During the 2022-2023 academic year, five scholars were asked a series of questions, designed to elicit their views about the mental health law and policy issues most warranting our attention. Included were family health expert Jo Ellen Patterson, a Professor at the University of San Diego who joined the Faculty of Law as a Fulbright Visiting Scholar in September 2022, Monnica T Williams, Professor of psychology and Canada Research Chair in Mental Health Disparities, Emmanuelle Bernheim, Professor of law (civil law) and Canada Research Chair in Mental Health and Access to Justice, Jennifer Chandler, Professor of law (common law), Vice-Dean, Research, and the University of Ottawa’s Bertram Loeb Research Chair, and Sophie Nunnelley, mental health law scholar and Associate Director of the Centre for Health Law, Policy and Ethics.

These scholars were asked three questions: (1) What is an issue in mental health law and policy that you are thinking about these days and why is it important?; (2) What is something you find challenging about working in this field?; and (3) What message would you like to give policy makers? The responses were notable in their emphasis on some shared themes, as well as, in some cases, their raising of distinct points of concern. The following is a synopsis.  

A major theme emerged around the tension between autonomy and coercion in mental health care. Several scholars emphasized that, as Bernheim put it, the “rights of persons targeted by coercive measures in mental health” are a fundamental issue, particularly when aimed at people living in precarious conditions, and racialized and marginalized people. “It is time to take the exponential use of coercive practices in mental health seriously,” Bernheim said.

Chandler also emphasized this point, noting that one of the “central and inescapable tensions” in mental health law is balancing “competing conceptions of autonomy, well-being and dignity of people with mental health conditions.” She explained that this tension is currently playing out in the Supreme Court of Canada’s decision to grant public interest standing to the Council of Canadians with Disabilities to bring a constitutional challenge to British Columbia’s mental health laws governing involuntary hospitalization and treatment. Chandler also raised the example of ongoing debates about whether capable adults with mental disorders should have access to medical assistance in dying.

Nunnelley, whose research focuses on issues of legal capacity and decision-making rights in mental healthcare, raised similar themes. She argued that the perceived dichotomy between respecting autonomy and supporting health is a false one. “In other contexts, we recognize that rights are good for health; there is no inherent conflict here,” she said. Nunnelley would prefer to see Canadian mental health law stop placing involuntary hospitalization and treatment at its core, and instead follow the “substantial evidence regarding the benefits of rights-respecting voluntary supports.” This latter approach would understand rights and care as “two sides of the same proverbial coin.”

A second significant theme discussed by these scholars was the critical need for improved access to high quality mental health training and care. For Patterson, an expert in training and education to support family well being, this is a particularly timely concern given the increase in mental health challenges in the population as a result of COVID-19. She worries “there has been little focus on what constitutes excellence in mental health training and few measures of excellence”. Williams also discussed issues of access. She is particularly focused on access to psychedelics for mental health concerns. However, she is also concerned with the state of the healthcare system and access to mental health care as a whole. “The health care system is on the verge of collapse and needs a major overhaul,” she said. Williams is also concerned with end-of-life distress among patients, an issue that came up in Chandler’s discussion of medical assistance in dying.

A strong focus on prevention emerged when the scholars shared their messages for policymakers. For Patterson, preventing mental health disorders could improve people’s quality of life and ultimately save money. This would mean focusing on supporting children and families and providing education about basic mental health hygiene, including simple ways to reduce stress. Nunnelley suggested we should be thinking about mental health within a social determinants of health approach. She noted, for instance, that Ontario social assistance rates have not kept pace with inflation. “It is very hard to have good mental health when basic needs are not met,” she said.

Other messages concerned the need, expressed by Williams, for removing “red tape and obstacles” to psychedelic research, and making psychedelics available to respond to the increasing need for mental health care. Chandler raised the tensions that can arise within families when they are called upon to support loved ones with serious mental health issues, for instance, when families play a role in securing hospitalization and treatment, and when family members are left “in the dark” because of medical confidentiality. She noted that these tensions are exacerbated in our “under-resourced system”.

The University of Ottawa is pleased to have such a strong concentration of mental health expertise. Through interdisciplinary conversations regarding these mental health scholars’ varied research areas, we found that synergies emerged. Most notably, issues of autonomy and coercion, prevention, and access to mental health training and care, are of central concern for scholars, and will be important to follow as these conversations evolve.