Roughly one-in-five of the population of Canada is diagnosed with some form of mental disorder. The biggest issue when it comes to the rights and freedoms of people suffering from mental illness has to do with those who are labelled with the symptom of "anosognosia". This word refers to lack of insight, or the inability to know that one has an illness. The problem with diagnosing someone with anosognosia is that if the assessment is wrong and the person does, in-fact, possess all of their mental faculties, they are dismissed outright. Freedoms can thus be removed by a paternalistic system.
From the common sense view; it is clear that in many cases someone labelled “at risk” should be hospitalized against their will, as only those capable of carrying out their duties to themselves and to society are due rights.
Someone with anosognosia however has a deficit in the self-awareness required to attend to such responsibilities, and thus cannot meaningfully claim all their rights. They therefore lack freedoms that a self-aware person has, and must be treated paternalistically by presiding authorities until such a time as their own competency is affirmatively re-established. If this means forcibly treating someone against their will, we can both assume their personal judgment is invalid, and their will is misaligned from their own best interests. Those of us with sound minds, then, might know what serves their best welfare instead. Because of the manifold dangers present within mental illness, we act as though it is better to mistakenly give forced psychiatric treatment to a hundred people who are best left alone, than to leave a single person in genuine need untreated.
If we let people who are anosognosiastic make decisions, it is rare for there to be any kind of urgent dangers. However, we should look to the worst case scenario. That is to say, if someone categorically refuses to seek treatment whatsoever, and this results in the injury or death of themselves or others... what follows? We would collectively have to be okay with this consequence. Being at peace with accidental injury means that the personal freedoms of our fellow citizens remains a priority. (These injuries were not caused by us doing anything wrong.)
In fact, this attitude going forwards might prevent even worse abuses, such as giving psychotropic drugs to people who are well, but have been wrongly deemed to be ignorant of a condition that they do not, in fact, have. From this point of view, the harm of enforcing an incorrect diagnosis far outweighs the harm of letting someone evade treatment. As anyone who has been diagnosed and treated for a mental illness can attest to, sometimes the diagnosis and treatment of it are worse than the initial illness itself. As opposed to the common sense view above, this might be called the libertarian view.
I think we can imagine a better option here. I hesitate to even give it a name. First we must admit that nobody has insight into the future. We should not pretend to know if someone is a risk to themselves or others. We don’t live in a "Minority Report" world. Imprisoning someone, or otherwise taking away their rights, because we predicted a crime prematurely by some oracle or algorithm is a serious violation of human rights. We don't do it with sex offenders, thieves, or even murderers. We see that even suspected felons have rights. So why is it considered standard operating procedure for those mentally struggling? And, before saying that it's in the mental patient's best interest, consider that we don't take away the alcohol from alcoholics, or the casinos from problem gamblers. Abolishing the freedoms of someone living with mental illness, who is otherwise law-abiding, has no precedent anywhere else in our human structures.
Since it largely happens to people that psychiatrists label as lacking insight of their own well-being, it's arbitrarily based on the fallible judgment of a small handful of doctors. The world is a weird place, and sometimes in life, weirder – more vividly wild -- things, happen to people than what overloaded doctors will be willing to believe by the end of a three-to-five minute admissions interview with a stranger. Once the mandatory psychotropic drugs are administered, it's even harder for the innocent individual to stay conscious enough to be taken seriously.
A hospital should be a place of healing, and just like in the case of sexual intercourse, consent must be given at all stages. If you convince someone to go to a hospital by saying, for example, that it is like a vacation, and once there they learn it is opposite of what they agreed to, principles of consent should allow them to leave at any time. Consent means that if someone says "yes", they must be able to say "no" later on. This rule is simple and basic, and needs to be universally respected. Personally, I've been a voluntary patient, and quickly learned that signing into a hospital led to a much longer stay than I had planned. The three day stay I was promised very quickly became a week, then two weeks, then a month, then two months, and finally three. The experience felt hopelessly endless. The hospital was a prison, except without any straight-forward answers as to my release date. Also those of us in the ‘care’ of this facility were treated with neither rights and liberties nor dignity. Suffice to say, a hospital should be a place where patients will voluntarily stay for long-term treatment. Being periodically asked something like "here are the reasons we think you should be here, but regardless do you still want to be in the hospital?" and having that answer taken seriously would go a long way. The hospital system needs to be fixed, and there are conversations that need to be had for the sake of the roughly one-in-five people who suffer from a mental illness in their lifetime. This is a conversation about the well-being of your family, and sometimes yourself. How do you want to be treated when doctors deem you ignorant to your own best interests? You should have a plan.
Anyway, it goes without saying that giving another person psycho-altering drugs and locking them in a dungeon is an egregious wrongdoing. This is essentially the experience of a schizophrenic in a hospital. It's also the reality of the mentally well who are there because of some person's misjudgment. Unfortunately, it is sometimes hard to tell these two classes of people apart.
For those who indulge in heavy drugs willingly, first-timers often have a sober trip spotter to watch over and attend to them. This person must be well-meaning, knowledgeable, and safe. To the point of forced psychiatric care, it’s important to remember that these doctors who order the medication are not only often overburdened but also otherwise removed from the patient. Patients mostly interact with nurses and other patients. The person having to suffer through these intense experiences, often have no real or meaningful support while they’re wrestling with the sometimes severe side-effects of antipsychotics (formerly known as "chemical restraints"). In this case, the idea of trip spotters can be transplanted. Patients who have been ill and have since recovered, peers who know what it’s like, could help a lot in orienting scared people to the experience, which is otherwise very industrial and detached.
The sad reality of these discrepancies and mistreatment is largely driven by the fact that the people with the final say in the policies surrounding mental illnesses and institutionalization are rarely those who have suffered from any of these challenges personally. This leaves these policy makers ignorant and removed from the actualities of these experiences. People suffering from severe mental disabilities are the advocates through their lived existence. However, even with the best intentions, their voices are often excluded from discussions, their wisdom overlooked. The severely mentally ill are left without any real power in the conversation despite being those with the most to offer. Treated schizophrenics are not leaders in deciding mental health policy. This negligence can only be intentional. The way in which these structures are run now can be more damaging to the overall health of those interned to them, both to those who do face psychological challenges but find themselves mistreated and to those who are mistakenly diagnosed, but committed regardless.
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