By Moira Wyton, Local Journalism Initiative Reporter
Enshrining human rights in British Columbia’s Mental Health Act should be a priority to improve outcomes for the rising number of people treated involuntarily for mental health and substance use, says an advocacy group.
The act, which grants uniquely broad powers to B.C.’s health-care system to admit and treat people in crisis without their consent, is currently under review by the Ministry of Justice, The Tyee reported earlier this year.
The legislation as it stands lacks a clear purpose and appropriate safeguards for people at their most vulnerable, according to a report issued last week by Health Justice, a non-profit whose website says it aims to “improve the laws and policies that govern coercive health care in B.C.”
“We need clarity with what we’re trying to achieve and what values we as a province hold,” said executive director Kendra Milne in an interview as the report was released. “B.C. really is an outlier even in Canada, because most other jurisdictions have a purpose and objective included in their laws.”
After two years of consultations with people who have experienced involuntary detention, families, health-care workers and community leaders, Health Justice is proposing eight guiding principles for B.C.’s act.
They include recognition of human rights and holistic approaches to mental wellness, compliance with the UN Declaration on the Rights of Indigenous Peoples, promoting self-determination and equitable treatment, as well as improving care oversight and access, and ensuring the participation of those who experience mental illness in decision-making.
The Union of British Columbia Indian Chiefs, BC Civil Liberties Association and 18 other organizations signed the report in support or recognition of the need for the recommendations.
Not all mental health advocacy organizations agree the act needs to change. The BC Schizophrenia Society, which serves more than 5,000 British Columbians living with schizophrenia and psychosis, says improving service delivery and access is more important than changing the act.
Many families also fear changing the act could deprive their loved ones of care if they are unable to recognize their own illness, as many people with schizophrenia and other serious mental illnesses can be at certain times.
“The purpose of the B.C. Mental Health Act is to help people who are seriously ill receive the medical treatment and care they need and deserve so that they can regain their health,” reads the organization’s position on the act.
“Early treatment and stabilization on medication greatly improves the prognosis for people with chronic and severe brain diseases.”
Milne said there is fundamental agreement across organizations that people with mental illness deserve dignified and quality care, and that reviewing the act should be seen as an opportunity to improve how the health system does that.
“It’s important to put the principles our leaders say they value in the law to create a framework to evaluate how well it is working,” said Milne.
“Then it becomes less negotiable and about measuring the effects rather than the intentions.”
It’s an endeavour jurisdictions including Victoria, Australia and Ireland have used recently to acknowledge and address the failures of their own mental health legislation.
The Ministry of Justice and the Ministry of Mental Health and Addictions are currently reviewing the act, which has come under renewed attention as Premier David Eby suggested he would expand mandatory mental health and substance use treatment for people who experience multiple drug poisonings in a day.
Eby said the review of the act was also triggered by legal cases, including a charter challenge to the clause that deems involuntary patients have consented to any and all recommended treatments when admitted. The province has fought the case, brought by the Council of Canadians with Disabilities, for more than six years but it was greenlit by the Supreme Court of Canada in June 2022.
His proposal to expand treatment, supported by RCMP in Kelowna and the mayors of Kelowna and Victoria, received swift pushback from several legal experts and groups advocating for the rights of people who use drugs, as did the NDP’s withdrawn July 2020 attempt to expand involuntary treatment for children who experience drug poisonings.
But Eby’s mandate letter to new Minister of Mental Health and Addictions Jennifer Whiteside asks her to prioritize expanded mental health and substance use support for people “causing detrimental harm to themselves” while “upholding the rights of all British Columbians.”
The number of people admitted involuntarily under the act each year has doubled to more than 28,000 since 2013. The province’s population grew by just 20 per cent in the same time frame.
Health Justice says this rise indicates an over-reliance on coercive care to deal with people experiencing mental health crises, rising drug poisonings and homelessness in the absence of accessible and preventative community-based supports.
For the BC Schizophrenia Society, that rise shows more people are getting needed treatment and underscores the need to ensure existing safeguards are applied evenly. “Our mental health system does not want to detain people indefinitely,” BCSS CEO Faydra Aldridge told The Tyee in a previous interview. “It’s there to protect people for the time they need protection.”
Reports from the ombudsperson and legal non-profit Community Legal Assistance Society have found poor human rights compliance and administrative oversight for people admitted involuntarily.
As attorney general in April, Eby introduced amendments to the act to establish an independent rights information service for people admitted involuntarily, which is set to begin operations in February 2023.
At the time, Eby acknowledged the act is “very dated” and many major parts have not been changed since the 1960s.
Milne says any changes to the act need to include a robust consultation with the people who have experienced involuntary treatment and defined principles to guide the work.
Enshrining clear objectives for the legislation would lay the foundation for improving care and ensuring accountability and proper oversight.
“The goal of Health Justice is really to support conversations about this change across groups to create a community consensus,” Milne said. “It’s a very complex subject and it’s not served well when we don’t hash out that complexity.”