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Laurie in Debate

Bill 31: Mental Health Amendment Act, 2007

Bill 31: Mental Health Amendment Act, 2007 debate in the 26th Legislature of Alberta, 3rd Session by Ms. Laurie Blakeman, MLA Edmonton-Centre

Alberta Hansard – December 04, 2007

The Chair: We are debating subamendments SA1A, SA1C, SA1G, SA1H, SA1I, SA1J, SA1K. It’s the chair’s understanding that it’s satisfactory to vote on these in a block with the exception of SA1C. Is that correct, hon. Member for Edmonton-Centre?

Ms Blakeman: Yes. Thank you very much, Mr. Chairman. As we launch into this complicated series of amendments and subamendments on Bill 31, the Mental Health Amendment Act, 2007. What we have is that the committee that had this bill referred to it in the summer, which was the Community Services policy field committee, did review this act. It was referred to it. They did review it. The committee brought forward a series of amendments, and the government has followed with a series of subamendments, and right now we’re looking at the subamendments that the government had provided.

Now, what happened – and this was all, I’m sure, well intentioned. I did for the most part read the Hansard from the committees. There was a great deal of concern with the committee over the requirement that we have “two physicians, one of whom must be a psychiatrist,” which was the wording that was primarily used in the original amending act. There was concern that two physicians, one of whom is a psychiatrist, may not be readily available in many parts of Alberta, and there was a real concern on behalf of the committee members that something had to be done to be able to look after people with a mental illness who don’t live in a metropolitan area. The act in other places had said: well, if there’s no way to take someone into treatment and look after them, then we won’t apprehend them under a community treatment order. But that left a lot of places in Alberta without any assistance for people with mental illness.

The committee went through a very long series of shifting definitions and ended up bringing forward in the committee recommendations a series of amendments to change it from “ two physicians, one of whom must be a psychiatrist” to a much broader definition. I think they ended up with a result that they did not intend. Let me phrase it that way. Essentially they had ended with saying “two health professionals.”

Now, that’s health professionals as defined under the Health Professions Act, which, as we know, has come back before this Assembly a number of times because we are adding in new health professions as they meet the criteria under the new Health Professions Act. So this is a range of . . .

An Hon. Member: A nutritionist and a dental hygienist.

Ms Blakeman: Yes. That’s exactly right. Thank you. You must have been reading my notes.

That includes people from a nutritionist, a dental hygienist, nurses, nurse practitioners – you know, if we were going to have midwives, they would end up under that health professions designation – doctors, of course, nurses, speech therapists, optometrists. There are a number of health professionals that are coming under that. That is too wide a definition, a pool of people, to pull from, and I don’t think it was ever intended by the committee. Again, I was not on that committee, so I am just discerning this by reading Hansard. Their concern had been to make sure that there would be someone available in nonmetropolitan areas to be able to designate someone under a community treatment order. They had it always in mind that one of those health professionals would be a physician, but they didn’t define it that way.

I’m speaking on behalf of the government here; I’m sure the minister himself will be speaking to it soon enough.

An Hon. Member: Don’t be too sure.

Ms Blakeman: That’s right; he already has spoken. My apologies. This was an attempt to clarify that too-broad definition. I was willing to group together all of the government’s subamendments that are essentially accomplishing the same thing. There’s no need to go through and debate every single section of it. The one section that I did not agree to group in are the government’s subamendments and the originating committee amendments in section C because that’s dealing with competency, and I think there’s a larger issue there. But I am willing to deal with – in fact, I’m speaking to the package of amendments now – government subamendments under A, G, H, I, J, and K, that are essentially changing the wording back to say in most cases “two physicians” and in some cases also gets specific by saying that one of them will be a psychiatrist to issue orders for apprehension and assessment and, potentially, a community treatment order.

I think that aside from my objection to the entire concept of a community treatment order, if this act is going to pass – and clearly the majority of people in this Assembly wish it to pass; I do not, and I will restate my objections – then even I would say it should be done by the professionals that are trained to do this. I know that there are additional regulations that are contemplated by the government, where in very particular areas under a regulation they could in fact designate someone that was a health professional that has met certain criteria to be able to perform those same functions. But we have to rely on the government that they’re not going to put someone in a position where they would be working beyond their scope of expertise.

I’m willing to support the package of amendments that goes through the entire package from the committee and adjusts all of those definitions from health professionals back to the more specific physicians or two physicians or physician and a psychiatrist definition as appears throughout the amendments. I think that’s an appropriate thing to do. I think it does protect people that are involved in this process or come into contact with this process, that have a mental illness or may be considered eligible for a community treatment order, aside from the issues of whether we should have these or not. But I think it’s appropriate that it is a qualified health professional, like a physician or a psychiatrist, that deals with this. So I’m in favour of the package of government subamendments that have been noted. Thank you.

The Chair: Are you ready for the question on the package of subamendments A, G, H, I, J, and K?

[Motion on subamendments A1A, A1G, A1H, A1I, A1J, and A1K carried]

The Chair: Now, back to subamendment A1C.

Ms Blakeman: I asked for section C to be pulled out because that is a section that is dealing with a number of criteria, the criteria that these physicians or health professionals would be using. A number of changes were made in the committee recommendations, which are then being additionally adjusted by the government subamendment. But if I let the government subamendment go through, then I would lose the ability to talk about this section separately.

I think what’s important here is that the criteria have been broadened quite a bit. It was much narrower in the original version. The committee has now expanded that, and the suborder that we are talking about here, government suborder to C, is reinstating the physicians instead of health professionals, but it’s also adjusting and affects the way community treatment orders would be assessed or implemented, which I think is more problematic. This is appearing as government subamendment (a) (vi) (B), which strikes out paragraph (A), which was talking about that the person is not competent.

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Just to put this in context, we’re backing up, saying that these health professionals, once they examine somebody, and care and treatment for the person exists in the community, is available to them, and would be provided, and in the opinion of the physicians “the person is able to comply with the treatment or care” – and then there’s a series of criteria – either they consent to the issuing of a community treatment order – if they’re competent, that individual consents – or “if the person is not competent, in accordance with section 28( 1)” or “consent to the issuing of the community treatment order has not been obtained” – and what’s been taken out here is “ the person is not competent.” But the physicians maintain that the individual has “while living in the community, exhibited a history of not obtaining or continuing with treatment or care that is necessary to prevent the likelihood of harm” or section (C), which is, “a community treatment order is reasonable in the circumstances and would be less restrictive than retaining the person as a formal patient.” Now, what happens, I think, is that that clause, “the person is not competent,” actually turns up somewhere else as a slightly differing qualifier.

I just have concerns about this section overall because I think it is broadening and giving wider powers to be able to commit someone to a community treatment order. I continue to be concerned that individuals while they are ill are losing their right to refuse medical treatment, which is something we’ve been moving to overall. This is a difficult argument, I will admit. I just believe in the personal integrity and dignity of each person to be able to make those kinds of integral decisions over their lives. If they’re not in great shape, I would have preferred that there was something like a personal directive that they could have put in place when they were better that would have indicated their personal preferences. My problem around the widening of all of this competency and commitment criteria is that I think the individuals are even less likely to be able to control their own lives given these new wider boundaries. That was one of my original concerns coming into this bill. It’s not been alleviated; it’s been exacerbated. That’s my concern around this. In order to talk about it I’ve got to be able to pull out that separate amendment C, which does amend and remove the clause about the person not being competent. That’s my concern over this particular amendment.

Again, I’m a bit caught because it’s amending a number of different clauses. There are probably a dozen of them in here under section C that it’s amending. In most cases it’s putting in the “physicians” requirement instead of the “health professionals,” but it does deal in that one section with the competency issues. That’s my dilemma. Once again, it’s grouping a number of things together, some of which I would support and some of which I wouldn’t.

…

Ms Blakeman: Thank you, Mr. Chairman. This is the crux of it for me because this is around the definitions of how it is determined that somebody is eligible for or qualifies for or would fall under the need for a community treatment order. What has happened is that the committee widened that criteria and definition by quite a bit, in my opinion. Remember that we had started at a point where the original Mental Health Act had talked about: an imminent danger to themselves or to others. The bill then widened that to talk about the concept of deterioration which is not imminent, that has a longer time period attached to it, and the concept of harm rather than danger. So there were two fundamental definitions that got changed by this act.

Then all of that got widened by the criteria around it by the committee that met over the summer and the policy field committee. It’s quite wide now, and that’s my concern. We started out talking about people who had a serious psychosis or schizophrenia, but by the definitions that are available in here now, someone who is clinically depressed would now qualify and could be picked up and put under a CTO the way this is now sitting. That causes me great concern even when you layer in that we’re back to two physicians, one of whom should be a psychiatrist unless you’re in a nonmetropolitan area, I’m going to call it, where there aren’t the resources to have those individuals available. This is what’s really getting to me because when you look at the mental health statistics in Canada, where we’re now looking at 1 in 3 people having an experience with mental illness at some point, the potential to capture far more people than I believe was originally intended now exists in this layering of amendments, and that’s a real concern for me.

I don’t think we started into this to pick up people that had a depression issue or bipolar or something like that. This was to deal with people who were in serious trouble of harming themselves or harming others. The whole definition has broadened itself. That issue of consent and who we’re looking at capturing in this legislation is far more serious given the amendments that are under contemplation here today.

That’s a lot of my issue because, yes, we’re talking about mental or physical deterioration. We’re talking about competency and consent. All of this is captured in this amending section C, which actually shows up in the bill as 9.1 and then all of the subs that are coming under that. It’s around, you know, how we’re defining this: whether the person has been incarcerated in any way in the immediate two years – that’s now being amended to three years – from 60 days to 30 days. There are a number of changes that have happened back and forth here.

This is where you get the clause about: “The treatment or care the person requires exists in the community.” Well, this is part of my original issue. We’re now hearing the minister say in the House that, in fact, he has allocated some money to the Canadian Mental Health Association to help with this issue. But where I started from with this act is that we had people who had deteriorated because we’d never supplied them with adequate community supports, and this bill still doesn’t give them adequate community supports. There’s nothing in this bill that provides more community supports for people. There’s nothing in this bill that sets up an assertive community treatment program at all.

What it does is set up the community treatment orders, and now it has a very broad definition of who would qualify for that, and that’s at the heart of my disagreement with what has happened in this process. On behalf of my constituents and others who have contacted me from across Alberta, that’s my concern. I need to put it on the record and detail it on behalf of these people because I think we went far beyond where we started, and we will capture far more people. We were originally talking about maybe 30 or 60 people this would apply to in all of Alberta. That’s much wider now. When you start to look at how many people will be touched by or experience some form of mental illness in their life, we could be potentially capturing a lot of people under this act.

We still have not put one more treatment bed in place, one more transitional housing apartment, one more support service. That has not happened through this bill. All we’ve done is put in place an ability to apprehend and incarcerate somebody in an institution or make them comply with medication requirements. That’s what’s happened with this bill, not anything else. Let’s not kid ourselves that anything else is in that bill except for the community treatment orders.

I’m happy to hear the minister say that he has allocated some money to the Canadian Mental Health Association, but, you know, how much? For how long? Are we going to get transitional housing? Do we get treatment beds out of it? Do we get emergency treatment beds out of it? No. That’s not what’s in this bill. I continue to have issues with this, but it’s now 5 or 6 in the morning, and I won’t make anybody stay up any later to hear me air my concerns about this. I think there’s a real issue, and this may well end up getting challenged at some point down the line because it’s too wide a net now, so I continue to object to it.

Thank you.