The British Columbia government has released guidance to doctors and health authorities “clarifying” when the province’s Mental Health Act may be used to treat people with substance use and mental health disorders.
It comes with the launch of the B.C.’s first involuntary treatment facility, to be housed in the South Fraser Pretrial Centre, just weeks away.
A second facility in Maple Ridge, targeting people who aren’t in the justice system but have concurrent disorders and acquired brain injury that lead to dangerous behaviour, is slated to open in May.
The 11-page guidance document lays out a trio of scenarios under which someone can be treated involuntarily under the Mental Health Act, all of them involving mental impairment.
The law does not, otherwise, permit doctors to use involuntary treatment to stop someone’s “risky decision-making or override the person’s harmful or self-harmful behaviour.”
“There is a small but growing number of people who are living with overlapping mental health and substance use challenges as well as brain injuries from repeated overdoses,” Health Minister Josie Osborne said Wednesday.
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“Some of these people are a risk to themselves or others, and can’t make decisions about their own care. We must make every effort to ensure these people do not get left behind and that they have the right supports to help them on their pathway to recovery.”
The guidance, authored by B.C.’s chief scientific adviser for psychiatry, toxic drugs and concurrent disorders Dr. Daniel Vigo, is meant to inform health care providers on the circumstances under which the Mental Health Act can be used.
Osborne said there were no changes being made to the legislation itself.
“This document contains important clarifications about when and how people can and should be admitted and treated involuntarily,” Vigo said, adding it seeks to clarify “misconceptions” about when the Mental Health Act can and can’t be used.
“These … have created barriers to the adequate care of people with severe substance use disorders suffering states of mental impairment that unequivocally met the threshold specified in the act,” Vigo said.
“The person has a mental disorder that seriously impairs the person’s ability to engage with others and their environment, they require treatment to prevent their substantial physical or mental deterioration or for the protection of themselves of others, and the person is not suitable for voluntary admission.”
Vigo said substance use disorders are already classified as a subtype of mental disorder. But he said no mental disorder in and of itself requires involuntary treatment and stressed that 99 per cent of cases wouldn’t meet the threshold.
According to the guidance, the Mental Health Act cannot be used by doctors as a “controlling intervention to curb risky decision-making” unrelated to a state of mental impairment.
Instead, it lays out three primary scenarios that would qualify someone to be admitted for involuntary care.
The most common example, Vigo said, would be simultaneous disorders, such as someone with a substance use disorder and a concurrent mental illness such as a psychotic disorder.
Another example would be someone who was clearly mentally impaired, but where it was unclear if the source was drugs, a mental disorder, or both.
The third scenario would be someone showing an ongoing mental impairment after remission from an acute state.
Patients of these types, he said, could be held long enough to get the treatment they need for the underlying conditions once they have been stabilized through treatment for their immediate condition. Under the current system many people with concurrent conditions are falling through the cracks, with consequences for both them and the public, Vigo said.
“These patients may get stuck in a revolving door of symptom-centred care that fails to address the root cause of the syndrome,” he said.
“This would not be dissimilar, for example, to discharging a patient with fever, difficulty breathing and confusion with ibuprofen, because the fever came down and they say they want to go home.”
Vigo said his staff has been working to identify the most severely affected patients in the system, those with the highest level of treatment needs, including addiction, overdose, and brain injury along with the lowest capacity to seek out and engage with services.
He said his office is currently fine-tuning estimates on staffing levels and the number of necessary beds, and working with the province on the creation of long-term psychiatric rehab beds in underserved parts of the province.
