QUEBEC CITY — Quebec's health minister has introduced sweeping changes to the province's mental health laws, aiming to make it easier to involuntarily hospitalize individuals in mental health crises. The reforms, outlined in Bill 23 tabled on Tuesday, lower the threshold for such interventions from requiring a "serious and immediate" danger to simply a "risk of danger," potentially allowing earlier action to protect both patients and the public. Health Minister Sonia Bélanger described the overhaul as a long-overdue modernization of the Protection of Persons Whose Mental State Presents a Danger to Themselves or to Others Act, known as P-38, which hasn't been significantly updated in over 25 years.
The bill comes amid heightened public concern following two high-profile tragedies linked to mental health issues. In 2023, Quebec police officer Maureen Breau was fatally shot by Isaac Brouillard Lessard, a man with schizoaffective disorder who had been deemed a significant risk to public safety but was permitted to live outside an institution. Brouillard Lessard, who was later shot dead by police, had been found not criminally responsible for offenses five times between 2014 and 2018 due to his mental illness. A coroner's inquest into the incident revealed numerous failings in his assessment and supervision, including his resistance to treatment and non-compliance with court-ordered medication. Witnesses testified that he wasn't adequately monitored despite professional recommendations for ongoing care.
More recently, two weeks before the bill's tabling, Chong Woo Kim, the owner of a dépanneur in Montreal's Plateau-Mont-Royal neighborhood, was stabbed to death by a man with a history of violent crime. Police had attempted but failed to detain the suspect preventatively in a hospital in August, highlighting gaps in the current system. Premier François Legault had pledged these reforms in response to Breau's death, emphasizing the need for better tools to intervene in mental health crises.
Bélanger, in a statement accompanying the bill, stressed its focus on supporting those at risk. "After more than 25 years, it was time to modernize our tools to intervene more humanely and earlier," she wrote. The legislation would permit certain procedures, such as psychiatric evaluations, without patient consent and shift some decisions on involuntary hospitalization from courts to an administrative tribunal, streamlining the process but raising questions about oversight.
Psychiatrists and mental health professionals have largely welcomed the changes. Marie-Michèle Boulanger, a forensic psychologist at the Institut national de psychiatrie légale Philippe-Pinel, argued that the existing criteria under P-38 are overly restrictive. "I’ve never spoken to a psychiatrist who didn’t think those criteria were too restrictive," she said. Under the current law, Boulanger explained, interventions often require waiting until harm has already occurred. "You almost have to wait until the person actually does something dangerous to keep them in hospital," she added.
Boulanger recounted common scenarios in emergency rooms where patients exhibiting clear signs of impending danger are released because they haven't yet met the legal threshold. "So often in the emergency room, we have to let people go even though they seem dangerous to us because they don’t meet the criteria, they’re not yet ‘dangerous.’ But we know that, given the course of their illness, they likely will be soon, either to themselves or to others, and there’s nothing we can do," she said. This, she noted, explains why violent incidents frequently make headlines: individuals seen in ERs shortly before an event are discharged due to legal limitations.
She highlighted the experiences of patients with conditions like schizophrenia, who suffer recurring psychotic episodes. Psychiatrists, according to Boulanger, aim to act at the onset of symptoms to prevent escalation. "When patients are ill, they don’t want to be kept … otherwise, there wouldn’t be a problem. We wouldn’t need a law. But when they get better, they often ask us: ‘Why didn’t you keep me when I was in hospital?’" she said. Many such patients, she added, are brought in multiple times by police or family but released, allowing their conditions to worsen—leading to reckless behavior, financial ruin, or greater danger by the time involuntary measures can be applied.
However, patient advocates and legal experts express deep reservations, warning that the reforms could erode civil liberties without tackling root causes like resource shortages. Patrick Martin-Ménard, a health law lawyer who represents patients in involuntary confinement proceedings, contended that coercion is already applied broadly under the existing framework. "Coercion is already widely used in the current system, and it primarily affects the most vulnerable: People experiencing homelessness, people with intellectual disabilities, people who are generally not in a position to defend themselves," he said.
Martin-Ménard argued that tragedies like the killings of Breau and Kim stem from systemic underfunding rather than overly lenient laws. Regarding Brouillard Lessard, he noted the coroner's findings of inadequate follow-up and supervision. "If the system is well funded and functioning properly, then the professionals within it can use the tools that already exist to prevent these situations," he said Thursday. He cautioned that easing criteria without bolstering resources would perpetuate a cycle of failures. "You can make the criteria as strict or as coercive as you want, but if the underlying system doesn’t have the resources to provide the care these individuals need, and the follow-up required, tragedies … will continue to happen."
The shift to administrative tribunals for hospitalization decisions particularly alarms critics, as it removes judicial safeguards. Martin-Ménard described courts as the primary procedural protection for patients. Additionally, he pointed to the potential for trauma from forced interventions, which could deter future help-seeking. "When they actually need help, they no longer turn to it. They become more marginalized, and at that point are at greater risk of deterioration. It becomes a vicious cycle," he said.
François Winter, spokesperson for the Association des groupes d’intervention en défense des droits en santé mentale du Québec (AGIDD-SMQ), echoed these concerns, emphasizing the gravity of liberty deprivation without criminal charges. "For many, being locked somewhere you can’t leave is traumatic. This isn’t an escape room. This is serious. It’s a loss of liberty without having been accused of a crime. That’s extremely serious in a society governed by the rule of law," Winter said. He noted that excessive coercion fosters resentment toward the mental health system, exacerbating isolation.
Winter also criticized the bill for diverging from recommendations in a recent consultation by the Institut québécois de réforme du droit et de la justice (IQRDJ). "The IQRDJ didn’t propose changing the hierarchy of the courts in the process, and it didn’t propose redefining the concept of dangerousness. This bill does both," he said. Reports from AGIDD-SMQ members indicate rising anxiety among clients. "This bill is creating anxiety and even panic," Winter added.
Bélanger's office has not directly addressed these criticisms, but Boulanger acknowledged the vital role of advocates in preventing abuse. "They want involuntary hospitalization to remain a measure of last resort and to prevent abuse, because being hospitalized against your will is extremely traumatic. We don’t do it lightly. It’s only when it’s necessary," she said. She noted broad support among psychiatrists, police, and families for revising the criteria, while stressing that interventions are never taken lightly.
The debate underscores broader challenges in Quebec's mental health landscape, including chronic underfunding and access barriers. Both Martin-Ménard and Winter called for increased investment in services as the true path to prevention. "In the end, we’re still facing a situation where we’re in a social crisis, a public services crisis," Winter said. "There’s a wall in front of us, and instead of turning and going in another direction, we’re pressing the gas pedal and turning up the radio so we don’t hear anything."
As Bill 23 advances through the National Assembly, its passage could reshape how Quebec balances public safety with individual rights. Lawmakers will weigh the endorsements from medical professionals against warnings from rights groups, with the outcomes of past inquests like Brouillard Lessard's serving as stark reminders of the stakes. For now, the reform promises earlier interventions but leaves open questions about implementation amid resource constraints.