Mental Health Act news roundup

BC’s Mental Health Act has been in the news a few times over the past several weeks. Here are some rights-related highlights:

Should the Mental Health Act be used to detain youth with substance use disorder?

At a BC coroner’s inquest into the overdose death of 16-year-old Elliot Eurchuk, pediatrician Dr. Tom Warshawski testified that he supports using the Mental Health Act to treat young people for substance use disorder against their will. Dr. Perry Kendall, B.C.’s former provincial health officer, told the inquest that there’s not enough evidence that involuntary treatment would prevent deaths and improve health outcomes.

In fact, critics of involuntary treatment for substance use issues, especially treatment programs that rely on detox and impose abstinence, say that such hospitalizations can increase overdose risk at discharge, because people emerge with lower tolerances to opioids.

Eurchuk died two months after being hospitalized under the Mental Health Act for his substance use. His case shows that some clinicians are willing to use the legislation for that purpose, but it’s worth asking if this application of the law is appropriate. Psychosis that results from substance use might require involuntary treatment to keep the person safe, but does substance use alone, without psychosis, meet the Mental Health Act’s criteria for involuntary hospitalization? (See our rights materials for more information about the criteria for involuntary hospitalization.) And does applying the law to substance use risk broadening its scope so much that any young person with a substance use disorder is now at risk of being detained?

Eurchuk’s parents, Rachel Staples and Brock Eurchuk, expressed the same frustration that family members of people with severe mental illness and substance use disorder often face: the inability to get pertinent medical information about their loved one from clinicians, who are bound by privacy and confidentiality laws.  The Canadian Mental Health Association, BC division, has produced guides (2016) to help families navigate information sharing: one guide is for families of youth, and one is for families of adults with mental health and substance use issues.

Ultimately, the inquest’s jurors recommended that the government fund more long-term treatment facilities for substance use disorder to reduce waiting lists and close the gaps in care that leave families desperate. They did not recommend widespread use of the Mental Health Act to force youth with substance use disorder into treatment.

Community groups issue open letter to provincial government urging a review of the Mental Health Act

The Community Legal Assistance Society, Pivot Legal Society, West Coast LEAF (Women’s Legal Education and Action Fund), British Columbia Civil Liberties Association, and Together Against Poverty Society wrote an open letter to the government in response to its launch of A Pathway to Hope: A Roadmap for Making Mental Health and Addictions Care Better for People in British Columbia. The groups commended the government’s plan to invest in more community-based and voluntary mental health and addiction services but expressed disappointment that the plan didn’t include a review of the Mental Health Act.

In an interview with Stephen Quinn on The Early Edition, Laura Johnston, lawyer with the Community Legal Assistance Society, said that the decades-old Mental Health Act “takes a really outdated approach. It focuses on things like detention, coercion, even disciplining people with mental illness in involuntary settings, and so essentially what the community groups are saying is that we won’t see system change until we see this law change.”

Johnston said:

There’s this old-fashioned idea that if you respect individual rights, that person might not be getting access to mental health and addictions treatment, and of course that’s just not true. In fact, these two things go hand in hand, and I was disappointed to see our government using language that sort of pitted these two things against each other. What we know is that if you give someone dignified and fair treatments and a right to be heard in a very intrusive setting—mental health detention—then you’re more likely to have therapeutic outcomes. In fact, you cannot give effective mental health and addictions treatment without also upholding individual rights.

This suggestion, that giving involuntary patients a sense of procedural justice—by offering them a voice and treating them with respect—is therapeutic aligns with our team’s research findings. A culture of respect and transparency and can mitigate the trauma that involuntary patients experience and can encourage patients to stay engaged with the mental health system and take an active role in their treatment and recovery.

Johnston emphasized in the interview that reforming the Mental Health Act isn’t about abolishing involuntary care:

Involuntary care is always going to be an important part of our mental health system. It exists for a reason. No one’s suggesting that we do away with it. What the community groups are trying to focus on is that when you are in involuntary care, you’re treated in a dignified and humane way. Our Mental Health Act simply does not do that. It currently authorizes discipline of people with very severe mental health and addictions problems. It has no limits on things like seclusion or mechanical restraints that tie you to your bed. The problem with treating people in involuntary care in a very coercive way is that that care itself creates harm. It can create trauma, and then when people get out, they avoid contact with mental health and addictions services, because they’ve been frightened and traumatized by their experiences and they don’t want to repeat them. So in fact really intensive involuntary care can have an alienating effect where the people who really need this care avoid contact with services they need.

The government’s plan, A Pathway to Hope, does address some of the findings of the BC Office of the Ombudsperson’s report, Committed to Change, which investigated how well health authorities met their obligations under the Mental Health Act to safeguard patients’ rights and found poor compliance with the law. The Ministry of Health, Ministry of Mental Health and Addictions, and health authorities are developing a set of standards with the goal of achieving 100% compliance with the Mental Health Act’s rights obligations. (Read our post on why 100% compliance may not be enough to ensure that patients understand their rights.)