B.C. doctors given updated involuntary care guidelines, with new beds coming soon

Doctors now have updated guidelines on how to provide treatment to people against their will. We bring you the latest on the controversial policy.

As the B.C. government prepares to open new involuntary care beds, doctors have been provided “clarifying” guidelines for forcing treatment onto patients suffering from a combination of serious mental health problems and drug addiction.

The updated guidance was delivered by Dr. Daniel Vigo – who is overseeing the province’s expansion of involuntary care under the title of chief scientific adviser for psychiatry, toxic drugs and concurrent disorders – and contains what he describes as “stringent” restrictions on locking patients up without their consent.

Speaking at a news conference Wednesday, Vigo stressed that people who are addicted to drugs but not suffering from severe mental impairment will not be held against their will.

“By the same token that we do not treat people with lung cancer who continue smoking involuntarily, nor people with cirrhosis of the liver who keep drinking, outside of episodes of confusion or intoxication, we also do not treat the substance use disorder, per se, involuntarily,” he said.

Advocates for drug users have expressed concerns about forced treatment, pointing to research suggesting it is not effective for addressing substance use disorders in particular – something Vigo said he agrees with.

Earlier this week the Vancouver Area Network of Drug Users and other community organizations called on the government to reverse course on its expansion, and instead put the funding toward voluntary treatment beds and detox facilities.

“Our community is crying out right now for this help,” said Darren Graham, of the B.C. Association of People on Opiate Maintenance.

No Mental Health Act changes

The Ministry of Health also confirmed that, for now, B.C.’s expansion of involuntary care will not involve legislative changes.

That means doctors will be using the same Mental Health Act framework currently used to impose treatment – though Vigo said he believes the law has been misapplied over the last 10 to 15 years, due to an outdated understanding of the way modern street drugs affect those suffering from severe mental illness.

He cited a “technological revolution in backyard production” allowing cheap synthetic drugs to flow into communities, and “inevitably harm the brains of people who use them.”

“The problem is that we had not taken stock of the complexity of concurrent disorders, and acquired brain injury, in the context of addiction to these new drugs,” Vigo said.

Faydra Aldridge, CEO of the B.C. Schizophrenia Society, said her non-profit organization, which supports schizophrenia patients and their families, backs the province’s new approach.

“We have seen significant changes on the frontlines,” said Aldrige, speaking alongside Vigo at the government’s news conference. “People’s needs are becoming more complex, and require a higher level of care than what was traditionally available.”

She expressed hopes that the increased use of involuntary care will “improve” the lives of the “extremely vulnerable population” her organization serves.

New beds in Metro Vancouver

Across B.C., patients are already admitted under the Mental Health Act at 75 designated facilities, including dozens of hospitals with psychiatric units and 25 mental health inpatient facilities.

The government expects to open new involuntary care beds at the Surrey Pretrial Services Centre this month, and at Alouette Homes in Maple Ridge this spring.

As doctors begin reading and interpreting the province’s updated guidance, Vigo said his vision is for involuntary care patients to be returned to the community as soon as possible.

“The Mental Health Act allows for the discharge from inpatient care to treatment in the community on extended leave, ensuring that patients do not need to stay in hospital for a minute longer than strictly needed to stabilize, implement a treatment plan and ensure continuity of care,” he said.

With files from CTV News Vancouver’s Isabella Zavarise