Detaining youth for substance use is coercive
Call for advocacy services ignored, say Kendra Milne and Laura Johnston.
Coercive health care can perpetuate colonial state policies and reinforce inequities — evidence shows secure care is disproportionately used with Indigenous youth and girls and young women. Kendra Milne and Laura Johnston
On June 23, the B.C. government tabled Bill 22 — the Mental Health Amendment Act — which proposes new authority for medical facilities to detain youth for seven days after an overdose for problematic substance use.
If passed, it would create yet another form of coercive health care in a province that is already known for overreliance on involuntary health-care mechanisms.
While Bill 22 uses some new terminology — “stabilization care” — detaining youth using substances isn’t a new idea. Secure-care legislation has been in place for years in other jurisdictions and various secure-care bills have been tabled repeatedly in B.C. — four times since 2000. Those bills were met with widespread opposition from several communities who hadn’t been consulted, and ultimately, they never passed.
Coercive health care can perpetuate colonial state policies and reinforce inequities — evidence shows secure care is disproportionately used with Indigenous youth and girls and young women. Civil liberties associations point to severe infringements on constitutional rights. Substance-use groups point out that there is no evidence from jurisdictions that have tried it that coerced substance-use treatment works better than voluntary treatment.
But here we are again with Bill 22 and, once again, without adequate consultation of impacted communities and advocacy groups.
The public bodies we have appointed to provide expertise and direction on issues related to overdose deaths and the well-being of children and youth also have serious concerns about the bill. B.C.’S chief coroner observed that the amendments bring a “potential for an increase in fatalities” absent adequate voluntary services. The representative for children and youth expressed concerns about Bill 22’s reliance on involuntary detention when the representative’s office has been calling for increased voluntary care for many years.
It’s difficult to know what government hopes a new form of involuntary health care will accomplish. Health-care providers in B.C. already have the legal authority to provide medical treatment in urgent or emergency situations under the Health Care (Consent) and Care Facility (Admission) Act. Doctors in B.C. already have the legal authority to detain youth of any age in facilities if they believe the youth needs observation or treatment under the Mental Health Act. These powers are regularly being used to detain youth who engage in problematic substance use. In fact, girls and young women were the largest-growing population of people detained under the Mental Health Act in recent years in B.C.
While coercive health-care mechanisms are common approaches in B.C., there are unique dangers to Bill 22’s proposed detention. What happens at the end of the seven days? A shortterm deprivation of a substance may just be long enough to detox and reduce drug-tolerance levels, creating a heightened risk of overdose after release. Further, people often report that the experience of involuntary care is so negative or traumatic that there is little therapeutic benefit from the services and it makes them avoid health services in the future for fear of being detained again.
In the face of these risks, Bill 22 has few safeguards. It provides no right to an independent hearing for youth who want to challenge their detention. And incredibly, there is no provision for detained youth to access legal services, despite research that shows access to an independent person who can help you understand your legal rights promotes health outcomes. B.C.’S ombudsperson’s unequivocal finding last year that the provincial government should establish independent legal advice and advocacy services for people detained in the health-care system was ignored in drafting this new form of detention.
To support youth struggling with substance use we must think beyond involuntary care. Research shows that effective mental-health and substance-use care is accessible, evidence-based, culturally safe and trauma-informed. Critically, it must ensure that people have a chance to be heard and involved in their care.
The overdose epidemic is a stark public health emergency that shows our current approaches to health care and drug policy aren’t working. To solve it, we need new approaches — not more of the same.