Improving patients’ understanding of their rights under British Columbia’s Mental Health Act

In a 2011 survey of mental health patients in BC, 43% of respondents who had been involuntarily hospitalized said that their rights under the Mental Health Act were not explained to them in a way they could understand. One possible reason for this lack of understanding is that the document used to give rights information to involuntary patients, the statutory Form 13, may not be an effective communication tool. Another possible reason is that the rights-information process doesn’t meet patients’ information needs. Using a qualitative approach anchored in a transformative research paradigm, which seeks to redress power differences by involving the community of interest in designing and implementing solutions, I aimed to identify key features of a patient-centred rights-information process. First, I user tested Form 13 with people who had experienced involuntary hospitalization. The main findings were that the form’s content was unclear and had an intimidating and disempowering tone. Armed with this feedback, I coordinated a patient-oriented research team to develop a new suite of rights-communication tools to supplement Form 13. I user tested the tools with people who had experienced involuntary hospitalization. Participants found the suite of tools friendlier to use compared with Form 13. They appreciated that the many formats within the suite would accommodate different communication preferences and would give patients several opportunities to learn about their rights. I did a thematic analysis of the full set of user-testing interviews to learn more about involuntary patients’ experiences with the rights-information process. A key theme was that patients wanted more transparency and open communication about every aspect of their hospitalization. They also wanted clinicians to foster a culture where patients could feel safe talking about rights. The uncertainty from a lack of information exacerbated participants’ mental distress and made some fearful of hospitalization. A better understanding of what they could do under the legislation and how much they could participate in treatment decisions would reduce feelings of powerlessness and could help involuntary patients engage in their own recovery.