The following letter was written by Dr. Richard O'Reilly, psychiatrist emeritus professor of psychiatry at Western University London, Ontario and Dr. John Gray, lead author of mental health law and policy. It was published on The Guardian Opinion page November 16, 2023.
The title of the letter is:
MENTAL HEALTH BILL CONTAINS FATAL FLAW. CRITICAL WORD MISSING IN PROPOSED COMMUNITY TREATMENT ORDER LEGISLATION.
Marlene Bryenton and her husband, Lloyd, have been pushing for changes to P.E.I.'s Mental Health Act to allow family members to compel people in crisis be admitted for treatment. They have been pushing for changes to the community treatment order under P.E.I. Mental Health Act.
OPINION LETTER:
The Government of Prince Edward Island is to be commended for its proposal to make community treatment orders (CTOs) available to Prince Edward Islanders. A significant number of individuals who suffer from severe and persistent mental illnesses do not appreciate that the hallucinations and delusions they experience are symptoms of illness and stop the treatment needed to keep them well when not in hospital.
This predictably results in a revolving door of admissions and discharges. It also occasional results in tragedies in which the person harms themselves or, more rarely, harms someone else.
IMPROVING LIVES:
All Canadian provinces, except for P.E.I., have already legislated CTOs, or equivalent laws, that require an individual to attend clinical services and take treatment in the community, if the person cannot understand the need for treatment and is at high risk of stopping treatment. Independent reviews, carried out in these provinces, show that CTOs work well and have improved the lives of severely ill patients and their families.
Unfortunately, we see a fatal flaw in the proposed P.E.I. bill, which would restrict the use of CTOs to people who in the previous two years have been “admitted as an involuntary patient in a psychiatric facility on two or more separate occasions, for a total of at least 30 days.” Because of the shortage of psychiatric beds, it is increasingly rare for anyone to meet this requirement for recent hospitalization. Even a patient with a severe psychotic illness who has been had been hospitalized for six months would not qualify.
DOCTOR'S ASSESSMENT:
Without a change in the legislation accessing a CTO in P.E.I. would be the more difficult than in any other Canadian province. For example, New Brunswick, the most recent province to legislate CTOs, permits a person to be placed on a CTO based on a doctor’s assessment of their symptoms, behavior and risk rather than on an arbitrary number of admissions and Saskatchewan, the first province to introduce CTOs, later dropped its requirement for multiple admissions or for a specific number of days spent in hospital.
Because of the shortage of psychiatric beds, it is increasingly rare for anyone to meet this requirement for recent hospitalization. Even a patient with a severe psychotic illness who has been had been hospitalized for six months would not qualify.
The ineffectiveness of P.E.I.'s proposed legislation is illustrated by the case of a P.E.I. man recently reported in the media. The P.E.I. resident apparently developed a psychotic illness five years ago and was hospitalized for a month. After he was discharged from hospital, he stopped his medication, rapidly relapsed and then in quick order lost his job, his home, his family and ended up living rough on the streets of Toronto.
His mother, Marlene Bryenton, spent the last year tirelessly working to have her ill son admitted to hospital in Ontario and finally she arranged for him to be brought back to P.E.I. for treatment. It was Mrs. Bryenton who first suggested that P.E.I. introduce CTOs so that they would be available to prevent her son from again simply stopping medication when he is eventually discharged.
Unfortunately, despite his mother’s efforts, her son will not be eligible for the CTO legislation his mother has helped to bring to P.E.I. When discharged from his current admission, he will only have had one psychiatric admission in P.E.I. in the previous two years, irrespective of how long his current admission lasts.
ONE SIMPLE WORD:
The good news is that one simple word can make the P.E.I. legislation available to individuals like this. Adding the word “or” in the requirements for hospitalization in the previous two years would allow a longer admission to be an alternative to the requirement for multiple admission. The legislation would then read that a person must have been “ … an involuntary patient in a psychiatric facility on two or more separate occasions, or for a total of at least 30 days.”
This would bring P.E.I.'s legislation into line with that of other provinces, such as Ontario, which requires that in the previous three years the person has had two admissions or at least 30 days in hospital.
It’s a small word, but it will make a world of difference to Marlene Bryenton, her son and the many other residents of P.E.I. who suffer from severe mental illness and to the families who support those individuals in the community.