We Need Alternatives to Alberta’s Compassionate Intervention Act

Two seemingly unrelated events happened in recent weeks that, because of their juxtaposition with our current reckoning with national identity, soldered together in me a simple realization: whether or not it is entered voluntarily, our system of care for mental health and addictions is wholly inadequate. Rather than spend resources on forcing people into a weak system, we should instead focus on strengthening the system.

The first event was the introduction of Bill 53, the Compassionate Intervention Act, to the Alberta legislature last month.

The second was an incident I witnessed just outside Calgary’s Foothills Medical Centre. I saw someone in crisis who, in my opinion as a community-based doctor whose practice serves people affected by exclusion, disenfranchisement and homelessness, required medical care. But police were the first responders.

Alberta’s Compassionate Intervention Act changes the law so not only doctors and judges, but also police and bylaw officers can initiate involuntary treatment for a person at risk of harm to themselves or others.

Under existing legislation through Alberta’s Mental Health Act, it must be shown that a person lacks capacity to make their own health-care decisions at the time of assessment. In contrast, the new Compassionate Intervention Act allows for the detainment of individuals whose faculties may be intact but who have a history of, in the officer’s opinion, dubious judgment.

To illustrate: as a physician, I can currently request that a person who is presenting a risk to themselves or others be taken — even forcibly — to hospital for assessment only if they are unable to make that decision for themselves at the time.

Contrast that already ethically fraught, and sometimes violent, scenario with granting any junior peace officer the right to apprehend a perfectly cogent person for no other reason than, say, they jumped off a neighbour’s roof while inebriated last year.

For youth to be detained, the threshold is even lower, as minors are presumed to lack capacity to make their own health-care decisions.

Supports first, not policing

Driving my child to sports practice on a recent quiet Sunday morning, we passed the massive but aging complex that is Calgary’s Foothills hospital. On the corner, we saw a person who appeared very disorganized, his backpack’s contents strewn about while he paced nearby, quietly speaking to nobody.

Having worked in community mental health for 15 years, I recognized the hallmarks of psychosis.

After dropping my child off a few blocks away, I circled back. The gent was still there, now lying in a ball on the sidewalk. He seemed to have been overwhelmed by the task of gathering his belongings. I turned into the hospital parking lot. Walking from my car towards the crumpled man, first-aid kit in hand, I saw a police cruiser mount the curb and park on the grass.

In less than the minute it took me to cross the parking lot, another two cars pulled up, lights flashing, sirens on.

As six officers hopped out of three shiny new SUVs to survey the scene where the man lay, still and now silent, a scenario common to my clinical practice unspooled in my imagination: the mental health of a patient with a “community treatment order,” whom I know well, deteriorates. This can happen for many reasons. In my experience, destabilization of housing; lack of food, water or sleep; a change in medications, relationships, other health conditions or the weather; cultural disconnection; or simply disease progression can all contribute.

When I — or a case manager who knows the person even better than I — observe escalating risk, I can request that the patient be conveyed to a health-care facility for assessment and treatment. This whole process can take a couple of hours and involves several phone calls, legal forms, conversations and explanations.

After the police take the patient away, I worry — about their welfare, our therapeutic alliance and whether I did the right thing.

Later, I’ll check to ensure they’ve been admitted to hospital. Too often, I’ll learn they’ve already been discharged from our severely strained system.

One of my patients could very well be in the situation facing the man lying atop a heap of old clothes and dirty blankets that Sunday morning, encircled by six law enforcement officers and less than a block from the tertiary care hospital’s front door.

Can these scenarios be prevented? I believe they can, by investing in supportive housing and accessible-to-everyone, non-profit health care that includes on-demand access to — ahem, why not start with voluntary — mental health and addictions supports.

How should such a social safety net be funded? Having increasingly observed people tumble and fall through collapsed health and social care systems only to be surrounded by the police’s sidewalk squad, to me the answer is clear: slow the cash flow to law enforcement, reject wasteful and ineffective involuntary care, and reclaim simply caring, as we do in Canada, for each other.

People with mental illness do not need additional punishment.

What we all need is to demand that government redirect taxpayers’ resources toward health and housing — away from any expansion of involuntary care.