Abstract

<p>Reforms in areas related to mental disability are under debate in England to an extent unprecedented for almost half a century. The Law Commission’s proposals on incapacity, following further consultation from the Lord Chancellor’s Department, have now largely been accepted in principle by the government for legislative enactment at some time in the undetermined future. A joint green paper from the Home Office and the Department of Health has established a policy agenda concerning the governance of people with serious personality disorders. Proposals by an expert committee chaired by Professor Genevra Richardson on mental health reform have likewise been followed up by a government green paper, and the two green papers have in turn resulted in a joint white paper on reform of the Mental Health Act 1983. All this takes place as the Human Rights Act 1998 takes effect, with its guarantees relating to liberty and security of the person, standards for hearings, respect for private and family life, and protection from inhuman or degrading treatment. Throughout the development of the reforms, a number of similar themes have recurred, involving civil rights, the provision of appropriate legal processes, anti-discrimination, the respect for people with capacity, the extension of controls into the community, and the safety both of people with mental disabilities and of the public as a whole.</p><p>At least in the public arena, most of the debate has focussed on the English situation. The premise of this paper is that the situation in the rest of the world may have something to teach us. The paper examines the law of Ontario. While it focuses primarily on those issues related to the Richardson Report and its subsequent government response, Ontario legislation divides issues somewhat differently to English law, and thus overlap with the other reform proposals is inevitable.</p>

Highlights

  • Reforms in areas related to mental disability are under debate in England to an extent unprecedented for almost half a century

  • A joint green paper from the Home Office and the Department of Health has established a policy agenda concerning the governance of people with serious personality disorders.[3]

  • Proposals by an expert committee chaired by Professor Genevra Richardson on mental health reform have likewise been followed up by a government green paper,[4] and the two green papers have in turn resulted in a joint white paper on reform of the Mental Health Act 1983.5 All this takes place as the Human Rights Act 1998 takes effect, with its guarantees relating to liberty and security of the person, standards for hearings, respect for private and family life, and protection from inhuman or degrading treatment

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Summary

Historical Overview

The contemporary history of mental health law in Ontario conveniently begins in 1967, with the passage of a new Mental Health Act.[6]. New guardianship legislation covering financial and personal decisions other than health care and mental health confinement was passed as the Substitute Decisions Act 1992.15 The government was acutely aware of the need for effective enforcement and administration of these statutes. In Ontario, homicides by those with psychiatric difficulties have in recent years been high profile as they have been in England, and the government responded with Brian’s Law (Mental Health Legislative Reform), 2000.18 This law makes minor amendments to the existing confinement criteria, as well as adding a new ground of confinement concerning people who lack capacity to consent to treatment and whose mental illness is both of a recurring nature and has been shown amenable to treatment. Monahan et al ‘Coercion and commitment: Understanding involuntary mental hospital admission’ 18 International Journal of Law and Psychiatry (1995) 249

Lessons for England?
Criteria and Process for Involuntary Admission
Treatment Provisions
Community Treatment Orders
The Consent and Capacity Review Board and Due Process Protections
Conclusion
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