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Statement of Opposition to
Community Treatment Orders click here for background information on these issues Community treatment orders, or "leash laws", can force people (who have committed no crime) to take psychiatric drugs under threat of being taken into custody. Unfortunately, the popularity of community treatment orders is based on widespread public prejudice toward people with a psychiatric history. This is a result more of misinformation than ill intention. Support for this legislation requires that scientific evidence, ethical and legal issues, and provincial consultations, be ignored. There is no lack of scientific evidence that these measures are unnecessary and harmful. As for the law - it is not surprising that the general public does not understand the Mental Health Act. It's shocking that Ontario doctors are so ignorant of the law that they lobby for powers that already exist. We want to ensure that the public and the government are operating from better information, and are listening to a more broad-based voice on mental health issues. The perceived need for C.T.O.'s is based on a number of false premises. Myths About Dangerousness People who have been discharged from psychiatric hospitals are no more violent than other people in their community. 2 Yet most people believe that if someone's been on a psych. ward they're scary and dangerous. Countless movies and books connect "psycho" with "killer". In truth almost all crime 1 is committed by "sane" people. Recently, in Ontario, a few cases of violence by disturbed people have resulted in tremendous publicity, exaggerating people's fears about "lunatics" out of all proportion to reality (ironically enough). What is needed to address these fears is not the rounding up of innocent people with psychiatric histories. What's needed is for people to be educated to look beyond the stereotypes and learn what is true. Psychiatrists can not reliably predict dangerousness. Scientific research has clearly shown that they can not predict whether or not a person will act in a dangerous manner - in fact mental health professionals are wrong in their predictions about individuals over 80% of the time. 3 Two leading U.S. investigators in the field concluded that "there is no empirical evidence to support the position that psychiatrists have any special expertise in predicting dangerousness". 4 Well known Canadian reaearchers recently wrote that "... three decades of research has failed to produce an accurate scheme for predicting violence." 5 Most often, psychiatrists predict that people are dangerous when they are not. 6 (Once in an institution, the same thing applies to the use of seclusion and restraints.) This means that large numbers of non violent people are already locked up for no reason. Unfortunately these people's situations seldom see the light of day. This unjust detention continues because what gets publicity is the rare times when someone is released who then does something violent. Perhaps it's time that society (and the courts) stop asking psychiatrists to make predictions that they have no more ability to make than anyone else does. Confusion of Cause and Effect Homelessness: It's comfortable for society to blame homelessness on mental illness. Having done this, it can then justify introducing laws to lock up and drug homeless people in order to "help" them. Are you willing to be troubled by the truth? "Much ... of the psychological disorders seen in the homeless might better be viewed as a consequence rather than as a cause of homelessness." 7 In the Clarke Institute's recent study "Pathways to Homelessness" researchers found 3% of homeless people identified mental illness as a reason for lost housing. Other research found that "when chronic patients are in need of both housing and psychiatric assistance, housing interventions are more important than psychiatric services for patients' ability to stay in the community". 23 This means that the solution is not psychiatry, but affordable homes. Crisis: If someone has a psychiatric history, that does not mean that crises are caused by problems "all in their heads". More often the cause of a crisis is a life situation: poverty, unemployment, lack of decent housing, abuse, loneliness, poor health. 8 This means that the solutions that are needed are also in the outside world - not in the individual's biochemistry. Social science evidence shows that positive outcomes for individuals has more to do with their having their self identified needs met than with the provision of any mental health services. 24 It's also faster and cheaper to provide what is needed than spending millions on unwanted services. Some services are so unwanted that Bills are developed to force people to use them. Other needed and wanted resources are stretched to the limit. Myths About What Is Needed A. Psychiatric drugs There is little basis in fact for the faith in psychiatric drugs. When we are talking about forced treatment, we are talking primarily about psychiatric drugs (usually neuroleptics). But these drugs do not make most people better; they are only helpful to a minority of people (approximately 34%). 9 To put it another way, studies have found the drugs to be useless for 63-68% of people labeled schizophrenic. 10 Some evidence suggests that neuroleptics are never necessary because a placebo or simple sedative have the same effect. 11 In one of the rare studies comparing use and nonuse of psychiatric drugs in a supportive residence, each group was matched so participants were as similar as possible, then some received neuroleptics and others did not. People receiving no medication demonstrated significantly better "clinical results". 12 This information is not widely known because of a truly astounding bias favouring drugs despite all the evidence of their ineffectiveness and harmfulness. 13 (The predominance of research funding by pharmaceutical companies explains this, and has in fact been demonstrated to bias researchers.) In fact, psychiatric drugs harm more people than they help - sometimes irreversibly, even fatally. Some common side effects of psychiatric drugs are: lack of feeling, lack of will, a sense of gloom, unbearable restlessness such as leg movements even while trying to sleep, strange involuntary movements such as writhing, twitching, spasmodic movements, trembling, a rigid walk, inhibition of the gag reflex, etc. These serious drug effects have been found by researchers in from 62 to 90% of people on neuroleptics.14, 15, 16 The damage caused by the drugs is irreversible for over 30%. 17 Ironically, many of the feelings and behaviors caused by the drugs (possibly permanently) are the same as what is considered to indicate that a person has "schizophrenia". 18 Despite the terrible damage that can be done, researchers have found that professionals rarely seek people's informed consent. 19 The so-called "atypical, new" drugs may be as harmful as the old ones. 13 Some antidepressants can cause suicidal or aggressive thoughts and behaviour. 25 Psychiatric Diagnoses: have been shown repeatedly in research to be highly unreliable and therefore to lack scientific validity. In other words, it is the exception rather than the rule for the same person to receive any consistent diagnosis from different mental health professionals. This means that we can't very well talk about the various "treatments" for particular "mental illnesses" when there is little agreement on whether these diagnostic labels accurately describe anyone. 26 B. Forcing "Treatment" Harm is also done by the trauma of forcing something into the body of an unwilling person. Most people who have been in the psychiatric system are survivors of abuse. 20 To have no control over what is happening to their own bodies is to retraumatize them. In fact, to be healthy a person requires more control over one's life, not less. If it is accepted that people in crisis might need some support, the chance of developing a supportive "therapeutic relationship" when someone has been "treated" with force is not very good. 21 Controlling people in the community through "assertive case management" is mistakenly believed to be a helpful approach. A recent review of the research literature about the use of this approach in the U.S. found that it has many undesirable aspects (such as stopping the development of social support networks), and has no specific successes to recommend it. 22 A recent review of all the research on ACT (or PACT) teams suggests that they increase suicide rates. 27 Unfortunately, a great deal of government money has just been invested in this approach, ignoring what the real experts (people who have been in the system) have said is needed. C. Resources It is erroneously assumed that people must be forced to take advantage of all the good resources that are there to help them. In fact, there are not enough good resources, like affordable housing, and even when people try to access what resources there are, they are often refused. People have often tried to get their needs met and can not. How ludicrous to then use this as a reason for forcing services upon people. Community Treatment Orders are not needed for those people who want to be forcibly drugged if they "go crazy". Anyone who decides they want to be drugged or institutionalized under certain conditions can state what they want to happen, and when, in a Power of Attorney form. (People should be cautious about creating these forms, however, as they are difficult to "take back".) D. Ethical, Legal and Practical Issues To state that the existing Mental Health Act does not allow people to be detained who might be dangerous is untrue. The M.H.A. allows people to be detained who may be dangerous to themselves or someone else, or who can not take care of themselves and may suffer impairment within weeks. This Act already allows psychiatric consumers and survivors to be the only people in Canada who can be locked up without committing any crime, or any dangerous act whatsoever. Forcing harmful substances upon an individual who is not harming anyone, or extorting their consent by threatening incarceration, may be considered discriminatory under the Canadian Charter of Rights and Freedoms , or a Charter violation of an individual's right to security of the person. Case law in Ontario (Swain) protects the rights of capable people to make decisions about their own medical treatment. These legal bases for challenges indicate the unfairness of this proposed legislation, and the amount it is going to cost the government to impose C.T.O.'s. Ethically, these proposed violations of people's very selves has no justification. It can't be justified by the threat of violence, because the psychiatrically labeled are not more violent than other members of society. Drinking alcohol does increase rates of violence, but no one is talking about Prohibition. A lack of compliance with a treatment that is considered "for their own good" can not justify forced treatment, when heart, stroke, and diabetes sufferer are often noncompliant, yet are not having drugs forced upon them. It is more sensible to assist people in getting the resources that they want, and access when they want it, than it is to force something unwanted upon people. Community treatment orders ("leash laws"), and laws that allow more people to be taken to psychiatric institutions, will place a greater burden on police, psychiatric facilities and community mental health workers to enforce these new laws. And it will damage their relationships with psychiatric survivors and consumers, homeless people (who would be additional targets of such legislation), and their advocates. Instead: We propose that resources be allocated according to what province wide consultations and research have indicated would actually help. 1. Affordable and subsidized housing. REFERENCES
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