Quebec psychiatrists say it may be time to change the criteria defining who can be forced to get treatment, in the wake of a recently released coroner's report into the police shooting of Martin Couture-Rouleau in October 2014.
Couture-Rouleau slammed his Nissan Altima into three people, two of whom were wearing army fatigues, in a parking lot in Saint-Jean-sur-Richelieu.
He killed Warrant Officer Patrice Vincent, and before he was shot dead, he called 911 to send a message to Canada to stop fighting the Islamic State overseas.
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In his report, Coroner André-H. Dandavino highlighted how Couture-Rouleau's father tried in vain to get treatment for his 25-year-old son as he descended into mental illness.
The coroner directed three of his five recommendations to the Quebec Association of Psychiatrists, which put the matter at the top of its agenda during a meeting of its board of directors last Friday.
The association's president, Dr. Karine Igartua, says research into the connection between radicalization and mental illness is a burgeoning field, but it is already on her association's radar.
"We used to think that radicalization had nothing to do with mental illness," she said in an interview with CBC's Quebec AM. "That is more true when you are dealing with organized groups.
When does religious extremism signal mental illness?
Igartua said people who are drawn into radical ideas on their own are more likely to have some sort of mental illness or disorder, often psychosis or psychotic depression, but also, less often, personality disorders or autism spectrum disorders.
Her association is already trying to inform its members about the phenomenon and develop expertise on the subject, which were two of the coroner's recommendations.
Child psychiatrists will devote a day this June to discussing radicalization and how to prevent it, in the lead-up to the association's annual congress.
A multicultural, multidisciplinary team of specialists is also coaching mental health teams around the province on the issue.
Two new specialized teams are also being created in Quebec City and Laval, Igartua said.
A father's desperate search for help
Coroner Dandevino also questioned why Couture-Rouleau was never seen by a psychiatrist, even though his father repeatedly turned to mental health and support workers and police in an effort to get help for his son's increasingly worrisome behaviour.
The young man had barged in on a baptism, ranting against Christianity. Police intervened but did not bring him to a hospital.
Police were also called when Martin-Rouleau tried to conduct an exorcism on a family member, but again, the man was not taken to hospital because Couture-Rouleau insisted there was nothing wrong with him.
'I think it was let go until it deteriorated into danger.' - Dr. Karine Igartua, president of the Quebec Association of Psychiatrists
Igartua said the Couture-Rouleau case highlights the fact that police cannot force a person with mental illness to get professional help against their will, unless that person poses an imminent danger to themselves or others.
The psychiatric team members who did see Couture-Rouleau ran into the same roadblock, she said.
"He was seen by a mental health worker and told the mental health worker all kinds of crazy things, but again said that he wasn't mentally ill and he didn't want treatment," Igartua said. "So, again, nothing was done."
Igartua said it is time to debate whether it's time to change the legal criterion of imminent danger, which prioritizes the right of individuals to make decisions themselves.
With some mental illnesses, especially psychotic disorders, people may not recognize that they have a problem, she said.
"Part of a psychosis is to have a break with reality, and so the idea that they actually have a mental illness is foreign to them."
Igartua would like to see the criteria take into consideration if a person's health and social functioning are deteriorating and if that person has insight into their situation.
"Often we can see that people are mentally ill for a long time before they become dangerous," she said.
She believes if different criteria were in force, Couture-Rouleau could have been compelled to get help for his mental illness before he killed anyone.
"I think it was let go until it deteriorated into danger," she said.
'Dropped the ball' on counselling father
Throughout his ordeal, no one told Couture-Rouleau's father that he had the option of going to court to seek interim custody of his adult son — another fact that drew the coroner's criticism.
Going the judicial route is an onerous task for any family member, Igartua said, but she agrees with the coroner that Couture-Rouleau's father should have been counselled on his right to do that.
"A lot of people kind of dropped the ball on this one," she said.
However, she said, family members would not be compelled to go to court if the criteria for forcing their relative to accept psychiatric treatment were changed.