Volume XXXIV, Number 2, Fall 2009
MENTAL HEALTH AND THE LAW : ETHICAL, SCIENTIFIC AND ORGANIZATIONAL ISSUES
Dossier : Mental health and the Law
centers in Québec (Centres jeunesse du Québec, CJQ) p.123
Based on two open-ended interviews with people suffering from a mental illness and who have been incarcerated, this article explores their perspectives on both health and justice systems. In their view, there is a divide between the needs of people with mental health problems and the care that is offered. The difficult juncture between needs and services seems to have numerous explanations (prejudice, lack of training of personnel, difficult administrative process, lack of communication between “inside” and “outside”); and the elements that could facilitate this juncture appear to be scarce (mutual help among inmates, community based mental help
In this article, the author examines the impact of judicial intervention of individuals with mental illness on family members. The author submits the hypothesis that an offer of more diversified services could reduce legal intervention of these individuals and consequently attenuate the devastating effects on family members. According to the families’ equation, the more services will be developed and adapted, the less frequent family will have to call upon the legal system to intervene and fewer individuals with mental illness will find themselves behind bars.
In recent years, advocacy groups promoting patients’ rights have lead to significant changes including the implementation of policies reducing measures of seclusion and restraint of patients with mental disorders. These policies are unanimous in that constraint is to be used as a solution of last resort and must be applied only under unique and exceptional circumstances. The reaction of healthcare workers to these new policies and to increase attention of patients’rights is often ignored in the current literature. Indeed, it is not rare for healthcare workers to come to think that the patients’ rights supersede their own. In this article, this issue is examined from two perspectives. First, the author examines experiences of healthcare workers followed by a presentation of ethical and legal issues arising from the policies which promote the reduction of seclusion and restraint measures.
Although psychiatric advance directives (PADs) are grounded in the ethics of autonomy, the relationship between the two is unclear. PADs are legal documents that allow individuals with mental illness to record their treatment preferences should they become incompetent in the future. The relationship between autonomy and PADs has been discussed in ethical, legal, and philosophical terms, but has not been clearly operationalized for clinical purposes. Autonomy is a fundamental ethical value that includes having the independence from outside controlling influences and the mental capacity to direct one’s personal actions. Individuals with mental illness sometimes require assistance to understand their ethical and legal rights with respect to autonomous choice, and professional stakeholders need education regarding the importance of autonomy for clinical practice. Competency to consent to treatment is the mental prerequisite that ensures individuals with mental illness are able to complete PADs with insight, whereas autonomy is the value that empowers individuals to work towards their recovery.
This article explores several conundrums and attempts to identify ways of redirecting the Canadian ship of state. It first presents an overview of some of the salient features of the array of mainly coercive provincial and territorial mental health statutes. The failure in the main of the Charter to deliver on its early ostensible promises for people with mental health problems is assessed. Next, the author argues that extant legislation remains anchored in the medical model, when other human rights promoting paradigms transforms the statutory agenda.
In this article, some hopeful outlooks on the evolution of the law are identified and ways of assessing the state and progress of legislation are advanced, drawing from international organizations and some inspiring efforts in other countries. Potential contributors to the evolution of Canadian mental health law are surveyed. The author concludes that there are coherent ways of changing tack, although in this fraught legislative field, no one can make confident predictions about the future.
This study aims at establishing a comparative psychological profile of male and female adolescents at the moment of the application of measures in juvenile centers in Québec (centres jeunesse du Québec, CJQ) as well as their family and social characteristics. The study compares 213 adolescents (12-17 years old) receiving services in CJQ in accordance with the juvenile offenders act (Loi sur les jeunes contrevenants), with 213 adolescents from high schools of impoverished neighbourhoods. Results reveal serious problems of adaptation, external disorders and interiorized disorders and a regular substance abuse among many juvenile offenders. These problems are much more frequent in CJQ than within the juvenile population. The situation of these adolescents is worrisome, given that a high prevalence of depression and sexual victimisation is also observed in females. Finally, families whose adolescent receives services in CJQ have less financial, personal and social resources, as well as more difficulty exercising their parental role compared to parents in the general population. In conclusion, recommendations are proposed concerning psychosocial services necessary for these adolescents and their families.
In this article, the authors attempt to better examine the practice of prescription of psychotropic medication of inmates of Québec’s correctional facilities. Although prescription of this medication is considered the most widespread “psychiatric treatment,” studies on the prevalence of these prescriptions remain scarce. The study includes a sample of 671 inmates, 500 men and 171 women. Globally, 40,3 % of inmates have received at least one prescription for psychotropic medication in the period between 2002 and 2007. Results show that women are more likely than men to have been prescribed medication. Inmates who have received at least one prescription are older than other inmates. Most prescriptions have been given by physicians and the cases of polypharmacy are numerous. On a period of five years, the class of medication the most widely prescribed is the following: anxiety/hypnotic medication, antidepressants and antipsychotic medication. The authors conclude that further analysis of factors associated with prescription of this class of medication of this population is needed.
In Québec, as elsewhere in North America, psychiatric deinstitutionalization, lack of community mental health resources as well as legislative changes to civil and criminal codes have led to an increased probability that individuals with a mental illness come into contact with the criminal justice system. Based on the principle of therapeutic jurisprudence, mental health courts constitute emerging diversion programs, taking place within the court, implemented to offer an alternative to incarceration for individuals with a mental illness. This article offers a critical synthesis of the scientific literature on the topic. The authors first present the context in which mental health courts were developed ; describe their objectives and functioning ; and introduce the Montreal Mental Health Court pilot project, renamed PAJ-SM (Plan d’Accompagnement Justice et Santé) the first of its kind in Québec. The paper examines the research on mental health courts and tackles some of the stakes of diversion programs. The challenges and limits inherent to specialized courts are discussed as well as methodological obstacles related to the study of these complex intervention programs. The authors conclude that mental health courts offer promising intervention venues, but that they do not constitute a panacea to resolving all issues related to the contact of mentally ill individuals with the justice system. Mental health courts must be accompanied by other intervention strategies for persons with mental health problems at all stages of the criminal justice process.
Attention deficit hyperactivity disorder (ADHD) is the most frequently diagnosed behaviour problem in school-age children. Although more and more preschool-age children are referred in clinical settings for typical ADHD symptoms, few studies have examined the nature, the assessment as well as the treatment of ADHD in this age group. This literature review addresses the nature, the assessment, and the treatment of ADHD during the preschool period. The main themes reviewed are: prevalence, symptomatology, etiology, comorbidity, consequences on normal development and adaptation of the child, evolution of symptoms from preschool to school period, difficulties related to diagnosis, assessment modalities, psychosocial treatment, and pharmacological treatment.
Approximately fifty percent of older adults with a mental health problem do not receive services. A proactive outreach strategy, Project PIE (Prevention-Intervention-Education) relies upon the assistance of non-traditional referral sources, namely community liaisons, to identify and refer to the CSSS vulnerable or isolated elders with a mental health problem. An evaluation of this project reveals encouraging results. The project appears useful, relevant and efficient to detect elders with a mental health problem and offer the required assistance. This project also appears to be a means to foster social solidarity.
This essay presents a perspective on intervention in psychiatric consultation based on the patient’s subjective experience as supported by Kendler in 2005 in the American Journal of Psychiatry in his position against biological reductionism in psychiatry, distinguishing the psychic approach from the biological. The paper presents aspects of the setting and major features of the assessment in the consultation process, then proceeds to discussing principles of intervention as to specify dimensions of the psychiatric intervention in this particular context.