This op-ed, co-written by Jackson P. Loyal, Will Small, Ruth Lavergne  first appeared in Vancouver Sun on March 23, 2023. Photo by Francis Georgian.

Involuntary admission to hospital is care provided without consent, or against the will, of a patient. This is an extraordinary power used when a clinician decides a person is experiencing a mental health crisis and poses an immediate risk to themselves and/or others. This power is made possible by the Mental Health Act. We need to think carefully about how this power is being used in British Columbia.

The British Columbia government recently announced nurse practitioners will now be able to assess and involuntarily admit someone experiencing a mental health crisis. Prior to this, only physicians were able to commit someone under the Mental Health Act. The purported goal is to increase access to treatment and reduce demands on emergency department physicians. Expansion of the Mental Health Act to facilitate greater use of involuntary care echoes other recent proposals intended to address the toxic drug poisoning crisis and perceived rise in repeat violent offending through involuntary care.

Recent research shows a dramatic rise in involuntary psychiatric hospitalizations in British Columbia, increasing 65.7 per cent from 2008 to 2018, while the proportion of people who were voluntarily hospitalized for mental health and substance use has fallen. Emergency department use for mental health and substance use issues has also increased substantially over the same time period.

Framing involuntary care as “timely, compassionate and appropriate care” is disingenuous when people in B.C. often struggle to access voluntary services.

The evidence on the benefits of involuntary care is mixed, and is especially limited in relation to substance use. While potentially lifesaving, involuntary care can simultaneously be traumatic and harmful for individuals, and there is limited evidence to suggest it improves connections to healthcare services. Following discharge from their involuntary hold, patients may not disclose symptoms, and they may avoid seeking treatment in the future for fear of being detained again. People who use substances are especially vulnerable to harm. Once discharged from hospital, they are at increased risk of toxic drug poisoning due to reduced tolerance and the unpredictably toxic illict drug supply because relapses are common.

A report released in 2019 by the BC Ombudsperson revealed the majority of mental health facilities failed to comply with procedural requirements for involuntary admissions. This represents an infringement on the rights of people involuntarily admitted to hospital. The Ombudsperson made 24 recommendations to ensure the rights of people involuntarily admitted were being protected. To date, only eight of these recommendations have been implemented.

Nurse practitioners are valuable healthcare providers and make significant contributions to our healthcare system. However, expanding nurse practitioners’ responsibilities to include involuntarily commitment is merely a response to the symptoms of a dysfunctional healthcare system. It may reduce demands on emergency department physicians and address police concerns by expediting transfers from police to hospital. However, other consequences may not yet be fully appreciated, and it does not address the underlying problems giving rise to these issues.

Facilitating greater use of involuntary commitment perpetuates a reactive approach to treatment. It further stigmatizes people with mental health and substance use issues and will likely make the situation worse for people who need care. The focus on involuntary treatment suggests the government is prepared to punish people for being unwell and perpetuate cycles of crisis and coercive treatment, rather than invest in preventative, community-based services.

We urge the government to invest in building the capacity of voluntary services so people can access the treatment they need and prevent their conditions worsening to the point of crisis. Implementation of a regulated supply of currently illicit drugs is also needed to immediately reduce fatalities stemming from the toxic drug poisoning crisis. People with mental health and substance use issues deserve to be treated with compassion and deserve therapeutic — not punitive — healthcare.