Standing outside the Vancouver Mental Health and Substance Use Services building on a rain-soaked Tuesday morning, Sarah Chen recalls the day her brother disappeared into British Columbia’s mental health system. “One day he was in crisis, the next he was admitted under the Mental Health Act, and then—nothing. For weeks, we barely knew where he was or what treatment he was receiving.”
Sarah’s experience reflects a troubling reality in BC’s mental health care system: no one knows exactly how many residents are currently on extended leave from psychiatric facilities while still under involuntary care orders. This administrative black hole has advocates, families, and even healthcare providers deeply concerned.
“It’s like having a detention system without a proper registry,” explains Jonny Morris, CEO of the Canadian Mental Health Association’s BC Division. “We track people in the criminal justice system with great precision, but somehow lose count of vulnerable people under mental health detention.”
Extended leave, commonly known as “psychiatric leave,” allows patients initially detained in hospital to continue treatment in the community while technically remaining under involuntary status. While intended as a less restrictive alternative to hospitalization, it comes with serious implications for patients’ rights and freedoms.
The data gap emerged last month when researcher Laura Johnston from Health Justice requested specific numbers on extended leave patients through freedom of information requests. The Ministry of Health responded that it “does not have a record containing the total number of people currently on extended leave.”
This admission surprised even those familiar with the system’s challenges. BC’s Mental Health Act has long faced criticism for having some of Canada’s least protective safeguards for involuntary patients. A 2021 report by the BC Ombudsperson found “widespread non-compliance” with existing legal safeguards across the province’s psychiatric facilities.
When I visited St. Paul’s Hospital psychiatric unit last year for an unrelated story, a psychiatric nurse who requested anonymity told me, “Sometimes I wonder if we’re truly keeping track of everyone. The paperwork becomes overwhelming, and people can slip through administrative cracks.”
The practical implications of this data gap are profound. Patients on extended leave must comply with treatment plans, typically including medication, and can be returned to hospital if they don’t adhere to conditions. Yet without centralized tracking, questions arise about consistent follow-up, appropriate review of detention orders, and whether some patients remain under involuntary status longer than necessary.
The Ministry of Health acknowledges the data limitation but points to regional health authorities as responsible for tracking their own patients. “Each health authority maintains records of individuals on extended leave within their region,” a ministry spokesperson wrote in an emailed statement. “We’re currently exploring options to improve provincial data collection.”
For Indigenous communities, the lack of transparency carries additional weight. Harold Williams, a mental health advocate from the Squamish Nation, describes a pattern of disproportionate impacts. “Our people already experience higher rates of involuntary treatment. When there’s no accountability through proper record-keeping, it perpetuates a system of colonial control over Indigenous minds and bodies.”
The legal community has also raised alarms. Melanie Benard, a disability rights lawyer with over a decade of experience in mental health law, points out that extended leave “exists in a strange legal limbo with fewer oversight mechanisms than in-hospital detention, despite having similar restrictions on liberty.”
According to data from the BC Schizophrenia Society, approximately 15,000-20,000 people are involuntarily admitted to psychiatric facilities in BC each year. However, without tracking extended leave numbers, it’s impossible to know how many remain under involuntary status after hospital discharge.
Family members like Sarah Chen find themselves navigating a fragmented system with little guidance. “We eventually found my brother was on extended leave, but it took weeks of phone calls and showing up in person to get information. No one seemed to have a complete picture of his situation.”
Jay Chalke, BC’s Ombudsperson, emphasized the importance of proper record-keeping in a 2019 interview: “Involuntary psychiatric detention represents one of the most significant exercises of state power. Robust documentation and data collection aren’t just administrative niceties—they’re essential safeguards against potential rights abuses.”
Some healthcare providers suggest the problem goes beyond record-keeping to resource limitations. Dr. Sujatha Ramakrishna, a psychiatrist who has worked within the BC system, notes, “When mental health teams are chronically understaffed, patient tracking becomes secondary to crisis management. We need designated administrative support specifically for maintaining these critical records.”
The Community Legal Assistance Society (CLAS) has repeatedly called for comprehensive reform of BC’s Mental Health Act, arguing that the province lags behind other Canadian jurisdictions in protecting patients’ rights. The absence of independent review for extended leave decisions remains particularly problematic.
As the rain intensifies outside the mental health services building, Sarah Chen reflects on her brother’s journey. “He’s doing better now, but I still wonder: how many others are out there, technically detained by the state but essentially unaccounted for? Everyone deserves better than to disappear into a data gap.”
The Ministry of Health has indicated plans to address the data collection issue as part of a broader mental health system review, though no specific timeline has been provided. For now, patients, families, and advocates continue navigating a system where one of the most fundamental questions—how many people are currently under state control—remains unanswered.
