Election 2020: Fixing the Mental Health System

By Moira Wyton, The Tyee, Local Journalism Initiative Reporter

Experts and advocates are hoping the next B.C. government will focus on expanding preventative mental health-care services and overhauling  the aging and “outdated” Mental Health Act to protect individual dignity  in care.

Expanding mental health care

And support for Black,  Indigenous and racialized communities should be at the forefront of all  strategies for mental health care, they say.

All three parties say they would expand  access to affordable mental health-care services, particularly for  children and youth through schools and Foundry youth centres, which support youth from 12 to 24 with health and wellness resources, including free counselling.

The Greens want to see that happen through a  $1-billion investment that would include providing some counselling  under the Medical Services Plan, while the BC Liberals want to fund  psychiatric nurses in schools to support kids from a young age.

North Vancouver-Seymour  Liberal candidate Jane Thornthwaite said “this is the kind of system we need to help children and to prevent  mental illness to exacerbate into self-medication and substance use.”

Esquimalt-Metchosin NDP  candidate Mitzi Dean said a New Democrat government would open 10 more  Foundry centres in rural communities, doubling the number currently in  operation. It would also fund dedicated mental health teams in schools,  she said.

Updating the Mental Health Act

But the parties’ positions are much more  mixed when it comes to addressing deep and complex issues with the  Mental Health Act and involuntary treatment in the province. 

A March 2019 report from the provincial ombudsperson recommended establishing individual  rights advice service for people involuntarily detained, which the NDP  attorney general accepted at the time.

But more than a year later nothing has  happened, and experts say the opposition to the NDP’s Bill 22 point  towards the need for a far-reaching and independent review of the act  under which people are detained in the first place.

Bill 22 would have amended the act to allow  the health-care system to detain and involuntarily treat youth who  overdose for up to seven days, which experts said would increase the risk of overdosing again upon release. 

The bill was opposed by a coalition of Indigenous and health organizations, including the Union of BC Indian Chiefs, and was paused by the NDP in July, just over a week after being introduced.

“The act grants a huge amount of power over  people who are really, really vulnerable,” said Kendra Milne, executive  director of non-profit advocacy organization Health Justice. “We would  love more reporting on how often it’s used and under what  circumstances… because the more people feel coerced and disempowered,  the more traumatized they can be.”

Dean would not comment on whether the NDP  would consider an independent review of the legislation, saying its  priority would be on service provision. The Greens also do not have an  official stance on the act.

Thornthwaite, however, was emphatic that a review is “a long time overdue” and she would support such a process.

But a BC Liberal promise to establish a  Safe Care Act to more forcefully be able to admit youth who use  substances into treatment gives Milne cause for concern. 

“Part of the public conversation is really  related to the idea that the solution to these social problems is to  remove people’s rights and force them out and into less visible places,  instead of really changing those systems,” said Milne.

This is particularly true for Black,  Indigenous and racialized people who are involuntarily treated and  detained at higher rates than white people across Canada.

Black, Indigenous and  racialized mental health experts say it is essential that any mental  health-care strategy focus on the specific needs and cultural contexts  of the communities most likely to experience mental health issues.

Since COVID

spring survey found that 38 per cent of Canadians feel their mental health has  deteriorated since the pandemic began, and the rates are even higher  among racialized individuals.

Cultural stigma around mental health,  language barriers, affordability concerns and a significant lack of  racialized mental health-care professionals all contribute to an acute  lack of culturally safe and competent care in B.C.

“For some people, experiencing really bad  mental care can be so traumatizing that it really can be worse than not  having sought that care in the first place,” said Benjamin Cheung, a  cultural psychology lecturer at the University of British Columbia.

“So if there isn’t a system that addresses  the needs of racialized people, then we’re actually creating more  problems, and they become exacerbated, and there’s a distrust in the  mental health-care system.”

Publicly funded

Cheung said recruiting and supporting more  racialized mental health-care professionals, particularly in  universities and schools, is essential to address the need among  students. Most don’t have access to extended benefits to cover mental  health services, so services need to be publicly funded, he said.

Cheung added students he speaks to face  huge issues affording mental health care, and those who have coverage  through family often don’t feel they can access that care.

“It’s just layer upon layer of  affordability issues… and it doesn’t matter if they can afford it if  the care isn’t good,” said Cheung.

Shawna Narayan, a UBC graduate student  studying mental health services among racialized people in Metro  Vancouver, says even incorporating diverse cultural references and  translation in online resources could go a long way for people looking  for support online.

“[Racialized adults] face so many barriers,  and it’s just magnified in mental health care because they face so much  stigma,” she said.

Narayan said focus groups for a coming paper highlighted poor treatment in emergency rooms for people in mental health crises.

“The point of care is often when it’s a  crisis, and there needs to be more services and treatments and therapies  available before then,” said Narayan.

The Greens want to review the practice of  wellness checks by police in B.C. — which have recently and continue to  cause the deaths of several Indigenous and racialized people in Canada —  and to expand the number of integrated mental health crisis teams that  respond to these calls.

The Liberals would also expand the number  of these teams available. The NDP don’t have a stance on the issue as  the review of the Police Act they initiated before the election is on  pause.

 Lyana Patrick, an expert in Indigenous  health and community well-being at Simon Fraser University, said the  conversation around mental health needs to shift from focusing on the  individual to building strong communities if the system is to serve the  particular needs of Indigenous peoples.

She wants the next government to focus more  on community-scale solutions to mental health issues faced by  Indigenous people as a result of historical and ongoing harms of  colonialism, and on the importance of connection to culture and  community for healing.

“I do really see the huge importance of  self-determination in health programming and services, and capacity of  Indigenous organizations to deliver that themselves,” said Patrick, who  is Dakelh from the Stellat’en First Nation in northern B.C.

She and Cheung agree that educating  professionals and working to make the mental health-care system safer  for Indigenous peoples and other racialized communities is important,  but that the much-needed transformative change and care is already being  done by those communities themselves.

The next government should fund this work and then work with communities, the said.

“I’m not sure we have the luxury to wait or  completely transform [the current system] to meet Indigenous needs,”  said Patrick. “We just have to do all this work at the same time.”

Candidates in North Island Riding

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