QUEBEC CITY, June 7 /CNW Telbec/ - Enforcement of the Act respecting the
protection of persons whose mental state presents a danger to themselves or to
others must be stricter to better protect both individuals and their families.
Citizens with mental health problems have legal rights. Recognizing their
rights as patients will change nothing, however, if their rights are treated
differently from one establishment to another, has concluded Québec
Ombudswoman Raymonde Saint-Germain after examining complaints and reports
brought to her attention by people with mental health problems or by their
friends and families with regard to protective custody in hospitals.
    The Québec Ombudswoman has noted that some hospital staff have difficulty
ensuring the provisions of the Act are applied. According to her, complying
with the Act is a daily struggle in certain establishments, calling into
question practices, attitudes, and the service culture.

    Protective Custody

    When people go-or are taken-to a hospital's ER because of their mental
state, they must be seen by a doctor as quickly as possible to assess whether
their state presents a grave and immediate danger. If necessary, they may be
held against their will, without a court order, for up to 72 hours. However,
the Québec Ombudsman has noted that patients are too often held against their
will in solitary confinement. They are kept under observation without ever
being formally taken into protective custody and are not allowed to leave the
establishment until the doctor decides.
    The Québec Ombudswoman finds these practices disturbing and nonconducive
to attaining the Act's objectives. "Aside from the ambiguity surrounding their
true status, these patients are not informed that they are being taken into
custody, not told why it is happening, and not informed of their right to
contact family or a lawyer. This right to information is nevertheless set out
in the Act," notes Ms. Saint-Germain.

    Consent to Care

    The Québec Ombudsman has also noted situations where people with mental
health problems have been treated without their consent or that of their
representatives despite the lack of emergency. Holding a person against his or
her will on the basis of a medical evaluation or a court ruling does not give
staff the right to take a blood sample or perform a psychiatric evaluation
without consent. The Québec Ombudswoman finds this confusion disturbing,
concluding, "This situation is proof of a lack of awareness surrounding
patients' rights and also demonstrates the need for major changes so that
clinical practices and the way establishments and services are organized allow
staff to treat people with mental health problems with respect."

    The Tobacco Act

    In her annual report, the Québec Ombudswoman identifies other situations
involving services and care given to people with mental health problems. One
notable case involves not allowing users under observation at hospital
psychiatric care units to smoke. In such circumstances nicotine depravation
can have considerable effects. Real difficulties arise when the only
alternative for this group of patients being kept in custody is nicotine
patches, a form of treatment that requires free and informed consent. Given
that a medical prescription is required for nicotine patches, the Québec
Ombudsman considers them to be a form of care. Users must therefore give their
consent and be allowed to make a free choice, a right enshrined in the Québec
Civil Code. The Québec Ombudsman therefore recommends that establishments
offer users being held in custody other alternatives to overcome their
nicotine cravings. The Ombudsman believes other means should be available so
that the situation of smokers admitted to observation units can be taken into
consideration. The Québec Ombudsman is currently discussing the matter with
Ministère de la Santé et des Services sociaux.
    "The complaints dealt with by the Québec Ombudsman with regard to mental
health show that affirming rights does not always mean they will be respected.
Staff and management must be vigilant on a daily basis to identify situations,
causes, and ways to ensure user rights are respected. It's a never-ending
process," concludes the Québec Ombudswoman.
    -%RE: 1

For further information:

For further information: Dominique Bouchard, Information Officer, (418)
643-2688, Cell: (514) 346-2643,
dominique.g.bouchard@protecteurducitoyen.qc.ca; Source: The Québec Ombudsman

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