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(CCD) which is one of the plaintiffs inthe case. “There’s a blatant violation ofthe equality and liberty rights of peoplewith disabilities,” she says.

Benard says psychiatric patients’ rightswere clarified in constitutional law 25years ago and implemented in everyprovince—except BC. For example, inother provinces, after being involun-tarily committed, a person still cannotbe involuntarily treated until a compe-tency test is conducted. “You look atthings like, does the patient understandtheir diagnosis? Do they understand thetreatment that’s proposed, the risks andbenefits of undergoing the treatment?”says Benard.

“It’s really discriminatory to assumethat everyone with a mental healthproblem is mentally incapable of makingtheir own treatment decisions,” saysJohnston. She says it’s also importantto understand how “wide-sweeping”involuntary treatment has become. “Alot of people believe that you have to bea danger to yourself or others to be invol-untary, and that’s just not true.” InBC, anyone can be committed if a physi-cian believes that the person has a mentaldisorder and that committal could provide“protection” or prevent the person’s“mental or physical deterioration.”

“It gives a lot of discretion to thedoctor,” comments Johnston.

According to government statistics, BC psychiatrists have beeninvoluntarily committing people at unprecedented rates: 13,641people last year—a doubling since 2002, or 73 percent increase per100,000 people.

Though statistics weren’t available, it’s widely believed that theuse of “Extended Leave” has increased even more dramatically. Thisoccurs when someone is considered well enough to be released fromhospital and live at home, but is still being forcibly treated. And thereseem to be more people like Sarah who voluntarily seek help, onlyto get committed if they disagree with recommended treatments.

Jonny Morris, the Canadian Mental Health Association’s (CMHA)provincial policy director, says involuntary treatment has been “along-standing issue” of polarized contention among patients, familymembers, service providers and community groups. Morris hopesthat this constitutional challenge will “raise public awareness about

he psychiatric nurse held out apaper cup with pills. Sarah claspeda handwritten note. Having learned

not to protest loudly, the 24-year-oldgave the nurse her note that read, “I havea right to my mind and my body.” Then,she reluctantly put the pills in her mouth.

Sarah knew that she had to execute herescape out of British Columbia quickly,before the drugs seized control of hermind again.

Sarah (she requested her name be with-held) is sharing her story to show supportfor a constitutional court challengerecently launched by Community LegalAssistance Society (CLAS). The Vancouvernon-profit is arguing that a key part ofBritish Columbia’s Mental Health Act,called “deemed consent,” violates theCanadian Charter of Rights and Freedoms.

“At CLAS, we’re routinely told thatpeople are either considering leaving BCto avoid our deemed consent laws, or thatthey’ve done so in the past,” says LauraJohnston, one of the lawyers representingthree plaintiffs in the case.

CLAS has many concerns about BC’sMental Health Act, explains Johnston.However, this case is focused on how the“deemed consent” provision violates rightsto security of the person and equalitybefore the law. “This case isn’t arguingthat forced treatment can never be consti-tutional,” says Johnston, “But it does say that forced treatment whichis imposed unilaterally by a doctor with no checks or balances andno recourse to anybody else is unconstitutional.”

Every Canadian has the right to allow or refuse medical treatments,even if our choice could cause injury or death—such as choosingwhether to undergo risky surgery. We can write advance directivesabout what we will and won’t accept if we lapse into a coma or other-wise become mentally incompetent, and appoint a “substitute” tomake decisions for us. However, in BC, the moment we become aninvoluntary psychiatric patient, those rights are eviscerated. Mentallycompetent or not, and regardless of what’s in our advance directiveor what our substitute says, we are “deemed” to consent to any treat-ments a psychiatrist recommends.

“I was shocked when I came across these sections of [BC’s] MentalHealth Act. I thought I was misunderstanding things,” says MelanieBenard, a lawyer with the Council of Canadians with Disabilities

28 November/December 2016 • FOCUS

T

I WAS SHOCKED WHEN I CAME

across these sections of [BC’s] Mental

Health Act. I thought I was misunder-

standing things. There’s a blatant

violation of the equality and liberty

rights of people with disabilities.”

—Melanie Benard, lawyer

Council of Canadians with Disabilities

“

focus reporting from the frontlines of cultural change

Escape from British ColumbiaROB WIPOND

Some people say that our province’s strong mental health laws save lives.A constitutional court challenge says they lead to discrimination, abuse, fear and the flight of psychiatric refugees.

an often hidden part of the system” and promote “respectful” dialogueabout how things could be managed differently.

The initial court submission from Community Legal AssistanceSociety provides a glimpse into this hidden world.

The dangers of psychiatric treatments Plaintiff Louise MacLaren is a 66-year-old retired nurse from

Victoria. She’s been frequently treated against her will in hospitaland at home over the decades. According to the submission, MacLarenexperiences “extreme anxiety” when forced to undergo electrocon-vulsive therapy (ECT), which causes her “confusion and disorientation”for weeks afterwards, and permanent memory losses. While a typicalECT treatment involves 12 rounds of shocks over three weeks,MacLaren has received 300 rounds. “In 2010, staff administeringECT forgot to place a mouth guard in Ms. MacLaren’s mouth duringthe treatment,” says the submission. “Ms. MacLaren shattered herteeth due to the convulsions in her jaw[.]”

The other plaintiff is a 24-year-old Vancouver man with a Master’sdegree in music and piano. Since 2015, he’s been forced to takeantipsychotic medications at home that cause “involuntary move-

29www.focusonline.ca • November/December 2016

ments, muscle stiffness, muscle pain, and loss of dexterity, all of whichimpede his ability to play the piano.” These side effects, the submis-sion states, cause him deep suffering “because playing piano is sucha fundamental aspect of his life.”

Apart from Council of Canadians with Disabilities, the plaintiffsaren’t speaking to media. Other people, though, paint an equallygrim picture of involuntary treatment.

After what she calls a “bad event” in her life, Sarah went to a LowerMainland psychiatric hospital seeking help. She asked for a sleepmedication, but didn’t want anything more. “I wanted to be able tomanage what was going on for me, especially relating to the emotionsthat I was feeling, and the negative feelings, without medication…Thatwas very important to me.”

However, she was also given an antipsychotic. “It was an ugly, uglyfeeling,” says Sarah, describing how the antipsychotic dulled herthinking and emotions. “If a family member came to visit me, I wouldn’tfeel that happiness that they were there. Which was terrifying.”

Sarah asked to stop the antipsychotic. Instead she was made aninvoluntary patient and told that if she didn’t take it, then securitywould inject her. So she continued to take the drug orally, which wasalmost equally repugnant to her. “The fact that I had to do this tomyself…It’s you actually taking the pill and putting it in your mouth.”

For many, involuntary treatment is often violent. Irit Shimrat is the Vancouver-based author of Call Me Crazy: Stories

from the Mad Movement, and editor of a magazine published by therecently shuttered West Coast Mental Health Network—BC’s onlycharitable non-profit service organization run by and for peoplewho’ve experienced psychiatric treatment. (WCMHN had its $100,000in annual funding axed by the BC government without explanation,while hundreds of millions in new funding has gone to conventionalservices run by mental health professionals.) Shimrat has twice gonefor over a decade without any psychiatric involvement, but in betweenthose periods has been forcibly treated over a dozen times. The lasttime that she “went crazy,” says Shimrat, was after both her closestfriend and her mother died. “I was shattered emotionally, and I wasbehaving in ways that were very disturbing to my neighbours.” Whenin acute distress, Shimrat’s been apprehended after throwing herbelongings out the window, and after running around naked yelling“Emergency!”

Shimrat says many people like her experiencing intense mentalturmoil become afraid and “loud and feisty and angry and irrational”when threatened with forced treatment. In response, staff can become“mean,” she says. During one admission, Shimrat says she foughtas she was stripped in front of male police and orderlies, tied to agurney in four-point restraints, injected with an antipsychotic, andlocked in isolation. “The experience of being locked up is brutal,”comments Shimrat. “But the experience of being locked up and thendebilitated with antipsychotics is much worse.”

Antipsychotics are tranquilizing medications that are the mostcommonly used drugs in situations regarded as short-term “psychi-atric emergencies” or long-term “psychosis.” While some people canfind a tolerable dosage that quells their mind but leaves them stillfunctional, for others—especially when they’re not allowed to partic-ipate in treatment decisions—antipsychotics can be debilitating.

“The whole time that I was ever on antipsychotics I sort of fluctu-ated between wanting to die and thinking that I had died and gone tohell,” says Shimrat. “All colour was drained from the world, like every-thing was grey, and I couldn’t remember where I was from moment

THE WHOLE TIME that I was ever on antipsychotics

I sort of fluctuated between wanting to die and thinking

that I had died and gone to hell.” —Irit Shimrat

“

Irit Shimrat, author and editor of The Networker

See page 4 to subscribeor donate to FOCUS

30 November/December 2016 • FOCUS

to moment or why I was standing where I wasstanding, what I had been planning to do.There was just a sort of sense of grinding,endless tedium and pain, physical pain as wellas the pain of not being able to think.”

Shimrat says she has also experiencedakathisia, a restlessness and agitation that 30percent of antipsychotic users sometimesexperience and that can, in extreme cases,cause suicidal feelings and violent rages. “It’shorrible,” she says.

“I’ll never recover completely from thetrauma of it,” says Shimrat. Her experiencesof being involuntarily treated, she says, havebeen “infinitely worse than even the worstmoments of my so-called mental illness.”Shimrat believes that many psychiatric patientsare becoming worse and not better because“they’re having their brains tampered with”in these frightening and damaging ways.

For her part, Francesca Simpson says she’s“feeling pretty good” on medications becausethey “bring me down and take the edge off.”However, she wants more control over thetypes and amounts. She’s currently beingadministered a long-acting antipsychoticinjection, plus two antipsychotics and a moodstabilizer daily, which she finds excessive.Since 2010 she’s been almost continuouslyinvoluntarily treated in her home by anAssertive Community Treatment (ACT)team. Simpson describes it as “intrusive,”“humiliating” and “demeaning.” She mustbe at home at certain times every day to haveher meds “witnessed.” For the injections,she must pull her pants down. ACT staffchange constantly; she prefers women butcan’t refuse the “strange men” entering herhome. Staff probe her personal life whilelooking for signs of any emerging need tore-hospitalize her. “Everything that I do ispathologized,” says Simpson.

The whole experience “used to just makeme furious,” says Simpson, “but I’ve givenup on that.”

Many people raise concerns that, over thelong term, treating people against their willsdissuades even those who want help fromseeking it, because it undermines trustingrelationships with mental health practitioners.“It’s dangerous to ask for psychiatric help,”Simpson concurs. “Certainly when I getthrough this, if I’m ever in trouble again, Iwill go nowhere near that system.”

Trust and distrust of psychiatrySeveral health authorities declined to

provide interviews about involuntary treat-

ment. The BC government issued a writtenstatement saying that some patients “maynot understand or realize that they needpsychiatric care.” That’s also the concernfor Deborah Conner, provincial directorof the British Columbia SchizophreniaSociety, who says BCSS could intervene inthe CLAS case.

Conner bristles to hear words like “outdated”linked to BC law. “The reality is our MentalHealth Act is actually leading the charge indoing the least harm.” Conner says the “safe-guard” that BC law provides is that peopledon’t “languish” in hospital but get treat-ment quickly and continually, which sheclaims prevents brain matter loss. “That’sbeen proven,” she says. “When you haveearly intervention which includes medica-tion, those treatments actually prevent ongoingbrain damage.”

“There are very many people in this worldof psychosis who have no way—they don’tshare the same reality—they have no way ofstepping outside their illness and havinginsight into what’s happening to them,” saysConner. “We have lots of people who said,‘Thank God you treated me forcibly, becauseif you didn’t, I would be dead.’”

I mention that others describe forced treat-ment as traumatizing.

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EVERYTHING THAT I DO

is pathologized.”

—Francesca Simpson

“

“Unfortunately, in some cases that’s the only way to save that personso that they can get treated and get on a path to recovery,” says Conner.“Just painting [with a broad] brush, saying in all these cases it shouldbe treated this way and nobody should be traumatized, that’s like seeingwith rose-coloured glasses.”

BCSS shares a little common ground with CLAS. “We’ve alwayssupported family or caregiver involvement in any situation,” saysConner. The BCSS wants policies allowing people to have psychi-atric advance directives and to appoint family members or othersto participate in admissions and discharge planning. But BCSS stopsshort of wanting anything legally binding. Conner says psychia-trists must retain powers to exclude appointees who aren’t “appropriate”and to bypass advance directives.

What about people seeking help at hospitals just for depression oranxiety at levels that might not unduly interfere with their compe-tency to make treatment decisions? Conner points out that long-terminvoluntary treatment requires two psychiatrists to agree. “If peopleare involuntarily committed, it seems to us that there’s a reason whythat happened.”

I suggest that it sounds like Conner is putting a lot of trust in psychi-atrists. “When you have two psychiatrists who’ve done a thoroughreview and assessment and where they have family input, that’s thetrust,” responds Conner. She concedes that such assessments canbe difficult, but believes that medically-trained psychiatrists are bestqualified to make them.

In contrast to Conner, Shimrat argues that involuntary psychiatrictreatment is primarily a means for policing very upset and/or verysocially disruptive but otherwise law-abiding people, that has becomeculturally acceptable because it is masked as science-based health care.“Psychiatry is seen as a branch of medicine and distress is seen as aform of illness,” says Shimrat. “And so with the mindset thatthey’re saving lives and improving things for people, the practitionersfeel that they’re morally in the right.”

Certainly, pharmaceutical industry money and influence have hadprofound impacts on psychiatry and our cultural beliefs. Governments,families and patients alike are often swayed by psychiatrists’ assertionsof “proven” and “evidence-based,” where more accurate would be“some studies seem to suggest…” Barely a day goes by, for example,that we don’t hear about blood tests for depression, brain scans foranxiety disorders, the genetics of schizophrenia, brain damage causedby psychosis, and unequivocally “safe and effective” psychotropicpharmaceuticals. If any one of these “discoveries” were ever truly vali-dated, though, it would be Nobel Prize-worthy. However, the last timepsychiatry garnered a Nobel was for lobotomies—since then, Nobelcommittees have apparently more rigorously vetted psychiatric claims.

Instead, the widely promoted “chemical imbalance” theory ofmental disorders has been so resoundingly debunked that promi-nent psychiatrists like Ronald Pies have taken to insisting that it wasonly an “urban legend” which no “well-informed psychiatrists” everbelieved. The American Psychiatric Association recently clarifiedthat no mental disorders can be detected through any biological tests.“Anti-anxiety” drugs are just addictive sedatives. “Antidepressants,”“antipsychotics” and “mood stabilizers” are marketing names fordrugs with clinical pharmacology descriptions stating that their “ther-apeutic mechanism of action is unknown”—while their knownharmful side effects are legion, including sometimes brain damage.And there’s a growing body of research suggesting that, over long-term use, most psychiatric medications are doing most people more

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Lawyer Benard believes stigma, stereo-types and sensational news stories about rarecases of violence drive much of society’ssupport for involuntary treatment. “We feellike we need to be protecting these people atall costs and that we know what is best forthem better than they can themselves.” Benardnotes that organizations run by people withdisabilities or with experience as psychiatricpatients, like Council of Canadians withDisabilities, often take different positionsfrom most mental health organizations, whichare typically run by mental health profes-sionals and family members of patients.“Sometimes there is a conflict betweenprotecting the rights of a person in crisis andthe desires and wishes of those around them,”says Benard.

Because of these ubiquitous prejudices,Shimrat says that she’s “really happy” aboutthe constitutional challenge but also skep-tical. “Whatever is going to be on paper isunlikely to change what happens on theground.” Indeed, Ontario’s rate of involun-tary treatment seems to be only slightly lowerthan BC’s.

A former BC tribunal chair says she sawappeal panels frequently exhibit a “defer-ence to” and “over-reliance on” psychiatrists’perspectives. Michael Perlin, an expert onUS mental health law, blames it on “sanism.”Perlin’s books show, in encyclopaedic detail,that a near all-permeating deference to psychi-atrists exists within judicial processes, coupledwith an “irrational prejudice of the samequality and character of other irrational prej-udices” towards people diagnosed withmental disorders.

Sarah splits BCSarah requested an appeal. Her psychia-

trist didn’t have to, but chose to stop forciblymedicating her. Faculties back intact, Sarahresearched and discovered that Alberta’s lawswere different. She began preparing an escapeplan, just in case.

The review panel for Sarah’s appeal reacheda 2-1 split decision—leaving Sarah incarcer-ated. She began a silent protest, giving staffhandwritten objections when they handedher drugs. For two days, her tight-lippedprotest also provided a cover for tonguingand not ingesting the pills. But her psychia-trist soon proposed an antipsychotic injectionthat would keep Sarah drugged for weeks.Sarah worried that her thinking would becomeso foggy she’d never be able to execute herplan. “I knew I had to leave,” she says.

harm than good, while being extremely diffi-cult to withdraw from.

The ultimate recourse for involuntarytreatment proponents is to argue that disor-dered people “lack insight” while, as BCSSboard member John Gray has written,“[C]ompulsory treatment will usually restoresomeone’s freedom of thought from a mind-controlling illness…”

Though superficially compelling, these arephilosophical—not medical—assertions thatprovoke many questions. How often and forhow long do we keep aggressively “freeing”someone’s mind, exactly, before the personbecomes free enough to refuse our interven-tions? Who among us has the rightful authorityto determine who has “proper” insightinto reality? Is it crazy to be driven mad byan insane and destructive society, or is it asign of sensitivity that should be nurturedand supported rather than drugged away?Meanwhile, if we simply claim that the answersare “obvious” to anyone “sane,” then we cutoff an important human legacy and poten-tiality—our ability to deeply question ourselvesand our culture.

Stigma, stereotypes…sanismIf final judgments to psychiatrically treat

people against their wills are not truly beingdriven by indisputable medical science, thenwhat is driving them?

A person in BC can appeal a committal toa three-person tribunal. Hearings are notopen to the public, not bound by rules ofcourt process, and notoriously erratic. Patientsare often forcibly drugged during hearings.Though every patient has a right to a legalaid lawyer, hundreds annually cannot getone because government hasn’t providedsufficient funding. Less than one-fifth ofpatients win.

In August, a patient sued to push the BCgovernment to fund enough legal advocates.“It’s very troubling that despite numerouscalls on the government to increase fundingto ensure that everyone who is entitled tolegal aid gets it, that they’ve pretty muchignored the problem,” says Kate Feeney ofthe BC Public Interest Advocacy Centre, co-counsel in that case. (Government begannegotiating, so the case adjourned untilDecember.) Many argue that this whole farceis but one example of how prejudiced societyis against psychiatric patients—pointing tohow even the BCSS and CMHA have donelittle over the years to raise alarm about thislegal representation crisis.

Into a small satchel bag she stuffed a changeof clothes. Cash she’d been withdrawing toavoid using a trackable credit card. Her iPad.She acted like she was going for a smokebreak, walked to where she could get a taxi,and got out where she could disappear intoa crowd. She changed her clothes in a publicbathroom and threw out the ones she’d beenwearing at the hospital. She cut off her hair.Then she bought a ticket for a red-eye busto Alberta.

“It was the most nerve-wracking bus rideof my life,” says Sarah. “I had a feeling everytime we stopped that there would be RCMPwaiting for me.”

The driver announced when the bus hadcrossed into Alberta and begun the descentfrom the mountains. “I actually got veryemotional as I crossed the border,” says Sarah.“I’d spent the entire night in the dark…It wasreally beautiful, early in the morning, the sunwas coming up…I was crying, and there wassomebody sitting a couple seats from me,said ‘Are you okay?’ And I was like, ‘Yeah,I’m fine.’”

But as the bus sped into Calgary, she sawher picture appear on the RCMP websiteas a “missing person,” along with a warrantfor her arrest.

There are other waysMedia coverage of the CLAS constitutional

challenge has been sympathetic, and thereseems to be mounting support for possiblemental health law changes in BC to remove“deemed consent” and allow people to havecompetency tests, advance directives, andsubstitutes.

The CMHA’s Morris says there should begeneral equality between the way peopleexperience both physical and mental healthcare. “What would it take to ensure thatpeople with mental illness are afforded all ofthe similar rights and protections [as everyoneelse]?” Morris also notes that forced treat-ment is often related to a late-stage crisis thatmight have been prevented with more volun-tary supports in our communities, andimprovements in other “social determinantsof health” like housing, income, employ-ment, and education.

Similarly, Chris Summerville of theSchizophrenia Society of Canada says thathis organization is recognizing advances inunderstanding of how people can recoverthrough self-empowerment and assistancein meeting their biological, psychological,social, spiritual and communal needs. In

32 November/December 2016 • FOCUS

contrast to the BC Schizophrenia Societyposition, Summerville feels BC law could beupdated to have “a little more care and caution”built into it.

Francesca Simpson and Irit Shimrat suggestthat if we at least made our psychiatric hospi-tals warm, respectful places that providedplenty of options and supports for people tovoluntarily explore enhancing their own well-ness, we wouldn’t have to worry much aboutpeople not wanting to go for help, or“languishing” in them. Offering robust coun-selling and psychotherapy services in ourhospitals would seem to be a logical start—rather than relying almost totally on drugsand ECT, as is now the case.

Shimrat points to alternative approachessuch as exercise, arts, mind-body practices,and non-drug emergency response methodslike peer respite homes and Open Dialoguefamily interventions. “There are other ways,”says Shimrat. “But that knowledge is suppressedand disrespected because of the strength ofthe status quo.”

Johnston says she’s “under no illusion” thatthe constitutional challenge will cure the mentalhealth system or society. But she hopes that atleast the BC government will “engage withstakeholders and many different people andorganizations to craft a new, fair legal frame-work for treatment for involuntary patients.”

“Not detainable”—in AlbertaSarah turned herself in to Calgary police.

She overheard the officer explain to herpsychiatrist in BC that, under Alberta mentalhealth law, Sarah didn’t appear detainable.“It was a good feeling,” she says. “But I knewit was a very scary next chapter of my life,starting it completely from the ground up.”

Sarah is now in Ontario, where she hassupportive family, and is studying naturalways of improving well-being. “I’ve beenvery fortunate in certain respects,” says Sarah.“What am I missing? My friends. My family…I was seeing somebody, that was a positivething in my life, and that’s gone now.”

She finds the term “psychiatric refugee”strong, but also feels it’s in some ways apt.“I would love to come back,” says Sarah. “Ifthe laws change, I probably would.”

Rob Wipond has been reporting

on the lack of civil rights in the

BC mental health system since

1998. He is the recipient of a

number of journalism awards

for his writing in Focus.

33www.focusonline.ca • November/December 2016

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