Spotlight on Institutional Psychiatry is a one-time newsletter that I compiled and edited in the spring of 2018. It is comprised of several articles written by an ad-hoc group of psychiatrized people and our allies in Vancouver, Canada, as well as some of the work of artist and psychiatric survivor Ronda E. Richardson. Taken together, these articles and artworks constitute our responses (both direct and indirect) to a scathing 2017 report written by lawyer Laura Johnston of British Columbia’s Community Legal Assistance Society (CLAS) — Operating in Darkness: BC’s Mental Health Act Detention System.
Here in BC, CLAS’s Mental Health Law Program provides legal representation for people who are in hospital against their will. The program’s primary mandate is representing “involuntary patients” at legal appeal proceedings (review panel hearings). These generally take place within three weeks of committal.
Here I must note that many “involuntary patients” have no idea that legal help is available, even though hospitals are officially obliged to let us know. Never — in all the times I have been brought to hospital in handcuffs, by police, stripped naked, injected, tied down and put in solitary confinement, then eventually released into the ward’s general population — has any staff member mentioned that I have a right to a hearing to review the legality of my detention.
During a review panel hearing, as CLAS’s report states, the detainee is likely to be wearing pyjamas or a hospital gown, while every other person in the room is in a suit. Most often, the legal representative’s role is to argue against a psychiatrist whose aim is to prolong the term of detention. Needless to say, the deck is stacked against the “patient,” and Operating in Darkness makes this clear.
I have never seen anything like this report. Within its pages, CLAS representatives not only highlight their frustration at being unable to do their jobs effectively, due to the draconian regulations mandated by the BC Mental Health Act and related legislation; they also detail the outrageous rights violations to which psychiatric inmates are routinely subjected.
It is stunning to see such a powerful condemnation of psychiatric “hospitalization” coming from a group of people who are neither psychiatric survivors nor antipsychiatry activists. And CLAS’s report does not mince words. It consistently refers to “hospitalized” mental patients as “detainees,” and demonstrates that what happens to us when we’re inside is a matter of human rights, rather than of “medicine” or “care.”
So, let me tell you a bit more about the report’s contents; about what makes BC’s “mental health” (and related) legislation so bad, and the constitutional court challenge CLAS has launched to seek redress for its victims; and about what’s in Spotlight on Institutional Psychiatry, why we created it, and what we hope it will accomplish.
The CLAS report
Operating in Darkness paints a vivid and galling picture of what happens inside BC’s psychiatric hospitals and wards. For example, it details the ways in which restraints and seclusion are used against psychiatric detainees. (Yes! They actually use the word “against”!) It also points out many other ways in which standard psychiatric procedure contravenes our fundamental rights, as mandated by the Canadian Charter of Rights and Freedoms. The report specifies that restraints and seclusion, particularly when used as a disciplinary measure, “can amount to a violation of the right to be free from cruel and unusual treatment or punishment.” Obviously, our right to freedom of movement is violated through the use of detention, seclusion and restraints. But the report also notes that the right to life, liberty, and security of the person is routinely abrogated by “non-consensual physical touching and forced administration of psychotropic pharmaceutical agents.”
Here are just a few quotations from Operating in Darkness, categorized by subject:
“Staff have absolute control over where you go, what you wear, what and when you eat, when you bathe, when you sleep, what restraints you are placed in, whether you are placed in seclusion, and which psychiatric treatment you are administered.”
Punitive use, and harmful effects, of restraint and seclusion
“… restraints and seclusion are used … as a routine admission procedure, a psychiatric treatment method, a coercive tactic to elicit cooperation with involuntary psychiatric treatment, a disciplinary measure, a behaviour modification tactic, and for staff convenience.”
“There are no criteria in the BC Mental Health Act and its regulations that define, govern, or establish oversight of restraints and seclusion use against detainees. This absence is particularly concerning in light of the fact that regardless of why they are used, restraints and seclusion can cause harm to individuals and create or contribute to mental health problems.”
Incapacitation by drugging
“… it can be very difficult for detainees to access the practical tools necessary to make a complaint, such as a phone, a computer, or a pen and paper. It is also difficult for someone who is experiencing mental health problems or negative feelings as a result of an involuntary detention, while under the influence of psychotropic pharmaceutical agents, to sustain the focus necessary to conceptualize and organize their complaint, present the complaint in a way that others will understand, file the complaint, and participate in the complaint process.”
What makes BC’s mental health legislation worse than the rest of Canada’s?
In BC, and only in BC, we who are in hospitals against our will are thereby automatically deemed to “consent” to treatment. A September 2016 article published in the Georgia Straight (Vancouver’s free weekly newspaper) explains: “under the BC Mental Health Act [MHA] … patients admitted involuntarily are ‘deemed to consent,’ meaning treatment decisions are entirely at the discretion of doctors.” The article quotes lawyer Melanie Bernard (who sits on the board of directors of the Council of Canadians with Disabilities) as saying, “In all other jurisdictions in Canada, adults are presumed to be capable of making treatment decisions. What we see in BC’s outdated law is that there is no assessment of the patient’s capacity. Involuntary psychiatric patients are just presumed to be incapable of consenting and health care providers can impose treatment at will. That violates their right to liberty and equality.”
As a result of this “deemed consent” stipulation, psychiatric “patients” in our province — and nowhere else in Canada — can be subjected to the use of force in the absence of a “competency test.”
And it is not only the MHA that discriminates against us; so do other pieces of health-related legislation. All other (actual or potential) BC patients are allowed to decide in advance (while deemed competent) what can or cannot be done to them by doctors, in the event that they become unable to make treatment decisions due to unconsciousness or incapacitation. They can appoint a representative of their choice: a trusted person who will uphold their wishes. They can fill out an “advance directive” form, which specifies what treatments they will or will not accept. And those decisions will be respected by doctors and hospital staff. “Involuntary psychiatric patients,” however, are explicitly excluded from all of these protections.
Investigative journalist Rob Wipond wrote about some of these problems in a Focus magazine article to which he gave the startling title, “Escape from British Columbia.” This refers to the fact that some people have had to run away from home, to other provinces with less dreadful mental health laws, in order to avoid being force-treated. Wipond notes that the number of people committed to psychiatric facilities in BC has doubled since 2002. In 2015, 13,641 people in British Columbia were psychiatrically incarcerated. “Though statistics weren’t available,” he adds, “it’s widely believed that the use of ‘Extended Leave’ has increased even more dramatically.
“Extended Leave” is BC’s euphemism for psychiatric parole: what the U.S. calls “involuntary outpatient committal.” Elsewhere in Canada, as in the U.K., the term “community treatment order” is used. Basically, under such an order, if you do not comply with treatment, you can be put back in hospital.
Since writing this article, Wipond has obtained statistics indicating that BC imposes community treatment orders far more frequently than do most other provinces and countries.
Wipond echoes Operating in Darkness with regard to the unfairness of review panel hearings, and gives further details: “A person in BC can appeal a committal to a three-person tribunal. Hearings are not open to the public, not bound by rules of court process, and notoriously erratic. Patients are often forcibly drugged [before attending] hearings. Though every patient has a right to a legal aid lawyer, hundreds annually cannot get one because government hasn’t provided sufficient funding.” Unsurprisingly, fewer than one-fifth of patients win these appeals.
In the same article, Wipond draws attention to a constitutional court challenge launched by CLAS in September 2016, which highlights some of the terrible effects of BC’s mental health legislation. The Council of Canadians with Disabilities is a co-plaintiff.
CLAS argues that the BC MHA violates the Canadian Charter of Rights and Freedoms. Wipond quotes Laura Johnston, the author of Operating in Darkness, as saying that people leave BC specifically in order “to avoid our deemed consent laws,” and that “forced treatment which is imposed unilaterally by a doctor with no checks or balances and no recourse to anybody else is unconstitutional.”
One of the individual plaintiffs in the CLAS suit is 66-year-old Louise MacLaren, who has frequently received forced treatment, both in hospital and at home, over a period of decades. Quoting from CLAS’s affidavit to the court, Wipond writes, “According to the submission, MacLaren experiences ‘extreme anxiety’ when forced to undergo electroconvulsive therapy (ECT), which causes her ‘confusion and disorientation’ for weeks afterwards, and permanent memory losses.” The submission further states that, in 2010, “staff administering ECT forgot to place a mouth guard in Ms. MacLaren’s mouth during the treatment. Ms. MacLaren shattered her teeth due to the convulsions in her jaw.” (Note this use of the active, rather than the passive, voice: we read, not that “her teeth were shattered by the treatment,” but rather that she shattered her teeth — as if it were her fault.)
The other individual plaintiff, a 24-year-old Vancouver man with an advanced degree in music, has been forced to take “antipsychotic” (neuroleptic) medications in his own home. As stated in the affidavit, the drugs cause “involuntary movements, muscle stiffness, muscle pain, and loss of dexterity, all of which impede his ability to play the piano… [which] is such a fundamental aspect of his life.”
How can legislative change help?
As many of you reading this know from your own experiences, mental patients everywhere are routinely locked up in hospitals and brutalized by psychiatric staff, regardless of what “mental health” legislation may or may not permit. In my view (and I am not alone in this), all such legislation is discriminatory by definition, since its primary purpose is to permit the incarceration and forced drugging of citizens who have committed no crime, on the grounds that we are perceived as mentally ill and in need of treatment — despite the absence of any medical evidence that mental illness exists, and regardless of the myriad ways in which psychiatric treatments damage our brains, bodies, minds, hearts and souls.
What would really help, of course, is banning forced “hospitalization” and treatment, as opposed to tinkering with the rules that govern exactly when and how psychiatrists can deprive us of our liberty and bodily integrity. In B.C., legislative reform could, in some cases, protect individuals through the use of advance directives, representation agreements, competency hearings, etc. But the explicit repeal of legislation authorizing the use of force in psychiatry would make an enormous difference in so many people’s lives.
It would also bring BC into compliance with the Convention on the Rights of Persons with Disabilities (CRPD), ratified by Canada in 2010. The CRPD guarantees the right not to be committed to a hospital or other “mental health” facility; the right to leave a facility when you want to; the right to be fully informed before consenting to treatment; the right to refuse treatment; the right not to be put in physical restraints or solitary confinement; and the right to supported (not substituted) decision-making.
Our hopes for Spotlight
We who created Spotlight on Institutional Psychiatry were thrilled to see legal representatives writing so frankly about what they regularly witness in psychiatric facilities. In particular, we commend CLAS’s recognition of the facts that hospital staff have total control over our lives; that restraints and seclusion are used for patient control and staff convenience, and can worsen or even cause “mental health problems”; and that psychiatric drugs can make it impossible for us to think, focus and function.
The primary purpose of Spotlight is to encourage people to read Operating in Darkness. But we also wanted to provide a supplement to the report, detailing, in our own words, how we — a handful of people who have been devastated by psychiatric treatment, a family member horrified by the suffering psychiatrists inflict, a cleric whose effort to provide sanctuary was stymied by a lobby group, and a progressive journalist alarmed by what’s going on in BC — have observed, experienced and been affected by the outrages described in CLAS’s report.
In Spotlight on Institutional Psychiatry, you will read about the lack of response to CLAS’s report on the part of the “mental health” establishment, some of the specific harms caused by psychiatric drugs, the hell of psychiatric solitary confinement, the long history of oppression in the name of “care,” a few of the many non-psychiatric ways of dealing with unusual emotional states, and the family lobby group that advocates for increasing the use of force in psychiatry. You will also read a proposal for a new psychiatric diagnosis — aphorismomania, or definition-madness: a condition suffered by psychiatrists, whose symptoms include the impulse to “join random nouns derived from Ancient Greek in order pass them off as medical terms” (e.g., “schizophrenia”) and to “diagnose hypothetical physiological abnormalities … for which there is no scientific evidence.”
One day, perhaps, outsiders will be able to hear and believe our own psychiatric horror stories, told in our own words. Meanwhile, however, we need all the help we can get from people who have sufficient status to be taken seriously.
We hope that legal professionals will read both Spotlight on Institutional Psychiatry and Operating in Darkness, and will be moved to speak out; that “mental health” professionals will take note of CLAS’s bold stance on the devastating effects of forced psychiatric treatment; and, above all, that psychiatric survivors will feel encouraged and inspired by our efforts.
Bonus radio show! On May 22, activist Irwin Oostendie, host of the program “Democracy North” on Vancouver’s Co-Op Radio, interviewed Rob Wipond (who wrote the introduction to Spotlight on Institutional Psychiatry), Ronda E. Richardson (whose brilliant illustrations made Spotlight so much more striking), and me. You can listen to the show here.