Visions Journal

Trudy Norman, PhD

Reprinted from the Involuntary Treatment: Tensions and choices issue of Visions Journal, 2025, 21 (2), p. 4

Involuntary psychiatric treatment is a controversial topic in health care. In BC, the numbers of those over age 15 detained rose 66% between 2008 and 2018. The largest increase was for people experiencing substance use disorders (139%), reflecting an overall rise from 14,195 in 2008 to 23,531 in 2018.¹

What might this rise in numbers mean? Is involuntary treatment helpful? And what of substance use disorders? What are the experiences of people who have received involuntary treatment? What do we need to change within our care systems to ensure people get mental health, substance use, and other supports they need? These are some of the questions explored herein.

For many years I was an outreach worker serving people experiencing homelessness in a mid-sized city. A number had serious mental health and substance use concerns. I got to know Shay through regular encounters in a soup kitchen.

Shay mostly talked to himself. Often, when I spoke to him, he ran away. He was very malnourished. He would neither apply for income assistance nor see a doctor. After months of observation, contact attempts and worker input, a psychiatrist with the downtown health centre decided to certify Shay and hospitalize him. After several weeks Shay’s overall health significantly improved and he was lucid. He spoke with the doctor.

Shay was angry. He understood people worried about him. He admitted he felt better physically than he had for some time. He also said the medications slowed his mind and made it cloudy, dulled his creativity, and made him feel less like a person. When asked what he would do upon discharge, Shay said he would stop taking psychiatric medication. When the doctor pointed out that this may well result in him returning to his previous fearful and unhealthy state, Shay noted that yes, that may happen and, that was his choice to make. The doctor felt Shay understood the potential consequences of his behaviour and released him from hospital. Upon release, Shay stopped taking medication and returned to his previous psychotic state. He disappeared a few months later. I eventually heard that he had passed away.

I often thought of Shay while working on this issue of Visions. For me, his story highlights the complex and nuanced intersections between a person who needs medical assistance, their human rights, life needs, and the health care system. How do we best address these needs within our current social, cultural, and political contexts? This Visions issue is meant to add to this important conversation as it relates to involuntary treatment. I encourage you to think about the question and draw your own conclusions.