Alberta Politics & Government Thread 3.0

[puffnstuff]

He needs to reveal why his Ministry bought that building from Mraiche

[Yamer]

Compassionate Intervention Centres.

Yeah, and the Concentration Camps were for Jewish people to work on their focus.

[Geraldsh]

Originally Posted by Yamer

Compassionate Intervention Centres.

Yeah, and the Concentration Camps were for Jewish people to work on their focus.

I don’t think that is a valid comparison, the Jews were never given the option to “be better”.

[Fuzz]

Originally Posted by Monahammer

I was trying to post a photo of the letter, but can't. Sites non confidence in gov plan to deal with AHS scandal.

Spoiler!

Rehosted.

[Yamer]

Originally Posted by Geraldsh

I don’t think that is a valid comparison, the Jews were never given the option to “be better”.

"Be better" was as subjective a term to the guards as it is to the UCP.

The issue is the soft language for a principal they, evidently, only selectively believe in (involuntary treatments).

There is going to be very little compassion involved if the UCP is mapping this out. Besides, it hasn't proven to be very effective, something I trust the UCP will also not improve.

I believe there are better ways to spend this money in order to curb and treat addiction, but most of them involve thought and actual compassion.

[MrButtons]

Peter Guthrie stepped down https://edmontonjournal.com/news/pol...esigns-cabinet

“In recent months, I have voice concerns regarding the Government of Alberta’s procurement practises across all departments,” it reads.

He goes on to state he had taken steps to address what he termed “inconsistencies” and also pointed to his recommendation of creating a financial oversight committee to review and advise on major government contracts.

“If implemented, such a committee could have been instrumental in preventing some of the issues we are now seeing in Alberta Health and AHS,” his statement reads. “Unfortunately, the majority of cabinet does not appear to share my concerns.”

[woob]

Hopefully more follow his lead, but they'll likely all remain as pigs at the UCP government trough.

[Fuzz]

Originally Posted by Yamer

"Be better" was as subjective a term to the guards as it is to the UCP.

The issue is the soft language for a principal they, evidently, only selectively believe in (involuntary treatments).

There is going to be very little compassion involved if the UCP is mapping this out. Besides, it hasn't proven to be very effective, something I trust the UCP will also not improve.

I believe there are better ways to spend this money in order to curb and treat addiction, but most of them involve thought and actual compassion.

You'd think they'd like, you know, setup a pilot project to optimize spaces, treatment, see what is working, costs, potential security needs, you know, before this a massive outlay of money for an "Alberta Model" that hasn't be tested or proven. But then they might have to listen to the advice of experts, and we all know how they feel about that.


I guess the good news is these spaces will be available for healthcare when a serious government (not a clown show) gets elected.

[Makarov]

Originally Posted by Fuzz

You'd think they'd like, you know, setup a pilot project to optimize spaces, treatment, see what is working, costs, potential security needs, you know, before this a massive outlay of money for an "Alberta Model" that hasn't be tested or proven. But then they might have to listen to the advice of experts, and we all know how they feel about that.


I guess the good news is these spaces will be available for healthcare when a serious government (not a clown show) gets elected.

This seems to be the consensus at the moment:

Conclusions:
There is a lack of high-quality evidence to support or refute involuntary treatment for SUD. More research is needed to inform health policy.

SOURCE: https://journals.lww.com/cja/fulltex...datadecoded.ca

[SeeGeeWhy]

Originally Posted by MrButtons

Peter Guthrie stepped down https://edmontonjournal.com/news/pol...esigns-cabinet

Where was this arsehole when AI reps told me to "sue them" after they refused to pay for valid extras building new schools for their asses? Sure love being bankrupted trying to better our Province!

[Whynotnow]

Originally Posted by Makarov

I've spent a lot of time litigating the homelessness/addiction file. My views have evolved a lot. And I agree with you: I think we, as a society, need to try involuntary treatment when a person's addiction is so strong that they are a danger to themselves (by using fentanyl or rejecting shelter). With good intentions, we've turned sidewalks and parks into the asylums of the 21st century. It hasn't worked. Its cruel. I think we need to try something else.

EDIT: And obviously, I'm in the same boat as you. It feels strange to agree with the Smith government on something, but this is one where I very much do (and indeed recognize that her government appears to be a leader in Canada on this issue).

That said, the hypocrisy of their anti-vaccine rhetoric is now overwhelming and fair game for criticism.

I have concerns, the history of governments and forcing treatment on people is not great. Forced sterilization, forced lobotomies, etc are a dark dark stain on Alberta. Would you force an obese compulsive eater to be locked up to lose weight? Other addictive behaviours or destructive behaviors next?

However, what we are doing right now is awful and we need to do way, way more. More treatment spots, more supports for those nearing poverty, more social workers, more presence in urban areas to deal with disorder, a massive crackdown on dealers, etc. There’s no single thing but we almost are doing nothing in any of the right areas.

[Paulie Walnuts]

https://twitter.com/user/status/1894457202611818911

[Makarov]

Originally Posted by Whynotnow

I have concerns, the history of governments and forcing treatment on people is not great. Forced sterilization, forced lobotomies, etc are a dark dark stain on Alberta. Would you force an obese compulsive eater to be locked up to lose weight? Other addictive behaviours or destructive behaviors next?

However, what we are doing right now is awful and we need to do way, way more. More treatment spots, more supports for those nearing poverty, more social workers, more presence in urban areas to deal with disorder, a massive crackdown on dealers, etc. There’s no single thing but we almost are doing nothing in any of the right areas.

I understand those concerns. Really. I share them.

In response, I'd just say this:

1. Any legislation permitting involuntary treatment would undoubtedly require a psychiatrist (ie, a physician bound by their fiduciary duty to their patient) to be the front-line person who decides that a person is enough of a danger to themselves to order involuntary detention and involuntary treatment.

2. Any such legislation would obviously also grant affected people (or someone appointed their power of attorney over personal care, etc) to challenge such a decision.

3. We've come a long way as a society since the late 1970s. I'd like to think that institutions that provide involuntary treatment are much more sophisticated and humane now.

4. As alluded to in my paragraph 3, every province in Canada already has legislation permitting involuntary treatment. However, most of them only permit it when the affected person lacks the capacity to consent to treatment. That's a very high test. However, there are a couple of provinces which already have legislating permitting involuntary treatment. However, those provinces have not invested in sufficient institutional space so the authority is not exercised very often.

5. All provinces already have legislation which permits involuntary detention under mental health legislation. When that legislation does not also permit involentary treatment, it actually creates the potential for a terrible situation: indefinite involuntary detention (indefinite because the affected person does not receive treatment, so continues to meet the threshold for involuntary detention).

6. Most of the studies out there on involuntary treatment compare its results to voluntary treatment. Unsurprisingly, voluntary treatment tends to yield better results than involuntary treatment. However, I think those studies miss the point (to a degree anyway). The comparison should really be between outcomes after involuntary treatment and outcomes after no treatment (sleeping rough in encampments and daily use of fentanyl).

7. People who regularly use fentanyl die. At utterly appalling rates. And even when they're saved by staff at safe consumption sites or even by shelter staff, their hearts regularly (like, multiple times a year) stop for significant periods of time, causing repeated damage to their brains.

8. I think that a sophisticated government, acting in good faith and on the advice of experts, could design involuntary treatment legislation and institutions that are humane and effective (well, at least significantly more effective than the current do-nothing approach).

Anyway, sorry for the long argument.

[Street Pharmacist]

For those in support of involuntary treatment, I'm curious what the goals of therapy are.

Typically, the goal of therapy is to minimize harm to the patient. Literature shows that abstinence rarely happens and abstinence is no longer a goal of therapy. It seems to me, the goal of the legislation is to make abstinence the goal of therapy. I'm just not sure how incarcerating someone would accomplish that.

Like, how does locking someone in a building stop drug seeking behavior? I'm genuinely confused how this would work. Or is this a permanent thing? Lock them up forever?

[Makarov]

Originally Posted by Street Pharmacist

For those in support of involuntary treatment, I'm curious what the goals of therapy are.

Typically, the goal of therapy is to minimize harm to the patient. Literature shows that abstinence rarely happens and abstinence is no longer a goal of therapy. It seems to me, the goal of the legislation is to make abstinence the goal of therapy. I'm just not sure how incarcerating someone would accomplish that.

Like, how does locking someone in a building stop drug seeking behavior? I'm genuinely confused how this would work. Or is this a permanent thing? Lock them up forever?

The goal of treatment is to treat the person's addiction to fentanyl so that they don't use fentanyl (recognizing that relapses and set backs are inevitable and part of the process). Every time someone uses fentanyl, they risk their lives. That is not an overstatement.

And the whole point of involuntary treatment (as opposed to just involuntary detention) is to treat the illness (not just detain the person). I'm no expert in what that treatment looks like or how effective it is (and I certainly appreciate that treating opiate addiction is incredibly difficult), but I come back to... it must be better than doing nothing and just letting people suffer and die on the streets.

I don't know. I don't have the answers. I've spent many, many sleepless nights thinking about this. I know people who have lost children and siblings to this crisis. I've spent hundreds of hours drafting affidavits, cross-examining affiants, cobbling together arguments in facta and in court. I still don't have the answers. But, in this moment, I feel like the status quo is not acceptable.

[Street Pharmacist]

Originally Posted by Makarov

The goal of treatment is to treat the person's addiction to fentanyl so that they don't use fentanyl (recognizing that relapses and set backs are inevitable and part of the process). Every time someone uses fentanyl, they risk their lives. That is not an overstatement.



And the whole point of involuntary treatment (as opposed to just involuntary detention) is to treat the illness (not just detain the person). I'm no expert in what that treatment looks like or how effective it is (and I certainly appreciate that treating opiate addiction is incredibly difficult), but I come back to... it must be better than doing nothing and just letting people suffer and die on the streets.



I don't know. I don't have the answers. I've spent many, many sleepless nights thinking about this. I know people who have lost children and siblings to this crisis. I've spent hundreds of hours drafting affidavits, cross-examining affiants, cobbling together arguments in facta and in court. I still don't have the answers. But, in this moment, I feel like the status quo is not acceptable.

I think you're dancing around the question a bit. A goal of therapy is not to treat the illness. That's the therapy. I think you're saying the goal of therapy is to prevent harm to the patient. I think all clinicians share that goal. The goal of therapy should not, therefore, be a specific treatment.

As for its practicality, if you're able to leave, is not involuntary so it is in fact incarceration. You can easily force abstinence via incarceration but I don't know how you change their behavior when they leave incarceration.

I've lost multiple patients to opioids and one of my best friend's brother died downtown Edmonton from exposure because of opioid use disorder. I share the concern. These are real people that simply look less sympathetic to many because they may be homeless or look unwell. But all of them are somebody outside of that illness and it's too easy to ignore that.

There's a reason they often say "First, do no harm". You don't pick a random treatment because others aren't working. We are losing the fight on the supply side. The current therapies are working but the scale of devastation is so great it isn't enough.

I have real concerns, both civil and medical, about choosing one drug over another to incarcerate someone over. Opioids are deadly, but not as deadly as alcohol and yet we don't incarcerate alcohol addicts. Cigarettes are the only legal product that exists that will kill you if used correctly and yet we don't incarcerate cigarette addicts. We've chosen to incarcerate those with opioid addictions because it's yucky and culturally acceptable.

[Yamer]

The cure for addiction isn't simply removing a person's ability or avenue to use a substance for a set period of time. It's comprehensively improving a person's wellbeing to the point where that wellbeing is unequivocally valued; to where a substance becomes a hinderance to that wellbeing.

Involuntary intervention can often be a first step. However, involuntary treatment is a soothing solution to lazy and simple-minded people that like to think they're helping, but in fact have never had a brighter resolving thought beyond what equates to "lock 'em up".

You want to solve addiction? You can't, but how about addressing the myriad inequities and social failures that lead to it in the first place.

[Whynotnow]

Originally Posted by Makarov

I understand those concerns. Really. I share them.

In response, I'd just say this:

1. Any legislation permitting involuntary treatment would undoubtedly require a psychiatrist (ie, a physician bound by their fiduciary duty to their patient) to be the front-line person who decides that a person is enough of a danger to themselves to order involuntary detention and involuntary treatment.

2. Any such legislation would obviously also grant affected people (or someone appointed their power of attorney over personal care, etc) to challenge such a decision.

3. We've come a long way as a society since the late 1970s. I'd like to think that institutions that provide involuntary treatment are much more sophisticated and humane now.

4. As alluded to in my paragraph 3, every province in Canada already has legislation permitting involuntary treatment. However, most of them only permit it when the affected person lacks the capacity to consent to treatment. That's a very high test. However, there are a couple of provinces which already have legislating permitting involuntary treatment. However, those provinces have not invested in sufficient institutional space so the authority is not exercised very often.

5. All provinces already have legislation which permits involuntary detention under mental health legislation. When that legislation does not also permit involentary treatment, it actually creates the potential for a terrible situation: indefinite involuntary detention (indefinite because the affected person does not receive treatment, so continues to meet the threshold for involuntary detention).

6. Most of the studies out there on involuntary treatment compare its results to voluntary treatment. Unsurprisingly, voluntary treatment tends to yield better results than involuntary treatment. However, I think those studies miss the point (to a degree anyway). The comparison should really be between outcomes after involuntary treatment and outcomes after no treatment (sleeping rough in encampments and daily use of fentanyl).

7. People who regularly use fentanyl die. At utterly appalling rates. And even when they're saved by staff at safe consumption sites or even by shelter staff, their hearts regularly (like, multiple times a year) stop for significant periods of time, causing repeated damage to their brains.

8. I think that a sophisticated government, acting in good faith and on the advice of experts, could design involuntary treatment legislation and institutions that are humane and effective (well, at least significantly more effective than the current do-nothing approach).

Anyway, sorry for the long argument.

Thoughtful response, I’d be really worried about this hinging on number 8 though, that’s pretty much the opposite of what we have.

Another not insignificant concern is I feel this would disproportionately affect indigenous people and we also don’t have a good track record there.

But more needs to be done, now, I think we all agree on that.

[Makarov]

Originally Posted by Whynotnow

Thoughtful response, I’d be really worried about this hinging on number 8 though, that’s pretty much the opposite of what we have.

Another not insignificant concern is I feel this would disproportionately affect indigenous people and we also don’t have a good track record there.

But more needs to be done, now, I think we all agree on that.

Sorry, I should have been more clear: I have zero faith that the Smith government is the right government to start pushing the boundaries on this.

[Makarov]

Originally Posted by Yamer

The cure for addiction isn't simply removing a person's ability or avenue to use a substance for a set period of time. It's comprehensively improving a person's wellbeing to the point where that wellbeing is unequivocally valued; to where a substance becomes a hinderance to that wellbeing.

I'm not talking about just involuntary detention (which is already authorized in various provincial mental health legislation). I'm talking about involuntary detention with involuntary treatment at the same time (which, presumably, would attempt to do what you've outlined here).

Originally Posted by Yamer

Involuntary intervention can often be a first step. However, involuntary treatment is a soothing solution to lazy and simple-minded people that like to think they're helping, but in fact have never had a brighter resolving thought beyond what equates to "lock 'em up".

You want to solve addiction? You can't, but how about addressing the myriad inequities and social failures that lead to it in the first place.

I don't think that's very fair. I'm certainly not suggesting that involuntary treatment is some panacea. Addiction and homelessness are incredibly complex. Recovering from addiction is a lifelong process (that will almost certainly involve numerous relapses). Addicts living in homeless encampments are the most vulnerable people in our communities and have all no doubt suffered horrific traumas in their lives. We need a multifaceted, multi-disciplinary response. I just think that involuntary treatment can be a useful and important tool (if used carefully).