Will forcing health authorities to complete all Mental Health Act forms help patients better understand their rights?

Poor form completion rates

In the recently released report, Committed to Change, the BC Office of the Ombudsperson detailed disturbing findings that involuntary patients aren’t consistently told about their rights under the Mental Health Act. Further, family care partners aren’t always told that their loved ones have been detained. These stories are appalling, but will enforcing better record keeping prevent these scenarios from happening?

According to the Mental Health Act, when a person is admitted as an involuntary patient under a medical certificate (Form 4):

  • They’re supposed to learn their rights by being read and given Form 13.
  • They’re supposed to nominate a near relative to notify about their hospitalization, using Form 15.
  • Their care team is supposed to send Form 16 to that near relative. Form 16 tells the near relative that the person (a) has been detained and (b) has rights under the Mental Health Act. This form is supposed to be sent or given to the near relative immediately after the person has been admitted.

The BC Office of the Ombudsperson found:

  • Form 13 in only 49% of patient files,
  • Form 15 in only 43% of patient files, and
  • Form 16 in only 32% of patient files.

In response to these poor compliance rates, the Office of the Ombudsperson issued this recommendation:

Recommendation 9: By June 30, 2019, the Ministry of Health and the Ministry of Mental Health and Addictions work together with the health authorities to establish clear and consistent provincial standards aimed at achieving 100 percent compliance with the involuntary admissions procedures under the Mental Health Act through the timely and appropriate completion of all required forms.

In other words, these three forms should appear in 100% of patient files. But will mandating 100% compliance solve the problem of patients and family care partners not knowing patients’ rights?

I don’t believe they will. Continue reading “Will forcing health authorities to complete all Mental Health Act forms help patients better understand their rights?”

A chance to make a better Guide to the Mental Health Act

Cover of the 2005 edition of the Guide to the Mental Health Act

In Committed to Change, a report detailing the failure of the mental health system to uphold the rights of involuntary patients hospitalized under the Mental Health Act, the BC Ombudsperson issued 24 recommendations “to ensure the rights of people with serious mental illness are respected and public confidence in our mental health system is enhanced.” (BC Ombudsperson 2019, p. 3)

One of the recommendations is that, “By March 31, 2020, the Ministry of Health update and reissue the Guide to the Mental Health Act to incorporate the changes made arising from this report and other changes.” (BC Ombudsperson 2019, p. 98)

Continue reading “A chance to make a better Guide to the Mental Health Act

Committed to Change—the Ombudsperson’s critical new report about involuntary patients’ rights

Over 2017 and 2018, the BC Ombudsperson’s Office investigated whether hospitals in the province were meeting their Mental Health Act obligations to safeguard involuntary patients’ rights by filling out the required forms at admission. On March 7, 2019, the report of this investigation, Committed to Change, was made public.

Cover of the Ombudsperson's report "Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act" showing the title superimposed on a photo of a long hospital corridor.

Continue readingCommitted to Change—the Ombudsperson’s critical new report about involuntary patients’ rights”

The Mental Health Review Board’s website

Screen shot from the BC Mental Health Review Board website, taken January 9, 2019.

When I interviewed people who experienced involuntary hospitalization (certification) about their information needs, some of them told me that, when they choose to exercise their rights, they’d like more information about what comes next.

What happens after you hand in Form 7 to ask for a review panel hearing? Or what happens after you hand in Form 11 to ask for a second medical opinion?

Continue reading “The Mental Health Review Board’s website”

Second medical opinions under BC’s Mental Health Act

Involuntary patients over the age of 16 have the right to ask for a second medical opinion from a doctor who’s not on their treatment team. My interviews with former involuntary patients and with clinicians seem to show that both groups are confused about how this right works, so this post aims to answer some of the most common questions about it.

A cartoon showing a doctor examining a patient on a bed.
Continue reading “Second medical opinions under BC’s Mental Health Act

The Mental Health Review Board’s new Rules of Practice and Procedure

In its 2017–2018 annual report, the Mental Health Review Board announced plans to modernize its Rules of Practice and Procedure. On August 28, 2018, the review board released the new Rules, and all review panels are expected to follow them by October 15, 2018.

The board also released a document outlining the key changes to the Rules and issued five Practice Directions documents:

The review board intends for these documents to “ensure that a patient is given a procedurally fair hearing that also proceeds expeditiously.” Many of the polices are meant to streamline the review panel hearings: they encourage both case presenter and patient (or patient representative) to come to the hearings prepared to give the review panel the evidence they need to make their decision. But several of the new rules also support patients’ rights, and this post will highlight some of those points.

A cartoon depicting a mental health review board hearing. The three-member panel sits along one edge of a large table. The patient sits with his representative on one side of the panel and the case presenter, in this case the doctor, sits on the other side.
A review panel hearing. Illustration by Jonathon Dalton.

Continue reading “The Mental Health Review Board’s new Rules of Practice and Procedure

A revised Form 7—better for patient rights?

Involuntary patients have the right to ask for a hearing with a review panel if they want to challenge their certification. To do so, they (or someone on their behalf) must fill out Form 7.

Earlier this year, the Ministry of the Attorney General, together with the Ministry of Health and the Mental Health Review Board, revised Form 7, partly in response to the Community Legal Assistance Society’s report Operating in Darkness, which was critical of many aspects of the Mental Health Act and how it was implemented in practice. In May, the Mental Health Review Board announced “that after several months of consultations, our new Form 7 ‘Application for Review Panel Hearing’ has received Cabinet approval by way of an Order in Council approved on May 15, 2018.” Continue reading “A revised Form 7—better for patient rights?”

What’s a near relative?

One of the questions we get most often is “How can family and friends help involuntary patients exercise their rights?” We’ll cover that topic in more depth in a future blog post, but before we can get there, we have to lay the groundwork by clarifying what a near relative is.

The rest of this blog post speaks to patients.

Cartoon showing two people holding hands outside of the hospital doors.
Illustration by Jonathon Dalton

Choosing a near relative

If you’re admitted as an involuntary patient (certified), a member of the staff, usually a nurse, will ask you to choose someone to be your near relative. This near relative will be informed: Continue reading “What’s a near relative?”

Highlights from the Mental Health Review Board’s 2017–2018 annual report

The Mental Health Review Board conducts review panel hearings that decide if someone who is an involuntary patient should continue to be certified. (Our rights materials have some information about how involuntary patients can apply for a review panel hearing and what a hearing may involve.)

This past year, the Mental Health Review Board moved from the Ministry of Health to the Ministry of the Attorney General. Under the Ministry of Health, the board hadn’t been regularly reporting on its activities (See Operating in Darkness, p. 18). Now, under the Ministry of the Attorney General, the Mental Health Review Board is subject to the Administrative Tribunals Act, which requires that the board publish an annual report. In June, the Mental Health Review Board issued its 2017–2018 report, giving the public a glimpse into its operations for the first time in years.

Cover of the Mental Health Review Board Annual Report from 2017 to 2018

The report is only 19 pages long, so it’s not too onerous to read, but here are a few highlights: Continue reading “Highlights from the Mental Health Review Board’s 2017–2018 annual report”