does involuntary care work? three b.c. residents share their personal stories
11 minute read
this spring, the province opened 10 involuntary care beds at surrey pretrial centre and 18 beds at the alouette jail in maple ridge for people with severe mental illness and addictions. getty images
shadrin_andrey
/
getty images
“i am alive,” nicole luongo says, “stably employed, stably housed, all of those things, despite going to treatment — not because of it.”
involuntary care — forced hospitalization under the mental health act — is controversial.
it elicits strong opinions from people who say they’ve been either harmed or helped by the treatment, which the b.c. government is ramping up in an effort to tamp down violent acts by people struggling with mental illness and substance use.
while luongo contends involuntary care was detrimental to her recovery, chris said it has made his life more stable. the 45-year-old, who spent the last 19 months in a combination of involuntary and voluntary care in coquitlam, recently started a full-time welding job.
“it has helped me. it’s got me off the streets,” said chris, who asked postmedia to use a pseudonym to avoid jeopardizing his employment.
the b.c. conservative public safety critic is among those who back involuntary care, although elenore sturko, a former rcmp officer, says the overstressed system needs improvements.
she is pushing for “compassionate intervention legislation” that would, for example, allow parents to have severely addicted children admitted, even if they don’t have a diagnosed mental illness as well.
advertisement
“we need to look at ways that we can make sure that there’s never a dead end for families looking for help,” sturko said.
the b.c. schizophrenia society’s jack middleton agrees there is a role for forced care.
“involuntary treatment is a protection for people who pose a risk to themselves or others. without it, patients experiencing schizophrenia and unaware of their illness can find themselves caught in a vicious cycle — too ill to be discharged from a hospital but not receiving the treatment that they require,” middleton told a government committee last month.
vancouver defence lawyer kyla lee, though, maintains expanding involuntary care will inappropriately strip away constitutional rights from people who can still make decisions, even if they do have a drug addiction. she adds research shows forced treatment doesn’t work in the long run for many substance users.
the b.c. mental health association concedes forced detention “may be a needed last resort” for anyone at extreme risk of violence, but argues society’s focus should instead be on improving supports so people never reach crisis point.
“the reality is that we are already relying heavily on involuntary care without really examining whether it is effective,” the association says on its website.
advertisement
this spring, the province opened 10 involuntary care beds at the surrey pretrial jail and 18 beds at the alouette jail in maple ridge, to be used for people with severe mental illness and addictions. this was largely in response to an increasing number of violent stranger attacks.
these 28 new beds are in addition to 2,000 spots that already exist in b.c. psychiatric wards or mental health facilities for both voluntary and involuntary care.
the province promised in march to open 140 more new beds inside hospitals, but the health ministry said there is no information yet on their timing or location.
the number of british columbians in forced treatment has risen steadily: from 11,000 in 2011 to 18,000 in 2020-21 — a number that’s believed to be even higher today. by comparison, patients in voluntary care over that decade largely remained stagnant at about 11,000 a year, according to the b.c. ombudsperson.
below, three people share their personal experiences with involuntary care:
nicole luongo is with the canadian drug policy coalition.
jason payne
/
png
nicole: ‘dehumanizing’ care
it happened shortly before she graduated from grade 12, and again while she was studying for her masters at ubc, and also while she pursued her phd at oxford university in england.
advertisement
every time nicole luongo was involuntarily institutionalized it was a “dehumanizing” experience that left deep emotional scars.
“the ptsd i live with — not as a result of being mentally ill, not as a result of being a substance user, but as a result of what i endured in treatment for those conditions — is so severe that my quality of life continues to be exceptionally poor,” said luongo, 36.
the former college instructor now works as a policy analyst with the canadian drug policy coalition and no longer takes drugs. but if she relapses, she said, she’d rather take her chances with toxic street drugs than be locked inside a hospital again.
“i would choose fatally overdosing over ever having to be involuntarily detained and institutionalized again. that is something i will avoid at all costs.”
the journey that led to involuntary care for luongo, a smart and driven young woman, began during her troubled childhood in surrey.
she struggled with undiagnosed obsessive compulsive disorder, which she believes triggered a severe eating disorder that began when she was 10. during her final years of high school, she was medicated and frequently hospitalized, which she coped with by drinking more and more alcohol.
advertisement
then, from ages 17 to 19, she was involuntarily admitted to various metro vancouver hospitals, where the terrified teenager frequently regained consciousness in adult psych wards with no memory of how she got there. “waking up with my clothes having been cut off, in handcuffs, having catheters forcibly inserted, in isolation rooms.”
she insists she received little treatment beyond medication during those stays, which were as short as a few days or as long as a month. “there is nothing to do all day but wait.”
luongo spent her late teenage years homeless in the downtown eastside, but was eventually able to quit drugs for about five years. she completed an undergraduate degree in sociology with financial help from her parents, but her sense of well-being remained poor.
when she was 25, during her masters at ubc, and again at 27, while she was pursuing a phd, she suffered major psychotic breaks, which she partly attributes to internal turmoil over repeatedly being told in psychiatric care that she was born with a “broken brain.”
she was involuntarily hospitalized after these episodes as well but, like before, it was not the right solution.
“i’ve been to treatment voluntarily and involuntarily myriad times, and every time i tried so hard. i desperately wanted to be well,” luongo said.
advertisement
“the modalities that were either offered to me or imposed on me were not adequate.”
she said she has extraordinary sympathy for british columbians who support the expansion of involuntary care because they are desperate to help loved ones unable to find help for severe mental illness and addictions.
luongo, though, would argue money should instead be spent on preventing people from becoming unwell in the first place. that includes spending to modernize outpatient mental health and drug treatment systems that are regulated and accessible; providing a living wage and other programs to lift people out of poverty; and providing affordable housing, including some with supportive services, to end homelessness.
“when you are in a protracted state of extreme material disadvantage, you are kind of forced to live like an animal,” luongo said. “being in survival mode really does produce the symptoms of mental illness and also disincentivizes people to get well.”
the canadian drug policy coalition calls for legalizing and regulating the drug supply to reduce overdoses and provide those struggling with mental health a safe alternative to abstinence.
“my policy recommendations are not merely anecdotal, they are grounded in scientific evidence. but the reason i became interested in the scientific evidence to begin with was because of my negative experiences.”
chris painted a lot of artwork while in red fish and in second stage housing.
advertisement
chris: ‘a real big step’
chris spent eight months in involuntary care inside coquitlam’s red fish healing centre for mental health and addictions after a judge ruled in november 2023 that was the best hope to rehabilitate him and protect the public.
he then transitioned out of red fish to second-stage housing, which is also on the old riverview hospital grounds. he has lived there for the last year while attending treatment and using day passes to go to work.
after a lifetime of battling mental illness and substance use, struggles that were exacerbated during the covid pandemic when he lost his oil rig job and became homeless, chris said he was suicidal before entering the involuntary program at red fish.
“it’s actually made me a better person, this whole program,” said chris, who faced being sent to jail if he relapsed while in treatment. “that was a real big step in making me sober.”
in an ideal world, though, he would like this type of help to be available without being certified under the mental health act and giving up his freedom.
chris described his eight months inside red fish as being locked inside a mental hospital, with “good, in-depth” treatment programs, as well as group therapy sessions that included art, music and fitness.
advertisement
the staff and peer support workers are excellent, he said, but both the 105-bed red fish and the second-stage housing require more employees to meet the needs of all the patients. that includes facilitating more outings, which he believes are important for reintegration into society.
chris would like to move off the riverview grounds, but says patients need more help finding affordable places to live, ideally in supportive housing.
“people are leaving this program and going into their own housing where they’re by themselves, and they’re really scared,” he said.
and he’d like to be connected with a mental health team in the community to improve his chances of long-term stability.
“i’ve wanted to become something my whole life,” he said. “i want a fresh start.”
in 2023, chris pleaded guilty to randomly assaulting a stranger on a downtown sidewalk in a b.c. interior city.
at the time, chris thought the woman talking on her phone was filming him, and shouted a racist slur. he spat on the frightened victim, pushed her and slammed her phone on the ground before bystanders collared him.
despite a long history with mental illness, chris didn’t start committing crimes until the pandemic. involuntary care was a good alternative to the justice system, which can be a “blunt instrument” for people with mental illness as the underlying reason for their offences, said his lawyer, andrew cochrane.
advertisement
in chris’s case, a forensic social worker and a prosecutor agreed that involuntary care was the best option for chris and to reduce risk to the public. his vancouver lawyer says it has worked.
“he’s just made a real remarkable turnaround,” cochrane said of his client. “it’s night and day.”
some families believe involuntary care could help loved ones who cannot get sufficient help for their severe mental health and addictions.
getty images/istockphoto
jane and richard: ‘doomed to fail’
while she was growing up in victoria, jane’s childhood best friend was richard, a kind boy who was funny, played the viola, and adored animals.
as teenagers, they fell in love.
in 2003, when he was 20, richard wept in hospital after being diagnosed with schizophrenia. richard was jane’s “entire world” and, despite being only 18, she was determined, with the support of his parents, to care for him and build a life together.
jane tried her best over the next 20 years, but ultimately felt “doomed to fail.”
richard was taken into involuntary care three or four times — but only after his behaviour became so extreme it led to destructive outbursts, criminal charges and, eventually, hard drugs.
for the past three years, he has been homeless on the streets of victoria.
“richard’s severe mental illness was never properly treated over the course of the 20 years i was with him,” said jane, who works in health care.
advertisement
“the hospitalizations were never long enough, the followup care was never sufficient.”
the couple’s names are pseudonyms because jane, who is separated from richard, did not want to identify him without his permission.
jane and richard’s parents could recognize the early warning signs of his breakdowns and tried to get him help before he deteriorated. they reached out to emergency rooms, doctors, case workers, crisis lines and police, but failed to get him admitted under the mental health act before a psychotic event.
“unfortunately, he never presented clinically ‘bad enough’ in the earlier stages of an episode that any doctor would be willing to commit him to hospital against his will. each time, it took a lot of escalation,” jane said.
that escalation included traumatizing a neighbour in 2013 by saying he would burn their building down, trashing the home he shared with jane in 2018, and threatening someone with a large knife in 2022.
jane knows involuntary care is complicated. she doesn’t endorse people being held inappropriately against their will or being traumatized by their institutionalization.
but she’d like the system to better consider the opinion of family members who can recognize when a loved one’s mental health is declining. for someone like richard, with a history of hospitalizations and police interactions, she wants a “lower threshold” to allow intervention before someone spirals.
advertisement
“i believe if his family had been taken more seriously during our attempts to get him help … we could have helped save him,” she said.
“the help was just not there when we needed it.”
the few times richard was in involuntary care, he would get better, jane said. but there was never sufficient outpatient medical services for him or community support to assist her as his caregiver.
the uncertainty left them both feeling scared.
in 2018, shortly after richard completed a college computer science program, jane and his parents were unable to get him admitted before another psychotic episode. he broke furniture, racked up $40,000 in debt, and disappeared onto vancouver’s streets before being hospitalized.
by then, jane argues, it was too late.
in an email to postmedia, the health ministry said the toxic drug crisis has led to “a growing group of people with extremely complex needs,” including severe mental health and addictions, who can pose a risk to others and can’t make decisions about their own care.
dr. daniel vigo, b.c.’s psychiatric adviser, has found some doctors and nurses are hesitant to certify patients under the mental health act if they also use drugs. so this spring, he clarified that people with mental health and substance use issues are eligible to be admitted involuntarily.
advertisement
the number of beds for involuntary patients in b.c. has been expanded over the last decade by about 18 per cent, the health ministry said.
jane ended her relationship with richard in 2021, fleeing with the couple’s eight-month-old son after richard became aggressive and verbally abusive.
he moved in with his parents but wasn’t well and by 2022 gravitated to street life. richard has since been offered a free bed in a drug treatment facility, but jane said he was too street entrenched to accept.
“i feel like there’s so many places along those 20 years when, if things had been different, that he would not have ended up (homeless),” she said.
“i have lost my best friend and partner, and my son doesn’t have a father. … we need to do better than this as a society.”
for more 世界杯决赛2022 and content around diseases, conditions, wellness, 2022年世界杯名单猜测, drugs, treatments and more, head to healthing.ca – a member of the postmedia network.
share story
