B.C. issues new guidance to doctors for involuntary care under Mental Health Act

New guidance is being issued to B.C. clinicians on when people with mental impairment resulting from substance-use disorders can be forced into care.

The direction by Daniel Vigo, B.C.’s chief scientific adviser for psychiatry, toxic drugs and concurrent disorders, aims to clarify when a person can be involuntarily treated under the Mental Health Act. Previously, the legislation was largely left to interpretation by individual doctors and hospitals, which resulted in inconsistent application. Nothing in the legislation, however, has changed.

“The document will settle some of the spurious controversies generated during the past decade around the use of the Mental Health Act, controversies that have tied the hands of many physicians and created barriers to the care of people with substance-use disorder in their moments of greater need,” Dr. Vigo told a news conference on Wednesday.

Premier David Eby first announced that B.C. would be expanding its use of involuntary care in September, during the leadup to a provincial election in which the issues of drug use, crime and social disorder factored prominently.

Dr. Vigo is a psychiatrist, psychologist and public-health specialist who was appointed to his current position in June. He had the task of providing advice on how to improve care for the challenging population of people living with a combination of severe mental illness, addiction and brain injuries, who may not be able to make rational decisions about accessing care and services.

Alongside Health Minister Josie Osborne, Dr. Vigo cited several instances of incorrect interpretation of the health act. This included clinicians believing that someone with a primary substance-use disorder and a clear state of impairment cannot be involuntary admitted. Another example would be someone who has been involuntarily admitted cannot be treated with an addiction medication such as buprenorphine.

Dr. Vigo said there was, for a time, legitimate debate about when the act could be applied in such scenarios, but that “our evolution of this has changed because of the dramatic impact of toxic drugs on our brains.” He cited as examples psychosis or mania from crystal-meth use, or a neurocognitive disorder because of acquired brain injury from repeated overdoses.

The new document noted that the act cannot be employed “as a controlling intervention to curb risky decision-making, or override the person’s harmful or self-harmful behaviour if the decision-making or actions of the patient are unrelated to the state of mental impairment.”

Dr. Vigo said an estimated 18,000 people receive involuntary care in B.C. each year. He referred to data showing that for people involved with Assertive Community Treatment teams, admissions to the emergency department can decrease by about 40 per cent within a year. An ACT team is an intensive team-based service delivery model for people with serious mental illness.

In response to a reporter’s question, Ms. Osborne said she wanted to make clear that the guidance was not about making it easier to involuntarily detain people.

“This is about correctly identifying those people who will benefit from involuntary treatment,” the Health Minister said. “At the same time, it is so important that we continue to invest in, and build out, that continuous system of mental-health and substance-use supports that are voluntary.”

Under the Mental Health Act, people can be committed for treatment against their will if they meet all of several criteria, including that they are a risk to themselves or others, their mental disorder seriously impairs their ability to react appropriately to the environment and that they require treatment in or through a designated facility.

The act allows a person diagnosed with a mental disorder who is unwilling to be treated to be detained first for 48 hours. Within that time frame, a second certificate is required to detain the patient for a month. The certificate can be renewed for another month, and then the renewals are good for three months and then six months at a time.

But B.C. has few facilities to accommodate long-term stays for those involuntarily committed. A 10-bed unit for people being held on remand or who have been sentenced, at the Surrey Pretrial Services Centre, is expected to open this month. A secure housing and care facility on the grounds of the Alouette Correctional Centre in Maple Ridge is expected to open later this spring.

With a report from Mike Hager