Self-determination in mental health law and service matters
An edited version of this story first appeared in Transition magazine under a different title, to read the magazine click here.
Worry not, this story has a happy outcome so far. All the usual accoutrements you’d tick off from the checklist for a happy life, like a loving spouse and family, great friends, achievements at university and in the workplace, a secure home, and even a couple of dogs to complete the picture. When I type it out like that, I almost sound normal.
The road to this picture of domestic bliss, however, took complex routes through BC’s mental health system. In an effort to de-sensationalize madness, I’ll just summarize by saying that I spent a few of my young adult years experiencing mental distress. I was certified multiple times under BC’s Mental Health Act, with accompanying involuntary hospital stays, and then about a year spent certified outside of the hospital under the Extended Leave provision of the Act.
Encapsulating the experience of involuntary treatment succinctly proves a little more difficult. While involuntary treatment did play a role in eventually determining the medications that worked for me, significant, ongoing, disabling trauma was an unacknowledged and untreated (by the mental health system) side-effect of the delivery of such treatment. I also would like to underscore that you don’t need to have your hands and feet mechanically restrained, or be put in the solitary confinement of a “quiet room,” or be held down and injected with a short-acting intramuscular antipsychotic in order to come out of involuntary treatment with significant trauma (although many people experience these violations multiple times over). Many people find it disturbing enough to know that these harmful actions, and others, are allowed by the laws of BC.
The traumas people like me experience stem directly from BC’s Mental Health Act, which authorizes detention and involuntary of treatment related to mental health in hospitals and health care facilities throughout BC. I refuse to believe that nurses feel intrinsically motivated to tie down another human being, or restrict their access to fresh air, or to drug them against their will. The incitement to those inhumane actions flow from the archaic legislation governing involuntary treatment in BC. Portions of the legislation remain from the 1960s, a time when it was believed the best way to “help” people living with mental distress was to coerce and control them. In short, the Mental Health Act assumes that the system has the answers to other people’s problems.
Part of the reason that many other societies (see: Peru, Scotland, England, and Australia) have developed recommendations to move away from coercion and control in their mental health laws is that there are less harmful ways of doing things. My own experience provides a worthwhile example. After coming through the meat grinder of the mental health system, I was feeling threatened and vulnerable, and picking up the fragments of my life. My incredible, visionary spouse then gave me a gift. They simply asked me, “if you could do anything, what would you do?” They put meaningful choice back into my hands, after it had been removed in pervasive and sinister ways. There are infinite ways that my spouse has supported me over the years, but that question seeded so much growth for me, for us, and for our community. That picture of domestic bliss? Healthy relationships, university, work, etc.? Medication doesn’t do any of that. It all started with my spouse’s gift to me – a question.
“My incredible, visionary spouse then gave me a gift. They simply asked me, “if you could do anything, what would you do?” They put meaningful choice back into my hands, after it had been removed in pervasive and sinister ways.”
And questions form the basis of self-determination. To put it simply, the immediately necessary reform of BC’s Mental Health Act begins with the government having the courage to stop dictating what happens to people living with mental distress, and having the vision to ask us the right questions. Doing so will benefit the individuals, families, and communities of BC. Take it from someone who’s seen a question blossom into a loving, healthful, meaningful life.