Involuntary Care Doesn’t Work. What BC Should Do Instead

Everyone deserves to live in a safe city. The events that left one person dead and another very seriously injured after a recent attack in downtown Vancouver are tragic and painful, and British Columbians are rightly calling on the government for a response.

I’m a lawyer at the Community Legal Assistance Society, a Vancouver-based non-profit law firm addressing the needs of those who are disadvantaged or face discrimination. Speaking on behalf of CLAS, we agree that a response is needed, but ask that the response by government be grounded in the relevant facts and evidence about what will genuinely improve mental health care and safety in this province for all — including people in mental health crisis.

The number of people being detained under B.C.’s Mental Health Act has increased dramatically over the last two decades.

However, we know through provincial data that the use of detention, force and coercion has repeatedly proven to be ineffective, and often counterproductive, in reducing or preventing mental health crises.

Safety is best achieved through evidence-based treatment and harm-reduction approaches for people experiencing mental health crises or living with mental disorders.

The provincial government’s recent announcement of a plan focused on increasing involuntary detentions is not supported by the facts.

Detentions are already rising. And they don’t work

A common misconception is that B.C. has decreased its reliance on mental health detentions over the years, which has led to the current crises in homelessness, mental health and addictions. But the evidence shows that detentions have, in fact, increased dramatically.

The province is detaining more people in psychiatric facilities than before. In 2005, there were about 12,000 involuntary admissions under B.C.'s Mental Health Act. In 2023 this number surged to nearly 30,000 involuntary admissions, a staggering increase of 150 per cent.

In addition to the high number of people placed in involuntary detention, B.C. has extremely broad laws allowing forced psychiatric treatment that do not exist in any other province.

An evidence-based approach clearly shows that the reliance on detention, force and coercion over the past two decades has not led to better outcomes. Instead, resources should be focused on voluntary mental health care, services and community support that people desperately need and often cannot access.

Creating fear, avoidance

B.C.’s over-reliance on coercive approaches deters many people from seeking the mental health care they need. Many individuals experience the health-care system as an environment that deprives them of their basic rights and uses violence, rather than one that provides compassionate and dignified care.

The current inquest into the death of Paul Spencer at Royal Jubilee Hospital in Victoria highlights the violence that can occur to people while in detention.

After arriving at the hospital, Spencer was informed that he would be detained as an involuntary patient under the Mental Health Act. When he became agitated, he was violently restrained by three security guards and placed in solitary confinement, where he died.

Measures like detention, restraints and solitary confinement are meant to be last resorts, yet they remain all too common in B.C.’s health-care system.

For many, reaching out for help can lead to prolonged detention and involuntary treatment, sometimes lasting years.

As a result, people in need of care often avoid the system altogether, hiding from the very services that could help them and prevent a crisis from occurring in the first place.

Violent events that attract substantial media attention feed into the hurtful and false stereotype that people with mental health diagnoses are all violent offenders who threaten public safety. Again, evidence shows that this isn’t true.

People with mental health diagnoses are no more likely to engage in violent behaviour than the general population. In fact, the evidence shows that people with mental disabilities are more likely to be victims of violence than to commit violence themselves.

The minority of people who do commit violent acts while seriously unwell and unable to understand the nature of their actions are not acquitted and set free. They can be detained indefinitely until an expert panel determines it is safe to release them.

Studies have shown that people found not criminally responsible on account of mental disorder are less likely to reoffend than people in the general criminal system.

We all embrace a common goal of safer communities and finding meaningful, long-term solutions that can help avoid such tragic events. B.C. already relies on detention, force and coercion in mental health care more than it ever has. These strategies demonstrably have not worked to date.

The B.C. government must consider the extensive body of evidence and use facts to build a comprehensive and properly resourced mental health system based on evidence-backed harm-reduction and treatment options.

By moving toward voluntary, compassionate and effective care, we can better support individuals in crisis and work toward safer communities for everyone.