Dr. Daniel Vigo says he hopes to clear up misconceptions that substance-use disorders disqualify people from forced treatment.
The B.C. government has released guidance to psychiatrists and other health-care workers on when individuals struggling with mental-health and substance-use problems can be involuntarily detained under the law and provided with treatment.
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Prepared by Dr. Daniel Vigo, B.C.’s chief scientific adviser for psychiatry, toxic drugs and concurrent disorders, the memo aims to provide clarity around the thresholds that must be met for an individual to be admitted under the Mental Health Act, which he said have been misapplied for years by doctors and nurses.
Previously, the government believed it might need to change the law itself but now doesn’t believe that is the case.
“The document will settle some of the spurious controversies generating during the past decade around the use of the Mental Health Act, controversies that have tied the hands of many physicians and created barriers to the care of people with substance-use disorder in the moment of greater need,” said Vigo at a news conference Wednesday with Health Minister Josie Osborne.
He explained that these misconceptions include health-care professionals not treating substance-use disorders as mental-health disorders or refusing to admit people under the Act because they don’t believe substance-use issues qualify.
Currently, people struggling with addiction can be detained at the hospital for a certain number of hours before a psychiatrist needs to either admit them under the Act or release them.
Health Ministry staff said that the practice in many hospitals is to automatically release people with a substance-use disorder without waiting to see if they have another mental-health disorder that makes them eligible for an extension to their detainment.
It’s estimated there are around 18,000 people in B.C. who receive occasional involuntary treatment and Vigo believes the focus needs to start with the about 150 people who are most affected by a combination of mental-health and substance-use disorders.
“This is not about making it easier to apprehend people or apprehending more people,” said Osborne. “This is about correctly identifying those people who will benefit from involuntary care in the manner that Dr. Vigo has explained. 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.”
As for Vigo’s research into what is fuelling the toxic drug crisis, which he was commissioned to undertake last June by Premier David Eby, the psychiatrist said it’s clear the main culprits are the widening availability of cheap and powerful drugs, the closure of mental institutions such as Riverview Hospital in Coquitlam and the lack of co-ordination between psychiatrists and addiction-medicine specialists.
He and Osborne reiterated their plan to provide treatment at the Surrey pretrial jail by the end of March and at the Alouette Correctional Centre later this spring. The province is also hoping to add 140 mental-health beds to hospitals across the province.
The cost of implementing these remains unclear, as while the province provided $500 million in the 2025 budget to stabilize existing treatment and recovery services, there was no information provided on how much is being allocated for new involuntary-care services.
The commitment to expand involuntary care is also a major reversal from the NDP’s previous position that forced treatment would cause more harm than good, a view shared by advocates who want the province to focus on voluntary care.
“One of the challenges when involuntary care comes up is that we know that people are seeking voluntary care, and there just simply isn’t enough,” former chief coroner Lisa Lapointe, who has been an outspoken critic of involuntary care, told Postmedia News. “I hear from care-providers and people in the community who are working with those who are substance dependent that people are dying on waiting lists.”
Others, such as Conservative MLA Elenore Sturko, who has been pushing for an expansion of involuntary care for over two years, believe the government isn’t going far enough.
She told reporters following the announcement that she was disappointed to see that Wednesday’s announcement makes no changes to the Act and will allow physicians to continue leaving patients with substance-use disorders untreated.
“This is for individuals with concurrent disorders of addiction and mental health. But they’re not actually treating the addiction. They’re treating the symptoms of psychosis,” she told reporters.
“For many people in British Columbia, when they were talking about involuntary care, they would have hoped that the process that was being explored by this government was one that not only included treating the acute symptoms of the psychosis and the psychotic behaviours, but offered a long-term solution to the addiction.”
Earlier Wednesday, Sturko introduced a private member’s bill that would require physicians and nurse practitioners to notify relatives when their loved one is apprehended and when they’re released.
She said such legislation would be useful for information-sharing in cases such as an incident on Feb. 26 where a man was detained after committing two home invasions and assaulting a senior at a South Surrey trailer park while under the influence of drugs. Later, at Peace Arch Hospital, the man tried to disarm a police officer and had to be restrained by a physician.
“My bill would be a supplement to the Mental Health Act and could be useful, for example, in gathering information for a person who may be exhibiting psychotic behaviour and have an addiction like Dr. Vigo mentioned,” said Sturko, explaining that a relative of the man involved in the Feb. 26 incident had wanted to share information with the hospital and police but was never contacted.
“We had the announcement from the government on updating their plans for involuntary care for individuals who may have a substance-use disorder and a mental-health disorder, and again, family communication and participation is something that’s really important in these issues.”