Principles Underlying Mental Health Legislation

A position paper developed by the Canadian Psychiatric Association 's Standing Committee on Professional Standards and Practice and approved by the Canadian Psychiatric Association's Board of Directors in June 2010. Introduction According the World Health Organization (WHO) the fundamental aim of mental health legislation is to protect, promote and improve the lives and mental well-being of citizens.1' pl Mental health legislation must balance the interests of a person with mental illness with the interests of society. However, mental health legislation must also balance conflicting interests of a person who suffers from mental illness. Every Canadian citizen has the right liberty, autonomy, and procedural fairness; however, citizens, including those who suffer from a mental illness, also have the right be protected from harm. Moreover, when health care is publicly funded, citizens have a right equal access that health care. Lack of resources sometimes limits access both physical and mental health services. However, for some people with mental illness, the effects ofthat illness, particularly impaired appreciation of the need for treatment, is an additional major barrier accessing health care. An essential function of mental health legislation is ensure that these people receive necessary treatment when specific criteria are met. In Canada, mental health legislation typically includes statutes that oversee involuntary hospitalization and, in many jurisdictions, community treatment orders.2 In some Canadian jurisdictions, consent and capacity provisions are also considered under the rubric of mental health legislation, whereas other jurisdictions have consent and capacity legislation that is not specific mental illness. Whether consent and capacity legislation is separate from, or integrated with, mental health legislation, it is critical the functioning of mental health legislation. In some international jurisdictions, mental health legislation outlines standards for mental health services. This type of service legislation can play an important role in improving access mental health care. For example, service legislation may be designed ensure that underserviced areas or specific populations receive the necessary level of resources. While the Canadian Psychiatric Association (CPA) recognizes the potential benefits of this type of service legislation, it is an approach that has not been adopted in most Canadian jurisdictions and will not be considered in this paper. It is important note that service legislation does not obviate the need for legislation authorizing involuntary hospitalization and treatment. The introduction of mandatory outpatient treatment - often referred as community treatment orders or, in the United States, as outpatient committal - has stimulated considerable academic and public debate. As noted elsewhere, the CPA views mandatory outpatient treatment as a valuable tool ensure that some people, with severe mental illness who lack insight, receive a comprehensive plan of treatment while living in the community.3 Legislation is not static and as it evolves it must take into account advances in medical science, the availability of effective treatments, and changes in the service system. The CPA recognizes that different jurisdictions will adopt different legislative models. There are no perfect solutions, and attempts balance conflicting interests inevitably lead compromises. However, mental health legislation should adhere numerous basic principles. In this paper, the CPA outlines 10 important principles that should guide the development of mental health legislation. The CPA is aware that there are other controversial issues that are unresolved, and comments on 2 of these issues at the end of this paper. Principles 1. Reciprocity Involuntary hospitalization results in a loss of liberty for a citizen who, in most instances, has not committed a crime. …