More than three decades ago, British Columbia politicians made the decision to end the practice of warehousing the mentally ill. The infamous Riverview Hospital, where patients were subjected to forced sterilizations and other indignities, was closed and was to be replaced with recovery-oriented community care.
The second part of this plan, like too many places in Canada, was executed as a half measure, at best. The government at the time promised a mental health care system that would be “one of the best in the world”. This does not happen. The province’s auditor general later found that British Columbia had no clear plan, no standards of care and not even an idea of how many people needed treatment.
Decades later, the results are sadly evident. A relentless crisis of homelessness, mental illness and untreated drug addiction in Vancouver’s Downtown Eastside and across the country, alongside a wave of random violent attacks in Canadian cities, is driving political pressure to take a fresh look at involuntary treatment.
British Columbia is pinning its hopes on a model of care that is literally built on the past. The Red Fish Healing Center for Mental Health and Addiction, which handles the most complex cases, is built on the Riverview land. The majority of patients – 60% – were sent to the 105-bed facility without their consent.
British Columbia NDP Premier David Eby, a former civil liberties lawyer who defended clients in Vancouver’s Downtown Eastside, is a surprising advocate for involuntary care. He argues that interference with liberty is justified when the alternative is to leave people with mental health and addiction problems to a miserable existence on the streets, at risk of death or brain damage from overdose.
Failure to intervene in such cases, he said, is cruel.
Mr. Eby’s choice of words is entirely appropriate and highlights the moral issue at the heart of this new push for involuntary care. Should a person in a mental health crisis, who poses a risk to themselves or others, have the right to refuse treatment? Mr. Eby’s response is that a compassionate, medically-based response does not always require consent.
Alberta’s United Conservative Party government is looking to go further than BC, as reported by The Globe and Mail. The province is considering introducing the Compassionate Intervention Act, which would be Canada’s first involuntary treatment law that specifically targets addictions. The UCP, which focuses on crime and social order issues, may have different reasons, but it is considering a similar path to that of the NDP in British Columbia.
Critics of Alberta’s proposals (including provincial NDP leader Rachel Notley) have called the yet-to-be-drafted law unconstitutional, ineffective and cruel. Ms Notley wrote that “effective and lasting treatment meets people where they are”.
These critics ignore the obvious: if someone has been deprived of agency by addiction or disease, the cruellest act possible is to leave them to drown on their own. Mr. Eby, with his impeccable progressive credentials, has come to this realization.
There is an important caveat to any increase in unintentional healing. Support for prevention, early intervention and treatment should be the primary focus. Involuntary care can only be a palliative when all else has failed. Unfortunately, these failures are commonplace.
The Red Fish installation tackles the worst of these failures. His patients have exhausted other treatment options. Many have been violent either with health care personnel or by committing a crime on the street. All of them struggle with serious drug addictions. The facility offers intensive treatment lasting several months, but the real test will be how patients fare once discharged from hospital, and those results are not yet known.
Eby says the province needs more facilities like Red Fish. This is in line with the recommendations of a group of experts commissioned by his government to study repeat offenders and random attacks by strangers. While the panel called for a new type of involuntary rehabilitation facility for those at risk of harm to others, it also urged the province to spend significantly more on mental health programs.
More and better mental health supports are needed, but involuntary care has a role to play in some cases. Not to provide it would be, to use Mr. Eby’s word, cruel.