British Columbia needs to overhaul a mental health system that allows psychiatric facilities to detain people with little justification, to deny them access to a lawyer and to take away their personal clothing as a form of punishment, a legal advocacy group says.
The Community Legal Assistance Society published a report titled "Operating in Darkness" on Wednesday, which describes B.C.'s mental health detention regime as one of the most regressive in Canada.
The report says the province's Mental Health Act allows people in care to be put in solitary confinement, strapped to a bed or given involuntary treatments like drugs and electroconvulsive therapy.
Report author Laura Johnston said it is "extremely unusual" for a provincial mental health act in Canada not to prohibit the discipline of patients who are being held without consent.
"Not only does our act not prohibit it, but it actively authorizes it," Johnston said, adding that disciplinary measures include the use of restraints, solitary confinement and withholding personal clothing.
"You can 'earn your way' back up to your clothing access by good behaviour. But bad behaviour, you can lose your rights to clothing," she said, describing the practice as disturbing.
Spike in involuntary detentions
The society, a non-profit group that provides legal services to people in mental health detention, has launched a charter rights court challenge against the provincial government over the same issue.
The group started the court action in September 2016 on behalf of two people being treated against their will, arguing that B.C.'s laws deprive involuntary patients of their rights to equality and life, liberty and security of the person.
The Ministry of Mental Health and Addictions responded to Wednesday's report in a statement, saying it welcomes feedback from groups that have experience with such issues.
"Our government established a dedicated Ministry of Mental Health and Addictions to give this area the attention it deserves, and to make a difference for the people and families suffering without the kind of support they need," the statement says.
The ministry declined further comment because of the legal action before the court.
While voluntary mental health detentions have remained stable at about 17,000 per year over the past decade, the number of involuntary detentions spiked from about 11,900 to more than 20,000 over the same time period, the report says.
Female patients routinely have their clothes removed by male staff, doctors can make detention decisions without conducting in-person exams and there is no legal aid for patients at the time they are detained, the report says.
Johnston dismissed what she called a widely held view that people can only be detained if they are deemed to be an imminent threat to themselves or others. Involuntary detention can occur if it is believed someone may "deteriorate" without in-hospital treatment, which is a much lower standard, she said.
'Who's monitoring this system?'
One of the features that sets B.C. apart from mental health regimes in other Canadian jurisdictions is the absence of a regular review process, Johnston added.
"That is the main point of this report: Who's looking at this system? Who's monitoring this system?" she said.
A lack of oversight makes it difficult to understand why detention numbers are rising so steeply and whether policies such as solitary confinement or restraint are successful, she added.
The report calls for an independent commission to overhaul the B.C. Mental Health Act, and makes a number of recommendations, including better training for health-care providers, regular detention review hearings and the re-establishment of an independent mental health advocate.
"Whenever there is a system that takes away your liberty, takes away your freedom to make choices about your body, who touches it, what goes in it, what happens to it, we need to make sure there are very careful safeguards in place," Johnston said.