Review of Canadian mental health law and policy.

Abstract

JOHN E. GRAY, MARGARET A. SHONE, and PETER F. LIDDLE Canadian Mental Health Law and Policy Markham, ON: Butterworths, 2000, 400 pages (ISBN -0433-43052-4, C$110, Softcover) Reviewed by JOHN HUNSLEY The approach of most psychologists and other mental health professionals towards the realm of public policy and law is perhaps best characterized as one of benign neglect. Most of us concentrate our efforts on conducting research and/or providing services and professional training. Far too infrequently do we attempt to contribute to the shaping of broader policy issues that affect both those who receive our services and our professions themselves. Fortunately, the authors of this book - a policy advisor, a lawyer, and a professor of psychiatry - take their responsibility to inform and guide public debate very seriously. They have produced a multidisciplinary text that succinctly summarizes the main points of Canadian mental health laws and the variability across provinces and territories in these laws and in their typical interpretation and application. By their estimates, there are 800,000 Canadians with severe mental disorders (especially schizophrenia and bipolar disorder) whose lives may be touched and, indeed, altered by these laws. For these individuals, their family members, and the health and legal professionals who work with them, this book offers a concise guide to the laws dealing with key issues such as involuntary hospital admission, authorization of psychiatric treatment, and treatment refusal. Although not always an easy read for those unfamiliar with legal terms and writing, the book is geared to a wide audience that includes legal and policy specialists, mental health professionals, and advocates for the mentally ill. The first quarter of the book focuses on setting the stage for later presentations on Canadian law and policy. To this end, early chapters are focused on providing an overview of Canadian mental health law, historical considerations affecting legal interpretations, and the nature, causes, and treatment of severe mental disorders. This last chapter is rather dated and limited in scope, providing little information on either (i) the important treatment implications (including therapeutic enhancements and reduced side-effects) of the second generation of antipsychotic medication or (ii) the role of psychosocial interventions in reducing relapse and rehospitalization. In contrast, the chapter on historical matters will undoubtedly be of value to those who teach courses on professional standards and ethics. The authors' presentation of how the legal requirement of physical dangerousness supplanted the standard of the need for treatment is particularly compelling, as are their discussions of how the Canadian Charter of Rights and Freedoms might affect mental health law policy and law reform. Most of the remaining chapters, comprising the majority of the text, focus on specific mental health laws dealing with (i) involuntary hospitalization, admission procedures, and treatment requirements, (ii) conditions for refusing treatment, (iii) assisted community treatment, (iv) legal safeguards for patients, (v) mandated services, and (vi) psychiatric issues in the Canadian criminal justice system. Taken together, these chapters provide information on the Mental health acts of each province and territory, the mental disorders provisions of the Criminal Code of Canada, and the numerous adult guardianship, substitute decision-making, and consent to health care laws. …