BC’s Mental Health Act
The BC government announced it will review the Mental Health Act! We’ve created a framework for an effective and meaningful review.
Click here to learn more.
The BC government announced it will review the Mental Health Act! We’ve created a framework for an effective and meaningful review. Click here to learn more.
Our Areas of Focus
Below are brief summaries of our areas of focus with BC’s Mental Health Act.
Guiding Principles
BC’s Mental Health Act is a law that gives power to the health system and to people who work in the health system. It applies to people with mental health issues and to people with other kinds of disabilities and health issues. The Act grants the health system a lot of power. It lets a doctor decide to keep a person in a hospital or facility even if they want to leave. It also lets doctors give medication and other psychiatric treatment even if the person does not consent or want that treatment. Many reports have found problems with BC’s Mental Health Act and the way it is being used.
We have identified eight guiding principles that can help improve BC’s mental health law:
Recognize human rights
Take a holistic approach to mental wellness
Prioritize access to quality health services
Nothing about us without us
Comply with the UN Declaration on the Rights of Indigenous People (UNDRIP)
Prioritize equity and respect the different elements of a person’s identity
Promote self-determination at every opportunity
Accountability and oversight is needed to make services better
Decolonizing Services and Laws
For some First Nations, Métis, and Inuit people in BC, detention and involuntary psychiatric treatment under the Mental Health Act are a continuation of the control and repression of community self-determination and traditional health practices, replacing them with government control and colonial understandings of risk and wellness. Involuntary treatment can be experienced as yet another institutional means of suppressing the autonomy of First Nations, Métis, and Inuit people and pathologizing the impacts of, and resistance to, ongoing colonization.
These are some of the specific steps BC could take in reforming its mental health law:
Acknowledge colonial harms and resistance to those harms
Recognize community-specific self-determination
Rapidly expand funding for Indigenous-led services
Eliminate racism in the mainstream mental health system
Reduce or eliminate approaches that rely on use of force and control
Ensure mainstream mental health law and services strengthen Indigenous determinants of health, including connections to land, culture, identity, spirituality, language, and traditional health practices
Take meaningful action to ensure accountability and oversight
Denial of Justice
Whenever state power is exercised to detain and infringe fundamental rights, those impacted must have a way to access justice. Access to justice provides transparency to see how powers are being exercised, safeguards to ensure detaining authorities exercise their powers appropriately, accountability when powers are misused, and meaningful remedies for someone whose rights are violated. Systemic reports, data, and case law show that access to justice rates have become worse in recent years for people impacted by the Mental Health Act. BC must address access to justice barriers because providing involuntary patients with as much choice, voice, and participation as possible can reduce the harms of detention and coercion and promote better health outcomes.
Areas where access to justice must be strengthened include:
Access to rights information
Access to legal advice
Access to legal representation
Access to review panels
Access to courts
Gender Equity in Involuntary Treatment
Experiences of detention and involuntary treatment under the Mental Health Act do not impact all people and communities in the same way. Aspects of a person’s identity and life experiences, including gender, sex, sexual orientation, Indigeneity, race, (dis)ability, migration status, or family status, can shape the way they experience it. Cis and trans girls and women; trans, non-binary, and Two-Spirit people; and other gender-diverse people may experience disproportionate challenges and harms. In addition, involuntary treatment is often used with the aim of keeping the people subject to it “safe,” so investigating the extent to which that prevents and responds to gender-based violence is crucial.
This project found that:
Gender-based violence and discrimination are common experiences during involuntary treatment.
BC’s involuntary treatment system and Mental Health Act do not meet human rights obligations because they fail to prevent and adequately respond to gender-based violence, as well as fails to provide trauma- and violence-informed services, an important means to ensure equitable services.
BC’s mental health law should include mandatory guidance on violence prevention, equitable services that are gender- and violence-informed, and meaningful responses to gender-based violence if it occurs.
Oversight and Accountability
The powers under the Mental Health Act are some of the most serious state powers authorized in Canadian law – powers to detain, to administer injections and electroconvulsive therapy without consent, to “discipline” patients in any way, to mechanically restrain, to confine alone in a seclusion room. When someone experiences detention and involuntary treatment, we need ways to be sure they will be treated with respect and dignity and that there are ways to address improper use of power. BC’s Mental Health Act has some of the weakest oversight and accountability safeguards in Canada.
Here’s 5 types of oversight and accountability that should be built into all mental health systems:
Individual complaints system that means there are accessible and effective ways for a person to ask for review or raise concerns about an experience.
Systemic oversight that is accessible and effective so that there are ways to review how a group of people were impacted by a similar experience.
Proactive monitoring that is built in and independent from the government and the health care system.
Data collected in an ethical way to monitor how the law is being used.
Transparency in data, information, and records so that they are accessible and allow meaningful public analysis of how the system is working.
Decreasing Reliance on Police & Security
The BC Mental Health Act authorizes police to apprehend and transport someone to a doctor or nurse practitioner for examination if the person is acting in a way that’s likely to endanger safety and they appear to have a mental disorder. In addition, many facilities that detain people under the Mental Health Act also employ security guards or contract with private companies that provide security guards, who can be involved in restraining and intervening in other ways with involuntary patients. Relying on police and security guards to respond to mental health or substance use health distress can be traumatic and risky. Police and security are often responding to crises where skills and services are needed that they are not equipped for and should not be expected to provide. There are many ways that the BC Mental Health Act could be reformed to reduce reliance on police and security guards and provide safeguards to ensure that any police or security interventions promote safety and dignity to the greatest extent possible.
Some of the recommendations we made to the Legislative Assembly’s Special Committee on Reforming the Police Act:
Prioritize hearing the perspectives of people with lived experience of police interaction related to their mental health or police apprehension under the Mental Health Act. Their voices have been missing from many of the existing BC reports in this area.
Police should not be part of the first line response to community mental health crises. Relying on police creates harm, reinforces involuntary treatment as a pathway to services, and people do not get the supports they need.
BC should develop community-based, civilian crisis response services with integrated peer and cultural supports. Those services should not be coercive or involve Mental Health Act apprehension powers; if involuntary treatment is considered necessary, a second line response can be activated.
Barriers to mental health crisis services should be resolved with a focus on the needs and wellbeing of the person in crisis; the focus should not be on solutions that better meet the needs of service providers that do not centre the person in crisis.
BC should develop standards to minimize harms and support the human rights of people being apprehended under the Mental Health Act.
Conditions and Treatment Decisions that Support Wellbeing
The BC Mental Health Act establishes many of the laws that shape the conditions and treatment that people experience when detained in hospitals and other facilities. There are many ways that the Mental Health Act could be improved to better respect human rights and incorporate evidence-based best practices that promote wellbeing.
Change is necessary because:
The Mental Health Act authorizes detaining hospitals and facilities to “discipline” patients. This means that patients can be solitarily confined in seclusion rooms, mechanically restrained with straps that tie them to their beds, or otherwise punished during their time in hospital. There are no limits on when, how, why, or how long someone can be disciplined and no review process.
The Mental Health Act removes health care consent rights for involuntary patients. All involuntary patients can be administered any form of psychiatric treatment the facility chooses without consent from the patient or their families or personal supporters who know them best.
The Mental Health Act fails to address many important aspects of daily living conditions that could support recovery. There are no patient rights to access phones or computers, to receive visitors, to protections during clothing removal, or to grounds passes to get exercise or fresh air. The result is that many involuntary patients experience unnecessary trauma, isolation, and alienation from the health care system.
Involuntary Treatment in Long-term Care
Involuntary psychiatric treatment under the Mental Health Act means that a person’s right to make decisions about their own care is removed.
In long-term care, this often plays out in subtle and sometimes invisible ways:
Antipsychotic medications may be prescribed and administered without clear consent, even when they pose serious risks.
Families may be shut out of decision-making, unable to access information about what’s happening.
Decision-making planning decisions, like representation agreement or advanced directives, may not respected.
People with dementia may be seen as “too far gone” to participate in conversations about their care or their rights, even when they have periods of clarity and can self-advocate and deeply held values.
Staff and systems often lack trauma-informed and rights-based frameworks to engage with residents and their families in meaningful, supportive ways.
Our Funders
Health Justice is funded by grants and donations. We are grateful for multi-year financial support from:
Law Foundation of BC
Vancouver Foundation
Conconi Family Foundation
IRAS (Independent Rights Advice Service)
In addition, we are incredibly grateful for every person or organization who supports our work.