Treatment refusal in the involuntarily hospitalized psychiatric population: Canadian policy and practice

Policies governing coercive psychiatric interventions must be scrutinized to ensure they are not only beneficent but just. Within Canada, in seven of ten provinces, persons may be detained in hospital against their will for dangerousness due to mental disorder but, if capable of making treatment decisions, may refuse treatment for the very illness that led to detention. In examining this issue, the purpose of this paper is threefold. First, it will demonstrate that treatment refusal amongst involuntarily hospitalized psychiatric patients has arisen from a recent separation, in law, of hospitalization from treatment. Second, it will argue that legal provisions that allow the detention of psychiatric patients prior to assessment of their treatment decision-making capacity discriminate against the mentally ill and undermine health service delivery. Finally, this paper will propose that a more just policy would allow involuntary hospitalization of only those patients who are both incapable of making treatment decisions and harmful to themselves or others.