Eight guiding principles for a human rights-based mental health system
Principle 1: Recognition of human rights
This quote describes an experience that many people with lived experience of involuntary treatment describe in similar terms: detention and involuntary treatment under the Mental Health Act make them feel less than human. They are forced to continually reassert their humanity, including that they are credible experts about their own bodies, minds, lives, and needs.
Recognition of humanity and the common protections and freedoms that all people need to live with dignity is the core foundation of human rights law. Including the recognition of human rights explicitly in BC’s mental health law would ensure that the rights of people accessing services remain at the centre of the law’s purpose and the ways in which services are designed, delivered, and evaluated. The inclusion of a clear commitment to human rights is the first step towards fulfilling obligations under international human rights agreements.
“Behind every issue, whatever your issue is, there is an entire person. There is a human being and they have human rights.”
“When talking about safeguards, the conversation often shifts to detaining the wrong people or people who aren’t crazy or people who don’t deserve it. The person who is as crazy as you can imagine still deserves to be treated well, still retains all these rights, it’s not about ‘these rights are important for people who actually deserve rights’. The rights are important for everyone, not just the wrong people being detained.”
Given that services are intended to help and the role of service providers is to provide that help, it can be hard to recognize how genuine attempts to help can cause real harm. Even with the best of intentions, making assumptions about what is best for another person can be impacted by unconscious bias and deeply entrenched stereotypes about people with mental health and substance use-related disabilities. Our history is full of examples of people who intended to help others, but who nevertheless caused significant harm to the very people they were trying to help. A human rights framework supports us to focus on the impact of actions rather the intentions.
Other places in the world have already begun to ensure that a recognition of human rights are explicitly embedded in mental health legislation. These include:
Victoria, Australia
Ireland
Norway
Portugal
New Zealand (in progress)
Washington state
Specific principles that could be incorporated into BC’s mental health law to better recognize human rights include:
Any person who has or is perceived to have a mental health or substance use-related disability has the same rights as all other people and those rights must be taken into account in exercising powers under the act and in the provision of services.
A person’s right to respect for their dignity, bodily autonomy, and liberty will be recognised and taken into account in exercising powers under the Act and in the provision of services.
BC’s mental health law will protect and promote the human rights and dignity of people with mental health and substance use-related disabilities and all people subject to the law.
Principle 2: A holistic approach to mental wellness
“Hospitalization and medication didn’t bring back the friends I had lost. It didn’t fill the gaps that were in my resume. It didn’t repair my confidence which had been shattered. It didn’t instantly make me feel comfortable being around other people. I had lost my comfort with others because I had been paranoid for a long time (but never violent). So, my recovery journey involved a lot of rebuilding. I did the rebuilding mostly through volunteering. Medication was not the whole answer. As for the hospital, I had to do my rebuilding in the community, not in an institution.”
As this quote from a person with lived experience clearly illustrates, mental wellness requires more than hospitalization, and mental health is more than the absence of symptoms. However, mental health laws like BC’s Mental Health Act are understood almost entirely through the lens of authorizing detention and involuntary treatment in or through designated facilities. People with lived and living experience often shared with us that they experience the Act and involuntary treatment as almost entirely focused on medication compliance.
The Act does not incorporate broader understandings of health and wellness and it does not protect a right to or establish any services outside of hospitalization and involuntary treatment. It does not recognize the key role of housing, income, community inclusion, supportive relationships, and freedom from discrimination in supporting mental health and recovery from illness. As a result, these aspects of what we all need to be well are missing from BC’s legal scheme related to mental wellness, and are often missing from mental health services.
A human rights framework recognizes the broad and intersecting things we all need to be well, from health services, to adequate housing, to a standard of living that allows us to live with health and dignity, to freedom from violence and discrimination, to access to culturally-based practices, to participation in our communities, to self-determination for Indigenous communities. These rights align and, in many ways, mirror the social determinants of health. They also align with a recovery-oriented approach to mental health, which recognizes wellness occurs in the context of a person’s life – relationships, community membership, standard of living, and experiences of discrimination all deeply shape our ability to recover or be well.
Jurisdictions outside of BC have recognized the importance of more broad and holistic understandings of mental wellness in their mental health laws. These include:
Nunavut
New Zealand
Victoria, Australia
Tasmania, Australia
Specific principles that could be incorporated into BC’s mental health law to take a more holistic approach to mental wellness include:
Mental health and substance use services will be comprehensive, accessible, inclusive, equitable, and free from stigma.
A person living with mental health or substance use-related health issues or psychological distress will be provided with access to a diverse mix of care and support services.
BC’s mental health law will promote conditions so that people can experience good mental health and wellbeing, as well as recover from mental health or substance use-related health issues or psychological distress, and so they can connect and coordinate with other support services to respond to the broad range of circumstances that influence mental health and wellbeing.
BC’s mental health law will recognize the importance and contributions to wellbeing of a person’s chosen connections with family, friends, kin, and community.
Principle 3: Access to quality health services
“But they didn’t like let me stabilize or anything. They just put me on the injection. The first time I got it, I walked from my place. And then, in order to walk back, I literally had to stop in the back alley and lay down for two hours in the pissing rain on the concrete. I was so fucking tired. I could not physically go on and my eyes lay down for two and a half hours and had a nap in the pouring rain. ”
This quote illustrates the lived experience of accessing mental health services that do not offer person-centred support. The result of an experience like this could easily lead to distrust of service providers and treatment options; by failing to take basic steps to monitor the impacts of a new medication, the service providers and treatment put the individual in a situation that undermined their safety and dignity.
The right to mental health includes the right to equitable access to mental health services, and those services must meet core human rights standards in order to support the dignity of the individual accessing them. The UN Committee on Social, Economic and Cultural Rights has interpreted this to mean they must be:
Available: services must be timely and adequate in quantity to meet community needs, including related to determinants of health.
Accessible: services must be affordable, equitable, geographically and physically accessible.
Acceptable: services must be person-centred, respectful of the individual, culturally safe and responsive to different identity factors like Indigeneity, race, culture, language, gender, sex, and (dis)ability; they must also benefit the wellbeing of the individual.
Quality: services must be provided in accordance with evidence and professional ethics.
There are well documented issues with the inadequacy of mental health and substance use services in BC. Some key services not covered by the public health care system and publicly funded services subject to long waitlists. Members of the Indigenous Leadership Group shared with us that in many parts of the province, people are forced to travel long distances and leave their home communities, families, traditional territories, and support networks in order to access services. In addition, when people do get access to mental health service in BC, there are well documented issues with systemic racism throughout the health system and publicly reported concerns about inhumane and uncoordinated treatment.
When there is a failure to provide access to quality voluntary mental health and substance use health services, the perceived need for involuntary services increases: a member of the Indigenous Leadership Group shared with us, “The lack of services means that people must be in significant crisis before they can get access.” Further, as a Lived Experience Expert described, detention in hospital does not necessarily result in result in access to a range of treatment options.
“I don’t actually ever remember getting treatment. I got medicated against my will… I didn’t get any therapy, just medication and being held.”
BC’s over reliance on involuntary treatment, combined with the documented human rights violations occurring in BC’s involuntary treatment system, also undermines the quality of mental health services in BC because mental health professionals are unable to provide services in accordance with their professional ethical requirements. For example, in 2021 the Nurse and Nurse Practitioners of BC issued a position statement documenting how the Mental Health Act and BC’s current approach to involuntary treatment undermines the ability of nurses to provide patient-centred care.
Places outside of BC provide examples of the ways in which quality services could be expressly incorporated in BC’s mental health law. These include:
Nova Scotia
Nunavut
Victoria, Australia
Denmark
Washington state
Alaska
A specific guiding principle that could be incorporated into BC’s mental health law to ensure quality services is:
Mental health services and treatment will be:
Comprehensive and high quality;
Clinically safe and evidence-based;
Accessible;
Respond in a timely way to people’s needs;
Person-centred and consistent with a person’s values and wishes;
Provided as close to a person’s home community as possible;
Culturally safe and recognize a distinctions-based approach to cultural safety for First Nations, Inuit, and Métis people; and
Recognize the wishes and needs of people from diverse backgrounds.
Principle 4: Nothing about us without us - participation in law, policy, and services
A core element of international human rights agreements is the idea that communities impacted by a law, policy, or service should have a role in decision-making related to those matters; this is a necessary requirement for signatories of human rights agreements in order to provide effective health services. In other words, people with lived and living experience should have a meaningful role in decision-making that impacts them on both a personal and a systemic level.
This is especially important for people with mental health and substance use-related disabilities because they have historically been treated as incapable and decisions about them have been and continue to be made on their behalf without their participation or consent. This treatment continues today, as a person with lived experience highlighted in relation to existing treatment planning processes:
“The involvement of the patient, like, since it’s your mental wellness plan, you should probably be involved in it. But they don’t involve you at all. Like, they don’t ask you. ”
On an individual level, the right to health under the Convention on the Rights of Persons with Disabilities has been interpreted to mean that governments have an obligation to take progressive steps to eliminate the exclusion of people from decisions about their own health care and bodily autonomy.
On a systemic level, the Convention on the Rights of Persons with Disabilities requires that countries closely consult with and actively involve persons with disabilities, including children with disabilities, through their representative organizations. The UN Committee on the Rights of Persons with Disabilities has provided additional guidance, clarifying that there is a difference between disability organizations for people with disabilities versus respective organizations made up of and controlled by people with disabilities. In particular, the Committee has made it clear that organizations that provide services for people with disabilities, research organizations, and family member-based organizations do not replace the role of disability organizations for the purpose of consultations and participation, although they hold important expertise.
The importance of the participation of people with mental disabilities in decision-making about their own lives is reflected in the mental health laws of places outside of BC:
UK (in its mental health law review)
Nunavut
Scotland
Victoria, Australia
Denmark
Netherlands
Specific principles that could be incorporated into BC’s mental health law to ensure “nothing about us without us” include:
A person accessing mental health or substance use health services will be encouraged and supported to take part in decisions that impact their life and their views should be centred in decision-making.
A goal of BC’s mental health law will be to recognize and respect the right of people with mental health or substance use-related health issues or psychological distress to speak and be heard in their own voices, from their own experiences and from within their own communities and cultures.
The lived experience of a people with mental health or substance use-related health issues or psychological distress will be recognized and valued as having expertise that makes them valuable leaders and active partners in the mental health and substance use system, including in the design, delivery and evaluation of services.
The lived experience a people with mental health or substance use-related health issues or psychological distress will be recognized as necessary expertise in any design or amendments to provincial mental health law and policy in BC.
Principle 5: Compliance with the UN Declaration on the Rights of Indigenous Peoples
“What is cultural safety in this context? It means being cognizant of historical and intergenerational trauma, and the impacts of colonization while recognizing that, the systems in place that have inflicted trauma are still in active existence – one of the ways that this system exists is through the Mental Health Act.”
Cultural safety and humility have quickly become buzz words in the health care system in an effort to address systemic racism and improve accessibility for Indigenous people accessing services. However, defining what cultural safety looks like and taking practical steps to achieve it is a challenging path, as this quote illustrates.
There is immense diversity in approaches to wellness among different Indigenous communities in BC, but a core concept is that people, earth, and everything around us are deeply interconnected and that wellness comes from internal and external balance that goes beyond the absence of illness. These continue to be strong and sustaining wellness practices today.(1)
Despite this strong foundation, First Nations, Inuit, and Métis people in BC experience disturbing and immense health inequities due to the historic and ongoing impacts of colonization and discrimination. BC’s history of and continued genocide, colonization, and racism against Indigenous people was and is rooted in the intentional eradicating, limiting, or suppressing of Indigenous rights, relationship with the land, cultural and familial practices, and systems of health and wellness.
Many specific colonial tools have had and continue to have direct impacts on Indigenous wellness systems by undermining traditional ways of staying well and access to health knowledge and treatments. These include the historical and ongoing separations and interruption of families, communities, and knowledge sharing structures through day and residential schools, discriminatory Indian Act policies, child apprehension, and criminalization.(2) The forced displacement of communities from traditional territories interrupted the ability of Indigenous people to maintain balance with the environment and culturally based health practices.(3) BC also has a legacy of racist and discriminatory health services, from Indian Hospitals and segregated services to violations of bodily autonomy to entrenched systemic racism that continues today.(4)
First Nations, Métis, and Inuit people have continually resisted that systemic suppression to maintain these foundational wellness practices. They continue to be sustaining practices today despite colonial interference. However, this ongoing racism, colonialism, and genocide has had and continues to have detrimental impacts on the health and wellbeing of Indigenous people, creating significant health inequities.
The colonial mental health and substance use health system, and especially detention and involuntary treatment, can be experienced as an ongoing form of control, coercion, and loss of self-determination for Indigenous people. It is crucial that the self-determination of First Nations, Métis, and Inuit communities be at the centre of any mental health law in BC. Given BC’s commitment to implement the UN Declaration on the Rights of Indigenous People (UNDRIP) via the Declaration on the Rights of Indigenous Peoples Act, compliance with and principles from UNDRIP should be included as guiding principles.
Other places outside of BC provide examples of how Indigenous-specific rights and protections that align with UNDRIP can be incorporated into mental health law. These include:
Queensland, Australia
Nunavut
New Zealand
Victoria, Australia
Specific principles or areas that could be incorporated into BC’s mental health law to promote the rights of Indigenous peoples and compliance with UNDRIP include:
BC’s mental health law and services will be created, delivered and evaluated in compliance with the United Nations Declaration on the Rights of Indigenous Peoples.
Indigenous self-determination is a foundational principle to improve mental health and wellbeing outcomes of Indigenous people in BC.
Indigenous communities will be supported to develop their own self-determined wellness supports.
Mental health and substance use services will recognize that Indigenous people's ongoing connection to culture, community, and territory and the importance of this connection for their mental health and wellbeing.
All mental health and substance use services will recognize, respect, and support the distinct cultural rights of First Nations, Inuit, and Métis people and their right to receive culturally safe holistic services throughout BC.
First Nations, Inuit, and Métis people will be provided with mental health and substance use services in a way that recognises, is consistent with, and supports access to their traditions or customs.
Principle 6: Prioritize Intersectional Equity
“[A] lot of women coming home from Hastings may or may not have had sexual trauma in their past. So when you take them to a hospital and six security guards who are all men, strap them to a bed, rip their clothes off them. And this is done repeatedly. This might cause some long-term mental unrest for those women. And there’s never any counseling given about that, or any, like, nobody even acknowledges that or talks to you about it, or you know what I mean? And I think in that, like regard, gender should come into play… Like, we’re not necessarily all equal. We don’t all have the same past, or the same, like experiences and it should come into play. Like why? Why does there need to be six men security guards in the room when you’re getting changed.”
This quote illustrates the ways that gender and previous experiences of gender-based violence deeply impacted this individuals’ lived experiences under the Mental Health Act. It also asserts one of the many ways in which the use of force, coercion, and restriction on freedoms does not impact all people in the same way. When a person accesses mental health services, they are more than their health issue. Lived Experience Experts reminded us that they are a full and complex person with many aspects to their identity outside of their current health needs.
Prioritizing intersectional equity can include ensuring that different cultural, religious, spiritual, sex, gender identity, gender expression, age, and racial identities are respected in the mental health and substance use system. This respect can reduce harms and support their health. If identity is not respected, their wellbeing can be undermined. One Lived Experience Expert described the ways in which their role as a new mother and caregiver was not respected during their detention:
“In other countries, they have mother baby units for people that are experiencing that mental health crisis. Where I could have kept [my baby with me]. Maybe not in the initial stages when I was really unwell, but 3-4 days later, I was doing so much better. I could have been spending so much more time bonding, soaking up those moments that you’re supposed to be soaking up.”
The right to mental health includes a requirement to ensure equal access to services, including ensuring they are respectful and appropriate, for the communities that experience the biggest gaps in health outcomes or barriers to access. Equitable access means more than just physical access or availability; it also requires ensuring that services are safe for everyone and do not create unintended impacts or barriers due to personal identity factors like race, Indigeneity, gender, sex, (dis)ability, spirituality, or place of origin/migration status. It also means taking an intersectional approach that recognizes that multiple aspects of a person’s identity can overlap to shape their experience. In addition, international human rights treaties set out further specifics related to the right to non-discrimination and the right to mental health for communities that have historically and currently experience discrimination in the health system.
Many places outside of BC have already taken significant steps to name and prioritize equity in the principles that guide the application of their mental health laws. These include:
Northwest Territories
Tasmania, Australia
Scotland
Denmark
Queensland, Australia
Victoria, Australia
Specific principles that could be incorporated into BC’s mental health law to prioritize intersectional equity include:
Decisions that affect a person who is subject to BC’s mental health law will respect that person’s cultural, linguistic, and spiritual or religious ties, as well as their gender, sex, (dis)ability, race, ethnicity, Indigeneity, and social condition.
Mental health and substance use health services will respect the wholeness of a person and their identities beyond their current health needs.
Mental health and substance use health services will be responsive and accessible to any needs related to personal identity, including:
Race or ethnicity;
Indigeneity;
Gender, including experiences of gender-based violence;
Sex, including reproductive health needs;
Gender identity, including gender-related health needs;
Family status, including caregiving responsibilities;
Age, including the needs of children and youth;
Religion, faith or spirituality;
Geographic location;
Language or communication needs;
Culture; and
Social condition.
Principle 7: Promote self-determination at every opportunity
“We’re defaulting to involuntary treatment as opposed to using it as a last resort. You go to the hospital and it’s a pre-determined outcome rather than what needs to happen. It feels like a box being ticked.”
The quote above from a Lived Experience Expert expresses how the health care system can default to certification under the Mental Health Act without meaningfully providing access to voluntary services and options.
People with mental health and substance use-related disabilities have been subject to deeply entrenched discriminatory stereotypes about their capacity to make decisions in their own lives. The Committee on the Rights of Person’s with Disabilities has noted this continues today through laws that interfere with parenting rights, the denial of the right to control your own body, and the right to liberty. These stereotypical assumptions and denials of legal capacity are rooted in ableism.
BC’s Mental Health Act is outdated in its treatment of the legal capacity of people who experience detention and involuntary treatment. For example, despite other laws in BC that centre a presumption that a person is capable of making their own decisions, including the Adult Guardianship Act and the Health Care (Consent) and Care Facility (Admissions) Act, BC’s Mental Health Act does not include this presumption. In other words, adults with any other kind of health issue or disability in BC are assumed to be able to make their own decisions unless they are assessed otherwise in accordance with legal requirements. People experiencing detention and involuntary treatment under the Act do not get the benefit of this assumption; instead, the deemed consent model sends a message that there is assumption that they are incapable. Other laws in BC also commit to minimizing restrictions as much as possible, but the Mental Health Act does not.
These other laws that presume a person is capable until assessed as incapable and require services to minimize restrictions appear to be based on an understanding that treating a person as incapable, using coercion, or force come with harms that are that should be avoided whenever possible.
Some people with lived experience of involuntary treatment report great benefit from their involuntary treatment. Others report being deeply harmed and traumatized. Many report experiencing both benefits and harm from their experiences. However, it is clear that involuntary treatment carries the potential for harm and trauma.
BC’s current approach in its mental health law fails to acknowledge, make visible, and consider the harm that can be caused by the use of coercion, which can cause trauma. That is the case even if not everyone experiences these negative impacts and if some people find involuntary treatment to be a positive experience. One person with lived experience described the way that choice can be taken away and the importance of offering choice at every possible avenue:
“When we are treated involuntarily, choice is often taken away from us at many levels and about many things. It’s important to remember that even when someone is unwell and perhaps not able to make the same decisions they would normally make in some areas because their perception of reality is different, it doesn’t mean that they can’t make decisions in every area. People can still have opportunities to exercise choice. Many of the choices I would have liked to make when I was hospitalized were the same then as they would be now, when I am well.”
Human rights require the progressive realization of laws and services that recognize people as experts in their own lives. This means BC must be taking constant steps towards supporting the legal capacity and self-determination of all people with disabilities in every way possible – self-determination supports wellbeing and coercion can cause harm. It is necessary to expressly recognize these impacts in the law because of the historic and ongoing power imbalances in the mental health and substance use health system.
When a person needs mental health or substance use support, and especially when they are in crisis, they need access to services that they perceive as, and that actually are, safe and inclusive for them. They need services that will treat them as full humans and centre them in decision-making. This is a core aspect of trauma-informed practice, and for Indigenous people, it can help prevent the perpetuation of state control that is ever present in colonialism. People with lived and living experience describe it in simple and effective terms:
“If you make a person feel like they have no control, no agency, you’re making it more traumatic and setting them up for dependence, resentment, hostility towards the system.”
There is no shortage of examples of mental health laws from outside of BC that incorporate these principles. These include:
Nunavut
Nova Scotia
Northwest Territories
Ireland
Portugal
Ireland
Northern Ireland
Denmark
the Netherlands
Norway
Victoria, Australia
Queensland, Australia
Tasmania, Australia
South Australia
Hawaii
Alaska
North Rhine Westfalia, Germany
Berlin, Germany
Specific principles that could be incorporated into BC’s mental health law to ensure that self-determination is promoted at every opportunity include:
Unless the contrary is demonstrated, every adult is presumed to be capable of making decisions about their health care. A person’s way of communicating with others is not, by itself, grounds for deciding that they are incapable.
The primary mode of providing mental health and substance use services, including admission to hospital, will be through voluntary means.
Mental health and substance use services will be offered in a way that maximizes the self-determination of the person receiving service regardless of their legal status as a voluntary or involuntary patient.
People receiving mental health and substance use services will be supported to make decisions and to be involved in decisions about their assessment, treatment, and recovery including when they are receiving involuntary treatment. Their views will be prioritized.
Any restriction on the liberty or autonomy of people, and any interference with their rights, dignity, and self-respect, will be kept to the minimum necessary in the circumstances.
Coercion and force will be used only as a last resort.
Mental health and substance use services will recognize and consider that the use of coercion can cause harm even when it is intended to help.
Principle 8: Accountability and oversight strengthens services
When extraordinary power over a person’s rights is granted in law, human rights law requires adequate transparency, oversight, and accountability to monitor how the power is being used and to ensure it is not abused or used unfairly. People with lived and living experience are clear about the need to ensure accountability is part of BC’s legal approach to mental health:
“It should have to be justified each time they override a person’s choice. Not just making them involuntary, but all the little choices too. It would be onerous, but that’s transparency.”
Accountability measures include ethical data collection to understand how the powers authorized under a mental health law are being used, transparency about the results, and systemic monitoring and oversight that is independent from the system authorized to exercise power. They also include effective independent individual and systemic complaints mechanisms with accountability for responding to complaints and access to justice for people whose rights are impacted.
Lived experience of the existing accountability mechanisms often reveal they lack independence and can feel ineffective to the people using them. A Lived Experience Expert critiqued the lack of transparency and independence in BC’s existing complaints process, stating:
“Well, I guess we’ll fast forward to the end of the story, because they don’t explain that you don’t have anybody to complain to that’s independent. Not in the beginning of the process anyway. Because the people you’re complaining to is the quality office they are the hospital and so it was the patient quality care review [office], they’re the health authority. So why complain to the people that already hurt you about the people that hurt you…”
BC’s Ombudsperson has documented a glaring lack of transparency, systemic oversight, and safeguards in the face of the powers granted in the Mental Health Act. This deficiency has been assessed as evidence of a cultural problem in BC’s mental health system that does not place adequate importance on the rights of patients. Despite a systemic investigation documenting these issues, the Ombudsperson’s recent investigative update report notes that last three years have seen only minimal improvement on basic compliance issues, with the majority of detentions still violating the basic legal requirements in the Act. Issues with transparency, data collection, and basic legal compliance remain in BC’s current system; a shift to a rights-based approach will only underscore the importance of remedying these problems.
There is often an assumption that the purpose of safeguards is limited to preventing or addressing wrongful detention and involuntary treatment. Safeguards can certainly help avoid a situation where someone is detained inappropriately, but they also benefit every person who is subject to the legal power of the Mental Health Act.
BC has had more robust oversight in the past. In response to a 1994 investigation by the BC Ombudsperson related to the conditions, treatment, and accountability at Riverview, BC created the role of Provincial Mental Health Advocate. The goal of that role was to monitor and report to the public on the state of mental health services and the mental health system in BC. The role was established in 1998 only to be eliminated in 2001 after a change in government. Since then, there as been no coherent, dedicated system of accountability and oversight in BC’s involuntary treatment system or mental health and substance use health system more broadly.
Significant work is needed to make systemic and meaningful shifts in BC’s mental health and substance use health system so that the individuals accessing services see those shifts in their experiences. A guiding principle acknowledging the role and importance of accountability and oversight, and mandating that BC’s mental health law and its application be rooted in these principles, would be a strong foundation to start cultural change.
Jurisdictions outside of BC illustrate how principles related to transparency, accountability, and oversight can be included in mental health laws to support human rights. These include:
Nunavut
Nova Scotia
Ontario
Scotland
Ireland
Victoria, Australia
Norway
Specific principles that could be incorporated into BC’s mental health law to promote accountability include:
BC’s mental health law and services will promote, encourage, and foster the establishment and maintenance of high standards and good practices in the delivery of mental health and substance use services and to take all reasonable steps to protect the rights of people subject to the law.
A goal of BC’s mental health law will be to provide for independent oversight and safeguards in relation to powers exercised under the law.
BC’s mental health law and services will facilitate tracking data related to mental health and substance use-related health issues of people in BC, including but not limited to the use of involuntary treatment and the use of force.
Sources
(1) Truth and Reconciliation Commission of Canada, Canada’s Residential Schools: The Legacy – The Final Report of the Truth and Reconciliation Commission of Canada Volume 5, (2015) at 171; Mary Ellen Turpel-Lafond, “In Plain Site: Addressing Indigenous-Specific Racism and Discrimination in BC Health Care” (2020) at 154-55; National Inquiry into Missing and Murdered Indigenous Women and Girls, Reclaiming Power and Place: Final Report, Volume 1a (2019) at pages 416-17.
(2) TRC Volume 5 at 139-40; Monique D Auger, “’We need to not be footnotes anymore’: understanding Métis people’s experiences with mental health and wellness in British Columbia, Canada” (2019) 176 Public Health 92 at 96; National Inquiry Volume 1a at 432 -37; First Nations Health Authority, https://www.fnha.ca/wellness/wellness-for-first-nations/our-history-our-health.
(3) Billie Allan & Janet Smylie, “First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada” (Toronto, ON: the Wellesley Institute, 2015) at 5-7; Auger at 96; National Inquiry Volume 1a at 432 -37; https://www.fnha.ca/wellness/wellness-for-first-nations/our-history-our-health.
(4) In Plain Sight at 41, 155-165; National Inquiry Volume 1a at 432; https://www.fnha.ca/wellness/wellness-for-first-nations/our-history-our-health.
For all other sources, please see the full publication.