'Alarming' increase in involuntary detentions of youth under Mental Health Act: watchdog

As the NDP government reconsiders a bill to detain youth up to a week in hospital following a drug overdose, a report by B.C.’s children’s advocate says the mental health system doesn’t have adequate safeguards to support that.

Jennifer Charlesworth on Tuesday released a 119-page report — Detained: Rights of Children and Youth under the Mental Health Act — which includes 14 recommendations.

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It says the number of children and youth receiving involuntary mental health services in hospital psychiatric units and mental health facilities jumped an “alarming” 162 per cent between 2008 and 2018.

Involuntary child and youth admissions rose to 2,545 from 973 between 2008 and 2018, raising questions about the adequacy of the system of care and treatment and its ability to avoid unnecessary involuntary detention, the report said.

“While involuntary detention and treatment is an important part of the continuum of services and supports, it must be complemented by a robust array of voluntary services, supports and treatment and used sparingly and as a ‘last resort’ given the implications,” said Charlesworth. Involuntary detention must be done in a way to help rather than hinder healing, she said.

Charlesworth’s hopes the report is “good fuel” for the government’s ongoing review of Bill 22, a proposed amendment to the Mental Health Act to detain youth up to a week after an overdose to stabilize them, develop a treatment plan and reach parents or guardians. It was “paused” in July after the children’s watchdog, chief coroner and others criticized it and the B.C. Greens refused to support it.

Premier John Horgan hopes revamped legislation will return this year.

B.C. Green leader Sonia Furstenau said the report further underscores her party’s concerns; more than 20 are based on the Charter of Rights and Freedoms, the UN Declaration of the Child, and the disproportionate risk to Indigneous youth.

“One can hope that with today’s heartbreaking report … the premier will now understand why he should not force this legislation through as written,” said Furstenau.

The report found that about 10 per cent of youth are involuntarily admitted because of substance use concerns. “That’s a bit of an alarm for us,” said Charlesworth.

Almost 40 per cent of children and youth are involuntarily hospitalized for mood disorders, followed by neurotic disorders, Schizophrenia and delusional disorders, substance use disorders, adult personality disorders, and psychological development and behaviour disorders.

B.C.’s Mental Health Act, enacted in 1964 and updated since, recognizes that for some people, involuntary care is necessary to keep them, or others, safe. The aim of involuntary admissions is treatment for mental disorders.

A youth can be involuntarily or voluntarily admitted to a mental health facility with the rules varying slightly if they are older or younger than 16.

“It’s a powerful tool and it’s not always protective or therapeutic for these young people,” said Charlesworth. “For the young people we heard from, detention was largely experienced as one more trauma, on a trail of traumas.

“The bottom line is that the Mental Health Act is not designed with the needs of children and youth in mind.”

The report reviewed the files of 116 youth. The representative’s office spoke to 14 people from across B.C. who are now age 16 to 29 but were between 10 and 18 when they were first admitted under the Mental Health Act.

The youth, who had serious mental health concerns, generally didn’t question their diagnosis but rather how they were treated — at best stabilized and more often restrained with sedatives or seclusion, the report said. The report found inadequate oversight of restraint and confinement measures.

“Clearly, the time has come for government to devote special attention to how the Mental Health Act can be improved,” the report said.

The report said data was insufficient in a number of areas — either not collected or varying greatly from one health authority to the next — making some analysis impossible.

The Ministry of Health, for instance, informed the representative it believes Indigenous children and youth are disproportionately hospitalized involuntarily, yet there is no data available on the number of Indigenous children admitted under the Mental Health Act, the report says.

The report cites a lack of opportunity for young people detained under the Mental Health Act to have a say in treatment options and to stay connected with family and culture to help deal with underlying causes of their symptoms, the report says.

The representative heard young people while in detention most yearned for “connections with family, friends and community to support healing, instead of the loneliness and separation felt in the hospital setting.”


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