TheAlberta Mental Health Act 2010and Revolving Door Syndrome: Control, Care, and Identity in Making up People

Abstract

In this paper, I describe dividing practices in making up a specific medical-legal category-the revolving door patient-to identify, label, and direct the actions of particular people living with mental illness. The revolving door patient was a category that had been spoken of for some time, but became a formal legal subject with the introduction of the Alberta Mental Health Act 2010 and Community Treatment Orders (CTOs). I demonstrate how a rationale of control over unpredictable and dangerous individuals was primary in creating this new category, and that the characterization of the revolving door patient required a disciplinary technology to reduce danger. I argue that the CTO is a medical-legal technology that solves the problem of governing a subject in order to produce a patient that manages mental illness. I conclude by reflecting on how the narrative of the revolving door patient, and of mental illness more broadly, has implications for personal identity and tensions between care and control. Dans cet article, je décris comment des 'pratiques divisées' ont créé une catégorie spécifique médico-légale - le « revolving door patient » - afin d'identifier, d'étiqueter et de contrôler les comportements de certains individus vivants avec une maladie mentale. Le «revolving door patient», une catégorie dont on avait parlé depuis un certain temps, est devenu un sujet juridique formel par l'introduction de la loi de la santé mentale de l'Alberta 2010 et de l'Ordre de Traitement Communautaire (OCT). Je démontre comment une logique de contrôle sur les individus imprévisibles et dangereux eu un rôle prépondérant lors de la création de cette catégorie et que la caractérisation du «revolving door patient», entant que telle, a nécessité une technologie disciplinaire pour réduire le danger social. Je soutiens que le OTC est une technologie médico-légale qui résout le problème de contrôle d'un sujet en produisant un patient qui gère une maladie mentale. Je conclus en démontrant de quelle façon le «revolving door patient», et la maladie mentale en général, a des répercussions sur l'identité personnelle et produisent des tensions entre les soins et le contrôle.

Família que convive com pessoa com transtorno mental: genograma e ecomapa

“…Sabe-se que esses fatores podem estar relacionados a portagiratória, denominado pela literatura internacional de revolving-door. 21 A porta-giratória pode ocorrer como uma consequência da desinstitucionalização quando essa é tratada como desospitalização. As políticas públicas preveem a redução de leitos psiquiátricos, sem viabilizar as condições necessárias para o atendimento extra-hospitalar, refletindo negativamente no cuidado ao usuário e família, acarretando nas reinternações.…”

The social utility of community treatment orders: Applying Girard’s mimetic theory to community‐based mandated mental health care

“…In each of these cases, tighter control of people with SMI acted to allay people's fears of escalating violence, and move their attention away from possible systemic causes; the CTO legislation eclipsed contextual or relational understanding of the aetiology and treatment of mental illness and of violence in favour of containing and controlling a “defective” individual. The CTO creates a category of people who are “dangerous and unpredictable” (Barron, , p. 291), and in so doing relieves us of the need to consider the complex aetiology of violence, social unrest and mental illness.…”

“…Acknowledging a mutually creative relationship between individuals and their context allows us to see SMI both as a biological phenomenon and as socially construed: the social context effects the biology and the biology then influences the social context in an ongoing process (Riordan, ). Applying this notion to the CTO, we can see the CTO as something that creates the identity of the individual even as it acts to contain them (Barron, ). At the same time, the “rituals” or “processes” of the CTO (including appearances before capacity review boards and encounters with clinicians) also act to create identities for the other individuals involved, whether directly (clinicians, families) or indirectly (broader cultural context).…”

“…England, Israel, Norway, Australia, New Zealand, Scotland, Sweden, Denmark, Switzerland and the United States) in the care and management of clients with severe and persistent mental illness, most frequently schizophrenia, who have a history of treatment non‐compliance and subsequent relapse (Rugkåsa, ). There is ongoing controversy around their use: clinically, they may result in greater long‐term stability (Hunt, Da Silva, Lurie, & Goldbloom, ; Karagianis, ; Nakhost, Perry, & Frank, ); however, they also negatively affect individuals’ sense of autonomy, increase feelings of stigmatization and shame (Light et al, ; Strenstrud, Høyer, Granerud, & Landheim, ), and impose a disadvantageous identity (Barron, ). International disability rights legislation has recognized the need to address SMI in a way that does not involve coercion (United Nations, ; Wildeman, ), and yet the use of CTOs continues to be on the rise (Deridder, Molodynski, Manning, Mccusker, & Rugkåsa, ; Psychiatric Patients Advocate Office, ).…”

“…Meanwhile, qualitative literature reveals that while clinicians and families find that CTOs provide a valuable safety net (Brophy & Ring, ; Canvin, Rugkåsa, Sinclair, & Burns, ), individuals with CTOs find them coercive, marginalizing and punishing (Corring, O'Reilly, & Sommerdy, ; Lawn, Delany, Pulvirenti, Smith, & McMillan, ; Light et al, ). This negative effect on individual's sense of agency and increase in their feelings of vulnerability can be viewed as an effect on identity: through the creation of a legal category, the CTO both constitutes and codifies a stigmatized identity (Barron, ). These things taken together—the lack of strong evidence of treatment efficacy, the support from clinicians and family and the negative effect on individuals’ identity—prompt reflection on how the CTO may meet needs that go beyond the needs of the person with SMI: for example, needs to quell collective anxieties, and to find an explanation for social unrest that resolves any obligation for deep examination of shared fragility.…”