Tag: mental health
Many in the legal profession are stretched thin when providing legal services during the pandemic. Working from home often blurs the distinction between work and “not-work”. A co-worker recently told me that with her computer on in her kitchen, it is as if she is always working. Adding issues of child-care and home-schooling, or caring for isolated seniors only serves to heighten the complexity of the lawyer’s life.
(Clearly, non-lawyers face these challenges as well: often to a greater degree. Many lawyers have the luxury of being able to continue to work. Others are not so lucky.)
A recent decision of Justice Myers acknowledges the heightened demands on lawyers, judges and court staff during the pandemic, and the effect that these may have on their health and well-being.
Briefly, the case involved a commercial lease issue. The landlord wanted to rent out space in a mall to a call centre. Another tenant in the mall objected, asserting that is had a right to consent to the lease, and that the call centre would change the retail nature of the mall.
The landlord entered into a lease with the call centre that had a conditional period expiring February 1, 2021, in order to allow the landlord to obtain a court determination of the tenant’s claim to a right to consent. A court date was set for January 29, 2021, but counsel for the tenant was not available. A hearing on Saturday, January 30 was proposed by Justice Myers. Counsel for the tenant resisted, saying that “while his firm has conducted a fair bit of work during the pandemic on weekends and evenings, they have ‘been encouraged to be alive to the effects of doing so on younger members of the team who have childcare commitments etc.’”
Justice Myers noted that the court makes efforts to accommodate business transactions and recognizes real-time schedules. However, of significance, the court must also recognize the realities of lawyers’ lives and well-being.
The court takes very seriously issues of health and wellness of practitioners, members of the judiciary, and court staff during the pandemic in particular. While lawyers and the courts are in a service business, there has to be a brake applied to service providers’ willingness to compete themselves (or their juniors) into unhealthy states in the ordinary course of business. Recognizing that young counsel and staff may have other responsibilities or just need down time does not impair access to justice provided that everyone understands the need to make personal sacrifices when truly urgent circumstances arise.
Ultimately, a hearing date of February 4, 2021, was set. “Absent urgency that was not voluntarily assumed, I find it to be in the interests of justice to grant the adjournment sought.”
It is good to see that the court is recognizing the demands being placed on those in the legal profession, and the increase in these demands as a result of the pandemic. Yesterday was Bell Let’s Talk Day. Their motto, “When it comes to mental health, now more than ever, every action counts” is particularly apt.
Have a great weekend.
Just as an economic recession has serious ramifications for our society, so too does a social recession. A social recession can be described as a phenomenon whereby social bonds and human connection unravel the longer we are without interaction. Similar to an economic downturn, a social recession can have significant physical and psychological effects on people. Of particular concern to many is the effect that such a recession will have on the elderly, an already vulnerable population.
Restrictions in long-term care homes resulting from the Covid-19 pandemic have only magnified a deeper rooted pandemic of loneliness that was already in existence. The virus also shed light on an already strained and crumbling system. CBC Marketplace found that 538 of the 632 long-term care homes in Ontario were repeat offenders of abuse, inadequate infection control, inadequate hydration, unsafe medication storage, and poor skin and wound care. These homes were in direct violation of the Long-Term Care Homes Act and Regulations.
The importance of human connection cannot be underestimated. Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University, found that people with higher levels of social connection experience less inflammation (which is attributed to many chronic diseases) than those who are more isolated. Toronto long-term care resident, Devora Greenspon, although not infected with Covid-19, described her loneliness as “so deep it feels like a disease.”
Residents in Ontario’s long-term care homes have pleaded with the government to address the mass devastation caused by social isolation. It is crucial that elders and long-term care residents are protected from the spread of Covid-19. However, it is equally as important to halt the plague of loneliness from spreading any further. There must be a greater focus on the devastating effects of isolation on elders’ mental health as a healthy mind can often be the greatest weapon against disease. The inevitability of a social recession should not be overlooked.
Thanks for reading!
Suzana Popovic-Montag and Tori Joseph
On December 4, 2019, the Economic and Community Development Committee considered a proposal to improve senior services and long-term care in the city of Toronto, which is set to be considered by City Council on December 17, 2019.
The proposal is based on a Report from the Interim General Manager, Seniors Services and Long-Term Care which recommends ways to improve life for residents in long-term care facilities. The proposal sheds light on certain shortcomings of the current institutional model of long-term care facilities. Under the current system, after tending to basic care needs such as eating, bathing, and safety, and ensuring that they have met government mandated reporting requirements, staff are left with little free time. As a result, residents spend the majority of their days alone, without any form of genuine human interaction or purpose.
The proposal will revamp and hopefully reinvigorate the city’s 10 long term care homes by shifting the model of care to one that is emotion-centred. The key components of an emotion-centred approach to care would see increased staffing (with up to 281 new staff by 2025), more hours of care per resident per day, increased funding from the provincial government, and improved bedding.
More importantly, an emotion-centred approach emphasizes the emotional needs of residents, understanding that human connection leads to enjoyment of life. The new approach is based wholly and substantively on an understanding of ageing, equity, diversity and intersectionality.
If adopted, the city of Toronto will be the first to integrate diversity, inclusion and equity directly and comprehensively into an emotion-centred approach to care framework.
If you are interested in learning more, read this article from the Toronto Star. I also recommend reading this 2018 Toronto Star series called “The Fix” about a bold initiative to change care in a dementia unit in a Peel nursing home.
Thanks for reading!
Estate law is centred on asset planning for an end-of-life experience. So not surprisingly, we’ve seen just about every end-of-life situation you can imagine. I can tell you first-hand, many of these situations are painful, fearful, and depressing.
Does it have to be this way? The answer, in many cases, is “no.” We’re beginning to learn about new treatments that can help – and one of the most promising is the use of psilocybin, the active compound in hallucinogenic mushrooms.
Thank you legal cannabis
The legalization of cannabis in Canada and many U.S. states is breaking down barriers for research that was previously taboo, illegal, or underfunded. This is especially so in areas of mental health.
The treatment of physical pain with restricted drugs like morphine has long been accepted. But the use of mind-altering drugs for mental health? Not so much.
That stigma is changing. We’re on the edge of a new frontier in the treatment of “mental pain” – anxiety, depression, and fear of death – and psilocybin is front and centre.,
Research has shown that one of the most promising uses for psilocybin is in end-of-life situations. For those with a terminal illness, psychedelics not only provide relief from the terror of dying during the actual psychedelic sessions, but for weeks and months after.
According to researchers, psilocybin can create a deeper meaning and understanding of terminal situations – and is helpful in relieving the agony of the inevitability of death. Patients could reassure themselves and their loved ones that from a mental standpoint, they truly were okay. Many reported that using psilocybin was one of the most important experiences of their life. You can read more about the studies here.
Change is coming
There are calls for psilocybin to be reclassified for medical use, paving the way for the drug to be used to treat a number of mental health conditions – from fear of death, to depression, to addiction. The New York Times discussed this movement in a recent article.
This new attitude embracing research into the possible use of psychedelics for mental health is a welcome change. I look forward to the findings.
Thank you for reading,
Anxiety, depression and other mental health issues can occur for any number of reasons, but they often emerge when a loved one has died. While grief is a natural occurrence that’s distinct from depression, it’s not unusual for the grief over the death of a friend or family member to trigger a major depressive episode. And these conditions can worsen if the death results in family conflict, whether over the estate or other family issues.
When dealing with a mental health issue, we typically consider a number of treatments, from therapy, to medication, to increased social supports to help the person recover. These can all play a critical role in improving mental health.
But what can sometimes be overlooked are psychological improvement activities that a person can undertake themselves – ones that can have a measurable mental health benefit. One of the most surprising – and easiest to carry out – is a walk in nature, through a ravine, urban park, or rural area.
Taking a walk? Make it green
Exercise has long been proven to have significant mental health benefits. Many of us know this first hand from that “feel good” sensation after a workout. But there can be hurdles for someone suffering from a condition like depression to initiate even moderately intense exercise. These hurdles can include age, unfamiliarity with exercise routines, or just a lack of energy.
A walk – on the other hand – is something that most people can undertake quite easily. The key from a mental health perspective is to ensure that the walk takes place in a natural setting. A 2015 study compared the brain activity of people who walked 90 minutes through an urban setting to those who walked for the same length of time through a natural setting with trees and vegetation. The nature walkers showed significantly lower activity in the portion of the brain linked to ruminations, which can be a key contributor to depression and anxiety:
This isn’t the first study to show the link between time in nature and better mental health – and the science is strong. The Canadian Mental Health Association – Ontario has even funded park walks for youth with mental health issues, suggesting that nature walks are truly a beneficial activity for all ages.
Thank you for reading,
Since Bell’s “Let’s Talk” Mental Health Awareness Day took place this past Wednesday, I thought today would be a good opportunity to blog about the topic of consenting to treatment.
The Centre for Addiction and Mental Health has reported that 1 in every 5 Canadians, during any particular year, will experience an issue with their mental health. In light of this staggering statistic, it is possible that an individual may suffer from a mental illness that temporarily or permanently prevents him or her from consenting to treatment.
In Ontario, health practitioners are statutorily required pursuant to section 10 of the Health Care Consent Act (“HCCA”) to obtain consent before a proposed treatment can be administered. Consent must be obtained from either a capable patient or a substitute decision maker for the incapable patient. My colleague previously blogged about who qualifies as a substitute decision maker. In accordance with the HCCA, a patient is capable of giving consent if he or she is able to understand the necessary information to make an informed decision about the treatment and the consequence of the decision or lack of decision.
Despite the requirement for consent set out in section 10, section 25(2) of the HCCA allows for the treatment of incapable persons in urgent circumstances, and specifically provides:
Despite section 10, a treatment may be administered without consent to a person who is incapable with respect to the treatment, if, in the opinion of the health practitioner proposing the treatment,
(a) there is an emergency; and
(b) the delay required to obtain a consent or refusal on the person’s behalf will prolong the suffering that the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm.
Although there is some leeway for health practitioners to provide treatment to patients in urgent need of treatment without the consent of the patient or their substitute decision maker, it is nonetheless important to ensure that if you or someone you know suffers from a mental health issue that powers of attorney are in order to avoid delays when decisions need to be made about treatment.
Thanks for reading and have a good weekend!
Yesterday’s blog spoke to the issue of an Application for Psychiatric Assessment (Form 1) under the Mental Health Act R.S.O. 1990. To review, upon completion of the psychiatric assessment, the patient must either be released or admitted as an involuntary patient, a voluntary patient, or an informal patient.
• Involuntary Patient: Before you become an involuntary patient, a doctor must assess you and place you on a Form 3 (Certificate of Involuntary Admission), which lasts for two weeks. The Mental Health Act speaks very specifically to the legal criteria that must be met in order for such a Certificate to be completed. An involuntary patient is not permitted to leave the hospital or psychiatric facility.
• Voluntary Patient: There is no portion of the Mental Health Act that authorizes a psychiatric facility to detain a voluntary patient. In this regard, a voluntary patient can leave the facility at any time, as long as they do not pose a risk to themselves or others. If they were to be identified as posing a risk to themselves or others, then they must be made an involuntary patient (by means of a Form 3) in order to be detained.
• Informal Patient: An informal patient is either a child under the age of 16 years, or someone who is incapable of making treatment decisions for themselves (as defined by the Health Care Consent Act) and who therefore has been admitted to the facility under the consent of another person (i.e. ‘substitute decision-maker’; usually a concerned family member). The informal patient cannot be held against their will in the hospital, however, an informal patient can be made ‘involuntary’ if a doctor deems that a Form 3 is necessary.
Jennifer Hartman, Guest Blogger