Fast Facts

The Mental Health Act authorizes doctors to place involuntary patients in the community on leave from a detaining facility while they are still being administered involuntary treatment. [3]

Involuntary patients on extended leave in the community are subject to conditions they must comply with, and they are closely supervised by mental health teams. [4]

1 in 5 people detained and involuntarily treated under the BC Mental Health Act have a primary diagnosis of substance use disorder. This makes substance use disorders the third most common type of diagnosis for involuntary patients. [5]

Substance use disorders represented the largest growing diagnosis type for people detained and involuntarily treated under the Mental Health Act over the time period 2008/2009 to 2017/2018, with a 139% increase. [6]

There are no age parameters on detention and involuntary treatment under the BC Mental Health Act. Children and youth of any age can be apprehended by police and involuntarily admitted to facilities by physicians or nurse practitioners. [7]

Children and youth do not have the right to make autonomous decisions about their treatment when they are involuntary patients under the Mental Health Act. Just like adults, they are subject to involuntary treatment that is unilaterally determined by their doctor. [8]

The Representative for Children and Youth found that the number of children and youth who are detained and involuntarily treated has “increased alarmingly.” Between 2008/09 and 2017/18 involuntary admissions of children and youth rose by 162%. [9]

While Riverview Hospital closed in 2012, there are currently over 70 facilities in BC where people can be detained for mental health and substance use health treatment throughout the province, including a detaining facility that currently operates on the grounds of the former Riverview Hospital. [10]

There are secure, locked units in facilities where people are detained under the Mental Health Act and involuntary patients cannot leave without permission from the treatment team. [11]

There have always been forms of detention and involuntary treatment for people with disabilities, mental health issues, and substance use health issues in BC since colonization began. However, the use of detention and involuntary treatment has been dramatically increasing in BC since the mid-2000s. [12]

The rates of detention and involuntary treatment under BC’s Mental Health Act have doubled in the last 15 years. [13] There are now over 20,000 people detained under the Mental Health Act in BC every year. [14] To put that in perspective, there were only 662 patients at Riverview Hospital in the year 2000. [15]

The number of involuntary patients who are placed in the community on extended leave while receiving involuntary treatment has increased significantly in recent years. In 2008/2009 there were 848 people placed from detaining facilities on extended leave and in 2021/2022 that number reached 3,567. [16]

The law generally protects the right of adults to make our own health care consent decisions. It presumes we are capable of making those decisions unless we are assessed as incapable.[17] When we are assessed as incapable of making a health care consent decision, the law protects our right to have the people who know us best make the decision, like our families or other personal supporters we choose. [18] However, these rights are removed for involuntary patients under BC’s Mental Health Act. [19]

BC’s “deemed consent” laws mean that anyone can be made an involuntary patient, and all involuntary patients are “deemed” to consent to any form of psychiatric treatment the doctor chooses. There are no requirements to assess whether a person can make their own treatment decisions, to ask the person for consent, or to involve loved ones like the person’s family members or friends. [20]

The Mental Health Act states that every patient is “during detention, subject to the direction and discipline” of the facility staff. [21] This means that patients can be solitarily confined in seclusion rooms, mechanically restrained with straps that tie them to their beds, or otherwise punished. There are no limits on when, how, or why someone can be subject to these restraints and no independent review.

The Representative for Children and Youth has criticized this authorization in the Mental Health Act: “To permit the unregulated use of restraint and confinement of patients, and specifically of children, is unacceptable.” [22]

Unlike other laws that authorize serious impacts on rights and freedoms, [23] there is no independent review automatically built in for detention and involuntary treatment under the Mental Health Act. Instead, an independent review by a tribunal or court only takes place if involuntary patients make a request for one – the result is only approximately 3% of detentions are independently reviewed annually. [24]

Other Canadian jurisdictions have enshrined provincial Mental Health Advocates in their mental health legislation or have hired former judges and independent investigators to conduct reviews of their mental health legislation to ensure their laws are regularly evaluated and improved. [25] BC’s Mental Health Act has never been independently evaluated and reviewed.

There is little evidence to show that detention and involuntary treatment improves the health, safety, and well-being of individuals who receive the involuntary treatment or their surrounding communities.

• Studies have generally not found evidence that involuntary substance use health treatment leads to improved outcomes (like lower rates of substance use or lower rates of engaging in criminal activity in the future), and some studies show there are potential harms from the involuntary treatment (such as higher rates of overdose and drug poisoning deaths following release). [26]

• Studies have generally demonstrated that people who received compulsory mental health treatment in the community were no more likely to be connected with services, did not have higher rates of social functioning, mental state, or quality of life, and did not have lower rates of readmission to hospital when compared with people who received voluntary treatment.[27]

• People who are detained and treated against their will can experience trauma and harms leading to fear and avoidance of health care services.[28]

While other places in Canada and the world have mental health laws that reflect commitments to providing a range of mental health services, BC has no standardized set of services that are consistently available during involuntary treatment. [29] Instead, there is evidence that a range of holistic, person-centred supports are often not available during involuntary treatment in BC. [30]

The Centre for Applied Research in Mental Health and Addiction report that government refers to in its September 15, 2024 announcement says that systemic studies examining the effectiveness of involuntary care for people with substance use disorders “are limited and inconclusive” and focus groups with people with lived and living experience with substance use “did not endorse involuntary care under the inadequate conditions of the existing health system.” [31]