B.C. is providing clarity to doctors on the ability to administer treatments such as overdose-prevention drugs to youth held involuntarily during mental health and addiction crises.
Doctors will be told they can use substance-use treatments on children held involuntarily under the Mental Health Act.
Dr. Daniel Vigo, the province’s advisor on psychiatry, toxic drugs and concurrent disorders, is recommending the use of long-lasting Buprenorphine for youth admitted to the hospital while undergoing mental health and addiction crises. This drug can prevent overdose and stop an addict from getting high from opioids for up to 30 days.
This will be new to some doctors. Involuntary care is only available for psychiatric treatment, so Vigo is clarifying that substance-use disorder is a mental health condition, and that this drug can be used in that context.
“What’s new today is that I’m saying that we can use it with the consent of the parents for a kid who is in the moment suffering a mental disorder,” Vigo said.
Vigo issued this guidance to ensure doctors know when they can authorize involuntary treatment for youth under 19, and when to involve families.
“We should always protect the rights of the child and always use the least restrictive intervention possible,” Vigo said. “In exceptionally severe cases, the least restrictive intervention is admitting and treating the child, even if it is against the wishes.”
Some of this guidance is counter to how many doctors in the province have practised up to this point, he said.
Previously, many doctors thought that parents could not be contacted when a young person close to adulthood is undergoing a crisis. The new guidance says that a child 16 or under can be treated “voluntarily” with the consent of a parent, and involuntarily if 17 to 19 years old.
Either way, the family should be involved and informed, Vigo said.
“When the child or adolescent shows up at a hospital suffering from a severe disorder that impairs their ability to engage in care, we should immediately connect with the child’s parents or guardians to understand the background and define what the best treatment plan is, never leaving the family out,” he said.
Brenda Doherty appeared alongside Vigo at the announcement and told the story of her 15-year-old daughter, using it as a stark example of what can happen when families are not involved.
“She was admitted into a hospital, and she was assessed as a mature minor and released without my knowledge of her even being there, and she was given a bus pass, and she left, and she died a day later,” Doherty said, while struggling to hold back tears. “Had we had something like this in place, it may have helped save her life.”
These changes will also allow doctors to treat patients without fear that they are doing something wrong.
Premier David Eby says he believes this will help solve what he called an “alarming” finding that emergency room physicians have conflicting understandings of their authority under the Mental Health Act.
He also acknowledged that this guidance may be controversial.
“This is not an issue where everyone’s going to agree,” he said. “But I hope that we can all agree that we need to do our absolute best to provide frontline treatments and supports to kids, if it means that they’re not going to have a brain injury, and it means they’re not going to die of an overdose.”
There have been opposition and protests to some of the recent guidance on involuntary care, and a Charter challenge is working its way through the B.C. courts, arguing that forced care violates people’s rights.
Recent legislation passed by the B.C. government earlier in the week provides legal cover for doctors should this case determine these are rights violations. The government has also recently introduced a program to ensure people held against their will, including those under 16, can communicate with a rights advisor.