Should a person diagnosed with mental illness who seems dangerous and unpredictable be forced into treatment?
It’s a tough question, and one that Alberta legislators were compelled to tackle after a violent incident between an RCMP officer and a person with psychosis resulted in both of their deaths.
The result was the new Alberta Mental Health Act of 2010 (AMHA), which mandates treatment for a particular type of person dubbed the “revolving door patient” – an individual who has been diagnosed with mental illness, seems particularly at risk of harming themselves or others, repeatedly rejects treatment, and needs to be controlled.
Gary R.S. Barron, PhD candidate at the University of Alberta, was uneasy with how the law was being devised. So the researcher decided to analyze the AMHA by reviewing more than 2000 related media pieces, government documents, and other materials. His findings have just been published in the Canadian Review of Sociology.
In his paper, Barron argues that the AMHA promotes an oversimplified characterization of people diagnosed with mental illness.
According to Barron, the lead-up to the AMHA encouraged the assumption that all mental illness is dangerous. He says the law ultimately limits possibilities for how others understand and interact with people diagnosed with mental illness, and for how people diagnosed with such conditions understand themselves.
While advocates say the new AMHA is about ensuring care for people diagnosed with mental illness, Barron argues its key function is to protect the public from danger.
“The legislation did not increase opportunities for care, guarantee services to people with mental illness diagnoses, increase funding to health care, or otherwise improve access to services or supports,” says Barron. Rather, the law forces anyone deemed a revolving door patient to make a choice between hospitalization or a Community Treatment Order, which commits an individual to supervision and treatment in the community.
Barron emphasizes that the AMHA ensures “treatment” not “care.” There’s a difference.
“Care begins with dialogue to learn who a person is from conversation, to engage with them on terms that are not biased or pre-determined. Treatment is to act based on predetermined definitions, to presume we know a person and their condition,” says Barron.
“The law provides a script for doctors to understand the personhood—the identity, mental state, capacities and potentials—of the person they treat, rather than keeping open to understanding mental illness as human experience potentially worthy of incorporation into identity, as a part of everyday life for the people who undergo it,” explains Barron.
According to Barron, the AMHA reduces the reality and experiences of people diagnosed with mental illness.
“Many people diagnosed with mental illness have been arguing for their experiences to be allowed to be regarded as legitimate human experiences. The AMHA predetermines that those are not legitimate.”
Barron says that beyond having tough conversations about coercion, control, care, and treatment, we need to regularly revisit and question the categories we impose on people.