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Committing a person suffering from serious mental illness against their wishes requires several complex steps. "The bar is high. They have to make sure the reason is sound and solid," says Amanda Varnish-Sharma, an early-intervention family worker at the Schizophrenia Society of Ontario. After all, an involuntary committal essentially strips a person of his rights. While it is often frustrating, "sometimes you have to wait for things to worsen." Details differ by province. Here is the procedure in Ontario.

In a serious and immediate crisis, families may call the police directly and ask that their loved one be taken by force to the hospital. The decision is left to the discretion of the officers involved.

More typically, a justice of the peace or a doctor is asked to sign the documents. Anyone can begin this process, though usually it's done by friends or relatives. It must be demonstrated that the person is a danger to himself, has endangered others or has caused someone else a reasonable fear of harm, or else that he cannot take care of himself. This often requires documentation and letters from outside sources.

After assessing the evidence, a justice of the peace may then sign a Form 2, permitting the police or family members to take the person to the hospital. The examining doctor then signs a Form 1, committing him into care for a 72-hour assessment. Jesse's parents got their family doctor to make a house call for the examination, making a justice of the peace unnecessary.

After three days, a patient is assessed by a second doctor, who determines whether he should remain in hospital. If the patient contests the decision, his case may be appealed to the province's consent-and-capacity board, composed of a psychiatrist, a lawyer and a member of the public.

The final decision to commit a patient involuntarily is completely at the discretion of the doctors. A doctor may release an adult patient without consulting the people who had him committed. Guardians are involved in the decision when the patient is a minor.

According to the Canadian Institute for Health Information, roughly half of the people admitted to hospital for a mental illness in Ontario (the only province to collect statistics) were sent against their will. However, there were significant differences, depending on the type of mental illness diagnosed:

Half of the patients with mood disorders, such as depression and bipolar disorder, were committed involuntarily.

Those diagnosed with schizophrenia were twice as likely to be committed against their will than to admit themselves into care.

People with anxiety disorder were three times more likely to go to hospital of their own accord than involuntarily.

Patients under the age of 24 were more likely than people in other age groups to be committed involuntarily. But for most age groups, the numbers were evenly split between those committed without their permission and those who went willingly to the hospital.

Erin Anderssen

*****

COMING UP IN THE SERIES

Monday Depressed and

employed: The workplace

challenge, by André Picard

Tuesday

Trapped in a Vancouver

hospital room, by André Picard

Wednesday

Addiction as mental illness,

by Carolyn Abraham

and Tonia Cowan

Thursday

Sentenced to insanity in an

Alberta prison, by Dawn Walton

Friday

Scotland's good example,

by Elizabeth Renzetti

Saturday, June 28

What needs to be done:

The solutions, by André Picard

A made-in-Canada miracle,

by Carolyn Abraham

Essay: Fighting the stigma,

by Senator Michael Kirby

On the Web

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Speak Your Mind

People with mental illnesses are still burdened by a stigma that can prevent them from seeking care. It also stops the public from seeing and solving the problem. Has mental illness affected your life or that of a loved one?

To help end that stigma, visit

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The contributors

Carolyn Abraham, medical

reporter for The Globe and Mail, gained the consent of clinicians and patients at the Centre for Addiction and Mental Health in Toronto to intimately observe a group-therapy program for weeks this spring. She also interviewed CAMH's Dr. David Goldbloom to get the big-picture view.

Erin Anderssen, a Globe feature writer, spent a week in Miramichi, N.B., and did hours of follow-up interviews to document the story of Peter O'Neill and his family's struggle to keep him alive. In Toronto, she sat down with Jesse Bigelow and his parents to record their account of Jesse's journey through schizophrenia.

Charla Jones, staff photographer, travelled the country to take

all the photos in this section

(unless otherwise indicated).

She also conducted the interview

with teenager Alyse Schacter

for globeandmail.com.

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