Pandemic Injustice in Mental Health: Quebec’s Punitive Turn During COVID-19

In Quebec, the state of emergency due to COVID-19 has substantially changed practices in mental health. Formally, several measures must help contain the spread: hospitalizations are limited and replaced by telephone or video follow-up; visits and outings are prohibited; judicial activities are suspended with the exception of urgent applications like psychiatric assessment, psychiatric commitment and coercive care; and hearings take place over video. However, the idea that people with mental illness would have difficulty accepting and respecting sanitary measures justifies putting in place special precautions based on the possibility of a contamination risk. Observation of practices shows that, in order to manage risk, particularly punitive measures have been put in place, going beyond official directives and for a longer period than measures have lasted in the general population. Study of case law and newspaper articles highlights an abusive use of seclusion and prohibition of visits and outings, a diversion of psychiatric procedures to enforce confinement and distancing measures and significant procedural adjustments impacting people's ability to assert their rights. These risk-based practices not only break with previous law’s interpretations, but turns out to be discriminatory, establishing a noticeable difference between the general population, patients hospitalized for physical problems, even COVID-19, and people with mental illness. Quebec’s regulation of the COVID-19 pandemic in mental health highlights the limits of law and courts as safeguards of rights as well as the necessity of valuation and consideration of experiential knowledges, recognition of structural discrimination and massive investment in social services to enforce equality and justice.