Pivot Legal Society position paper calls for the elimination of involuntary treatment in BC

FOR IMMEDIATE RELEASE
March 23, 2023

xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish) and səlilwətaɬ (Tsleil Waututh) / Vancouver, B.C. – Today Pivot Legal Society released its position paper, Involuntary Treatment: Criminalization by another name. The paper comes amid government movement toward the expansion of involuntary treatment in BC, including by Premier David Eby and Minister of Mental Health and Addictions Jennifer Whiteside. Recent rumblings from municipal, provincial, and national politicians indicate that the latest call to expand involuntary treatment directly targets people who use drugs. Involuntary treatment - for any community - is a harmful and degrading intervention at odds with healing, wellness, and best practices in drug policy and mental health care. In the context of the drug toxicity crisis, this expansion could be deadly.

Involuntary treatment includes interventions such as forced medication, institutionalization and other coerced behaviour. It builds on a legacy of sterilization, segregation, abuse, experimentation, along with settler colonialism and medical racism in Canada based on eugenics and settler colonial ideologies. Three years ago, BC’s former Ministry of Mental Health and Addictions Sheila Malcolmson was forced to pause its proposed expansion of involuntary treatment for youth (or “youth stabilization care”) under Bill 22 following widespread condemnation.

Despite being forced to “pause” expansion at that time, BC NDP has not committed to scrap plans for future expansion, nor issued any directives to address the rampant use of involuntary treatment enabled by BC’s Mental Health Act and the Health Care (Consent) and Care Facility (Admission) Act. Premier David Eby campaigned on the expansion of forced treatment criteria in his recently successful leadership bid.

Kali-olt Sedgemore, President of the Coalition of Peers Dismantling the Drug War, is a longtime advocate for youth who use drugs, and was a staunch critic of Bill 22, which proposed involuntary treatment for youth who experienced overdose in BC:

Involuntary care creates mistrust in the health care system... These interventions break trust and relationships, and could mean someone dying due to fear. Involuntary care means more death.

"Involuntary care creates mistrust in the health care system. With this looming threat, overdose prevention site workers and peers are forced to make the difficult decision of calling 911 when an overdose occurs - and potentially forcing someone into involuntary care. These interventions break trust and relationships and could mean someone dying due to fear. Involuntary care means more death. The drugs are toxic and there is a high chance that people return to relying on the criminalized drug supply after involuntary treatment.

Without voluntary and consent-based supports in place, more people will likely end up dying. What you may see as harmful may not be harmful to the person you’re thinking about. What is deemed harmful to one is maybe not harmful to another; we must respect the rights and autonomy of people who use criminalized substances."

Sandra Ka Hon Chu, Co-Executive Director of the HIV Legal Network categorically rejects the notion that involuntary treatment is in the ‘best interest’ of people seeking access to healthcare:

Forced treatment is a gross violation of people’s rights to autonomy, liberty, and health... As with all state repression, those harms will be borne most immediately by Black, Indigenous, and racialized people.

"Forced treatment is a gross violation of people’s rights to autonomy, liberty, and health. While proponents contend that it is in the best interests of a person, coercive treatment denies the autonomy of people who use drugs and is an indefensible shortcut that causes profound harms, including by further alienating people from voluntary supports and exposing them to a greater risk of drug poisoning. As with all state repression, those harms will be borne most immediately by Black, Indigenous, and racialized people."

Marilou Gagnon, Professor in Nursing at the University of Victoria and Scientist at the Canadian Institute for Substance Use Research, highlights how involuntary treatment undermines the agency of people who seek healthcare, despite lack of access to safe(r) supply as we approach the 7 year anniversary of BCs Overdose Public Health Emergency:

...Continuing down this policy path is not conducive to healing, self-determination, and justice–fundamental pillars of an ethical and rights-based public health approach.

"Involuntary treatment is dehumanizing, harmful, ineffective, and only serves to further erode trust in the health care system. Nurses know that turning to coercive approaches is not a solution to the drug poisoning crisis. Shifting from incarceration to involuntary detention in healthcare settings is not what this crisis calls for. Continuing down this policy path is not conducive to healing, self-determination, and justice–fundamental pillars of an ethical and rights-based public health approach."

Tyson Singh Kelsall, RSW and PhD Student at SFU's Faculty of Health Sciences underscores the paucity of available supports, despite heavily politicized rhetoric:

...Emerging evidence shows that involuntary abstinence leads to increased non-fatal overdose and premature death—in other words, such a social policy would kill more people.

"Politicians far off from impacted communities continue to approach the symptoms of structural violence they themselves produce with punitive measures. Expanding involuntary apprehensions, while voluntary supports are inaccessible to most, and floating policy that would force reduced tolerance before discharging people back to a toxic street supply setting is not only cruel, but dangerous. Emerging evidence shows that involuntary abstinence leads to increased non-fatal overdose and premature death—in other words, such a social policy would kill more people."

The board of the BC Association of People on Opioid Maintenance, one of the drug-user led organizations that endorsed the position paper, notes the harms of incarceration - whether via the criminal legal system or the healthcare system:

The state has a poor track record when they incarcerate anybody, for any reason - especially youth and Indigenous people. They should not be allowed to find new paths back to old misdeeds.

Caitlin Shane, staff lawyer at Pivot Legal Society notes that recent emphasis on coercive treatment is a disingenuous cover for a failed social safety net:

...To gesture at involuntary treatment when virtually no voluntary or consensual supports exist—and amid state-authored crises of housing and drug toxicity no less—is par for the course of this state’s War on the Poor.

"The BC NDP’s renewed interest in forced treatment is a cynical ploy to distract us from the structural violence it enacts daily. To gesture at involuntary treatment when virtually no voluntary or consensual supports exist—and amid state-authored crises of housing and drug toxicity no less—is par for the course of this state’s War on the Poor.

Eliminating involuntary treatment, in all its forms, is rooted in the recognition of the rights, dignity, and autonomy of disabled communities. Instead of expanding the use of harmful and widely-discredited involuntary treatment frameworks, all levels of government must commit to fully supporting dignified, culturally safe, and consent-based healthcare."

The paper calls for shifts in care informed by intersecting identities , human rights and reducing barriers to care. It highlights the realities of coercive care and its preceding impacts. It has been endorsed by 16 healthcare, human rights, abolitionist, and drug-user led organizations, and 16 individual experts working in community, healthcare, academic, and advocacy settings. The paper’s 7 recommendations collectively demand an overhaul of BC’s treatment options by way of fulsome access to a spectrum of health and harm reduction supports and the elimination of carceral interventions, including police-based wellness checks.

The Position Paper outlines 7 recommendations:

Invest in robust access to voluntary treatment options, including primary care, detox, treatment programs that have strict regulatory oversight, harm reduction programming, safe supply, family programming, culturally affirming options, and treatment modalities that reflect the intersecting identities of people who use drugs. All voluntary options should be available immediately upon request and accessible across inner-city, rural, and remote areas.
Immediately fund and scale up safe supply programs to ensure a regulated and predictable supply of drugs is accessible to all.
Immediately eliminate all police involvement and power under the provincial Mental Health Act, particularly the ability to apprehend someone using an officer-based assessment; as well as repeal any potentially intersecting provisions, regulations and legislation that grants law enforcement a healthcare scope, including the warning and referrals subsection of federal Bill C-5, and the 'alternative measures' embedded into BC’s decriminalization framework.
Prevent the expansion of legislation that broadens apprehension criteria to include overdose.
Eliminate any form of involuntary and/or coercive treatment, including BC legislation, as well as any umbrella agency-level policy (i.e., employer or union policies that mandate employees into involuntary treatment programs).
Repeal all legislation and regulations that are used to disproportionately target Black, Indigenous, and racialized communities.
Repeal all legislation and regulations that are used to target people who use drugs and disabled people. There is already existing legislation that permits forced treatment against these groups. It is violent and unjust and must be eliminated.