CE v Alberta Health Services, 2023 ABKB 690

Court of King’s Bench of Alberta Citation: CE v Alberta Health Services, 2023 ABKB 690 Date: 20231206 Docket: 2303 16520 Registry: Edmonton Between: CE Applicant - and - Alberta Health Services Respondent _______________________________________________________ Reasons for Judgment of the Honourable Justice G.S. Dunlop _______________________________________________________ 1. Introduction [ 1 ] CE appeals the decision of a Mental Health Review Panel upholding her admission certificates and declaration of mental incompetence.

The Review Panel made its decision on September 6, 2023 and provided written reasons on September 17, 2023. [ 2 ] Between the Review Panel’s decision on September 6, 2023 and the hearing before me on November 15, 2023, renewal certificates were issued twice with respect to CE’s admission as a formal patient: first on September 22, 2023 and again on October

20,2023. As set out in paragraph 12 of the October 5, 2023 Order of Inglis, J, those renewal certificates are the subject of this appeal, without a further hearing before the Review Panel. [ 3 ] The appeal hearing before me is a rehearing, which means new evidence may be presented that was not before the Review Panel on September 6, 2023. It also means I must make my own decision. This is set out in section 43(4) of the Mental Health Act , RSA 2000, c M-13 . [ 4 ] I may cancel or refuse to cancel the Review Panel’s decision and I may make any other order I consider just.

This is set out in section 43(7) of the Mental Health Act . [ 5 ] I conducted the appeal hearing in private, as required by section 43(8) of the Mental Health Act . To protect CE’s privacy I am not including her full name in this decision. Instead I refer to her as CE. When I quote from documents that contain CE’s name, I substitute CE for her name in the quotation. [ 6 ] There are two aspects to the Review Panel’s decision: first, CE’s admission to Alberta Hospital as a formal patient; and second, the declaration that CE is incompetent to make treatment decisions.

Those two aspects are governed by different tests set out in the Mental Health Act . [ 7 ] The test for CE’s admission as a formal patient is set out in sections 2 and 8(1) of the Mental Health Act . The test is: • is CE suffering from a mental disorder, • does she have the potential to benefit from treatment, • is she likely to cause harm to others or to suffer negative effects as a result of or related to the mental disorder, and • is she unsuitable for admission to a facility other than as a formal patient? [ 8 ] The starting point for me is that none of those things is true.

Alberta Health Services must prove all four of those elements for me to uphold the Review Panel’s decision regarding CE’s admission as a formal patient. [ 9 ] The test for a declaration that CE is incompetent to make treatment decisions is set out in

section 26 of the Mental Health Act .

The test is: • is CE unable to understand the subject-matter relating to treatment decisions or unable to appreciate the consequences of making treatment decisions? [ 10 ] Alberta Health Services must prove that CE meets that test for me to uphold the Review Panel’s decision that CE is incompetent to make treatment decisions. [ 11 ] I have structured my reasons as follows: • first, I will review the evidence; • then, I will address each of the four essential elements for CE’s admission as a formal patient; • then, I will state my conclusion regarding whether to uphold the Review Panel’s decision that CE should continue to be admitted as a formal patient; • next, I will address whether Alberta Health Services has proven that CE is incompetent to make treatment decisions; • lastly, I will state my decision on the appeal as a whole. 2.

Evidence [ 12 ] The evidence on this appeal consists of: • affidavits filed by CE on October 5, 2023 and October 11, 2023; • CE’s medical records covering the period March 2019 to October 2023; • a November 9, 2023 letter from Dr. Daniel Li to the Public Guardian and Trustee; • Dr. Daniel Li’s testimony before me on November 15, 2023; and • CE’s testimony before me on November 15, 2023. 2.1. CE’s affidavits [ 13 ] CE is not represented by a lawyer in this appeal. She is acting for herself.

Her affidavits contain handwriting, some of which I am not able to read. [ 14 ] The body of CE’s October 5, 2023 affidavit reads:

Civil Rights violations description of what is violated. Disability Rights violated description of which is violated. My research on various things Schizophrenic autistic predications other research. Further research Schizophrenic medication [illegible] and other research. Handwriting of different disorders groups of disorders. [ 15 ] Exhibit A to CE’s October 5, 2023 affidavit reads: Civil human Bill of Rights.

Everyone except CE has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice, and if I lose so do all disabled people and autistics lose their rights as well as ADHD. If I lose this all people charged with murder or assault on a disabled person as autism is a national government claimable disability. I not only lose this right for me but for all disabled and all people aside from this mental ill patient too lose their rights because this is genocide of both disabled and mentally ill. The I DIE ANYWAYS.

Canadian Human Rights violations Bill of rights violations 1

a) the right to individual to life liberty security personal enjoyment of property and right no not be deprived of except when in jail 2

a) authorize of effect of arbitrary detention imprisonment and [illegible] treatment or punishment 1976 abolishment of the death penalty [ 16 ] Exhibit B is similar to exhibit A, in that it asserts rights in general and does not provide any evidence about CE specifically. [ 17 ] Exhibit C is mostly typed but at the top of the first page is the following in handwriting: Deciding CE’s Right to Life or be killed by court / mental health. [ 18 ] The following are excerpts from exhibit C: I am an Autistic, ADHD and now suffer from PTSD, and I do Catastrophize that is four mental illnesses right there the probability to more is unheard of and not seen in medicine. ...

The more they give me in diagnosis the worse things get because I don’t know what I am supposed to be researching to fight against and this is confusing, and most of these have age limits to when they can be diagnosed. Age 6 to 18 for emotional dysregulation onset before ten, age 13-35 for schizophrenia and schizoaffective age 25 to 35 I don’t fit these age classifications but the more they dump on me the worse I get. Because I keep racking my brain to figure out, but you see they don’t see what their behavior and their diagnosis are doing to me that they are creating more trauma. Diagnosis is traumatizing. ...

I am autistic and ADHD PTSD AND Catastrophizing the rest is symptoms of abuse ... ... They THINK I am Schizophrenic because they think I hear voices. I do not hear voices at all. The DSM points out clearly that for an AUTISTIC to be subjected to the treatments of medication and schizophrenia medication that they must see and hear things Hallucinate and have delusions. My disorganized thoughts and speech come from ADHD. ... I either die before my time 25 years according to English, German and French papers as I research in at least 5 languages, and all say antipsychotics take 25 years off your life expectancy.

That means I am being killed by taking the medication for doing nothing wrong. ...

I need for this court to know I sing in 200 plus dialects of languages, I research medical problems to an extreme. ... Even though my diagnosis comes late in life autism comes first and is a recognizable Canadian disability and Revenue Canda gives disability funds for it. The dopamine study proves this, but it proves more, autism is dopamine low, and Schizophrenia is dopamine high. ... As for medication, the document I submitted is after clopixol injection I wrote that shortly after my injection that psychiatrists say I need, I am delusional and hearing things and seeing things on the medication ...

I want to point out if you give someone antipsychotics and cause a dopamine low you can also create hallucinations as Dopamine deficiencies also create hallucination and delusions. ...

They even say that I put holes in the walls of several places and that is not the case it was only the last place and the when and where I did it was wrong and why was made up fabricated stories, I did it while on the phone with a psychiatrists and after a home visit of a psychiatrist who amped up the conversation and went from no medication to maybe medication and CTO and Medication all in one conversation ... and this caused me to become so distraught after because I am scared of the hallucinations and delusions and the doctors doing this to me and all the abuse that they dish out and I cannot flee from them hanging up the phone, gets you slapped in the hospital, them never listening and thinking they are always right I get medicated and hurt and see thing, and if I freeze and become catatonic they drug me anyways and then I hear and see things, I cannot bargain or appease them, and crying as a form of flight mode as an anger response gets me medicated and I see and hear things and now getting aggressive is going to cost me my life. [ 19 ] My understanding of Exhibit D to CE’s October 5, 2023 affidavit is that it is a list of what CE wants me to do on this appeal.

The first item is: Autism is a birth brain defect and can no longer be detained under the Mental Health Act . [ 20 ] CE’s October 11, 2023 affidavit refers to adrenal insufficiency and an invitation to a conference in Spain.

Exhibit A is handwritten and includes the following: Adrenal insufficiency mood swings irritability inability to handle stress when added with antipsychotics that do not treat the adrenal insufficiency but in people who it creates prolactin levels to be different hyperprolactinemia mood swings hostility inability to handle distress – inability to cope with stress further CE recognized that [illegible] in her case [illegible] was not a complete fix for her adrenal insufficiency but psychiatrists are making more stress and making more stress making things more difficult for CE and they are adding more problems by throwing other hormones out … you cannot fix that with antipsychotic … by giving her medication that causes her to have even higher prolactin levels creating hyperprolactinemia and a hostile response [ 21 ] Exhibit A also includes a chart with dates along the top of each page and notations that I understand have something to do with CE’s cortisol levels. [ 22 ] Exhibit B to CE’s October 11, 2023 affidavit contains two nearly identical copies of what appears to be a message on the Linked In social media platform.

The message is not dated. The message includes the following: We are writing to formally invite you to participate in the 11 th World Congress and Expo on Applied Microbiology. This conference is taking place on November 15 -16 in Barcelona, Spain. 2.2. Medical Records

[23] Two bound volumes of CE’s medical records plus a few additional pages were entered as exhibits. [24] CE objected that some of the medical records are inaccurate. For example, there is a March 7, 2022 letter from a psychologistthat states in the reference line that CE’s current diagnosis was bipolar, which CE says is incorrect. According to CE she has never beendiagnosed as bipolar. I note that there is no reference in the body of the letter to a bipolar diagnosis.

It may be a mistake in the referenceline. [25] Another example of an inaccuracy in the medical records is a note by a psychiatric nurse dated July 29, 2023 that CE had“delusions of seeing cremated animals in her apartment”. According to CE, that is not a delusion; it is true. While CE did not expand onthis point during the appeal hearing, I am aware that sometimes people cremate their deceased pets and keep their cremated remains as amemento.

If that is something CE has done, then the psychiatric nurse jumped to an incorrect conclusion that this was a delusion. [26] A third example provided by CE of an inaccuracy in the medical records is a nurse’s handover note dated June 5, 2023 thatstates: “Slept. NPO for ECT.” Dr. Li confirmed in his testimony that ECT means electroconvulsive therapy. According to CE she hasnever received electroconvulsive therapy. However, the note referred to is marked “Version 2 of 3”.

Versions 1 and 3 of that note areimmediately after and immediately before the note referring to ECT, and neither version 1 nor version 3 includes a reference to ECT. Itappears that the nurse made a mistake with the notation regarding ECT and corrected it almost immediately, as both version 2 andversion 3 are time-stamped “06:24”. [27] During her cross-examination of Dr. Li, CE suggested that some of what happened to her at Alberta Hospital was omittedfrom her chart.

I have no evidence of that, but of course it is possible that some interactions between CE and Alberta Hospital staff arenot included in the medical records. [28] Medical records are created by human beings. We all make mistakes sometimes.

It is not surprising that there are some errorsin the medical records, but that does not make them completely unreliable. [29] Medical records containing observations made by medical professionals in the course of their duties are admissible evidence,without the individual medical professional coming to court to testify Ares v Venner (SCC), [1970] SCR 608 at para 26. [30] Some of the medical records in this case include not what a medical professional observed themselves, but rather what theywere told by others.

For example, the records include what hospital staff were told by police about what the police observed in CE’sapartment. That is hearsay and I give less weight to that hearsay evidence in the medical records than to direct observation evidence. [31] There are previous Mental Health Review Panel decisions regarding CE in her medical records. These include a review ofevidence before the Review Panels at the time of their decisions. As a

summary of the evidence before those previous Review Panels, Ihave considered those previous decisions. I have given no weight to the ultimate decisions of the Review Panels on whether CE shouldbe admitted and whether she is competent to make treatment decisions because I am required to make my own decision on those issues. [32] The medical records in this case also include statements by CE, some of which are summarised by medical professionals andsome of which are CE’s own words (for example, emails from CE).

CE’s statements in the medical records are admissible evidence ofwhat CE said and of what CE did or experienced. [33] The medical records describe CE’s interactions with medical professionals from time to time over the past 4.5 years. In myquotations from the medical records things I want to emphasize are shown in bold type. Where I think there are typos in the records, Ihave inserted what I think the author intended in square brackets. 2.2.1. Spring 2019 [34] The medical records include a discharge

summary following CE’s stay at the University of Alberta Hospital from March 19,2019 to May 17, 2019, which includes the following: It was then decided to treat her with CLOPIXOL DEPOT (100 mg IM Depot formulation (given May 7, 2019, and a second one givenMay 10, 2019). The plan is to continue a 200 mg IM Depot dose q2weeks. While on Zuclopenthixol IM Depot, CE’s behaviourimproved such that her electronic privileges were restored, and she was allowed to go on day passes that went well. She deniedresidual delusions. CE wanted to be discharged and was agreeable to a CTO supervised by Dr. ORIMALADE.

In addition to her psychiatric problems, she also had additional longstanding medical problems. GIM was consulted on March 20th toassist in the management of her primary adrenal insufficiency and recommended follow up with endocrinology. The Endocrinology teamassessed and adjusted her medical management (adrenals and thyroid) but felt that her current psychotic presentation was not due toan endocrine problem. [35] The abbreviation “CTO” comes up a few places in the evidence. I understand it to stand for “Community Treatment Order”,which is addressed in sections 9.1 to 9.7 of the Mental Health Act. 2.2.2.

May 2019 – February 2022 [36] A list of admissions indicates that from May 2019 to February 2022 CE had only two brief overnight admissions to hospital.One was from July 14 – July 19, 2020 at the Glenrose Rehabilitation Hospital. There is no indication in the medical records what thatadmission was for. The other was from May 19 to May 20, 2021 for eye pain. 2.2.3. February – August 2022 [37] A psychiatric history authored by Dr. Raheem Suleman dated June 8, 2022 includes the following:

She has a history of 4 previous psychiatric admissions and was previously on a non-consent CTO that was cancelled by a review panel in 2020. As per Dr. Orimalde, current diagnoses include schizophrenia, autism spectrum disorder, and ADHD. In the past, possible other diagnoses have included delusional disorder, dissociative identity disorder and cluster B (borderline) personality traits. She has a longstanding history of paranoia directed towards neighbours, which has led to neighbours moving away in the past. She was noted to be sending hundreds of emails to various authorities.

She has complained of neighbours trying to put cockroaches through her door, having noxious fumes being loud, being involved with drug dealers. She has also stopped eating and drinking in the past when she felt that her neighbours were poisoning her water. Later she developed a belief that her cousin was monitoring her, speaking to her through walls and that cameras were involved. These beliefs were noted to improve when she was on a CTO and taking aripiprazole depot regularly. Her last admission was from Feb 2, 2022 to March 24, 2022 at the UAH.

She had presented with paranoia regarding a neighbour named Barb, with possible auditory hallucinations, and a belief that she was being monitored by cameras. She was quite guarded on initial assessment. She was not taking antipsychotics at the time. A Form 11 was completed and upheld by the review panel, with the OPG acting as decision maker of last resort. She was commenced on clopixol IM. She remained relatively insightless, but less irritable, and she was ultimately discharged AMA. [ 38 ] Dr.

Suleman’s admission certificate dated June 8, 2022 includes the following: Recently sent an email to her psychiatric nurse endorsing suicidal ideation, in the context of a resurgence of persecutory delusions regarding her neighbours. With me, feels that her neighbours are monitoring her and speaking to her from behind closed doors, which is suggestive of auditory hallucinations . ... In the past, when she was on a CTO and receiving a regular depot antipsychotic, she was noted to have significantly less persecutory delusions.

During her most recent hospital admission to the University Hospital, he mental status also improved with resumption of antipsychotics ... [ 39 ] A discharge

summary from Alberta Hospital Edmonton by Dr Beula Jegadesh dated August 5, 2022 includes the following: According to documentation by Dr. Orimalade, patient under the care of Dr. Orimalade since May 2019. Maintained on Depot antipsychotic until CTO was canceled by Review Panel in October/November 2020. The patient discontinued the antipsychotic long- acting injection but had been seeing her psychiatrist and mental health therapist. While on CTO and when treated with antipsychotic long-acting injection, the patient had not complained about her neighbors and no repeated calls to the EPS or crisis.

The patient had been extremely upset and dissatisfied with the diagnosis and treatment yet had complied with a CTO. The patient’s intensity of delusions appears to have escalated since she was taken off the CTO and going off the Depot antipsychotics. On her current admission, the patient was preoccupied with being harassed bullied, spied on by her neighbors and her family. The patient had moved into her current apartment in April and believes that the harassment had begun shortly thereafter. The patient believes that she is an “easy target” because of her psychiatric diagnosis.

States that the residents in her building tap on the walls to annoy her, they talked about her, monitor her and they are aware of every little thing that she does such as the book that she is reading or that show that she is watching on TV. The patient believes that this [is] criminal harassment and the police are aware of what is going on and they allow it to happen. The patient also reports that she is being persecuted by her family of origin for over 20 years by “a wire tap”. Believes that her family monitors her, and they sexually harass her through wire tap. [ 40 ] Dr.

Jegadesh continues in the same August 5, 2022 document under the heading “COURSE IN HOSPITAL” which includes the following: The patient was commenced on oral Abilify and then the patient was given her first dose of injection Abilify Maintena 400 mg on July 7, 2022. The patient was extremely agitated and had to be held down by security guards while she received the injection. The patient reported to have been yelling and screaming and stating that she is being killed, physically abused an assaulted as she has been forced to take injection Abilify Maintena. ...

With treatment patient’s mental state seemed to improve. She was pleasant and bright and animated and reactive and despite the delusions were less delusionally preoccupied and was able to engage in hobbies such as knitting or doing puzzles. However, patient continued to threaten suicide if she was discharged on a CTO and on antipsychotic long-acting injection. The patient’s demeanor would change abruptly to anger and irritability at the mention of CTO or antipsychotic long-acting injection.

Unfortunately, patient’s delusional beliefs remained unchanged despite treatment, though she was less delusionally preoccupied. [ 41 ] Under the heading “DISCHARGE PLAN AND MANAGEMENT”, Dr. Jegadesh includes the following: The patient is likely to resurface in the near future given her disdain for psychiatric treatment and lack of compliance with the same. The patient was psychiatrically stable despite being chronically delusional at the time of discharge. 2.2.4. October 2022 – February 2023 [ 42 ] A Review Panel decision dated January 8, 2023 includes the following

summary of some of the evidence before the Review Panel during its hearing on December 29, 2022: CE’s psychiatric hospital admissions in 2022 were: February 2 – March 24; June 8 – August 5; and October 4 – now. The background circumstances for each admission were similar, including failure to follow treatment, symptoms of paranoia, and PACT team

intervention. Since February CE has been out of hospital for no more than 6 – 8 weeks between admissions. CE’s last psychiatric hospital admission prior to February 2022 was in March – May 2019. Between May 2019 and February 2022 CE had intermittent contact with mental health services and there are dispensing records for antipsychotic medication, but CE says they did not take those medications. ... CE’s condition improved when they took Risperidone. [ 43 ] A discharge

summary regarding CE’s stay at the Royal Alexandra Hospital from October 4, 2022 to February 14, 2023 written by Dr. Parveen Jahandar includes the following: While CE was in hospital Ethics was consulted regarding pros and cons of giving her antipsychotic medication. I have to explain that anytime when CE received an injection it was under force of security holding her down while she was screaming at the top of her lung. This was a very traumatizing experience for everyone who was involved with this process. I am not convinced about the benefit that she could get with receiving antipsychotic medication.

I do not think that she would get any insight about her delusional beliefs by getting antipsychotic medication and it seems that the intensity of her delusions also did not get significantly less. There was one benefit of antipsychotic, that was noticed by both myself and nursing staff, that she was less preoccupied with these delusions but for sure did not resolve it. I believe this benefit also could be accessed through involving her with activities that she enjoys. I think having a therapy dog would be very helpful to decrease her loneliness. ...

One note is that CE received 1 dose of Abilify Maintena 300 mg IM at the beginning of February. I told her that from my point of view she needs to continue Abilify Maintena which she disagreed for that reason this medication was not prescribed. [ 44 ] On February 14, 2023, the day she was discharged from the Royal Alexandra Hospital, CE sent the following message at 6:07 pm to the 108 Street clinic through the Connect Care platform: I know what you have done to me. So, stop lying. I do not have delusional disorder. You have used male sex abuser DNA on me and have destroyed me.

I am going to be evicted and I am going to be charged with abuse. And or a sex crime because of you because male sexual abuser DNA makes me a sexual abuser. You had no clue what I wanted or needed. You have destroyed my life. Because of your ill treatment I now hit myself. And I am delusional for life and autism and ADHD and PTSD, and savant are out of the picture. I don’t know if I can ever look at any of you in the face after what you have done to me. And this is for life. I may as well be dead. You have destroyed my life 2.2.5. March 2023 [ 45 ] On March 7, 2023, CE telephoned her psychiatric nurse.

The nurse’s notes about that call describe CE being irate about being evicted. The nurse indicates in her notes that she could hear CE smashing things in her apartment. [ 46 ] The nurse’s notes from a meeting with CE on March 10, 2023 include the following: CE is concerned that she may be evicted but has not yet received a formal eviction notice. She continues to believe that someone is entering her apartment and have turned off her freezer causing most of her food to spoil.

CE went out yesterday and bought some new dishes as she broke the others on Tuesday [ 47 ] The medical records include an email from CE to her psychiatric nurse on or before March 14, 2023 in which CE writes: I am not delusional, schizophrenic, everyone is in on this, and I don’t know who is helping or who is not. And I think that not just me will end up being really hurt if not more. I may have a broken right arm again and I cannot go to doctors Yes, that is a black eye.

Comes from hitting my head trying to get all the coices [voices] to stop that are abusing me and there are lots , and even sending emails I hear them saying stop sending emails and I just want them ti [to] stop talking to me and about me because I don’t understand what is going on. [ 48 ] There are many other messages by CE in the medical record in March 2023 which include statements by CE that people are recording her, shining laser beams on her and reading her journals through the windows. CE’s messages in March 2023 make frequent references to suicide.

She also makes frequent references to hearing voices and banging her head. [ 49 ] CE met with Dr. Ogechi and a psychiatric nurse on March 28, 2023. The progress notes of that meeting include the following: Hearing next week with Residential Tenancy Board as her current landlord is seeking to evict her. ... CE continues very focussed on the misdiagnosis of delusional disorder; she was able to explain what a delusion is but does not believe that she has any. She is positive that people are entering her apartment and damaging and stealing things. CE did later show writer all of

her furniture is broken although at times they did tell me they were destroying same, today they were attempting to blame the management company. 2.2.6. April 2023 [ 50 ] Based on communications between CE and medical staff, it appears CE was evicted and required to move out of her home by April 10, 2023. By the end of April, CE was living in a shelter. 2.2.7. May 2023 [ 51 ] On May 2, 2023, CE sent 70 emails to her psychiatric nurse, with repetitive content. On May 19, 2023, CE sent multiple emails to her psychiatric nurse which included the following: I am on the verge of being evicted again.

Over things I do not understand and cannot control or do anything about to stop it. All I can do is bang my head against a wall and pray it stops. ... It is not schizophrenia what I hear. This is crystal clear sound from a source and the next time I hear a peep from it I start banging my head against the wall again. [ 52 ] On May 25, 2023 Dr. Lawal met and assessed CE. Dr. Lawal’s notes from that meeting include the following: CE walked in with the aid of a walker and was calm and looking for help with the people harassing and disturbing her.

She said these people have been disturbing her for many years and they will not stop harassing her. She does not know who these people are, but she said they are 3-5 of them, 1-2 of them are females. She claimed they know everything about her, and they know where she stays. She believes everything they say about her. She said they talk about her and talk to her as if they are physically present with her. ... She believed her house has been wiretapped and they know everything about her finances. ...

She lamented how they came into her apartment behind her without any trace and stole her book which contained all the music she wrote and destroyed numerous things. 2.2.8. June 2023 [ 53 ] On June 2, 2023 CE was admitted to the University of Alberta Hospital and then on June 4, 2023 she was transferred to Alberta Hospital Edmonton, where she stayed until she was discharged on June 13, 2023. Throughout that period, she was a formal patient, based on certifications by two physicians. On June 13, 2023 those certifications were cancelled by Dr. Alikouzehgaran, whose discharge

summary includes the following: Was polite pleasant cooperative mood was good affect was bright reported “I know I was psychotic when I went to the hospital but now I am not psychotic I do not think part of my body is missing I feel okay and I do not want to take medication.” Denied any active psychotic symptoms denied any suicidal or homicidal thoughts ... Agreed to take zopiclone and requested to be on Vyvnase [ 54 ] CE continued to send numerous emails to her psychiatric nurse in June. Some include references to suicide. [ 55 ] On June 23, 2023 Dr.

Mobalji Lawal visited CE in her home and initiated a community treatment order for her which was supported by Dr. Aniekan Orok. Dr. Lawal’s notes from that visit include the following: I know CE as she is my patient in the community. I diagnosed her with schizophrenia when I assessed her on 25 May 2023. She lacks insight into her schizophrenia as she believes she only has ADHD and autism spectrum disorder despite her florid psychotic presentation and admitting to banging her head on the wall to get the voices out.

She has been admitted several times in the past, but she did not comply with medications leading to relapses and further admissions. I believe CTO will help ensure she gets her medication as required and engage more with mental health services. [ 56 ] Dr. Lawal describes what happened after June 23, 2023 in his July 13, 2023 apprehension order (form 23): Since we put her back on CTO on 23 June 2023 during home visit, she has been refusing to attend clinic appointments and refused to talk about medication options. She cancelled her clinic appointments by herself by going to MyChart on Connect Care and remove it.

In view of all these, we are unable to wait and allow her mental health to continue to deteriorate, sending several unsolicited emails to people, and now damaging her resident [residence] again. She as been tried on Abilify and Clopixol depot LAIs in the past. I have prescribed Clopixol depot injection for her to start 100 MG IM and on the 8 th day post first Clopixol depot injection increase dose to 200 MG every 2 weeks. She is going to refuse her injection and I will recommend certification and admission if deemed fit.

She is not cooperating with us in the community, and she is damaging the property she rented due to her psychosis.

This apprehension is for her mental state examination and to administer her first dose of Clopixol injection Depot 100 MG start. 2.2.9. July – August 2023 [ 57 ] Alberta Health Services included the following chronology in its brief on this appeal. CE took no issue with it during the appeal hearing. It accurately summarizes the medical records covering this period. I have omitted the footnotes. On July 16, 2023, Edmonton Police Service (“EPS”) apprehended the Applicant on a Form 23 following the Applicant’s non- compliance with a non-consent Community Treatment Order.

On attending the Applicant’s apartment, EPS found large holes in the walls exposing water and gas lines. The Applicant subsequently endorsed that the Applicant made the holes in the walls to stop harassing voices “laughing” at the Applicant, and that keeping the Applicant’s computer on was necessary for the same purpose. EPS brought the Applicant to the Royal Alexandra Hospital (RAH). On July 17, 2023, the Applicant was admitted to the ICU at RAH. That day, Drs. Marko Timchak and M. Marsh Joyal both issued Form 1 Admission Certificates on examination of the Applicant. On July 19, 2023, Drs. James W.

Osinchuk and Samer Aldandashi both issued Form 11 Certificates of Incompetence to Make Treatment Decisions in respect of the Applicant. The Applicant appealed the Certificates. On July 24, 2023, the Mental Health Review Panel heard the Applicant’s Appeal from the July 17, 2023 Admission Certificates and July 19, 2023 Certificates of Incompetence to make Treatment Decisions. The Mental Health Review Panel unanimously refused to cancel the Certificates and issued reasons the same day. On July 25, 2023, Dr.

Samer Aldandashi completed a Referral for the Public Guardian to act as Decision Maker of Last Resort pursuant to s. 28 of the MHA . The Referral proposed a treatment plan for administration of antipsychotic medication zuclopenthixol by injection every two weeks to treat schizophrenia. On July 27, 2023, the Public Guardian consented to the treatment plan proposed by Dr. Aldandashi as substitute decision-maker for the Applicant. On July 27, 2023 and August 10, 2023 RAH staff administered antipsychotic medication to the Applicant according to the treatment plan and consent of the Public Guardian.

On August 14, 2023, the Applicant was transferred from the Royal Alexandra Hospital ICU to Alberta Hospital Edmonton Addiction and Mental Health Adult Acute Assessment Unit for stabilization. Following the transfer, the Admission Certificates issued July 17, 2023 at RAH were not considered for renewal within the prescribed timelines of the MHA due to an oversight. On August 22, 2023, Drs. Daniel Ming-Ern Li (“Dr. Li”), and Radha Chawla (“Dr.

Chawla”) both issued Form 1 Admission Certificates and Form 11 Certificates of Incompetence to Make Treatment Decision on examination of the Applicant at Alberta Hospital Edmonton. [ 58 ] Dr. Li testified before me on November 15, 2023 about his treatment of CE from August onward, so I will discuss that when I come to his testimony in these reasons. 2.2.10. September 2023 [ 59 ] The medical records include a

summary of a conversation CE had with a staff member at Alberta Hospital on September 13, 2023, which includes the following: Came to nursing station for a 1 on 1, writer sat in foyer, talked about her not wanting to take injection as it gives her side effects that makes her scream, yell, delusional and hallucinate. Stated she is fearful, fearful of being in hospital and fearful of taking medications as she believes she doesn’t need them and the only thing would work is if staff listens to her and accept her way of dealing with her emotions.

Showed writer a few pictures from her phone of some of the damages she had done in her flat. Banging head and her body on walls, punching holes in walls, when asked the reason for same “I was hearing voices, and I was upset at the Doctors for not listening to me”. Stated she used a rolling pin for the damages. 2.3. Dr. Li’s November 9, 2023 letter [ 60 ] On November 9, 2023 Dr. Li wrote to the Public Guardian and Trustee.

That letter includes the following: With regards to the effectiveness of past treatments, CE’s auditory hallucinations and delusions have previously been significantly attenuated by depot antipsychotic medication, such as zuclopenthixol decanoate IM q 2 weeks.

This medication, and other depot antipsychotics, have decreased her psychotic symptoms to the point that she has been able to live in her residence with much lower risk for self-injury (e.g., head banging in response to auditory hallucinations), and direct damage to the apartment from destroying the walls, the latter of which occurs in response to severe auditory hallucinations and persecutory delusions.

With medications, CE becomes more clear and organized in her thinking and is able to engage with others in a more socially constructive and appropriate manner, and in doing so, is able to maintain her housing and other psychosocial supports (e.g. persons in the Autism Society). In addition, CE becomes less distressed by delusional fears of being killed by people in her paranoid delusional system.

If CE does not receive the recommended treatment, she will continue to have distressing auditory hallucinations and persecutory delusions that will prevent her from appreciating reality, and which will result in dangerous behaviors to herself, paranoia about others, and also destruction of property with subsequent eviction and homelessness. She has been evicted on numerous occasions in the recent years as a result of her untreated psychosis, with numerous and recurrent psychiatric admissions.

Her prognosis remains very guarded, with ongoing danger to self, others, and recurring psychiatric admissions and the likelihood of homelessness if she does not receive treatment.

2.4. Dr. Li’s testimony [ 61 ] Dr. Li is a psychiatrist with over 20 years of experience, practicing in Edmonton. He has been the Edmonton Zone Clinical Department head for Addiction and Mental Health for Alberta Health Services since 2019. He is also an associate clinical professor in the Department of Psychiatry at the University of Alberta. He is qualified to give expert opinion evidence regarding psychiatric diagnosis and treatment. [ 62 ] Dr. Li has been treating CE at the Alberta Hospital since her admission there on August 14, 2023.

He signed an admission certificate and a certificate of incompetence to make treatment decisions with respect to CE on August 22, 2023. A second psychiatrist, Dr. Chawla, also signed an admission certificate and certificate of incompetence on that date. Dr. Li and Dr. Chawla also signed renewal certificates on September 22, 2023 and October 20, 2023. [ 63 ] Dr. Li testified that CE’s condition improved after receiving the injections of anti-psychotic medications. She became easier to engage and less irritable and hostile. She also became slightly less delusional.

At that point her condition was such that she could be transferred out of the intensive care unit at the Royal Alexandra Hospital to the general psychiatric unit at Alberta Hospital. However, CE has not received any anti-psychotic medication since August 10, 2023 because CE refuses to consent to it and the Public Guardian will not consent to treatment on CE’s behalf while she is appealing her admission as a formal patient and declaration of mental incompetence. [ 64 ] After testifying regarding CE’s history prior to coming into his care, Dr.

Li described CE’s treatment and condition since coming to Alberta Hospital in August 2023. [ 65 ] As of August 22, 2023 Dr. Li had formed the opinion that CE was suffering from a severe psychosis, separate and distinct from autism spectrum disorder. Dr. Li explained that psychosis is an umbrella term for disorders of thought and perception in which a person has difficulties distinguishing between what is real and not real. This umbrella term includes schizophrenia and delusional disorder. In Dr.

Li’s opinion, CE meets the full criteria of schizophrenia, in part because CE has auditory hallucinations that are pervasive, complex, and intense. [ 66 ] Dr. Li noted severe emotional dysregulation when CE was stressed. She would shout and scream when stressed, sometimes for 30 minutes or more. [ 67 ] When Dr. Li assessed CE on September 22, 2023 prior to completing a renewal certificate, he observed that CE’s paranoia, hostility, and verbal aggression were getting worse, and that CE was involving the Alberta Hospital staff as the subjects of her paranoia. In Dr.

Li’s opinion, CE’s condition was deteriorating at this time because the anti-psychotic injections on July 27 and August 10, 2023 were wearing off. [ 68 ] Dr. Li completed another renewal certificate on October 20, 2023. On that day he noted that the frequency of CE’s emotional outbursts, screaming, shouting, and crying had increased since September 22, 2023. CE was also more intensely hostile with Dr. Li and hospital staff. As of October 20, 2023 after a few minutes of conversation with Dr. Li or hospital staff, CE would start shouting and expressing hostility. [ 69 ] Dr.

Li provided his opinion that CE’s psychosis is not caused by an adrenal insufficiency in part because tests measuring her cortisol levels and other relevant tests have been normal. He also opined that CE does not have a brain injury because she does not have a cognitive impairment. For example, he noted that she organized a move of her residence while she was in hospital, which shows she has strong cognitive capacity. [ 70 ] Dr. Li noted that schizophrenia and autism can co-exist in one person and referred to the DSM(

V) on this point. In particular, if there are prominent delusions or hallucinations lasting for at least a month with signs of continuous disturbance for over six months, that indicates schizophrenia. In Dr. Li’s opinion, CE fulfils that criteria of having co-morbid schizophrenia over and above autism. [ 71 ] Dr. Li further provided his opinion that it is impossible for anti-psychotic medication, administered within the therapeutic range, to cause psychosis. On the contrary, it turns down the volume on psychosis by inhibiting the system which is responsible for psychosis. [ 72 ] Dr.

Li believes that CE would benefit from treatment with anti-psychotic medication and referred to his November 9, 2023 letter to the Public Guardian. Dr. Li’s treatment plan is to administer anti-psychotic medications every 2 – 4 weeks, and, after the medication has taken effect, to add psychosocial treatment. In Dr. Li’s opinions, with that treatment, there is a prospect for CE to live in the community again. [ 73 ] Dr.

Li attributed the fact that CE had no psychiatric hospital admissions or calls to police or crisis workers in the period May 2019 to February 2022 to the fact that during the first part of that period (May 2019 to October 2020) she was receiving anti-psychotic medication as prescribed. After October 2020 she stopped receiving anti-psychotic medications and her hospitalizations resumed in February 2022. Dr. Li explained that it would take about two months for the effects of the medication to completely wear off. Dr. Li did not discuss the fact that CE had no hospitalizations during 2021. [ 74 ] Dr.

Li reported that while in Alberta Hospital since August 2023 CE has been heard saying “Shut the F up” when she is alone, indicating that she is hearing voices. Dr. Li also testified that CE has said that she can hear Dr. Li and the nurses talking about her when they are not with CE. [ 75 ] Dr. Li provided his opinion that CE does not recognize that she is affected by psychosis and is not able to understand that her auditory hallucinations are not part of reality.

When CE looks back, she can identify that there has been psychosis in the past, but when she is in the middle of the acute phase, she does not recognize that her symptoms are caused by an underlying illness.

[ 76 ] Dr. Li also provided his opinion that CE does not understand the consequences of refusing to take anti-psychotic medication, particularly that without that treatment her symptoms, including auditory hallucinations, will follow her to wherever she goes, which leads to self-harm in the form of banging her head against walls. In addition, CE does not appreciate the extent to which her untreated symptoms interfere with her enjoyment of life. 2.5. CE’s testimony [ 77 ] CE testified that autism is a birth defect and a brain injury. [ 78 ] CE accepts that she has autism, ADHD, and savant.

She can’t work or go to school, but she likes to research. She says her adrenal deficiency resolved itself somewhat, but it still causes mood problems and irritability and jitteriness. [ 79 ] CE complained that the hospitals don’t do cortisol levels when she is put into hospital. In CE’s view, her psychosis is a symptom of adrenal insufficiency. [ 80 ] She also testified that some of the blood work is inaccurate. [ 81 ] CE feels that she is being killed by mental health. She is being put on a stake and a platter.

The medical professionals can’t accept autism as a diagnosis. [ 82 ] The more they push for things, the more CE just wants to be dead. [ 83 ] CE believes that the anti-psychotic medication will take 25 years off her life [ 84 ] She noted that she had been offered letters to go to Barcelona Spain to speak about some of the knowledge she has. [ 85 ] CE does not understand why she should have to lose everything all because people want her to be schizophrenic and bipolar. [ 86 ] As far as CE is concerned her certification as a formal patient and declaration of mental incompetence is a kill order for her. [ 87 ] CE said that if someone comes into an ER and asks to see a SART nurse they should get to see a SART nurse. [ 88 ] CE testified that for 14 years she has not shed one hair on any part of her body.

She acknowledged that there could be a medical explanation for this, but, in her view, there is also the possibility that someone has been grooming her sexually for years and collecting those things. [ 89 ] CE said that everybody wants her to have something so that they can drug and assault her. [ 90 ] CE testified that her adrenal deficiency makes it difficult for her to handle stress and that the addition of anti-psychotic drugs creates more problems [ 91 ] In CE’s view she needs a therapist, not a psychiatrist.

She does not need to be on medication. [ 92 ] CE noted that the public guardian was not present for the appeal hearing even though she is supposed to be in charge of CE’s health. [ 93 ] CE testified that the day before the appeal hearing she asked for water and instead the staff played jokes and games. In her view, the staff do not understand autism. Autistics don’t understand jokes and games.

In CE’s view, this treatment is harassment which hurts her. [ 94 ] CE compared herself to people with Downs syndrome, who she noted can live on their own, marry, and have children. [ 95 ] CE testified that she was stable from 2011 to 2016 or 2017. The problems started when the police had to come because everybody picked on her. [ 96 ] CE said that if none of this stops, she will keep banging her head against walls or throwing things against walls. She does not ever want to go back into mental health because they destroyed her life.

They hold her down and tie her up and give her noxious substances that make her babel. [ 97 ] She said that after being medicated in Royal Alexandra Hospital in October 2022 she went through a period thinking there was a camera in her left eye. Then a couple of months later she started banging her head against walls. [ 98 ] She complained that the medical staff escalate conversations, starting off saying no medications and then changing to maybe medications and then medications and community treatment order. [ 99 ] CE testified that the psychiatrists and medical staff hate her. They want her dead.

To them its just a big game. They don’t get that CE is autistic and she takes things literally. [ 100 ] CE does not understand why she has to die. She said if she is kept in hospital, they will drug her and hurt her. Eventually she will kill herself somehow. [ 101 ] CE testified that the more she is medicated and subjected to community treatment orders, she is depolarizing. [ 102 ] CE notes that the diagnoses in themselves are traumatizing. She said that some drugs caused her fingers to go numb and a bunch

of other symptoms she can’t explain. [ 103 ] CE’s final statement in her testimony before me was the following: The harassment I’m pretty sure its some kind of wiretap, some kind of device. I just can’t explain it and I don’t understand how its being done and until I do, I can’t do anything about it and the reality is nobody else can do anything about it, either. And its not fair to me. But it is going to end up killing me. 3. Is CE suffering from a mental disorder? [ 104 ] Mental disorder is defined in

section 1 of the Mental Health Act : (g) (g) “mental disorder” means a substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs (i) (

i) judgment, (ii) (ii) behaviour, (iii) (iii) capacity to recognize reality, or (iv) (iv) ability to meet the ordinary demands of life, but does not include a disorder in which the resulting impairment is persistent and is caused solely by an acquired or congenital irreversible brain injury; [ 105 ] Irreversible brain injury and persistent are defined in

section 2.1 of the Mental Health Regulation , Alta Reg 19/2004 . (a) "irreversible brain injury" means a permanent disruption to the baseline function of the brain or to the structure of the brain caused or likely caused by an identifiable or probable (i) (

i) acute external action, including trauma, or (ii) (ii) pathophysiological event within the body, including an acute hypoxic event, but does not include a permanent disruption caused or likely caused by a neurodegenerative disorder; (b) (b) "persistent" means stable and unlikely to improve as a result of treatment. [ 106 ] CE agrees she has several mental illnesses, specifically Autism, ADHD and PTSD and catastrophizing. However, she argues that she does not have schizophrenia for several reasons. First, she asserts that a person cannot have more than four mental illnesses.

Second, she claims that an autistic person cannot have schizophrenia. Third, CE claims that she is too old to be diagnosed with schizophrenia, as diagnosis must occur before age 35. Most significantly, CE says she has been misdiagnosed because any symptoms she has are the result of her Autism, ADHD, PTSD and catastrophizing, or adrenal deficiency. She provided no references to scientific or medical literature to support any of those points. [ 107 ] During her cross-examination of Dr. Li, CE noted that there is no definition of voluntary patient in the Mental Health Act .

She also criticized the definition of nearest relative in the Mental Health Act and said that the Mental Health Act is full of flaws. Neither CE nor Alberta Health Services made any submissions about any flaws in the Mental Health Act . If there are flaws in the Mental Health Act , they are for the legislature to correct, not me. My job is to apply the Mental Health Act and the Mental Health Regulation to the facts of this case. [ 108 ] CE’s October 5, 2023 affidavit asserts that her human rights and civil rights have been violated, including her

section 7, 8 and 9 Charter rights. CE asserted during her testimony it is her body and she gets to say what goes into it. These points go to the constitutional validity of the Mental Health Act . CE did not file and serve a notice of constitutional question which is required for those arguments: Judicature Act , RSA 2000, c. J-2,

section 24 . Furthermore, I heard no argument on this issue from either CE or Alberta Health Services. Consequently, I make no finding regarding breaches of CE’s rights or the constitutional validity of the Mental Health Act . [ 109 ] CE also submitted during her cross-examination of Dr. Li that the Mental Health Act requires decisions to be made on fact not opinions whereas the certificates, such as Dr. Li’s August 22, 2023 admission certificate sets out his opinions, not facts. I do not agree. Psychiatric opinions, such as Dr.

Li’s, are essential to the operation of the Mental Health Act in many respects, particularly the issuance of admission certificates and declarations of mental incompetence. [ 110 ] Based on her cross-examination of Dr. Li, her testimony, and her closing submissions, I understand CE’s position is that she is not schizophrenic, that her symptoms are caused by her autism or one of her other conditions and that any hallucinations she has experienced are the result of the anti-psychotic medications she has been forced to take. [ 111 ] I accept Dr. Li’s evidence on these points.

First, a person can have both autism and schizophrenia. Second, anti-psychotic drugs cannot cause hallucinations when administered in the therapeutic range, which is what CE has received. Third the voices CE has heard have been auditory hallucinations which confirm that CE is suffering from schizophrenia. [ 112 ] CE also seemed to suggest that her autism is an irreversible brain injury. I accept Dr. Li’s evidence on this point that CE’s ability to manage complex tasks shows she does not have a cognitive impairment, or a brain injury as defined in the Mental Health

Regulation . Furthermore, even if CE’s autism were an irreversible brain injury, it is not causing her psychosis. Her delusions and hallucinations are caused by her schizophrenia. [ 113 ] CE has a mental disorder because she has a substantial disorder of perception that grossly impairs her capacity to recognize reality and her ability to meet the ordinary demands of life. Specifically, she hears voices and believes people are talking about her and harassing her, which has caused her to injure herself and act in ways that cause her to be evicted from her home. 4.

Does CE have the potential to benefit from treatment? [ 114 ] One of the main points of disagreement between CE and Dr. Li is whether treatment with anti-psychotic drugs would harm or help her. CE said in her affidavits and in her testimony before me that the anti-psychotic drugs cause her to hear voices and hallucinate. Dr. Li testified that the drugs cannot do that. I accept his evidence on that point. [ 115 ] CE received anti-psychotic injections at the Royal Alexandra Hospital on July27 and August 10, 2023. When CE came to the Alberta Hospital on August 14, 2023, Dr.

Li observed that CE’s symptoms were mild initially, but that CE became more delusional in the weeks that followed, during which CE was not receiving anti-psychotic drugs. [ 116 ] Dr. Li also testified, based on reviewing CE’s medical records, that in the period May 2019 to October 2020, when CE was receiving anti-psychotic drugs, she had no hospitalizations. but after she stopped taking the anti-psychotic drugs her hospitalizations resumed. The medical records support that observation.

However, the evidence before me does not explain how or why CE was able to manage through all of 2021 having no hospitalizations and no anti-psychotic medication after October 2020. [ 117 ] CE said in her October 5, 2023 affidavit and in her testimony on November 15, 2023, that the anti-psychotic drugs will take 25 years off her life, which she says is reported in the scientific literature. She did not provide copies or citations of any scientific literature to support that quotation. Dr.

Li did not testify on this point. [ 118 ] I am not satisfied on the evidence before me that the administration of anti-psychotic drugs is likely to shorten CE’s life. [ 119 ] The evidence regarding CE’s treatment and symptoms in 2023 is significant. CE received anti-psychotic medication at the beginning of February and none thereafter until July 27. She was hearing voices, banging her head against the wall and smashing her dishes in her apartment by mid-March. In April she was evicted and by the end of April she was living in a shelter.

In May she was still hearing voices and believed people were wiretapping her and coming into her apartment. In June she was admitted to the University of Alberta hospital as a formal patient, but she was discharged on June 13. In late June Dr. Lawal issued a community treatment order for her, but CE refused to receive anti-psychotic medication which led to continued symptoms and resulting damage to her property. By the time she was apprehended on July 16, 2023, CE had made holes in the walls of her apartment to try to stop the voices she was hearing in her head.

After CE received anti-psychotic medication in late July and early August, her symptoms abated, though not completely, but they returned again in September and October, as the medication wore off. This recent history supports Dr. Li’s opinion that CE would benefit from treatment with anti-psychotic medication. [ 120 ] While I appreciate that there may be negative side effects to the treatment, I am satisfied that treatment with anti-psychotic drugs would be more helpful than harmful for CE. CE has the potential to benefit from treatment 5.

Is CE likely to cause harm to others or to suffer negative effects as a result of or related to the mental disorder? [ 121 ] The medical record shows that in the past when CE has not received treatment with anti-psychotic medication she has suffered from delusions and heard voices resulting in her harming herself and damaging property which has led to her being evicted from her residence. I find that CE is likely to suffer negative effects as a result of her schizophrenia. 6. Is CE unsuitable for admission to a facility other than as a formal patient. [ 122 ] Dr.

Li testified that since she has been a patient at Alberta Hospital, CE regularly says that she wants to leave. [ 123 ] A community treatment order has been tried in the past, most recently in June of this year. CE did not comply with the treatment, which led to her damaging the walls of her residence by banging her head against them or hitting them with a rolling pin. I am satisfied that treatment as a formal patient is the only treatment option likely to work. 7.

Conclusion Regarding Admission as a Formal Patient [ 124 ] The evidence establishes each of the four requirements for CE to be subject to an admission certificate under

section 2 of the Mental Health Act and a renewal certificate under

section 8 of the Mental Health Act . 8. Is CE incompetent to make treatment decisions?

[ 125 ] As is set out in

section 26 of the Mental Health Act , for a person to be competent to make treatment decisions, the person must be able to understand the subject-matter relating to the decisions and be able to appreciate the consequences of making the decisions. [ 126 ] CE believes that a person cannot have both autism and schizophrenia. She believes that the anti-psychotic medications she has received in the past caused her to have hallucinations. Based on Dr. Li’s testimony I conclude that both beliefs are incorrect.

I further conclude that these false beliefs are making CE unable to understand her illness and unable to appreciate the consequences of receiving anti-psychotic treatment. Consequently, CE is incompetent to make treatment decisions. [ 127 ] I am not finding that the only rational decision for CE would be to receive anti-psychotic medication. I am not reasoning backward from the fact that she does not want that treatment to conclude that she lacks capacity. If she had capacity to make treatment decisions, she would be entitled to refuse treatment, even against medical advice.

Unfortunately, CE’s persistent misunderstanding of her illness and the effects of treatment are interfering with her understanding and appreciation on these points. [ 128 ] I am not finding that the best treatment option for CE is the administration of anti-psychotic drugs. This is not an issue for me on this appeal. I note that CE appears to have been able to manage without anti-psychotic drugs for all of 2021. I also note the February 14, 2023 discharge

summary of Dr. Parveen Jahandar which refers to the pros and cons of anti-psychotic treatment for CE. The best treatment for CE may not be clear. What is clear is that CE does not have the capacity to make that decision. 9.

Conclusion on Appeal [ 129 ] I find that CE is suffering from a mental disorder, specifically, schizophrenia; she has the potential to benefit from treatment with anti-psychotic medication; she is likely to suffer negative effects as a result of schizophrenia, specifically, delusions and hallucinations and consequent damage to her property and self-harm; and she is unsuitable for admission other than as a formal patient, because she is determined to leave hospital and refuse treatment.

I further find that because of her false beliefs regarding her condition and the effects of anti-psychotic medication, she is lacks the ability to understand her illness and to appreciate the consequences of refusing treatment. For those reasons, I dismiss CE’s appeal and uphold the decision of the Mental Health Review Panel. Heard on the 15 th day of November, 2023. Dated at the City of Edmonton, Alberta this 6 th day of December, 2023. G.S. Dunlop J.C.K.B.A. Appearances: CE (Self Represented Litigant) for the Applicant Ashley Groenewegen for the Respondent