Who is impacted by BC’s Mental Health Act?
Based on data we have access to through FOI requests, each year in BC approximately 20,000 people experience close to 30,000 involuntary admissions under the Mental Health Act. Involuntary detention rates have been increasing in the last 10-15 years. As far as we know, these are the highest rates of involuntary treatment in BC’s history – for example, at its peak population in 1955, Riverview detained 4,726 people.
BC’s currently reported numbers undercount the true rates of involuntary treatment because they exclude:
People apprehended by police or detained in an emergency department under the Mental Health Act but never admitted to an acute unit
Consistent data related to detention and involuntary treatment in tertiary facilities
The number of people who remain on extended leave (provincial extended leave data only reflects people who transition from detention onto extended leave each year; they do not reflect the number of people who are on continued involuntary status while on extended leave)
People detained under the emergency provisions of the Health Care (Consent) and Care Facility (Admission) Act or the Adult Guardianship Act
What we know about the people who are reflected in BC’s data
Below, we’ve included some graphs to display other information about those who are involuntarily treated in BC.
Graphic of different demographic data of people who are involuntarily treated in BC. It covers age, sex, and category of diagnosis.
A common misconception is that BC’s Mental Health Act is only being used on people with psychosis-related diagnoses. However, according to the available data, that is not the case. As shown in the graph, of those involuntarily treated in BC:
29.5% have schizophrenia, schizotypical and delusional disorders diagnoses
23.9% have mood [affective] disorders diagnoses
22.5% have mental and behavioural disorders due to psychoactive substance use diagnoses
12.8% have neurotic, stress-related and somatoform disorders diagnoses
11.3% have a diagnoses is other categories
While psychosis-related diagnoses are the highest recorded category, these diagnostic codes are applied to less than one-third of people involuntarily treated. Framing involuntary treatment as only impacting those with psychosis-related diagnoses is not only inaccurate but also contributes to the stigma that those with psychosis-related diagnoses face. By framing involuntary treatment as only impacting a specific type of diagnosis, it erases the complexity of an entire community. Most people assume involuntary treatment is used when a person is assessed as dangerous or violent, so connecting those assumptions with only one type of diagnosis reinforces stereotypes about people with those diagnoses. This reliance on stereotypes also allows for people to push for, justify, and normalize serious interventions for those they have now deemed as “other” instead of recognizing that many kinds of mental health issues, including health issues that are normalized and widely diagnosed like anxiety and depression, can lead someone to experience involuntary treatment. It’s important to remember that how we talk about people with mental health or substance use health issues can either combat discrimination or it can reinforce stereotypes that have real impacts in people’s lives.
Another common misconception is that BC’s Mental Health Act is mainly used to detain men. While the data we have access to takes a confusing and incomplete approach to gender-diversity and appears to only being recorded based on binary sex, we do know that of those involuntarily treated, the split based on sex is close to even, 55.3% are categorized as male and 44.7% as female.
What we don’t know about the people who experience involuntary treatment because data is not collected
1. Race and Indigeneity, even though other jurisdictions (UK, Australia, New Zealand) have identified systemic racism and inequity in involuntary treatment.
Systemic racism is difficult to track if the data to do so is not collected and is not presented transparently. This is important since we do know that other places have identified systemic racism and inequity in involuntary treatment. For example:
It has been shown in other places around the world (Time for a Paradigm Shift, Disparities in Care, Seclusion Report) that racialized people are often overrepresented in those who experience seclusion and restraint. With the use of seclusion and restraint being shockingly high in BC, it is not unlikely that we would see similar patterns of racialized people being more likely to be subject to this practice.
In Plain Sight documented widespread systemic anti-Indigenous racism in BC’s health care system, including racist stereotypes that reflect and reinforce the same colonial dynamics of First Nation, Métis, and Inuit approaches to wellness being seen as inferior. The use of the Mental Health Act is operating within this same health system and perpetuates the harms of anti-Indigenous racism and colonialism.
2. Gender, despite the fact that people with diverse genders are impacted differently by involuntary treatment (e.g. clothing removal, lack of access to gender affirming treatment).
The data collected is typically based on binary sex which does not account for or accurately reflect these experiences. These binary conceptions of gender have resulted in inequity for cis and trans women and girls; Two-Spirit, trans, and non-binary people; as well as other gender-diverse people. The mental health system has a long history of pathologizing behaviour that does not conform to current social norms and expectations related to gender, sex, and sexuality. Lived Experience Experts revealed how gender-based violence is incredibly prevalent in BC’s involuntary treatment system , including experiences of:
Violent police apprehensions and widespread use of seclusion, restraints, forced injections, and forced clothing removal, which have disproportionate impact on people who have previously experienced gender-based violence;
Failure to respect gender identity and withholding of gender-affirming treatments, clothing, and gear;
Apprehension of and separation from children, including newborn infants;
Unaddressed power imbalances that heighten the risk of violence and harassment from staff.
3. Meaningful outcomes resulting from involuntary treatment beyond symptom reduction between admission and discharge.
When data is collected it is typically focused on symptom reduction between admission and discharge as the only way of measuring resulting outcomes from involuntary treatment. However, this does not account for after discharge or anything other than symptom reduction. Mental health is more than the absence of symptoms and extends beyond the time of admission and discharge.
Collecting and having access to transparent data when considering who experiences involuntary treatment is not only useful in seeing the impacts and any potentially harmful trends in order to be able to address them, but also it is an incredibly important tool in combatting common misconceptions about those who are involuntarily treated. An absence of information can contribute to leaving space for people to perpetuate harmful stereotypes and hold damaging ideas of those who are being involuntarily treated. It can also create space for those in power to play off of people’s fears that are based in misconceptions instead of reality, leading to decisions being made without consulting people with lived experience expertise who are impacted by those decisions.
Related readings:
Data collection when it comes to seclusion and restraint use in BC:
What should oversight and accountability look like in a mental health system:
The BC government recently announced that there will be a review of the Mental Health Act. What is needed for this review to be effective and meaningful:
BC needs guiding principles in its mental health law:
https://www.healthjustice.ca/blog/guiding-principles-summary