Should people with severe mental illnesses be forced into treatment?

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Should people with severe mental illnesses and no home be forced into treatment?

It was with a heavy heart this week that Julian Daly, executive director of the Our Place Society in Victoria, decided to pen a commentary in the Times Colonist calling for involuntary care for a small subsection of people with severe psychiatric disorders who are experiencing homelessness.

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Daly has been head of Our Place since June 2020 and previously spent 11 years as the executive director of the Boyle Street Community Services in Edmonton. He is the latest and perhaps most prominent person to call for the need to deliver mental health support to people with acute illnesses whether they consent to it or not.

In an interview with CBC's On The Island he was quick to clarify that involuntary care is only needed as a last resort for people whose condition is so severe they are trapped in a cycle they can't escape.

"They end up barred from everywhere, they end up untreated. They wander our streets living rough, living pretty miserable lives and vulnerable lives, too," he said.

Daily says people like this need more complex support, the likes of which he and his staff simply can not provide. Although he's clear he isn't calling for return to asylums of old.

"That's absolutely not what I'm suggesting, what I'm suggesting is something that is more homelike, and is compassionate, and trauma informed," said Daly.

A slippery slope

However, other support workers in Victoria's downtown core have serious concerns about the idea of involuntary care.

"I don't like the word involuntary care," said Fred Cameron. "There were many times where I couldn't take care of myself and if I had been involuntary medicated I likely wouldn't have recovered."

Cameron is an operations manager with the SOLID Outreach Society, a peer-support organization run by people who have struggled with homelessness and addiction. He worries that ambiguous, soft sounding phrases like "involuntary care" represent a slippery slope.

From his experience, Cameron thinks building community among the majority of people living rough should be the priority rather than focusing on the minority of people who have severe psychiatric problems.

"If you allow it to happen organically, 99 percent of the people will be able to take care of themselves. There are a few exceptions but that is such a small portion of the population that I would be hesitant to put legislation in," he said.

Mental health supports still have a long way to go

There are those who support Daly's position that some people need to be helped regardless of their consent.

Nanaimo Mayor Leonard Krog has long advocated for a more proactive approach to treating people with mental illnesses living on the streets. He said fears over how people were treated in the past has impeded progress.

"The treatment of severe mental issues has improved a great deal since the days of nurse Ratched [of One Flew over the Cuckoo's Nest]," Krog said.

"Right now we're not doing what we need to be doing to solve the problem, to literally save people's lives."

In the 2021 provincial budget, the government promised to develop more complex, long-term care programs to help homeless people with acute mental health needs. Consultations with key stakeholders are now taking place to develop a framework.

Daly, Cameron, and Krog agree is that kind of support can't arrive soon enough.
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https://www.cbc.ca/news/canada/british-columbia/senior-mental-health-tent-victoria-island-health-1.5329261

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