Involuntary addictions treatment: What experts want you to know before you vote

Last month, The Wren asked Kamloopsians what they wanted local MLA candidates to address in the lead up to the B.C. election on Oct. 19. 

More than 100 readers responded to the survey. When asked what issues candidates should tackle, 78 per cent selected “health care,” 65 per cent selected “homelessness/social supports” and 52 per cent selected “housing.” 

“Recovery supports” also emerged as a top issue at 27 per cent, behind the economy at 24 per cent.

Many respondents also shared questions for candidates.

“Why is it so difficult to get a family member into drug and alcohol treatment facilities?” one reader asked. “Can people with addictions be forced into recovery?” 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 The Wren has previously reported, many Kamloops-based recovery service providers say they run waitlists for services and struggle to access stable funding.

As B.C. political candidates respond to community concerns about addiction and recovery access, the issue of involuntary additions treatment has emerged as a key point of debate and contrast between parties. 

The Wren reached out to experts to better understand how involuntary addictions treatment is currently used within the mental healthcare system. To find out where local provincial election candidates stand on the issue, The Wren asked local candidates to provide written responses, which have been lightly edited for clarity.

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 certified 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, improving their well being.”

What are the party positions on involuntary addictions 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, British Columbia’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 healthcare 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 have continued 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.

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 and another in Prince George on Oct. 11.

“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.”

What do Kamloops MLA candidates have to say?

The Wren asked Kamloops candidates: “What is your position on expanding involuntary care for people with brain injury, mental illness, and severe addiction.”

Kamal Grewal, BC NDP (Kamloops Centre): No response.

Peter Milobar, Conservative Party of BC (Kamloops Centre):  No response.

Randy Sunderman, BC Green Party (Kamloops Centre): The Canadian Mental Health Associations reports around 20,000 individuals each year in BC are placed in involuntary care, which is the highest rate of all provinces in Canada. 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.

The BC NDP and BC Conservatives have made this an election issue not because it is required or good government, but more to politicize this as part of their narrative on the toxic drug crisis, which both parties have failed to address over the years.

Involuntary care has a very low success rate while voluntary care has a much higher success rate, estimated to be in the range of 40 to 60 percent. The problem is we have not put the right tools in place to support rapid and optimal outcomes in the voluntary system. This would be a much better place to focus our energies on and would lead to better outcomes for people and be more cost effective for the provincial health system overall.   

Tristan Cavers, BC Green Party (Kamloops – North Thompson): The Green Party does not support involuntary care unless there is a danger to other individuals, aka a criminal matter.

Maddi Genn, BC NDP (Kamloops – North Thompson): No response.

Ward Stamer, Conservative Party of BC (Kamloops – North Thompson):  No response.

The Wren asked Kamloops candidates: What is your plan to address the toxic drug crisis and crime / homelessness?

Tristan Cavers, BC Green Party (Kamloops – North Thompson): The Green Party believes that “The Village” in Duncan is a model for addressing homelessness and this model should be scaled up. Getting people off the streets will immediately deal with a portion of crime.  We have a host of policies to address toxic drugs including expanded supervised use sites that have wrap-around services to ensure people are able to access detox facilities. We need to ensure we have social workers available for those in mental health crisis in our many regions rather than depending on police to deal with these situations. We propose a provincial police service where the province can better mandate the tasks our police should carry out. A review of our  prison system is required to address recidivism as well as lobbying federal officials why dangerous and repeat offenders are returned to our communities so quickly.

Maddi Genn, BC NDP (Kamloops – North Thompson): As someone who works with at-risk youth I have a unique understanding of the complexity of the problems toxic drugs, homelessness and crime bring to the community. We have worked hard to bring wraparound [comprehensive] supports that provide treatment, fight drug trafficking and address some of the underlying issues. I look forward to working with David Eby on further improving and developing new tools to intervene and support people with overlapping addiction, and health challenges.

Addressing the toxic drug crisis and improving access to housing and mental health services are top priorities for me. The BC NDP has improved mental health access for youths, provided more treatment options for those struggling with addictions and increased the availability of supportive housing. There are people who are struggling severely with addictions and mental issues who might need stronger interventions than we have right now, and involuntary care can be one of the tools in our toolbox for helping them. These are complex issues though, and people need wraparound supports.

Ward Stamer, Conservative Party of BC (Kamloops – North Thompson): No response.

Kamal Grewal, BC NDP: We’re taking action on all fronts to expand access to treatment and fight the toxic drug crisis so we can save lives and get people treatment so that they can recover. We will continue to drive forward our work to expand early intervention services and voluntary treatment available for people when they say they are ready for help. We’ve opened more than 650 new treatment beds across BC and (are) opening new treatment facilities. And, we’re working with police to fight drug trafficking, seize proceeds of crime and put criminals who deal these drugs behind bars.

Recently, Premier Eby announced the work we’ve been doing to provide more secure care for people with severe mental health and addictions issues, coupled with brain injuries from repeated overdoses who pose a risk to themselves or others. It’s new action to keep everyone safe.

Peter Milobar, Conservative Party of BC (Kamloops Centre): No response.

Randy Sunderman, BC Green Party: We are still in the process of unveiling specifics of our platform to address the toxic drug crisis, crime and issues of homelessness. One key BC Green platform item is the development of primary care. It is the basis of our health system, and it’s in crisis. People need the right care, at the right time, in the right place. They need to be able to access the system in an easy way, where their records are available, where they can make an appointment that fits into their lifestyle, where they can be assured that their children can continue to have care into their teen and adult years. 

The BC Greens want to see those who are seeking help with addictions find the help they need in a timely fashion. Currently, too many people are slipping through the cracks and are unable to find the supports they need. This is a multifaceted issue, but a key component is finding appropriate housing. 

While there is no one path to overcoming substance use disorders, we know that studies show that involuntary treatment has a 97 per cent relapse rate. Harm reduction is a critical component of an evidence-based solution to the toxic drug crisis. We need compassionate, evidence-based care and leadership. We must address the root causes of the mental health and toxic drug crisis in this province – harm reduction, voluntary treatment, robust preventative mental health supports and a properly funded plan to not just reduce poverty but eliminate it.