Visions Journal

BC's approach to involuntary treatment

Health Justice

Reprinted from the Involuntary Treatment: Tensions and choices issue of Visions Journal, 2025, 21 (2), pp. 8-10

It's no secret that involuntary mental health and substance use treatment is a hot-button issue in BC. Rhetoric related to expanding involuntary treatment is highly politicized. Often, the talk is more rooted in point-scoring than evidence-based policy or long-term solutions. People with lived and living experience of involuntary treatment feel their lives are being used in a game of political football.¹

Discussions about involuntary treatment are often steeped in fear, misinformation and an oversimplif ied focus on whether involuntary treatment is "good" or "bad." What's missing from these debates is nuance, humility, evidence-based policy and the voices of people with lived and living experience.

Instead, involuntary treatment is presented as a quick fix to deeply entrenched, systemic issues related to challenges affecting BC and beyond. These include:

• an inadequate mental health and substance use system

• lack of affordable housing

• Canada’s outdated drug policy

• unaffordability

• social exclusion

These problems were created by decades of policy decisions by various levels of government, and quick, politically-motivated announcements are not going to solve them.

Reality check

It might be worth talking about what involuntary treatment is, what it is not, and why that matters. In BC, involuntary treatment in the health system is governed by the Mental Health Act, a provincial law that authorizes the detention of a person in a designated facility. Many people don’t know that the province already has over 70 of these facilities, many of which have been operating for decades.²

Once detained, the law authorizes involuntary psychiatric treatment, which includes:

• forcibly administering medication³

• regular use of seclusion rooms

• physical, mechanical and chemical restraints⁴

Involuntary treatment usually does not involve:

• more holistic approaches to wellness

• access to safe housing

• adequate income supports

• long-term talk therapy

• a focus on the individual's wishes and goals for their lives⁵

Fundamentals of health care consent

Our ability to control what happens to our own bodies is one of our most fundamental human rights and is protected in the Canadian Charter of Rights and Freedoms. The Charter is the basis for sexual consent laws, reproductive rights and health care consent laws.

In the relationship between doctors and patients, doctors hold a lot of power and knowledge. This power imbalance is why health care consent ensures doctors must share information about proposed treatment options. Health care consent includes sharing:

• the condition being treated

• information about the proposed treatment

• risks and benefits of that treatment⁶

We have the right to decide whether to consent or refuse treatment based on the information provided. If we are unable to consent or refuse health care because of our health issues, BC has a system where, based on our previously expressed wishes, the people we choose or the people who know us best step in to consent or refuse. The goal underpinning this whole system is ensuring that our personal wishes, values and views are the focal point of any decisions.

Disregard for consent Under BC's Mental Health Act, none of those rights apply to people experiencing involuntary psychiatric treatment. Instead, they are deemed to consent to any psychiatric treatment their team sees as appropriate.⁷ This happens regardless of:

• their ability to make a particular decision

• any wishes previously expressed about what they would like to happen if they become unwell

• whether the people close to them, who know their views and wishes, are willing and available to make decisions for, or with, them

There is currently a case before the BC Supreme Court challenging whether BC's law violates the Charter. The BC government has been fighting this case since 2016.⁸

This means people who experience involuntary mental health or substance use treatment under BC's Mental Health Act lose the ability to control what happens to their bodies in extreme ways. Regardless of good intentions, the effectiveness of the treatment administered or why we think involuntary treatment is necessary, this loss of control has the potential to create serious and lasting harm.

Real people

Health Justice has undertaken hundreds of hours of engagement with people who've experienced involuntary treatment through our governance groups, interviews, focus groups, surveys and more. The harm of involuntary treatment is reflected in how they tell us they feel about their experience. Some find the experience positive in that it kept them safe. Some find it harmful, with no benefits. Many have a less binary view: some parts were helpful, but some parts caused significant harm. That harm can have a lasting impact.

People with lived and living experience of detention and involuntary treatment regularly leave feeling fearful of engaging with the health system again, ashamed and mistrustful, and carrying trauma, including PTSD.⁹ These effects are the opposite of what people need to feel safe accessing health care services in the future.

As well, involuntary treatment does not impact people equally. Children and youth, Indigenous, racialized and gender-diverse people may experience the loss of control over their own bodies in different or heightened ways.^10-13

A time for choice

The question, then, is how we can address the complex and entrenched social issues we see in our communities while also minimizing harm and supporting the dignity and humanity of the people who are suffering the most due to these issues? In April 2025, Premier Eby announced that the Minister of Health will undertake a review of the BC's Mental Health Act.¹⁴ At the time of writing, BC has not announced its plans for the review.

In our view, BC is at a crossroads. We can continue on our current path of quick fixes and oversimplified solutions, assuming involuntary treatment is inherently "good" and ignoring the harm created and lack of change in our communities that results.

Or, we can take the admittedly harder path: review the law and the mental health and substance use systems with intention and care.¹⁵ We can decide we want to take time to understand the complexity of the issues raised by involuntary treatment, including colonialism, ableism, power and the role of doctors, and create an independent process, removed from political dynamics.

We can centre the voices of people with lived and living experience to learn what works for them and what harms them. We can learn from places around the world grappling with similar issues, like Scotland, which is now reviewing its mental health law. This option requires significant bravery and, more importantly, humility.

However, walking this more difficult path alongside those most directly affected by the legislation will support wellness and safety for all members of our communities.