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BC Politics

Forced Mental Health Treatment Spikes in BC

Almost 20,000 people were held against their will last year. Critics say that’s because of inadequate supports for increasing and more complex issues.

Moira Wyton 23 Nov 2021 | TheTyee.ca

Moira Wyton is The Tyee’s health reporter. Follow her @moirawyton or reach her here. This reporting beat is made possible by the Local Journalism Initiative.

Almost 20,000 individuals were admitted to B.C. hospitals against their will for psychiatric treatment between April 2020 and this March 31 — a number that has more than doubled in 14 years, according to new data from the B.C. Ministry of Health.

In a report provided to The Tyee, ministry records show many people were admitted to hospital under the Mental Health Act more than once, with 28,386 total involuntary admissions in the 12-month period.

That’s double the 14,009 involuntary admissions recorded in the same period in 2007 and 2008, while the province’s population increased by just 19 per cent in the same period.

The jump is concerning, say some advocates and health-care professionals, given evidence that hospitals are more likely to involuntarily detain Black and Indigenous people.

And a 2019 report from the provincial Ombudsperson’s Office found hospitals fail to uphold the legal rights of the majority of patients.

Medical detention is an extraordinary state power with little oversight or accountability in B.C., the report found.

B.C. fails to notify patients of their rights about half the time, and only completes all the necessary legal and medical paperwork for about 28 per cent of patients. In Northern Health and Vancouver Coastal Health regions, that rate was 13 and 14 per cent, respectively.

In an emailed statement, a Ministry of Mental Health and Addictions spokesperson said the province has implemented quarterly audits and education for health-care workers to ensure the appropriate forms are filled out and patients are informed of their rights in a timely way.

Data from other provinces shows BIPOC patients are generally detained at higher rates than those who are white, but B.C. doesn’t track involuntary admissions by race. A spokesperson for the ministry said that work is underway to collect this data.

The province also does not have an independent rights advisor service for patients like other provinces, including Manitoba and Ontario, something B.C. Attorney General David Eby agreed to implement in 2019.

In an emailed statement to The Tyee, his office said work to implement that promise is still underway.

When asked why the practice of involuntary admission was becoming more widespread and frequent, an emailed statement from the ministry attributed it to a growing and aging population, as well as a rise in homelessness and overdoses due to the unpredictable toxic drug supply.

Last year, 1,734 people died of toxic drugs, and more than 2,000 people will die in 2021 if the current pace continues.

And many of the tens of thousands who overdose each year — there were more than 27,000 total overdoses in 2020 — survive and present with psychosis in hospital, and require admissions under 48 hours to stabilize, the ministry statement said.

But some health and justice advocates believe the rise in involuntary admissions also shows that people facing complex mental health challenges — often rooted in trauma due to poverty, racism and colonization — are not receiving adequate support from the under-resourced patchwork of mental health resources before their condition becomes a crisis.

“People are experiencing this paradox in B.C. that when they’re not getting support, then they’re being funnelled into emergency rooms when they’re in crisis,” said Kendra Milne, executive director of non-profit Health Justice, which advocates for the rights of people detained under the Mental Health Act. And the province has only sought to expand the number of people subject to involuntary detentions.

Last summer, the NDP government introduced and then pulled legislation that would allow up to 10 days of involuntary “stabilization care” for youth who overdose. The legislation was opposed by a coalition of Indigenous and health advocacy groups that said it would increase the risk of additional overdose and trauma.

The New Democrats have said they are conducting further consultations with stakeholders and considering reintroducing a version of the bill.

“Within the current context of the drug-poisoning crisis and its impact on youth, our ultimate objective is to provide the best care and support for vulnerable youth struggling with severe substance use, specifically following a life-threatening overdose to prevent further harm or death from occurring,” said a ministry statement.

But Milne said that expanding detention won’t prevent youth and others in need of crisis care from reaching that point in the first place. “There is an incredible and growing need for mental health and substance use services,” said Milne, who questions why the province is seeking to expand the scope of detentions without having all the recommended basic human rights safeguards in place.

An individual can be involuntarily admitted for treatment under B.C.’s Mental Health Act if three criteria are met: they have a mental illness that requires treatment; they have deteriorated significantly or pose a risk to themselves and others; and they cannot be admitted voluntarily.

Mental illnesses that may meet these criteria include depression, anxiety, schizophrenia, mania, psychosis, bipolar disorder and many other mental health conditions. People who overdose are also often admitted.

In hospital, patients are seen by a psychiatrist and given stabilization care such as medications, counselling and other forms of psychotherapy. Some patients may be placed in isolation for a time, have limited visits with loved ones and are not permitted to leave the site.

In 2020-21, patients stayed in hospital an average 13.9 days, a period that has been steadily decreasing from about 18 days in 2007-08. The ministry attributed this to the rise in admissions among overdose survivors who stay less than 48 hours.

The average number of stays per individual has increased slightly from 1.34 in 2007-08 to 1.43 in 2020-21.

That means some people who reach a crisis point are still being left unsupported when they are discharged and end up being readmitted, Milne said.

About 55 per cent of patients were men, 44 per cent were women and less than one per cent were listed as “other.”

The report includes information from each fiscal year since 2007-08, excluding 2017-18 and 2018-19 due to a data reporting issue, the Health Ministry said.

Milne also suspects the number of people being detained is increasing faster among Black and Indigenous people in particular, and those in rural areas with fewer supports.

“It’s the impacts of poverty and oppression, and housing crises causing them to be in crisis, and then we tend to jump to paternalistic responses and think we need to force them into support,” said Milne. “But they may well be seeking supports in certain ways and just not been able to access them.” And while detention can be the best option available for some people in crisis, it is frequently a traumatizing experience that can create or increase distrust in the health-care system and discourage them from accessing further support.

“A lot of people experience trauma, and they cycle in and out because the system was designed that way, they want to put on Band-Aids,” said one nurse who has worked in acute psychiatry care in B.C. for several years. The Tyee is not sharing their name because they were not authorized to speak to media.

“And it’s life-long trauma that can’t be solved in a two-week period.”

The nurse said one patient, a senior who needed to work a minimum wage job to make ends meet, stays with them. She was discharged, after treatment for anxiety and depression, back into the same housing conditions that contributed to her mental health crisis in the first place.

“The hospital’s concern is not to solve that,” the nurse added. “But where else would she go?”

Stephanie Watkins, a clinical counsellor for Northwest Inter-Nation Family and Community Services in Prince Rupert, said the majority of patients she sees who are detained, particularly youth, are suffering from complex impacts of trauma caused by poverty and colonization.

She said preventative supports such as counselling are difficult to find and access, and the hospital in Prince Rupert is not equipped with a mental health ward at all. The closest one is in Prince George, an eight-hour drive away.

“If people’s basic needs aren’t being met, like connection, food, shelter, water... that’s all mental health,” said Watkins, who is Haida. “As clinicians, we just do the best that we can with what we have.”

The province has said its goal is to build a system of care for mental health and substance use services in B.C., which Mental Health and Addictions Minister Sheila Malcolmson has admitted is often painstakingly slow work compared to the number of people in crisis.

“We are working closely with clinical and operational experts, Indigenous partners, service providers and people with lived and living experience from across the province to identify the appropriate safeguards and protections and to inform next steps,” said a statement from her ministry. Watkins sees a place for involuntary detention in that system. It can be lifesaving for people who pose an immediate physical risk to themselves and others, or whose illness prevents them from recognizing their need for care in a crisis. This includes some people who overdose and can’t consent because they are unconscious.

But Watkins is worried not enough is being done to prevent people from reaching a crisis point that necessitates such action in the first place.

“There really is no support. I know people could counteract that with ‘this and that,’ but unless we’re meeting people where they’re at, we’re really not supporting them at all,” she said.  [Tyee]

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