Chamber CEO calls for involuntary care for mental illness in Victoria

As the mental health and addictions crisis continues to wreak havoc on cities across B.C., one frustrated Victoria business leader is calling for a rethink of the provincial mental health strategy – even if that means pulling people off the street and putting them in care against their will.

"We have to take a look at the idea of involuntary care for some of these people who are no longer in a position to be able to care for themselves or make the right decision," said Bruce Williams, CEO of the Greater Victoria Chamber of Commerce, during a luncheon on Feb. 23.

Experts say this presents difficult choices about self-determination and who pays for care, while those who have struggled with mental health, addiction and life on the street say meeting basic needs like housing will go much further to address these problems than involuntary care.

The February luncheon was arranged to allow chamber members an opportunity to ask B.C.'s finance minister about the 2024 B.C. budget. Public safety was the first issue he brought up.

Finance Minister Katrine Conroy acknowledged it is a topic of conversation within government.

"We have a number of thoughts on that from different experts, experts that say it doesn't work, and experts that say it does," she said. "You have to balance it all and make sure what you're doing is not harming the person; that you're actually helping them."

Business leaders want "open episodes of addiction and mental illness breakdowns" off the streets, Williams said.

"It would make the streets safer for them, and for those of us who also work on those streets, and walk on the streets, and live in those neighbourhoods."

Looking for examples elsewhere

While generating a fair amount of controversy, New York City instituted a policy in 2022 that allows police officers, firefighters, mental health clinicians and other designees to either personally, or through police, effectuate the "removal of a person who appears to be mentally ill and displays an inability to meet basic living needs, even when no recent dangerous act has been observed."

This is different than what is allowable in B.C. Other than family members and guardians, police are the only people with this authority, and can only detain a person under the Mental Health Act when an individual poses an immediate threat to themselves or others.

The other difference in B.C., according to the University of Victoria'sErica Woodin, is that places like New York have more resources for mental health care than B.C. does.

"New York City, in my understanding, is putting a good deal of resources into a greater number of psychiatric beds and community supports," she told Black Press Media.

"Right now, it's very difficult to even get care for people who are at risk of harm to themselves or others [in B.C.]."

Woodin is a psychology professor and has spent years studying Victoria's Assertive Community Treatment (ACT) teams, which work to treat people who have severe mental health issues and have been identified as a risk to themselves or others. These teams, which include police, try to help with basic needs like housing and accessing medical care, as well as providing mental health treatment.

She contends that in the past half-century, the deconstruction of the old institutionalization system in Canada, which at one time included involuntary committals of those suffering with mental illness, was not replaced with adequate community supports.

This happened throughout the 1960s and 70s as new medications, such as powerful anti-psychotic drugs, allowed people with mental illness to recover and live in their communities.

But as time has gone on, the lack of actual services to provide mental health care for people, particularly those who have not been identified as a threat to themselves or others, has left a gaping hole in the system.

Falling through these gaps are people like Guy Felicella, who spent 20 years living on the streets of the Downtown Eastside in Vancouver dealing with addiction and mental health issues before finally getting the treatment he needed.

He said in an interview that undiagnosed learning disabilities and childhood trauma made recovering from addiction an almost impossible proposition — especially without the money to pay for treatment.

"Trauma therapy is not covered under MSP," he said. "You just can't go walk into a trauma therapist and start talking to them."

Felicella is a vocal advocate for addressing people's basic human needs, such as housing, then give them the choice and means to seek treatment. Until these needs are met, people will simply be scrambling to solve the daily struggle of how to get food and where to sleep, he said. Without a place to go upon release from treatment, people simply end up back on the street, and either stop taking meds, start using again, or both.

Forcing treatment when people aren't ready will also have little success, he said.

"It's more like turning the treatment industry into a prison industry," Felicella said of involuntary care. "And, that really wouldn't be a therapeutic environment for people to start healing from their pain and trauma."

Some tricky questions

Figuring out how to get people into treatment who have not outrightly shown themselves to be a danger to themselves or others while also respecting people's right to self-determination presents some difficult choices, Woodin said.

"There are layers of issues there that make these decisions really difficult."

Part of this is the difficulty of determining when a person is actually able to make a decision for themselves, epecially if they have refused to take anti-psychotic medication and are experiencing psychosis or mania.

"That's the debate right now, too, is to what extent do you coerce individuals to take medication that they do not want to take," Woodin said. "Their symptoms might be so severe that their judgment might be incapacitated"

If police or others do intervene, and the person is brought in for an evaluation, the question also remains of how that treatment is funded.

"If we have no services for them after the evaluation, then we have put the individual through what can be a stressful and potentially traumatic situation," Woodin said. "Being hospitalized against your will is not a pleasant experience for a lot of people."

Woodin and her colleague, Catherine Costigan, have been studying whether a police presence on the ACT teams is helpful or harmful. So far, she said that police officers trained specifically for the team tend to be able to look at cases through a mental health lens, rather than a criminal lens.

These teams work with people who have already been deemed high-risk, and who are given the choice to either participate or return to a hospital setting. This means it is a "coercive" model for care, as people aren't really given a choice.

"Could you use a coercive model like that for an individual who wasn't deemed to be at such high risk, but maybe still needed the supports?" Woodin asked. "That's the tricky question."