A/HRC/41/34/Add.2 provinces and territories has been implemented in various degrees and with different timings and rates of bed closures, investment in community-based services and decreased days in psychiatric institutions. Regrettably, Alberta, British Columbia, Manitoba, Nova Scotia, Prince Edward Island, Quebec23 and the territories continue to place persons with disabilities in institutions. Moreover, while some provinces have made good progress in terms of law and policies, mental health care seems to be still dominated by a biomedical model, the overuse of psychotropic medications and an overall conception that mental health conditions result from chemical brain imbalances or other neurobiological and genetically determined mechanisms. 51. On the other hand, investments to include persons with psychosocial, intellectual and cognitive disabilities into the community have been insufficient; many still lack access to employment, education, housing and adequate health care. Persons with autism in particular continue to be excluded from the design of services aimed at supporting them. Their health care is still based on attempts to “fix” behaviours rather than understanding them; this approach filters into society and translates into abuses and exclusion. Local mental health and “problematic substance use” services B. 52. There is a wide variety of mental health and “problematic substance use” services across provinces and territories that are not necessarily covered by public insurance and are often delivered in partnership with different stakeholders. The Special Rapporteur observed some of them in British Columbia, Manitoba and Quebec. 53. He learned first-hand about the least-restraint policy at Actionmarguerite, a care facility in Winnipeg that offers palliative services under Manitoba’s 2000 Protection for Persons in Care Act and Winnipeg’s regional policy on restraints in personal care homes. There, the use of restraints, both physical and chemical (medication), is restricted to the bare minimum through interdisciplinary assessments, consent and the understanding that any restraint may affect the person’s physical safety and psychological well-being. While that practice is in line with the Special Rapporteur’s recommendation24 to radically reduce medical coercion, he hopes that the policy and practice will advance to a point where they will also be in line with his recommendation to eventually eliminate all medical coercion in mental health settings. In addition, he recommends that the regional policy be re-examined to shift provisions on substitute decision makers to a paradigm of supported decisionmaking.25 54. The Special Rapporteur visited the Douglas Mental Health University Institute in Montreal and was particularly encouraged by the collaborative approach based on persuasion and support used by its eating disorders programme. The programme applies a non-coercion approach in treatment delivery under any circumstance, including when dealing with the most severe cases. The Special Rapporteur also learned about assertive community treatment in British Columbia, a recovery-oriented service for persons with mental health and “problematic substance use” issues delivered through a psychosocial rehabilitation perspective by multidisciplinary teams. He welcomes the focus of the government of British Columbia on integrating housing into mental health and “problematic substance use” services in partnership with various stakeholders. 55. The Special Rapporteur was briefed about cases of isolation and seclusion of autistic children in special education classrooms in Ontario, Saskatchewan and Alberta and about restraint through sedatives by Ontario school workers. Residential homes for autistic persons in Toronto continued to use physical restraints and expose vulnerable young persons to sexual and other physical and psychological abuse by staff. The government of 23 24 25 In Québec, individuals are held in custody in institutions in accordance with the legal provisions of the Province. See the report of the Special Rapporteur contained in document A/HRC/35/21. See Committee on the Rights of Persons with Disabilities general comment No. 1 (2014) on equal recognition before the law and the report of the Special Rapporteur on the rights of persons with disabilities contained in document A/HRC/37/56. 11