Dr. John Gray
In some Canadian provinces, including Ontario, mental health legislation creates a paradox: individuals may be involuntarily admitted to hospital because treatment is deemed necessary for their safety or the safety of others—yet if they are found capable of making treatment decisions, they retain the legal right to refuse that very treatment. The person remains detained, unable to leave, yet unreached by the therapeutic purpose that justified their admission.
The courts have sometimes referred to this as “warehousing”—a bleak metaphor evoking stagnation, inaction, and the absence of care. But, you can walk out of a warehouse. In contrast, an involuntary patient who refuses treatment cannot walk out. They are confined, not for punishment, but with no legal or clinical path to restoration, recovery, or reintegration. They are imprisoned because “imprison” means to confine or restrain a person against their will, where no therapeutic intervention is legally permitted or possible, within a bounded space or under conditions that severely limit their liberty.
Mr. Sevels in Ontario, for example, refused treatment and, because of this, was forced into solitary confinement (seclusion) for 404 days, detained for 5 years and only treated successfully when he seriously injured a staff member. The judge said he was “warehoused” but because he could not leave, he was in fact “imprisoned” in a hospital.
This is not therapeutic detention. It is, in function and form, imprisonment. The individual is held without a criminal charge, without trial, and without access to the medical intervention that might lead to discharge. Physicians and nurses become, against their professional ethical codes, jailors, not healers—tasked not with care, but with custody. The “hospital” becomes a prison for those whose treatment is withheld in the name of autonomy.
To detain a person under the Mental Health Act on the basis that treatment is necessary and then deny the legal authority to provide that treatment is to violate not only clinical ethics but the very Charter rights the system claims to uphold. It is neither just nor humane.
More details can be found on the Sevels case and similar “imprisonments” in the article by law professor Robert Solomon, Dr O’Reilly and Dr Gray (both on FASMI board) and Martina Nikolic. The article is “Treatment Delayed – Liberty Denied,”2009 87-3 Canadian Bar Review 679, 2009 CanLIIDocs 130, https://canlii.ca/t/29jf
The article also details Professor Starson, despite delusions, being found by the Supreme Court of Canada to be capable of refusing treatment under Ontario law. As a result, he was detained for 7 years, untreated and nearly died from a starvation delusion. But, like most refusers, was eventually treated after years of unnecessary suffering, imprisonment in a hospital, expense and family anguish.
John Gray was named as the 2025 recipient of the Owen Adams Award of Honour by The Canadian Medical Association (CMA) The Adams Award of Honour, is the CMA’s highest distinction for an individual who is not a physician. The award recognizes exceptional contributions to Canadian health care and health advocacy. Dr Gray (PhD) is a member of the FASMI board. He is also a board member of the BC Schizophrenia Society and has worked in mental health services in Saskatchewan and British Columbia and is lead author of the book Canadian Mental Health Law and Policy.
