Divide remains in Windsor on push for involuntary treatment

Hotel-Dieu Grace Healthcare in Windsor, Ont., on Monday, Nov. 30, 2020. (Chris Campbell / CTV Windsor)

The head of the Windsor hospital specializing in mental health care, Bill Marra, has come out against a push from municipal leaders in Ontario to enact involuntary treatment as a way of dealing with the crisis around homelessness and addiction.

On Wednesday, Hôtel-Dieu Grace Healthcare (HDGH) published an open letter from its president and CEO detailing opposition to the measure in seven points, including concerns around human rights and the effectiveness of such a model.

“The reality is one solution for all won’t work and involuntary treatment, really, there’s a lack of evidence to support that that’s a sustainable way to approach social and medical issues of this nature,” said Marra, in an interview with CTV News.

The open letter follows a letter signed by a dozen Ontario mayors, including the mayors of Windsor and Chatham-Kent, to Premier Doug Ford calling for him to use the notwithstanding clause in the Charter of Rights and Freedoms to supersede autonomy rights to employ involuntary treatment.

Marra said more support and expansion of current approaches can produce better outcomes.

“What we do right now is effective. I think we need more resources,” said Marra. “We want to be successful in providing supports to those individuals who are suffering from a mental health or an addictions disorder, or both.”

Marra also gave credit to the province for its incoming Homelessness and Addiction Recovery Treatment centres, known as HART Hubs, as a promising plan.

At the Association of Municipalities Conference on Aug. 20, Health Minister Sylvia Jones announced the Progressive Conservative government’s $378 million plans to ditch Consumption and Treatment Services (CTS) sites in favour of 19 new HART Hubs across the province.

The submission deadline was Oct. 18, which saw HDGH and the City of Windsor partner to apply.

 

Council responds

Windsor Mayor Drew Dilkens, in an interview with CTV News, concedes there are differing viewpoints on the approach, but believes mandatory care, in some cases, is a necessary step to address a growing problem he sees as requiring a more aggressive approach.

“I'm fighting like hell to make sure that I don't see this problem get any worse on the streets in the city of Windsor,” said Dilkens. “We cannot put our heads in the sand and think this is going to go away by using and employing the current approach.”

Dilkens argues those struggling with myriad issues and experiencing homelessness can’t make “sensible decisions for themselves” and so more money won’t help without the option to mandate treatment.

“Those who think there's going to be hundreds of millions or billions of dollars more put into this are fooling themselves,” said Dilkens.

Downtown councillor Renaldo Agostino, where the crisis appears most pronounced, says involuntary care may be a tool worth having and says officials won’t go overboard should it be granted the new power.

“We're not talking about coming down heavy handed on anybody,” said Agostino. “What we're talking about doing is it's a very narrow focus on those that are suffering from the most acute, severe illnesses and disabilities and those people cannot be out in our community and having an opportunity to harm themselves or harm anyone else.”

As for the premier, at an unrelated event near Barrie on Tuesday, Ford responded to a reporter question tersely when pressed on potentially forcing people into treatment.

“No, actually we won’t be sending them to the mental hospitals against their will,” said Ford.

However, the premier would go on to suggest property rights should be considered as it relates to encampments in public spaces.

 

Marra’s letter

In recent years, the debate surrounding involuntary treatment for individuals with mental health and addiction issues has gained significant attention. A comprehensive examination of the evidence reveals that involuntary treatment is often not considered a best practice model in mental health care.

Several key points support this position:

1. Lack of Evidence for Effectiveness: Studies indicate that involuntary treatment does not yield better long-term outcomes compared to voluntary treatment. A systematic review published in *Psychological Medicine* (2017) highlighted that while involuntary treatment may stabilize patients temporarily, it often fails to produce enduring improvements in mental health or reduction in substance use disorders.
2. Increased Risk of Trauma: Involuntary treatment can be traumatic for individuals, leading to feelings of helplessness, humiliation, and a loss of autonomy. Research in the *Journal of Trauma & Dissociation* (2010) suggests that coercive measures can exacerbate trauma symptoms, further complicating an individual's recovery and overall mental health.
3. Patient Engagement and Compliance: Evidence suggests that voluntary treatment methods foster better engagement and adherence to treatment. A study published in *Community Mental Health Journal* (2016) demonstrated that individuals who are treated voluntarily are more likely to participate in their care, leading to improved outcomes. In contrast, involuntary treatment can create distrust between patients and providers.
4. Human Rights Concerns: Involuntary treatment raises ethical and human rights issues. The World Health Organization (WHO) emphasizes the importance of respecting individuals' rights and support for autonomy in mental health care. The principle of informed consent is central to ethical medical practice. Involuntary treatment contravenes these principles, leading to potential violations of individuals' dignity.
5.  Alternative Approaches: Evidence-based alternatives exist that focus on voluntary engagement and supportive approaches, such as harm reduction programs and community-based interventions. For instance, a study published in *Harm Reduction Journal* (2015) highlighted the success of harm reduction strategies that empower individuals to make their own choices regarding treatment, showing effective outcomes in managing addiction without coercive measures.
6. Cultural and Contextual Considerations: Mental health treatment is not one-size-fits-all; cultural contexts and personal histories significantly impact treatment efficacy. Involuntary treatment often disregards these contexts, leading to alienation rather than healing. Most especially in a richly diverse region such as Windsor and Essex County, culturally competent care that respects individuals' backgrounds is essential for successful outcomes.
7. Legal and Policy Implications: Many jurisdictions in North America have actually moved away from involuntary treatment models, recognizing the need for more supportive, patient-centered approaches. Policies promoting patient autonomy and voluntary treatment protocols, such as crisis intervention teams, have been shown to reduce the necessity for involuntary admissions and improve community safety and individual well-being.

In conclusion, evidence consistently supports the notion that involuntary treatment is not a best practice for addressing serious mental health and addiction issues. Rather than coercive measures, the focus should be on developing supportive, voluntary, and collaborative treatment options that respect patients' rights and promote healing through engagement and empowerment. Emphasizing compassionate care can lead to more sustainable recovery outcomes and a more humane approach to mental health and addiction issues.