Australian and Canadian mental health Acts compared.
OBJECTIVE
The main objective of this paper is to compare the mental health Acts of the eight Australian jurisdictions and the 13 Canadian jurisdictions on three major issues: involuntary admission criteria, treatment authorization/consent and compulsory treatment in the community, in the light of international trends towards patients' rights.


METHODS
The legislation was examined against the background of rights instruments such as the Canadian Charter of Rights and Freedoms and the United Nations Convention on the Rights of Persons with Disabilities.


RESULTS
It was found that some Canadian involuntary admission criteria require the likelihood of bodily harm whereas all Australian Acts have broad harm and deterioration criteria. Unlike all Australian jurisdictions, some Canadian jurisdictions allow for the refusal of treatment that may be required for discharge. In addition, Canadian community treatment orders are much more restrictive than in Australia because they require a person to have considerable previous hospitalization despite meeting the committal criteria. Australian jurisdictions can use community treatment orders as a least restrictive alternative to inpatient status without prior hospitalization.


CONCLUSIONS
The paper concludes that there are significant philosophical differences regarding the purpose of involuntary admission between Australian and some Canadian jurisdictions where treatment refusal is possible. Australian mental health Acts have a relatively stronger 'treatment' focus than some Canadian Acts. The apparently stronger 'rights' focus of some Canadian laws (such as the permission of treatment refusal) can paradoxically result in a denial of liberty rights. The way in which the relevant legislation is shaped in both countries will increasingly be affected by international trends towards the rights of individuals with disabilities.
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada. jegray@shaw.ca
John Ellery
JE
Gray
Bernadette Maree
BM
McSherry
Richard L
RL
O'Reilly
Penelope June
PJ
Weller
D001315:Australia; D002170:Canada; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D008605:Mental Health Services / Q000331:legislation & jurisprudence*; D028701:Patient Rights / Q000331:legislation & jurisprudence; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*; D014480:United Nations