B.C. doctors get new guidance on involuntary care for drug users
British Columbia clinicians have received new guidance about involuntary care for adults, including a directive that it cannot be used to prevent harmful "risk-taking" by people who use drugs whose behaviour is not related to mental impairment.
The guidance from Dr. Daniel Vigo, B.C.'s first chief scientific adviser for psychiatry, is aimed at helping clinicians and others decide when involuntary admission is appropriate for people with both mental-health and substance-use disorders.
Vigo said in a news release that involuntary treatment "can be a tool to preserve life and treat the source of impairment" among those with such complex needs.
Health Minister Josie Osborne said the ongoing toxic drug crisis has led to a "small but growing number of people who are living with overlapping mental-health and substance-use challenges, as well as brain injuries from repeated overdoses."
While the new guidance aims to ensure those people have the right support in place, it does not constitute changes to B.C.'s Mental Health Act, she said.
"This is about providing a higher level of care to a very specific and vulnerable population," she told a news conference announcing the guidance on Wednesday.
The 11-page guidance document outlines three main scenarios when someone with substance-use disorder may receive involuntary treatment: simultaneous mental disorders, acute and severe psychiatric syndrome with unknown causes, and ongoing mental impairment after remission from an acute state.
But it notes the legislation must not be used as a "controlling intervention to curb risky decision-making" that is unrelated to a state of mental impairment.
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As the provincial election approaches, the poison drug crisis is top of mind. The B.C. Conservative Party has promised to use involuntary treatment for those experiencing severe addictions if it wins the October election. Tyson Singh Kelsall is a social worker and PhD candidate in SFU's faculty of health sciences. He joins Dan Burritt to unpack the issues surrounding involuntary treatment.
Vigo said the vast majority of people with mental disorders, including substance-use disorders, will not meet the "stringent threshold" for involuntary treatment.
"However, there is a fraction of a percentage point that in any given year will require it as a life-saving tool," he told Wednesday's news conference.
Vigo said substance-use disorders are a subtype of mental disorder, and many clinicians were already applying the legislation the way it was intended.
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But he said the "siloed evolution" of addiction medicine and psychiatry had resulted in some making "misguided interpretations" along with "segregated services" that left patients suffering from concurrent disorders falling through the cracks.
"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 those new drugs," Vigo said of today's highly toxic illicit drug supply.
"And for a time, there was a legitimate debate about whether the Mental Health Act applied or not. Now, in time, we have grown to understand that it does."
The expansion of involuntary care to those with concurrent mental health disorders was not well received by the Vancouver Area Network of Drug Users.
In a news conference on Tuesday, VANDU president Dave Hamm said there is a lack of evidence supporting the effectiveness of involuntary care for substance use disorders.
"Money should instead be invested in detox, sobering centres and other supports," he said.
"A sobering centre that is peer-led and medically supported will keep people stable and save lives while also opening pathways to treatment if they choose," he added.
Not aimed at apprehending people: minister
Vigo said dispelling misconceptions about involuntary care in the Mental Health Act was a step toward supporting those patients, in addition to bringing new services online, including mental-health units in corrections facilities and care homes.
"If we want less people to be treated involuntarily, we need to improve the quality and the quantity of the continuum of care, voluntary and involuntary," he said.
Osborne said the guidance was not aimed at making it easier to apprehend people under the Mental Health Act, rather the goal was to support clinicians in correctly identifying people who would benefit from involuntary treatment.
"At the same time, it is so important that we continue to invest in and build out that continuous system of mental-health and substance-use supports that are voluntary," the minister said.
The first of the new involuntary care beds open this month at the Surrey pretrial centre, while those at Alouette Homes in Maple Ridge will open later this spring.
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