Part 2: Prioritizing community care over institutions

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.

The current pandemic is a stark reminder that institutional settings are not always safe environments. From care facilities to hospitals to prisons to group homes to immigration detention, regardless of their purpose, institutional settings are at high risk for outbreaks of viruses like COVID-19. There have been numerous calls to release and discharge people from institutional settings whenever possible.

This makes it particularly hard to protect people who are more vulnerable in the pandemic in places like BC that rely heavily on institutional based care. BC has the highest rate of hospitalization due to mental health and substance use issues in Canada.[1] The rate of involuntary admission to hospitals and facilities under the Mental Health Act increased by 71% between 2005/06 and 2016/17 while voluntary care has actually decreased given population growth.[2]

[3]

As a result of over-reliance on involuntary admission to hospitals and facilities, people in BC often find they cannot access voluntary mental health and substance use services when they need them. Instead, their health may worsen until they are involuntarily admitted under the Mental Health Act, which is often a negative or traumatizing experience that may prevent them from getting therapeutic benefits from the services or alienate them from accessing services in the future. And in a pandemic, we simply don’t have the infrastructure for community-based mental health and substance use care in place to adequately support discharging large numbers of people from institutional settings.

And the risks of institutional settings aren’t limited to virus outbreaks. Countless examples show us that people in institutional settings are more likely to experience human rights violations, social isolation, and poorer quality of life and care.[4] That’s why international human rights agreements like the UN Convention on the Rights of Persons with Disabilities guarantees the right of all persons with disabilities to live in the community, with choices equal to others.[5]

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 support a strong infrastructure of voluntary and community-based services to ensure dignified and effective care.

[1] A Pathway to Hope: A roadmap for making mental health and addictions care better for people in British Columbia British Columbia Ministry of Mental Health and Addictions (June 26, 2019), p. 5.

[2] Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, Ombudsperson’s Special Report No. 42 (March 2019), p. 14.

[3] See note 2.

[4] See for example, Dulcie McCallum, The Need to Know – Woodlands School Report: An Administrative Review (August 2001).

[5] United Nations Convention on the Rights of Persons with Disabilities, Article 19.