Unpacking Involuntary Care: A Series
Part One: The Present
Unpacking Premier David Eby’s Statements About Involuntary Care for Special Populations*
*We are using the term “special populations” to refer to those who are being specifically targeted by the current NDP government’s increasingly authoritarian mandate for involuntary treatment. At present, this population consists primarily of those who are houseless, interacting with the criminal justice system, using substances, may have a brain injury, and are experiencing severe mental illness.
A Disturbing Mandate
With the last provincial election in BC in the fall of 2024, the BC NDP joined the call for expanding involuntary care for people with brain injuries, mental illness, & severe addiction.
The announcement included the addition of more than 400 hospital-based mental health beds and two new secure care facilities to provide this population with “dignified and compassionate care.”
Since that time, further beds have been added and expansion is now occurring across the province (1).
Calls for concern
Eby’s government has faced significant backlash over these announcements from advocates and various other organizations. According to CMHA BC at the time of the announcement, “there are around 30,000 Mental Health Act apprehensions of around 20,000 individuals each year in BC (2), which is the highest rate of all provinces [and territories] in Canada (3).” “Over the last two decades, there has been a dramatic increase in the reliance on involuntary services, while voluntary services have not kept up with demand (4).”
“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) and there is a lack of evidence to support the effectiveness (5,6)” [of this approach.] “Existing evidence actually suggests that involuntary treatment leads to an increased risk of death due to drug poisoning upon release (6).”
**Substance use alone is not something people can be apprehended under BC’s Mental Health Act for; underlying co-morbid mental illness would be the reason for detention
BC’s Mental Health Act
BC’s Mental Health Act (passed in 1964) was last updated in 1998. This outdated and sweeping piece of legislation results in 30,000 apprehensions each year (2), with almost 15% of mental health patients in BC [being] [re]admitted to hospital at least three times a year. This is higher than the Canadian average.
BC’s Mental Health Act is also the only remaining legislation of its kind in Canada to retain provisions for “deemed consent (7).”
“’Deemed consent,’ outlines that everyone with involuntary status is deemed to consent to all forms of psychiatric treatment and can be forcibly treated, regardless of their actual capacity to consent or have a substitute decision maker — a provision which is currently being challenged in the Supreme Court of Canada (7,8).”
Involuntary care in BC
There are numerous reports and firsthand accounts of the misuse and abuse of seclusion, restraints, and sedation in involuntary care settings across BC (9, 10).
“BC’s Mental Health Act does not place any limits on when, how, or why someone can be subject to seclusion or restraints. There is no requirement that it be a last resort or only used to address serious safety risk. It also does not include a single safeguard for this unlimited power, including for children and youth (10).”
A disturbing example of this is seen in the case of Paul Spencer (age 43) who was killed while he was detained at theRoyal Jubilee Hospital’s Psychiatric Emergency Services (PES) in Victoria in 2019. After being beaten, physically restrained by security, placed in seclusion, given sedatives, and left in a prone position, Spencer was found to be unresponsive after 7 minutes alone in the seclusion room (11).
The BC coroner ruled Spencer’s death accidental and due to the effects of “physical restraint, hypertensive cardiovascular disease, psychosis NOS, and the administration of sedating medication (alongside long term use of risperidone) (12).”
None of the 9 recommendations made to Island Health by the jury in Spencer’s inquest were binding and at least one of the recommendations (to avoid restraining, sedating, and leaving patients in a prone position) have not been implemented as evidenced by firsthand experience from one of our VIVED team members in January 2025.
Similarly, apprehension by police (under section 28) using handcuffs and/or aggressive tactics can easily lead to violent and dangerous situations, especially for those who are BIPOC and/or ESL (11).
In 2022, for Victoria resident Michael Belfon (age 64), police deployed “an armoured truck, K9 unit, tear gas, pepper spray, and ultimately, a plastic bullet” due to a mental health call made by a stranger. This resulted in “a month and a half-long hospital stay... and the loss of his home” (where he had lived for 14 years.)
Despite video evidence to the contrary, Victoria police insisted that Belfon refused to communicate and was armed with improvised weapons, none of which was true.
Dignified and Compassionate care according to David Eby
The toxic drug supply crisis, increasing poverty and disparity, as well as unaddressed mental illness and shrinking voluntary options for care are all concerning. However, when we look at the evidence as well as the lived/living experience of people facing these challenges, involuntary care is ineffective and can be deeply traumatizing.
Nothing about BC’s Mental Health Act or approaching the complex needs of those living at the intersections of multiple policy failures by involuntarily detaining and treating them speaks of dignity or compassion.
Recommendations
There have been numerous recommendations and calls to action in regard to BC’s Mental Health Act and the future of mental healthcare and substance use services in this province (8, 12) (e.g. CMHA BC and Health Justice BC.)
Vancouver Island Voices for Eating Disorders (VIVED) echoes these calls to action and urges those in positions of power to follow evidence-based recommendations in the care of those who are living unhoused, may have brain injuries, are using substances, and expriencing mental illness.
What Can We Do As the Public?
Keep discussing these issues; keep learning about these issues. We highly recommend following Health Justice BC on social media or signing up for their newsletters.
Volunteer with organizations providing peer support, creating alternative crisis response options, providing harm reduction services, and advocating for reform (or abolition) of the BC Mental Health Act (e.g. CMHA BC, Health Justice BC, Mental Health Recovery Partners, Umbrella Society, etc.)
Get Political. Ask what your city counsellors, mayor, or MLA are doing to protect the fundamental human rights of their vulnerable constituents. Attend rallies and protests, join letter writing campaigns, and address stigma in your daily conversations with people in your life.
If we are truly seeking solutions that support the people facing these challenges as well as the “safety” of our communities as whole, we should be looking to the ample evidence that already exists around safe supply, harm reduction, accessible community services, affordable housing, poverty reduction, expanding voluntary treatment options, and pushing publicly-funded psychotherapy for all.
S. Ritchey