CAA comment
Opponents to the concept of involuntary care trot out the ‘hoary old chestnut’ of a patient’s rights, but when it comes to rights, we argue every person has a right to care appropriate to their health issue. If that means involuntary care, then we support that approach.
When a person’s acuity is so manipulated by deleterious health, then in the name of humanity, we must take care of them until they are well enough to look after themselves.
Our view is tempered in that there needs to be clear medical oversight as there must be legal oversight to ensure the patient’s rights are protected and the community, one does not outrank the other.
A mechanism to have any person taken into temporary care to be assessed and the necessary information placed before a Court to determine whether the person’s involuntary care should continue and for the accountability intervals to the Court for their continued involuntary care is the mechanism that we should aspire to develop.
Police and Ambulance first responders must be given the power to place people whose acuity is compromised into temporary care to be medically assessed.
Temporary Health Orders would be the most logical authority mechanism. They were thrown around with ‘gay abandon’ during the COVID-19 pandemic, so it should be well accepted by the community.
The imminent closure of one a Victorian jail provides an opportunity for the facility to be converted to accommodate involuntary patients, and in tight fiscal times the cost to the government in paying out on contracted services to operate the prison for many years may provide some financial benefit to the State – at least we will be getting something back including saving some lives currently wasted.
Some politicians, police and community groups argue involuntary care is key to addressing severe addiction and mental health issues
The brutal stabbing last month of a 58-year-old city employee in Nanaimo, B.C., made national headlines. The man was stabbed multiple times with a syringe after he asked two men who were using drugs in a public park washroom to leave.
The worker sustained multiple injuries to his face and abdomen and was hospitalised. As of Jan. 7, the RCMP were still investigating the suspects.
The incident comes on the heels of other violent attacks in the province that have been linked to mental health and substance use disorders.
On Dec. 4, Vancouver police fatally shot a man armed with a knife inside a 7-Eleven after he attacked two staff members while attempting to steal cigarettes. Earlier that day, the man had allegedly stolen alcohol from a nearby restaurant.
Three months earlier, on Sept. 4, a 34-year-old man with a history of assault and mental health problems randomly attacked two men in downtown Vancouver, leaving one dead and another with a severed hand.
These incidents have sparked growing calls from politicians, police and residents for governments to expand involuntary care and strengthen healthcare interventions and law enforcement strategies.
“What is Premier Eby, the provincial and federal government going to do?” the volunteer community group Nanaimo Area Public Safety Association said in a Dec. 11 public statement.
“British Columbians are well past being fed-up with lip service.”
‘Extremely complex needs’
On Jan. 5, B.C.’s newly re-elected premier, David Eby, announced the province will open two involuntary care sites this spring. One will be located at the Surrey Pretrial Centre in Surrey and the other at the Alouette Correctional Facility in Maple Ridge, a city northeast of Vancouver.
Eby said his aim is to address the cases of severe addiction, brain injury and mental illness that have contributed to violent incidents and public safety concerns.
Involuntary care allows authorities to mandate treatment for individuals with severe mental health or substance use disorders without their consent.
Amy Rosa, a BC Ministry of Health public affairs officer, confirmed to Canadian Affairs that the NDP government remains committed to expanding both voluntary and involuntary care as a solution to the rise in violent attacks.
“We’re grappling with a growing group of people with extremely complex needs — people with severe mental health and addictions issues, coupled with brain injuries from repeated overdoses,” Rosa said.
As part of its commitment to expanding involuntary care, the province plans to establish more secure facilities and mental health units within correctional centres and create 400 new mental health beds.
In response to follow-up questions, Rosa told Canadian Affairs that the province plans to introduce legal changes in the next legislative session “to provide clarity and ensure that people can receive care when they are unable to seek it themselves.” She noted these changes will be made in consultation with First Nations to ensure culturally safe treatment programs.
“The care provided at these facilities will be dignified, safe and respectful,” she said.
‘Health-led approach’
Nanaimo Mayor Leonard Krog says involuntary care is necessary to prevent violent incidents such as the syringe stabbing in the city’s park.
“Without secure involuntary care, supportive housing, and a full continuum of care from detox to housing, treatment and follow-up, little will change,” he said.
Elenore Sturko, BC Conservative MLA for Surrey-Cloverdale, agrees that early intervention for mental health and substance use disorders is important. She supports laws that facilitate interventions outside of the criminal justice system.
“Psychosis and brain damage are things that need to be diagnosed by medical professionals,” said Sturko, who served as an officer in the RCMP for 13 years.
Sturko says that although these diagnoses need to be made by medical professionals, first responders are trained to recognise signs.
“Police can be trained, and first responders are trained, to recognise the signs of those conditions. But whether or not these are regular parts of the assessment that are given to people who are arrested, I actually do not know that,” she said.
Staff Sergeant Kris Clark, a RCMP media relations officer, told Canadian Affairs in an emailed statement that officers receive crisis intervention and de-escalation training but are not mental health professionals.
“All police officers in BC are mandated to undergo crisis intervention and de-escalation training and must recertify every three years,” he said. Additional online courses help officers recognise signs of “mental, emotional or psychological crisis, as well as other altered states of consciousness,” he said.
“It’s important to understand, however, that police officers are not medical/mental health professionals.”
Clark also referred Canadian Affairs to the BC Association of Chiefs of Police’s Nov. 28 statement. The statement says the association has changed its stance on decriminalization, which refers to policies that remove criminal penalties for illicit drug use.
“Based on evidence and ongoing evaluation, we no longer view decriminalization as a primary mechanism for addressing the systemic challenges associated with substance use,” says the statement. The association represents senior police leaders across the province.
‘Life or limb’
Police services are not the only agencies grappling with mental health and substance use disorders.
The City of Vancouver told Canadian Affairs it has expanded programs like the Indigenous Crisis Response Team, which offers non-police crisis services for Indigenous adults, and Car 87/88, which pairs a police officer with a psychiatric nurse to respond to mental health crises.
Vancouver Coastal Health, the city’s health authority, adjusted its hiring plan in 2023 to recruit 55 mental health workers, up from 35. And the city has funded 175 new officers in the Vancouver Police Department, a seven per cent increase in the force’s size.
The city has also indicated it supports involuntary care.
In September, Vancouver Mayor Ken Sim was one of 11 B.C. mayors who issued a statement calling on the federal government to provide legal and financial support for provinces to implement involuntary care.
On Oct. 10, Conservative Party Leader Pierre Poilievre said a Conservative government would support mandatory involuntary treatment for minors and prisoners deemed incapable of making decisions.
The following day, Federal Minister of Mental Health and Addictions Ya’ara Saks said in a news conference that provinces must first ensure they have adequate addiction and mental health services in place before discussions about involuntary care can proceed.
“Before we contemplate voluntary or involuntary treatment, I would like to see provinces and territories ensuring that they actually have treatment access scaled to need,” she said.
Some health-care providers have also expressed reservations about involuntary care.
In September, the Canadian Mental Health Association, a national organization that advocates for mental health awareness, issued a news release expressing concerns about involuntary care.
The association highlighted gaps in the current involuntary care system, including challenges in accessing voluntary care, reports of inadequate treatment for those undergoing involuntary care and an increased risk of death from drug poisoning upon release.
“Involuntary care must be a last resort, not a sweeping solution,” its release says.
“We must focus on prevention and early intervention, addressing the root causes of mental health and addiction crises before they escalate into violent incidents.”
Sturko agrees with focusing on early intervention but emphasises the need for such interventions to be timely.
“We should not have to wait for someone to commit a criminal act in order for them to have court-imposed interventions … We need to be able to act before somebody loses their life or limb.”