British Columbia’s Mental Health Care
We Would Like Your Comments on This Information
If you live in British Columbia and have any added information or updates on the situation for the family members of individuals involuntarily admitted to a psychiatric unit, please write to us at: Comment@NeuroSciRandD.com We would appreciate getting more first-hand updated information.
Mental Health Law in British Columbia
Through the past three years we’ve been posting updates about the British Columbia Mental Health Act and how it treats family members of people with mental health conditions. British Columbia is Canadian Province. Our posts have been in response to a query from a reader. The reader asked what a family member can do when a relative has bad medication side effects, or stops taking their medication, and the Mental Health Authorities put up a brick wall keeping the family out. The authorities respond that the individual is an adult and should be able to make their own choices. If we’re talking about someone with schizophrenia off their medications this might be complete nonsense. The reader pointed out that the person in question is clearly too mentally ill to make any choices. The reader further commented that they need to change the laws to give the family a say.
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The Dilemma in British Columbia
The crisis seemed to arise from an overly strict interpretation of Canadian law about treating people with psychiatric diagnoses. The law is called the Mental Health Act. Under this Act people who are involuntarily detained, or out of the hospital on leave during an involuntary detention, have no right to give or to refuse consent for any psychiatric treatment. Under the law they are said to have “deemed to consent”, interpreted as consenting to all psychiatric treatment. Medications can be given against their wishes or preferences. The Law could allow electroconvulsive therapy that they don’t want. This situation holds true even when they might well be capable of making their own treatment decisions. They aren’t even allowed the right to a substitute decision maker, a legal representative or family member, to give or refuse consent on their behalf.
“Deemed Consent” with Involuntary Detention Can Be Awful
If you’re a person with a mental health medical condition, “deemed consent” can be a miserable part of the law. That’s because “deemed consent” means that when people are involuntarily detained under British Columbia’s Mental Health Act they have no right to give consent to or refuse consent to any psychiatric treatment. And among all the Canadian Provinces and Territories only British Columbia uses “deemed consent”. This lack of any right to have a say in their own care is also true if they are released from the hospital on leave. “Deemed” here is a legal term. It means people detained for their mental health are “deemed” to have given consent to any and all psychiatric treatment even if it seems that they are mentally capable of making their own treatment decisions.
The British Columbia Schizophrenia Society Information
The crux of the matter for our reader was the issue of not having the right to choose a family member as a substitute decision maker. The British Columbia Schizophrenia Society seems to present that the situation is now a bit better. They provide information for families on their website. Some of the information seems than less helpful, like, “Families should encourage their loved one to obtain treatment voluntarily.” They say that families often play a crucial role in facilitating involuntary admission. The British Columbia Schizophrenia Society offers that If the individual is truly unwilling to voluntarily see a physician and get medical help family can (1) appeal directly to a physician to have their relative seen, (2) request police assistance, or (3) get an order from a judge or justice of the peace. It would be great if this “crucial role” part were true during an involuntary admission.
But What About After That Involuntary Admission?
But the three paths for family members listed above are just to get the person into an involuntary psychiatry unit admission. Can the family still play a crucial role after the involuntary admission? It’s great that when an admission to a psychiatric unit is being considered the families can provide important collateral information to the physician, police officer, or judge. But do the inpatient physicians listen to the family after the admission? Well, yes and no. The patient is involuntarily admitted under a “First Certificate” for up to 48 hours and if needed under a “Second Certificate” for up to a month. And, on admission, information is provided to both the patient and a near relative on their rights on how to access a “Review Panel”, how to get a lawyer, and how to request a second opinion on the treatment.
A Word About “Representation Agreements” In Canadian Mental Health Law
In British Columbia, a Standard Representation Agreement, sometimes called a Section 7 Representation Agreement, lets an individual choose a person to make or help with making health-care, personal-care, legal, or routine financial decisions. The person chosen is legally known as your representative. This Standard (Section 7) Representation Agreement can be made by an adult even if that adult has trouble understanding the information. This adult individual can use this Agreement to name a representative. There’s a different Representation Agreement called an Enhanced (Section 9) Representation Agreement. This agreement is for individuals who can understand what the agreement is about and what it allows their representative to do. The individual can use this Section 9 Agreement to name a representative to make health-care and personal-care decisions on their behalf.
It Can Work Well For The Concerned Family, But Not Always
Usually families can offer the treating physician information that might be relevant and helpful after a person is admitted to a psychiatric unit. Information such as how well any previous treatments worked, any issues with side effects, and the treatment plan that the patient would prefer. With an involuntary admission the patient is likely viewed as not being capable of making decisions, so the unit’s Director who will authorize any treatments. If a family member has Standard (Section 7) Representation Agreement that includes treatment preferences, the preferences can be considered by the unit’s Director, but this does not apply to treatment under the Canadian Mental Health Act. In the case of a person involuntarily committed to a hospital, the British Columbia Mental Health Act takes precedent over a formal Representation Agreement, and decisions are solely made by the unit’s Director with advice from the treating physician.
Certified and Involuntarily in the Hospital – Family Can Only Suggest
So it would seem, talking to people and reading all of this, that once the individual has been certified and involuntarily admitted to the in-hospital psychiatric unit, the family can offer hopefully helpful suggestions but the treating physician and unit Director have the final say and the family cannot do much about it. But, there is the Review Panel. If an involuntary patient wants to be discharged from hospital or from Extended Leave against their physician’s advice, the patient (or anyone else, like a family member, acting on the patient’s behalf) can appeal to a Review Panel. If the appeal is successful, the patient must be released.
The Review Panel Story
Setting up the situation at this point, a person is detained in a hospital’s psychiatric unit. They might or might not have a Standard (Section 7) Representation Agreement to name a representative. But either way, the British Columbia Mental Health Act takes precedence over the Standard (Section 7) Representation Agreement, so for a person who is involuntarily committed treatment decisions are solely made by the unit’s Director (with advice from the treating physician). But the patient wants to be discharged from the hospital against their physician’s advice. So, the patient or anyone else, like a family member, acting on the patient’s behalf can appeal to a “Review Panel”. A Review Panel has a lawyer, a physician, and a non-lawyer non-physician lay person, and all three people are independent of the hospital.
The Review Panel Is an Independent Tribunal
Review Panels are run by the Mental Health Review Board, an independent tribunal. It gets its authority from the Mental Health Act for Protecting the Rights of Involuntary Patients. Each Review Panel consists of three members appointed from the Mental Health Review Board: a physician member, a legal member, and a community member, with the attorney (legal member) chairing the Review Panel hearing. A Review Panel reviews the situation and decides whether the patient’s certification and involuntary detention should continue. To reach this decision the panel uses four criteria. All a Review Panel can do is decide yes or no on the continuation or not of the involuntary hospitalization. The Panel can’t offer any opinion about the patient’s treatment. If a family member is opposed to their relative being released they can be involved in the Review Panel hearing.
The Four Criteria Used By A Review Panel To Reach a Decision At a Hearing
- Does the patient suffer from a disorder of the mind that seriously impairs their ability to react appropriately to their environment or to associate with others?
- Does the patient require psychiatric treatment in or through a designated facility?
- Does the patient require care, supervision and control in or through a designated facility to prevent their substantial mental or physical deterioration or for their own protection or the protection of others?
- Can the patient be suitably admitted as a voluntary patient?
More About the Actual Review Panel Hearing
If a patient appeals to a Review Panel a family member is told and given the date of the hearing. By contacting the attending physician, family members are able to offer information in support of keeping their relative in the involuntary admission. A family member or friend may participate in a hearing either as a patient representative or as a witness. Alternatively, a family member or friend may observe a hearing as a support person. In fact, the Mental Health Review Board encourages the patient to bring someone to represent them at the hearing. This representative may be a lawyer, an advocate, a family member, a friend, a near relative, or another person who will advocate for and represent the interests of the patient. The family has the Mental Health Act on their side in the Review Panel hearing in that the Act states:
“A hearing by a Review Panel must include:
(a) consideration of all reasonably available evidence concerning the patient’s history of mental disorder including (i) hospitalization for treatment, and (ii) compliance with treatment plans following hospitalization, and
(b) an assessment of whether there is a substantial risk that the discharged patient will as a result of the mental disorder fail to follow the treatment plan the director or a physician authorized by the director considers necessary to minimize the possibility that the patient will again be detained under section 22. [the admission criteria]”
Other Rights The Patient Has In Addition to the Review Panel
The Mental Health Act requires that the psychiatric unit sends a written notice to a near relative upon an application for a review panel hearing. The patient needs to choose a near relative but if the patient doesn’t or can’t choose one, the hospital will choose one or send the notice to a Public Guardian or Trustee. A “near relative” can be a grandparent, parent, sibling or half-sibling, spouse, a friend, a caregiver, or a companion. A “near relative” can also be a legal guardian. A common law spouse or same sex partner is considered a near relative. The “near relative” receives notice of admission, review panel application, discharge, and rights. They may exercise rights on person’s behalf for the following:
- Renewal certificate examinations
- Second opinion on appropriateness of treatment plan (patient, or family request)
- Review Panels or Courts for discharge
Well, Yes, Sort of Okay, But…
After all this, let’s return to our readers concern. What can a family member can do when a relative on involuntary admission to a psychiatric unit has bad medication side effects want to stop taking their medication? And the answer after all this explanation is, nothing. During an involuntary hospital stay, or a leave during an involuntary hospital stay, the family cannot have any real impact. At best, the family can offer suggestions. But the psychiatric unit Director has the final say and if the Director ignores the family members they cannot do much about it.
