What are the new involuntary care beds in Maple Ridge?

This summer, 18 new involuntary care beds opened in Maple Ridge’s Alouette Homes.

Dubbed “approved homes,” these spots are to provide long-term involuntary care in a home-like environment. The program is run by Vancouver Coastal Health and Connective, a social services non-profit.

These are people with a combination of mental health issues, substance use issues, and some cognitive impairment or brain injuries, said Bonnie Wilson, the Vice President of Vancouver Community Care for Vancouver Coastal Health (VCH). 

With this combination of medical issues, she said it can be hard for people to access support in the traditional way of doing so, and the individuals moving into Alouette Homes have been in tertiary mental health care for a long time and need long term support.

“They haven’t been able to successfully manage in other settings,” Wilson said. “So that’s the gap that this will fill — it’s somewhere between sort of a hospital setting and a group home setting,” Wilson said.

She said they will receive similar care to what they received while living in hospitals, but have a better space to live.

“If you could imagine being in a hospital setting for a couple of years, what that would feel like,” Wilson said. “I think it’s not that they’re getting better care or worse care. I think the care itself is similar. I think it’s more about the environment and those kinds of cues that really signal to people that they’re not living in a hospital, that they are progressing, that they’re actually getting to live in a home.”

Liz Vick Sandha, Connective’s chief operating officer, said the organization had been discussing this program with VCH for a number of years, and the opportunity came up relatively recently to start the program at Alouette Homes. They wanted to try “to find a way to respond to the fact that the mental health system is stretched at every level.”

“This is 18 beds, and this is going to be addressing the needs of probably the most unwell people, which is great, they need that,” said Jackson Loyal, a PhD candidate at UBC’s school of population and public health who is doing his doctoral research on involuntary treatment.

But he said what is left out of this conversation is that both the number of unique individuals and the number of hospitalizations involuntarily admitted is increasing every year, while the proportion of people receiving voluntary treatment remains the same.

“What that . . . signifies is that the treatment that we are providing is becoming less and less voluntary. It is increasingly involuntary,” he said.

Where did this come from?

On Sept. 15, 2024 — just a little over a month ahead of the provincial election — Premier David Eby announced that the province would open “highly secure facilities for people under the Mental Health Act,” with Alouette Homes marked as the first “secure housing and care facility.”

“This announcement is the beginning of a new phase of our response to the addiction crisis. We’re going to respond to people struggling like any family member would. We are taking action to get them the care they need to keep them safe, and in doing so, keep our communities safe, too,” said Eby.

These actions come from the recommendations of Dr. Daniel Vigo, B.C.’s B.C.’s first chief scientific advisor for psychiatry, toxic drugs and concurrent disorders.

In an interview with  The Tyee, he said a few hundred “complex” patients are falling through gaps in care, and that with an increasingly toxic drug supply that can cause things like Alzheimer’s or vascular dementia, B.C.’s existing services cannot meet their needs.

At the same time, Eby announced a correctional center in Surrey and that it is building over 400 mental health beds that will provide involuntary care.

How has involuntary traditionally worked in B.C.?

While the government recently made these promises to increase involuntary treatment in B.C. — and the approved homes in Maple Ridge are a new concept — it is a practice that is already widespread across the province. 

“I think that really is a misconception, is that involuntary care is a new thing. It’s not a new thing,” Bonnie Wilson said.

Involuntary treatment is legislated under B.C.’s Mental Health Act, which passed in 1964.

To involuntarily admit someone, a physician or nurse practitioner assesses an individual to see if they meet four criteria: Do they have a mental disorder? Do they require treatment in or through a designated facility? Do they require care, supervision and control in or through a designated facility to prevent their mental or physical deterioration, or the protection of themselves or others? Can they not be admitted as a voluntary patient?

“We have to be so careful about how we use that provision, because essentially, we’re providing a health care service when that person isn’t consenting to it,” said Wilson.

Some researchers, like Jackson Loyal, are concerned the approach is already is over-utilized in B.C. Each year, about 30,000 people are involuntarily admitted to the hospital in the province.

Angela Russolillo, a professor at UBC, said B.C’s acute mental health services have evolved “around institutionalized care,” with people receiving treatment in places like Riverview, a psychiatric hospital in Coquitlam.

But in the 1950s and ‘60s, the understanding of best practices shifted from institutionalized settings to the idea of community based care.

But B.C. didn’t invest enough in community based services to meet demands, Russolillo said. More resources have gone into acute care instead of community based services. Those that exist, especially to support mental health and substance use, “are really overstretched.”

This leads to someone with mild to moderate mental health issues having long waits to access care, and their issue possibly escalating so that they might have to rely on emergency services.

“The prioritization of how services are allocated has really, really unfortunately prioritized involuntary admission as the point of access to services, versus community based or preventative interventions,” she said.

Jackson Loyal said has spoken with physicians, nurses, social workers, occupational therapists, psychologists, who work in both community and hospital settings. What he heard is that the care they’re providing is: “a lot of putting out fires.”

“They’re going from one acute crisis to the next, and just because of the strain of the system, there’s very little opportunity to do that therapeutic work,” he said.

Does involuntary treatment work?

Involuntary admissions have increased, and Russolillo said that B.C. isn’t achieving the outcomes they’re hoping for — things like better health and quality of life.

While there’s evidence it can be beneficial at times, there’s also evidence can cause harm, according to Russolillo and Loyal. People might be traumatized from the experience, not want to return to health services afterwards, and even increased mortality.

“It’s not an either or, it is a both and,” Loyal said.

But for substance use — which is what political parties like both the Conservative Party of British Columbia and the federal Conservatives have called for — there’s very little evidence it works. According to the Canadian Centre on Substance Use and Addiction, these claims are “largely based on limited data, and there is a significant lack of high-quality research to determine its effectiveness compared to voluntary treatment or no treatment at all.”

Nor is this allowed under the Mental Health Act.

Russolillo said that increasing involuntary treatment without “a large evidence base to support its effectiveness is problematic in many ways.” 

She said that B.C. is already increasing involuntary admissions without it resulting in improved health outcomes. Meanwhile, there’s evidence that things like counselling, housing, income and community based services can help people.

“But all of those would require a full restructuring of the system, which may not be something politicians are willing to take on when we’re looking at election cycles,” Russollio said.