B.C. doctors get new guidance on involuntary care for drug users

British Columbia clinicians have recently received new guidance regarding involuntary care for adults, particularly focusing on individuals with both mental-health and substance-use disorders. This directive, issued by Dr. Daniel Vigo, B.C.’s first chief scientific adviser for psychiatry, emphasizes that involuntary admission should not be utilized to prevent harmful “risk-taking” behaviors by individuals who use drugs without any mental impairment.

The guidance outlines three main scenarios in which involuntary treatment may be deemed appropriate: simultaneous mental disorders, acute and severe psychiatric syndrome with unknown causes, and ongoing mental impairment following remission from an acute state. However, it emphasizes that involuntary treatment should not be used as a means to control risky decision-making unrelated to mental impairment.

Health Minister Josie Osborne clarified that the new guidance does not signify changes to B.C.’s Mental Health Act but rather aims to provide a higher level of care for individuals facing overlapping mental-health and substance-use challenges, particularly those impacted by the ongoing toxic drug crisis. She highlighted the importance of ensuring that individuals with complex needs receive the necessary support without infringing on their autonomy.

Dr. Vigo underscored that involuntary treatment can be a life-saving tool for a small percentage of individuals with mental disorders, including substance-use disorders. He acknowledged that while most individuals will not meet the stringent criteria for involuntary treatment, there are cases where it is essential for preserving life and addressing the source of impairment.

The expansion of involuntary care to individuals with concurrent mental health disorders has sparked debate, with some advocating for a focus on harm reduction strategies and investment in detox and sobering centers. Dave Hamm, president of the Vancouver Area Network of Drug Users, expressed concerns about the effectiveness of involuntary care for substance use disorders and emphasized the importance of peer-led and medically supported interventions.

Overall, the new guidance aims to provide clinicians with clear criteria for determining when involuntary treatment is appropriate while also emphasizing the need for a comprehensive continuum of care that includes both voluntary and involuntary services. By dispelling misconceptions and enhancing the quality and quantity of mental-health and substance-use supports, the goal is to better identify individuals who would benefit from involuntary treatment while also promoting voluntary treatment options.

As the province continues to address the complex needs of individuals with mental-health and substance-use disorders, the implementation of new involuntary care beds at facilities like the Surrey pretrial center and Alouette Homes in Maple Ridge represents a step towards improving access to care for vulnerable populations.