Rep. for Children and Youth Report: Alarming Increases in Involuntary Treatment

On January 19, 2021 the Office of the Representative for Children and Youth released Detained: Rights of Children and Youth under the Mental Health Act. The report documents a comprehensive and important investigation of how BC’s mental health and substance use treatment system – and the law that governs it – has been serving children and youth. Here are three highlights from the Representative’s report:

1. Alarming increases in involuntary treatment of children and youth

The report found that the number of children and youth receiving involuntary services in BC’s mental health and substance use treatment system has “increased alarmingly”. Between 2008/09 and 2017/18, involuntary admission under BC’s Mental Health Act has increased for people of all ages. But while the rate of involuntary admission of adults has increased by 57%, the rate of involuntary admission of children and youth has increased by 162%. Based on previously released FOI data, this alarming increase is disproportionately experienced by girls and young women.[i]

During that time period, far more children and youth were receiving involuntary services than voluntary services under the Mental Health Act. This means that our mental health and substance use treatment system is increasingly providing services in a coercive or adversarial way, rather than working collaboratively with children and youth in their recovery. And the health care system’s overreliance on involuntary mechanisms can mean that voluntary services aren’t available when children and youth ask for help.

Although the Ministry of Health suspects that Indigenous children and youth are disproportionately detained and involuntarily treated, there is no data available on the number of Indigenous children and youth admitted under the Mental Health Act. The Representative’s report expresses concern about the absence of data tracking, noting that anti-Indigenous racism and inaccessibility of culturally safe care has been well documented in BC’s health care system, most recently by the significant review, In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care.

“This lack of data on vulnerable young people leaves a gap in understanding the full effect of B.C.’s Mental Health Act. Data assists in finding patterns, in identifying population impacts, in ensuring rights are upheld and in recognizing areas for improvement – all vitally important issues, and even more so where the deprivation of liberty is involved.”

2. BC’s overreliance on involuntary treatment is not serving children and youth well

Our Mental Health Act should be designed to protect people with mental health and substance use related health needs. But the representative found that the BC Mental Health Act could be doing much more to ensure that children and youth are receiving the best possible care from the mental health and substance use treatment system.

Laws that impact children and youth need additional safeguards and protections because they may face additional barriers in understanding the impact of the law on them, accessing their rights, or raising their voice. The Ombudsperson’s 2019 Mental Health Act investigation showed a vivid example of this: although detaining facilities had a generally very poor rating of 51% compliance with their legal obligations to notify people of their rights when detained, Children’s Hospital had a compliance rating of 10%.[ii] That means that 90% of children and youth detained at Children’s Hospital in that time period may not have been notified of their rights – a serious violation of the Canadian Charter of Rights and Freedoms.

The Representative’s report found that the BC Mental Health Act does not have the safeguards and protections necessary to serve children well. For example, the Representative expresses concern that the Mental Health Act authorizes unlimited and undefined disciplinary measures, such as mechanical restraints and isolation in seclusion rooms. The use of such measures is carefully defined and governed in other settings, like residential care facilities and correctional centres, but completely absent for people detained in psychiatric wards and facilities in this province.

“To permit the unregulated use of restraint and confinement of patients, and specifically of children, is unacceptable.”

The Representative also found that while access to the independent tribunal designed to review Mental Health Act detentions was generally very low for all detainees, only 1% of detentions for children and youth are subject to independent review. To address this, the report recommended amending the Mental Health Act to build in automatic periodic reviews of detention (something that courts in other provinces have found is necessary to ensure mental health legislation complies with the Canadian Charter of Rights and Freedoms) and that the BC government take immediate action to fulfill its outstanding commitment to create an independent legal advice service for mental health detainees.

3. We can learn by listening to children and youth with lived and living experience

It’s clear from the Representative’s report that the BC Mental Health Act needs to be reformed to bring it in line with current evidence-based best practices that promote the health and human rights of children and youth. So how do we move forward?

The stories the children and youth shared in the report are compelling and show us the value of listening to those most directly impacted by laws and systems. In these stories we can see children and youth who wanted help from our mental health and substance use treatment system, but felt as if they weren’t listened to – just detained, medicated, and discharged. By prioritizing the voices of those disproportionately impacted, like girls and young women, we can improve services and health outcomes.

Our way forward then is clear – we must listen to people with lived and living experience and build new laws and systems that ensure a full range of wrap-around, culturally safe, and trauma-informed services are available for children and youth to promote recovery.

[i] Ministry of Health FOI Data, Request HLTH-2017-72558.

[ii] Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, Ombudsperson’s Special Report No. 42 (March 2019), p. 62.