There has been a push to expand mandatory treatment for people suffering from mental health and addiction issues in British Columbia as the province continues to grapple with so-called “unprovoked stranger attacks,” which has emerged as a major public safety concern in the province. An expert report last year said that involuntary treatment may be necessary when violence is a concern, albeit with strict accountability mechanisms.
But the Vancouver-based Pivot Legal Society, with the support of such organizations as West Coast LEAF and the B.C. Poverty Reduction Coalition, is calling for an abolition of involuntary treatment options, which can include interventions such as forced medication, institutionalization and other coerced behaviour. The organization characterizes such treatment as a “harmful and degrading intervention” at odds with best practices in drug policy and mental health care, and part of a “broader spectrum of violent, colonial, racist medical treatment.” It said an expansion of involuntary treatment could be deadly in light of the drug toxicity crisis in British Columbia.
Under B.C.’s Mental Health Act, a person can be detained in a psychiatric facility if a doctor deems it necessary for their health and safety, as well as the safety of others. But Meenakshi Mannoe, a criminalization and policing campaigner with Pivot who authored the organization’s position paper on involuntary treatment, said evidence shows that people who are subject to forced abstinence treatment are at greater risk of overdose.
“And that is something we have seen here in B.C. when people are incarcerated even for short provincial sentences,” she said. “We want to be very clear that forcing drug users into involuntary treatment, whether through amendments to the Mental Health Act or some other health care provision, is really setting people up to die because it is not addressing the underlying condition, which is the contaminated and poisoned drug supply.”
Kali-olt Sedgemore, president of the Coalition of Peers Dismantling the Drug War, said involuntary care creates mistrust in the health care system.
“These interventions break trust and relationships, and creates mistrust in the health care system. With this looming threat, overdose prevention site workers and peers are forced to make the difficult decision of calling 911 when an overdose occurs — and potentially forcing someone into involuntary care,” said Sedgemore. “These drugs are toxic and there is a high chance that people return to relying on the criminalized drug supply after involuntary treatment.”
Instead of involuntary treatment, Pivot said there should be “robust access” to voluntary treatment options, including primary care, detox, culturally affirming treatment programs which reflect the intersecting identities of people who use drugs. The organization also said the province should immediately fund and scale up safe supply programs to ensure a regulated and predictable supply of drugs, and eliminate all police involvement and power under the Mental Health Act.
Mannoe noted British Columbia is approaching a grim anniversary — seven years since the province declared overdose deaths a public health emergency.
“The provincial government in particular is looking at what they can do to expand involuntary treatment while there are very few routes to voluntary or consent-based treatment, which is the best standard in health care — you want to work in a manner that centers the needs of your patient,” she said. “How is it the province is advocating for involuntary treatment when people can’t even access a family doctor?”
And while stranger attacks “sound quite scary,” Mannoe said they are still a relatively uncommon experience.
“That is not to excuse such violence whatsoever — it is not appropriate to stab people or threaten people, or harm vulnerable members of your community,” she said. “But it is still situated within this broader context which is Vancouver is so profoundly divided around race, income and living situations. Serially jailing people, and not addressing the lack of income and housing that they have, just perpetuates the problem.”
A spokesperson for B.C.’s Ministry of Mental Health and Addictions said in an email that “nothing is more important than keeping people safe and ensuring people are treated with dignity and respect,” and noted that during the spring 2022 legislative session the province passed legislation to amend the Mental Health Act so that people who have been involuntarily admitted can access support from an independent rights adviser.
“There are situations when someone is experiencing a mental health emergency where involuntary admissions under the Mental Health Act can be necessary to protect health and save lives,” the spokesperson said. “Government understands the gravity of these situations and takes seriously the need to balance the rights of the individual with its obligation to help and protect people living with mental illness.”
The spokesperson said the Act “provides authority, criteria and procedures for involuntary admissions for those who require treatment due to a mental disorder that seriously impairs their ability to react appropriately to their environment or associate with others.”
“Involuntary treatment is limited to psychiatric treatment only. The current Act does not provide for involuntary care for substance use disorder in the absence of a concurrent psychiatric disorder,” the spokesperson said. “It is always necessary to ensure that legislation is meeting the needs of people in B.C. The province regularly receives suggestions to improve the Mental Health Act and is in the early stages of reviewing sections of the Act.”
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