VANCOUVER, BC – (September 18, 2024): On September 15, 2024, Premier Eby announced that his government is expanding involuntary care for people with brain injury, mental illness, and severe addiction. Included in this announcement are the addition of more than 400 hospital-based mental health beds and two new secure care facilities – one for those involved in the criminal justice system and another for those apprehended under the Mental Health Act, also located on the grounds of a correctional facility.
Other than adding more psychiatric beds and creating specific facilities, the announcement earlier this week regarding involuntary care doubles down on an existing approach to involuntary care by the Government of BC, where significant legal powers already exist under the Mental Health Act.
There are around 30,000 Mental Health Act apprehensions of around 20,000 individuals each year in BC, which is the highest rate of all provinces in Canada.[1] 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.[2] Despite historic investments by the Government of BC in the last number of years, we know that barriers remain to on-demand voluntary care for both mental health and substance use services.
People with substance use disorder are the fastest growing population being detained under BC’s Mental Health Act, yet this is not commonly known.[3] This fact, along with the recent announcement, is concerning to CMHA BC, knowing that there is a lack of evidence to support the effectiveness of involuntary treatment for people with substance use disorder, and that existing evidence actually suggests that involuntary treatment leads to an increased risk of death due to drug poisoning upon release.[4,5] The reality is that we are already relying heavily on involuntary care without really examining whether it is effective.
There is a striking opportunity to examine gaps and failings in services before and after involuntary care to determine what is going wrong. Those seeking voluntary services report significant closed doors to care and subsequently do not get the care they need at the right time. For those who have experienced involuntary care, there have been concerning accounts out of psychiatric wards across the province, including the inappropriate use of restraints and seclusion rooms, the coercive use of sedation and a lack of trauma-informed care that has led to further trauma. Our partner Health Justice just released a report focused on distressing accounts of gender-based violence experienced during involuntary care.
Despite these worrying trends, there remains very little oversight or accountability of the mental health system. 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. BC’s Representative for Children and Youth and the BC Ombudsperson have each recently issued systemic investigation reports documenting serious concerns about the administration of BC’s Mental Health Act and the associated impacts, including on young people.
We agree that all communities must be safe and free from violence. A community is safer when people can access the support they need to be well, when and where they need it. We acknowledge that involuntary care may be a needed last resort for those at extreme risk of harm to themselves or others, but it must be just that – a last resort, not a sweeping solution. While there are a small number of people with more serious mental health and substance use conditions that are at elevated risk of violence, this risk is the result of the failure of many systems to support these individuals before they reach a point of crisis.
We must examine recent extreme examples to understand where systems have failed so we can focus on prevention and early intervention in the future. Without addressing root causes and interrogating the gaps and failings of the current system, even with involuntary care, people will be released back into community without the necessary supports needed to help them on their journey to wellness. The cycle will continue.
Should the next Government move forward with the plans announced earlier this week, we strongly urge them to:
- Critically examine gaps and failings before the use of involuntary care
- Improve the oversight and quality of involuntary care to move from an over-reliance on containment to proper dignified and humane care, and
- Demonstrate to the public that the BC Mental Health Act is fit for purpose.
In line with our recently released Policy and Advocacy Roadmap, should the next Government move to re-open the Mental Health Act in the next legislative session, we strongly urge them to immediately establish a comprehensive review of the Mental Health Act under the Public Inquiry Act. This would be led by an independent commissioner and staff, to ensure legislative amendments are grounded in evidence, human rights, and lived expertise. Our hope is that this public inquiry could lead to the establishment of a long-term mental health commissioner for future oversight and accountability.
There have been historic investments in the mental health and substance use system, to the tune of $2.65 billion since 2017. We cannot stop this momentum and need to do more to ensure there is a robust network of on-demand voluntary care, so we call on the next BC Government to close the gap in access to voluntary community-based mental health services, raise the bar in the quality of mental health services and respond with care to those experiencing a crisis.
Footnotes:
1. Wyton, M. (2021, November 23). BC forced mental health treatment spikes. The Tyee. https://thetyee.ca/News/2021/11/23/BC-Forced-Mental-Health-Treatment-Spikes/
2. Loyal, J. P., Lavergne, M. R., Shirmaleki, M., Fischer, B., Kaoser, R., Makolewksi, J., & Small, W. (2023). Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018. The Canadian Journal of Psychiatry, 68(4), 257-268. https://doi.org/10.1177/07067437221128477
3. Ibid.
4. Werb, D., Kamarulzaman, A., Meacham, M. C., Rafful, C., Fischer, B., Strathdee, S. A., & E. Wood. (2016). The effectiveness of compulsory drug treatment: A systematic review. International Journal of Drug Policy, 28, 1-9. https://doi.org/10.1016/j.drugpo.2015.12.005
5. Pilarinos, A., Kendall, P., Fast, D., & DeBeck, K. (2018). Secure care: More harm than good. Canadian Medical Association Journal, 190(41), 1219-1220. https://doi.org/10.1503/cmaj.180700
Additional Reading:
- Health Justice’s report Facade of Safety: Gender-Based Violence in BC’s Involuntary Mental Health System
- Ombudsperson of BC’s report Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act
- Representative for Children and Youth’s report Detained: Rights of Children and Youth under the Mental Health Act
- Community Legal Assistance Society’s report Operating in Darkness: BC’s Mental Health Act Detention System
- CMHA BC’s Policy and Advocacy Roadmap (released August 2024)