For My Father, Who Should Have Lived

Oct. 10, 2020 — World Mental Health Day — my father, Glen Fawkes, died by suicide on a highway bridge north of Nanaimo. His death came just 19 days after he was discharged from Royal Jubilee Hospital’s Psychiatric Emergency Services, where he’d been involuntarily held and discharged under the Mental Health Act.

The Mental Health Act is a piece of provincial legislation that sets policy for “the treatment of the mentally disordered who need protection and care.” Under the Mental Health Act, a person can be involuntarily admitted for mental health treatment in hospital if three criteria are met: they have a mental illness that requires treatment; they have deteriorated significantly or pose a risk to themselves and others; and they cannot be admitted voluntarily.

My family — the Fawkes family — is calling for changes to the Mental Health Act because it’s clear that B.C.’s current approach to mental health is inadequate. For months, we were desperate to connect my dad with vital and necessary mental health supports. Despite our best efforts, we turned up with nothing. No one seemed to take our concerns seriously as we left emergency rooms and doctors’ offices feeling disheartened and terrified for his health.

Two years later, we look to policy-makers for help. Wrought by the pandemic, toxic drug crisis and stagnant legislation, health authorities are still struggling to cope with the harsh reality — people are sick, addicted and dying. The government is facing monumental pressure to reform legislation. The Mental Health Act is now a hot-button issue for experts and advocates.

My family has added to the mounting pressure on provincial leaders, and we’re still waiting for answers about the details of my father’s days in hospital, receiving mental health care, before he died by suicide.

We’re calling for changes to the Mental Health Act to provide more stringent accountability mechanisms, more robust consent arrangements, and stipulations to ensure the involvement of loved ones, families and peer support groups throughout assessment, admission and treatment processes.

We brought my father to the hospital several times in the months leading up to his death — we were desperate for help. We knew his mental health was declining rapidly and he was appearing to show signs of psychosis. We wanted to be by his side, to support him as he was admitted to hospital and to be a part of his recovery plan.

But those wishes were never granted. We were barred entry to facilities and provided little opportunity to speak with his health-care practitioners. We were forced to watch from afar as physicians dictated his path — based solely on their “opinions” of short assessments conducted in isolation.

My family is not alone in this fight for change. Here also is the mammoth legal battle against the province, which is challenging whether the Mental Health Act is compliant with the Canadian Charter of Rights and Freedoms.

For their part, the academic community has taken extraordinary steps to highlight the Mental Health Act’s paltry respect for human rights. A recent article in the journal Health, authored by four leaders in nursing education, denounced the act’s coercive style of care, adding “advocacy for structural change is needed.”

Then there are the government’s own damning reports. Earlier this year, the Special Committee on Reforming the Police Act recommended that “an all-party parliamentary committee undertake a broad review of the Mental Health Act.” This came after two jarring investigations by the B.C. Ombudsperson, which outlined health authorities’ flagrant non-compliance with provincial law.

Finally, there is the overwhelming outcry from patients and families like mine, pleading the government to reconsider its strategy.

While the province was proactive in announcing the appointment of mental health rights advisers and the decriminalization of illicit drug possession earlier this year, many see these changes as peripheral to the core problem: the Mental Health Act is fundamentally out of step with B.C.’s reality.

At its heart, the Mental Health Act is meant to help “provide people with mental disorders the treatment and care they need,” according to the 2005 Guide to the Mental Health Act.

Specifically, it sets out “authority, criteria and procedures” for admitting and treating individuals who pose a risk to themselves or others.

In practice, the act has instilled a technocratic approach that relies on involuntary hospital admissions. B.C. now posts the highest rates of mental health detentions in the country — a statistic that is more reminiscent of punishing legislation than our efficiency in administering treatment. One needn’t look far online to read about appalling anecdotes of forceful, rash and careless treatment at psychiatric treatment centres around the province.

Part of the issue, advocates argue, are the legal requirements for admission. From the moment a patient enters a facility, the cards are stacked against any form of collaborative, community-led care. Legally, it is only physicians that determine whether a patient should be detained.

Patient wishes and family input are beyond consideration. If admitted under the act, patient consent to treatment is automatically assumed — a legal practice known as “deemed consent.”

Collectively, these procedures have been flagged by the United Nations, domestic legal associations and academics, as being well outside the international norm for the protection of human rights.

The other issue is that B.C. health authorities are seemingly divorced from consequence.

Despite health authorities violating the Mental Health Act in more than 50 per cent of cases — as reported by the B.C. Ombudsperson in 2019 and again in 2022 — the Ministry of Mental Health and Addictions appears uninterested in providing meaningful ways for patients whose rights were violated to receive redress, instead opting to “support compliance” related to administrative procedures.

The health authorities’ accountability to the public is strained by extraordinary opacity. In 2019, the B.C. Office of the Ombudsperson reported that authorities were operating “without any effective public oversight,” adding “the absence of statistical information impedes community groups, advocates and other external stakeholders from providing informed and effective feedback on the institutional mental health system.”

Reading between the lines: the veiling of service makes it easy for rights to be steamrolled and maltreatment to be ignored.

And, if families or patients start asking questions, there’s a bureaucratic barricade that challenges experience-driven advocacy. In my family’s case, we continue to wait — over 480 days and counting — for Island Health’s comments on the quality of my father’s pre-suicide care.

Ethically, politically and legally, the situation is clear: B.C. is suffering mental health degradation under a searing system. Provincial laws are failing to restrain the power of practitioners and administrators — allowing sloppy service, undignified treatment and bureaucratic stonewalling to run their course.

B.C. will not emerge from its mental health crisis without supporting collaborative, community led care that offers upstream interventions, and, when necessary, a more respectful and co-ordinated transition to involuntary treatment. But this must be married with legal reform: B.C. cannot fall back on the ratcheting of repressive regulation. We need accountability to hold government bodies accountable, we need consent procedures that respect human rights, and we need family and community members collaborating with health-care practitioners to design treatment plans.

With more community-based initiatives emerging and mental health being connected to the province’s worsening record on homelessness, substance use and crime, now is the time to make change — to seriously scrutinize our strategy, to invest in collaborative care, and to let the ashes of tragedy re-emerge as a legacy. But that can only begin if our politicians accept the need for a public, consultative and independent review of the Mental Health Act.

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For more information about the Fawkes family letter writing campaign, which aims to voice concerns about mental health policy in B.C., email [email protected]. Check out the social media movement via the hashtag #ReviewTheAct on Twitter and Facebook.