British Columbia’s ombudsperson has found the legal rights of mentally ill patients involuntarily admitted to psychiatric facilities across the province are being denied.
Jay Chalke released the report, Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, which puts forward 20 findings highlighting the lack of compliance with the legal documentation required on involuntary admission to designated psychiatric facilities in the province.
“Involuntary detention and treatment is the most intrusive form of mental health care available,” Chalke said.
“This is a failure to comply with the Mental Health Act, the law that allows people who are gravely ill — our friends, daughters, sons, parents and grandparents – to receive timely treatment while protecting their legal rights.”
Chalke acknowledges that involuntary admissions are often a necessary last resort for mentally ill people who are at risk of harming themselves or others. The report finds legally required admission documents were missing, late or improperly completed. The ombudsperson found in some cases facilities used standard rubber stamps to generally authorize treatment for individual patients instead of describing the specific treatment proposed for that patient.
“The state, when it uses such an extraordinary power, has a critically important duty to follow the law. This includes properly completing documentation of what is happening to an individual and why,” Chalke said.
“To not do so is not only unacceptable, it is contrary to law.”
Minister of Mental Health and Addictions Judy Darcy says the findings in this report “align” with the province’s goals for mental-health care. The province is committing to strengthening the monitoring and evaluation of the Mental Health Act.
“Nothing is more important to me than keeping people safe. This is balanced with the need to ensure dignity and fairness when someone is vulnerable and receiving mental-health care,” Darcy said.
“This is critically important as we work to improve the systems of health and mental health. Our government takes the safe practice of involuntary admissions under the B.C. Mental Health Act very seriously.”
The province was given an interim report and has already launched a review of existing Mental Health Act forms and tracking tools, with the goal to develop standardized provincial tools. On top of that the province has initiated regional working groups in Fraser Health, Island Health, Northern Health and Vancouver Coastal Health, to address the recommendations in the report.
To improve the public’s knowledge of the issue, a video is in development to inform patients and families of involuntary admissions under the Mental Health Act and of their rights.
“Government accepts the intent of all of the recommendations in the report and the ministries of Mental Health and Addictions, Health and Attorney General, as well as the health authorities, are working together to address them,” Darcy said.
“People who access mental-health care in B.C. deserve to be treated with dignity and respect. Anything less is unacceptable. Our priority is to build a system of mental-health and addictions care that works for everyone, and that is what we are working toward.”
The report’s findings were based on an investigation that reviewed admission records of every involuntary admission in the province that took place in June 2017. A detailed analysis of mandatory admission forms across the province found that all of the forms were properly filled out in 28 per cent of the cases.
Vancouver Coastal Health, Northern Health and the Provincial Health Services Authority had the lowest overall compliance rates.
“There was no consent for treatment form in 24 per cent of patient admissions across all health authorities,” reads the report.
“There was a wide variation among hospitals in the issuance of the consent to treatment form with a low of nine per cent compliance at the University Hospital of Northern British Columbia.”
The report makes 24 recommendations, all of which have been accepted in principle by government and health authorities. They broadly include increasing oversight and accountability by conducting regular compliance audits, training staff and physicians regarding the necessity of form completion and the codification of standards for compliance with the Mental Health Act and the Ministry of Attorney General has committed in principle to develop an independent rights adviser service that would work in designated facilities in the province and provide advice to patients about the circumstances of their detention.
“Implementing these recommendations will make a significant impact by ensuring that someone who is involuntarily detained receives the best mental health treatment in a manner that is respectful of their human rights,” Chalke said.
“While the findings in this report are troubling, the commitment by government and the health authorities to the recommendations made is cause for optimism.”