Visions Journal

Involuntary treatment stops short of addressing the homelessness crisis

Trevor Goodyear, PhD, RN and Angela Russolillo, PhD, RPN

Reprinted from the Involuntary Treatment: Tensions and choices issue of Visions Journal, 2025, 21 (2), pp. 31-33

Homelessness is a pressing issue in BC. Every day, the housing crisis is pushing more people onto the streets. At the same time, the public is sounding the alarm about rising and unmet mental health and substance use needs, which are intensified by the toxic drug crisis. For some people in our communities, these health and social issues go hand in hand.

Many are calling for involuntary treatment, which forces people with a mental disorder into treatment without consent, as a solution to these issues. But is this really the best option?

We’ve seen these issues first-hand

As nursing researchers, we've worked clinically with people receiving involuntary treatment. We've also studied how homelessness, mental health and substance use overlap, increasing the risk for negative health and social outcomes. And we can tell you: forcing people into treatment doesn’t solve these complex issues. There are better ways.

The rise of involuntary treatment

Involuntary treatment under BC's Mental Health Act isn't new. This legislation has been in place for decades despite persistent human rights concerns. In 2024, the BC government announced plans to amend the Act to allow for involuntary treatment of people with substance use disorders, not just mental disorders.¹

Each year in BC, there are approximately 30,000 involuntary admissions.² From what we can tell, we are now seeing the highest rates of involuntary treatment in our province's history. Meanwhile, rates of voluntary treatment have plateaued. People aren’t choosing to enter treatment because good, accessible options just aren't available. Instead, more people are reaching crisis points where forced treatment is seen as the only option.

The use of involuntary treatment is rising in parallel with the toxic drug crisis—now the top cause of death for people ages 19 to 59 in BC. There's also public campaigning to create safer streets amid high-profile violent incidents involving people who are homeless and experiencing mental health and substance use crises. In the face of these issues, communities are desperate to act.

Involuntary treatment might seem like a tangible solution. But it's not the right choice. Many groups, including government and health leaders, are drawn to involuntary treatment as a means of doing something to help. However, quick fixes do very little to address the issues that land people on the streets or in crisis in the first place.

More harm than help

There's little evidence that forced treatment helps people who are struggling with homelessness and mental health and substance use challenges.³ In fact, it risks doing more harm than good. Involuntary treatment can be destabilizing and often perpetuates the instability it aims to resolve. There are clear links between involuntary treatment and trauma, health care avoidance and fatal overdose after relapse, as forced abstinence can reduce a person's tolerance to opioids.¹ In our clinical work, we've also seen people become displaced through involuntary treatment. They can lose their personal belongings, tents and social housing. This takes a heavy emotional toll and can feel like an assault on human dignity.

For people who have histories of trauma or exposure to child welfare, jail, shelters and social housing, being forced into psychiatric or substance use treatment can feel like yet another system taking control and limiting choices. Involuntary treatment can even signal danger, leading to people avoiding services. This makes people more likely to remain homeless and experience worse mental and physical health.

Policy changes that expand involuntary treatment have unintended and unevenly distributed consequences. While anyone can end up homeless, it's not random. Indigenous and racialized people, 2SLGBTQIA+ people, youth and others facing inequality are hit the hardest. These groups also experience inequities in mental health and substance use challenges, and when it comes to forced treatment.²

Focus on the real issues

The push for involuntary treatment ignores the real reasons people end up on the street or in crisis. These issues come from:

• underfunding for, and lack of, affordable housing
• poverty and inadequate income supports
• poor availability of community-based and voluntary mental health and substance use treatment
• intergenerational trauma and structural inequalities, including systemic racism and colonialism^1,2

These gaps lead people to receive care only when they are in crisis, at which point involuntary treatment becomes a last resort and a first-line support. We can do better than the current system, which is marked by fragmentation, long wait times and under-resourced capacity to provide compassionate and voluntary supports.

Towards meaningful solutions

There's an uncomfortable truth we as a society must confront: involuntary treatment serves to make the public more comfortable rather than to genuinely help people in crisis. The issues we're seeing in BC can't be solved by clinging to unproven policy solutions.

The path forward requires collective commitment from all groups—public, policy-makers and people with lived and living experience—and the courage to confront complex issues. While there are no simple solutions, the direction is clear: less coercion, more care. The question is not whether we can afford to make meaningful changes, but whether we can afford to continue without them.

Pathways to More Voluntary Care

Research shows that social determinants (root causes) such as housing access, economic conditions and our early childhood upbringing shape people's risk for homelessness and mental health and substance use challenges.⁴ To address these determinants, international guidance tells us we must invest in:

• a living wage
• a safe place to call home
• giving people a sense that they belong and are valued in society

Bold actions can also improve access to mental health and substance use care in our communities, including:

• sponsoring more team-based care to address the shortage of primary care providers
• enhancing public health insurance (i.e., MSP) coverage of psychiatric and psychological services
• building cross-sector capacity for schools and health and social services to support substance use education, harm reduction and treatment