Systems advocacy

BCSS Public Policy Initiatives

BCSS has led many public policy initiatives to improve the mental health system on behalf of individual and families living with severe mental illness. Find out more below.

• Involuntary Treatment Under Mental Health Act

  The current Mental Health Act allows involuntary patients to be treated without their consent if certain conditions are met. The Council of Canadians with Disabilities and others have launched a challenge to allow people to refuse treatment under the Mental Health Act.

  BCSS does not support this position. The ability to refuse treatment can have many negative consequences, such as relentless suffering from untreated hallucinations, delusions and other psychotic symptoms; increased use of restraints and long periods of seclusion; poorer patient prognosis; increased assaults on nurses and fellow patients; increased ward disruptions; increased taxpayer costs for additional nursing staff to manage untreated behaviours; and longer patient stays. Long hospitalization also deprives patients of normal family life, community and social connections, employment, and other essential links to recovery.

  BCSS believes that the BC Mental Health Act is about the care and protection of citizens who are affected by serious and debilitating brain disorders. It is about the right to effective treatment to regain one’s health and be restored to home and community in a timely manner. It is about the right to be well.

  Learn more about the BC Mental Health Act.

• Collection of Information for Medical Certificate

  An amendment to the Mental Health Act has been proposed to add “a requirement for a physician or nurse practitioner to take reasonable steps to consult with a near relative of the individual or with an individual who provided information leading to an apprehension of the individual and to consider any information, including a history of mental disorder, received as a result of the consultation prior to completing a medical certificate.”

  BCSS supports this amendment. The Mental Health Act is intended to protect individuals who have a mental disorder and ensure they can receive appropriate treatment. Unfortunately, it has often failed to do so because healthcare providers have insufficient information to make decisions about the person’s admission, treatment, and discharge. This has too often resulted in people dying by suicide or experiencing other harm after being discharged prematurely or without adequate treatment planning.

  Bill 214 aims to address these issues by requiring consultations and information sharing with family members and other care providers when a person is held for examination under the Mental Health Act. People living with a mental disorder or experiencing acute mental distress may not be able to provide adequate and accurate information about their condition, which can result in inadequate and inappropriate care. Consultations with family members and other care providers can provide the information needed to make informed decisions for the treatment of vulnerable people.

• Understanding Schizophrenia Prevalence Rates

  The prevalence rates, service needs, and social impacts of an illness are often key factors in determining how much funding is allocated for the treatments and service levels for that illness. The worldwide lifetime prevalence rate is typically estimated to be 1% for schizophrenia and 4% for psychotic disorders more broadly.

  Prevalence rates reported within Canada generally align with the standard 1% rate with the Canadian Chronic Disease Surveillance System (CCDSS) reporting a 1.1% annual prevalence rate for schizophrenia in BC and an annual prevalence rate of 0.9% for Canada overall. However, some authorities have cited much lower rates, such as the 0.25% to 0.64% range reported by the National Institute of Mental Health for the lifetime prevalence of schizophrenia and related psychotic disorders in the United States and a 0.55% annual prevalence rate for schizophrenia spectrum disorders reported in a 2023 BC study.

  Lower estimates of schizophrenia prevalence rates need to be considered with caution due to the high likelihood of underreporting. This can be due to a narrow definition of the illness, the nature of the illness, exclusion of key populations, and the methodologies used in studies. A 2023 US study, Mental and Substance Use Disorders Prevalence Study (MDPS), addressed many of these concerns and reported a lifetime prevalence rate of 1.8% for schizophrenia disorders.

  Based on both Canadian and international studies and the general underreporting of schizophrenia, BCSS recommends adopting 1.8% as the schizophrenia prevalence rate for service planning, with the understanding that the rate may well be higher.

• Declaration of Commitment to Recovery

  In 2014, the Mental Health Commission of Canada released its Declaration of Commitment to Recovery “to promote understanding of key recovery principles and stimulate implementation of recovery-oriented approaches” and asked organizations and individuals to sign the Declaration as a show of support. The Declaration outlines key recovery principles in an effort to make recovery a reality across the mental health system.

  Although BCSS supports recovery, many of the recovery principles outlined by MHCC exclude individuals who, because of their illness, are not able to direct their own care. This includes people who are severely ill and require involuntary treatment, people who commit a crime because of their illness, and people who are experiencing first-episode psychosis.

  BCSS advocates for a Comprehensive Recovery Model that includes principles for individuals whose illness prevents them from actively engaging with and directing their own recovery.

• Repeat Offenders and Random Stranger Violence

  The Province of British Columbia hired experts in mental health and policing to conduct a rapid investigation into public safety challenges related to repeat offending and violent stranger attacks and recommend evidence-based solutions. More than 60 experts contributed to the report, which was published in 2022 with 28 recommendations.

  Several issues identified by the report aligned with BCSS advocacy efforts. The report acknowledged that psychotic disorders can lead to violence and that serious interventions, such as involuntary treatment, are sometimes necessary. The report also addressed continuity of care and the need for inter-agency coordination and information sharing prior to, during, and following incarceration.

  However, BCSS also identified several points of concern. Although the report addresses medical disorders and the need for psychiatric interventions, it speaks of root causes primarily in social rather than biological or medical terms. The report recommends strategies to divert people from emergency rooms and the justice system but may not go far enough into prevention strategies such as early education and intervention for mental illness. Finally, the report addresses the need for agencies to work together and share information but does not recognize families as a part of the circle of care.

• Extended Leave, Community Treatment Orders, and Continuity of Care

  It is the position of the British Columbia Schizophrenia Society that provisions for extended leave in the British Columbia Mental Health Act should be reflected in specific written hospital policy for community treatment.

  The BCSS believes that specific written directives for community treatment under provisions for extended leave in the Act would significantly improve preventive care throughout the province.

  Extended leave is an important tool which can help alleviate the problem of chronically ill patients who lack the insight to continue treatment after they are released from the hospital. Conditional release under extended leave allows for stabilization of such patients, ultimately improving their prognosis. As an added benefit, written policy for institutions regarding extended leave would ultimately (i) strengthen cooperation between hospitals and community care teams; (ii) decrease the frequency of hospital use; and (iii) reduce the incidence of violence.

  The provision in the British Columbia Mental Health Act for extended leave should be particularly applicable in cases where individuals repeatedly require rehospitalization because of their failure to follow treatment plans. This provision allows for readmission to the hospital if necessary without the formality of a new commitment.