New book addresses involuntary treatment | Anita Szigeti

By Anita Szigeti

Law360 Canada (April 24, 2023, 2:16 PM EDT) --
Anita Szigeti
Anita Szigeti
Rob Wipond’s new book Your Consent is Not Required takes on heightened and urgent importance in the midst of a sudden push across North America for even greater state powers to detain and force vulnerable citizens into “treatment.” We have been bombarded lately by news of various proposals to expand the existing reach of involuntary psychiatric committal and forced medication administration to those who pose no particular danger but are behaving oddly, and/or to people who use drugs.

All this is purportedly aimed at making our streets, communities and public transportation safer. Such legislative and regulatory reforms have been floated in New York, Alberta, British Columbia and Toronto.

What’s behind the concerted lobbying for even more coercion directed toward hospitalizing and treating people with mental health and addictions issues against their will is in part rooted in age-old false stereotypes of dangerousness. However, it is also equal part benevolence, paternalism and current day mantras of the need to intervene early and aggressively to “prevent suffering.” As Wipond notes:

“Across North America, awareness-raising campaigns in schools, workplaces and mass media encourage us to talk about problems, ’spot the signs and symptoms’ of mental disorders, and get ourselves or others into early treatment.

Along with these campaigns, various claims are promoted: At any time, one in five adults has a mental disorder. Mental illnesses alter brain-chemical balances, and medications can correct these imbalances. Modern treatments are safe and effective. The only major systemic problems are that stigma and underfunding prevent too many people from getting help. Involuntary treatment is rare but sometimes necessary, and patients are thankful afterwards — just as we thank the doctors who performed lifesaving surgery on our unconscious bodies after a car crash. How could anything possibly be wrong with ’improving people’s mental health’?”

Throughout the book, Wipond challenges and effectively debunks all of these myths and other underlying presumptions most people take for granted and accept as valid, scientifically proven, politically liberal premises we tend to presume have taken civil liberties into account.

Nothing could be further from the truth. Having worked as a defence lawyer representing 10,000 individuals embroiled in the justice system consequent to being diagnosed with a mental disorder over 30 years at the bar, I know that Wipond’s thoughtful analysis is right on all fronts. But there is enormous value in this book, because it chronicles the experiences of people who have been traumatized by involuntary psychiatric detention and treatment, together with a probing analysis of the medical and legal systems as they apply to them.

There has not been much, if anything of this nature available in print, until now. One reason for the dearth of data and analysis out there is identified by Wipond as the impenetrable nature of recordkeeping and likely purposeful shielding of rates of involuntary committal from public scrutiny.

Wipond has done the heavy lifting for us. He uncovers the data and chronicles it in a logical sequence. Involuntary psychiatric detention has risen to shocking levels in recent years and continues to escalate. Diagnostic labels in the highly controversial DSM-5 are resulting in unprecedented numbers among us suddenly identified as “mentally ill.”

Half of teens under 18, projected to 60 to 70 per cent of us over a lifetime. Ordinary human emotions of sadness and distress become easily pathologized as soon as they pose an inconvenience to our families, disturb members of the public or become difficult to manage for care facility operators. Contrary to what we are so frequently told, there is no shortage of inpatient psychiatric beds, and it is not even a little bit difficult to get someone admitted to a psych ward against their will using our existing mental health laws. If anything, the current regimes in Canada, and especially in B.C. set extremely low thresholds for involuntary detention and treatment (British Columbia (Attorney General) v. Council of Canadians with Disabilities [2022] S.C.J. No. 27).

Wipond looks at both Canadian and U.S. experiences and laws. He cites the 1979 SCOTUS judgment that recognized “psychiatry is an inexact science”, but yet:

“The court then decided to lower the standards of evidence required for civil commitment, declaring that it is worse for “a mentally ill person to ‘go free’ than for a mentally normal person to be committed.”

A consistent theme in Your Consent is Not Required is that mental health laws and policies are not informed by the experiences of persons who have been subjected to coerced treatment. Wipond remedies this by including the voices of the affected individuals throughout the book. Indeed, the book begins with Wipond’s own father’s story of a period of depression culminating in debilitating shock treatments and his family’s struggles to be heard in that process.

Being hauled off to psychiatric detention in handcuffs, in a police cruiser, being secluded and physically or chemically restrained are hugely traumatizing experiences that scar many people for life. Their pain in having their healthy human emotions declared symptoms of mental disorder, a phenomenon recently acknowledged by Ontario’s then chief justice in Sim (Re), 2020 ONCA 563 comes through loud and clear. There are chapters addressing the “Catch-22 of insight”, which in Canada led to our formulation of the test for treatment decision making capacity in Starson v. Swayze 2003 SCC 32.

The book documents the extent to which psychiatry discounts the serious medical adverse effects of many psychiatric medications as merely “side-effects” with negligible harm when compared with benefits, despite that sometimes they can be life-threatening.

These are just some of the highlights of this informative, eye-opening book. Other chapters examine the profits made by institutions when a bed costs $1,500 a day, using mental health laws to suppress political speech, the horrors of psychosurgery, and the refusal to consider alternative therapies.

The book largely restricts itself to considerations of involuntary psychiatric detention, forced medication administration and the straitjacket custodial control of guardianship. I hope there will one day be a sequel, exposing the injustices in our forensic psychiatric system that detains and monitors those found unfit or not criminally responsible in criminal justice. Until then, Your Consent is Not Required should be required reading for anyone involved in supporting, treating, caring for or representing persons living with serious mental health issues. 

Anita Szigeti is the principal lawyer at Anita Szigeti Advocates, a boutique Toronto law firm specializing in mental health justice litigation. She is the founder of two national volunteer lawyer associations: the Law and Mental Disorder Association and Women in Canadian Criminal Defence. Find her on LinkedIn, follow her on Twitter and on her blog.

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