Academic journal article Canadian Review of Sociology

The Alberta Mental Health Act 2010 and Revolving Door Syndrome: Control, Care, and Identity in Making Up People

Academic journal article Canadian Review of Sociology

The Alberta Mental Health Act 2010 and Revolving Door Syndrome: Control, Care, and Identity in Making Up People

Article excerpt

ON FEBRUARY 28, 2004, A SERIES of unfortunate events led to the deaths of Jim Galloway, an officer of the Royal Canadian Mounted Police (RCMP), and Martin Ostopovich, a man who had been diagnosed with schizophrenia and was experiencing distress. In what follows I demonstrate that the deaths of Ostopovich and Galloway, together with a concern for the uncertainty surrounding mental illness and the dangers it implies, came to drive the process of creating new mental health law in Alberta. The result was the introduction of Community Treatment Orders (CTOs) and expanded involuntary committal criteria for the purpose of managing a particular type of person diagnosed with mental illness.

Past research has argued that CTOs are coercive, that this coercion originates from a particular environment where limited resources are available, and access to services is thereby allocated by mandating a patient to receive treatment (Mfoafo-M'Carthy and Williams 2010). Everett (2001) has also argued that "doing good" to protect society from dangerous individuals has been marshaled as a rationalization for introducing CTOs. I argue that while a lack of resources for people diagnosed with mental illness is a problem, it is not the source of the CTO's coercion. Rather, coercion was identified as a necessary solution to the problem defined in the characterization of a particular subject--a person diagnosed with mental illness that is dangerous and unpredictable and who can gain access to mental health services, but habitually refuses to do so due to a lack of insight into what is best for the subject's self. This subcategory of person diagnosed with mental illness is known as the revolving door patient. I argue that the CTO is a medical-legal technology that solves the problem of the revolving door patient by producing a patient that manages mental illness. It is the articulation and formalization of the revolving door patient that I describe in this paper. I do so by examining media and public hearing documents from the process that created the Alberta Mental Health Act 2010 (AMHA).

The AMHA introduced new criteria for involuntary committal. These criteria characterize the person that would be subject to CTOs and distinguish between types of people diagnosed with mental illness and who could also be identified as having particular histories and behaviors. To apply a CTO, two physicians, one of whom is a psychiatrist, must determine that a person is "suffering from a mental disorder" and be of the opinion that one or more of the following three conditions are met:

1. Within the immediately preceding three-year period the person has on two or more occasions, or for a total of at least 30 days, (i) been a formal patient at a facility and/or (ii) been in an approved hospital or been detained in a custodial institution, where it is evident that he/she would have met the criteria to be detained as a formal patient.

2. The person has within the preceding three-year period been subject to a CTO.

3. The person has, while living in the community, exhibited a pattern of recurrent or repetitive behavior that indicates that the person is likely to cause harm to himself/herself 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 (Alberta Health Services 2010:80).

If at least one of these conditions has been met, the two physicians must then separately conclude within 72 hours that all of the following conditions also apply:

1. The person is likely to cause harm to themselves or others, or to suffer substantial mental or physical deterioration or serious physical impairment if they do not receive continuing treatment or care while living in the community.

2. The treatment or care the person requires exists in the community, is available to the person, and will be provided to the person. …

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