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Since BC NDP leader David Eby announced an expansion to BC’s involuntary mental health care system many experts have raised concerns.

Alfred Achoba is the executive director for the Kamloops branch of the Canadian Mental Health Association, and he said involuntary care is an ineffective long-term solution to the mental health and addiction crisis in the province.

“Generally speaking, we've seen that when you forcefully put people in a facility, we've always known that it's counterproductive,” he said. “We know that when people make a choice to seek help, that they are more willing, we see better results."

The province plans to add more than 400 mental health beds by modernizing 280 existing beds and adding more than 140 new mental health beds, according to a press release.

“People with addiction challenges, brain injuries and mental health issues need compassionate care and direct and assertive intervention to help them stabilize and rebuild a meaningful life,” Eby said in the release. “We are taking action to get them the care they need to keep them safe, and in doing so, keep our communities safe, too.”

The BC Mental Health Act allows people to be detained by police and taken to a health care facility if they pose a danger to themselves or others. Achoba said people are usually held in a health care facility for anywhere from a few hours to two weeks, but a doctor can decide to hold people for longer. People in involuntary care can be placed on medication temporarily.

“You temporarily lose that right to be able to decide for yourself,” he said. “When we're forcing people into treatment or into a care home, we're also infringing on their rights. All of those coercive measures lead to ineffective outcomes.”

Achoba said there's no meaningful follow-up after a physician diagnoses a patient and deems they are fit for release.

“That's where the ball drops. Oftentimes those solutions or options provided to clients are temporary. It’s just to keep them safe at the time,” he said.

READ MORE: Involuntary mental health care must be 'dignified and humane,' B.C. premier says

A more effective long-term solution would be investments in voluntary care to make it easier to access and improve availability, he said.

“Part of the reason why there's so much pushback around this whole idea of involuntary care is because the end goal is still going to lead to that circle of addiction, which is what we've been trying to break. And that's when people are out of involuntary care, where do they go? Back to the street where toxic drugs are rampant,” Achoba said.

In B.C., there are already roughly 30,000 Mental Health Act apprehensions a year of about 20,000 individuals.

Kim Mackenzie, the mental health association’s director of policy, said involuntary care is a last resort rather than a reliable treatment option that will solve the overarching problem.   

“You can imagine there are repeat hospitalizations happening as well in that 30,000 number. And so I think there's a misperception that we're not involuntarily detaining people who are at risk to themselves or others right now,” she said.

“We actually have the highest numbers across provinces in Canada for involuntary detention under the Mental Health Act,” she said. “The fact that there are repeat hospitalizations may lead us to question what's going on for those folks. We have to recognize that involuntary care isn't really a panacea.”

Mackenzie said involuntary care is an expensive way to help people who are struggling compared to voluntary care.

“Policing costs, and emergency department costs. Those are two very expensive things on the public purse. So, we'd love to see a lot more investment in early intervention and prevention,” she said.

She has numerous concerns about involuntary care in B.C., particularly the lack of oversight.

“The biggest challenge that we have in B.C. is that there's no one overseeing the implementation of the Mental Health Act or involuntary care in general. And we don't have good data on the effectiveness of it,” Mackenzie said.

The association is calling for an independent office to improve the use of the Mental Health Act.

“We'd love to see an independent Office of the Mental Health Commissioner, kind of like the Office of the Human Rights Commissioner. That really is tasked with overseeing the system and actually understanding what those gaps are,” she said.

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Health Justice is a non-profit in B.C. that has published several reports about the problems with the involuntary care system ranging from gender-based violence, to the fact that most patients who request a hearing never get one.

People detained under the Mental Health Act have to request a review hearing. Out of 2,569 requests for a hearing only 937 hearings were actually conducted, according to a Health Justice report.

Health Justice’s report on gender-based violence includes numerous personal accounts of how people, particularly women and queer people, are mistreated when taken into involuntary care.

“And then when they reached me, all these cops, like, six or seven cops, came out from that van. And they didn’t just stop me. They just beat me. They beat me, they beat me, they beat me, they… they put me to the ground, they put their feet on my legs, they were crushing my chest with their weight. I wasn’t able to breathe... it continued until the paramedics arrived,” a person with lived experience said in the report.

Health Justice said this issue doesn’t have a simple solution.

“Complex problems are not solved with quick fixes. There is no doubt that people and communities experience harm when people’s mental health, substance use, and other basic needs go unmet. But the answer is not to create more harm by using these serious issues, and the lives of real people, in a game of political football,” Health Justice said on its site.

While the Canadian Mental Health Association is a non-partisan organization, but Mackenzie said mental health and addiction are going to continue to be a politicized issue.

“We would just really encourage any political parties to really dig into the issue to better understand what we know and what we don't know, in particular when it comes to involuntary care, what we don't know. And think about longer term solutions that aren't silver bullet solutions. Because my experience working in this sector is that there are no silver bullet solutions,” she said.

Achoba in Kamloops said crime, addiction, homelessness and mental health have all been lumped together into one issue when they are really distinct problems which require different solutions.

“Obviously, when you compound all of these together, they do exacerbate each other. What we would love to see is definitely a clear distinction where an individual who is going through a psychosis because of their mental health is not being apprehended under the guise that they are suffering from an addiction issue,” he said.

Click here for the Canadian Mental Health Association's B.C. policy roadmap.

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