[DATE]

CURRENT MENTAL HEALTH LAWS ARE IMPEDING ACCESS TO CARE

Dear Hons. Doug Ford, Sylvia Jones, Vijay Thanigasalam, Marit Stiles, France Gelinas, Robin Lennox, Bonnie Crombie, Lee Fairclough, Doug Downey, Michael Tibollo and Kristyn Wong-Tam,

Ontario’s current mental health laws prevent my family member from accessing inpatient psychiatric treatment when they need it because criteria for involuntary hospital admission are too narrow, excluding many individuals who are suffering serious non-bodily harms or who have suffered mental or physical deterioration and who have not benefited from prior treatment (MHA Section 20 (1.1; 5)). Moreover, if they are admitted and are found to be incapable for treatment decisions, they may contest a Consent and Capacity Board's finding of incapacity to the Superior Court but not access treatment while they wait. (HCCA section 18).

My family member’s symptoms have included:

• Hallucinations  
• Delusions – fixed false beliefs
• Disorganized speech or behaviors
• Social withdrawal and reduced motivation
• Emotional lability or dysregulation
• Grandiosity
• Impulsive behaviors

My family member does not have insight into their symptoms or the consequences of their mental illness. They declined treatment with psychiatric medications. The only way to improve their health is through an involuntary admission for treatment. 

Although my family member is experiencing serious harm due to untreated illness, they cannot be involuntarily admitted because they are not a likely serious bodily harm risk to self/others, or at likely risk of serious physical impairment (Form 3, Box A criteria). My family member has also never had psychiatric treatment before, and therefore cannot demonstrate a history of their health improving in response to treatment. Consequently, despite suffering substantial mental or/and physical deterioration, they do not meet the Ontario Mental Health Act’s criteria for involuntary admission to a psychiatric facility (Form 3, Box B criteria). This creates a gap in care for those who are significantly mentally unwell and not receiving psychiatric treatment, despite their likely risk for other forms of serious harm (beyond acute bodily safety risks), or despite psychiatric treatment being in their best interest or being a previously-expressed capable wish for treatment.

Another problem my family member has faced, or I am worried will happen, is even when they meet the requirements for an involuntary admission and are found to be incapable of consenting to treatment, they will be detained in hospital without treatment. This would happen if my family member challenges a review board’s finding of incapacity and has to wait for a Superior Court hearing.

As a result, my family member remains unwell and untreated, with no appreciation of their situation and is suffering the following consequences:

• Causing physical harm to others
• Causing physical harm to self
• Cognitive, memory, or thinking impairments
• Educational impairment or loss
• Relationship problems or loss, or social isolation
• Family estrangement
• Financial insecurity  e.g. financial loss, bankruptcy, not qualifying for ODSP
• Food insecurity
• Housing insecurity  e.g. eviction, transience, homelessness
• Interference with physical health, or accessing physical health services
• Being physically assaulted
• Legal or forensic involvement
• Lack of, or loss of vocation or work/employment

The following is my story of the consequences suffered because my loved one did not access inpatient psychiatric treatment:  [    ] 

I urge you to change the Ontario Mental Health Act so that involuntary admission is accessible to people suffering from a serious mental disorder needing treatment that can only be provided in a psychiatric facility, when they are at a likely risk of serious bodily or non-bodily harm. I urge you to make involuntary admission accessible when they are at likely risk of substantial mental or physical deterioration, and are incapable to consent to psychiatric treatment and consent from their legal Substitute Decision Maker has been obtained, while removing the criteria of needing to demonstrate past response to treatment (MHA Section 20 (1.1; 5)).

I urge you to change the Health Care Consent Act so that treatment can be given during lengthy court appeals. (HCCA section 18)

Please see the attached Ontario Psychiatric Association’s (OPA) proposed Mental Health Act and Health Care Consent Act changes. I support the views in this document.

Where do you stand on the issues identified by the OPA and what do you propose to address and remove these barriers to care? What can you do to make these legislative changes happen?

Sincerely,

[YOUR FIRST + LAST NAME

ADDRESS WITH POSTAL CODE]

[DATE]

CURRENT MENTAL HEALTH LAWS ARE IMPEDING ACCESS TO CARE

Dear Hons. Doug Ford, Sylvia Jones, Vijay Thanigasalam, Marit Stiles, France Gelinas, Robin Lennox, Bonnie Crombie, Lee Fairclough, Doug Downey, Michael Tibollo and Kristyn Wong-Tam,

Ontario’s current mental health laws prevent my patients from accessing inpatient psychiatric treatment when they need it because criteria for involuntary hospital admission are too narrow, excluding many individuals who are suffering serious non-bodily harms or who have suffered mental or physical deterioration and have not benefited from prior treatment (MHA Section 20 (1.1; 5)). Moreover, if they are admitted and are found to be incapable for treatment decisions, they may contest a Consent and Capacity Board's finding of incapacity to the Superior Court but not access treatment while they wait. (HCCA section 18).

My patients’ symptoms have included hallucinations, delusions, disorganized speech or behaviors, social withdrawal and reduced motivation, emotional lability or dysregulation, grandiosity or impulsive behaviors. 

The patients I am describing usually lack full insight into their symptoms or the consequences of their mental illness. They declined treatment with psychiatric medications and the only way to improve their health is through an involuntary admission for treatment.

Although my patients experience serious harm due to untreated illness, they cannot be involuntarily admitted because they are not a likely serious bodily harm risk to self/others, or at likely risk of serious physical impairment (Form 3, Box A criteria). These patients have also never had psychiatric treatment before, and therefore cannot demonstrate a history of their health improving in response to treatment. Consequently, despite suffering substantial mental or/and physical deterioration, they do not meet the Ontario Mental Health Act’s criteria for involuntary admission to a psychiatric facility (Form 3, Box B criteria). This creates a gap in care for those who are significantly mentally unwell and not receiving psychiatric treatment, despite their likely risk for other forms of serious harm (beyond acute bodily safety risks), or despite psychiatric treatment being in their best interest or being a previously-expressed capable wish for treatment.

Another problem my patients have faced, or I am concerned will happen, is even when they meet the requirements for an involuntary admission and are found to be incapable of consenting to treatment, they will be detained in hospital without treatment. This would happen if my patients challenge a review board’s finding of incapacity and have to wait for a Superior Court hearing.

As a result, these patients remain unwell and untreated and suffer serious non-bodily harms or eventually serious bodily harms such as causing physical harm to self/others, cognitive, memory or thinking impairments, educational impairment or loss, relationship problems or loss, social isolation, family estrangement, financial insecurity, food insecurity, housing insecurity, interference with physical health or with accessing physical health services, victim of physical assaulted, legal or forensic involvement or lack of/loss of vocation, work or employment.

I urge you to change the Ontario Mental Health Act so that involuntary admission is accessible to people suffering from a serious mental disorder needing treatment that can only be provided in a psychiatric facility, when they are at a likely risk of serious bodily or non-bodily harm. I urge you to make involuntary admission accessible when they are at likely risk of substantial mental or physical deterioration, are incapable to consent to psychiatric treatment and consent from their legal Substitute Decision Maker has been obtained, while removing the criteria of needing to demonstrate past response to treatment (MHA Section 20 (1.1; 5)). 

I urge you to change the Health Care Consent Act so that treatment can be given during lengthy court appeals.

Please see the attached Ontario Psychiatric Association’s (OPA) proposed Mental Health Act and Health Care Consent Act changes. I support the views in this document. 

Where do you stand on the issues identified by the OPA and what do you propose to address and remove these barriers to care? What can you do to make these legislative changes happen?

Sincerely,

[YOUR FIRST + LAST NAME

ADDRESS WITH POSTAL CODE]