Forced drugging of seniors still increasing

By Rob Wipond, April 2012

Ombudsperson, BCCLA and Greens criticize BC’s draconian laws.

I WAS READING THE CORONER'S REPORT on Kathleen Palamarek and something didn’t seem right. I’d been following her story since 2006. This was a diminutive, timid, 88-year-old nursing home resident with dementia and a heart condition, who’d been somewhat controversially diagnosed with dementia-related psychosis. She’d died of a heart attack. The coroner had found the antipsychotic olanzapine in her body. 

Palamarek hadn’t been taking olanzapine willingly; she’d frequently complained about feeling woozy and “drugged up.” She couldn’t refuse the drug, though, because her doctors had declared her incapable and, when she’d protested, they’d certified her under BC’s Mental Health Act (MHA). Antipsychotics are being used increasingly in seniors’ homes as chemical restraints to pacify and control people. But Health Canada has issued the highest possible warnings to doctors that antipsychotics are “not approved for the treatment of patients with dementia-related psychosis” and that these powerful tranquillizers have been linked to a near-doubling of death rates in the elderly, mostly from heart attacks. 

Yet here’s what coroner Stan Lajoie wrote about Kathleen Palamarek’s heart attack: “Death was clearly and unequivocally due to natural causes.” There was not so much as a hint anywhere in his seven-page report that her heart attack might have been linked to a drug known to dramatically increase heart attacks in the heart-weakened elderly. Why?

While I investigated that, new reports revealed in sharper detail the close relationships between BC’s staggering levels of antipsychotics use, and our province’s lack of legal protections for seniors’ basic human rights.

Focus last year uncovered that 47.3 percent of BC seniors’ home residents were being given antipsychotics, above the US and Canadian average of 26 percent, and four times the rate in Hong Kong. A December, 2011 BC Health Ministry report showed rates still climbing: 50.3 percent are now being given antipsychotics. Vancouver Island is highest at 51.5 percent. 

In February, BC Ombudsperson Kim Carter released a report showing that much of this is occurring with perilous disregard for safety and without residents’ consent. Carter found that antipsychotics are routinely doled out by facilities’ staff on an ad hoc “PRN” (“as needed”) basis, with no policy guidelines or controls. “Having procedural safeguards in place is especially important where the PRN medication is an antipsychotic, because of the potential risks associated with the use of these medications,” Carter wrote. Further, it’s often done without the consent, or even the knowledge, of residents or family members. “[T]here is currently no legal requirement to document that a person in care’s capacity to give consent has been considered or assessed, or that informed consent has been obtained from a person in care or a substitute decision-maker,” Carter wrote.

Meanwhile, when seniors or families resist, care home staff and psychiatric hospital directors sometimes override their wishes by using involuntary committal laws in ways for which the Mental Health Act (the Act) was never designed. Carter uncovered that this, too, is being done in an improvised, autocratic manner, commenting that “we expected that the Ministry of Health and the health authorities would have created procedures to guide directors of mental health facilities in their use of section 22 of the Act. We found that this is not the case.” Astonishingly, Carter also found, in all 100 cases she examined, that these incarcerated seniors were actually being profited from—charged up to 80 per cent of their after-tax income monthly. “In my view,” wrote Carter, “it is unfair for a government to involuntarily detain seniors, subject them to treatment and then charge them fees for that detention. This is especially true when there is no clear legislative authority for doing so.” 

In January, the BC Civil Liberties Association issued a position paper cogently encapsulating the Act’s extraordinary powers. The paper states that BC’s Mental Health Act “abrogates fundamental patient rights” more than any similar legislation in Canada. The BCCLA notes that in BC a doctor can certify someone “without… even personally examining or observing the person.” And, the paper describes, the Act trumps many other laws. If you’re still legally competent to make decisions, or you’ve appointed a substitute decision maker—too bad. If you want to appeal, you’ll have to wait a month while you’re forcibly treated first. And you’ll be on your own at your appeal, because legal aid “is limited and the number of advocates is insufficient.” If you decide to sue? The Act includes a broad “immunity from liability” that, according to the BCCLA, protects even “substandard” care and “disastrous” treatments.

How did our Mental Health Act get this way? The answer is instructive, because it exposes the same attitudes steering BC seniors’ care. Basically, politicians have been lobbied by doctors, pharmaceutical companies and pharma-backed non-profits, and people like Susan Inman, past president of the BC Schizophrenia Society, mother of a daughter diagnosed with schizophrenia, and dogged campaigner against civil rights. They’ve influenced public opinion in BC so effectively that even the otherwise human rights-defending Tyee.ca has published articles by Inman in which she has, for example, called it a “major problem” that the Canadian Mental Health Commission might provide “funds for court challenges to human rights abuses.” This would be terrible, Inman claims, because “40 to 50 percent of psychotic people don’t understand that they are ill” and that they need antipsychotics, and therefore none of them deserve or would benefit from having choices. 

The impacts on seniors of these paternalistic attitudes have been far-reaching. For example, since new legislation in September, BC citizens can now write legally binding “advance directives” to guide decisions about our care when we’re old and infirm, or fall into a coma. Hypothetically, this could end forced treatment of seniors with antipsychotics. Except there’s one situation where your advance directive can be ignored: When you get certified under BC’s Mental Health Act. 

Rights activists used to point out that a convicted serial killer has more control over his life than a person who’s been certified under BC’s Mental Health Act. Now, even a person in a coma has more control over his life.

And of course, all other factors remaining the same, we’ll expect use of the Act by doctors to simply increase in proportion to the use of advance directives by seniors. We’re already seeing Mental Health Act use increase as media coverage has made the public more aware of dangers with antipsychotics. BC Ministry of Health statistics show that, from 2002 to 2011, there’s been a 50 percent increase in involuntary committals of British Columbians aged 65 or older. On Vancouver Island, it’s doubled, from 129 to 267 people. But these numbers merely hint at how extensively the Act is actually being used. This is because the Act is like carrying a loaded gun; it’s so easy for doctors to fill out the one-page form to certify someone, they usually need only wave it around, not actually shoot it, to win compliance.

And we shouldn’t dismiss the dangers. While Inman points to a miniscule percentage of people with schizophrenia who have violent tendencies, BC laws allowing doctors to circumvent consent are killing more people than an army of serial murderers, psychotic or otherwise, could ever do. For example, extrapolating from research statistics, hundreds of thousands of seniors across Canada are being forcibly drugged with antipsychotics, and thousands are dying from reactions to them. Even Health Canada’s Adverse Drug Reaction database, still largely a voluntary effort, identifies 3200 deaths of seniors since 2006 linked to four antipsychotics.

Meanwhile, Kathleen Palamarek was “clearly” and “unequivocally” not one of them? I contacted the coroner’s office, and they punted general responsibilities for identifying adverse drug reactions back to treating physicians. But doctors obviously have a stake in absolving themselves and their treatments. So how many more seniors are dying from antipsychotics than we know of?

Recently, I worked with several academics, activists and people who’ve experienced forced psychiatric treatment, to draw up proposals for change. Our document garnered the support of Jane Sterk and, this February, became the official “Mental Health and Social Justice Policy” of the BC Green Party. The platform could be especially transformative for seniors’ care. So I want to thank the BC Green Party for taking a strong stand, unprecedented amongst BC political parties, in defence of the human rights of our elderly. Why don’t you thank them, too? You may need those rights someday. 

Rob Wipond has been researching and writing on mental health issues since 1998. He’s posted links to references at www.robwipond.com.