Reprinted from the "Families and Crisis" issue of Visions Journal, 2017, 12 (4), p. 7
In 2012, “approximately 11 million Canadians (38%) aged 15 and older reported having one or more immediate or extended family members with a mental health problem, that is, problems with their emotions, mental health, or use of alcohol or drugs.”1
In times of crisis, families experience a huge amount of stress—from dealing with their immediate emotions of fear and anxiety to dealing with the medical system and supporting their loved one as he or she is being hospitalized. Having provided support for families for more than 34 years, BC Schizophrenia Society (BCSS) understands the importance of family involvement in the treatment and care of people living with schizophrenia and other serious and enduring mental illnesses.
BCSS also understands the toll this takes on families. Families impacted by mental illness need support from a wide range of mental health professionals, as well as other families with lived experience—before, during and after a crisis event.
In the most extreme incidences of psychosis, when an individual experiences visual or auditory hallucinations or beliefs that seem real, the individual may be of harm to him- or herself. In some extreme cases of untreated or treatment-resistant psychosis, the individual may cause harm to others (most often, family members). Fortunately, in these rare cases when a person is at risk of harming him- or herself or others due to mental illness, the individual can be involuntarily admitted to a hospital for psychiatric evaluation. While this process may be fraught with anxiety and fear for both the individual and the family, it is often the first step to getting the help needed.
Under BC’s Mental Health Act, a psychiatric evaluation consists of a physician explaining to the involuntarily admitted person the nature of his or her condition, options for treatment, and the likely benefits and risks of treatment. If the patient is deemed capable, he or she can sign for their own treatment. If the patient is found incapable by the attending physician or psychiatrist, the physician or psychiatrist then explains to the director of the psychiatric unit the nature of the patient’s condition and the pros and cons of treating the patient. The final decision to accept or refuse treatment is then made by the director of the psychiatric unit.
This process is currently being challenged in the BC Supreme Court.2 If this challenge is successful, there may be dire consequences for untreated involuntary patients, families, physicians, nurses and the medical service system. This challenge to BC’s Mental Health Act wants decisions to treat or not treat to be made by a substitute decision maker, usually a family member.
Most family members want to be closely involved with the development of the treatment plan for their involuntarily admitted family member. However, many families do not know or understand the impacts of one medication or treatment over another, and many do not want to be the person who actually consents to a treatment that an involuntary patient may be actively resisting. Often, relationships between family members and those living with schizophrenia and other enduring and serious mental illnesses are strained. One client who meets weekly with her son said, “If I had to consent to treatment he did not want, even though it was necessary, all hell would break loose and my relationship with my son [would] probably [be] destroyed.”
Treatment legislation such as BC’s Mental Health Act exists to help families and people with severe and persistent mental illnesses (like schizophrenia) in crisis situations. It helps ensure that people receive medical treatment as soon as possible in order to provide a better long-term outcome. Most importantly, it ensures that involuntarily admitted patients are not kept in hospitals for an indefinite period of time, trapped in their psychosis.
Supporting people living with schizophrenia and other severe and persistent mental illnesses means supporting their families. It means giving families the tools they need to assist in making decisions about the care of their loved ones, and it means advocating for systems that ensure accessible treatment through involuntary services. BCSS works with families and communities across the province to provide psychosocial education, health literacy, advocacy, research and direct emergency support.
From the experiences of its members and of families in other provinces, BCSS is convinced that the challenge to BC’s Mental Health Act will not advance the treatment or the rights of people who live with schizophrenia and other severe and persistent mental illnesses. The current Mental Health Act benefits those who are so ill that they cannot accept treatment voluntarily. It protects them—and their families—by ensuring that they have access to the treatment they need, when they need it.
Visions editor’s note
The recent court challenge of BC’s Mental Health Act is complex; there are many competing rights to consider and try and balance. The challenge argues that the Act ignores the principle of consent protected under the Charter of Rights and Freedoms and the United Nations Convention for the Rights of Persons with Disabilities. BC’s Mental Health Act is different from similar legislation elsewhere in Canada because once someone is involuntarily admitted, they are deemed to have consented to any psychiatric treatment chosen by the treating physician. This authority does not just apply in hospital but also applies when the person is back in community on extended leave. Other jurisdictions in Canada have other legal steps or safeguards to try and first get consent or put more limits on treatment (substitute decision-makers are just one of these potential safeguards). It’s clear that involuntary admissions are stressful and often traumatic for all involved. Yet, is there a way to protect a patient’s rights while not increasing the distress or fear experienced by family members? For more context, see this editorial from the Canadian Mental Health Association’s BC Division at www.cmha.bc.ca/charter-challenge.
About the author
Deborah is Executive Director of BC Schizophrenia Society and has been a part of the organization for more than a decade in various roles. She is currently looking to further connect and expand with organizations nationally and internationally
Pearson, C. (2015). The impact of mental health problems on family members. Health at a Glance. Statistics Canada Catalogue no. 82-624-X. Ottawa, ON.
Woo, A. (2016, September 17). B.C. patients launch court challenge over forced psychiatric treatments. The Globe and Mail. Retrieved February 25, 2017, from www.theglobeandmail.com/news/british-columbia/bc-patients-launch-court-challenge-over-forced-psychiatric-treatments/article31846031/