New Mental Health Act will finally open door to community treatment orders in P.E.I.

P.E.I.'s new Mental Health Act passed second reading in the legislature Friday. Whenever the law comes into force it will make the province one of the last jurisdictions in Canada to allow community treatment orders.

A community treatment order allows a patient who might otherwise become an involuntary patient in a psychiatric facility to work with a psychiatrist and mental health team outside of a hospital setting, said Dr. Javier Salabarria, Health P.E.I.'s medical director of mental health.

"It's really a balance between patient rights and liberties and providing the necessary psychiatric care," said Salabarria.

Under a community treatment order, a person can continue to live at home while going through treatment as long as the conditions of their order are being met. Those can include taking prescribed medications and showing up for appointments.

"We have new tools, new medications, new ways of delivering medications that are exceedingly successful to allow individuals to be in the community, to live, work and be with their families, to sleep in their own beds. That is the goal, it's quality of life in the community," Salabarria said. 

Criteria have to be met

P.E.I.'s existing Mental Health Act dates from the '90s. Salabarria said under the old law, the province's approach to mental health treatment was based around hospital admissions, which the new act aims to change.

"The entire purpose of the community treatment order is to minimize the amount of time in hospital and to minimize frequent re-hospitalizations," he said. 

Because compelling someone to receive treatment is an infringement of their Charter rights, the act outlines criteria that have to be met for a psychiatrist to issue a community treatment order.

For example, a person has to have been involuntarily admitted to a psychiatric facility on at least two separate occasions in the previous two years, for a combined total of at least 30 days.

The necessary treatment options also have to be available in the person's community. Once someone has been issued a community treatment order, that can also be used to trigger a new one. 

I made as strong an argument as I could in the house that...the restrictions were unnecessary and that we should give as much flexibility as possible to psychiatrists in order to make that decision, but we weren't successful in that and I think that's a real loss for Islanders.— Green Party MLA Peter Bevan-Baker

P.E.I.'s Green Party introduced an amendment that would have allowed a psychiatrist to issue a community treatment order to a patient regardless of their treatment history, if the patient was considered "likely to cause serious harm to himself or herself or to another person, or to suffer substantial mental or physical deterioration."

The Greens said the less-restrictive conditions mirror the approach in New Brunswick's legislation, but the Green amendment and several others were defeated.

"I made as strong an argument as I could in the house that ... the restrictions were unnecessary and that we should give as much flexibility as possible to psychiatrists in order to make that decision, but we weren't successful in that and I think that's a real loss for Islanders," said Green MLA Peter Bevan-Baker.

P.E.I.'s health minister said after much consultation he's happy with the bill that's been presented and is open to amending it as necessary.

"I don't think the Mental Health Act will stay on the shelf for another 20 years," said Mark McLane. "I think it's something we'll need to revisit as we move through the introduction of community treatment orders."

The Greens also voiced concerns about who was consulted during the drafting of the bill. Officials within the department said 27 different community organizations were consulted, as well as Island psychiatrists and mental health professionals.

The new legislation also provides added criteria around what patients can be involuntarily admitted to a psychiatric facility in the province.

While previously that included those who were deemed likely to cause harm to themselves or others, under the new law those deemed by a psychiatrist to be "likely to suffer substantial physical or mental deterioration or impairment" can also become involuntary patients.

One amendment out of five from the Green Party actually made it into the new law. That amendment dictates government will have a maximum of six months to bring the new Mental Health Act into force once it receives royal assent.