The housing crisis is pushing more and more people onto the streets. More than one in ten Canadians report experiencing some form of homelessness in their lifetime.
Homeless people are forced to camp and are increasingly becoming victims of the not-in-my-backyard (NIMBY) phenomenon. Governments are dismantling encampments — and some are willing to use the notwithstanding clause to avoid court rulings on their actions — and banning supervised drug use sites near daycares and schools.
Now involuntary treatment appears to be on their radar.
The increase in involuntary treatments
It is currently possible to forcibly treat someone anywhere in Canada. Provincial mental health legislation allows for involuntary commitment and involuntary treatment.
Criteria range from danger to a lack of capacity to consent and the need for treatment. But involuntary commitment and treatment should only be used as a last resort.
The right of citizens to decide what happens to them is fundamental. According to the Supreme Court of Canada, the right to self-determination outweighs other interests, “including what physicians believe is in the best interests of the patient.” Psychiatric diagnoses or substance addictions have no legal consequences for the right to consent for care.
In Canada, data on the use of involuntary commitment and treatment are not systematically collected. Available research shows that there has been a steady increase in the use of mental health legislation to detain people in Quebec, Ontario and British Columbia for more than a decade.
This increase is similar to the situation in other Western countries, indicating that coercion is now an integral part of mental health treatment. Racialized and indigenous peoples and people living in precarious conditions are overrepresented among those forced into treatment.
Research shows that there are structural violations of the rights of people who are involuntarily admitted or treated. Class action lawsuits have been won or are underway in several Canadian provinces alleging abuse of privileges in psychiatric wards.
Quebec will have to compensate people detained illegally.
The New Brunswick Ombudsman concluded that patients at the Restigouche Hospital Center in Campbellton were “victims of negligence, abuse and unacceptable treatment.”
British Columbia was forced to establish a rights advisor service following the Ombudsman’s alarming findings in 2019. He reported a systematic failure of health care institutions to comply with the procedural safeguards required by the Mental Health Act, including consent to treatment, and by the Ministry of Health to adequately monitor compliance with procedures by institutions.
Still, the BC government has announced it will expand involuntary care to keep people and communities “safe.”
Unfounded arguments
The arguments of proponents of involuntary treatments are not supported by science.
First, they often suggest that homelessness is due to mental health problems or addiction, when research shows that financial problems are the leading cause of homelessness. Rising housing and living costs and low incomes are behind the unprecedented increase in homelessness.
The situation was predictable.
Economic inequality has increased since the 1980s. Housing affordability has fallen over the same period. Homelessness is a structural problem, not an individual problem.
Second, proponents of involuntary treatment draw a link between mental health/addiction and public safety, suggesting that people with mental health problems or drug users are violent.
Research has long refuted this link in terms of mental health, and the situation is nuanced for addiction. Nevertheless, proponents of involuntary treatment argue that treating people against their will is necessary because they are unable to make decisions for themselves. This assumption is also refuted by research, which reveals a much more complex reality.
Furthermore, risk assessment and disability assessment tools are controversial and primarily target marginalized and racialized people.
The focus on public safety also perpetuates prejudice and fear, increasing popular support for coercive measures such as involuntary treatment. For example, nearly 70 percent of Ontarians support legislative changes to facilitate involuntary treatment.
Third, some politicians claim that involuntary treatment works. Current data do not support a strong causal relationship between involuntary treatment and treatment adherence, relapse prevention, or social functioning. On the contrary, they show adverse effects associated with coercion.
Expanded access to community services, the use of experiential knowledge of the people involved and a trauma-informed approach appear promising and more respectful of human rights.
Change the language
Advocates of involuntary treatment, such as Patrick Brown, the mayor of Brampton, Ontario, argue that “the old approach doesn’t work.”
Because the term ‘involuntary treatment’ has a negative connotation, they now call it ‘compassionate care’.
This change in terminology is consistent with the CARE program implemented in California in 2022. Homeless people with certain psychiatric diagnoses may be subject to involuntary treatment through “compassionate civil court.” CARE’s compassionate approach is presented as a paradigm shift.
But is that so?
Making it easier to incarcerate homeless and marginalized people is not a new or original idea, to say the least. Rather, it is a very old approach that dates back to the Middle Ages.
It is claimed that involuntary treatment is necessary because people would not voluntarily enter therapy. Yet mental health and addiction services are difficult to access across Canada thanks to decades of underfunding. It is difficult to justify violating people’s rights to involve them in involuntary treatments when voluntary treatments are inaccessible.
Compassionate care is in fact nothing more than a smokescreen intended to hide coercion, structural inequality and the lack of social responsibility of governments.
Emmanuelle Bernheim, titular professor, law school, titular chair of research in Canada and cleric and access to justice | Professor, Faculty of Law, Canada Research Chair on Mental Health and Access to Justice, L’Université d’Ottawa/University of Ottawa
This article is republished from The Conversation under a Creative Commons license. Read the original article.