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Involuntary and coercive psychiatric treatment : a critical discourse analysis of British Columbia's Mental Health Act

University of British Columbia

British Columbia’s Mental Health Act (MHA) is a piece of legislation mandating involuntary treatment of people experiencing mental health issues who are unwilling to receive treatment on a voluntary basis. Utilizing Fairclough’s Dialectical–Relational Critical Discourse Analysis, this thesis analyzes how the MHA and a companion document, the Guide to the Mental Health Act, structures practices of overriding usual requirements for consent to care, and removes self-determination for people deemed in need of involuntary treatment. Findings illustrate how the Act and Guide are constructed within socio-historic discourses of biomedicalism, psychiatry, ableism, colonization, marginalization, and neoliberal orientations of governments. These discourses delineate a boundary between ‘normal’ or acceptable behaviour and ‘abnormal’ or unacceptable behaviour deemed in need of correction through psychiatric treatment. The Act and Guide constitute involuntary service-users as patients with “mental disorders” who are too vulnerable or dangerous to care for themselves and therefore in need of protection, from themselves and others. These texts align “mental disorders” with incompetence and incapacity justifying the need for protection. Involuntary and coercive treatment practices authorized by the Act are implemented by nurses, physicians and police officers. The manner in which the Act and Guide constructs patients and protection highlights how discourse operates to produce and maintain dominant social relationships beyond the clinical setting. Thus, the discourses of the Act can be seen as produced within the project of governing and as being central to the maintenance of the social order. Although the MHA’s stated intentions are to reduce harm and provide care for people experiencing mental health issues, this analysis illustrates how discourses employed by these texts participate in the violation of safety and consent of the people it intends to serve - commonly disadvantaging those already experiencing social and economic marginalization. Current health care practices and structures that rely on harmful narratives and discourses based on deficit, vulnerability, dangerousness, and incapacity can be countered by employing discourses of equity. Nurses are ideally positioned to challenge discourses and practices that compromise people with mental health issues’ human rights, entrenching social inequity.

Text

2018-12-12

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/68044

Nursing

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/