Coquitlam, Port Coquitlam mayors back expansion of involuntary mental health and addiction treatment; experts question policy

Coquitlam Mayor Richard Stewart and Port Coquitlam Brad West were among a coalition of B.C. civic leaders demanding federal funding to support expansion of involuntary care for those suffering from severe mental health and addiction issues.

The coalition was headed by Vancouver Mayor Ken Sim, and included 10 mayors, three First Nation chiefs, Vancouver’s chiefs of police and fire rescue services, the president of the Canadian Police Association, and a former drug advisor to the U.S. White House.

The group spoke on the steps of Vancouver City Hall on Sept. 16, pleading for immediate action from the federal government on involuntary care, bail reform for repeat offenders, and halting the illegal flow of drugs through Vancouver’s port. 

“This is about doing what is right for our communities,” West said. “We need action from the federal government that prioritizes public safety with a national strategy that also provides appropriate care and support to those who need it most.”

The announcement comes on the heels of provincial election promises from both major party leaders regarding involuntary treatments. The B.C. Conservatives declared their support for expanding mandatory care on Sept. 11, and the B.C. NDP followed suit on Sept. 15, retreating from its previous position.

At a press conference on Monday, Premier David Eby announced the province would open secure facilities for those detained under the Mental Health Act, including units at correctional facilities and regional facilities for long-term care.

The first mental health unit would be opened at the Surrey Pretrial Centre, while the first regional mental health facility would be constructed at Maple Ridge’s Alouette Correctional Centre, according to the province.

Both Eby and the coalition of mayors also advocated for the reopening of Riverview Hospital in Port Coquitlam. Today, the 105-bed Red Fish Healing Centre for Mental Health and Addiction facility, is located on the old hospital grounds, which at one point thousands of pshyciatric patients.

Mayor Stewart has been advocating for Riverview Hospital to be reopened for years.

He said that 10 years ago, his daughter was involuntarily committed under the Mental Health Act due to mental illness, and that action led to her recovery.

“In Canada, mental illness – including addictions – is the only illness for which a person can die because of an inability to seek treatment,” Stewart said. “Unfortunately, too many suffering with mental illness and/or addiction cannot seek help, and if they do seek help there is none available. In the context of a toxic drug epidemic, these people are dying of neglect.”

Drug and policy experts, however, have voiced significant concerns over the expansion of involuntary care.

Nicole Luongo, a systems change analyst with the Canadian Drug Policy Coalition, said in the last few years the NDP has changed course from what it initially promised for drug policy.

Opposition parties in B.C. have increasingly used drug policy as a wedge issue since the decriminalization pilot was introduced on Jan. 21, 2023. But Luongo said the decriminalization project has not been implemented robustly, nor has there been any educational campaign surrounding it, adding it was “quite a disappointment” to see the NDP acquiesce to the opposition.

She said rates of drug use and addiction have stayed steady across the country; the rates of homelessness, on the other hand, have gone up exponentially. 

“The government is really allowing itself to evade scrutiny and criticism for the material conditions that drive most chaotic and compulsive drug use,” Luongo said. “They offer the government a trend or a pattern of people to point to.”

Homelessness in the Tri-Cities increased 86 percent over three years, according to the 2023 Point in Time Homeless Count. Greater Vancouver saw a 32 percent increase in the same timeframe.

Kora DeBeck, associate professor at SFU’s School of Public Policy, said B.C.’s harm reduction policies, such as safe supply prescriptions, have been very effective, though only implemented in small restrictive models. 

She said she thinks the public has been misled in terms of why there is so much chaotic behaviour on B.C. streets, describing it as a function of an unpredictable drug supply, contaminated with fentanyl, benzodiazepines, and other drugs, which causes users to be unstable. 

“These are the kinds of factors that are a breeding ground for what we are seeing. It’s certainly not a failure of harm reduction,” DeBeck said. “I think we really need to be looking at transformational change, and not going back to doing the same old thing that we’ve done before – criminalizing drug use.”

Both experts questioned why the province was suddenly supporting involuntary care, when its voluntary treatment system has significant gaps.

Luongo described the waitlists for detoxification services, outpatient and inpatient mental health services, and addiction services as “astronomical,” adding drug users would be able to stabilize if they had easier access.

Instead, most common treatment forms are rooted in 12 step programs, which are outdated and lack any basis in evidence, she said.

“Why are we looking now to involuntarily institutionalize people, when people who want care can’t access it?” Luongo said. “Where is the funding for the involuntary treatment going to come from, if we can’t fund voluntary treatment?”

Involuntary treatments have also not been proven to have better health outcomes than voluntary types, according to DeBeck.

She said SFU conducted an observational study in Vancouver looking at the drug-use patterns of patients who were coerced into treatment, which showed there was no beneficial impact.

“There’s really not an evidence base to support this kind of approach,” DeBeck said, adding public health communities have voiced strong reservations.

DeBeck added the risk of fatal overdoses is high for these patients, especially in the context of fentanyl addiction, as relapses are extremely common and dangerous after a period of stabilization.

Another big concern is that involuntary treatments could erode trust between drug users – especially young people – and the health and social services, DeBeck said, describing it as an “really unhealthy dynamic.”

She said many drug users have severe childhood trauma, and forcing people into treatment is another traumatic experience.

“We know from young people who this has happened to: they will be less likely to reach out for help,” DeBeck said. “What they need is connection and trust and strong relationships.”

While the Canadian Drug Policy Coalition is not unilaterally opposed to involuntary treatment in all circumstances, Luongo said it should be a last resort, not a first or second option.

She said that the province’s focus should be on funding and expanding voluntary outpatient treatment services.

“It’s not that there’s just suddenly this huge demographic of inherently unwell people,” Luongo said. “It’s that people are driven to become really, really sick, because the voluntary supports they have been seeking don’t exist.”