BCSS Youth
Back-to-school mental health & wellness
While back-to-school can be an exciting time for some, others may be feeling anxious, fearful, stressed, or uncertain…
Helping provide families with a reason to hope and the means to cope.
BC Schizophrenia Society supports and defends the current BC Mental Health Act.
There are effective treatments for schizophrenia and psychosis, but even people who are very ill may refuse treatment because they are not able to recognize that they have an illness. Untreated mental illness puts people at significant risk of homelessness, suicide, and other harm.
The Mental Health Act is intended to protect people by providing for involuntary hospital admission and treatment. Families often play a crucial role in facilitating this process.
RESOURCES & INFORMATION
Accessing treatment can be challenging, so BCSS provides a wide range of information, tools, and resources to help families understand and navigate the Mental Health Act.
The BC Mental Health Act exists to help someone with an apparent serious mental illness who refuses to obtain necessary treatment. Families should encourage their loved one to obtain treatment voluntarily. However, with some illnesses, the person cannot be persuaded to accept treatment voluntarily. The only alternative is involuntary admission and treatment under the BC Mental Health Act.
A person can only be admitted involuntarily if a physician finds that the person meets all of the following four criteria:
Note: The concept of “protection” in #2 above can refer to different types of harm, not just physical danger. Included is harm “that relates to the social, family, vocational or financial life of a patient.”
It is helpful to provide a copy of Section 22 of the Mental Health Act, which sets out the admission criteria above, as well as a copy of Form 4 from the Guide to the Mental Health Act, to a physician, judge, or justice of the peace, in case they are not familiar with the BC Mental Health Act.
If a person is unwilling to undergo voluntary examination and admission, there are three options for obtaining involuntary admission. We advise attempting them in the following order, if possible:
When admission to a psychiatric unit is being considered, families can provide important collateral information to the physician, police officer, or judge involved.
It helps to use the following headings to make notes of symptoms and behaviours as they happen:
In a crisis, you may want to also seek advice or observations from a mental health clinic, family doctor, hospital psychiatric unit, police, urgent care teams, etc.
The first physician’s certificate admits the patient for up to 48 hours. The second certificate holds the patient for up to one month. After this, the certificate must be renewed.
During the admission process, information about the patient’s rights is provided to the patient and a near relative. This includes how to access the Review Panel, how to obtain a lawyer, how to request a second opinion on treatment, etc.
Families can often provide the physician with important information about the efficacy of previous treatments, problems with side effects, the patient’s preferences, etc.
Treatment is authorized by the patient if the patient is capable and in agreement with the treatment or by the Director if the patient is incapable.
If a family has a Representation Agreement including treatment preferences, it can be considered, but it does not apply to treatment under the Mental Health Act. That decision is made by the director of the psychiatric unit on the advice of the treating physician.
Physician Discharge: A person who does not meet admission criteria must be discharged. However, discharging physicians must consider whether “there is a significant risk that the patient, if discharged, will as a result of the mental disorder fail to follow the treatment plan … necessary to minimize the possibility that the patient will again be detained under section 22”. The person discharged from involuntary status can continue as a voluntary patient if the physician agrees.
Review Panel Discharge: A review panel uses the same criteria as a discharging physician.
Extended Leave (Compulsory Community Treatment)
“Extended Leave” is available under the BC Mental Health Act and can help people adhere to their treatment plan in the community.
Section 37 of the Mental Health Act states: “if the director considers that leave would benefit a patient detained in a designated facility, the director may release the patient from the designated facility providing appropriate support exists in the community to meet the conditions of the leave”.
The patient must continue to meet admission criteria, with renewal examinations following the same time periods as for inpatients. Responsibility for certificates can be delegated to community physicians who are part of a community mental health team.
If the extended leave conditions are broken, the patient returns to the hospital.
Families can recommend to an authorizing physician that a patient be put on extended leave, especially if relapses recur due to not taking medication. Families can also provide information regarding the conditions of extended leave and may participate in monitoring medication and compliance with other conditions (e.g., safe and stable residence, regular physician care, etc.).
If a patient wants to be discharged from hospital or from extended leave against their physician’s advice, the patient (or anyone else acting on the patient’s behalf) can appeal to a Review Panel. If the appeal is successful, the patient must be released.
A Review Panel includes a lawyer, a physician, and a person who is neither. All are independent of the hospital. Patients and their near relative are informed of their right to a Review Panel hearing on admission.
Details on how families can be involved with a Review Panel hearing if they oppose the desire of the patient to be released can be found on the Review Board website.
If a patient appeals to the Review Panel, the near relative (often a family member) is informed of the date of the hearing. Family members who want to provide information in support of further detention of the patient must contact the attending physician.
In addition to providing information relevant to involuntary admission, a family member may have important information for the Review Panel. The Mental Health 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 “near relative” receives notice of admission, review panel application, discharge, and rights. They may exercise rights on the patient’s behalf for the following:
Family members often have knowledge about the patient that would be helpful for clinicians responsible for admission, treatment plans, or discharge planning. Conversely, family members often need information from the medical team because the family is usually involved with supporting the person after discharge. If a patient consents to this information exchange, the clinician has authority to comply.
Sometimes a clinician will not provide information because the patient has not given specific consent. However, the Freedom of Information and Protection of Privacy Act allows for the following: “Public bodies [clinicians] may release necessary personal information to third parties without the consent of the client where disclosure is required for continuity of care or for compelling reasons if someone’s health or safety is at risk.”
Some clinicians believe that patient confidentiality is absolute. They are unaware of important exceptions pertaining to the Freedom of Information and Protection of Privacy Act. Reference to Appendix 13 of the Guide to the Mental Health Act can help physicians better understand these important legal exceptions. When everyone has the facts, essential information can flow both ways, allowing clinicians and families to work together to provide the best possible care and support for the patient.
Note: The Mental Health Act refers to a “near relative” who receives rights and other information. A patient can appoint anyone as a “near relative” including non-relatives. If no one is appointed by the patient, a person may be appointed by the physician from a list of relatives. It is possible that the closest relative (e.g., wife or husband) may not be appointed as the “near relative” by the patient even though that person is also the caregiver. The Guide to the Mental Health Act points out that physicians may also send notices to family members who have not been appointed as a “near relative”.
Families should encourage their loved ones to voluntarily seek treatment whenever possible, but sometimes, the only option may be involuntary treatment. Families need to understand the Mental Health Act to support their family members effectively through this process. This includes knowing the requirements for admission, discharge, and confidentiality. BCSS provides information and support to help families access this much-needed treatment for their loved ones.
BCSS Youth
While back-to-school can be an exciting time for some, others may be feeling anxious, fearful, stressed, or uncertain…
Education
In the interest of disseminating the plain facts about schizophrenia, Dr. Randall White, medical director of the BC…
BCSS Youth
Gen Z is leading the way in their response and willingness to stand up for their values, such as…