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Gaps in the system growing wider Add to ...

Except in extreme cases, judges should be careful about telling governments how to spend their money, or hospitals which patients to care for. So a decision by an impatient Ontario Court judge obliging a psychiatric hospital to take in an ill accused man immediately should not have been made, and was in fact overruled by the Ontario Court of Appeal this week. But the case does point to serious cracks in the mental-health and legal systems.

The case involved a patient at Toronto's Centre for Addiction and Mental Health, accused of a sexual assault but found unfit to stand trial. Under the Criminal Code, an accused can be ordered to receive psychotropic drugs if a doctor says those drugs will make him fit to stand trial. The drugs are administered in a psychiatric hospital.

That law allows for a major interference with the accused person's right to autonomy - justifiable in some circumstances - and Judge Mary Hogan, who presides over a special mental health court, expressed great frustration that, when she ordered the treatment, there was no bed immediately available in CAMH or another facility. The accused would have to languish in jail for six days until a bed was ready. Judge Hogan ordered the accused to be taken to a bed in a CAMH hallway while he waited.



The problem, as CAMH had explained, is that if it accepted this particular patient immediately, another patient would have to be bumped. Should a judge give one patient priority over others of whom she has no knowledge?



There have been many other such cases, and they reveal - as in many public services - a system trying its best to make do, but falling short of public expectations. It is galling, in this context, to know that the federal government's tough-on-crime agenda will put many more people in prison for longer periods, and impose greater costs on corrections that will necessarily mean less money for mental-health and other services.



The overload on psychiatric hospitals apparent in these cases is also a barometer of the state of the mental-health system generally: overburdened from childhood through adulthood. It's a difficult place to try to save money, because problems don't go away if left untreated, and small problems tend to become big ones. Any expansion of corrections will hurt the mentally ill in two ways - by bringing more into jails where they do not belong, and by limiting the dollars available for mental health care.



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