The British Columbia Review Panel: Factors Influencing Decision-Making

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In Canada, administrative tribunals exercise substantial authority in deciding the fate of individuals who have been civilly committed.1 These tribunals make decisions regarding committed individuals who want to reject some aspect of their care, either a refusal to take medications or a desire to leave the hospital. In British Columbia, Review Panels deal exclusively with individuals seeking release whose physicians will not release them from hospital. The Panel's task is to determine whether the conditions for involuntary detention continue to be met. When the Panel releases someone, it is by definition against medical advice. Review Panel members are sometimes criticized by hospital staff and in the media for interfering with “medical” decisions for which they have little expertise. In fact, however, the tribunals are legal, and not medical, decision-makers, whose role is to determine whether the statutory requirements for overriding an individual's choices have been met. The present study examines one such tribunal, the British Columbia Review Panel, with a view to clarifying the factors that influence decision-making and determining how patients released by the Panel fare in the community.2 We have gathered data for all the patients in the largest provincial mental health facility who applied for a Panel in the calendar year 1994 (N = 279). In this article, we present the results of the 90 patients who went on to complete Review Panels during the calendar year. We examine the factors that influence Review Panel decision-making for these individuals. Further, we followed 248 individuals into the community, either after being released by the Review Panel or by their physicians later in the same calendar year, in order to identify relevant differences between the two groups. The article begins with a brief overview of civil commitment and review in British Columbia in order to set the framework within which the Review Panel operates. After setting the stage we move on to present the findings of our study that are relevant to review panel decision-making. Finally, we discuss the implications of the findings for law reform relating to the Review Panel.

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International Journal of Law and Psychiatry, v. 23, issue 2, p. 173-194