Dr. Jacqueline Montwill:

I will answer that question. We are in a quandary here because some of our colleagues are describing that this law will be used for people with no mental illness. If anyone comes to my clinic or our emergency department where our junior psychiatric doctors are, and they are distressed for any reason, we will admit them. If they are suicidal and pose a risk to themselves, or if they are so distressed that we are very concerned about them, we will do a proper assessment. That sometimes takes two or three weeks and at the end of that assessment we will be able to formulate a proper diagnosis and a treatment plan. I do not know when a woman in a crisis pregnancy is going to go from having the acute adjustment reaction where she is saying, "This is the worst thing in my world; I want to kill myself; I cannot deal with this," to having no mental illness. I would follow that woman all the way through anyway if she ever had a situation where she was thinking of suicide.

However, we have to make a distinction in that, with this law, there will be women who will present with a firm belief that they are entitled to an abortion and who we can say, hand on heart, have no mental illness and will threaten suicidality. That is the issue. What do we do for those patients? I would say to them that they should not be threatening suicide, that suicidal ideation is not a good mindset to be in, and therefore let us do our assessment. However, if the woman is saying she does not want any of that, and when we have no concerns that they have a mental illness, we are in a quandary.

I will outline what we would say in our practice. In the case of a woman who came in and about whom we were absolutely sure, after a two-week assessment, that she had no mental illness, we would be able to say to her that we were terribly sorry, that we could not stop what had happened to her and that she had a crisis pregnancy. We would be able to say to her that while she was saying she was suicidal and that was not a good place in which to be, there were all these supports to which we could link her, including all the supports in the community, as well as being able to monitor her and make sure she was okay. However, after our assessment, we could tell her that she did not have a mental illness but had a crisis reaction.

The problem is it is very difficult to say, if a woman does not have mental illness and presents, in this law, that we will not be able to offer a treatment if she does not want one. This is what the people who are advocating the law are saying and we must address that issue about saying what we would do. We have situations in our practice in which people threaten suicide and do not have a mental illness. They come in and ask for different things to happen in their lives, but after our assessment, we know they do not have a mental illness. We say to such people that they do not have mental illness that would respond to treatment but they have a huge problem with their mortgages or with their partners who are being completely unreasonable or with other stresses such as bullying, etc. and we will divert them to the proper treatments and supports for those problems.

It is confusing and, to be honest, I am half-confused myself because I will treat any patient who comes to me when he or she is distressed, and while we will not send anyone home, the people who advocate this law want to get out of the way of saying the patient has a mental illness because they know abortion is not a treatment for mental illness. Consequently, they now are saying that in the case of a patient who does not have a mental illness but who is saying she intends to kill herself, surely she should be able to have an abortion for that reason. All I can say about that is we do not have a test to be able to say who can commit suicide. Consequently, the problem is we have no criteria of which we know and if the Government insists on this, there is no way any psychiatrist can state that a woman will not commit suicide. That is all we can say. I do not know if that answers the question.