Myth:
“Most involuntary patients are too unwell or lack the capacity to understand their rights or to meet with a Rights Advisor.”
Reality:
Most patients have the ability to learn, communicate,
and make decisions, even if they may require support or accommodations to do so effectively. It is important that rights and safeguards are in place to show respect for a patient’s autonomy, especially as involuntary detention is a serious exercise of state authority. Patients whose autonomy are respected are better able to engage with their own recovery, which in turn helps health care providers.
Involuntary patients have rights under the Mental Health Act and under the Canadian Charter of Rights and Freedoms. If a patient is not able to understand their rights following initial admission, there is an ongoing legal obligation to reassess the patient regularly and try again to inform them of their rights.
It is important to be flexible about timing for when a person meets a Rights Advisor. Patients can ask to meet with a Rights Advisor anytime during their involuntary admission. Meetings can be easily rescheduled if the patient is not up to meeting at the scheduled meeting time. Follow-up meetings are offered to patients who need more time to understand their rights and engage with a Rights Advisor.
Myth
“The treatment team already tells patients their rights, so the Independent Rights Advice Service is not necessary.”
Reality
Evidence shows that the current system does not do a good job of informing patients of their rights. Recent investigations by the BC Ombudsperson and the Representative for Children and Youth have shown that many involuntary patients are not properly informed of their rights. There are also complex power dynamics that exist between patients and health care providers. This is particularly true when a patient is involuntarily detained in a facility and given treatment without their consent.
Most healthcare providers only get limited training on rights under the Mental Health Act and may not be able to answer patient questions. In contrast, all Rights Advisors complete more than 50 hours of training on rights and processes under the Mental Health Act. Health care providers are also very busy and have a lot on their plates. Rights Advisors have more time to focus on rights information for involuntary patients.
The service gives involuntary patients access to information and support from someone who is not involved in decisions about their care or treatment. This helps to foster an environment of trust where the patient feels safe asking questions and getting help. Patients who feel safe in communicating their needs and concerns can better engage with their own recovery, which aids the whole health care team.
Myth
“Rights Advisors encourage involuntary patients to challenge their involuntary status.”
Reality
Rights Advisors are neutral: they do not try to influence a patient to take a particular position or action. The role of the Rights Advisor is to explain rights and support the individual to be the decision maker. If the individual chooses to exercise a right, the Rights Advisor supports the individual’s decision.
Under the Mental Health Act, involuntary patients have a long-established right to apply for a review panel hearing or make a court application. While these rights are not new, more patients may become aware of these rights after meeting with a Rights Advisor.
Rights Advisors can also explain the limitations of certain rights to help manage expectations and make sure the correct processes are followed. For example, a Rights Advisor can explain what matters the Mental Health Review Board can decide on. This could help prevent a patient from applying for a review panel hearing for a matter that is outside of the panel’s
jurisdiction.
Myth
“Rights Advisors encourage patients to refuse treatment or to work against their treatment team.”
Reality
Rights Advisors are not healthcare providers and do not provide any comments or input on a patient’s care or treatment.
Rights Advisors are trained to advise patients to start by raising concerns about their treatment with their treatment team. The treatment team must explain the options for treatment and the likely risks and benefits. The patient should be involved in planning care and treatment whenever possible.
Under the Mental Health Act, patients have the right to request an opinion from a second doctor on whether their treatment is appropriate. Rights Advisors can explain the option to request a second medical opinion and help a patient to complete Form 7: Request for Second Medical Opinion.
Myth
“Rights Advisors encourage patients to file complaints and to contact the BC Ombudsperson.”
Reality
Rights Advisors are neutral: they do not try to push a patient to file complaints or report concerns. Rather, Rights Advisors listen to the specific concerns that the person has and then explain the options available for reporting concerns or filing complaints based on their situation.
Rights Advisors are trained to advise patients to start by first trying to resolve their concerns at the local level, such as with their treatment team. Where appropriate, Rights Advisors may also refer patients to the Patient Care Quality Office within a health authority.
If appropriate, a Rights Advisor may refer a patient to the
BC Ombudsperson. The BC Ombudsperson can provide information about where else the person can raise their concerns. In general, the BC Ombudsperson will ask the complainant to use existing complaint and appeal mechanisms within an organization before their office will get involved.
Myth
“Many involuntary patients lack insight into their mental illness, so meeting with a Rights Advisor is likely to do more harm than good.”
Reality
Involuntary detention can be a confusing and frightening experience. Sometimes a patient just wants the chance to meet with a supportive person who will listen to their concerns.
Rights Advisors are independent and have training and experience that make them well-positioned to offer support to involuntary patients. For example, some Rights Advisors have lived experience of the mental health system, either directly or through supporting a loved one. Some have also worked in a peer support role.
In other jurisdictions, rights advice service users have reported that having someone who listened to their point of view was invaluable and reduced their feelings of isolation. Another study found that service users would overwhelmingly recommend rights advice services to others, despite not always getting the outcome they wanted.
References
Newbigging, Karen, et al. The Right to be Heard: Review of the quality of Independent Mental Health Advocate Services, (2012) Lancashire: University of Central Lancashire.; Maylea, Chris, et al. Evaluation of the Independent Mental Health Advocacy Service (IMHA), (2019) Melbourne: Social and Global Studies Centre, RMIT University.; Ontario Psychiatric Patient Advocate Office. Honouring the Past, Shaping the Future: 25 Years of Progress in Mental Health Advocacy and Rights Protection, (2008) Toronto. BC Ombudsperson. Committed to Change: Protecting the Rights of Involuntary Patients Under the Mental Health Act, (2019).; Representative for Children and Youth. Detained: Rights of Children and Youth Under the Mental Health Act, (2021).