Visions Journal

The ethics and impact of treatment in mental health care

Michelle C. Danda, PHD, RN, CPMHN(C)

Reprinted from the The Vibes Are Off: Young People, Anxiety and Depression issue of Visions Journal, 2025, 21 (1), pp. 37-39

Forced treatment is a big and often controversial part of mental health care. In most areas of health care, consent is a requirement. That means we cannot do medical treatments unless we have permission. Mental health care is different. It gives doctors and nurses the legal power to detain and treat people against their will.

In BC, the Mental Health Act allows a doctor to give forced treatment if they believe a person with a mental disorder is likely to seriously harm themselves or others, and if they think the person would not choose to stay in hospital. The laws aim to protect someone with severe mental illness from harming themselves and/or others, but the Mental Health Act forces people to get help for their mental health issues, even if they do not want it.

I’ve been a nurse for over 17 years. I have given involuntary treatment to many people. I’ve also supported them in their recovery—sometimes right after very upsetting hospital experiences. I carry these experiences with me. They are ethically complex, emotionally exhausting and often morally distressing.

A legal tool unique to psychiatry

We cannot legally force someone with diabetes to take insulin or someone with cancer to do chemotherapy. But individuals receiving involuntary psychiatric care can have their ability to make decisions overridden by a medical doctor. Their judgment is assessed based on a medical doctor’s decision about the potential for future harm. These laws disproportionately affect people who are:

• Indigenous 
• Racialized 
• Experiencing poverty 
• Living with complex trauma

The point of involuntary treatment is to ensure safety, but it is important to recognize that these laws exist within a broader context of systemic challenges and social inequities. They are not simply responses to immediate medical emergencies.

Moral distress as a nurse

The ethical burden of involuntary treatment doesn’t fall equally across professions. Nurses, particularly in in-patient settings, are often the ones who carry it out. We give the injection. We apply the restraint. We are with the patient. The tension between legal authority and relational care is lived in our bodies.

I have felt this moral distress. I’ve cared for a person who pleaded with me not to give an injection, and I did it anyway—because the law allows me to. I’ve locked someone in a seclusion room and stood outside the door while they shouted to be let out. I’ve felt conflicted when someone was discharged quickly after being certified, knowing they were still unwell, but also that the hospital could no longer justify detaining them. I have supported individuals who were readmitted multiple times under the Mental Health Act, and each time, the trauma appeared deeper, their trust further eroded.

In these moments, I question not only the intervention, but the system that makes it seem like the only option. When community resources are underfunded, housing is unstable and culturally safe and trauma-informed supports are lacking, involuntary treatment becomes a substitute for care—not an extension of it.

Working in community and in-patient settings

In community work, I’ve seen people avoid help not because they didn’t need it, but because they’d been hurt by the system before. For many Indigenous and racialized people especially, being certified under the Mental Health Act feels more like punishment than care. I’ve also cared for people whose mental illness made it hard for them to stay safe or take care of themselves. In some of those cases, a short hospital stay under the Mental Health Act helped. 

But it still raised hard questions:

• What happens when the person leaves the hospital? 
• Will they get the support they need? 
• How do we rebuild trust after treatment they didn’t choose?

I’ve worked with people from many different backgrounds—culturally, and in gender, immigration and income. The more someone is pushed to the margins of society, the more likely they are to be treated with force. Using the Mental Health Act isn’t just about medical care. It also shows the deeper problems of systemic racism and unfairness.

Consequences to coercion

Research and advocacy groups like Health Justice emphasize that coercive treatment is not neutral—it’s often harmful. People describe the experience as humiliating, frightening and disempowering. It can lead individuals to avoid the mental health system altogether. I’ve seen this first-hand. Clients discharged after involuntary admission often decline follow-up, and some refuse to return to hospital even when they are deeply unwell. 

Involuntary treatment is one of the most serious parts of mental health care—and one of the hardest to feel good about. It exists not because it always helps, but because there aren’t enough other options. As a nurse, I’ve seen both the harm it can cause and the times when it’s been needed. 

I’ve followed the rules and still asked myself if it was right. The question isn’t just whether we should have involuntary treatment. It’s about how we use it, when we use it and what we’re doing to build a system where we don’t need to use it so often. 

Being ethical means more than just following the law. It means thinking carefully, taking responsibility and, most of all, showing compassion.