Psychiatric detention

Making A Difference: Norway’s NPM

Have you ever wondered if NPMs are making a difference in practice? For many of us interested or otherwise engaged in torture prevention the above conundrum is a recurrent question. After all, if the sum total of any preventive work is at best negligible, or even worse, why waste the time and effort?

In its newly published 2018 Annual Report the Norwegian NPM takes a fresh look at this fundamentally important question, devoting a full chapter to gauging impact. Most positively, in four of its past five Annual Reports the NPM has retrospectively cast its eye over the year of activities to document effected change.

Even though Canada and Norway are quite different national contexts, not least in terms of size of geography and population, Norway’s industrious NPM has nonetheless advanced some illuminating insights into how one NPM is making a difference on the ground through its preventive work.

making a difference

As noted in these pages just a few months ago, Norway ratified the OPCAT in 2013 and designated the Parliamentary Ombudsman as the NPM. The NPM has been operating since 2014 and consists of an independent department within the Parliamentary Ombudsman, comprising a team of multi-disciplinary staff. Detailed information about the structure and operation of Norway’s NPM can be found in the 2018 Annual Report.

The Norwegian NPM has described in detail how it is making a difference in practice in chapter 5 of the 2018 report. In these pages it has sketched out the all-important process of follow-up to monitoring visits, as follows:

“After each visit, the NPM publishes a report describing its findings and making recommendations for preventing torture, inhuman and degrading treatment. Much of the preventive work begins after the reports have been published.

We ask all places we visit to provide written feedback on how the recommendations have been followed up within three months of the visit report being available.

The feedback we received throughout the year indicates that the institutions generally followed up the recommendations in a thorough manner. The majority of places have implemented numerous measures that play an important role in reducing the risk of inhuman and degrading treatment …

Certain recommendations require limited effort to follow up, while others are more challenging. This means that the NPM’s follow-up can sometimes continue over a long period, and at other times be concluded relatively quickly.” (49)

The report highlights the measured impact of the Norwegian NPM’s activities vis-a-vis specific thematic areas. These include the following:

  • Documenting the use of force in detention;
  • Preventing the use of coercive measures;
  • Ensuring the right to information can be exercised in practice;
  • Facilitating the participation of detainees in decisions which impact on them;
  • Improving the material conditions of detention;
  • Enhancing injury reporting procedures;
  • And minimizing resort to solitary confinement, isolation and segregation.

It bears noting that in 2018 a sizeable number of these gains were made in child welfare, health care and immigration detention settings. In one instance a child welfare facility was even temporarily closed due to allegations of abusive use of force.

Making a difference

As in Canada, resort to solitary confinement, isolation and segregation by different detaining authorities, including in prisons and health care settings, has been a significant cause for concern for the Norwegian NPM. In late 2018 the NPM also published a separate thematic report on the use of segregation in mental health care institutions, a summary of which is available in English.

In conclusion, the 2018 Annual Report of the Norwegian Parliamentary Ombudsman offers Canadian (and other) readers a very welcome insight into how decisive change can be effected in a range of detention settings and, it should be stressed, over a relatively short period of time. For those persons on the receiving end of such change, the positive impact ought not to be underestimated.


Visit the English version of the Norwegian NPM’s website.

Listen to an interview with the Norwegian NPM Director, Helga Fastrup Ervik, and learn more about the activities of her institution.

Read the current and past Annual Reports of the Norwegian NPM.

Read the summary of the December 2018 report, Segregation in mental health care institutions – risk of inhuman treatment.

Posted by mp in Health care, Norway, NPMs, Places of detention, Prisons, Psychiatric detention, Solitary confinement

Top UN Disability Expert Urges OPCAT Ratification & End to Disability Based Deprivation of Liberty

A leading United Nations disability expert concluded an 11-day mission to Canada on Friday by urging the country to ratify the OPCAT in a broader focused, critical End of Mission Statement. In the same document the UN expert expressed concern about the over-representation of persons with disabilities in adult and youth prisons and their deprivation of liberty on the basis of disability in healthcare settings.

The Special Rapporteur on the rights of persons with disabilities, Catalina Devandas Aguilar, wound up her extended mission to Canada in the nation’s capital, Ottawa, on 12 April 2019, having visited cities and communities in Ontario, Québec, New Brunswick and Nova Scotia.

disability expert
Catalina Devandas Aguilar, United Nations, Special Rapporteur on the Rights of Persons with Disabilities during A Day For All, Event. 3 December 2015. UN Photo / Jean-Marc Ferré

In the statement the UN disability expert highlighted an array of concerns, including vis-à-vis Canada’s legal and policy framework. In this connection she urged Canada to ratify the OPCAT as well as other key international human rights instruments.

In relation to the wider issue of deprivation of liberty Catalina Devandas Aguilar advanced various concerns, not least concerning prisons. She stated:

“I am very concerned about the overrepresentation of persons with disabilities, particularly those belonging to indigenous or other minority communities, in both prisons and the juvenile justice system. I have also received alarming information that persons with psychosocial disabilities are diverted to mental health courts for minor offences where they are subjected to higher penalties and stricter regimes.”

More generally, the UN Special Rapporteur expressed disquiet about deprivation of liberty on the basis of disability in Canada.

In January 2019 the UN disability expert issued a report, ‘Rights of persons with disabilities’, which underscored the widespread deprivation of liberty of persons on the basis of impairment:

“The deprivation of liberty on the basis of impairment is a human rights violation on a massive scale. Persons with disabilities are systematically placed into institutions and psychiatric facilities, or detained at home and other community settings, based on the existence or presumption of having an impairment. They are also overrepresented in traditional places of deprivation of liberty, such as prisons, immigration detention centres, juvenile detention facilities and children’s residential institutions. In all these settings, they are exposed to additional human rights violations, such as forced treatment, seclusion and restraints.” (§85)

Disability expert
Abandoned psychiatric institution by Michael Hummel (2009).

The UN disability expert witnessed glimpses of this depressing global reality during her mission to Canada, voicing the following concerns:

“Provincial and territorial legislation across Canada provides for the involuntary hospitalization and treatment of persons with psychosocial disabilities, in contradiction to article 14 and 25 of the CRPD. For example, the Mental Health Act of British Columbia contains very broad criteria for involuntary admissions and, once detained, a person can be forcibly treated without their free and informed consent, including forced medication and electroconvulsive therapy.”

As highlighted on this website a few weeks ago, a critical report by the Office of the Ombudsperson of British Columbia cast a long, dark shadow over the efficacy of fundamental detention safeguards in the province’s mental health institutions. In a word, they have been mostly ignored in practice.

The UN expert’s End of Mission Statement continues:

“I have been informed that the rates of involuntary admissions and community treatment orders are increasing across Canada. Similarly, the number of inpatient beds in psychiatric hospitals, particularly in forensic units, is also increasing. In addition, different interlocutors told me that there is a significant number of persons with psychosocial disabilities who no longer need to be in the hospital but cannot leave due to the lack of community-based alternatives.”

“I urge the provincial and territorial governments to transform their mental health systems to ensure a rights-based approach and well-funded community-based responses, ensuring that all health care interventions are provided on the basis of free and informed consent.

“I have also noticed that there is a lack of independent monitoring of mental health facilities and institutions. I would like to recommend the provincial and territorial governments to establish independent monitoring mechanisms for centers of deprivation of liberty, including hospitals and institutions.”

Several of the above concerns regarding the deprivation of liberty on the basis of disability and use of coercion were also underscored by the UN Special Rapporteur on the right to health during a November 2018 mission to Canada.

In a report issued earlier this year the Canada OPCAT Project also highlighted the lack of independent oversight of such institutions, a point echoed by the UN Committee against Torture during its November 2018 examination of Canada.

Whether Canada will act on these collective concerns, including by ratifying the OPCAT, remains to be seen. Regrettably, there is little to suggest that OPCAT ratification is a political priority for the Canadian Government at the present moment, despite its past assertions to the contrary.  

On a slightly more positive note the UN Special Rapporteur concluded her End of Mission Statement by emphasizing the following:

“As a highly-developed nation, Canada still lags behind in the implementation of its obligations under the Convention on the Rights of Persons with Disabilities. There are significant shortcomings in the way the federal, provincial and territorial governments of Canada respect, protect and fulfill the rights of persons with disabilities. Notwithstanding, the country has the potential to undertake a major transformation and fully embrace the human rights based approach to disability introduced by the Convention. The various pilot initiatives and good practices in place could, if adequately scaled up, promote systemic change for persons with disabilities in Canada.”  

The UN Special Rapporteur’s full report on her visit to Canada is scheduled to be presented to the UN Human Rights Council in March 2020.

Finally, Canadian civil society actors may also wish to take note that, in August/September 2019, the UN Committee on the Rights of Persons with Disabilities will draft the List of Issues Prior to Report in relation to Canada and its second periodic review. This moment will be a timely opportunity for Canadian civil society to indicate to the UN Committee the key issues to which Canada should be responding in its subsequent report. The Canada OPCAT Project will keep readers posted of any developments in this respect.


Read the End of Mission Statement.

Read the UN Special rapporteur report focused on ending deprivation of liberty on the basis of disability. Lire le rapport en français.

An alternative version of the report designed for wider distribution is also available.

Explore the Special Rapporteur’s dedicated website.

Visit the related OHCHR website on Catalina Devandas Aguilar’s work.

Posted by mp in Health care, OPCAT, Places of detention, Prisons, Psychiatric detention, UN Special Rapporteur, UNCRPD

Committed to Change – Involuntary Mental Health Detention in B.C.

In a critical new report by the Office of the Ombudsperson of British Columbia a long, dark shadow is cast over the efficacy of fundamental detention safeguards in the province’s mental health institutions.

The March 2019 report, Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, reveals some unsettling findings regarding the far-reaching extent to which mental health law-related safeguards are ignored in practice by health-care practitioners in the province of British Columbia, as the Infographic below succinctly illustrates.

Committed to Change
Committed to Change Infographic (March 2019)

Patient rights in B.C. are protected through a series of legal procedures which practically take the shape of written forms to be completed on admission. These crucial forms bring to life an array of key detention-related safeguards. Routinely these forms must be completed upon admission of a person to psychiatric detention, demonstrating that the detention criteria has been met, consent to treatment has been obtained, there has been a notification of the patient’s rights, and his or her relatives have been notified. As the Commitment to Change report reveals, these basic rights have frequently been ridden roughshod over in practice.  

The press release accompanying the report quotes B.C. Ombudsperson Jay Chalke as stating:

“Involuntary detention and treatment is the most intrusive form of mental health care available. 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 … 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. To not do so is not only unacceptable, it is contrary to law.”

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. In 2016-2017 alone, some 15000 persons were involuntarily admitted to mental health institutions in the province.

A detailed analysis of mandatory admission forms from June 2017 found that across the province, all of the required forms were completed in only 28% of involuntary patient admissions, as the above Infographic illustrates. Key findings include:

  • A number of directors of designated facilities admitted and detained people involuntarily without adequate information and reasons to demonstrate how the patient met the criteria for admission;
  • There was no consent for treatment form in 24% of patient admissions across all health authorities;
  • A number of directors of facilities  permitted the psychiatric treatment of involuntarily detained patients in circumstances where the patient objected to treatment and no Consent for Treatment form was completed;
  • There was no rights advice form for more than half of the involuntary patients. This form advises the patient of their legal rights including how to get legal advice and challenge their detention;
  • The health-care authorities acted unreasonably in failing to adequately monitor, audit and address designated facilities’ compliance with the involuntary admission procedures under the Mental Health Act.

Interested readers may also wish to watch the following short animation, which captures the main findings of the B.C. Ombudsperson’s report.

According to the report, there exists in the province of British Columbia some 77 acute in-patient mental health units and other psychiatric facilities. Canada-wide, the Canada OPCAT Project has calculated at least 234 such facilities (please see chapter 3 of the 2018 report, Instituting An NPM in Canada – Lessons Based on Global OPCAT Practice). The wide-spread disregard of fundamental safeguards in detention in British Colombia is therefore especially worrying in view of the large numbers of such facilities.

In its Executive Summary the report states:

“We were disappointed to find significant levels of non-compliance when we reviewed the forms. In many cases, forms were simply not completed. In many other cases, the forms were completed late or in a manner that did not provide anything close to adequate reasons.” (p.6)

It also underscored the key point:

“Failure to complete these forms is not just a matter of missed paperwork; it is a failure to follow the law. The safeguards in the Mental Health Act protect the inherent rights and dignity of some of the most vulnerable people in our society. When they are not observed, the balance between individual rights and society’s interest in protecting people with mental illness is upset.” (p. 7)

The B.C. Ombudsperson’s Office report makes 24 recommendations, all of which have reportedly been accepted in principle by government and health authorities.

In this same connection it bears noting a recent report of the Special Rapporteur on the rights of persons with disabilities, Catalina Devandas Aguilar. In her 2019 report, which was presented at the 40th session of the UN Human Rights Council on 5 March 2019, the UN Special Rapporteur has questioned the very notion of deprivation of liberty on the basis of impairment. Her reports merits a close reading, as it goes a considerable way in questioning the international legality of this extremely wide-spread practice.

From an oversight perspective, however, the UN expert’s report also stresses:

“National preventive mechanisms, national human rights institutions and independent mechanisms for the promotion, protection and monitoring of the implementation of the Convention must be expressly mandated to carry out inquiries and investigations in relation to the deprivation of liberty of persons with disabilities and provide them with assistance in accessing representation and legal remedies. Disability-specific settings of deprivation of liberty, such as psychiatric facilities and other institutions, must be effectively monitored. Having accurate data on the numbers of persons with disabilities deprived of their liberty will also allow monitoring of the trends and changes over time, thus enabling better preventive and deinstitutionalization strategies.”

If and when Canada ever ratifies the OPCAT, NPMs under the OPCAT will have a key role in monitoring Canada’s in-patient psychiatric facilities.

Under the OPCAT NPMs should regularly monitor psychiatric institutions and social care homes. For example, in England and Wales the Care Quality Commission undertakes this vitally important function, issuing a range of reports on mental health institutions, residential care and nursing homes as well as its flagship annual report on the implementation of the Mental Health Act. Similarly, the Parliamentary Ombudsman of Norway annually visits a significant number of such facilities, some reports of which can be found in English.  The monitoring of such domains is also currently a priority area for the Swiss NPM, the Commission nationale pour le prévention de la torture. There additionally now exist useful practical tools on the monitoring of such detention settings (please see under Other Resources).


Read the full report, Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act.

Browse the accompanying press release.

Examine the related Infographic.

Committed to Change

Read the UN Special Rapporteur on the rights of persons with disabilities 2019 report, Ending Deprivation of Liberty on the Basis of Disability.

Watch the presentation of the 2019 report of the UN Special Rapporteur on the rights of persons with disabilities at the 40th session of the UN Human Rights Council on 5 March 2019.

Study the New-Brunswick Ombud’s 2019 report on the deliberate ill-treatment of mental health patients at a facility in the province.

Posted by mp in Health care, Oversight bodies, Psychiatric detention

COPCAT en bref: Échec À Protéger

En mai 2017, le Bureau de l’ombud a reçu une dénonciation écrite anonyme alléguant des manquements significatifs à la protection des patients du Centre hospitalier Restigouche (« CHR ») contre les mauvais traitements et les soins inadéquats infligés par son personnel.

Notre enquête dans cette affaire nous a permis de conclure que ces allégations sont fondées.

Nous croyons que, dans de multiples cas, des patients du CHR ont subi des mauvais traitements significatifs.

Ombuds NB Échec À Protéger

Nous croyons que, dans de multiples cas, des patients du CHR ont subi des mauvais traitements significatifs.

… c’est avec confiance que nous présentons les conclusions suivantes :

Des risques pèsent continuellement sur la sécurité des patients et du personnel au CHR. Il y a un besoin urgent de prendre des mesures correctives;

De graves incidents de mauvais traitements des patients ont eu lieu au CHR;

Le CHR ne prodigue pas périodiquement des soins adéquats aux patients;  

Le manque chronique de personnel a érodé la culture et le modèle de service au CHR; et,

De sincères tentatives visant à faire évoluer la culture et à améliorer la prestation de services n’ont pas connu de succès.

Nous recommandons d’envisager une révision considérable de la mission du CHR. Avec le personnel actuel, cet établissement se voit tout simplement dans l’impossibilité d’offrir tout l’éventail des services en santé mentale visés par son mandat.

Échec À Protéger

Lire Échec À Protéger en français.

Read the report in English.

Lire les observations du Comité de l’ONU contre la torture de décembre 2018 concernant la nécessité d’un contrôle indépendant de la détention psychiatrique au Canada.

Posted by mp in Acts of abuse, Oversight bodies, Psychiatric detention

COPCAT Shorts: Failure To Protect In Canadian Psychiatric Care

In May of 2017, the Office of the Ombud received an anonymous written disclosure alleging significant failures to protect patients of the Restigouche Hospital Centre (“RHC”) from mistreatment and inadequate care at the hands of staff.

Our investigation into the matter has concluded that these allegations are substantiated.

We believe that in multiple cases there has been significant mistreatment of RHC patients.

… we feel confident in stating these conclusions:

There is an ongoing safety risk to both patients and staff at RHC. Corrective measures are urgently needed;

There have been serious incidents of mistreatment of patients at RHC;

RHC is not consistently providing adequate care to patients;

Chronic understaffing has eroded the culture and service model at RHC; and,

Sincere attempts to change the culture and improve the service delivery have not succeeded.

We recommend substantial revision of the mission of RHC. With the existing staff, the institution simply can not provide the entire range of mental health services it has been mandated.

Failure To Protect
Failure To Protect Ombud New Brunswick from 7 February 2019.

Read Failure To Protect in English.

Lire le rapport final en français.

Read the Concluding observations of the UN Committee against Torture from December 2018 concerning Canada and the need for independent oversight of psychiatric detention in Canada.

Posted by mp in Acts of abuse, Oversight bodies, Psychiatric detention