Uncovering the impacts of involuntary hospital admissions
How research is illuminating an underexamined judicial practice
Courtroom with people.
Photo: edb3_16
Through courtrooms across Canada, people thought to be experiencing mental health problems can be involuntary admitted to a psychiatric facility. While the aim of involuntary admission is to protect the safety of that person and also of the public, people living in poverty or homelessness are overrepresented among those involuntarily admitted. And, many of them report undergoing additional hardships, both during and after hospitalization. For example, they might find themselves financially worse off afterward because they lost their job. Further, with no new tools and no support following their stay, many end up back in hospital.
To bring issues like these to light, including those unique to Indigenous communities, Canada Research Chair in Mental Health and Access to Justice Emmanuelle Bernheim is examining the outcomes of involuntary admissions, and how the practice challenges individual rights.
“Involuntary admissions may be rooted in compassion, but that does not negate the coercion that is part of it,” says Bernheim. “In many cases, that coercion pushes people deeper into poverty.”
A gap in the legal discourse
Bernheim’s interest in involuntary admissions started in a first-year law class. When the subject came up, she was surprised by the lack of discussion about how the practice infringes on individual rights. To Bernheim, it felt as though it was seen as normal to disregard the rights of people living with mental health problems. She says no legal scholars at the time seemed interested in the human rights implications of this legal process, either. So she began researching the issue herself.
Later, in 2020, a 37-year-old Atikamekw woman named Joyce Echaquan died a preventable death during a stay at a Quebec hospital. Her death sparked conversations about racism and systemic discrimination faced by Indigenous people in health care and social services, including overuse of involuntary admissions.
Recognizing Bernheim’s expertise on involuntary admissions, a reporter covering Echaquan’s case reached out to Bernheim for more information. That set Bernheim on a new path. With her colleague Eva Ottawa, she applied for a SSHRC grant and used it to research involuntary admissions in the Atikamekw community where Echaquan had lived in Manawan, Quebec, located about 270 kilometres north of Montréal.
Exploring involuntary admissions in Manawan
Person walking down a rural lane.
Photo: santividal
Indigenous people who are involuntarily admitted to a psychiatric facility are often sent to hospitals that are hours away from their home communities. In hospital, they’re then overseen by staff who don’t speak their language and who work in a health-care system that doesn’t recognize the value of traditional Indigenous Knowledge.
The system also treats recovery from mental illness as an individual responsibility, rather than, as many Indigenous communities see it, a communal one.
“They are two different worlds,” Bernheim says. “Yet Indigenous people are treated in hospitals as if they’re the same as everyone in that world.”
To gain insights into unique issues faced by Indigenous people dealing with the mental health-care system, Bernheim and her team conducted dozens of interviews in the Atikamekw community. They spoke with people who had been involuntarily admitted to hospital, with police and nurses in the community, and with medical staff and social workers in the hospital to which mental health patients from the community are admitted.
Assessing the impacts of cultural safety measures
The interviews revealed issues around the measures put in place by the Quebec government in the aftermath of Echaquan’s death. The measures included designating “cultural safety agents”, Indigenous people whom medical staff can call on to help in treating others from the same community. The patient’s consent is often not obtained before bringing in a cultural safety agent, so the practice itself actually undermines their autonomy.
A second measure was mandatory cultural safety training, which aims to educate medical staff on the unique cultures and histories of Indigenous people who might come to them for care. In the interviews, staff said they weren’t sure how to actually apply this training to their practice.
As part of the second phase of their research project, Bernheim and her team are delivering workshops in the Atikamekw community. The workshops will explore topics like the differences between mental health and territory health, and how language shapes conceptions of mental health and well-being.
Helping Indigenous communities advocate
The workshops will also inform development of a document based on the research, which Bernheim hopes will empower members of the Atikamekw community to advocate for recognition of the value of traditional Indigenous Knowledge and self-determination in health care.
While Quebec’s laws about involuntarily admitting mental health patients and around applying traditional Indigenous Knowledge in health-care settings are different from those in other jurisdictions across Canada, Indigenous communities throughout the country face similar issues with hospital practices based on Western ideologies. Because of this, Bernheim hopes the resulting document will also support advocacy in Indigenous communities all across Canada.
In the meantime, Bernheim says governments have a lot of work to do to improve the treatment of Indigenous people in public hospitals.
“Our health-care system treats mental health problems as something that’s wrong with the individual,” Bernheim says. “Until the systemic factors behind these issues are acknowledged and addressed, Indigenous people will remain stuck in this cycle of ineffective treatment.”
She also hopes the research will spark broader discussions about the exceptional power Canada’s legal system wields in involuntary admissions, and the threat the practice poses to individual rights.
Want to learn more?
Visit Emmanuelle Bernheim’s website to learn more about her research and publications. Her book The Violence of Therapeutic Justice – An ethnographic Study will be published in 2025.