Life, Liberty, and the Security of Persons: A candid dialogue about Involuntary Hospitalizations
The potential benefits and pitfalls of involuntary psychiatric hospitalizations, concerns about the potential misuse of the BC MHA, particularly for patients without supportive families, etc.
This dialogue explores the potential benefits and pitfalls of involuntary psychiatric hospitalizations, concerns about the potential misuse of the BC MHA, particularly for patients without supportive families, and acknowledges efforts to improve patient rights, advocacy, and reduce trauma within the current system.
The author supports the British Columbia Mental Health Act (MHA), citing personal experiences of life-saving care received during involuntary psychiatric treatment that helped her and her daughter resume their roles in society.
The author emphasizes the importance of the MHA in ensuring the safety and well-being of individuals unable to seek help due to severe mental illness, highlighting that involuntary treatment preserves life and security while curtailing liberty temporarily.
The author of this article writes about her support of the current British Columbia Mental Health Act that allows involuntary psychiatric treatment for people experiencing mental health issues and are unable to care for themselves. Below is a brief digital dialogue between the author and Kaiyros Admin.
Caroling Friend:
Dear Kaiyros,
This may not be in accordance with your local laws and the Charter of Human Rights. Nevertheless, it is a position statement supporting involuntary psychiatric treatment endorsed by two people with lived experience:
My daughter (35 y.o.) and I (62 y.o.) are psychiatric patients wishing to register our immeasurable gratitude for the life-saving provisions of the existing British Columbia Mental Health Act (“MHA”). Because of the care we have received under the MHA, we were able to resume our roles within our families and communities.
We are both treated for bipolar disorder. My daughter suffers from intermittent psychosis, and I am sober 17 years from alcoholism. During five involuntary hospitalizations (me once, her four times), we have been protected in facilities where treatments restored our minds with clarity and our souls with dignity. My daughter and I understand how precipitously we can be overwhelmed by perilous thoughts and actions. Nevertheless, our cooperation during a crisis is limited by confusion and distress. We rely heavily on the discernment and courage of our loved ones to bring us to help. On one occasion, my daughter was secured and brought to care by the Royal Canadian Mounted Police (RCMP).
We shudder with the prospect that our future society may lack the legal incentive to salvage us from episodes of severe mental illness. The Canadian Charter upholds our rights to life, liberty, and security of the person. In the context of severe mental illness, liberty conflicts with life and security. The MHA mandates liberty be curtailed when a patient is incapable of seeking help for psychiatric disorders and there is a risk of harm to self and/or others. Liberty may be restored if life is preserved and treatment is provided. The current MHA is a strong instrument of compassion and respect, a declaration that we are worthy of health and wholeness.
Additionally, we are concerned about divisive implications if families are to become decision-makers for involuntary psychiatric treatments. The flourishing of patients living with mental illness is, in part, a function of family support, which staff actively facilitates. If families are forced to choose involuntary treatments for their loved ones, this will almost certainly destabilize families with guilt and resentment, undermining sustainable recovery.
As persons with lived and living experiences of severe mental illness, we implore you to protect the high standard of psychiatric care under the current BC MHA to which we owe our lives.
With deep concern,
Caroling Friend and daughter
Kaiyros Admin:
Dear Caroling,
I trust all is unfolding well for you this weekend. I continue to stand in honor and reception of your hard-earned wisdom, and the unlikely yet inevitability of God’s grace flowing through you.
The editor wanted to add a counterpart to your liberty, life, and security article. As a person with lived experience of this issue myself from “the other side” – as a mental health therapist and crisis support counselor – I am torn between supporting the potentially humane medicine this Act may offer individuals like you and your daughter, and the nefarious applications by un-awakened professionals who abuse or are unaware of their power…especially for patients with no one to advocate on their behalf.
You wrote: “We rely heavily on the discernment and courage of our loved ones to bring us to help.”
My main concern is for those who do not have the privilege of discerning loved ones or family to support this potentially life-altering decision. For instance, I’ve seen persons with developmental disabilities behind bars in an institution serving out an indefinite sentence for a small crime they committed years or decades ago…lost in a sea of paperwork, hospital bureaucracy, and diagnostic labels, with no one to advocate on their behalf…
When you have time, I would love to know your thoughts on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588262/
With grace,
Kaiyros
Caroling:
Thank you for this article. I have worked closely with 2 of the authors in an advisory capacity for 3 years. Much good has come from their critique. There were serious gaps in applying the law, which are being righted.
Decreasing iatrogenic trauma has been the focus of many projects. In the last year, I have been involved in piloting a new program where 2 Mental Health workers attend on-site to shelters, group homes, and subsidized supervised buildings where someone is in a crisis. The outcome is that fewer calls are made to 911 police and ambulance. Moderate de-escalation crisis intervention successfully triages people with the least potential for re-traumatization.
We have got funding for the expansion of car 87/88, a mobile team of a mental health worker, and a trained plain clothes police person. Once again, they are highly successful in avoiding traumatic apprehensions. People get the help they need without the indignity of being handled by police who may not be trained in mental health care. As a clinical psychologist, my daughter assesses candidates for the police force. She has been instrumental in refusing candidates who are not appropriate, given how much dual training is required. She is impressed by how much volunteer work candidates have done in our inner city core and on crisis lines. If you aren’t comfortable responding to folks with mental health issues, don’t sign up.
Now, I must confess that personally and professionally, I have encountered Healthcare workers (nurses and security guards) who have become calloused. It’s difficult work, and disengagement may occur. One of my friends was the manager of a spinal cord unit with recently injured patients. She would never hire a psych nurse because they had lost their sensitivities about what it was like to suddenly have restricted freedoms.
The article makes faulty deductions. Increased committal rates can’t be pinned on aggressive admissions, as convenient as that may be for their argument. We have never had fewer psych beds per capita or more folks who are homeless suffering concurrent disorders. Elective psych admissions are rare. The beds are almost exclusively needed for involuntary patients. This explains their statistic in the introduction. There has been a sharp and deadly rise in substance use as people self-medicate for psychosis, PTSD, and chronic pain. Many have had severe Adverse Childhood Events, and like Indigenous people or refugees, suffer multigenerational trauma. Like San Francisco (We were there in May 2023 for the Am Psych Assoc conference), Vancouver has an inner core of folk who certainly would qualify to be brought in and treated for their psychiatric conditions. But there are no beds or advocacy for those deemed unworthy. As a privileged white healthcare professional, I was brought to care by my family. If I had crumpled on the wrong street, shouting and fisting at unseen foes, a passerby would walk around me or even cross the street to avoid me because, in part, there is demoralization due to stigma and a critical lack of human resources and facilities.
There is a group of high-functioning folk from the “Hearing Voices Network” who may have, in the past, been confined unfairly. They don’t accept treatment and usually don’t meet the criteria for social and occupational dysfunction associated with serious mental illness. They have launched a charter challenge to the BC Mental Health Act (MHA). I hope to testify in favour of the MHA. For people with early psychosis, this website has normalized symptoms and sometimes delayed treatment. Nevertheless, their voices about their voices must be heard.
https://bchvn.ca/
I also have heard them speak articulately at events. On the other hand, folk suffering from longstanding schizophrenia often have cognitive disabilities, including a lack of executive functioning. They are not ideal witnesses for organizing themselves or the rigors of court.
The initial audit by the Ombudsperson’s office revealed that many of the required forms were not being completed. After several years of remedial education and oversight, staff are nearly 100% compliant with the original forms. Patients have for decades been required to sign that they have been informed of the reason for their admission, the treatment plan, and their rights and means to contest the involuntary admission. When I was involuntarily in hospital for a month in 2014, I was NEVER informed of my situation or my rights. Another form ensures that a family member or friend designed by the patient receives notification of where the patient is.
Because many patients are not in contact with family or friends or are in conflict with their family, a new service provides advocacy. “Independent Rights Advisors” are trained to assist patients in understanding their rights when confined in a facility. Independent rights advisors are not answerable to staff; however, staff are obligated to tell each patient about their service when they are well enough to process the information. By 2026, all patients will be visited by Independent Rights Advisors. Longstanding patient rights include 1) asking for a second opinion by an independent physician, 2) having representation by a legal aid (free) lawyer before a judge in court, and 3) having representation at a review panel where their commitment under the Mental Health Act can be challenged and reversed.
I have contributed to revising forms for enacting the Mental Health Act and the guide to the Mental Health Act and requesting a consultation with an Independent Rights Advisor. I have also revised seclusion and restraint guidelines. I am only one of many people with lived experience who have been included at every step to improve patients’ rights and healthcare professionals’ compliance with the existing BC MHA.
Thank you for this prompt. I hope I’ve offered a balanced response. Change rarely comes from tepidness. It is the passion of folk like the authors that compels improvement. I would be honored to discuss this further anytime.
Kaiyros:
Thank you for your comprehensive response to this. I am still digesting what you wrote and I am grateful that your personal experience over many decades (it seems) offers a more erudite, panoramic view than I could offer at this time with this issue. The topic of involuntary seizure of a patient’s autonomy, “voice and choice”, is a complex one, no doubt. I will grapple with the gems you posed a bit longer…
*later reply: One thing I will add is that I find it encouraging to know they are including actionable, efficacious steps towards instilling proper emotional and spiritual scaffolds to the otherwise cold, blunted mechanics of preserving basic safety for those being involuntarily confined and the people around them. It’s especially heartening to learn that you and the stories of many like you are included in the legislature that will directly impact even more people like yourselves. I’ve known about the Hearing Voices Network for some time and marvel at the courage and creativity that blossoms from acknowledging and expanding the spectrum of neurodiversity in that way. But I also see the pitfalls of normalizing mental suffering.
Thank you for the heartfelt education. Thank you for the poignant reminder that “change rarely comes from tepidness“.
Caroling:
Thank you for so patiently reading my response to the article. One of my fellow advocates has written about the collateral problems of anti-stigma campaigns. Folk can suffer significantly from depression, anxiety, OCD, PTSD, etc. The anti-stigma campaign frees them to speak about their experiences and recovery. This can prevent isolation and self-harm and facilitate accessing occupational resources for treatment without fear of dismissal. I’ve never been able to get life insurance. The rub is people floundering with serious mental illnesses such as psychosis, mania, and paranoid depression do not benefit from us normalizing their conditions. They are often in peril, and the stigma sticks; an impenetrable oil slick conveniently obscuring their distress.
No need whatsoever to respond. I deeply value our conversations.
*Additional information is here if you want to find out more about the rights of a psychiatric patient in BC under the current Mental Health Act.
**This is the article referenced in the above dialogue that outlines an argument against the BC MHA.