B.C Premier David Eby speaks during a news conference about improving access to mental-health and addiction care in the Downtown Eastside in Vancouver, on May 31.ETHAN CAIRNS/The Canadian Press
In the political scramble to grapple with the drug overdose crisis and widespread issues of addiction, governments have deployed an array of experimental policies.
British Columbia has been a leader, from harm reduction services such as supervised drug consumption sites and prescribed opioids to expanded treatment and rehabilitation.
What gets less attention is the thousands of people in B.C. each year who receive involuntary treatment, in cases where people are deemed to be a danger to themselves and to others. In 2021, the province opened the Red Fish Healing Centre, a 105-bed facility in the Vancouver suburbs. A typical stay lasts for at least six months and roughly half of the people there are involuntary patients.
There is a renewed push to expand such treatment – but tentative steps in B.C. and Alberta illustrate the challenges in figuring out the details, amid broader problems in health care and difficulties to access voluntary drug treatment.
Last Sunday, ahead of a provincial election campaign that begins in the coming days, the B.C. NDP announced plans to expand involuntary treatment. The idea, including an update of the province’s Mental Health Act, is one the NDP have mulled for several years. In an interview with The Globe editorial board in early 2023, Premier David Eby said B.C. needs several more facilities like Red Fish. Mr. Eby, whose career started as a civil liberties lawyer, argued then that such interventions are sometimes necessary: “I don’t think it’s respectful of people’s human rights to let them die in the streets, when we know that’s what’s going to happen and we can see it coming.”
Action did not follow, so the timing may seem questionable, coming just before a tightly contested election. The NDP under Mr. Eby expanded treatment but were seen to focus on harm reduction. On Sunday, Mr. Eby displayed a tough-on-crime stance, from involuntary treatment to calling on Ottawa to spend more on drug searches at the border.
Mr. Eby’s proposal also belies the fact involuntary treatment is already widely used in B.C. and has been for years. While the era of housing several thousand people at a single institution is in the receding past, involuntary treatment is not. A report from the B.C. Ombudsperson shows, in 2020-21, that about 18,000 people were discharged from involuntary care, compared with about 11,000 from voluntary care. Previous data indicated about one-fifth of involuntary cases were related to drug addiction and the average stay was 6.5 days. The NDP plan appears to contemplate longer-term involuntary treatment.
The NDP’s move also shows how the seemingly divided politics of drug overdoses has far more overlap than commonly understood. Alberta Premier Danielle Smith last year promised involuntary treatment. Like Mr. Eby’s tentative steps forward, no legislation in Alberta has since emerged.
The problem political leaders are trying to solve isn’t entirely clear either. Vancouver Police report crime is down significantly this year. But a recent random attack in Vancouver that left one man dead was cited by Mr. Eby and Vancouver Mayor Ken Sim as the reason for more involuntary care. Yet in that case, the alleged killer had previously twice consented to psychiatric treatment. Mr. Sim claimed violent repeat offenders were responsible for “a large portion” of crime. Data shows the opposite, that mental illness and drug use drives only a small fraction of violent crime in Canada.
Critics of involuntary care – a challenge to province’s Mental Health Act is in court next spring – argue that the focus should be voluntary treatment care. There’s not enough beds available and the wait time is 35 days.
But as this space argued last year, involuntary care has a role to play in some cases. Getting involuntary care right, however, is difficult. A 2019 B.C. Ombudsperson report found hospitals were “failing to follow legal safeguards” and a 2022 report showed inadequate improvements.
Evidence around involuntary care is limited and mixed. A B.C. government report released on Sunday stated short-term involuntary care was necessary in some cases but warned that expected benefits “need to outweigh the foreseeable harms.”
After record overdose deaths in 2023, the number of people dying has fallen 8 per cent this year. That’s good news but the crisis is far from over.
The scale of the overdose crisis demands an array of policies and that includes involuntary care.