Part 1: Support people are crucial in times of crisis

To mark Mental Health Week 2020, Health Justice is doing a 3-part series on lessons we can learn from COVID-19 that can inform improvements to our mental health laws.

When we have a health crisis or a disability, our personal supporters – families, friends, and the communities who know us best – are a vital part of support and recovery. They can help with communication, understanding information, promoting quality care, and connection to traditional or culturally specific care. They can help us make health care decisions or make health care decisions for us when we can’t.

Now, because of physical distancing measures, many of us feel cut off from our loved ones who are in care facilities or other residential care placements. Prohibitions on access in health care and residential care settings across many sectors as a result of COVID-19 has resulted in heart-breaking stories about loved ones being left out of crucial health care, decision-making, and end-of-life care. We have become reliant on transparent communication from facilities and public health officials to stay on top of developments with pandemic impacts and learn how our loved ones are doing during this difficult time. It has highlighted how imperative it is to our dignity and well-being to have those we trust support us through our most difficult times.

Sometimes an essential support person is a necessary accommodation to enable people with disabilities to access health care services. Health Justice joined a number of other organizations in a letter calling on BC to make clear and consistent provincial policy during the time of COVID-19 to ensure respect for the rights of people with disabilities to a family member, friend, or worker who provides essential support with communication and decision-making in health care settings. You can join the call here.

But excluding personal supporters is not a temporary pandemic response for involuntary patients under BC’s Mental Health Act – it’s the status quo.

In BC, there are two separate sets of laws for how health decisions are made when we cannot make them for ourselves. Everyone has the right to appoint the people you trust to help you with decisions as a representative. If you haven’t appointed someone, health care providers go to a personal supporter to make the decision (sometimes people call this going to our ‘next of kin’).[1]

Everyone, that is, except involuntary patients under the Mental Health Act. The Act overrides the health care consent rights that everyone else has and says that the detaining facility does not need consent from a representative you choose or a personal supporter.[2] The law allows any form of psychiatric treatment – from injecting medications to electroconvulsive therapy to psychosurgery – to be forcibly administered to patients without involving the people who know them best.

This means if your daughter, your father, or your partner is an involuntary patient under the Mental Health Act, you are not permitted to be involved with their psychiatric treatment decisions. But we know that our families, friends, and communities are critical to our mental health and evidence shows that health outcomes are improved by involving personal supporters.[3] The outdated approach in the BC Mental Health Act that excludes personal supporters needs to change.

Health Justice is working to transform our Mental Health Act into a law that is evidence-based and promotes human rights principles – a law that BC can be proud of. As this pandemic highlights, we have to make sure that our mental health laws include our personal supporters.

[1] Health Care (Consent) and Care Facility (Admission) Act, RSBC 1996, c 181, Part 2.

[2] Health Care (Consent) and Care Facility (Admission) Act, section 2; Mental Health Act, RSBC 1996, c 288, section 31(1).

[3] Mental Health Legislation and Human Rights (Geneva: World Health Organization) 2003, 11.