Bill 22: Proposed involuntary treatment raises more questions than answers for youth who use drugs

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      By Andreas Pilarinos and Elisabeth Bailey

      The overdose crisis, exacerbated by the COVID-19 pandemic, continues to impact communities across British Columbia. While researchers, health-care providers, and parents agree that youth need timely access to a continuum of treatments for substance-use disorders, the proposed changes to B.C.’s Mental Health Act do little to engage and support youth in search of help.

      Bill 22, the Mental Health Amendment Act, permits the involuntary admission of youth into hospital settings for up to seven days following an overdose. Proponents argue that an overdose event provides a critical window of opportunity to intervene and connect youth with relevant community supports and treatments.

      Supporters cite a pilot project at B.C. Children’s Hospital that provided youth with “stabilization care” before connecting them to community supports after discharge. It is important to note that findings from this pilot have not been published or made publicly available, so it is difficult to judge how directly they relate to the proposed legislation.

      However, this pilot alone does not justify the expansive amendments proposed in Bill 22, particularly without explanation of how the suggested care will be provided in the current health-care context. Without immediate availability of youth-specific services in both hospital and community-based settings, the ability of providers to follow through on “stabilization care” and the proposed discharge plans is severely limited.

      Despite undoubtedly positive intent, there is concern among public health experts, health-care providers, youth, and families that Bill 22 will exacerbate the risk of harm. For example, the use of involuntary treatment may have the unintended consequence of frightening youth away from the very emergency health services that are often a first point of contact.

      To date, research examining the use of coercive substance-use treatment is limited and inconclusive. A 2019 Vancouver-based study that included young people found that neither involuntary nor voluntary treatment led to statistically significant reductions in substance use, highlighting the deprived state of B.C.’s fragmented treatment system.

      This is a testament to known treatment barriers that include long wait times, treatment costs, unplanned discontinuation of services, and a lack of suitable treatments within reasonable proximity. Although B.C. Children’s Hospital may be equipped to deliver comprehensive care and referral, the ability of more remote and rural hospitals to offer such supports is questionable. We applaud the announced expansion of Foundry Centres but wonder where youth will go after receiving stabilization care in the years before these additional resources are operational.

      While youth continue to report difficulty accessing treatment, Bill 22 itself does little to improve the quality and accessibility of needed services. Intervening only after an overdose fails our youth by waiting for the worst-case scenario rather than prioritizing investment in a robust voluntary system.

      Advocates of the bill must demonstrate the effectiveness of involuntary-treatment admissions. The absence of favourable and conclusive evidence suggests that this is the wrong approach. Instead, numerous public-health experts have stressed the importance of improving voluntary treatment services by educating health-care providers on best practices with youth, implementing culturally safe, trauma-informed care, and scaling up youth-specific treatment services.

      The government must also commit to expanding and enriching treatment services and supports in rural and remote communities and developing clinical guidelines that ensure youth have access to reliable and consistent care throughout B.C.

      The potential effects of Bill 22 on young Indigenous peoples in B.C. must also be considered. Ongoing impacts of intergenerational trauma mean that Indigenous youth are overrepresented among people who use drugs and are thus more likely to be impacted. Given the health-care system’s history of complicity in colonialism and the government’s commitment to the United Nations Declaration on the Rights of Indigenous Peoples, Bill 22 may damage and undo ongoing reconciliation efforts.

      In light of these serious issues, B.C.’s chief coroner, the representative for children and youth, and the Harm Reduction Nurses Association have expressed concerns with Bill 22. We share these concerns and ask for meaningful reengagement with youth, public-health experts, health-care providers, and families to address clear gaps in the treatment system before passage of such amendments.

      We share the goals of providing safe, equitable treatment for youth but fear that implementing involuntary care in the absence of ready access to voluntary services raises more questions than answers.

      Andreas Pilarinos is a PhD student in the interdisciplinary studies graduate program at UBC and a housing support worker in Vancouver. His research examines the treatment experiences of youth who use drugs. Elisabeth Bailey is a mental health nurse and assistant professor of teaching at UBC's school of nursing. 

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