New provincial guidelines around the use of involuntary care are getting a thumbs-down from groups advocating for drug users and their families.

Dr. Daniel Vigo, government's chief scientific adviser for psychiatry, toxic drugs and concurrent disorder, Wednesday released new guidelines, which he says will help clinicians determine when involuntary treatment under the Mental Health Act might be appropriate.

Vigo said the changes aim to dispel misconceptions about the use of the act, including the misconception that substance use disorders were not mental health disorders. The intent is to clarify how the act can be used to help people dealing with both mental health and substance-use disorders, when their substance use is worsening their mental health

Clinicians had previously disagreed whether substance-use disorders qualified as a sole reason for involuntary treatment, which led to an uncertain application of the act. 

Vancouver Area Network of Drug Users, a prominent advocacy group, whose self-stated goal is to improve the lives of drug users, their families and their communities, questioned the province's priorities.

VANDU vice-president Dave Hamm asked why the province is putting resources toward involuntary treatment, while denying resources for voluntary treatment, with many people lacking access to voluntary treatment. 

"This community (Vancouver's Downtown Eastside) has dealt with so much death," Hamm said. "This is not treatment, it is trauma. The very‬ people that are being denied access to voluntary treatment and basic services will be traumatized even‬ further with involuntary treatment."

Moms Stop the Harm, a network of Canadian families impacted by substance use-related harms and deaths who advocate for changes to drug policy, have also raised criticism. 

"What this type of announcement does is instill fear in people," Traci Letts, board chair, said. "Every drug user thinks they are going to get picked up and held involuntarily and forced into treatment." 

The Langley resident noted that it is important to understand that the act has not been changed. She said Wednesday's announcement was just guidance for clinicians, adding that those non-binding guidelines are so vague, that they could be interpreted in multiple different ways.

"It's very concerning for advocates," she said. "It's very concerning for our organization and our members. It goes against what we believe is a harm reduction focus." 

B.C. Health Minister Josie Osborne said Wednesday the changing guidelines are not about making it easier to apprehend people or apprehending more people.  

"This is about correctly identifying those people who will benefit from involuntary care in the manner that Dr. Vigo has explained," she said. "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." 

Meanwhile, the provincial chapter of the Canadian Mental Health Association said it is still reviewing the new guidelines.

"While we appreciate efforts to provide clarity in this complex area, we have some initial concerns about the implementation framework and potential impacts on both care providers and those seeking treatment," it said.

The organization added it remains committed to working constructively with government to ensure approaches that best serve British Columbians facing mental health and substance use challenges. 

B.C.'s two opposition parties have criticized the guidelines but for different reasons. 

"It's going to disappoint families who are hoping to have a long-term addiction treatment for individuals, this announcement is actually not for that," Conservative Elenore Sturko, MLA for Surrey-Cloverdale, said Wednesday. "This is for individuals with concurrent disorders of addiction and mental health, but they are not actually treating the addiction. They are treating the symptom of psychosis." 

Sturko had earlier that day introduced amendments to the act to improve communication between healthcare providers and close relatives of individuals who are taken to hospitals during mental health crises. The changes would require physicians and nurse practitioners to consult near relatives or individuals who provided information leading to an apprehension before certification under the act. It would also require hospitals to inform near relatives before discharging patients and informing them if patients have withdrawn consent for information sharing.

Two comparable private member bills tabled in 2023 and 2024 died on the order papers. 

B.C. Green Jeremy Valeriote also re-affirmed his party's opposition to government's changed direction on grounds that B.C. does not need to increase the number of people receiving involuntary care.  Vigo had pegged that number at about 18,000 per year. 

Government last year announced the addition of 10 beds at Surrey's Pretrial Services Centre set to open this month to treat individuals with severe mental-health, substance use and addiction challenges being held in custody and 20 beds at the Maple Ridge's Alouette Correctional Centre for for individuals needing long-term care and housing.

Government also announced the building of more than 400 mental-health beds at new and expanded hospitals by modernizing approximately 280 outdated beds and adding more than 140 new mental-health beds, with more to come, with all facilities providing involuntary care under the act. 

-with files from Anna Burns