t i s h C o l u m b i a , i s an  a v e h i c l e i n a d a n g e r o u s manner  disordered"  then  r e q u i r i n g protection f o r himself or  The d i f f e r e n t d e f i n i t i o n s  the p r o v i n c i a l provides  F o r e x a m p l e , i n Nova  f o r "mental d i s o r d e r " i n  a c t s as w e l l as t h e d i s c r e t i o n g i v e n  the opportunity  physicians  f o r unequal a p p l i c a t i o n of the  l e g i s l a t i o n within a province  and a c r o s s  the nation.  P l a c e of Treatment Generally, a l l the acts provide facility  and t h o s e  f o r the province  f o r treatment of B r i t i s h  within a  Columbia,  S a s k a t c h e w a n and Quebec i n c l u d e c o m m u n i t y f a c i l i t i e s mental Health treatment.  clinics  designated  The f a c i l i t y  voluntary treatment  as c e n t r e s  for psychiatric  i s t h e p l a c e where most o f t e n  of p s y c h i a t r i c disorders i s o f f e r e d but  where c o m p u l s o r y o r i n v o l u n t a r y t r e a t m e n t There a r e o t h e r  s u c h as  may be  given.  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 treatment f o r disease  (e.g.,  t u b e r c u l o s i s ) but  d i f f e r e n c e b e t w e e n t h o s e a c t s and  the  venereal  disease  and  mental h e a l t h a c t s i s t h a t the compulsory treatment these diseases  does n o t  include c u s t o d i a l care.  treatment f o r these diseases confinement i n a  do n o t  normally  require  of 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  hospital  f o r compulsory treatment.  r e m o v i n g an  individual  an  individual  f r o m t h e c o m m u n i t y has  not been removed from the  B.C.  The  a long h i s t o r y procedure  l a w s 2400 y e a r s l a t e r .  The  has  labels  d i s o r d e r o r b e h a v i o u r r e q u i r i n g r e m o v a l have changed  c u s t o d y has  remained  entrenched.  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 h a v e two c o m p l e t e d ; one judicial  i s the medical  or l e g a l route.  disordered officer. orders,  in  This p r a c t i c e of  d a t i n g b a c k t o t h e Roman c o d e o f 450  but  The  Rights  t h a t o f Quebec have a p r o c e d u r e t o p l a c e  of the  for  facility.  C o m p u l s o r y T r e a t m e n t and All  the  p e r s o n be The  route  other  s e e n e i t h e r by  The  t o have t h e  or h o s p i t a l t h a t provides  j u d g e does n o t  p e r s o n but  been used t o p r e s e n t p r o c e d u r e f o l l o w e d by  the medical o r two  route  One  the law  signs  individual compulsory  table  graphically.  physicians  be  i s the  n e c e s s a r i l y have t o see  the p h y s i c i a n does.  one  to  a p h y s i c i a n or a  p h y s i c i a n or a judge then w r i t e s or  taken to a f a c i l i t y  disordered  the  E a c h method r e q u i r e s t h a t  often called c e r t i f i c a t e s ,  treatment.  and  routes  includes  the has The the  time allowed f o r v a r i o u s steps taken t o c o n f i r m treatment, the people  needed t o complete  t i m e s o f r e v i e w and r e n e w a l Table  compulsory  t h e p r o c e s s and  of compulsory  treatment  the  (see  1). Table  1 s c h e m a t i c a l l y presents the v a r i a t i o n  p r o v i n c i a l procedures  of compulsory  between t h e i n d i v i d u a l b e i n g seen  treatment.  The  specialist  u n t i l a s s e s s e d by t h e f a c i l i t y ' s  staff  provinces.  a r e two  In B r i t i s h Columbia,  treatment  f o r one  or other  the c e r t i f i c a t e s  year.  The  the  be h e l d i n  areas of d i f f e r e n c e between  two p h y s i c i a n s a r e v a l i d t o h o l d a p e r s o n compulsory  time  and t h e v a l i d i t y o f  p h y s i c i a n ' s r e p o r t , and t h e t i m e t h e p e r s o n may the f a c i l i t y  i n the  the  s i g n e d by  in a facility  procedures  for  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 steps 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  difference  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 r e n e w a l  of compulsory  the B r i t i s h Columbia  treatment  i s made.  a c t i s t h e most r e s t r i c t i v e , w i t h a  y e a r as t h e t i m e f o r t h e f i r s t  and  subsequent  renewals.  M o s t 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 in  one  year.  The  p r o v i n c i a l mental  variations  i n t h e way  compulsory  treatment.  The  i n which  five provincial  the review p r o c e s s .  Again,  The  renewal  h e a l t h a c t s do h a v e w i d e  they address  a common m a t t e r ,  a c t s have a s e c t i o n t h a t d e f i n e s one  from the B r i t i s h  instrument i s the l e a s t developed.  There,  Columbia  action  depends  60  upon t h e p a t i e n t r e q u e s t i n g  a review,  and  t o make a  i m p l i e s t h a t t h e p a t i e n t c o m p r e h e n d s what i s meant c o m p u l s o r y t r e a t m e n t and review  can  describe  be  a l s o u n d e r s t a n d s t h a t an  requested.  The  t h e p r o c e d u r e , who  other  provinces'  p a r t i c i p a t e s and  f r e q u e n c y so t h a t t h e p a t i e n t does n o t  study,  the  i s s u e of r i g h t s i s not  Those r i g h t s t h a t a r e  involuntary treatment, to having Again, is  with  initiate  little  uniformly  what  the  action.  included  in  addressed. treatment,  to appeals or reviews  of  to sending or r e c e i v i n g communication  e a c h o f t h e 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  the  the matter of r i g h t s .  r i g h t s t h a t are mentioned w i l l British  The  or  visitors.  included regarding  province,  appeal  included r e l a t e to consent to  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 ,  and  by  statutes  In the mental h e a l t h a c t s of the p r o v i n c e s this  request  Mental Health  specific  Act  on c o n f i d e n t i a l i t y o f r e c o r d s  each  now  be  noted.  Columbia  for Biritsh  i n f o r m a t i o n on  For  rights.  Columbia  contains  T h e r e i s no  or consent f o r  section  treatment.  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 t h e r i g h t s o f t h e p a t i e n t u n d e r S e c t i o n 27. In the e v e n t t h a t t h e r e i s no n e x t o f 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 s e n t t o t h e 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  rights stated i n Section  to the court states:  for a discharge.  "Nothing i n t h i s  27  are the  As w e l l ,  r i g h t to  i n Section  s e c t i o n a f f e c t s the  apply  27 i t  r i g h t of  a  61 person  t o a p p l y f o r a w r i t of habeas corpus  prerogative In  or other  writ."  regard to treatment, the Act  states:  t h a t a p e r s o n o v e r t h e age o f 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 t h e c a p a c i t y t o make a p p l i c a t i o n and an a g r e e m e n t f o r payment f o r m a i n t e n a n c e and t r e a t m e n t i n t h e f a c i l i t y and t o a u t h o r i z e h i s treatment i n the f a c i l i t y . 2 Saskatchewan In  t h e S a s k a t c h e w a n 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 c o n s e n t records.  to treatment or c o n f i d e n t i a l i t y  S e c t i o n s 29,  30 and  31 o f t h e A c t d e a l w i t h  against involuntary admission procedures. does  of  The  appeal  A c t , however,  state: C o m m u n i c a t i o n s may be w r i t t e n by o r 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 o p e n e d , e x a m i n e d o r w i t h h e l d , and t h e d e l i v e r y o f t h e c o m m u n i c a t i o n n o t o b s t r u c t e d i n any way o r d e l a y e d e x c e p t when t h e r e a r e r e a s o n a b l e and p r o b a b l e g r o u n d s to b e l i e v e t h a t the contents of the communication w r i t t e n by t h e p a t i e n t w o u l d 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 t h e 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 w o u l d 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 c a u s e unnecessary d i s t r e s s . 3 In  of  t h i s manner t h e S a s k a t c h e w a n A c t r e c o g n i z e s t h e  an i n d i v i d u a l t o e x p r e s s o r c o m m u n i c a t e i d e a s o r  right  wishes.  Ontario 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  regarding rights.  The  r i g h t of consent  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  content  to treatment i s statement:  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 n o t 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 without the consent of the p a t i e n t , o r , where t h e p a t i e n t has n o t r e a c h e d t h e 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 , except under the  62 a u t h o r i t y o f an o r d e r o f a R e g i o n a l R e v i e w B o a r d made on an a p p l i c a t i o n o f t h e o f f i c e r i n c h a r g e . 4 There i s t h e a d d i t i o n a l p r o v i s o in  r e l a t e d t o p s y c h o s u r g e r y and  the Act i t states: The c o n s e n t o f t h e i n v o l u n t a r y p a t i e n t o r t h e 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 n o t i n c l u d e a n d s h a l l n o t 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 t h e Ontario  record  c o n f i d e n t i a l i t y of the patient's  i s covered i n Section  disclose, transmit can,  Act,  26a. G e n e r a l l y ,  o r examine a c l i n i c a l  no p e r s o n  record.  shall  Those who  a s 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 , a r e d e s c r i b e d .  R e g a r d i n g freedom t o communicate, t h e a c t s t a t e s : No c o m m u n i c a t i o n w r i t t e n b y a p a t i e n t o r s e n t t o a p a t i e n t s h a l l be o p e n e d , e x a m i n e d o r w i t h h e l d , a n d i t s d e l i v e r y s h a l l n o t i n any way be o b s t r u c t e d o r d e l a y e d . 6 However, t h e r e the  i s a section of the a c t that puts l i m i t s t o  above s t a t e m e n t by w i t h h o l d i n g  pieces  or obstructing  those  o f c o m m u n i c a t i o n t h a t may i n t e r f e r e w i t h t h e  treatment o r cause unnecessary d i s t r e s s .  To t h i s e n d :  The o f f i c e r i n c h a r g e o f t h e f a c i l i t y h a s t h e a u t h o r i t y t o open a n d e x a m i n e t h e c o n t e n t s o f w r i t t e n communication, w i t h t h e e x c e p t i o n o f t h a t from a 7 B a r r i s t e r a n d S o l i c i t o r o r a member o f t h e R e v i e w B o a r d . Appeal against 27  involuntary treatment i s w r i t t e n i n section  a n d 28 p r i m a r i l y . Quebec For  the province  o f Quebec, t h e r e  i s no i t e m  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 Mental P a t i e n t s ' P r o t e c t i o n Act.  of records  regarding i n the  However, t h e i n d i v i d u a l s  r e c e i v i n g compulsory o r c l o s e treatment  g  are provided  with  63 more i n f o r m a t i o n provincial included  about the  r i g h t s at the  acts would i n d i c a t e .  in this  outset  than  Patients' rights  l e g i s l a t i o n with  other  are  a section stating that:  every h o s p i t a l centre or r e c e p t i o n centre to which a p e r s o n 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 s u c h person 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 o f t h e 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 e n d e d . ^ Some o f t h e  rights included  r i g h t s t o have t h e  i n d i v i d u a l ' s recovery.  i n f o r m e d of such measures u n l e s s  b e s t i n t e r e s t a t t h a t t i m e t o be comment on with the  an  the  to a patient.  c l o s e treatment are r i g h t s given  the  p a t i e n t must in his  There i s a  exchange of  correspondence  the p u b l i c  o f i t s members.  The  curator,  appeal  i n the w r i t t e n i n f o r m a t i o n The  are being  i t i s not  advocate, a p h y s i c i a n , a notary,  procedure i s included  The  informed.  requirements of the  B o a r d o f R e v i e w o r one  given  regulations  f a m i l y n o t i f i e d of the measures  taken to hasten the a l s o be  i n the  on  rights  mechanisms f o r e n d i n g i n f o r m a l  also b r i e f l y  s t a t e d i n the  t o a p a t i e n t a d m i t t e d under c l o s e  notice  or  of  treatment.  Nova S c o t i a Nova S c o t i a has  the  f o r mental d i s o r d e r , the S c o t i a l e g i s l a t i o n has  most r e c e n t  Hospitals Act,  a rather  dealing with patient rights. r i g h t s t o c o m m u n i c a t e by  proclamation  lengthy  Within  letter  and  1978.  The  the m a i l  i n p a r t i c u l a r , c o m m u n i c a t i o n t h a t may  detrimental  e f f e c t on  addressee.  Nova  s e c t i o n are  dealt with,  the  act  section, Section  this how  o f an  In regard  shall  62,  the" be  have a to  letters  64 or 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 access 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  section  c o m m u n i c a t i o n a l s o d e a l s w i t h t h e use o f t h e Visiting  to  on  telephone.  o f 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  circumstances.  The  facility  p o s t i n g c o p i e s of the r i g h t s of people  i s responsible for under o b s e r v a t i o n or  o f p a t i e n t s i n a p l a c e w i t h i n t h e h o s p i t a l where t h e y visible  t o these groups of  are  people.  A l l p a t i e n t s or persons admitted 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 s e n d 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 telephone 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 , t h e r i g h t t o h a v e a f i l e r e v i e w e d by a R e v i e w B o a r d o r a C o u r t , and t h e r i g h t t o h a v e a d e c l a r a t i o n o f c o m p e t e n c y o r c a p a c i t y r e v i e w e d by a R e v i e w B o a r d o r 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 person admitted 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 t h e Review Board.10 S e c t i o n 63 a d d r e s s e s t e r m s and If consent  c o n f i d e n t i a l i t y of records  c o n d i t i o n s of r e l e a s e of i n f o r m a t i o n w i t h  stating consent.  by t h e p a t i e n t i s n o t p o s s i b l e b e c a u s e o f  inability  or 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  Public Trustee  i s designated to act.  is "No  stated specifically person  be  i n the l e g i s l a t i o n  admitted to a h o s p i t a l  u n l e s s he c o n s e n t s  Consent t o  1  admitted to a f a c i l i t y  i n these  shall receive  t o such treatment." "'"  And  treatment,  i s f o u n d t o be  words:  treatment  the person  for observation with his  and upon t h e r e q u e s t o f a q u a l i f i e d m e d i c a l I f the i n d i v i d u a l  treatment  may  consent  practitioner.  i n c a p a b l e of c o n s e n t i n g  then the designates of t h a t person  may  give  to  consent.  65  The  citations  on t h e m a t t e r  from t h e p r o v i n c i a l  statutes reveal that,  o f r i g h t s f o r t h e m e n t a l 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 . 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 .  in the definitions,  mean one v o l u n t a r i l y about r i g h t s  admitted  although  to hospital.  i n Other P r o v i n c i a l In t h e f i r s t  part of t h i s  i s spelt  Disordered Statutes  s e c t i o n , compulsory  treatment  t o be r e s t r i c t i v e o f r i g h t s a n d f r e e d o m s .  r e s t r i c t i o n s were  inherent  i n t o c u s t o d i a l care  i n a mental h o s p i t a l .  statutes.  The  i n the act of taking a patient  a r e 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  Land  Little  on r i g h t s i n t h e 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  provincial  o c c a s i o n a l l y i t may  i n t h e B r i t i s h C o l u m b i a A c t compared t o t h e  more e x t e n s i v e c o n t e n t  was n o t e d  Again,  a p a t i e n t i s , f o r t h e most p a r t , one  r e c e i v i n g compulsory treatment  out  T h e s e r i g h t s as  ill  As w e l l ,  there  i n other  F o r example, i n t h e B r i t i s h  Columbia  (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 o r p e r s o n o f u n s o u n d m i n d . . . t h e 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 t h e c o n s e n t o f t h e 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  states i n  section 23(c) whose h u s b a n d 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 h a v e as h e r s e p a r a t e p r o p e r t y . . . .13 The  Superintendent  o f 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 m e n t a l d i s o r d e r a s 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 .  provides the authority i n the following  The a c t  clause:  . . . f o r any o t h e r r e a s o n t h a t t h e 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 f r o m t h e i n s p e c t i o n o f t h e p e r s o n ' s d r i v i n g r e c o r d o r any o t h e r i n f o r m a t i o n the Superintendent has r e s p e c t i n g t h e 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 o r s u s p e n d . . . .14 The  m e n t a l l y d i s o r d e r e d h a v e 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 C o l u m b i a s t a t u t e s ; c o n s e q u e n t l y , labelling heavy  as a 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 p a t i e n t c a r r i e s  penalties. S i m i l a r e x a m p l e s o f r e s t r i c t i o n s on t h e m e n t a l l y  disordered person found  w r i t t e n into other p r o v i n c i a l  a c t s c a n be  i n t h e s t a t u t e s o f O n t a r i o , Nova S c o t i a a n d  Saskatchewan.  In the province of Ontario, the Election Act  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 a r e p r i s o n e r s . . . o r who a r e p a t i e n t s i n mental h o s p i t a l s . . . a r e d i s q u a l i f i e d from voting.15 The  Marriage  Act of Ontario section 7 states:  . . . no p e r s o n s h a l l i s s u e a l i c e n s e t o o r s o l e m n i z e t h e m a r r i a g e o f any p e r s o n whom he knows o r h a s r e a s o n a b l e grounds t o b e l i e v e . . . by reason o f b e i n g mentally 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 h a s b e e n f o u n d 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 i n c o m p e t e n t 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 s u s p e n d h i s r i g h t s and p r i v i l e g e s a s a member f o r s u c h t i m e . . . . 1 ' The  1(c)  Nova S c o t i a M o t o r V e h i c l e A c t , c h a p t e r  states:  251 s e c t i o n  67 . . . r e v o k e d r i v e r s l i c e n s e when r e g i s t r a r h a s s u c h reason t o b e l i e v e t h a t such a person 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 informaties or d i s a b i l i t y rendering i t unsafe f o r s u c h a p e r s o n t o d r i v e a m o t o r v e h i c l e upon t h e 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  O r d e r s s e c t i o n 26 (c ) s t a t e s : . . . a n y m a r r i e d woman (1) whose h u s b a n d 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 j u d g e 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 h e r t o h a v e a n d e n j o y a l l t h e e a r n i n g s o f h e r i n f a n t c h i l d r e n a n d 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 t h e debts o r o b l i g a t i o n s of h e r 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 . I n summary, t h e p r e s e n t m e n t a l h e a l t h s t a t u t e s a n d other 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 h a v e shown v a r i a t i o n i n  t h e i r c l a u s e s a n d w o r d i n g f o r t h o s e deemed t o n e e d care.  compulsory  F o r C a n a d i a n s who a r e " 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 d e p e n d upon t h e p r o v i n c e i n w h i c h 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 a r e n o t c o n f i n e d  to t h e mental h e a l t h acts but a r e found i n o t h e r p r o v i n c i a l acts.  Most i m p o r t a n t i s t h e v a r i a t i o n found i n t h e  determination of mental d i s o r d e r a r i s i n g  from t h e d e f i n i t i o n  p r o c e d u r e b a s e d upon t h e s u b j e c t i v e o p i n i o n o f t h e 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 a n d may c o n s t i t u t e c r u e l a n d u n 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  freedoms.  t h e i r r i g h t s and  I t i s t h i s document t h a t p o s e s  a challenge to the  r e s t r i c t i v e contents of present mental h e a l t h a c t s . l i m i t a t i o n o f r i g h t s and freedoms provincial  The  a r e p r e s e n t i n each o f t h e  a c t s a l t h o u g h n o t i n e x a c t l y t h e same f o r m .  Thus  68  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 i n need o f r e v i s i o n t o 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  redress  the  a d m i n i s t r a t i v e complexities a r i s i n g with a mobile  population.  69  Footnotes " " " B r i t i s h C o l u m b i a : R.S.B.C. 1 9 7 9 , c . 2 5 6 , M e n t a l 1964, s e c t i o n 30.  Act,  Health  2 I b i d . , s e c t i o n 22. 3 S a s k a t c h e w a n : R.S.S. 1 9 7 8 , c . M. 1 3 , M e n t a l H e a l t h A c t , 1978, s e c t i o n 2 9 . 4 O n t a r i o : R.S.O. 1 9 8 0 , c . 2 6 2 , M e n t a l H e a l t h A c t , 1 9 7 8 , section 31a(2). 5  Ibid.,  section  *~Ibid., s e c t i o n 7 Ibid.., s e c t i o n  31a(3). 19(1). 19(3a).  g  C l o s e t r e a t m e n t i s t h e t e r m u s e d i n Quebec l e g i s l a t i o n t o mean c o m p u l s o r y 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. 1 9 7 7 , c . P. 4 1 , 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, s e c t i o n 27. 1 0  1978,  N o v a S c o t i a : R.S.N.S. 1 9 6 7 , c . 2 4 9 , H o s p i t a l s A c t , section 62(8).  """"""Ibid. , s e c t i o n  46(1).  12 B r i t i s h C o l u m b i a : R.S.B.C. 1 9 7 9 , c . 2 2 3 , L a n d ( W i f e Protection) Act, section 9(1), (3). 13 B r i t i s h C o l u m b i a : R.S.B.C. 1 9 7 9 , c . 2 5 2 , 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 C o l u m b i a : R.S.B.C. 1 9 7 9 , c . 2 8 8 , M o t o r V e h i c l e A c t , s e c t i o n 88. O n t a r i o : R.S.0. 198 0, c . 1 3 3 , 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. 1 5  """ ^ O n t a r i o :  R.S.O. 1 9 8 0 , c . 2 5 6 , M a r r i a g e A c t , s e c t i o n 7.  17 Ontario: 1  R.S.O. 1 9 8 0 , c . 2 3 3 , Law S o c i e t y  Act, section  8  Nova S c o t i a : R.S.N.S. 1 9 6 7 , c . 1 9 1 , M o t o r V e h i c l e A c t , chapter 251, s e c t i o n 1 ( c ) . 19 Nova S c o t i a : R.S.N.S. 1 9 6 7 , c . 1 7 6 , M a r r i e d Woman's Property Act, chapter 26(c)  70 Chapter CONCLUSIONS AND This  s t u d y has  VII  IMPLICATION AND  PLAN FOR  CHANGE  examined the mental h e a l t h  of f i v e Canadian p r o v i n c e s  and  the  legislation  development of  these  s t a t u t e s f r o m e a r l i e r a c t - p a s s e d i n E n g l a n d and  Canada.  The  apprehend  s t u d y has  some o f t h e transport  shown t h a t t h e s e a c t s a r e  mentally  disordered  i n the  them t o a t r e a t m e n t f a c i l i t y  a u t h o r i t y t o implement the were s t u d i e d i n t h e  Canadian context  f r e e d o m s as p r o c l a i m e d  Rights  Freedoms.  I t was  health  v a r i a t i o n s i n the  a c t s u n d e r r e v i e w ; and  v a r i e s and province  may  be  The  with  to define  to  s e c t i o n s of the noted that  definition  of  mental  each  of r i g h t s "mental  within  of the  having enforced  not  t h o s e not  disorder"  each  definition.  in a facility  t r e a t m e n t i s not  Finally,  address the  disordered"  and  and  t h i s treatment i s also r e s t r i c t i v e .  Communication w i t h  scrutinized.  of  are  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 , appeal against  acts  Canadian Charter  restrictions  imprecision  the  These  reference  interpreted differently  because of the  to  study that there  i t was  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 has freedoms i n i t s c o n t e n t s .  and  i n the  stated earlier in this  inter-provincial  community,  compulsory treatment.  r i g h t s and and  t o o l s to  open b u t  by  the  person  restricted  and  i t i s concluded that these acts  i s s u e s of treatment f o r the  do  "mentally  or the promotion of mental h e a l t h .  They  are  legislative  documents t h a t d e f i n e  r e s t r i c t i o n s on that provide  c e r t a i n mentally  f o r the  within a province. issues uniformly definitions The  and  T h e s e s t a t u t e s do  i n a l l provinces;  in a place  where t r e a t m e n t may i t was  property other health  found t h a t the  The  sources of the  a c t s were t h e and  t r e a t m e n t and  the  requirements. i s to place  l i m i t a t i o n s on  restrictions  a d m i n i s t r a t i o n of a c t s  changed over the  last  "mentally  manage  i n the  the  the  "mental enforced  shown  t o i n j u s t i c e s of the including  "disordered",  provincial  restrictions province.  An  e s c a p e f r o m one  a r e met  with  new  set of  that  health  "mentally  W i t h 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 , the  law. the  o r d i f f e r e n t ones i n a n o t h e r  added p r o b l e m , t h a t of a d m i n i s t r a t i n g the  to a mobile population  of  mental  f o r mental  o r more y e a r s ,  subject  that  limiting effects  E v e n t h o u g h i t was  fifty  him  enforced  the  r i g h t s to vote,  appeal process to challenge  still  a  or those around  s u b j e c t i v e nature of d e f i n i n g  confinement.  are  these  r e s t r i c t i o n s of  t h e c o n t e n t s and  disordered"  services  a c t were o f w i d e r i m p a c t i n  r e s t r i c t i o n s on  and  enforced.  d r i v e were e x a m p l e s o f t h e  laws.  disorder"  be  statutes placed  The  and  address  acts  a danger t o h i m s e l f  treatment w r i t t e n i n t o the provincial  individuals,  r a t h e r t h e y have  provincial  i s posing  disordered."  not  p r o c e d u r e s t h a t meet l o c a l  p e r s o n who  other  disordered  place  a d m i n i s t r a t i o n of mental h e a l t h  essence of each of the  Further,  a procedure to  a t a t i m e when t h e r e  act  i s a national  Charter To  of R i g h t s  and  answer the  Freedoms was  questions  also  r a i s e d by  shown t h a t m e n t a l h e a l t h  a c t s , as w i t h  interactive with  e c o n o m i c and  conditions  social,  of the  and  this  Thus,  the  considered  t h i s u n d e r s t a n d i n g and  r e a s o n t o amend t h e  i n d i s c r i m i n a t e law the  of d i s c o v e r i n g  of the  t h a t was  i n s a n e n e e d s t o be From t h i s  health  acts  s t u d y i t has  i n C a n a d a do  future, there  s t a t u t e s and  different  f o r each p r o v i n c e  changes i n the pressures plan  The  "disordered"  new  is  change  the  continuation  from  of  the  w r i t t e n to c o n t r o l the  poor  and  b e e n shown t h a t p r o v i n c i a l  t h a t the  restrictions  as w e l l as how  i n the p r o v i n c e .  and  mental  the  are  they are  applied  I t i s p o s s i b l e t o make  s t a t u t e s i n an o r d e r l y manner e v e n t h o u g h  f o r c h a n g e come f r o m w i d e l y  f o r change w i l l  various  truly  impose r e s t r i c t i o n s upon  disordered"  each p h y s i c i a n  With  a l t e r e d i n new."'acts.  "mentally  by  treatment,  the p o s s i b i l i t y i n the  the  advances  legislation.  existing  or p e r c e p t i o n s  new  p r o c e s s e s and  content from confinement to treatment. values  and  to  when d e v e l o p i n g  treatments f o r mental i l l n e s s  are  societal  stigma attached  in technology, e s p e c i a l l y i n disease must be  was  a l l legislation,  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 ,  all  study, i t  technological  n a t i o n or p r o v i n c e .  b e l i e f s about mental i l l n e s s  noted.  interested  issues, together  address the groups, the  with  diverse  sources.  c o n t r i b u t i o n s made by a d m i n i s t r a t i v e and  technological  change.  the The  the  economic  Plan The  plan  f o r Change  f o r changing mental h e a l t h  legislation  will  i n v o l v e p r o f e s s i o n a l g r o u p s , p a t i e n t and s p e c i a l i n t e r e s t g r o u p s , and t h e g o v e r n m e n t a d m i n i s t r a t o r s The  of mental  health.  p l a n , b a s e d On r e c o m m e n d a t i o n s d e v e l o p e d f r o m t h i s  will  describe  study  t h e r o l e o f t h e p a r t i c i p a n t s and a method o f  processing. Recommendations From t h i s 1.  s t u d y i t i s recommended:  that a n a t i o n a l standard  mental d i s o r d e r 2. modified  and a c o n f i n e m e n t p r o c e d u r e .  that current  p r o v i n c i a l mental h e a l t h  t o conform with  a n a t i o n a l standard  d e f i n i t i o n of mental d i s o r d e r 3.  t h a t the t i t l e  accurately  be d e v e l o p e d f o r d e f i n i n g  statutes  regarding  be the  and a c o n f i n e m e n t p r o c e d u r e .  o f t h e s e p r o v i n c i a l a c t s more  r e f l e c t the contents;  e.g.,  Mental  Disorder  Confinement A c t . 4. t h a t t h e d e f i n i t i o n o f m e n t a l d i s o r d e r a d d i c t i v e or habituated or  s t a t e s as w i t h  not  i n g e s t i o n of  include alcohol  drugs. 5.  disorder  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 of mental f o r t h e p u r p o s e o f c o n f i n e m e n t be made by  i n d i v i d u a l s f r o m two p r o f e s s i o n a l g r o u p s s u c h as and p s y c h o l o g i s t , 6.  physician  o r p o l i c e and n u r s e .  t h a t t h e c o n f i n e m e n t p r o c e d u r e be  separately  two  defined  on a d m i s s i o n f r o m t h e c o m m u n i t y and f o r t h a t  from  74 within a 7.  facility. that review  and a p p e a l  c o n f i n e m e n t be d e v e l o p e d provincial  nationally  ~  for inclusion i n  s t a t u t e s a n d t h a t t h e s e n o t be d e p e n d e n t o r b a s e d  upon t h e v i c t i m 8.  procedures regarding  initiating  the process.  that sections regarding  confidentiality,  communication,  c o n s e n t and n o n - i n t r u s i v e  treatment  p r o c e d u r e s be w r i t t e n i n t o t h e a c t . 9.  that other current statutes with sections that set  restrictions be  reviewed  on t h e 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  disordered  i n t h e l i g h t o f t h e recommendations and t h e  C h a r t e r o f R i g h t s and Freedoms. To i m p l e m e n t t h i s o r any p l a n t o r e - w r i t e o r amendlegislation will  take time.  However, t h e r e a r e a l r e a d y  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 t h e n t o t a k e needed a c t i o n s . for the task w i l l to the p o l i t i c a l  responsibility implementation,  The t i m e  be s u b j e c t t o d e l a y o r u r g e n c y pressures, social pressures  service delivery issues.  some  required according  and o t h e r  B u t as a p l a n n e r w i t h a  t o a d v i s e on l e g i s l a t i o n a n d i t s i t i s p o s s i b l e t o plan f o r necessary  despite other pressures.  So, t h i s p l a n w i l l  first  changes  describe  t h e r o l e o f t h e 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 o f proceeding. Role of 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 o f mental h e a l t h s e r v i c e s  will in  take the l e a d r o l e .  This group's response  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 present  and  social,  e c o n o m i c and  T h i s group can  i s central  legislation,  i n t e r e s t group a c t i o n s f o r change.  i n t e g r a t e the pressures  for  legislative  change t h a t are o u t s i d e t h e v i e w of each of t h e p a r t s of system such  as t h e 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 to  a d v i s e on p r o v i n c i a l  provincial  can  seek out  s u b m i t t e d by c o n c e r n e d The  s e r v i c e s as w e l l as  and  respond  provinces.  t o comments  groups from a l l p a r t s of  society.  s p e c i a l i s t physicians together with physicians  generally w i l l  need t o examine t h e i r c u r r e n t  r e g a r d i n g the d e f i n i t i o n especially  treatment  and  treatment  as i t r e l a t e s t o t h e use  These p e o p l e  practice  of the  of compulsory  need t o c o n s i d e r the n e c e s s i t y of  procedures  disordered,  f o r the m e n t a l l y i l l ,  treatment.  enforced  particularly i f  there 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 treatment non-consenting victim. both  able  represent  services to counterparts i n other  These o f f i c i a l s  the  individuals;  e.g.,  the unconscious  traffic  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  f o r m a l l y and  disorder,  informally,  i t s definition,  treatment.  and  education,  as i t r e l a t e d t o m e n t a l  treatment  T h i s p e r s p e c t i v e has  knowing t h a t i n t e r -  to  and  especially  enforced  relevance to the p h y s i c i a n  intra-provincial  differences  may  occur. The  other p r o f e s s i o n a l groups w i l l  be  asked  for their  76 opinions But  regarding  i t i s not  a l s o the  only  the  t r e a t m e n t of the m e n t a l l y  the  treatment that  d e f i n i t i o n or d e t e r m i n a t i o n  that i s equally have r e g a r d i n g  important.  The  considered  with  a new  sought out  to provide  is significant of a mental  education  their responsibility  l e g i s l a t i o n n e e d s t o be  s t a t u t e being  writers, police, psychologists,  but  disorder  these  professionals  towards the e x i s t i n g  r e s p o n d e d t o as  e v i d e n c e are  disordered.  i t may  written. lawyers,  need t o The  be  professions  legislative  s o c i a l workers, nurses  and  academics. One  i n t e r e s t e d group not  consumers.  Their  with current proposed  m e n t i o n e d above a r e  evidence i s necessary regarding  legislation  and  acts.  r e v i s i o n and  acts together  w r i t i n g of the  implementation of the  ongoing w i t h i n each of the departments but r i g h t s and  l e a d group can  and  relevant  amendments o r new  act.  last,  first, data;  items with  second,  act;  third,  an e v a l u a t i o n  p r o v i n c i a l mental  are  health issue  of  i s addressed.  b e g i n reviews of the mental legislative writers within  nationally.  of  Some o f t h e s e a c t i v i t i e s  r e q u i r e c h a n g e s so t h a t t h e  mental d i s o r d e r  legislative province  may  four parts:  with  s t a t u t e ; and  a d m i n i s t r a t i o n of the  The  Proceeding  method o f p r o c e e d i n g has  review of c u r r e n t  the  issues ~  the p o s s i b l e e f f e c t s of  Method of The  the  For  a beginning,  health  the  those items  that  c a n be c h a n g e d 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 t h e o u t s e t , followed  by t h o s e i t e m s t h a t r e q u i r e r e f i n e m e n t a n d  development over a l o n g e r p e r i o d of t i m e . example, a l t h o u g h compulsory presently  s o c i e t y views  treatment i s r e s t r i c t i v e ,  i t as a needed c o n t r o l mechanism,  but a p p e a l and r e v i e w p r o c e d u r e s or p r o t e c t e d redress.  To t a k e an  are not adequately  i n t h e s t a t u t e s and p e o p l e g e n e r a l l y  addressed  want  T h u s , work c a n commence i n t h e a p p e a l a n d 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 e n s u r e t h a t any c h a n g e s are c o m p a t i b l e w i t h  t h e Canada A c t .  i t e m s c a n be w o r k e d o n ; t h e " t i t l e " R e c o m m e n d a t i o n 3; a n d c o m m u n i c a t i o n , and n o n - i n t r u s i v e  Other  l e s s complex  mentioned i n confidentiality,  consent  treatment procedures mentioned i n  Recommendation 9 above. The  n e x t a n d more c o m p l e x t a s k o f r e f i n i n g t h e  d e f i n i t i o n of mental provincial well.  disorder  n e e d s t o be a d d r e s s e d by e a c h  a d m i n i s t r a t i v e group  The c r i t e r i a  a n d i n t e r p r o v i n c i a l l y as  f o r determining disorder  n e e d t o be  s p e l l e d o u t so t h e y a r e made l e s s d e p e n d e n t upon judgements.  The f a c t o r o f d a n g e r may r e q u i r e  t o be a p p r o p r i a t e  subjective  consideration  as p a r t o f t h e d e f i n i t i o n o f m e n t a l  disorder. With a c l e a r d e f i n i t i o n procedure  f o r compulsory  be w o r k e d o u t . convey,  f o r mental  disorder  then the  t r e a t m e n t , i f n e c e s s a r y , needs t o  Or two p r o c e d u r e s - - o n e  a n d one t o f o r c i b l y  t o apprehend  g i v e treatment--may  be  and required.  78 These t a s k s  do  considerable  not  have s i m p l e  s o l u t i o n s and  time to complete.  will  require  Time i s n e e d e d so t h a t  the  s t a t u t o r y c h a n g e s a r e made b a s e d upon a d e q u a t e , w e l l developed  information.  I n summary, f o r m e n t a l h e a l t h necessary to re-define p r o c e d u r e s by various  mental disorder  examining the  t r e a t m e n t not  amended a c t  custody oriented.  implementation of the ensuring  the  needs of s o c i e t y are  L e g i s l a t i o n can i s s u e but  the  statute w i l l  provide  t h a t are  involved  l e g i s l a t i o n can  s t a t e the  a p p l i c a t i o n or process  r e f l e c t e d i n the  law.  f o r managing  and  issue.  a r e many f a c t o r s  b e l i e f s as w e l l as t h e For  i t i s t i m e now  t h e s e r e a s o n s and current f o r a new  an  not  p r i n c i p l e s which recognize  observed d e f i c i e n c i e s i n the legislation,  or  in putting principles into practice.  s o c i a l values the  the  contents  new  complete the  for there  the  with  a c t u a l c o n t r o l o f human b e h a v i o r w i l l  a r e s u l t of l e g i s l a t i n g  k n o w l e d g e on  Once t h e  an o r g a n i z a t i o n  o c c u r as  current  from  so t h a t t h e  a review of the  i t is  confinement  then followed  legislation  i s proclaimed,  and  evidence s o l i c i t e d  g r o u p s m e n t i o n e d above and  p r o c e s s of r e - w r i t i n g the are  legislation,.first  mental focus.  the  state  a l l the  health  But  of other  79 BIBLIOGRAPHY A p p e l b a u m , P a u l S. 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" H o s p i t a l a n d Community P s y c h i a t r y , v o l . 3 2 , n o . 4 ( A p r i l 1 9 8 1 ) : p. 2 3 3 . R o z o v s k y , L o m e E. a n d F a y A. R o z o v s k y . "Importing Legal Concepts." D i m e n s i o n s o f H e a l t h S e r v i c e , v o l . 57, n o . 8 ( A u g u s t ____________ R o z o v s k y , L o m e E. " H e a l t h and L e g i s l a t i v e P l a n n i n g . " C a n a d i a n H o s p i t a l , v o l . 48, n o . 7 ( J u l y 1 9 7 1 ) : p p . 34-36. Rubin, J e f f r e y . E c o n o m i c s , M e n t a l H e a l t h a n d t h e Law. Company, L e x i n g t o n , M a s s . , 1978.  D. C. H e a t h a n d  84 Saskatchewan. R e v i s e d S t a t u t e s o f Saskatchewan, Mental Health A c t .  1 9 7 8 , c . M. 1 3 ,  Scallett, Leslie J. " M e n t a l H e a l t h Law a n d P u b l i c P o l i c y . " H o s p i t a l a n d Community P s y c h i a t r y , v o l . 3 1 , no. 9 ( S e p t e m b e r 1 9 8 0 ) : p p . 614-617. S c h u r , E d w i n M. The P o l i t i c s o f D e v i a n c e . J e r s e y , 1980.  Prentice-Hall,  I n c . , New  Shah, S a l u m A. " C r i m e a n d M e n t a l I l l n e s s : Some P r o b l e m s i n D e f i n i n g and L a b e l l i n g D e v i a n t B e h a v i o u r . " M e n t a l H y g i e n e , v o l . 53, no. 1 ( J a n u a r y 1 9 6 9 ) : p p . 21-33. Sharpe, G i l b e r t and G l e n n Sawyer. D o c t o r s a n d t h e Law. B u t t e r s w o r t h a n d Company L t d . , 1978.  (Canada)  Sharpe, G i l b e r t . "Commitment o f t h e M e n t a l l y 1 1 1 . " H e a l t h Law i n C a n a d a , v o l . 1, no. 1 ( S p r i n g 1 9 8 0 ) : p. 8. S t a n n a r d - F r i e l , Don. H a r r a s s m e n t T h e r a p y : A Case S t u d y o f P s y c h i a t r i c Violence. Schenkman P u b l i s h i n g Co., C a m b r i d g e , M a s s . , 1981. S w a d r o n , B a r r y B. a n d D o n a l d R. S u l l i v a n , e d i t o r s . The Law a n d M e n t a l D i s o r d e r , A C o m p r e h e n s i v e E d i t i o n o f t h e R e p o r t o f t h e C o m m i t t e e on L e g i s l a t i o n a n d Psychiatric Disorder. Committee o f t h e 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 of the Canadian Mental H e a l t h A s s o c i a t i o n , Canada, 1973. S z a s z , Thomas S. Law, L i b e r t y a n d P s y c h i a t r y . New Y o r k , 1 9 6 3 . S z a s z , Thomas S. Psychiatric Slavery. 1977 .  The M a c M i l l a n Company,  C o l l i e r M a c M i l l a n Canada L t d . ,  T a n c r e d i , L a w r e n c e R. "The R i g h t s o f M e n t a l P a t i e n t s : W e i g h i n g t h e 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 a n d Law, v o l . 5, no. 2 (Summer 1 9 8 0 ) : p p . 190-203.  85 Townsend, F. R., and L o r n e E. R o z o v s k y . "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 pp. 13-14. W e 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 t h e C a n a d i a n P r e s s , T o r o n t o , C a n a d a , 1980 .  Context.  1979):  Pergamon  86 APPENDIX A B r i t i s h N o r t h A m e r i c a A c t , 1867 S e c t i o n 91-92 Part VI.  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 o f t h e 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. . . . o f such House, l a The P u b l i c D e b t a n d P r o p e r t y . 2 The R e g u l a t i o n o f T r a d e a n d Commerce. 2a Unemployment I n s u r a n c e . 3 The r a i s i n g o f Money by any Mode o r S y s t e m o f T a x a t i o n . 4 The b o r r o w i n g o f Money on t h e P u b l i c C r e d i t . 5 Postal Service. 6 The C e n s u s a n d 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 a n d N a v a l S e r v i c e , and D e f e n c e . 8 The f i x i n g o f a n d p r o v i d i n g f o r t h e S a l a r i e s a n d 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 o f t h e Government o f Canada. 9 Beacons, Buoys, L i g h t h o u s e s , and S a b l e I s l a n d . 10 N a v i g a t i o n a n d S h i p p i n g . 11 Q u a r a n t i n e a n d t h e E s t a b l i s h m e n t a n d M a i n t e n a n c e o f M a r i n e Hospitals. 12 Sea C o a s t a n d I n l a n d F i s h e r i e s . 13 F e r r i e s b e t w e e n 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 o u n t r y o r b e t w e e n Two P r o v i n c e s . 14 C u r r e n c y a n d C o i n a g e . 15 B a n k i n g , I n c o r p o r a t i o n o f B a n k s , a n d t h e I s s u e o f P a p e r Money. 16 S a v i n g s B a n k s . 17 W e i g h t s a n d M e a s u r e s . 18 B i l l s o f E x c h a n g e a n d P r o m i s s o r y N o t e s . 19 I n t e r e s t . 20 L e g a l T e n d e r . 21 B a n k r u p t c y a n d I n s o l v e n c y . 22 P a t e n t s o f I n v e n t i o n a n d 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 , a n d L a n d s r e s e r v e d f o r t h e I n d i a n s . 25 N a t u r a l i z a t i o n a n d 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, e x c e p t t h e C o n s t i t u t i o n o f C o u r t s o f 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 Criminal Matters. 28 The E s t a b l i s h m e n t , M a i n t e n a n c e , a n d Management o f Penitentiaries. 29 S u c h C l a s s e s o f S u b j e c t s a s a r e e x p r e s s l y e x c e p t e d i n t h e E n u m e r a t i o n o f t h e C l a s s e s o f 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 Provinces. And any M a t t e r c o m i n g w i t h i n any o f t h e C l a s s e s o f S u b j e c t s e n u m e r a t e d i n t h i s S e c t i o n s h a l l n o t be deemed t o come w i t h i n  87 the C l a s s of Matters of a l o c a l or p r i v a t e Nature comprised i n t h e E n u m e r a t i o n o f t h e C l a s s e s o f S u b j e c t s by t h i s A c t assigned 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. I n e a c h P r o v i n c e t h e 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 c o m i n g w i t h i n t h e 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 f r o m 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 t h e C o n s t i t u t i o n o f t h e P r o v i n c e , e x c e p t as regards 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 Taxation w i t h i n the Province i n order t o the r a i s i n g o f a Revenue f o r P r o v i n c i a l P u r p o s e s . 3 The b o r r o w i n g o f Money on t h e s o l e C r e d i t o f t h e P r o v i n c e 4 The E s t a b l i s h m e n t and T e n u r e o f P r o v i n c i a l O f f i c e s and t h e A p p o i n t m e n t and Payment o f 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 t h e P u b l i c L a n d s b e l o n g i n g t o t h e P r o v i n c e and o f t h e T i m b e r and Wood t h e r e o n . 6 The E s t a b l i s h m e n t , M a i n t e n a n c e , and Management o f 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 t h e P r o v i n c e . 7 The E s t a b l i s h m e n t , M a i n t e n a n c e , and Management o f H o s p i t a l s , A s y l u m s , C h a r i t i e s , and E l e e m o s y n a r y 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 t h a n M a r i n e 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 , T a v e r n , 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 o f 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 Purposes. 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 t h a n s u c h as a r e o f the f o l l o w i n g C l a s s e s : (a) L i n e s o f Steam o r 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 o r o t h e r s o f t h e 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 b e t w e e n t h e 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 a s , a l t h o u g h wholly s i t u a t e w i t h i n the P r o v i n c e , are before 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 C a n a d a t o be f o r t h e g e n e r a l A d v a n t a g e o f C a n a d a o r f o r t h e A d v a n t a g e o f Two o r more o f 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 o f C o m p a n i e s 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 o f M a r r i a g e i n t h e 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 t h e P r o v i n c e . 14~" The A d m i n i s t r a t i o n o f J u s t i c e i n t h e P r o v i n c e , i n c l u d i n g t h e C o n s t i t u t i o n , M a i n t e n a n c e , 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 o f C i v i l and o f 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 Procedure i n C i v i l Matters i n those Courts. 15 The I m p o s i t i o n o f P u n i s h m e n t by F i n e , P e n a l t y , o r I m p r i s o n m e n t f o r e n f o r c i n g any Law o f 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 c o m i n g w i t h i n any o f t h e C l a s s e s o f 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 Matters of a merely l o c a l or p r i v a t e Nature i n the Province.  88 APPENDIX B C h a r t e r o f R i g h t s a n d F r e e d o m s , 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 o f t h e C a n a d i a n C h a r t e r o f R i g h t s and F r e e d o m s , C o n s t i t u t i o n A c t , 1982 a r e r e l e v a n t t o t h i s  study.  6. (2) E v e r y c i t i z e n o f Canada a n d e v e r y p e r s o n who h a s t h e s t a t u s o f a permanent r e s i d e n t o f Canada has t h e r i g h t : (a) To move t o a n d 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 p u r s u e t h e - g a i n i n g o f 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) a r e s u b j e c t to: (a) Any l a w s o r p r a c t i c e s o f 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 t h a n t h o s e t h a t d i s c r i m i n a t e among p e r s o n s p r i m a r i l y on t h e b a s i s o f p r o v i n c e o f 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 l a w s 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 o f p u b l i c l y p r o v i d e d s o c i a l services. 7. E v e r y o n e h a s 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 o f t h e p e r s o n a n d t h e r i g h t n o t 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 accordance 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. E v e r y o n e h a s t h e r i g h t t o be s e c u r e search or s e i z u r e . or  against  9. E v e r y o n e h a s t h e r i g h t n o t t o be a r b i t r a r i l y imprisoned.  unreasonable detained  12. E v e r y o n e h a s t h e r i g h t n o t 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 p u n i s h m e n t . 15. (1) E v e 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 a n d u n d e r t h e l a w and h a s 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 a n d e q u a l b e n e f i t of t h e 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 b a s e d 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 , s e x , age o r m e n t a l o r p h y s i c a l disability. (2) S u b s e c t i o n (1) does n o t p r e c l u d e any l a w , p r o g r a m 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 t h e 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 disadvantaged i n d i v i d u a l s o r groups i n c l u d i n g those t h a t are disadvantaged 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 , s e x , age o r m e n t a l 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 o r f r e e d o m s , as g u a r a n t e e d by t h i s c h a r t e r , h a v e b e e n 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 o f c o m p e t e n t j u r i s d i c t i o n t o o b t a i n s u c h remedy as t h e 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 t h e 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 g o v e r n m e n t o f Canada i n r e s p e c t of a l l matters 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 t h e Yukon T e r r i t o r y a n d N o r t h w e s t T e r r i t o r i e s ; and (b) To t h e l e g i s l a t u r e and g o v e r n m e n t o f e a c h p r o v i n c e i n respect of a l l matters w i t h i n the a u t h o r i t y of the l e g i s l a t u r e of 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 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 " , "Physician." The  Acts  d e f i n i t i o n s t h a t appear i n t h e f i v e p r o v i n c i a l  mental health  acts  a r e as f o l l o w s .  B R I T I S H COLUMBIA (R.S.B.C. 1 9 7 9 , c . 256, M e 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 c h a r g e o f a p r o v i n c i a l m e n t a l h e a l t h f a c i l i t y and i n c l u d e s a p e r s o n 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 o u t a d u t y c o n f e r r e d o r i m p o s e d on t h e d i r e c t o r u n d e r t h i s Act. M e n t a l l y D i s o r d e r e d P e r s o n - 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 o f t h e 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 react a p p r o p r i a t e l y t o h i s environment or 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 a n d c o n t r o l o f t h e person necessary f o r h i s p r o t e c t i o n or welfare or 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 u n d e r 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 c h a r g e o f 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 mentally disordered person. Physician  - 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 u n d e r S e c t i o n 5.  licensed  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 m e n t a l 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. 1 9 7 8 , c . M. 13, M e 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 t h e r e g i s t e r o f t h e C o l l e g e o f P h y s i c i a n s and Surgeons o f 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 w a r d , m e n t a l 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 or portion thereof set aside f o r the care, treatment or t r a i n i n g of mentally disordered persons. M e n t a l I l l n e s s - means a d i s o r d e r o f m i n d o t h e r t h a n p s y c h o p a t h i c d i s o r d e r or 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 disturbance i n a person's behaviour or f e e l i n g s or t h 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 m e n t a l d i s t r e s s or impaired a b i l i t y t o associate with others 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 o f w h i c h 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 person 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 treatment or d i a g n o s t i c s e r v i c e s f o r the purpose of determining the existence of mental d i s o r d e r . ONTARIO (R.S.O. 1 9 8 0 , c . 2 6 2 , M e n t a l H e a l t h Physician  - means a l e g a l l y  Mental Disorder  A c t , 1978)  q u a l i f i e d medical p r a c t i t i o n e r .  - means any d i s e a s e  or d i s a b i l i t y  o f t h e 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 t h e 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 o f 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 acceptable to 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 u n d e r o b s e r v a t i o n , treatment i n a f a c i l i t y .  c a r e and  I n v o l u n t a r y P a t i e n t - means a p e r s 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 o f i n v o l u n t a r y admission or a c e r t i f i c a t e of renewal. 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 t h e 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 o f p e r s o n s s u f f e r i n g from m e n t a l d i s o r d e r a n d d e s i g n a t e d a s s u c h by t h e r e g u l a t i o n s . QUEBEC (R.S.Q. 1 9 7 7 , c . P. 4 1 , 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 t h e meaning o f 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 q u i p p e d 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 c o m m u n i t y s e r v i c e c e n t r e w i t h i n t h e meaning o f 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 q u i p p e d 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 f r o m m e n t a l d i s o r d e r s . P s y c h i a t r i c Establishment f o r D e t a i n e d P e r s o n s - 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 of a person r e q u i r e s t h a t he be p l a c e d u n d e r c l o s e t r e a t m e n t .  92 Psychiatrist - a physician holding a specialist'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 t h e C o l l e g e o f P h y s i c i a n s and S u r g e o n s o f t h e P r o v i n c e o f Quebec. T h e r e i s no d e f i n i t i o n o f m e n t a l d i s o r d e r i n t h e M e n t a l Patients'^Protection Act. mental d i s o r d e r s Social Services. a facility  There i s a minor r e f e r e n c e t o  i n the Act Respecting Hospital centre  Health  i s defined  t o which persons are admitted  purposes, medical  diagnosis, medical  mental r e h a b i l i t a t i o n excluding,  S e r v i c e s and i n t h a t a c t as  f o r preventive  treatment,  physical or  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 a n d an i n f i r m a r y where a r e l i g i o u s or e d u c a t i o n a l  i n s t i t u t i o n receives  i t s s t a f f and  students.  NOVA SCOTIA (R.S.N.S. 1 9 6 7 , 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 , treatment at or i n a h o s p i t a l .  lodging or  P e r s o n U n d e r 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 p u s u a n t 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 t h e P r o v i n c i a l M e d i c a l B o a r d , o r who, on o r b e f o r e t h e 3 1 s t d a y o f December, 1977, i s e l i g i b l e t o w r i t e f o r a C a n a d i a n F e l l o w s h i p i n P s y c h i a t r y o f t h e 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 s o d e s i g n a t e d by t h e M i n i s t e r f o r t h e 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 o f p e r s o n s s u f f e r i n g f r o m p s y c h i a t r i c disorder. 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 t h e 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  Stage of procedure  British Columbia  P a t i e n t seen  2 physicians  Order written  Within 14 d a y s  Saskatchewan 2 physicians  1 physician  "'.  Assessment  Renewals  Ontario  Nova Scotia  Quebec 1 psychiatrist  2 psychiatrists  Within 7 days  Conveyed t o facility  Certificate(s) completed  Provinces  Within 7 days Not more t h a n 120 hours  good t o anniversary date of admission  good f o r 14 days f r o m when 1 s t seen  1 certificate (1 p h y s i c i a n ) good f o r 2 weeks  1st year 2nd 2 y e a r s  1 s t 3 Mon. 2nd 6 Mon, a l l rest 12 Mon.  1 s t 1 Mon. 2nd 2 Mon. 3 r d 3 Mon.  Within 24 h o u r s  Within 4 8 hours  W i t h 96 h o u r s W i t h i n 24 h o u r s 1 certificate by p h y s i c i a n (1 p s y c h i a t r i. ssi t ) W i t h i n 3 d a y s good f o r by p s y c h i a t r i s t 21 d a y s  1  1st 2nd 3rd 4th  2 3 6 12  Mon. Mon. Mon. Mon.  1st 2nd 3rd Rest  3 3 6 12  Mon. Mon. Mon. Mon.  

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