Understand your rights under BC's Mental Health Act
This blog is an informal place to talk about patients’ Mental Health Act rights. Posts take a closer look at an issue related mental health rights, especially in BC, and are written by patients and people with lived experience, care partners, clinicians, legal experts, and researchers.
This content has not been reviewed for legal accuracy and should not be considered legal advice.
The information in the rights materials available on this site will soon be out of date because of the following changes:
Before this change, only a physician could authorize involuntary hospitalization. If the physician believed that the person they examined met the criteria for involuntary hospitalization, the physician would complete the Form 4 medical certificate, which would allow a designated facility to keep the person in the facility for up to 48 hours. If a second physician examined the person and believed that they met the criteria for involuntary hospitalization, this physician could complete a second Form 4 medical certificate, which would allow a designated facility to hold the person for up to 1 month.
Now, nurse practitioners as well as physicians can perform the first examination and authorize involuntary hospitalization for up to 48 hours using the new Form 4.1 first medical certificate.
Only a physician can perform a second examination and authorize involuntary hospitalization for up to 1 month, and they would do so using the new Form 4.2 second medical certificate.
The existing Form 4 is still valid until January 31, 2024, and some health authorities are continuing to use it.
Nurse practitioners and physicians are required to write down an explanation of how an involuntary patient meets the four criteria for involuntary hospitalization on these forms. If you’re an involuntary patient and want to understand why you are being held under the Mental Health Act, you can ask your care team to see your Form 4 medical certificates. They might show you Forms 4.1 and 4.2 if they have started using the new system.
Involuntary patients or their family members can call Access Pro Bono to make an appointment for 30 minutes of free legal advice over the phone about the Mental Health Act from a lawyer. Access Pro Bono used to offer this service through a dedicated phone number for their Mental Health Program Telephone Clinic, but now they have merged it with their Summary Advice Program.
Currently, if you dial the old number for the Mental Health Program Telephone Clinic, the recorded message will give you the new phone number to call for an appointment for summary advice. It’s unclear how long they will keep this recorded message and discontinue the old number completely.
The Ministry of the Attorney General is establishing a new independent rights advice service, which will be run by the Canadian Mental Health Association, BC Division (CMHA BC), in partnership with Health Justice, the Community Legal Assistance Society and Métis Nation BC.
When this service launches in fall 2023, involuntary patients will have the right to ask to speak to a rights advisor. The rights advisor will meet with patients to give them information about their rights, answer their rights questions, discuss their options, and help them access their rights, like applying for a review panel hearing or applying for a second medical opinion.
The rights materials on this site:
Until the independent rights advice service launches, the information in the materials on this site is still valid, although people will be redirected to the new Access Pro Bono if they call the old number. This site remains the only place we’re aware of that offers reliable access to BC Mental Health Act rights information in languages other than English.
We currently have no plans to update the materials, for a few reasons.
Vancouver Coastal Health providers can try asking the Patient Health Education Materials office to update the materials. They have access to the original design files and should be able to make changes to the print resources.
Island Health providers can try contacting Mental Health & Substance Use Services leadership to have the materials updated on the health authority’s intranet.
After January 31, 2024, if there is demand from the community for us to update our rights materials and make them available on this site, we might be able to offer new print materials. We will not have the capacity to update our video.
We’re grateful to have been part of the effort to make Mental Health Act rights more accessible to more people, and we’re happy to see that the issue is being taken seriously by decision makers in the mental health system.
The Child, Youth, and Reproductive Mental Health programs at BC Children’s Hospital have launched a new education module about the Mental Health Act with a pediatric focus.
A CME-accredited version of the module for health care providers is available on the Learning Hub.
A new Mental Health Act Toolkit is available to the wider public at healthymindslearning.ca.
“Through collaboration with experts in mental health at BC Children’s Hospital and with input from patients and families with lived experience, this resource was developed primarily for health care providers admitting children and youth under the Mental Health Act,” says Angela Olsen, project manager at BC Children’s Hospital and Child Health BC. The team also created tools to support children, youth, and their families as they navigate the admissions process.
Olsen encourages people to share these tools widely among professionals who work with children and youth who are admitted under the Mental Health Act. If you have questions or feedback about these resources, contact her or Brittin Oakman.
The Mental Health Review Board schedules and conducts review panel hearings for involuntary patients who want to challenge their certification. (If you want to learn more about what review panels do and how to apply for one, our rights materials may help.) Last year was the first time the board published an annual report, which I summarized in a blog post.
The board has seen tremendous shifts over the past couple of years, with a new chair implementing a restructuring plan, a move from the Ministry of Health to the Ministry of the Attorney General, and a corresponding physical move to a new office.
This year’s annual report offers a glimpse of the progress and effects of this restructuring. Here are a few highlights, along with some of my reactions.
Continue reading “Highlights from the Mental Health Review Board’s 2018–2019 annual report”
BC’s Mental Health Act has been in the news a few times over the past several weeks. Here are some rights-related highlights:
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. Continue reading “Mental Health Act news roundup”
BC Children’s Hospital has launched an interactive video to help youth and their families better understand what it means to be certified under the Mental Health Act. The video explains:
Continue reading “New Mental Health Act video for youth in BC”
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):
The BC Office of the Ombudsperson found:
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?”
In a series of focus groups, members of our research team asked clinicians about the barriers they face when giving involuntary patients rights information. One barrier participants mentioned over and over was that many of their patients didn’t understand English.
Form 13, the document clinicians use to to tell patients about their rights, seems to be available only in English.
To help fill the gap in availability of Mental Health Act rights information in other languages, we’ve translated:
into eight of BC’s most commonly spoken languages other than English:
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“
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.
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”