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Bill 31 of The Legislative Assembly of Alberta Mental Health Amendment Act

Bill 31 of The Legislative Assembly of Alberta Mental Health Amendment Act. Cindy Jing Fang Sonja Gundersen Ulrike Kimbley-Nicolai. Outlines. 1. Overview of subject matter. 2. Pro’s and Con’s. 3. Mental Health Policy in China. 4. References.

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Bill 31 of The Legislative Assembly of Alberta Mental Health Amendment Act

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  1. Bill 31 of The Legislative Assembly of Alberta Mental Health Amendment Act Cindy Jing Fang Sonja Gundersen Ulrike Kimbley-Nicolai

  2. Outlines 1. Overview of subject matter 2. Pro’s and Con’s 3. Mental Health Policy in China 4. References

  3. Currently bill is between the Execution and Implementation phase (Wharf & McKenzie) "..The Mental Health Amendment Act has been proposed for implementation in two phases: Sept. 30 for broader mental health treatment admission criteria and Jan. 1, 2010 for regulations governing community treatment orders." http://www.health.alberta.ca/documents/Health-Action-Plan-April-09.pdf

  4. Current ruling: excerpt of the MH Act Admission certificate 2   When a physician examines a person and is of the opinion that the person is(a)    suffering from mental disorder,(b)    in a condition presenting or likely to present a danger to the person or others, and (c)    unsuitable for admission to a facility other than as a formal patient,the physician may, not later than 24 hours after the examination, issue an admission certificate in the prescribed form with respect to the person.

  5. to come into effect Sep. 30, 2009 (Telephone info from the Alberta MH Patient Advocate Office): the new Mental Health Amendment Act, REPLACES and EXPANDS section 2 b with: “likely to cause harm to the person or others orto suffer substantial mental orphysical deterioration or serious physical impairment, and”

  6. New: to come into effect January 1, 2010(Telephone info from the Alberta MH Patient Advocate Office): • Bill 31 introduces Community Treatment Orders (CTO’s). CTO’s have been used in other CA provinces (ON, BC, SK) and other countries (USA, NZ, Australia, UK) • A CTO is a legal enforcement to get individuals to comply with treatment in an outpatient setting in the community. • Section 9.1 “Community treatment order • (1)Two physicians, one of whom must be a psychiatrist, may, in accordance with the regulations, issue a community treatment order with respect to a person if                    (a)    in the opinion of the 2 physicians, the person is suffering from a mental disorder, [ …] “

  7. Community Treatment orders, section 9.1.1, c the 2 physicians, after separate examinations of the person by each of them within the immediately preceding 72 hours, are both of the opinion that the person is likely to cause harm to the person or others or to suffer substantial mental or physical deterioration or serious physical impairment if the person does not receive continuing treatment or care while living in the community,

  8. Attempt of CTO summary • If in prev. 3 years: on 2 occasions or 30 admission days as formal patient, or previously on CTO, if untreated • Valid for 6 months • Renewal possible • features of treatment to be specified by issuing physicians • Can be enforced with police

  9. CTO: Has to be agreed to by client. But if not, can be issues if: (A)    the person 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 to others, and  (B)    a community treatment order is reasonable in the circumstances and would be less restrictive than retaining the person as a formal patient.

  10. How much consultation was sought of the population which this amended policy is trying to serve? Standing Committee on Community Services (SCCS) of The Legislative Assembly Of Alberta advertised for written submissions from public- received 49 submissions, of which 22 were from private citizens. Three private citizens (of 16 presenters) engaged in Public Hearing. Unknown to group if those are affected in any means by Mental Illness They issued report on Bill 31, with recommendations.

  11. Letter submitted to SCCS by Pam Miller, MSW, PhD, RSW, President of ACSW • The ACSW asks the Standing Committee on Community Services to consider the following questions regarding the adoption of CTOs: • 1. Are sufficient resources available in all of our communities to support CTOs particularly in rural areas of Alberta? • 2. Will approving CTOs help to get needed resources in every community? • 3. Is the government committed to adding and maintaining sufficient and appropriate resources in communities across Alberta that will effectively support the implementation of CTOs?

  12. Process somewhat similar to Bill 44 (compare with Janet Kipling’s lecture) Group experienced during research, that there appears to be confusion, in communication with public and maybe lack of knowledge on what the facts are to date in this particular Bill and especially the section of the CTO

  13. Community TreatmentOrder Bill 31 Pro’s Con’s 文 文本

  14. Initial questions • By appointing Health Professionals in cases where a psychiatrist is not available, and the fact that a person does not have to be admitted before a CTO - has the legislation made it easier to commit someone to involuntary treatment?

  15. Initial questions • A month before initiation of the changes in Chapter 35, the changes are not yet available (referring to Alberta Queens Print) – we ask ourselves how the Health Professionals can prepare themselves for following through the changes made? • What has been done as far as evaluation of the previous Bill, and the implementation of this new Chapter 35?

  16. Therapeutic alliances (pro’s) • In cases where a psychiatrist is not available, it is now possible to designate a Health Professional (i.e rural areas) • A possible positive outcome can be that desicions actually can be made at an earlier point • And, the patient can be assessed by someone they have a relation to, instead of bringing in a psychiatrist from another area.

  17. Initial questions • Who are these Health Professionals? • What qualifications do the Health Professionals need to have? • Are we fit to take on that responsibility? Is it beneficial for the individual client?

  18. CTO can promote treatment compliance – we know that consistent treatment might improve the possibility to get better/get the condition under control (question: do we know whether it is due to the order itself, or the assistance they get throughout the time of the CTO?) • Example: a man with schizophrenia who feels safe when someone else takes the desicion for him, since he knows he is unable to be compliant with treatment otherwise

  19. …on the other hand…(con’s) • Physicians can get assistance from the police to follow through the order, which can also signalize to the public that these patients have done something unlawful

  20. since we know that one of the important factors in treatment is to build meaningful relationships and trust, is it beneficial that the Health Professionals can make decisions on CTO? (Can it be harmful to the therapeutic alliance?)

  21. There are many testimonys from patients who feel violated, that they have lost their trust in the system after any involuntary treatment • If we damage the therapeutic alliance, how can we help the patients develop other coping skills, to manage their condition?

  22. Least intrusive treatment (pro’s) • One of the arguments for CTO is less potential trauma through fewer hospitalizations • CTO is less restrictive than being involuntary hospitalized Question: • Are the Health Professionals aware of the need for documentation? How will we know if CTO was helpful and did in fact prevent hospital admission?

  23. …on the other hand…(con’s) • There is little evidence that CTO has an impact on the number of hospitalizations (documentation from Canada and Norway states this) • An example from England shows that the use of a crisis team available 24-7 could prevent hospital admissions in 2/3 of the cases. Can we learn something from other countries? • Has there been enough emphasize on continuity of care (linked care)? Can we deliver it to the client?

  24. Do they focus more on the alternative that requires less resources, instead of working on parallell care like the example in England? What is the economic agenda here? • Which groups in the society have made efforts to change the Bill, and what were the motives? (i.e too few hospital beds, lack of psychiatrists, easier assessment made on this group of patients, a more seamless care without hospitalization)

  25. Safety (pro’s) • One of human being’s basic needs would be safety, to feel protected from harm • The CTO aims to help stabilize mentaly ill so they will not harm themselves or others • We have examples of harm done by people (i.e The Virginia Tech University, where 32 people were killed) who did not receive the healthcare that was ordered upon.

  26. …on the other hand…(con’s) • Numbers say that the risk to society is minimal (Canadian Mental Health Association) • And how is it possible to measure the harm prevention that is actually done? How do we know that the treatment has been helpful? • Who has the knowledge to assess the effect of the treatment? What research has been done to reveal the effects of this Bill?

  27. More ethical concerns • Other people, with physical health concerns can refuse treatment (which can be harmful for themselves) – why do we support different treatments for different groups? • The Canadian Charter of Rights and Freedoms states that every individual is equal underthe law, should have equal protection…[ ]…All Canadian citizens, including those with mental illness, should have the right to make choices about whether or not to receive treatment….

  28. More ethical concerns • Arguers claim that CTO would violate The Human Rights, Article 3 and 12 (i.e right to freedom) • Article 25 states, one the other hand, the right to health, which can speak for the CTO

  29. Mental Health Policy Brief review of China What’s going on in China? 文本 文本

  30. Some Important Numbers 16 million 20％ 30 million Around 30 million children under 17 years old may be affected by mental health related problems. Around 16 million patients who are suffering from mental health problems in China. The expenses on mental health problems is 20% of the total expenses of all the diseases in China. And it would increase up to 40% in 2020.

  31. Some Principles of the Health Policy Prevention Publication Education intervention Mental health education should be taught in school. To 2010, 60% students should gain knowledge on mental health by school education. Crisis intervention. After disasters, mental health services should be offered to people. Eg. 2008 Earthquake To 2010, 50% of the population should gain knowledge on mental health. Prevention is the first step.

  32. Mental health identification Doctors who have at least 5 years working experiences in the mental health field are qualified to make the conclusion. • Money matters Patients don’t need to worry about the expenses. There are social welfare to help the patients afford the expenses. • After treatment There are policies to encourage schools or companies to offer learning or working opportunities to the cured patients.

  33. What’s role of social worker ? • Sorry, there’s few social workers in the medical field in China right now. • Eg. Shanghai Oriental Hospital • Eg. Shanghai Children’s Medical Center • Social work & Administration

  34. References • http://www.qp.alberta.ca/574.cfm?page=2007ch35_unpr.cfm&leg_type=Acts&isbncln=9780779741052 Alberta Queens Printer • http://www.ssa-edmonton.com/PDF%20files/Bill31-Comments.pdf Schizophrenia Society of Alberta • http://www.qsos.ca/CTOreview.pdf Ontario Review • www.cmha.ca • Canadian Mental Health Association – Community Committal, Advocacy, Position Statement Community Treatment Orders • http://www.cmha.ca/BINS/content_page.asp?cid=5-33-179 Canadian mental Health Association • Grahaam, J. ; Swift, K. ; Delaney, R.: Canadian Social Policy (2008) • http://www.assembly.ab.ca/committees/reports/CS/Bill_31_Report_FINAL_proofread_with_cover(no%20blank%20pages).pdf Report on Bill 31: Mental Health Amendment Act, 2007 • www.health.alberta.ca/about/AMHPA.html Alberta Mental Health Patient Advocate Office • http://www.chinacourt.org/html/article/200206/12/4572.shtml People’s Republic of China Supreme People’s Court • http://www.chinacdc.net.cn/n272442/n272530/n273736/n273796/n1600556/n1601039/8711.html Chinese Center for Disease control and prevention • http://www.scmc.com.cn/ Shanghai Children’s Medical Center • http://www3.interscience.wiley.com.ezproxy.lib.ucalgary.ca/cgi-bin/fulltext/121684753/PDFSTART Journal of Psychiatric and Mental Health Nursing 2009, 16, pp.177-186 • http://canlii.org/en/ab/laws/stat/rsa-2000-c-m-13/latest Mental Health Act, R.S.A. 2000, c. M-13 • http://www.health.alberta.ca/documents/Health-Action-Plan-April-09.pdf Health Action Plan Annual Report April 2009

  35. Ulrike Student number 10003657 • Cindy Student number 10035691 • Sonja Student number 10036668

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