#BCOmbuds;

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