Visions Journal

Failed by involuntary and voluntary mental health care

Zainab

Reprinted from the Involuntary Treatment: Tensions and choices issue of Visions Journal, 2025, 21 (2), pp. 41-43

Our journey began in 2009 when my daughter was 13. Since then, she has revolved in and out of psychiatric care under BC's Mental Health Act. The care she's received, forced and voluntary, can at best be described as inaccessible, incompetent, indifferent and cruel.

Accessing care has been fraught with challenges and barriers. These include waiting in the ER for seven excruciating hours with her in full blown psychosis, and being turned away because of lack of beds and her denial of symptoms, only to go through the whole admissions process again the next day.

Getting access to treatment was just the first barrier we encountered along the way. Other challenges include utter exhaustion from having to repeat our story with every new professional we encountered, and receiving no explanation for why doctors prescribe medications in the first place or the consequences for refusing to take them (solitary confinement in a straitjacket).

We've also wrestled with cultural and religious ignorance, stereotyping and condescending attitudes, including comments like, "how come your English is so good" and "this is how we do things in Canada." We've been greeted in Punjabi just because we're South Asian, and using prayer beads for comfort has been laughed at and equated with fundamentalist Muslim customs. I've had case managers blame me, a single mother, for being a "tiger mom," and accuse me, in my daughter's presence, of having my own mental issues.

A recovery that keeps slipping away

My daughter is now an adult—still not receiving the care she needs—and also struggling with a substance use disorder. Our experiences have led to my family's complete mistrust of mental health services in BC. We're lucky if we come across individual professionals who take the time to listen and treat us with respect.

For those who suggest that forced treatment is not an effective approach, my own experience as a caregiver who's had to make that crucial call under duress says otherwise. If my daughter hadn't been hospitalized involuntarily on numerous occasions, she would have been at grave risk of deteriorating to death by suicide or fatal overdose.

Tough choices

According to BC's Mental Health Act, people can be involuntarily admitted for treatment when their mental health is at risk of deterioration, or if they or others need protection. This is a last resort. And it is traumatic for everyone involved. A brutal and callous police force makes things worse—one time, the police threw down my daughter hard on the concrete pavement, causing a concussion and subsequent fear of treatment and authority.

Conversely, while yes, choice is important, it must be a capable choice. The person must understand the symptoms of their illness and consequences of rejecting treatment. In the throes of addiction and delusional thinking, my daughter has neither, so is incapable of making rational decisions. Also, the tendency to deny one's symptoms and illness is common.

Willingness to change is equally important. Treatment doesn't stick unless a person meets a provider halfway. We therefore find ourselves entrenched in this vicious cycle: the revolving door of treatment.

Families shut out

When an individual is in recovery, their families are also in recovery. Yet the family is mostly excluded from care, and there's little respect for their perspective and role as first responders and caregivers, with absolutely no therapeutic services offered to the family unit.

Every time my daughter interacts with the system, the family's input is completely ignored, despite the fact that she turns to us for constant support and we are an official part of her advocacy team, with all the appropriate sharing consents in place. We have to keep reminding the psychiatric team of this, as well as advocate for them to fully review her file and history for consistency of treatment.

Not once have we had the function of BC's Mental Health Act or details of her diagnosis explained to us. Nor have we been informed when she’s been admitted or released after several overdoses or suicide attempts. Sometimes, we’ve had to search for her frantically for 24 hours before f inding her.

We recently had to plead for a meeting with her psychiatrist and case manager after an overdose attempt. In the 15 minutes granted to us, they were so disorganized they couldn't find the relevant paperwork, including Form 16 (Notification to a Near Relative) and Form 20 (Extended Leave, which allows a patient to reside in the community under specific conditions).

When I asked about what supports were offered to her to thrive in the community, they said categorically that the extended leave is only for the purposes of administering medication; they simply didn't have the capacity to extend any other help. But my daughter doesn't possess any life skills or insight to follow through! Similarly, the psychiatrist refused to discuss opioid agonist therapy, saying it does not compete with the high produced by narcotics.

We later got a letter from the case manager informing us of the date of a review panel hearing. To our surprise, our daughter had challenged her extended leave authorization. The case manager simply refused to explain the family's role, or what happens at a hearing like this, citing confidentiality. Thankfully, our daughter didn't show up. Had her challenge been successful, we would have had to face our gut-wrenching fear of her symptoms worsening without access to proper medical care.

One-way confidentiality

We fully understand that the psychiatric team must respect confidentiality. But sometimes, the family can provide crucial information to help them protect a patient's well-being. Likewise, the family's confidentiality must also be respected. Unfiltered information shared by case managers with my daughter has often been taken out of context and contributed to her paranoia and mistrust of us, creating damage to an already fragile relationship with the family. We are her saviours, but also the enemy, depending on her wellness.

Where to go from here

There's a dire need for investment in more sensitive, empathetic, wraparound social supports and services. I also think BC's current Mental Health Act is outdated and needs a thorough review, especially regarding concurrent disorders and family involvement.

After 16 years of the revolving door, and despite having the voice to advocate for better treatment, I've lost faith in what the system has to offer. That said, I will continue to be the squeaky wheel. I won't give up hope that someone out there will take the time to listen and ensure my daughter doesn’t continue to fall through the cracks.