There has been a lot of talk about secure care, or mandatory treatment since Premier David Eby announced that the provincial government was planning to open "highly" secure facilities for people under the Mental Health Act throughout B.C., as well as secure treatment within BC Corrections.
According to the announcement, all of the planned facilities will provide involuntary care under the B.C. Mental Health Act for people certified as requiring it.
According to the Ministry of Mental Health and Addictions, people will have to meet all these three criteria to be considered for involuntary care: severe mental health challenges, addiction issues, and brain injuries from repeated overdoses.
Eby also committed to adding more than 400 mental-health beds at new and expanded hospitals in the province by “modernizing” about 280 outdated beds and adding more than 140 new mental-health beds, with more planned.
The NDP government will also, if re-elected, look at introducing secure care for youth struggling with mental health and addictions.
Some, like Squamish parent Brenda Doherty, have voiced support for the proposals, believing involuntary care would have been a valuable tool when she had tried everything else with her young daughter, Steffanie Lawrence, who died of an accidental overdose in 2018, after she had just turned 15.
Sḵwx̱wú7mesh Úxwumixw (Squamish Nation) has also spoken in support of an expansion of involuntary care.
"We are in the throes of a toxic drug crisis. In recent years, I can hear the leadership in B.C. Indigenous communities that have lost so many people to suicide, mental health issues, addiction, substance abuse and social challenges. Our people have been waiting," said Nation councillor and spokesperson Sxwíxwtn Wilson Williams at the Eby press conference when the plan was announced.
He added that many more resources are needed to deal with the social ills but called secure care expansion "a significant step forward."
Others, like the British Columbia Division of the Canadian Mental Health Association (CMHA BC), have expressed concern over the potential expansion of the use of involuntary care.
"CMHA BC is concerned that a movement to detain more people under these current conditions and culture, without addressing significant gaps in the quality and effectiveness of care, will not lead to positive or dignified outcomes for people," reads a Sept. 18 news release from the organization.
Navigating the complexities
Simon Fraser University's Kora DeBeck, also says that expanding the use of involuntary care to deal with people with substance use issues could do more harm than good.
She spoke to The Squamish Chief about using it for youth, in particular.
DeBeck, a School of Public Policy professor, said that she gets where parents who call for more involuntary care are coming from but said the data doesn't support expanding it.
"I absolutely have so much compassion for parents in that situation, and I'm a parent myself and totally understand that wish and instinct to do anything you can to support your kids," she said, but she points to a University of Alberta study that involved parents who had used that province’s involuntary system with their children.
Unlike in B.C., Alberta parents can apply for involuntary stabilization of their children with addiction issues for up to 15 days.
"While some parents were grateful to have their child temporarily safe, many were disappointed because involuntary stabilization had little impact on their child’s substance use," the report reads.
"Parents identified several risks of involuntary stabilization, such as angering the youth and undermining trust, and exposing them to negative peer influences."
DeBeck added that the existing use of the Mental Health Act for people with mental illness is well established, but expanding it to deal with addictions during the toxic drug supply crisis is not the best way to solve a complex problem.
"We know that also, for a lot of people who are using drugs, there's a lot of childhood trauma, a lot of traumatic kinds of experiences, so being forced against their will into what are generally very institutional kinds of settings is very, re-traumatizing, and has more impacts down the road in terms of then young people avoiding helping services and care and those types of things," she said.
Another risk related to the drug crisis in B.C. is that when people come out of forced treatment, their resistance to the drugs they were on has gone down during that period, so there is an increased risk of fatal overdoses if they go back to drugs after they are released, which many do, DeBeck said.
She also said that while there is the impression that there are perfect treatments for people's addiction to the current rotation of unregulated drugs that work, it isn't fully accurate.
"Our kind of gold standard medications for opiate use disorders, so methadone and Suboxone, as fentanyl has become more prominent in these settings, we've seen that these medications' effectiveness is going down," she said. "When I talk to addiction physicians, they're saying that people's tolerances are so high on fentanyl, but knowing what kind of dose to put someone on for methadone ... the medical guidelines, haven't caught up to what the context is with fentanyl."
Given all of this, DeBeck concludes that forcing people into addiction treatment against their will isn't good policy.
DeBeck said while the current government has thrown money at the problem and made some things better about seeking treatment, the current voluntary system is still inadequate, and that needs to improve.
"So young people don't have to wait; where treatment is tailored for young people," she said, as an example.
She further argues that recovery is also about poverty reduction, housing affordability and a healthy economy.
"They're using substances for a reason, and often, it's to help them cope with economic poverty, a lack of hope or vision for the future. And so if they go to some sort of addiction treatment and maybe they stop using drugs, they come out and ... 'I have no home, I have no job, I have no community, I have no connections.' There's nothing for them. And so I think we need to also be looking at treatment much more holistically and expansively. It's not just about them and ending their use of drugs. It's about giving them other options and more life opportunities."
Regulation/safer supply
In B.C., an average of close to seven people a day died from unregulated drugs in 2023, according to the BC Coroners Service.
In terms of addressing toxic drug deaths, in addition to treatment, and addressing social and economic disparity, DeBeck says the government should be "very involved in regulating the supply and distribution of drugs."
She said currently, so-called "hard" drug production and distribution is left to cartels and organized crime.
"They put in whatever they want, and they give it to whoever they want, and they target vulnerable, vulnerable people. They target young people. So, if government was regulating the production of drugs, then the content, purity, dosing—all of those things—would be transparent."
She said with the distribution of drugs; she isn't advocating how society approaches alcohol, where it's highly promoted and made available and marketed with events like happy hour and how liquor stores are very prevalent.
"That would be a catastrophic model for us," she said. "But I think if we look at something like what we've done with tobacco, I think we've taken a very public health-based approach to tobacco ... price controls are very strict, access controls are very strict, and it also has been, lots of public education around the harms of tobacco," she said.
"I think we have so many more tools when we look at regulation versus when we look at prohibition; with our current state of prohibition, we've really abdicated all control."
DeBeck said she knows it is hard for many in the public to imagine what regulation of now-illegal substances could look like, and some would fear a store on every corner, but she said it doesn't have to be that way.
DeBeck pointed to Dr. Bonnie Henry's report released in July that recommended enabling access to alternatives to unregulated drugs.
"These are things we could do," she said.
Recently, psychiatrist Dr. Daniel Vigo, who was appointed in June by Premier Eby as his chief scientific adviser for psychiatry and who is leading a team to chart a course for more involuntary and voluntary services, clarified to the Times Colonist what the expansion of involuntary care would mean.
"The main thing that is being misinterpreted is that what we are doing is suddenly increasing the people that are going to be forced to treatment, but if these things are implemented, there will be [fewer] people forced to treatment, [and] they will be the right people,” Vigo told Times' reporter Cindy E. Harnett.
He said that only a couple thousand people have a combination of mental illness, substance use and overdose-related brain injury, meaning much fewer people than that would even qualify for involuntary care.
Vigo also said that many of the studies involving involuntary care that some use to oppose the option were not randomized and that many such patients are not given the medication they need in treatment to sustain their health once back in the community.
The provincial government has said that clarifying the existing Mental Health Act and any changes that would happen, should the NDP be in power post-Oct. 19, would “ensure that people, including youth, can and should receive care when they are unable to seek it themselves.”
~With files from Cindy E. Harnett/The Times Colonist; files also from Jennifer Thuncher/The Squamish previous stories.
