Involuntary treatment of drug users under B.C.’s Mental Health Act could be deadly, legal group warns

A stock photo shows the emergency patient check in desk at a B.C. hospital.

A legal advocacy group in Vancouver is calling for B.C. to overhaul its approach to mental health care in order to eliminate involuntary treatment options.

In a position paper titled “Involuntary Treatment: Criminalization by another name,” Pivot Legal Society anticipates the provincial government is planning to expand the criteria for involuntary treatment to include people who survive overdoses.

“Recent rumblings from municipal, provincial, and national politicians indicate that the latest call to expand involuntary treatment directly targets people who use drugs,” the group wrote in a news release Thursday.

“Involuntary treatment—for any community—is a harmful and degrading intervention at odds with healing, wellness, and best practices in drug policy and mental health care. In the context of the drug toxicity crisis, this expansion could be deadly,” the statement continued.

WHAT INVOLUNTARY ADMISSION MEANS

Under B.C.’s Mental Health Act, a person must meet four requirements to be certified for involuntary mental health treatment.

According to the Ministry of Mental Health and Addictions, the option is reserved for when a person “is suffering from a mental disorder that seriously impairs (their) ability to react appropriately to his or her environment or to associate with others,” or “requires psychiatric treatment in or through a designated facility”—especially as it relates to their own protection or the safety of others. It’s also reserved for individuals who are “not suitable as a voluntary patient.”

According to a spokesperson for the ministry, there were 28,734 involuntary hospitalizations between 2021 and 2022.

“For 2022/23 in the first quarter, there have been 6,805 involuntary hospitalizations under the Mental Health Act,” the spokesperson wrote in an email to CTV News.

INVOLUNTARY TREATMENT ON THE RISE

A report published in The Canadian Journal of Psychiatry last October shows the number of involuntary hospitalizations among British Columbians aged 15 and older rose by 65.7 per cent between 2008 and 2018.

Within that decade, data shows apprehensions involving police spiked by more than 128 per cent, according to the article “Trends in Involuntary Psychiatric Hospitalization in British Columbia.”

“Our observations highlight an urgent need to strengthen the voluntary system of care, especially regarding younger adults, and people who use substances,” the report reads.

CHANGING THE FRAMEWORK

In its position paper, Pivot Legal Society highlights how, despite critiques of involuntary treatment in B.C., the premier is working to expand the criteria.

Last August, David Eby began advocating for the criteria to include residents who experience multiple overdoses, according to the paper.

Then in November, “he said he would expand involuntary treatment to the corrections system and develop an app to streamline mental health commitments by police,” the group notes.

“This framework, expanding carceral care, is being promoted while access to voluntary care remains inaccessible, high-barrier, strict and shifting in eligibility, and austere and punitive in practice,” reads the paper.

The group is advocating instead for B.C. to invest in voluntary treatment options—including bolstering safe supply programs.

In an email to CTV News, a spokesperson for the Ministry of Mental Health and Addictions highlighted the fact that B.C. had made a $1 billion targeted investment through Budget 2023 “to build a comprehensive system of care for mental health and addictions services.”

Pivot Legal Society also wants the government to repeal all legislation and regulations that are “used to disproportionately target Black, Indigenous and racialized communities…and that are used to target people who use drugs and disabled people.”

The ministry, however, says it is necessary to ensure legislation is meeting the needs of B.C., adding it regularly receives suggestions to improve the Mental Health Act, and is in the early stages of reviewing certain sections of it.

As B.C. approached the seventh anniversary of a public health emergency being declared over the drug overdoses crisis, one nurse says forcing people to get treatment is not the solution.

“Involuntary treatment is dehumanizing, harmful, ineffective, and only serves to further erode trust in the health care system,” said Marilou Gagnon, a nursing professor at the University of British Columbia. “Continuing down this policy path is not conducive to healing, self-determination, and justice–fundamental pillars of an ethical and rights-based public health approach."