British Columbia’s addictions strategy addressed

By John Kurucz for the LETHBRIDGE HERALD on October 31, 2024.

It was perhaps the touchstone moment in British Columbia’s evolving approach to dealing with severe mental illness and addictions — and it became a political lightning rod ahead of the Oct. 19 election.
A man armed with a machete attacked two people during the morning commute outside of the Queen Elizabeth Theatre in downtown Vancouver. The incident left one man dead, while another had his hand severed off and eventually re-attached. It was completely random, unprovoked and none of the three parties knew each other.
The Sept. 6 incident saw a White Rock man charged with murder and aggravated assault — he was on probation at the time of his arrest and had more than 60 documented contacts with police agencies across Metro Vancouver.
Five days later, B.C. Conservative leader John Rustad issued a statement in support of an involuntary care model for those with serious mental health and substance use disorders: laws to enable involuntary treatment for those at serious risk due to addiction; building the necessary facilities to house those in care; and establishing dedicated units for those experiencing severe addiction or mental health crises in order to lessen the burden on emergency rooms.
A further five days later on Sept. 16, NDP Premier David Eby announced the opening of dedicated mental health units in prisons, along with future plans to open up more bed spaces in hospitals across B.C. Eby, too, had voiced support for some forms of involuntary care.
In the intervening days since, both party leaders have advanced numerous talking points around how to dramatically shift B.C.’s approach to serious mental health issues, additions and crime.
This is something of a full circle moment for the province — having started with an institutionalized care model in the early 20th century, and then moving to community-based treatments in the 1980s and 90s. Depending on what type of involuntary care model takes root after the election, B.C. may see a hybrid approach of institutionalization and community-based care.
Nicole Luongo’s academic background is in medical sociology and she now works as a systems change coordinator with the Canadian Drug Policy Coalition (CDPC), in collaboration with researchers in Simon Fraser University’s Faculty of Health Sciences.
She spoke to the Lethbridge Herald to reflect on more than a century’s worth of public policy in the area of mental health, addictions and criminal justice.
 What were the primary failings of the institutionalization model — housing thousands at Riverview Hospital, for example — throughout the early 20th century and through the 1990s, Luongo was asked.
“On one hand, it kind of did work depending on how we define ‘worked.’ For the dominant majority of the public who simply wanted this demographic out of sight and out of mind, then to some extent the model did work.  Was the model in any way geared towards promoting autonomy, healing or good health? No. It was pretty purely predicated on segregation and disappearance. I don’t think the model of institutionalization that was in effect at Riverview was ever geared towards social reintegration.
 Critics of the community-based care model often suggest that the Four Pillars strategy hasn’t worked — that only harm reduction was emphasized, but not prevention, treatment or enforcement.
In response to those sentiments, Luongo said:
“I have little patience for that narrative because it’s not grounded in empirical reality. Those who have studied this have pointed out that there are still disproportionate resources directed towards enforcement.  Harm reduction is a bit like putting a BandAid on an open wound. It will reduce some rate of death but we are working against a toxic drug supply right now that is impossible to manage without regulation.
 B.C.’s removal of criminal penalties for the possession of small amounts of illegal drugs hasn’t translated to a marked drop in overdose deaths. When asked how the public should interpret that disconnect, Luongo replied:
“The most important thing to point out is that decriminalization alone was never meant to prevent overdose deaths — its primary purpose was to separate people from the criminal and legal systems. Although people may not be arrested or have a criminal record for possession under decriminalization, they are still subjected to the same toxic drug supply, so overdose deaths won’t go down. The NDP did themselves a great disservice by claiming that decriminalization was going to meaningfully reduce rates of overdose deaths. We knew that it wouldn’t but there was a dynamic of overpromising followed by under delivering.
 When it comes to balancing a person’s rights versus some segments of the population who want that person imprisoned over the long term, Luongo said:  
“Almost entirely absent from the conversation are people’s material conditions.  We know rates of poverty and homelessness have increased exponentially and in the Lower Mainland specifically, the rate of street-level homelessness has increased by 34 per cent. What I think we need to be focused on societally, economically and politically are preventative measures. I’m in no way denying that there are people who are very clearly unwell.
“But it’s really important to emphasize that this is an inherent state. People are pushed to become severely unwell through policy and legislative environments.”
 B.C., said Luongo, is probably the province in the country that has most liberal use of the Mental Health Act.
“In 2002, 850 patients detained under the Mental Health Act were transferred to other mental health facilities. That number grew to 28,000 involuntary admissions in 2020/2021.
Under the B.C. Mental Health Act, people are being detained everyday for a variety of reasons and many of them are detained because they are intoxicated. By and large the same people who are going to be detained around expanded powers under the Mental Health Act are already being detained.”

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