Content warning: This story mentions overdose, substance use, the toxic drug crisis and death. Please read with care. Find a list of local and general resources for support, harm reduction, emergencies and more at the bottom of this newsletter.
Last month, The Discourse asked readers in the Cowichan Valley, Nanaimo and Comox Valley what they wanted local MLA candidates to address in the lead up to the B.C. election on Oct. 19.
More than 350 readers responded to the survey. When asked what issues candidates should tackle, 69 per cent selected “healthcare,” 65 per cent selected “homelessness/social supports” and 59 per cent selected “housing.” A little more than 28 per cent of respondents identified “recovery supports” as a priority as well.
Many respondents also shared questions for candidates.
“Do you support involuntary care and support for those who are on the streets and can’t care for themselves?” one person asked.
“How will you prioritize recovery for people with addiction issues?” another asked.
Unregulated drugs kill an average of six people in B.C. every day, according to the BC Coroners Service. Although B.C. declared a state of emergency in 2016, people with substance use disorders seeking recovery services continue to face barriers due to a lack of available beds and services for diverse and unique needs.
As B.C. political candidates respond to community concerns about addiction and recovery access, the issue of involuntary treatment has emerged as a key point of debate and contrast between parties.
The team at The Wren, a sister outlet to The Discourse, reached out to experts to better understand how involuntary treatment is currently used within the mental healthcare system.
Does B.C.’s mental health act currently allow for involuntary addictions treatment?
The Mental Health Act defines the conditions under which a person can be involuntarily treated for psychiatric conditions. Each year about 20,000 people are taken into involuntary care, the highest rate among the provinces in Canada.
While the number of voluntary admissions to mental health facilities has remained stable over the last decade, the number of involuntary admissions is on the rise, according to the latest B.C. ombudsperson report on protecting the rights of involuntary patients.
Under current laws, having a severe substance use disorder does not mean you will receive involuntary treatment. Existing laws protect our rights to make decisions over personal health care. If we are incapable of understanding and making such a decision, the law protects our right to have the people who know us best, like family, make decisions for us.
Involuntary psychiatric treatment, on the other hand, can only take place if a person has a disorder that impairs their ability to function and associate with others and if they “cannot suitably be admitted as a voluntary patient,” among other conditions.
Once a series of criteria are met involving a medical examination and certificate, a person can be committed to receive psychiatric treatment involuntarily.
B.C. is the only place in Canada where a person with involuntary status is “deemed” to consent to all forms of psychiatric treatment, and this aspect of B.C.’s Mental Health Act is the subject of a constitutional challenge launched by the Council of Canadians with Disabilities that is currently in the courts.
“British Columbia’s force treatment provisions are the most draconian of any jurisdiction in Canada,” explains Dr. Isabel Grant, professor at the Allard School of Law specializing in criminal law.
“Once you are civilly committed under our legislation you have no right to refuse treatment.”
About 20 per cent of people involuntarily treated under the BC Mental Health Act have a primary diagnosis of substance use disorder, according to health researchers. And this figure is on the rise, as the independent advocacy organization Health Justice outlines in a fact sheet and statement.
However, limited oversight and data collection makes it hard to know how people with substance use disorders are being involuntarily treated, explains Kim Mackenzie, director of policy at Canadian Mental Health Association (CMHA) BC.
“We actually don’t know what’s going on for folks who are apprehended, detained or on extended leave under the Mental Health Act. We don’t know if the treatment that they’re receiving is effective, and we have no line of sight or oversight over that system — which is effectively removing somebody’s rights,” Mackenzie says.
As CMHA and other health experts point out, there is a lack of evidence in support of involuntary treatment for people with substance use disorders and some research shows the health outcomes are worse. Involuntary treatment can also increase a person’s risk of overdose and death when they leave, leading health experts to warn against this approach.
“This all points to some major issues with the current administration of the Mental Health Act,” Mackenzie says, a concern echoed by the BC Ombudsperson. “There’s very little oversight as to what people are experiencing while they’re being detained and whether it’s actually effective in improving their well being.”
What are the party positions on involuntary treatment?
Over the last several years, David Eby’s government has made efforts to further expand involuntary treatment.
In 2020, the B.C. government proposed amendments to the Mental Health Act that would give health care providers the power to deliver involuntarily treatment for up to seven days to youth who had experienced drug poisoning.
B.C.’s former chief coroner, alongside legal advocates like Pivot Legal Society, quickly responded with concerns about the potential for serious unintended consequences of the legislation “including the potential for an increase in fatalities.”
Through consultation with young people who use drugs, B.C.’s Representative of Children and Youth published a report raising concerns about the “alarming” increase in involuntary youth detentions under the existing Mental Health Act.
This may deter young people from trusting health care providers and seeking help, the report warned, and the reliance on involuntary care called into question “the adequacy of the voluntary, community based system of care and treatment.”
The proposed amendments fell apart.
Since then, discussions on how the government should care for the very small percentage — roughly three per cent — of people living with mental illnesses at a higher risk of violence have continued.
On Sept. 4, 2024, two violent unprovoked attacks in downtown Vancouver from a person with a lengthy history of mental health-related incidents brought the issue to the forefront once more.
A week later, Sept. 11, the Conservative Party of B.C. announced it would “introduce laws to allow involuntary treatment for those at serious risk due to addiction, including youth and adults, to keep the most vulnerable safe.”
Premier David Eby then announced on Sept. 15 that his government would, if elected, create “highly secure facilities” for the growing number of people with overlapping “addiction challenges, brain injuries and mental-health issues” being cared for under the Mental Health Act, under the guidance of B.C.’s chief scientific advisor for psychiatry, toxic drugs and concurrent disorders, Dr. Daniel Vigo.
Specifically, the government would establish beds in secure regional care facilities, first in Maple Ridge with plans to expand to Northern B.C., the Interior, Vancouver Island and the Lower Mainland.
In addition, “a designated mental-health unit in a B.C. correctional centre” would “provide rapid treatment for people with mental-health and addiction challenges being held on remand or sentenced to custody,” starting with a 10-bed facility in Surrey.
In a press conference, Eby acknowledged the Mental Health Act is interpreted inconsistently in hospitals and the government would seek immediate clarifications on how the act can be currently used to provide involuntary care for people with substance use and mental health disorders — including youth.
In the long term, the NDP government would, if elected, “introduce legislation to clarify authority under the Mental Health Act for involuntary care” through engagement with First Nations leadership to ensure concerns about the misuse of these approaches are addressed.
Later that day, Rustad accused the NDP of “blatant inconsistency” on the issue of involuntary care, reaffirming the Conservative Party’s commitment to expand it.
The Conservative Party released more details on its recovery plan on Oct. 8 stating it would “overhaul the province’s disjointed and underfunded treatment system” while ensuring safe consumption sites provide a “meaningful gateway to treatment.” Rustad has previously committed to shutting down safe consumption sites echoing language from the unaffiliated federal Conservative Party.
The Green Party of BC’s platform pledges to review the Mental Health Act. “It’s time for the act to be overhauled and oriented toward creating the conditions for all people to be well-informed by those who are or have been directly impacted by its legislation.”
The Green Party would also create an Independent Office of the Mental Health Advocate to provide oversight on the legislation and regulate substance use treatment in B.C. to ensure they provide data on outcomes.
Why are experts concerned about these proposals?
In response to the NDP’s Sept. 15 announcement, various organizations and experts were quick to respond with their concerns.
“In the lead up to the provincial election in 2024 there have been announcements, statements, commentary in media, and public debate about involuntary treatment for people with disabilities and mental health and substance use health issues in BC,” Health Justice published in a fact sheet.
“Much of this conversation has been based on political and partisan rhetoric that is missing basic facts about BC’s current laws and the realities of involuntary treatment in this province.”
The BC Association of Social Workers raised concerns about human rights violations and the efficacy of this solution in a statement released Sept. 17. “Involuntary care is a poor substitute for accessible withdrawal management, treatment, and support services in adequate numbers to meet demand.”
CMHA reminds us that the NDP didn’t actually change its position with the Sept. 15 announcement, because the use of involuntary treatment has expanded under its leadership.
“Over the last two decades, there has been a dramatic increase in reliance on involuntary services, while voluntary services have not kept up with demand,” it wrote in a Sept. 18 statement titled Involuntary Care Already Exists in BC, But Is It Working?
“It’s basically just a doubling down of the existing system. And that system, it’s not clear if it’s working,” Mackenzie says.
When it comes to involuntary treatment for youth, pediatrician and medical director for Kelowna’s Youth Recovery House Tom Warshawski told Healthy Debate that, if carefully implemented, involuntary care for young people who have overdosed could prevent further harm due to potential risk for brain damage after such an event. But “the devil will be in the details.”
“It has to be done with a tender touch, but we need to hold these youth involuntarily if necessary, so that we can have a pause to the pattern of dangerous drug use.”
Public policy professor Kora DeBeck raised concerns about applying tools for mental health crises toward people with substance-use disorders.
“While there is considerable overlap between mental health and substance dependence, they are not the same condition,” she told Healthy Debate. “And it is not wise to expand tools for addressing mental health crises to substance dependence.”
In particular, involuntary addictions treatment is “setting them up for a high risk of fatal overdose afterwards,” DeBeck warned. “We know how common relapse is in the journey of addiction treatment and when people are abstinent from substance use their tolerance to opioids declines significantly. The danger with relapse in the context of fentanyl is that it’s deadly.”
Concerns like these led outreach workers to organize a rally in downtown Vancouver on Sept. 29.
“Statements like this, saying we’re going to treat you involuntarily, we’re going to abuse the powers of the Mental Health Act because you use drugs — that makes my job harder to try to build trust for people in the healthcare system,” outreach worker Blake Edwards told CityNews.
But neither involuntary or voluntary treatment changes the risk of the toxic drug supply, recovery advocate Guy Felicella said in a statement. “Addiction is a chronic, relapsing condition. Until we address the toxic drug supply, people who buy them will die.”
