Visions Journal

Reform British Columbia's Mental Health Act

Marina Morrow, PhD

Reprinted from the Involuntary Treatment: Tensions and choices issue of Visions Journal, 2025, 21 (2), pp. 11-13

British Columbia stands at the point of an important historical moment with respect to supporting people in our communities with mental health and substance use problems. The province can choose to implement measures that will increase institutionalization and coercive practices, like involuntary treatment, restraints and seclusion. Or it can choose to follow international best practices.

These call for increased community-based care and supported decision-making that aligns with equity and human rights. Politicians and policy-makers must let their decisions be guided by sound evidence, which includes evidence based on people's lived experiences of mental health and substance use care.

A controversial law

Historically there has been much debate within the province about the role of BC's Mental Health Act. This debate has intensified based on growing concerns about community safety, harms from toxic drug supplies and increased homelessness and poverty. The Mental Health Act is a legal mechanism that allows the state to suspend a person's rights and involuntarily detain and treat them if certain criteria are met.

The criteria typically include:

• concerns about the person's dangerousness to themselves or others, or

• evidence that their mental health is deteriorating

The Act is not meant to be used punitively, or as a substitute for criminal justice. In Canada, all provinces and territories have mental health acts, but they don’t all have the same criteria with respect to the involuntary committal and treatment process.

In fact, BC is an outlier. It has the only mental health act that allows for deemed consent. This concept means that when people are detained under the Act, they're considered to have "deemed" to consent to all treatment that follows. In practice, this means the Act creates:

• centralized power: the director of the admitting facility and the treating psychiatrist decide on treatment

• little recourse for patients: there is no option for the person to refuse that treatment

• closed process: unlike other jurisdictions, there is no separate legal process to determine capacity and consent

• lack of independence: there is no meaningful access to an independent decision-maker and recourse to challenge treatment decisions¹

Negative outcomes

A wide body of research evidence points to the harms that people experience when receiving involuntary psychiatric treatment. These harms include:

• undermining the person's self-determination

• a feeling of loss of humanity

• disrupted communication with family and friends

• disruption of any existing therapeutic relationships²

Recent qualitative studies in BC show that some people are physically and mentally harmed in the context of involuntary treatment.³ Importantly, involuntary treatment has not been shown consistently to improve clinical outcomes.⁴ Black, Indigenous and migrant populations are more likely to be involuntarily detained, treated and experience restraints.⁵ In BC, youth appear to be a growing population being involuntarily detained and treated, and the gendered impact of involuntary treatment has been explored.⁶

Rising admissions

BC has one of the highest rates of hospitalization and readmission for mental health and substance use issues, and involuntary treatment has been on the rise, year over year, since 2008.⁷ The BC Mental Health Act has come under repeated scrutiny for concerns that it overrides human rights. For example, the Act is now subject to a Charter challenge by the Council of Canadians with Disabilities.

Most recently, the Committee on the Rights of Persons with Disabilities, which reviews Canada's compliance with the UN Convention on the Rights of People with Disabilities, singled out the Act—twice. First, they found that BC's use of deemed consent overrides mental health care consent and supported decision-making rights.

Second, they noted concerns that facility staff in BC have been disciplining involuntary patients, rather than working towards elimination of seclusion and restraints. Indeed, available BC data shows that one in every four people who are involuntarily committed experience seclusion and restraint.⁸

The evidence is clear that the Act does not sufficiently protect the rights of people who are subjected to it. Yet politicians, under pressure to solve the complex problems of mental health and substance use and, increasingly, to address community safety concerns, are repeatedly calling for greater use of the Mental Health Act and more institutional forms of care.

A plan for change

The problems we see today on our streets and in our communities are the result of many decades of neglect in funding community-based, voluntary care options in mental health, and in decision making at federal and provincial levels. This neglect has undermined harm reduction models in substance use care and increased homelessness and poverty. These problems can't be resolved with a single legal mechanism—the Mental Health Act.

Rather, they must be addressed by developing a comprehensive plan. This plan should involve thoughtful consultation with multiple and diverse lived-experience experts, community-based organizations, advocacy groups and mental health and substance use practitioners.

Nationally and internationally, excellent models of mental health care and support exist that are non-coercive, consensual and in line with human rights. Premier Eby has committed to reviewing BC's mental health legislation. He must do so to align the Act with best practices internationally and ensure that the human rights and dignity of British Columbians suffering from mental health and substance use issues are upheld.

Related Resources

For an update on the ongoing Charter challenge of BC's Mental Health Act by the Council of Canadians with Disabilities, see cbc.ca/news/canada/britishcolumbia/charter-challengebc-mental-health-actdeemed-consent-1.7549197

To read critiques and observations about the Mental Health Act by the UN Committee on the Rights of Persons with Disabilities, visit: tbinternet.ohchr.org/_layouts/15/ treatybodyexternal/Download.aspx?symbolno=CRPD%2FC%2 FCAN%2FCO%2F2-3&Lang=en

To learn more about the Gerstein Crisis Centre, a Toronto program noted by Human Rights Watch as a leader in addressing mental health issues humanely, visit: hrw.org/news/2021/12/02/canada-program-leads-wayaddressing-mental-healthcrises