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Red Fish Healing Centre for Mental Health & Addiction. A leading-edge centre for mental health and addiction treatment and research in British Columbia, located on səmiq̓ʷəʔelə in Coquitlam, formerly the Riverview lands.Handout

In his past career as a civil-rights lawyer, David Eby would have been first in line to argue against involuntary treatment for mental health and addictions issues. But as British Columbia Premier, he is now pushing to expand the province’s capacity to compel it because the alternative, he argues, is worse.

“I don’t think it’s respectful of people’s human rights to let them die in the streets,” he told The Globe and Mail’s editorial board, adding that the focus on deaths from toxic drugs don’t even capture the scale of the problem. Last year, there were 2,272 suspected fatalities in B.C. from the crisis.

“For every person that fatally overdoses, there are at least three people that are seriously brain-injured. And until you’re sufficiently brain-injured to the point of permanent long-term care, then people are being really spat out from the emergency room back into the community. So it’s cruel and it’s a miserable existence.”

But some of Mr. Eby’s strongest allies are reticent – even resistant – to embrace involuntary treatment as a solution. For critics, the past abuses of human rights and the horrific conditions of earlier so-called asylums remain front-of-mind. The B.C. Civil Liberties Association (BCCLA), where Mr. Eby previously served as executive director, is firmly opposed, while his new Minister of Mental Health and Addictions, Jennifer Whiteside, is tiptoeing around the subject.

Last year, almost 20,000 British Columbians were involuntarily hospitalized in B.C. under the Mental Health Act – a number that has been climbing. Some of them are discharged in as little as 48 hours. And there are not enough long-term options to actually treat complex mental health and addiction issues.

As the toxic drug crisis continues to defy efforts to reduce the death toll, Mr. Eby says the province needs to expand the availability of involuntary care and to update the Mental Health Act to provide clearer options for intervention.

But the contrast between Mr. Eby’s passionate rationale for expansion and the caution demonstrated by Ms. Whiteside has sowed confusion around the province’s intent.

Mr. Eby, in his mandate letter to Ms. Whiteside when he appointed her in December, directed her to identify the scale of the need for more involuntary care beds. It is a politically sensitive task, and the Minister of Mental Health and Addictions strongly emphasizes the need for consultation, particularly with Indigenous communities – who are dying at five times the rate of B.C.’s general population owing to suspected drug toxicity.

The NDP government has started down this road before: In 2020, Health Minister Adrian Dix tabled amendments to the Mental Health Act to allow for secure care of young people after an overdose. The bill was abandoned in the face of opposition.

Last summer, Mr. Eby raised the prospect of expanded involuntary care when he was running for the NDP leadership. His position was strengthened months later, when the province released a government-commissioned report on repeat offenders and random stranger attacks, which included recommendations for new kind of involuntary rehabilitation facility for those who present a risk of harm to others.

Mr. Eby’s proposal, however, was condemned by the BCCLA, which called it “misleading, immoral, and reckless.” Pivot Legal Society, where he once worked as a lawyer representing marginalized residents of the Downtown Eastside, also criticized his plan as misguided and stigmatizing.

Under the provincial Mental Health Act, a person can be detained in a psychiatric facility if a physician deems it necessary for their health and safety, as well as the safety of others. The province has 1,984 beds within the health care system designated for involuntary care.

Mr. Eby said there is not enough capacity in the system to help treat people who are at risk from the toxic drug supply, and doctors who are responsible for making a decision about involuntary care don’t have clear direction on what they can do: “The emergency room docs are struggling about whether or not they have the authority to intervene at that point.”

The Premier singled out the Red Fish Healing Centre for Mental Health & Addiction as his preferred model for expansion: “There’s general agreement that we need two or three more just to respond to the need.”

The facility, located in Coquitlam, includes a care unit with 15 beds for involuntary patients with concurrent, complex mental illness and substance use issues along with a history of aggressive or other high risk behaviours. Patients are typically there for three months.

B.C.’s overdose crisis needs life-saving interventions more urgently than decriminalization

Grant Charles, a professor at the University of B.C.’s School of Social Work, said the province has poorly-connected supports and insufficient resources for mental health and addictions, especially for early intervention. That needs to be fixed for the long term, Dr. Charles said. And to deal with the present-day crisis, he says the routine 48-hour detentions are not enough.

“We can get stuck in this argument that people with addictions have free will and we should respect their human rights, but the nature of being addicted means we don’t have full free will,” he said.

Dr. Charles welcomed Mr. Eby’s commitment to move forward on this file: “It’s potentially a sea change, and it’s more significant coming from a human-rights lawyer.”

The BC Liberal Opposition has produced its own mental health and addictions plan that offered up Red Fish as the path forward, and promised to expand free and accessible treatment and recovery options including involuntary care “where necessary.”

During a debate in the legislature Tuesday, Liberal Leader Kevin Falcon said he isn’t sure if the government agrees or not. He asked Ms. Whiteside if she supports expansion, but her response was evasive.

“We will continue to work with physicians, work with our health authorities with respect to the tools that they currently have under the Mental Health Act when it comes to circumstances under which an individual may need to be involuntarily admitted,” she replied.

In an interview, Ms. Whiteside stressed that involuntary care “is a significant tool to withdraw someone’s liberty” and she is focused on voluntary care options. She is prepared to listen to front-line physicians if they think the Mental Health Act is a barrier, but she believes the problems can be remedied without reopening the legislation.

“What we hear from front-line providers is that they need the places in order to be able to have somebody in detox, withdrawal management, and then on to treatment. So that’s where we’re focusing our efforts,” Ms. Whiteside said. For her, amendments are an “if,” not a “when.”

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