Visions Journal

A system in need of transformation

Tracy Windsor, RSW

Reprinted from the Involuntary Treatment: Tensions and choices issue of Visions Journal, 2025, 21 (2), pp. 18-20

I want to preface this article with an acknowledgement of my social location, which influences every interaction I have.

I am a white settler on the shared, unceded, ancestral territories of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish) and səlilwətaɬ (Tsleil-Waututh) Nations. I'm in my late 30s. I have a bachelor of social work, a master of social work, and I’m developing a PhD proposal. I'm the volunteer executive director of a small—but growing—non-profit organization.

I have a diagnosis of bipolar disorder (type I) with psychotic features. I identify with this diagnosis. For me, it explains the phenomena I experience, including mood fluctuations and changes in my perceptions of the shared reality. I use this term with my friends to describe the way the world is interpreted by most people, especially those not impacted by the experience of psychosis.

A full life

Despite limitations related to my bipolar disorder, I am normally gainfully employed. My recent experience of mania and psychosis and a subsequent crash into depression have severely limited my ability to be in a workplace setting outside my home or the hospital. Thankfully, I’m able to do paid and unpaid work—which I love and gives my life so much meaning—while I'm in hospital. I have a place to call home, which I visit on passes away from hospital and will return to when I'm discharged.

I am cognizant of the privilege I have and the respect I receive during my interactions with mental health professionals and police, which happen rarely, when I experience symptoms of bipolar disorder that are distressing to myself and those around me. Other people facing marginalization might not get that respect. My symptoms landed me in the situation I'm in now—as an involuntary patient detained under the Mental Health Act of British Columbia. I'm writing from here today.

Of note: this is my second time detained under the Mental Health Act in as many months. I first went in May 2025 for a manic and psychotic episode and stayed four weeks. I then had about a month outside of hospital, during which I spent time connecting with family. But I didn’t have adequate care to keep me feeling well.

I was detained again in June 2025, when my mood crashed into depression—likely, fallout from the manic and psychotic episode I had in the spring. Before these recent admissions, I was in hospital at the end of 2022, when I went in voluntarily for a brief depressive episode. The time before that was an involuntary stay in 2011 for depression, so it's fair to say I had a pretty good run of stability going on 14 years.

My first big psychotic episode was in 2008, which is when I was connected with the Early Psychosis Intervention program. I trusted the team there with my life. They told me the research says people with my diagnosis do best when they stay on medication for life. I believed them, taking my medications as prescribed every day, rarely questioning whether I needed them.

I hadn't had another episode of psychosis (that wasn't cannabis-induced) until this spring. I think it followed my choice to reduce my dose of medication. I was influenced by the idea circulating online, now proven wrong for me, that people might not face repeat psychosis.

The problems with involuntary treatment

Going into the hospital this time hit a little different. I knew that once I was admitted, I would be entering a setting where I'd be contained, sedated and subjected to a process of trial-and-error with medications meant to return me to my "usual" self.

When I arrived, there were few—if any—genuine efforts from care providers to build a meaningful relationship with me. Most interactions were limited to a quick checklist: questions like whether I was having thoughts of suicide or hearing voices. (Even though I've never heard voices, I'm still asked that question twice a day.) I also didn't want to go to the hospital because I know so much more about how psychosis and depression can be treated, and I knew I wouldn't necessarily get cutting-edge treatments.

That's part of what made this hospitalization so difficult: the awareness that care can look different—more relational, more attuned to the complexity of what I go through. I've experienced the difference it makes when someone actually sees you, not just your symptoms. This is where peer support matters so deeply.

Peer support: The unsung hero

Peer support is a huge part of my life. Peer supporters can connect with people with lived experience in ways that feel more human, more grounded and less like the interaction is just going through a checklist. Because they've been there themselves, peer supporters offer understanding rooted in empathy, shared struggle and mutual respect—something that’s hard to teach and impossible to fake. In moments where I've felt disconnected from the system, it's often been peers who've helped me feel seen, supported and hopeful again. Their presence reminds me that recovery is possible and I’m not alone. Peer workers don't just support individuals; they help transform systems, making them more compassionate, human and trauma-informed.¹

In the end, the issue isn't involuntary treatment itself, but the quality, culture and context in which it's delivered. When hospitalization becomes little more than sedation, containment and perfunctory questionnaires, it fails to offer the kind of care people need and deserve, especially in moments of deep vulnerability.

If we're going to use involuntary treatment—and without meaningful alternatives, it seems we have little choice—we must also commit to transforming it to invest in relationships, centre peer support and ensure the care is real, not just routine.