July 5 juillet 16:00 – 17:45
Room NCDH–200
Chair: Mary Kay
O’Neil
, Psychoanalyst, Montréal
Throughout the United States, individuals with mental
illness are confined against their will in psychiatric hospitals as a result of
allegations of dangerous behavior. Some are committed involuntarily by a judge
after an administrative hearing is conducted where the mentally ill person is
afforded legal representation, a right to be present and important due process
protections including the right to cross-examine witnesses and present one’s
own witnesses. However, a significant number of individuals who are initially
confined in psychiatric institutions on the basis of assertions that the
individual presents a danger to life or safety never see the light of an
impartial judge, lawyer, or family member. These mentally ill individuals are
not retained as an involuntary patient at the facility, but rather as voluntary
patients without the benefit of due process protections. The legal and medical
implications of being a voluntary patient in a psychiatric hospital will be
discussed. This presentation will make specific recommendations as to when a
psychiatric hospital will be permitted to accept and treat a mentally ill person
as a voluntary patient.
Severely chronically ill children’s health care needs are
both more expensive than and different in kind from that for non-disabled
children. In addition to the preventive care, and the occasional acute care
provided to non-disabled children, children with disabilities require “chronic
care.” For children with chronic psychological and cognitive impairments, care
can include long-term psychological, social work and occupational therapy. These
services exist on the border between “medical” and “social” care. This
distinction was unimportant prior to the era in which medical managed care
organizations came to dominate both public and private American medical
insurance. Recently, parents with chronically ill children have found that
essential care is neither fish nor foul: medical MCOs reject coverage because
it is not “medially necessary” or “curative.” Government services
are less available, as care for children is privatized into systems unaccustomed
to treating the chronically ill. This presentation will describe the current
state of this shifting situation, and examine the legal framework within which
the disjointed coverage must be brought together.
In Ontario, the Personal Health Information Privacy Act 2000 has been drafted in order to provide consistent and comprehensive rules that had been lacking with regard to those responsible for collecting health information. In addition to protecting the privacy, confidentiality and security of personal health information, a secondary aim is to facilitate the use of personal health information to improve quality of care for patients.
In New Zealand, the Mental Health [Compulsory Assessment and Treatment] Amendment Act 1999 came into force in April 2000. This amendment was designed to facilitate family involvement in the care, assessment and treatment of the mentally ill. It arose from a concern that New Zealand Privacy Act legislation was being used by mental health professionals to avoid communicating with the family. The World Schizophrenia Fellowship noted in 1998 that research had conclusively shown that there were significant clinical, social and economic advantages to providing mental health services in a family-inclusive way.
In contrast, clinical experience suggests that the family may have been instrumental in developing the patient as a representative of family pathology. On the other hand, in many cases the family is the reconstituting unit for the fractured individual.
This paper compares and contrasts two very different legislative approaches to this dilemma in Commonwealth communities with otherwise very similar approaches to mental health legislation and the treatment of the mentally ill.
Several decades of rights work has produced no substantial change in the pattern of psychiatric oppression. Defense work, occasionally successful for individuals, does not address bio-psy triumphalism. Psy-ideology and pseudoscience mystify severe distress and breakdown, and grossly exaggerate efficacy of psy-medication. We have neurotransmitter disturbances and broken brains–not unmet needs, powerlessness, hopelessness, or broken identities. The framework represses out the larger social context–unrestrained competitive individualism, pervasive insecurity, oppressive work, erosion of community, the triumph of the Market–creating and aggravating powerlessness, especially for those who are more vulnerable because of specific histories. Courtroom psychiatric testimony–crude and selective–continues to employ the “entity” paradigm. Despite several decades of withering criticism and thorough debunking, the concept of “diagnosis” persists. A steady bombardment from Academic Psy-Big Pharma sustains debunked concepts, especially “Schizophrenia.” The DSM continues to serve as textbook and Bible in the courtroom. “Competency” and “dangerousness” hearings are generally charades, rationalizing the hegemonic “need for treatment” (medication, hospitalization). The need is for bold strategies to contest psy-ideology, judicial deference to psy-pseudoscience and authority, and the scandalous paucity of critical resources–real employment, adequate housing alternatives and income and a range of small supportive asylum locations. Tribunals would require cadres of advocates (including lawyers) armed with critical perspective, plus special judges committed to affording equal consideration to alternative critical-position philosophy and testimony.
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