| On February 28, a cop was killed and a debate about whether some of Alberta’s mentally ill citizens should be forced into treatment was reignited.
It was on that day RCMP Cpl. Jim Galloway, 55, was shot and killed during a six-hour armed standoff with Martin Charles Ostopovich, 41, in the quiet community of Spruce Grove just west of Edmonton.
Ostopovich, who was also killed that day, had been diagnosed with paranoid schizophrenia five years previously after sustaining a serious head injury resulting from a rollover car accident, according to family members. He was well known to RCMP and had a criminal history dating back to 1978 with charges against him that included unsafe storage of a firearm in 1983 and possession of a weapon in 1986. Although Ostopovich was prescribed medication to treat schizophrenia he was reportedly not taking it.
Fay Herrick of the Schizophrenia Society of Alberta (Calgary Chapter) says that the Ostopovich story should cause the Alberta government to consider more intrusive ways of dealing with mentally ill people who refuse to accept treatment. One of the options being forwarded by her organization is amending the Mental Health Act to include mandatory treatment orders.
If mandatory treatment orders are introduced in Alberta, a person with a psychiatric history similar to Ostopovich could be forced to accept treatment by being involuntarily hospitalized before a crisis erupts. It’s something that the provinces of B.C., Saskatchewan and Ontario are trying, and a strategy Herrick and the Schizophrenia Society hopes is adopted here.
Alberta’s current Mental Health Act has provisions for involuntary detention and hospitalization if a person is shown to have a mental disorder, is a danger to themself or others and there are no other alternatives. The Schizophrenia Society believes that criteria is too restrictive and is lobbying Alberta’s legislators to amend the Mental Health Act to add mandatory treatment orders under broader terms.
"If the person runs into trouble with the law and there is a history of non-compliance then we think mandatory treatment should be considered," says Herrick.
The Schizophrenia Society calls their proposal "outpatient commitment." Essentially it would be a court order that would force a mentally ill person (who is unable to provide for their own basic needs) to follow a treatment plan that includes taking prescribed medications or face involuntary hospitalization.
This is an issue that hits close to home for Herrick. Her 37-year-old son was diagnosed with schizophrenia as an 18-year-old high school student. Since then he has been hospitalized 15 times, including three times when Herrick went before the courts to get a mental health warrant under current laws to have her son hospitalized against his will.
"One time he came home with the clothes on his back and that’s all," she says. "He had decided to stop taking his medication."
Ron LaJeunesse, executive director of the Alberta division of the Canadian Mental Health Association of Alberta sympathizes with people like Herrick but says mandatory treatment orders are not the answer.
"They (treatment orders) have usually been a knee-jerk reaction to a shooting," he says.
LaJeunesse believes the Alberta government can make the most positive impact by providing expanded mental health services.
"Treatment orders don’t work unless there is comprehensive services; we don’t have comprehensive services in Alberta," he says. "The solution isn’t legislation."
Linda McKay-Panos, executive director of the Alberta Civil Liberties Research Centre at the University of Calgary, says that any legislative approach in response to mentally ill individuals who refuse treatment would ultimately be challenged in the courts.
"It would definitely be difficult to pass something that would pass muster with Canada’s Charter of Rights," she says.
McKay-Panos has written extensively on the topic, including the book Representing the Mentally Disabled and the Law. The 744 page volume is now more than a decade old and is being updated to encompass the issues that are currently being debated.
"The civil liberties position in general is that people should be able to refuse treatment," she says. "You and I can unplug and leave the hospital anytime we choose; persons who are mentally disturbed, and I use that term in the broadest terms, should also have that right."
A yet-to-be-released provincial mental health plan that identifies gaps in the mental health system is now being considered by Alberta’s Health Minister, Gary Mar. The so-called "blueprint for mental health services" includes input from regional health authorities, consumers of mental health services and organizations such as CMHA and the Schizophrenia Society.
One of the key recommendations, according to a draft of the document, is that more funding be directed toward what is called assertive community treatment. Assertive community treatment is a community-based service model offered to the most severely mentally ill, including those with schizophrenia. It was developed in the 1960s from groundbreaking research by Drs. Arnold Marx, Leonard Steinand Mary Ann Test in Madison, Wisconsin. Since that time, organizations including the U.S. Department of Veterans Affairs have implemented assertive community treatment to provide services and support to some of its most resistant clients.
In Calgary, the Assertive Community Teamoperated by the Calgary Health Region provides services to adults with severe or persistent mental illness who have avoided treatment or who have been unable to engage in traditional mental health or community services. A typical Assertive Community Team client may be homeless and have difficulty remembering to take prescribed medications.
Assertive Community Teams are made up of a psychiatric nurse, social worker and a rehabilitation specialist who are proactive in their approach by meeting with clients in their own environment and by offering support and services on a year-round basis. In Alberta, the Assertive Community Team began in 1999 as a demonstration project in Calgary and Medicine Hat and is now delivered on a province-wide basis.
Other recommendations contained within a draft of the report urges the province to provide an additional $500 million to mental health services on top of its current annual budget of $472 million.
The Provincial Mental Health Report is expected to be released to the public in the next few weeks.
During the intervening period, concerned individuals and organizations alike will be watching the provincial government to see what direction it takes as social policy that could affect some of Alberta’s most ill citizens is re-engineered. |
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