Summary:

• Current “duty to report” legislation leads to involuntary and often traumatizing healthcare for our clients, that violates our professional obligations to uphold culturally competent care, informed consent, justice, and trauma-informed care.
• This legislation has led many therapists to enact this duty to report out of fear, inexperience, and a lack of confidence in the client themselves. It has also discouraged our profession as a whole to seek out and develop non-carceral care options for clients in crisis.
• Queer and BIPOC communities are significantly more likely to be hospitalized or detained against their will for mental health symptoms, and as a result, those communities are significantly more likely to avoid seeking adequate mental health care.
• The ongoing use of forced hospitalization, which may include the use of involuntary medication and physical restraints, is a continuation of history that began with asylums and madhouses to take away the rights of people who are deemed “ill” and maintain a hierarchical power structure of therapist/doctor being above the client; the use of such measures has no place in trauma-informed healthcare.
• The intent of this change in legislation is not to prevent or eliminate the use of emergency services in situations of suicide risk, but to give the client CHOICE, and to allow the psychotherapist to pursue non-carceral options in their safety planning without fear of disciplinary action from CRPO.

I’ve seen firsthand the profound fear and shame clients face when struggling with suicidal ideation, especially in Western healthcare settings. Clients who’ve said they felt more suicidal upon leaving a hospital, ones who said they would never call a crisis line or seek help again, and ones who lost complete faith in healthcare as a whole.

The current regulation by the College of Registered Psychotherapists of Ontario (CRPO) around “risk of harm to self” is a significant concern and violates clients’ bodily autonomy, often causing significantly more harm through involuntary incarceration. 

Under the CRPO’s existing “duty to report” mandate for clients who express suicidal ideation, Registered Psychotherapists are required to report any imminent threat of harm to self to relevant authorities—namely emergency services. This has led many therapists to enact this duty to report out of fear, inexperience, and a lack of confidence in the client themselves. It has also discouraged our profession as a whole to seek out and develop non-carceral care options for clients in crisis.

Many individuals refuse to disclose these suicidal thoughts to all healthcare workers due to the fear of hospitalization or detention. This not only hinders their chances of receiving much-needed help, but also infringes upon their right to bodily autonomy. The current system is not trauma-informed, and is especially harmful to Black, Indigenous, and other people of colour, as well as people within the 2SLGBTQI+ community, who have historically been mistreated in healthcare settings, including high levels of mistreatment in hospitals and with police.

The most necessary elements in therapeutic relations are trust and safety, built upon the understanding that a client can be open about their mental state without facing punitive measures. The present “duty to report” requirement directly subverts this principle. The ongoing use of forced hospitalization, which may include the use of involuntary medication and physical restraints, is a continuation of history that began with asylums and madhouses to take away the rights of people who are deemed “ill”; the use of such measures has no place in trauma-informed healthcare.

According to the World Health Organization, close to 800,000 people die due to suicide annually, which is one person every 40 seconds. More concerning, some of these cases consist of people who did not seek help because of fear of institutionalization (source: WHO). In Canada, approximately 4,500 people die by suicide each year, and the populations most at risk are men, Indigenous people, people serving federal sentences, and 2SLGBTQI+ folks (Source: Government of Canada). The phenomenon of not seeking help is shown at an alarmingly higher rate for Queer and BIPOC communities due to discrimination and poor quality of care received in healthcare settings (Source: Journal of Counselling Psychology). This alarming statistics underscores the urgency of revising the current CRPO “duty to report” to a “duty to act reasonably,” especially if we claim to value and uphold our promises of justice and culturally competent care.

This reform would enable clients to discuss their feelings openly and ensure that therapists are equipped to respond appropriately, without the risk of a traumatizing hospitalization or detention. By ensuring reasonable measures are taken before any form of institutionalization, therapists can deliver help where it is most needed. This would not mean that hospital settings or emergency services go completely un-used, but that clients who are already connecting to a psychotherapist are given the choice to use services, and therapists are allowed to use non-carceral interventions in their safety planning without fear of disciplinary action from their licensing board. 

To protect both therapists and their clients, we urge the CRPO to prioritize this crucial reform. Join us in urging the CRPO to reform the "duty to report" regulation around risk of harm to self to a "duty to act reasonably." Every signature can make a difference. Please sign this petition.