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Many involuntarily admitted to psychiatric facilities without proper paperwork: report

A study of people involuntarily admitted to a B.C. psychiatric facility found they had no or incomplete paperwork in almost three-quarters of cases, according to a report Thursday by B.C. Ombudsperson Jay Chalke.
B.C. ombudsperson Jay Chalke recommended.

A study of people involuntarily admitted to a B.C. psychiatric facility found they had no or incomplete paperwork in almost three-quarters of cases, according to a report Thursday by B.C. Ombudsperson Jay Chalke.

About five admission forms are legally required to be completed when someone is involuntarily committed. Chalke’s report found just 28 per cent were done in cases studied across the province.

“I think we were taken aback when we saw the results,” he said in a phone interview.

Chalke called involuntary detention and treatment the “most intrusive” form of mental-health care available.

Involuntary admissions are often a last resort for mentally ill people who are at risk of harming themselves or others, so “the state, when it uses such an extraordinary power, has a critically important duty to follow the law,” Chalke said.

The forms used in an involuntary admission to a mental-health facility ask for information including reasons for detention, consent and description of the treatment. The forms require that patients’ rights are explained, including the right to challenge their detention, and that notification is given to relatives.

Chalke’s 124-page report, titled Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, is based on a study of involuntary admissions in June 2017 in B.C.

It makes 24 recommendations, including regular compliance audits with annual targets, improved records management and increased public reporting; training staff and physicians in the necessity of completing forms and compliance with the Mental Health Act; and creating an independent rights adviser service that would work in designated facilities and provide advice to patients about the circumstances of their detention and their options.

Mental Health Minister Judy Darcy said she was surprised by the low compliance rate of hospitals.

“That’s why we’ve moved very, very quickly,” Darcy said. “We accept the intent of all those recommendations and we’re moving forward to implement them.”

The government received a draft copy of the report months ago and began working on the recommendations, she said. Darcy said the province’s goal is 100 per cent compliance and it will honour the timelines in the compliance review.

By June 30, for example, the Health and Mental Health and Addictions ministries must work together with health authorities to establish clear provincial standards to achieve 100 per cent compliance.

Darcy said training programs are being developed for doctors and health-care providers, and a video is in the works to help patients and their families understand their rights.

Chalke said he’s encouraged that the government has committed to act on the recommendations, but will be satisfied only when they are completed.

About 15,000 mentally ill people were involuntarily detained in one of B.C.’s more than 70 psychiatric facilities in 2016-17 — a number that has grown by about 70 per cent in the past decade, the report said. The average detention was 14 days.

The analysis found there was no “consent for treatment” form in 24 per cent of patient admissions across all health authorities, although there was wide variation among hospitals.

The lowest compliance was nine per cent at the University Hospital of Northern British Columbia, and the highest was 100 per cent in Richmond and Peace Arch District hospitals.

Also showing high compliance were the Burnaby and Royal Columbian hospitals at 98 per cent. Nanaimo Regional General Hospital was in the top half with 91 per cent.

Victoria General Hospital, however, was in the bottom five hospitals, with consent for treatment forms filed in only 57 per cent of cases, according to the report.

At Cowichan District Hospital, consent to treatment forms were filled out in 62 per cent of cases, and at Royal Jubilee Hospital, in 77 per cent of cases.

Of six health authorities, Island Health is in the bottom half. A total of 79 per cent of involuntarily admitted patients in June 2017 files had consent for treatment forms in their files.

The fact that many busy hospitals had full compliance or high compliance suggests there is no serious impediment to completing the forms, Chalke said. “It’s clearly something can be done, but it takes a change in culture.”

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