The BC NDP’s Mental Health Amendment Act (Bill 32) – which removes reference to “deemed consent” in the Mental Health Act while expanding liability protections for workers and police officers – passed in a confidence vote this week.
Bill 32 can be seen as one act in a broader BC NDP strategy to significantly expand the use of involuntary treatment across the province. Bill 32 follows the release of new guidelines for using the MHA against people diagnosed with substance use disorder, including through forced injections of Sublocade (a long acting form of buprenorphine) in March 2025, as well as the expansion of involuntary treatment into prisons.
In May, Filter Magazine reported on how one person was being involuntarily treated in a former solitary confinement unit inside Surrey pretrial centre.
This case underscores broader concerns that drug user rights and disability justice organizations have raised. The Council of Canadians with Disabilities have been pursuing a Charter challenge to the provision of ‘deemed consent’ in the MHA. The challenge by CCD was heard in court prior to the passing of Bill 32, but the Supreme Court of Canada has yet to release a ruling.
The eventual Charter ruling could put the BC NDP in a defensive stance on their apparent intent to run roughshod in expanding involuntary treatment eligibility and interventions.
Bill 32 tries (“in an act of desperation,” per one Vancouver Sun columnist) to evade the Charter challenge ruling on the definition of deemed consent in the MHA by erasing it, while adding further liability protection for the healthcare workers and police who implement the MHA.
Bill 32 struck “deemed consent” from the MHA. This could be seen as a cruel interpretation of BC’s Office of the Human Rights Commissioner’s recommendation to replace the deemed consent provision with better safeguards for patients, including an enhanced psychiatric assessment regarding capacity – under the MHA, people are exempt from the province’s standard Health Care (Consent) and Care Facility (Admission) Act, which assumes patients are capable to consent and empowers patients to have a substitute decision maker if they are assessed as incapable. While Bill 32 does repeal the deemed consent provision, it does not provide any new safeguards for patients. And unlike the deemed consent provision, which was restricted to “treatment,” Bill 32 curiously extends worker and police protections for the provision of “care” and “professional service,” which are not yet defined within the MHA. During committee debate on Bill 32, Health Minister Josie Osborne stated that healthcare workers would be notified, but receive no new training on these changes.
At the November announcement of Bill 32, alongside Osborne and Premier David Eby, stood Daniel Vigo, the province’s “Chief Scientific Advisor on psychiatry, Toxic Drugs & Concurrent Disorders.” Vigo’s appointment by Eby came three months prior to the 2024 provincial election campaign with a large, publicly-funded government contract.
Vigo has since attended several BC NDP press conferences championing involuntary treatment. In sharp contrast, it was only a few years ago that Vigo co-authored a peer-reviewed study in the International Journal of Drug Policy which found several reasons as to why further involuntary treatment would not be the appropriate healthcare intervention for people who use drugs. The IJDP study included recommendations for an “idealized” form of involuntary treatment, one of which was the “[e]limination of police and criminal justice system involvement from care and treatment encounters.” Another recommendation was the inclusion of peer advocates.
Meanwhile the Canadian Mental Health Association’s rights advisors service staff requested that politicians “back down” from passing Bill 32 in a statement put out by the Disability Justice Network of BC. There also remain questions as to how and why Vigo could release the initial new set of guidelines under the MHA in March without having to undergo the same legislative process as Bill 32 did.
In any case, by increasing the number of beds, staff and resources allocated toward involuntary treatment, the BC NDP are incentivizing its systematic use within the healthcare system. All of this comes alongside the continued absence of well-resourced alternatives for intervention – particularly as little-to-no new community care infrastructure is being funded, and harm reduction services are facing a general rollback from government resources.
For example, The Tyee has reported that one of the two last sex worker drop-in spaces in Vancouver is facing possible closure next spring, after several other services for sex workers and women’s safety were shuttered in the past year.
The care providers among us hear daily from individuals and families who want access to well-resourced, non-carceral or punitive outreach teams — the type of service mentioned in Vigo’s 2021 IJDP study. Services of this kind could intervene in mental health crises and/or provide meaningful support around substance use related harm. Instead, families face eligibility and resource barriers, and are left with nowhere to turn for voluntary and meaningful support for their loved ones.
If the BC NDP were committed to saving lives and improving public health, they would listen to experts who have condemned these policies. They could invest in what the evidence already shows works: stable and affordable housing, culturally safe voluntary care (which is woefully lacking), harm reduction, safer supply and disability-justice based approaches that uphold community-building efforts. We know that punitive and carceral approaches like this only prolong collective and individual harm for those who are most at risk of structural violence.
“This community has dealt with so much death,” says Dave Hamm, president of the Vancouver Area Network of Drug Users, in a press release. “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.”
Instead of funding adequate care and services that people want to access, the BC NDP are incentivizing the use of the MHA to medically incarcerate patients, in what appears to be a continued effort to invisiblize the impacts of the toxic drug poisoning public health emergency that they have sanctioned by erasing and disappearing the very people most impacted by it.
Under Eby, the BC NDP have likewise become well-versed in evading accountability from the courts. Since 2023, Bill 32 is at least the third major legal challenge that the BC NDP have faced to their reforms. Attempts to increase legal tools of displacement and criminalization have continually been challenged, and each time the province has opted to forge ahead rather than strengthen people’s rights.
Criminalizing poverty and public space
In October 2023, Eby and then Minister of Public Safety Mike Farnsworth announced their intent to criminalize public consumption of unregulated drugs during the ongoing public health emergency through the implementation of Bill 34.
Bill 34 faced opposition from numerous community groups at the outset, including the Surrey Union of Drug Users and Care Not Cops, before facing a Charter challenge led by the Harm Reduction Nurses Association with representation from Pivot Legal.
HRNA and Pivot would win an injunction to stop Bill 34 from being implemented until the Charter challenge was heard in court. Rather than wait to hear which Charter rights they may be infringing upon, the BC NDP quickly made a formal request to the federal government – circumventing the legislative processes needed to pass Bill 34 – to reform BC’s existing decriminalization pilot project framework to exclude it from almost any public space. This essentially restricted decriminalization to people who have access to or own private places they can use substances, thereby re-entrenching the criminalization of those who survive in public spaces. The federal government accepted the province’s request, and the BC NDP repealed Bill 34, rather than face the Charter challenge.
The BC NDP responded to a court decision on the contracting out of tenancy rights in so-called “supportive housing” buildings with a similar approach of punishing the people already facing marginalization. Part and parcel to this marginalization are the provincial and municipal-level policies and funding allocations linked to the poor quality of housing and intensive forms of carceral surveillance.
“This community has dealt with so much death…The very people that are being denied access to voluntary treatment and basic services will be traumatized even further with involuntary treatment.”
When the BC Court of Appeal ruled that the government must more clearly define supportive housing in McNeil v. Elizabeth Fry in 2024, rather than bolster tenancy rights and/or ensure higher standards of care, the BC NDP focused primarily on exempting supportive housing from some existing tenancy rights through an Order-in-Council. The order legalized landlord-led guest bans and removed restrictions on landlord entry into tenants’ units without notice.
Care is not forced, coercion is not care
One reason involuntary “treatment” is a more apt descriptor than “care” is that treatment does not imply compassion, autonomy, health or wellness. Neither are well-defined regulatory terms in BC and interventions conducted under the umbrella of treatment are wide-ranging.
The practical components of involuntary treatment within the healthcare system include indefinite time in a locked ward, forced isolation and undressing, forcibly being administered antipsychotics (and now opioid agonist therapies if you have a substance use disorder diagnosis), as well as being placed in handcuffs and other body restraints.
These carceral threats of apprehension and detention drive people away from the healthcare system. Just like Kali-olt Sedgemore, executive director of Coalition of Peers Dismantling the Drug War, noted in a press conference this week, we too worry that people, including harm reduction workers, may think twice about calling 911 when responding to an overdose because of the heightened risk of our peers and other relations being placed in indefinite detention. This is in addition to the tools of criminalization police officers already use, such as threats of drug charges, street sweeps and civil forfeiture.
Many survivors of involuntary treatment have sounded the alarm on the traumatic sense of loss of control, powerlessness, erosion of autonomy, and the impacts of long-term medical surveillance. This reality can push people away from our social welfare and healthcare systems, and into more harmful contexts. Narratives of positive outcomes from involuntary treatment for select people cannot erase the significant harm caused to many while detained or because of the discretionary powers embedded in the MHA. Expanding these powers and reducing accountability in the MHA will expand who is captured in the webs of involuntary treatment, increasing social coercion both in its use and the ever-present threat of its use.
One youth, L*, shared their experience of enduring involuntary treatment on Monday:
“When I was 15 years old I was placed on a 72-hour hold in a psychiatric facility. I ended up spending 86 hours there. Within this time, I did not talk to a therapist, got screamed at and treated like an animal by the staff. When I wanted to speak to my parent, the nurse made me sit in complete silence without crying for 20 minutes twice, then the second I started crying the phone was taken from me and I was forced to take drugs to fall asleep.”
A carceral approach to mental health, substance use, and crisis is not in line with public health principals. But it has become convenient cover for the BC government to avoid confronting the ongoing housing and toxic supply crises in BC by invisibilizing those disproportionately impacted by both. This extension of colonial violence has been repeatedly condemned by researchers and people with lived experience alike.
(Bad) propaganda about youth
Youth and children are consistently weaponized as anecdotes, not as patients, but as political objects pathologized by politicians to elicit emotion while neglecting to fund and implement evidence-based practices.
Youth and young people have bodily autonomy, and they deserve healthcare and treatment options that respect this autonomy with dignity.
Politicians and media have worked in tandem to reinforce involuntary treatment narratives as interventions to prevent deaths and overdoses experienced by youth. Parents may be desperate to ensure the safety of their children, and ensure the temporary safety of children outside of their care. Yet studies show that these parents themselves have found that involuntary treatment as a form of stabilization angers youth, erodes trust and exposes youth to peer influences they would not otherwise be exposed to.
The BC NDP appear to be moving toward making involuntary treatment the only available option to youth and parents by incentivizing apprehension and detention through the MHA in the context of a lack of viable alternatives, which are often followed by referrals to private unregulated and expensive recovery services. At the same time, the province is further restricting access to prescribed safer supply options, which are now virtually inaccessible for youth.
The province withdrew funding for the city of Vancouver’s main youth detox center in 2022 – a voluntary space that saw around 400 visits from youth per year. Vancouver Coastal Health then moved toward home-based detox services for youth. It is unclear how such a service would include young people without a home or safe living environment.
The evidence is clear, to reduce the overdoses and drug related deaths experienced by youth, the supply of substances they have access to must be regulated and safe. Parents and children deserve access to comprehensive healthcare options and accurate information to make informed decisions for and as youth who use substances and/or experience mental health crises. Forced treatment is a traumatizing experience that erodes trust in the caregivers who youth have trusted and in the medical system and other health practitioners.
“After I was released, my addiction spiraled. In the times that I did want help I was terrified to reach out. My experience had isolated me, and I felt safer in active addiction than in any medical program,” L* continued.
Forcing youth to enter abstinence-based detox programs through apprehension under the MHA is coercive, particularly with a lack of voluntary options: no long-term recovery centres, limited youth-specific resources, and a crisis in availability of safe and stable housing. Youth who use drugs, in particular in unstable housing situations have made clear their needs – for example, a group of youth from Vancouver and Lisbon, Portugal came together and listed a number of calls to action, including:
“An end to compulsory or involuntary abstinence-based treatment programs. We want to be listened to regarding what drugs do for us, socially, physically, mentally, and emotionally, in our daily lives. Youth-dedicated drop-in centers and service hubs should center relationship- and trust-building and harm reduction.”
The enduring coloniality and disablism of our carceral systems
Grant Charles, a social work professor at the University of British Columbia, flippantly told the CBC this week that, “It’s not like you can just pick somebody off the street and throw them away forever” under the MHA.
While it is not clear exactly who Charles is referring to in the interview – police officers can and do almost exactly that. In the city of Vancouver alone, the police apprehend people thousands of times every year under the MHA. Police are empowered through the MHA to assess, handcuff and forcibly take a person to a locked unit for up to 48 hours.
In his interview, Charles adds there are “often time limits on how long it’s [the MHA is] used for.”
The word “often” must be doing a lot of work in Charles’ assessment, because once someone has been apprehended, physicians have discretion to extend or discharge someone’s stay. After this physician assessment, there is no maximum time that someone can be detained, nor is there a time limit on being placed on “extended leave” (forced medication regimes enforced primarily by physicians and police, outside of a locked ward). Patients can request a review, as Charles mentions, but the 2019 Ombudsperson report showed that rights-based administrative work is often left incomplete by workers. Review panel hearings are an awkward tribunal with a power imbalance, where your healthcare provider argues against you to continue your detention or extended leave under their care. In 2022-2023, only 37 per cent of the people who did manage to submit an application for a review panel received a hearing.
And of the small fraction of people who did receive a review panel hearing that year, they lost 84 percent of the time (their detention or extended leaves were upheld). In 2023-2024, applicants lost their challenge 88 per cent of the time, according to the BC Mental Health Review Board’s annual report.
Professor Charles defends use of involuntary treatment in an interview with CBC on Dec 1. Screenshot.
Vigo’s 2019 report to the BC government did note that international legal norms call for clearly stated time limits when it comes to compulsory treatment, however this has not been implemented.
We can look to current and past trends in the uneven weaponization of involuntary treatment, not only in the MHA, but also embedded in the family policing/child protection system, workplace drug testing, police interactions and incarceration to understand what social relations will be reinforced through the increased license to use involuntary treatment.
When examining police data from 2011 to 2020, the Office of Human Rights Commissioner found that Indigenous Peoples were disproportionately represented in chargeable police interactions in Prince George, Vancouver, Nelson, Surrey and North Cowichan. The OHRC found that Black people were both disproportionately arrested and faced with police interactions linked to mental health in Vancouver, Surrey and Nelson. Arab people were arrested at disproportionate rates by police in Vancouver, Surrey and Prince George. Prior to the Vancouver Police Department declaring a formal end to its practice of street checks, their internal statistics showed their officers targeted Indigenous Peoples. The practice of BC police organizations releasing lists and headshots of men who are overwhelmingly Punjabi or otherwise racialized men in their drug war press materials continues. The OHRC data shows that South Asian men are disproportionately strip searched by the VPD – including due to police suspicion of drug trafficking.
According to the BC government, Indigenous children make up less than 10 per cent of the population, but more than 68 per cent of the children in the child welfare system as of 2022. BC’s Representative of Children and Youth reported in 2021 that while they believe Indigenous children are disproportionately detained under the MHA, the province was not formally tracking this.
In other words, it is likely to be Black, Indigenous, brown and/or disabled people who are targeted under the BC NDP’s growing carceral interventions, including the expansions of involuntary treatment.
Stripping people of their bodily autonomy because of a perceived health risk under the guise of “public safety” and managing behaviour is a form of ableist policy.
“There is nothing more ableist than healthy, housed, well supported policymakers sitting around a table deciding how chronically ill and disabled people should be “managed,” opposed to expanding tangible standards of operating procedures,” Phindile Tshabalala with the Disability Justice Network of BC said this week.
When we add ableist interventions, including eugenicist ones, to the equation of settler-state racial capitalism, the manufactured fear and racialized narratives of what constitutes a threat will grow louder.
“That is not compassion. That is eugenics dressed up as, cost effective efficiency,” Tshabalala added.
Mona Woodward called Eby and Vigo’s plans to expand involuntary treatment “another way to criminalize Indigenous people, we know the jails are already full of my Indigenous kin. This is the continuation of a colonial framework to keep Indigenous people below the poverty line, criminalized and oppressed” last year.
Carcerality does not produce safety in healthcare. It creates conflict and disorder.
Some physicians, nurses and nurse practitioners may view the passage of Bill 32 as a protective measure that is long overdue, a legislative fix that shields healthcare workers from liability and therefore represents a net positive regardless of broader implications.
But liability protection cannot be mistaken for genuine safety, nor can it override what evidence and professional standards require of clinical practice.
Research on involuntary treatment environments demonstrates that coercive frameworks fundamentally reshape the care relationship: “Most participants in our study were aware of the power imbalance caused by the ITO [Involuntary Treatment Order]. Nurses emphasized management of the ITO’s conditions left them feeling trapped between coercion and care.”
When the state expands detention powers under the guise of health care, it positions healthcare workers as both enforcers and caregivers, a structural arrangement that produces conflict and harm rather than resolving it.
The more urgent question is whose safety Bill 32 ultimately secures. A 2024 statement from the Canadian Nurses Association and HRNA states that “prohibition-based policies…do not meaningfully address safety concerns.”
CNA and HRNA also contend that the “invasive and dehumanizing policies such as searching personal belongings have been shown to worsen health outcomes and create new safety concerns for nurses and patients.” These outcomes include premature discharge from hospitals and health centres, increased law enforcement interactions and incarceration. Each of these on their own, and especially when taken together, serve to increase volatility in clinical environments and diminish trust in health services.
Bill 32 does not prevent these harms. Instead, it reinforces conditions that produce them by expanding the use of coercion without addressing the lack of adequate voluntary, community-based care.
And the ethical burden placed on healthcare workers is not removed or softened by legal indemnity or further liability protection from the province.
HRNA and Doctors for Safer Drug Policy’s recent statement warns that coercive policy “would force us to act against our ethical commitments, inflicting profound moral injury.”
The CNA code of ethics requires nurses to “respect the inherent dignity and autonomy of all people” and to support the right to refuse treatment. When consent is overridden, the therapeutic relationship collapses, the risk for conflict escalates, and neither patients nor healthcare workers are safer for it.
In other words, expansions of involuntary treatment, particularly when geared toward substance use, will see healthcare workers override their own clinical judgement in addition to disregarding principles of informed patient consent.
In healthcare positions other than nursing, such as social work and outreach work, we see how the avoidance of carceral punishment, including medical incarceration and forced antipsychotics, can lead to the “non-take-up” of services, and ultimately to care avoidance.
It should not go unnoticed that with Bill 32, the BC NDP have prioritized healthcare worker and police officer safety over patient safety. The safety of people experiencing involuntary treatment went relatively unmentioned in a policy reform on deemed consent. The people most impacted by the deemed consent provision were left out of shaping its changes.
Another patient safety issue is the post-discharge realities of the toxic drug emergency. International research has also linked involuntary treatment to an increased risk of dying from overdose, particularly in the first weeks after discharge. Vancouver-based research has suggested that involuntary treatment has no significant impact on a patient’s substance use patterns after discharge, while across BC there is a heightened chance of dying by overdose after being released from a period of incarceration.
Opposition to involuntary treatment expansion
On Monday, a coalition of nine groups, including DSDP, HRNA, Coalition of Peers Dismantling the Drug War, Disability Justice Network of B.C, Northern Peer Guardians, and Care Not Cops joined Canadian Students for Sensible Drug Policy Vancouver to oppose Bill 32. The coalition also released a list of the first 294 healthcare workers who have committed to refusing to implement the BC NDP and Vigo’s unsafe expansions of involuntary treatment against people with diagnosed substance use disorders. This list includes more than 50 physicians and nurse practitioners.
Work in healthcare? Add your name to the refusal campaign here.
The refusal campaign is a concrete form of moral non-participation in state sanctioned violence that follows years of public opposition to current forms of involuntary treatment in BC and its expansion.
The campaign comes after many attempts from community groups and public health experts to stop the BC NDP’s attempts to expand the use of involuntary treatment.
In 2020, a large coalition, which included the Union of BC Indian Chiefs, BC Civil Liberties Association, groups of young people, BC’s Chief Coroner, and groups of healthcare workers put pressure on the government to drop their problematic “youth overdose bill,” which would have expanded the MHA to detain young people who experience multiple overdoses. At the time, the BC Green party held the balance of power in the legislature, and were vocally against the bill. Knowing they would not have the required support to pass it, the BC NDP paused the policy.
When the state expands detention powers, it positions healthcare workers as both enforcers and caregivers, a structural arrangement that produces conflict and harm rather than resolving it.
During his short but successful BC NDP leadership campaign in 2023, Eby toyed extensively with expanding involuntary treatment and information sharing mechanisms between police and the healthcare system. Shortly after Eby won, several community groups and individuals, including Women Transforming Cities, CPDDW and Care Not Cops joined Pivot Legal Society to call for the abolition of coercive treatment, and the immediate elimination of all police power embedded in the MHA (just as Vigo’s 2021 IJDP study did). In response, involuntary treatment expansion again seemed to be put on hold.
Contrast to community care
Eby and Osborne announced Bill 32 the week that the Drug User Liberation Front compassion club’s Charter challenge against the federal government’s prohibitionist Controlled Drugs and Substances Act started.
The contrast could not be more stark. The compassion club is many things that involuntary treatment can never be: voluntary, life-saving, inclusive of those impacted, and genuinely guided by a respect for bodily autonomy. The model directly intervenes in the cause of a public health emergency while providing social benefits of inclusion and belonging.
The compassion club model follows the logics of traditional supply-chain public health strategies, i.e. pulling and replacing a contaminated supply, just as we do for everyday items ranging from vegetables to alcohol, without a primary focus on individual-level behavioural changes.
The DULF compassion club distributed drugs that people actually use in a way that is accessible to the people who use them. Prior to distribution, drugs were tested and labelled for ingredients before distribution. DULF did what the health authorities, the government, and many of us have either failed or neglected to do: intervene directly in the unregulated drug supply driving a public health emergency.
And DULF’s compassion club was successful in terms of reducing overdoses and public health harms linked to the unregulated drug market, according to peer reviewed research findings, the members who participated in the club, and in the ruling of BC Supreme Court Justice when she found its operators guilty of possession for the purpose of trafficking.
As one social worker put it at the time of the DULF’s shuttering: “A non-prescribed, regulated and predictable supply is the only way out of this crisis.”
DULF is far from the only model of care that is an antidote to David Eby and the BC NDP’s approach of medical incarceration. Peer-to-peer supports, from low-barrier overdose prevention sites that generate community connection, to grassroots crisis responses that are decoupled from police, to the provision of basic necessities through mutual aid, to cultural programming that expands care and belonging are all alternatives we could be building and scaling up. The province and police must – at minimum – stand down from closing down successful community-led interventions and sending our kin into their growing number of locked wards.