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Alberta

They’ll Always Be ‘Everyone’s Someone’ to Me

Why a Calgary doctor is against forced treatment in Alberta.

Bonnie Larson 21 Aug 2023The Tyee

Bonnie Larson is a doctor who has worked with people experiencing homelessness for 15 years.

As I breezily depart a trendy Calgary coffee shop on a crisp Saturday morning clutching an extra hot latte, I hear someone calling my name.

“Bonnie!”

A woman’s voice, low and gravelly. Hair in messy topknot. Torn black warm-up pants. I had sailed right past her in my singular quest for riverside caffeine euphoria. The spring morning is fresh at 9 a.m. I think, at first, that she must be a previous patient of mine. She had clearly spent the night outside. But as I look closer, I instantly recognize her lopsided smile. An old family friend, a girl I used to babysit. The youngest child in their family, now grown.

“Beth!” I hug her close. She smells of stale tobacco and Pantene shampoo. [Editor’s note: The Tyee is using a pseudonym to protect Beth’s privacy.]

An Edmonton city councillor made a recent remark on addiction treatment that I continue to carry with me. On the issue of forcing a person who uses drugs into treatment, Coun. Tim Cartmell said that if it were his child, he would sooner see them made to go to treatment than have someone “step over them on the sidewalk.”

As a parent, I can certainly understand that sentiment. As a physician who works with people experiencing homelessness, I know it’s more complicated than that.

Beth and I wander the back alleys of gentrified Bridgeland and catch up on two decades. She smokes a cigarette from the stash in my purse and a bit of "down" — likely a mash-up of fentanyl and benzodiazepines — off a tiny piece of foil. I sit with her and learn of the compounded tragedies that have landed her here. My heart sinks. She uses my phone to call her auntie. Says, “I’m okay. Well, not okay, but alive.” And laughs. I’ve turned away while she is on the phone, for fake privacy, and she doesn’t see my tears.

Beth had not known that I am a doctor now, working with people who use drugs, meeting them on the streets. That’s what I do now, I told her, a bit proudly, far too doctorly. Somehow, she is unsurprised.

I want to know how I could help. But at the same time, I’m scared. If she asked, I know that I would not be able to get her a spot in detox, or give her a prescription for Suboxone, or drop her off at a supervised consumption site so she would not die of poisoning by the substance on her shiny bit of crinkled foil. I knew that I could not sit with her forever. Part of me, though, wanted nothing more than to sit with her forever under a knitted blanket, reading Robert Munsch books like we did when she was small.

“Just be like a sister to me, OK? Can we just talk?” She studies me sympathetically, like I’m the one in need of comfort.

I am relieved, released of the responsibility to futilely search for community resources that do not exist. Wraparound programs and services — ones that I trust to have Beth and my patients’ best interests in mind — are very rare these days. Most have fallen to the experimental recovery-oriented system of care, or ROSC, which shepherds all down a single pathway towards abstinence. Alberta’s model is unique in that it excludes harm reduction from the continuum of care. As such, it is a system akin to an extension ladder that is missing the first 10 feet of rungs. Lacking entry-level steps that meet people where they are with non-judgmental care, patient-centredness and barrier-busting pragmatism, the ROSC ladder is impossible for most to even mount, let alone climb.

‘Compassionate intervention,’ to what end?

Later that day, I cram some clothes from my own daughter’s closet into a grocery bag: a soft baby blue fleece sweater to complement Beth’s charcoal gray eyes, a stylish pair of ripped jeans, and some satin hair ties to accompany hygiene essentials. I send a text to outreach workers, asking them to call me if they connect with her. I feel the familiar knot of uncertainty in my stomach. Could I have done more when I had the chance? Where is she sleeping tonight?

I freeze in the spacious walk-in closet, imagining how scared I would be if it were my daughter out there on the streets. How helpless I would feel. How easy it would be to take refuge in any promise of help, rescue, or relief from the pain that plagues a worried parent. This feeling is what the creators of the so-called Compassionate Intervention Act are counting on. A pre-election promise to further crack down on substance users and people experiencing homelessness made by Danielle Smith’s United Conservative Party in March 2023, development of the act is now part of the majority government’s official mandate and will extend powers to remove a person’s autonomy — beyond what the current Mental Health Act allows for qualified health professionals — much further into the purview of law enforcement officers.

It is not only that these new rules will make it possible for police to force people to attend, and comply with, treatment. It is also that the Alberta government has spent the past four years destroying so many of the other options including wraparound care programs like Lethbridge’s ARCHES. I know this because my own wraparound, low-barrier, trauma-informed medical practice is part of the wreckage.

I am far from alone. I personally know many who would not only never step over a person in distress on the streets but will, paid or unpaid, actively go looking for them day and night, even if that’s not their official job. These are salt of the earth people who will help anyone, anytime. They will get down on their knees in broken glass to ensure someone — it might be your child — is alright.

Yet they do their work unsupported, underfunded, and are often themselves deeply stigmatized and antagonized. These are nurses, business owners, and lawyers. They are your next-door neighbour. They are the “pathological altruists” and “radical leftists” you may have heard political leaders deride. I am one of those.

I agree that something must be done. But parents and families should know the truth: draconian interventions would not be needed if the support network, full of dedicated workers who care deeply about people experiencing homelessness and folks who use drugs, had not been dismantled in the first place.

Forced care is not compassion

Creating new legislation is also a waste of needed resources when we already have a way to get people to care who are suffering from a mental disorder and are a danger to themselves or others. The key distinctions between Alberta's current Mental Health Act and the new proposed Compassionate Intervention Act are that the new legislation’s only eligibility criteria is substance use. It permits any police officer, not just physicians and judges, to legally force someone into treatment.

Ask why, if adequate health supports existed, law enforcement should be involved with health issues.

Don’t get me wrong, I have worked closely with law enforcement to get certain patients who lack the capacity to choose for themselves to hospital when there are no other options for their own safety and they are likely to benefit from treatment. The determination of someone’s ability to decide for themselves is one of the most difficult clinical decisions to make. Additionally, the definition of "risk to self or other" is rarely straightforward. It takes years of training to understand the ethical and clinical nuances of capacity and risk, which is why this mechanism is normally stewarded by judges and physicians.

Personally, even after decades of training and practice, having to invoke the Mental Health Act for a patient who meets the strict criteria is something I still lose sleep over. I do not think this responsibility should fall to police officers or anyone else who is unprepared.

If you’ve ever had to call the police for help with a family member in a mental health crisis, you know desperation. I can understand, when the government repeatedly insists that forced care is a form of compassion, why a parent might imagine a scenario where police will gently accompany their loved one to a comfortable facility where they will get that ever-elusive help. Unfortunately, I can attest as a witness to such moments: there is sometimes blood on the floor after they take the patient away.

These moments occur not because they are the best path but because there are no other options. The fact that there are no other options are due to policy decisions, not a lack of knowledge about what works. I would far rather call an experienced mental health team to assist me in those moments than hand my patient over to a beat cop.

A few years ago, when overdose death rates were climbing but still nowhere near what they are today, I made a submission to a City of Calgary grants competition. It proposed an emergency response team for addictions, staffed by trauma-informed care providers that would come to your kitchen table or curbside when you needed help the most. We would show up. We would do what was needed, where it was needed: safe withdrawal, treatment with medications, counselling, connection to housing, income and long-term trauma therapy.

It was rejected.

So, I find it difficult medicine to swallow, whether from a city councillor or a parent or anyone, when it is said that we have no other options.

A fatal error

From within our desperate UCP-induced haze of discomfort and desperation, we choose to fund and support law enforcement "solutions" instead of real care. These are not solutions for us, for our children, for my patients, for Beth. They are political agendas that are killing young people and manipulating their families.

If someone like Beth is your child, I hope I can convey the truth that there are very committed, caring, truly compassionate individuals out there who are trying their best to accompany them. There are proven solutions to drug poisonings, treatments for substance use disorders, and ways to end homelessness. If only those individuals and solutions were supported rather than scorned.

As a parent myself, my warning to our community is this: it is truly a fatal error to believe that giving police the power to force someone into treatment will save your child.

All this will force is people into hiding or, if they do get caught, cause grave suffering and a steep increase in mental anguish and risk of drug poisoning. Compassion was already in the house, folks. But it, just like the word “recovery,” has been co-opted for political gain. And, like so many tumbling towers of political lies and promises that have led to far, far too many lives lost, it looks as though we are going to find out the truth the hard way.

In the meantime, we “leftist lunatics” will watch out for everyone’s someone, including yours. I carry the bag labelled “Beth” in my car, hoping each day to catch a glimpse of her topknot, soulful eyes and sweet smile. We will carry one for your child, too, if only you will allow us.  [Tyee]

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