Nothing is more important for those with serious mental illness than prompt treatment of psychosis. The longer a psychotic episode is allowed to continue untreated, the more pernicious and heartbreaking the illness and the lower the level of eventual recovery. All too often, however, especially when involuntary committal is required, people with schizophrenia are allowed to deteriorate, with grave and sometimes tragic consequences.
This informs almost everything that Pathways does. We advocate for timely treatment of those with serious mental illness. We help families overcome obstacles that are thrown in their way. We particularly fight for involuntary committal where appropriate, so that a person suffering from psychosis, with no insight into his or her own condition and hence spurning treatment, will nevertheless get the help that they need and be freed from the grip of their illness.
• identifying the mental illness early;
• not waiting until someone is profoundly psychotic before acting;
• outreach (going to where an ill person is, to assess them, when that person refuses to go to a psychiatrist or a hospital on their own).
• prompt admission into hospital when hospitalization is called for;
• involuntary committal where appropriate;
• adequate acute care beds at Lions Gate Hospital;
• adequate tertiary facilities, including locked wards, in the Lower Mainland;
• proper lengths of stay in hospital so that patients are stabilized (rather than premature discharge leading to recurrence and the “revolving door” syndrome in and out of hospital);
• assertive case management (actively keeping on top of cases and acting early on danger signals).
A key part of our advocacy is to ensure that professionals understand and respect the B.C. Mental Health Act, especially around involuntary committal. It’s not unusual, for example, for a family member trying to get treatment for an ill relative to be told by a psychiatrist, “Yes, he’s ill, but I can’t commit him, he’s not dangerous.” This, however, is a serious misreading of the Act. A person need not be in danger of causing bodily harm to themselves or others to be admitted. The leading grounds for committal in the Act are to “prevent…. substantial mental or physical deterioration.” In other words, the system has a responsibility to treat someone who is falling seriously ill because of the illness itself and the damage it does. The Act is there to protect people from harm and, according to the Guide to the Mental Health Act, “physical, social, family, vocational or financial harm may be included in the definition of “protection” from serious harms caused by a mental disorder.”
As well as promoting understanding of the Mental Health Act on this point, we assist family members in their own direct efforts – at hospital emergency wards and with outreach workers – to get their ill relatives into hospital when treatment is needed. We explain the committal criteria to them; arm them with copies of the Guide to the Mental Health Act, and in a pinch, if they’re still running into difficulty with the system, will even accompany them to hospital, when we can manage, to help them make their case.
We also stress the importance, for purposes of assessment, of “collateral information”; information, from family members and friends, detailing symptoms of their ill relatives whom they have watched falling ill.
Gradually, as we articulate the need for treatment and for committal where appropriate, and as professionals themselves come to a better understanding of the committal criteria, the system is improving.
Involuntary admission, Section 22 of the B.C. Mental Health Act
Involuntary admission, excerpt from the Guide to the Mental Health Act
An explanation of the committal criteria and how they are to be applied, plus other details, such as police intervention when necessary and judicial orders.
Assistance from Relatives and Others in Obtaining Treatment
Suggestions for families and friends on how to help obtain treatment for someone suffering from the illness, excerpted from the 2005 Guide to the Mental Health Act.