5 Important Things About Nunavut’s New Mental Health Act

The Nunavut legislature recently passed new mental health legislation with many promising changes, including clear recognition in the law of Inuit-based approaches. The new Mental Health Act has been described by Nunavut MLAs as a welcome replacement to old legislation, parts of which dated back to the 1960s.

It’s useful to look to examples like Nunavut’s new legislation as we think about how to modernize and improve our Mental Health Act in BC, which also has components that date back to 1964 when it was originally brought into effect. While there are many interesting aspects to Nunavut’s new Mental Health Act, here are 5 important things to know.

1. The Act has a clear purpose to guide how the law is interpreted and applied

The new Act begins with a clear purpose for the law: to improve the mental wellness of Nunavummiut and address Inuit-specific needs related to mental wellness. The Act identifies critical values and principles, including that care will be provided to people with serious mental disorders in a way that:

• is clinically safe and effective,

• is culturally safe,

• is compassionate and minimizes the potential for trauma,

• is the least restrictive possible,

• respects the rights of individuals being provided care, and

• supports the engagement of individuals being provided care in their treatment.

This type of purpose section provides clear expectations and guidance to people interpreting and applying the law, which promotes consistency and transparency.

2. The Act has recognized roles for Inuit family, community, and culture

The new Act recognizes clearly defined and meaningful roles for Inuit family, community, and culture. For example, the Act recognizes a tikkuaqtaujuq (selected representative) for individuals receiving mental health care under the law. A tikkuaqtaujuq is someone that the individual can choose in advance, but if someone hasn’t designated a tikkuaqtaujuq, then health care providers must select a family member or friend who is most directly concerned with the individual’s care. A tikkuaqtaujuq is kept meaningfully informed and involved in decision-making at every step. The recognition of a tikkuaqtaujuq encourages connections and planning with an individual’s support network in advance of a mental health crisis in a way that is culturally meaningful.

The new legislation also requires appointing at least three Inuit cultural advisors to the Mental Health Review Board. Inuit Cultural Advisors are chosen based on their knowledge of Inuit societal values, the Inuit language, and Nunavut. Their role is to meet with the individual who is going to a hearing before the Mental Health Review Board, as well as the individual’s tikkuaqtaujuq, and to give evidence and advice on Inuit societal values and perspectives that are relevant to the hearing.

Inuit legal systems and health care systems that preceded colonialism were based on maligait (natural laws or ways to be followed). Inuit cultural beliefs and values are associated with the implementation of these maligait, ultimately contributing to “living a good life”. In many ways the “new” legislation recognizes the value of traditional Inuit laws.

3. The Act protects patient rights and well-being

The new Act has many protections to safeguard patient rights and well-being, including:

• the right to recognition of the ties to people the individual considers family and the contribution those ties make to the individual’s well-being;

• the right to respect for the individual’s cultural and ethnic identity, language, and religious or ethical beliefs;

• the right to have mental health treatment explained before it is administered and the right to consent or refuse consent to mental health treatment; and

• the right to be accompanied by a support person during an assessment.

This kind of recognition that an individual receiving mental health treatment under the Act is a whole person with connections, language, culture, and values of their own can go a long way to reducing the harms of mental health detention and promoting an individual’s well-being.

4. The Act makes it clear when involuntary status should not be used

The new Act provides clarity about when health care providers should take the significant step of making someone involuntary (detaining someone or taking away other health care consent rights). For example, the law says that people should not be made involuntary based only on that individual's political, religious or cultural beliefs; sexual orientation or gender identity; or alcohol or drug use.

The Nunavut law also says that people should not be made involuntary if they give consent to assessment, transport, admission, or treatment. This provides much needed guidance about situations where the law cannot be used to make someone involuntary and ensures that voluntary services are provided whenever possible.

5. The Act creates rights advocates for patients

The new Act creates a meaningful way for people to learn about their rights when they are made involuntary or subject to other restrictions of their rights. The law says that health providers must notify a rights advocate, who will talk with the individual about the laws they are subject to, the reasons why the laws are applying to them, and the rights they have, like the right to a lawyer or the right to apply for review.

Research shows that access to this kind of independent rights advice service promotes self-determination and health outcomes for people impacted by coercive mental health laws. The inclusion of rights advice in Nunavut’s new Mental Health Act will go a long way to support the goals of improving the mental wellness of Nunavummiut and addressing Inuit-specific needs related to mental wellness.