PRP CONFERENCE 2016: Negotiating power in mental health institutions How Ontario’s legislation on capacity to consent to treatment is put into practice

Topic Decision Sustained interest Personal relevance Accessible information Minimal harm

Underlying Assumptions of Research Mental illness exists insofar as it has a tangible impact on the lives affected The desire for social control plays an important role in how the mental health system is structured There is a disconnect between legislation on capacity to consent to treatment and how that legislation is enacted Engaging with institutions involved in the development and application of these laws will help to illustrate the prevailing discourses that underlie the operationalization of this law

Further Assumptions Knowledge is constructed from interactions between people Mental illness is not a one-size-fits-all experience People have multiple lived realities which deserve to be taken into consideration in questions of capacity People who are marginalized experience an “absence of voice” (Kovach, 2005) that is continually reinforced within institutions

Literature Review Key Constructs: Mental Illness Deinstitutionalization Informed Consent Capacity & Legal Competence Coercion

Research Design Institutional Ethnography (Dorothy Smith) “Problematizes social relations at the local site of lived experience” (Walby, 2007); Explores how texts mediate the everyday practices of institutions; Explores the potential for collaborative action within unique experiences.

Methods Examined texts Conducted interviews Health Care Consent Act (1996) Mental Health Act (1990) Substitute Decisions Act (1992) Conducted interviews three ~hour long, semi-structured, open-ended, exploratory CCB Lawyer, Administrative Lawyer, Patient Relations social worker

Findings Themes: Bureaucratic process Limitations of the health care system Enactment of legislation Institutional power Paternalism

Suggestions for current students Recognize & accept – but continue to address – research limitations Have a clear picture of what you do (and don’t) want to say Talk to your classmates & your supervisor – that’s what they’re there for! Have multiple people read over your paper (I found a mistake very recently…Sorry Anne!) Remember that revisions ARE necessary and often extremely helpful

References Kovach, M. (2005). Emerging from the margins: Indigenous methodologies. In L. Brown & S. Strega (Eds.), Research as resistance: Critical Indigenous and anti-oppressive approaches (pp. 19-36). Canadian Scholars’ Press. Walby, K. (2007). On the social relations of research: A critical assessment of institutional ethnography. Qualitative Inquiry, 13(7), 1008-1030. doi:10.1177/1077800407305809.