CCHR supports calls for investigation into involuntary commitment and forced treatment constituting torture in Canadian psychiatric hospital. Says it’s a global problem, including in the U.S.

By CCHR International
July 10, 2023

The practice of involuntarily detaining individuals labeled as “mentally ill,” depriving them of their rights, and forcing them to undergo treatments that can harm them is a worldwide problem, including in the U.S. An estimated 907,000 individuals are involuntarily committed every year to psychiatric facilities across the U.S., Europe, Australia, New Zealand the United Kingdom—or about two people every minute.[1] Recently, Canada exemplified just how wrong involuntary hospitalizations can be, citing Royal Jubilee Hospital in British Columbia (BC). Among British Columbians ages 15 and older, forced detainment rose from 14,195 to 23,531 (65.7%) between 2008/2009 and 2017/2018 compared to a 0.5% increase in voluntary admissions. There was a 162% increase in involuntary commitments among children and youth.[2] In 2019, over 10,000 people were certified (deemed as able to be treated involuntarily), incarcerated, and treated against their will under British Columbia’s Mental Health Act.[3]

One of the most vocal critics of Royal Jubilee is whistleblower, Dr. Anna Sylwestrowicz, a retired Clinical Assistant Professor of Anesthesiology Pharmacology and Therapeutics at the University of British Columbia and Clinical Assistant Professor in the Department of Anesthesiology, Pain and Perioperative Medicine at Island Health. She resigned in January 2020 and has liberally exposed her concerns on Twitter: “I have been a physician for 32 years and I am disgusted by what I have researched and witnessed at Royal Jubilee Hospital Mental Health Services in Victoria BC.”[4] She wants to see a thorough investigation of the Royal Jubilee Hospital’s practices.

Families have been outspoken about involuntary commitment and patient abuse at the facility. Kyle Fawkes said his father, Glen, committed suicide less than three weeks after being released from the facility. His family’s concerns came as the mental health system, especially Royal Jubilee, faces continued scrutiny for alleged mistreatment of patients, according to Capital Daily.

“It’s a situation that has left the hospital on the receiving end of hundreds of online horror stories and repeated calls to overhaul both the hospital’s psychiatric services and the way mental-health patients are cared for in the province,” said Capital Daily.[5]

Royal Jubilee is one of several healthcare facilities under Island Health, or the Vancouver Island Health Authority, a publicly-funded healthcare provider in British Columbia.[6]  

The psychiatric hospital came under scrutiny from the British Columbia Ombudsperson, Jay Chalke, who, in 2019, found the province’s hospitals and health institutions were regularly violating the Mental Health Act. In March 2019, the Ombudsman issued a 132-page report, “Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, about health authorities’ compliance with the Mental Health Act in a single month, June 2017.” In that one month, more than half of patients who had been involuntarily admitted under British Columbia’s Mental Health Act had no record of being notified of their rights—a requirement by law. About a quarter of patient files were missing a Consent for Treatment form. Less than a third contained any record of patients’ relatives being notified of their commitment.[7]

“Involuntary detention and treatment is the most intrusive form of mental health care available,” said Ombudsman Chalke. “The state, when it uses such an extraordinary power, has a critically important duty to follow the law. This includes properly completing documentation of what is happening to an individual and why. To not do so is not only unacceptable, it is contrary to law.”[8]

Georgette McBain, 75, would no doubt agree. In 2014, she won her case to be discharged from Royal Jubilee Hospital after being held there against her will for four months. “I was treated with medication from morning until night,” McBain said. She was initially admitted to Royal Jubilee suffering from pneumonia. However, once admitted, doctors recommended that she undergo psychiatric assessment. She left the hospital. Hours later, police went to her condominium and forcibly returned her to the hospital, McBain said. On March 14, she was placed on the geriatric psychiatric ward. “I went through hell,” she said.[9]

She applied to have her case heard before the British Columbia Mental Health Review Board. On June 25 of that year, the Board determined that McBain’s involuntary commitment did not meet the requirements of the Mental Health Act, and she was discharged.[10]

In 2016, dozens of former patients of Royal Jubilee Hospital’s Psychiatric Emergency Services (PES) shared stories online of being patronized and belittled. Complaints continued in June 2020 when Ella Hale, 18, voluntarily admitted herself to psychiatric service. She stayed overnight in the unit and saw a psychiatrist the following morning.

“She was very quick to dismiss my problems as teenage problems,” Hale said. While in college, Hale met Emma Epp, 19, who had also been treated at the facility, and together, they started a Facebook group on February 2021, where they shared their experiences. The group, titled “PES: A Pathetic Excuse for Support,” had more than 513 members and 89 posts by March 15, 2021. PES refers to Psychiatric Emergency Services. Facebook group allegations aimed at PES staff range from shaming and victim-blaming to emotional abuse and dismissal from the unit while patients were still on heavy doses of drugs.[11]

Having to go to Royal Jubilee Hospital’s Psychiatric Emergency Service “is terrifying,” said Epp. “My brother had cancer for his whole life … [But] my mom says she would rather have a kid with cancer than a kid with mental illness, I think that shows how broken our system is.”[12]

Dr. Sylwestrowicz further stated, “I believe our mental healthCARE at Royal Jubilee in Victoria BC is complete quackery based on pseudoscience… hopefully an external independent audit will be performed and random audits of the specialist physicians who prescribe long acting injectable neuroleptics and potent combinations of antidepressants, stimulants and antipsychotics….”[13] She believes some patients have received Electroconvulsive “Therapy” (ECT)—the passage of up to 460 volts of electricity through the brain causing a grand mal seizure—“over 70 times, while on cocktails of medications, and injected long acting antipsychotics.”[14] 

The medical records of patients receiving ECT at Royal Jubilee Hospital “need to be reviewed by an independent reviewer. Most are ‘involuntary’ and on cocktails of psychotropic medications…,” she wrote on Twitter.[15]

In 2022, the British Columbia Ombudsperson revisited the recommendations made in 2019 to protect the legal rights of people involuntarily detained, finding rights still lacking. In some cases, he said, “facilities used standard rubber stamps to purport to authorize treatment for individual patients instead of describing the actual treatment proposed for that specific patient. In other cases, physicians failed to explain why a person met the criteria for involuntary admission yet the patient was nonetheless admitted.”[16]

Such forced hospital commitments are contrary to directions given by the World Health Organization and United Nations organizations that point out involuntary commitment is a violation of the UN Convention on the Rights of Persons with Disabilities. Both the U.S. and Canada have adopted the convention but Canada took it a step further, ratifying it as law in 2010.[17] The UN High Commissioner for Human Rights recently proclaimed that forced psychiatric treatment “must be abolished.”[18]

That’s a reiteration of comments made in 2014 when the UN specified that policies must be developed to respect the person’s autonomy, will, and preferences and abolish laws that permit forced treatment. People have the right to be free from involuntary detention in a psychiatric facility and not to be forced to undergo forced treatment.[19]

In 2015, the UN Committee on the Rights of Persons with Disabilities again called for the elimination of the use of forced treatment, including seclusion and various methods of restraint in medical facilities, including physical, chemical and mechanic restrains. The Committee found, like patients do, that these practices are not consistent with the prohibition of torture.[20]

In June 2023, Health Justice, a non-profit organization that advocates to improve the laws and policies that govern coercive health care in British Columbia, issued a report on “Coercive mental health and substance use treatment is part of BC’s problem, not the solution.” There is a documented lack of accountability in that use of power, it said. The use of seclusion and restraints is unregulated.[21] 

At least one province in Canada has responded to some of these abuses by enacting a law that requires a coroner’s inquest into any death in a New Brunswick psychiatric facility unless the death is determined to be from natural causes. The provision, called Hillary’s Law, creates a mandatory requirement for a coroner to conduct an inquest under specified circumstances related to non-natural deaths in custody, in a hospital facility, or where the use of force may have been a factor.[22]

Involuntary detainment in a psychiatric facility is a form of coerced treatment. An “emergency hold” of patients for assessment is typically 72 hours. Psychiatric wards can hold someone for up to three days if the psychiatrist believes the person is a threat to themselves or others. Based on their opinion, they can advise a further 14-day hold and the patient. Laws can vary by state, and country by country.[23]

Dr. Peter Gøtzsche, a physician and respected international medical researcher says: “Forced treatment in psychiatry cannot be defended, neither on ethical, legal or scientific grounds. It has never been shown that forced treatment does more good than harm, and it is highly likely that the opposite is true.”

Dr. Gøtzsche continues: “The evidence we have tells us that forced treatment increases the harm done not only to patients but also to others. Violence breeds violence, but perhaps the strongest argument against forced drugging and ECT is that, apart from psychiatric patients, only soldiers at war are forced to run risks against their will that might kill them. The difference is that soldiers have usually chosen themselves to become soldiers whereas psychiatric patients have not chosen to become psychiatric patients.”[24]

“We need to abolish our laws about this, in accordance with the United Nations Convention on the Rights of Persons with Disabilities,” says Gøtzsche. [25]

CCHR concurs and says that it should not be limited to the Royal Jubilee Hospital in Canada but to all psychiatric facilities in Canada, the U.S., and around the world.

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[1] Luke Sheridan Rains, Tatiana Zenina, et al., “Variations in patterns of involuntary hospitalisation and in legal frameworks: an international comparative study,” The Lancet, Vol 6, May 2019, https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(19)30090-2.pdf; Gi Lee, M.S.W. and David Cohen, M.S.W., Ph.D., “Incidences of Involuntary Psychiatric Detentions in 25 U.S. States,” Psychiatric Services, 72:1, Jan. 2021, https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201900477

[2] Jackson P. Loyal, MPH, et al., “Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018,” Canadian Journal of Psychiatry, Vol. 68, Issue 4, 6 Oct. 2022, https://journals.sagepub.com/doi/full/10.1177/07067437221128477

[3] Rob Wipond, “The case for electroshocking Mia,” Focus on Victoria, 28 Apr. 2020, https://www.focusonvictoria.ca/investigations/the-case-for-electroshocking-mia-r18/

[4] https://twitter.com/annasylwestrowi/status/1672266278449610753

[5] Martin Bauman, “Family Calls for Overhaul of Royal Jubilee’s psychiatric emergency services and Mental Health Act, Capital Daily, 3 Sept. 2022, https://www.capitaldaily.ca/news/royal-jubilees-psychiatric-emergency-services-mental-health-act

[6] https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/government-finances/public-accounts/2020-21/sup-e/vancouver-island-health-authority-fs-2020-21.pdf

[7] Martin Bauman, “Family Calls for Overhaul of Royal Jubilee’s psychiatric emergency services and Mental Health Act,  Capital Daily, 3 Sept. 2022, https://www.capitaldaily.ca/news/royal-jubilees-psychiatric-emergency-services-mental-health-act; “Systemic Investigation Update: Report on the Implementation of Recommendations from COMMITTED TO CHANGE: Protecting the Rights of Involuntary Patients under the Mental Health Act,” Ombudsperson British Columbia, Systematic Investigation Update, July 2022

[8] https://bcombudsperson.ca/news_release/hospitals-failing-to-follow-legal-safeguards-for-mentally-ill-patients-involuntarily-detained-b-c-ombudsperson-investigation-finds/

[9] Cindy E. Harnett, “Woman confined in psychiatric unit for 4 months wins release,” Times Colonist, 26 July 2014, https://www.timescolonist.com/local-news/woman-confined-in-psychiatric-unit-for-4-months-wins-release-4611915

[10] Cindy E. Harnett, “Woman confined in psychiatric unit for 4 months wins release,” Times Colonist, 26 July 2014, https://www.timescolonist.com/local-news/woman-confined-in-psychiatric-unit-for-4-months-wins-release-4611915

[11] MLA Adam Olsen, “‘Belittled and dismissed:’ Former patients of Victoria Psychiatric Emergency Services call for change,” Victoria News, 16 Mar. 2021, https://www.vicnews.com/news/belittled-and-dismissed-former-patients-of-victoria-psychiatric-emergency-services-call-for-change/

[12] https://www.cbc.ca/news/canada/british-columbia/royal-jubilee-psychiatric-treatment-call-for-change-1.5965691

[13] Dr. Anna Sylwestrowicz on Instagram, https://www.instagram.com/p/CmqB_zlryOQ/

[14] https://twitter.com/annasylwestrowi/status/1672720887441936384

[15] https://twitter.com/annasylwestrowi/status/1673055679366701056

[16] “Ombudsperson finds only one-third of recommendations are implemented three years after report calling for improved safeguards for people involuntarily detained in B.C. psychiatric facilities,” British Columbia Ombudsperson, 26 July 2022, https://bcombudsperson.ca/news_release/ombudsperson-finds-only-one-third-of-recommendations-are-implemented-three-years-after-report-calling-for-improved-safeguards-for-people-involuntarily-detained-in-b-c-psychiatric-facilities/

[17] http://www.ccdonline.ca/en/international/un/canada/making-domestic-implementation-real-and-meaningful-feb2011

[18] Rob Wipond, “The case for electroshocking Mia,” Focus on Victoria, 28 Apr. 2020, https://www.focusonvictoria.ca/investigations/the-case-for-electroshocking-mia-r18/

[19] Peter C. Gøtzsche, Simon Vinther, and Anders Sørensen, “Forced Medication in Psychiatry: Patients’ Rights and the Law Not Respected by Appeals Board in Denmark” Clin Neuropsychiatry, v.16(5-6); 2019 Oct, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650169/

[20] Peter C. Gøtzsche, MD, “Abolishing Forced Treatment in Psychiatry is an Ethical Imperative,” Mad In America, 17 June 2016, https://www.madinamerica.com/2016/06/abolishing-forced-treatment-in-psychiatry-is-an-ethical-imperative/

[21] https://www.healthjustice.ca/blog/coercive-mhsu-treatment

[22] “Hillary’s Law passes, calling for automatic inquests after suicides in psychiatric units,” CBC, 19 June 2023, https://www.cbc.ca/news/canada/new-brunswick/hillary-hooper-suicide-coroner-s-act-changes-1.6879268

[23] https://themighty.com/topic/mental-health/negative-effects-forced-involuntary-mental-health-treatment/

[24] Peter C. Gøtzsche, MD, “Abolishing Forced Treatment in Psychiatry is an Ethical Imperative,” Mad In America, 17 June 2016, https://www.madinamerica.com/2016/06/abolishing-forced-treatment-in-psychiatry-is-an-ethical-imperative/

[25] Peter C. Gøtzsche, MD, “Abolishing Forced Treatment in Psychiatry is an Ethical Imperative,” Mad In America, 17 June 2016, https://www.madinamerica.com/2016/06/abolishing-forced-treatment-in-psychiatry-is-an-ethical-imperative/