Psychiatric facilities across British Columbia are regularly violating the legal rights of people involuntarily admitted for mental-health reasons, according to a new report from the province’s ombudsperson.
Jay Chalke on Thursday released Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, the product of a review of records from all facilities in B.C. that can involuntarily admit patients for the month of June, 2017.
It found that facilities frequently failed to complete legally required documentation on involuntary admission, stamped generalized treatment descriptions on forms rather than write patient-specific ones, and failed to inform patients of their legal rights.
The report makes 24 recommendations to nine public bodies, including B.C.’s health authorities, health ministries and Attorney-General, all of whom have accepted all the recommendations in principle. Mr. Chalke said his office will be “rigorously monitoring” their implementation and publicly reporting on progress.
“Together this report speaks to a systemic failure that has acutely undermined the protection of some of our most vulnerable,” Mr. Chalke said. “The good news is that in response to this report there is a collective commitment, at least in principle, to do better.”
Under B.C.’s Mental Health Act, a person can be involuntarily detained and admitted to hospital if he or she meets certain criteria. That can include a physician determining that the person is a risk to himself, herself or others, or that that person has a mental condition that impedes his or her ability to react appropriately to the environment.
Upon admission, facilities are required to fill out a number of forms that authorize and set out the reasons for detention, describe and authorize a proposed course of psychiatric treatment; require a physician to assess the patient’s capability to consent to treatment; provide information about the patient’s rights; and provide the patient with an opportunity to notify a close relative.
Mr. Chalke’s office found “significant levels of non-compliance,” with some facilities simply not completing the forms and others using a standard rubber stamp to describe a broad range of possible authorized treatment options.
He cited as an example the stamp on an admission file for a 15-year-old: “Psychiatric and medical assessment and treatment which may include medication regime, counselling/therapy, family and/or group, use of seclusion room, testing and/or consultation by psychology, occupational/recreational therapy, educational speech and language pathology and/or other specialists or disciplines as recommended by your clinical team (i.e. bloodwork, X-ray, etc.).”
“Obviously it’s not possible to obtain informed consent to such an expanse of treatment options,” Mr. Chalke said. “The word ‘etcetera’ at the end of the stamp makes it even more problematic to obtain informed consent.”
In addition to recommendations regarding accountability measures and 100-per-cent compliance with procedural safeguards, the report calls on the government to create an independent service with legislated powers to help patients navigate their rights.
Laura Johnston, a lawyer with the Community Legal Assistance Society who wrote a 2017 report on the violation of Charter rights of involuntary patients, said the report’s findings reflect what people in the community have said for years.
She was particularly pleased that the Attorney-General accepted a recommendation to mandate the Legal Services Society, the legal-aid provider in B.C., to deliver independent rights advice to involuntarily admitted patients.
“It will make a significant difference to the conditions of detention if you can get access to legal advice right away,” Ms. Johnston said.
Deb Nolet, whose adult daughter Sarah Louise Charles died by suicide in April, 2015, after several involuntary detentions, said an independent rights advisory body “would certainly be an improvement – but only if they were contacted soon enough to make a difference.
“Persons admitted unwillingly are likely unable to process what help they may receive or have explained to them," Ms. Nolet said.