The Current - Could involuntary treatment help people with mental health and addiction?

Episode Date: November 18, 2024

As the addiction crisis continues to affect people and communities across Canada, some political leaders say that involuntary treatment can help those with severe mental illness or addiction get the care they need. Others say that getting help should always be a choice, made by individuals in consultation with their healthcare providers and loved ones. We hear from one mayor who wants his city to be considered for any future involuntary care pilot projects. 

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. Maybe you have lived with an addiction or mental illness. Perhaps someone you love has struggled. If nothing else, you've likely seen someone who is suffering in your own city or town. In communities across this country, the crisis and the homelessness that can come with it is almost impossible to ignore. Now, more and more political leaders are talking about forcing some people with severe addictions or mental illness to get treatment. In September in British Columbia, the Premier David Eby announced

that province's plans to open highly secure facilities to house people detained under expanded and voluntary treatment. We know that the current response that we offer is not adequate. It is costly for the people struggling with these conditions. struggling with these conditions. They are not safe. And increasingly, I'm concerned that the way that they are interacting in our communities is making everybody less safe. Not everybody is on board with this. Many experts say there is little evidence that forced treatment actually works. Civil liberties groups say it violates people's rights. The federal mental health and addictions minister, Yara Sachs, says provinces should focus first on meeting the needs of those who want treatment and aren't getting it. These are

decisions that individuals make with their health care providers and with their families and loved ones and the care that is needed for them. And I think that's where we need to keep it focused from a human-centered lens, from a compassionate lens, and from a health care lens. Alberta has promised legislation to force people with severe drug addiction into treatment, and in Ontario, several mayors have called on the province to expand involuntary care. Brampton has asked to be considered for any future pilot project, and so has Windsor, a city, like so many others, dealing with a rise in homelessness and people dealing with addiction. In a moment, we'll hear from the head of a treatment center there, but first, I'm joined by the mayor of Windsor, Drew Dilkins. Mayor Dilkins, good morning. Good morning, Matt. What does this crisis around addiction and mental

illness look like in your city? Well, I can say that my city, when I talk to other mayors and when I visit other cities across our country, we are in a much better place than what I see happening across our nation. And so I'm trying to do all that I can and get on board with all that I can to make sure that we don't get to the point where we see other communities are at today. But you have said the current system isn't working. So what's not working?

Just paint me a picture of what it looks like in Windsor. Well, let me paint you a picture. You know, if I go downtown Windsor today, it's about 45 degrees Fahrenheit out right now. A couple weeks ago, a few weeks ago, I went down to a board meeting, 8 o'clock in the morning. It was 40 degrees Fahrenheit out. And I parked on the street, and there's a man walking by with no shoes on. His feet were all black. His hair's all disheveled.

He's talking to himself. He's got a thin blanket around his upper body. And clearly, clearly just there's some psychosis or something going on there where he's not able to make sound decisions for himself. But we just have to let him walk by and go on his day because he's not hurting himself, apparently, or not hurting anybody else. or not hurting anybody else. And when I see that, that just feels so un-Canadian to me, that our system is set up, we're going to let a guy who clearly can't make sound decisions for himself continue to behave like he is, to the point where I think he is actually hurting himself walking around with no shoes at 40 degrees.

Like, come on, we've got to do better than that. And all I'm saying is there are people like that that need some support and some assistance that they're not getting, you know, that they're clearly not getting and the system is not acting on. And so listening to your T.F. with the minister, talking about the compassionate side and letting family and friends, you know, help in the decision making process, that is la la land. I mean, these folks don't have the family support available. They're on their own, mostly living on their own, out in encampments, out in the community. They don't have the family support that one thinks that they have

to help them make sensible decisions. So who's helping them? That's the question. Who's helping them? How do we help them? How do we get on the path so that they get the mental health and or addiction support that they need? So how would this work in Windsor?

You've asked to be part of this pilot project for involuntary treatment. And there are already ways, we should say, to put somebody in involuntary psychiatric treatment if a doctor says that they're a danger to themselves or others. But how would this work differently? Correct. So there is a system right now. But like you just said, you know, they have to be an imminent danger to themselves or others.

Well, clearly, I mean, we've had, you know, they have to be an imminent danger to themselves or others. Well, clearly, I mean, we've had, you know, three police shootings in 10 years from people who have who are in psychosis on the streets of our downtown. That's clear. I mean, those folks are imminent danger to somebody else and unfortunately had to be neutralized by police. And it's just horrendous that the community has to witness this happen all the time. But there is a whole subset of people who may not be an imminent danger to themselves or someone else, but clearly are not in a place where they're doing any good for themselves. And so let me be clear, I am not talking about, and some have suggested, you know, if they don't like this approach, they go right to the extreme. I am not talking about taking a bus and driving it up and down the streets and demanding every person who has a mental health challenge or an addiction get on board the bus. Who would be forced into involuntary treatment?

What we're talking about is you teed up the most severe cases. The guy walking around when it's 40 degrees with no shoes on who clearly is out of his mind and needs the state to help. Someone who clearly needs help and is not getting that help today. Those are the types of folks that we're talking about, the most severe and significant people who are obviously challenged and can't make sensible, logical decisions for themselves. Our colleague, Jennifer LaGrasse in Windsor, spoke with a mother in your community named Christy Soulier. Her 27-year-old son, Austin Trombley, died a couple of years ago from a fentanyl overdose. Take a listen to what she had to say. For an addict that's in active

addiction, I truly believe they have to hit their bottom. As a mom, of course, I encouraged them all the time and I asked them to get treatment. As a parent watching it, it's excruciating. You know, there was times when Austin was homeless because of his addiction. And I'd be up all hours of the night just crying. But knowing I couldn't force him to do something he wasn't ready to do. Forcing somebody to get sober when they're not ready is not going to work. What do you say to her? Yeah, Austin maybe.

I don't know Austin, never met Austin. But maybe he's not a candidate for what we're talking about. Maybe his behavior wasn't at the extreme level that we're talking about. I mean, can any of us really look in the mirror across our country today and say that the current system in any province is working? I mean, I always say that, you know, Windsor's better than London, London's better than Hamilton, Hamilton's better than Toronto, and all of us are looking at Vancouver saying, oh my God, we never want to get to that point where our community is just, you know, more or less taken over by this situation. And so the current system isn't working. So how do we work together to put the tools in place that allow us to deal with the most extreme cases where people can't make logical, sensible decisions on their own. And that's really the question I think we have to

grapple with and the one that I'm interested in dealing with. And I think if we help get those people into whatever treatment it is, if it's addiction treatment, great. If it's mental health treatment, great. Let's get them the supports they need because their behavior, their behavior also has a larger impact on places like our downtown, you know, where people are now afraid to go to the downtown because they see folks who are struggling, not getting the help that they need. And they don't know whether those folks are going to turn in to the kinds that are getting shot by police. How much of that is a factor that you have a very visible form of homelessness? And as you said, people are afraid to go downtown. You're worried that there will be an economic

hit to the very visible nature of homelessness in your city. There already is an economic impact. So you admit that that's a part of this? Well, I think that that certainly draws attention to it when you have business owners saying, listen, and property owners saying, listen, I have this business and I, you know, there's people defecating in my, sleeping and defecating at the front vestibule of my business. There's all sorts of bad behavior during the day. And if you could simply localize it, Matt, to one particular area, then you could apply a lot of resources and, you know, hopefully, you know, end the situation or certainly resolve a lot of the issues that are there. But now people are seeing it migrate out to their communities

more broadly. It's not just a localized issue in the downtown per se, at least not in my community. What evidence do you have that this is actually going to work? There were studies that were done, 42 studies reviewed by the Canadian Journal of Addiction, looking at the effectiveness of involuntary treatment. And the bottom line that came out of it is there's a lack of evidence, according to these studies, to support or refute involuntary treatment for substance use disorders. So what evidence do you have that forcing somebody into treatment would help them? Well, you're focused. First of all, you're saying there's no real evidence to say it works or it doesn't work, but you're also focused on substance use issues. I'm talking about mental health too.

And that mental health may have been caused. I mean, people doing crystal meth very quickly can get acquired brain injury. So, you know, there may be causes to the mental health issues. But let's just be like, let's use some logic and common sense. Clearly, if someone is struggling on the street, if I can stabilize them and get them into immediate treatment right away that they're unable to make the decision on their own, that stabilizing effect is positive.

We can get folks into immediate care who may not be able to find the pathways because of their mental health or addiction issues. It's not just me reading statistics, though. I mean, the health care leader in your own community, the head of Hotel Diagres Health Care, it provides mental health and addiction services, says there's a lack of evidence, but that that forced treatment can also bring an increased risk of trauma, as well as the human rights issues that are rolled into this. And so I just, what would you say to him? Not to me, but what would you say to him? Well, listen, again, I go back to the evidence and his own statement that he made to the community, the letter that he published talks about no evidence to say that it works. Well, I'm telling you the system and anybody listening to

this right now has to admit that the systems we have in place aren't working. And so a lot of folks would say who are in the industry, they'll say, well, just give us more money. Just give us hundreds of millions of dollars and more money and we'll just hire more people and do more. That's not coming. But guys, that's not coming. You know, so the money is not going to flow en masse, billions of dollars to every province, you know, to help deal with this. The money's not coming. So how are we going to deal with it in a sensible way? And so I'm not worried, you know, there's trauma and harm caused for sure when you have people walking around. What kind of harm is being caused to the guy

walking around when it's 40 degrees with no shoes on talking to himself clearly in a state of psychosis you know what kind of harm is happening to him that is so un-canadian to watch that play out on our streets we should not be allowing that i think it's inhumane and i think it's i think it's very un-canadian i have to let you go. All risk, all risk, you know, the other side of that, where someone feels like they're getting traumatized for getting treatment because they can't make logical decisions for themselves, I'm willing to take that risk because at the end of the day, we're trying to help somebody.

We're trying to help a human being. I have to let you go, but if you are able to move forward on this, will you be able to actually pay for more people in treatment? I mean, we heard from the federal, the minister saying that more people need to go into treatment. And you said that that won't be my problem to solve. I mean, cities, you know, we don't fund healthcare like that. That's a constitutional responsibility of the province and the federal government to figure that out. I'm just telling you, and every mayor that you will talk to will have to admit whether they're in support of, whether they're in support of involuntary treatment or not, they'll have to

admit that the situations are getting worse in every community and that the current systems in place are not working to end this issue. I'm glad to have you here as part of this conversation. As you've said, people across the country are dealing with this and may say that what we're doing right now is not working. Drew Dilkins, thank you very much. Thanks, Matt. Have a good day. And you, Drew Dilkins, is the mayor of Windsor, Ontario. In 2017, it felt like drugs were everywhere in the news. So I started a podcast called On Drugs. We covered a lot of ground

over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with season three of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy. On Drugs is available now wherever you get your podcasts.

Elizabeth Dolmage runs the Brentwood Recovery Home, which is an addictions treatment center in that same city of Windsor, Ontario, and she's been listening in. Elizabeth, good morning to you. Good morning. The mayor says that what is happening in your city when it comes to dealing with an addictions and homelessness crisis is not working. Do you understand why leaders across the country, like your mayor, are asking for forced treatment and voluntary treatment? like your mayor are asking for forced treatment and voluntary treatment? Yes, yes. I think I understand where that feeling of it's time to do something reactively to it.

And certainly Mayor Dilkens and I agree completely on the system is not working. We can agree that one of the challenges we face is having adequate resources to support people with severe mental illness. And that really is the group of people that I think Drew is referring to, right? They have severe concurrent disease. They're very mentally ill. This is not a group of people that we can just force them into involuntary addiction for their treatment, voluntary treatment for their addiction. We have to stabilize their mental health. And then we can begin to unpack some of what is happening for them related to their substance use disorder. Do you think, I mean, I ask you this as somebody who runs an addictions treatment center, do you think that involuntary treatment can work for some people?

Not until their mental illness is stabilized. Absolutely not. And I think when their mental illness is stabilized, then we really don't have to talk about involuntary treatment anymore. They will be ready to seek treatment. And we see that play out when we work in collaboration with our two hospitals here in Windsor. Well, what do we do then? If to the mayor's point, the system now isn't working and you have people who don't seem to have the capacity to seek out treatment for themselves, what do you do about that? I mean, the question is, I suppose, is does involuntary treatment work for mental illness, not just for addictions, but for mental illness? is, I suppose, is does involuntary treatment work for mental illness, not just for addictions,

but for mental illness? So we have, we do have therapies and medications that can work. You know, part of the conversation for me that's a bit challenging is we're not talking about, we don't seem to be emphasizing the vicious cycle that people are into right now when it comes to homelessness and access to mental health treatment and access to addiction treatment when they're ready. So Windsor's done all kinds of creative things recently, some innovative things that we haven't even given them time to get traction on. that we haven't even given them time to get traction on. You know, I have a wait list where people wait for several weeks,

as does every other addiction treatment center in this province. So we have individuals who are ready, who are wanting treatment, who are wanting to end the cycle of their disease. And we don't have beds for them. And while they wait for treatment, and we try and put the bandaid on the situation, supporting them while they're out in community, supporting them while they're still homeless without a roof over their head, we lose them. And so we, you know, we know from our data that about 43% of our people who are eligible, wanting to come in for treatment, while they're on that waitlist, we lose them back to the disease again. And so how do we, how do we as a system, how do we as a compassionate caring system system not address some of the core issues about access to mental illness treatment, access to addiction treatment, access to a roof over our head and basic earnings, basic income that allows me to put food on the table. You know, Mayor Dilkens talked about the cost.

Well, I'm going to suggest that the cost of involuntary treatment and the revolving door that the literature that we do have suggests that we're going to experience with people who are disproportionately experienced, with people who are forced into involuntary treatment doesn't seem like a long-term solution to me. This is something that, I mean, this is your work, but it's also something that has touched you personally, right? Absolutely. So I have loved people with substance use disorder. I have been the mom, I've been the stepmom, I've been the wife. It has been my experience that attempting to force someone into treatment does not work.

And so creating a safe space, keeping a roof over their head, loving them unconditionally, yes, that's what we need to do. The mayor called that la-la land. I mean, in terms of the funding that will be required for, okay, again, I'll use his words, that compassionate approach that the minister talked about, he said it's just, it's not possible right now. Well, then how is it possible to force involuntary treatment? So you're going to have to open more beds in hospitals, which costs substantially more money than it does to treat someone in an addiction treatment bed. their relapse rate, and their overdose rate. And there, you know, there was one study out of, and I'm sorry, I'm not going to remember, I think it was Mexico. You know, there was 80% of them were into the emergency department and using the healthcare system again. So, you know, to suggest that we can fund involuntary treatment and there'll be the money for that, which, you know, I think Drew was quite accurate and, you know, it's not going to be a cost to the cities.

and not fund treatment for people who are ready, willing, and wanting to have treatment kind of flies in the face of compassion and who we as Canadians want to be too. So on that point, you know, I have to disagree. The issues that need to be addressed are going to cost money. The cost of not addressing them is costing us money. Elizabeth, we'll leave it there. I'm glad to talk to you. Thank you very much. Thank you.

Thanks. Elizabeth Delmuch is executive director of the Brentwood Recovery Home. She's also in Windsor, Ontario. As both of them have said, this is an issue that's happening right across the country in communities large and small. We'd love to hear from you on this. You can email us, thecurrentatcbc.ca. For more CBC Podcasts, go to cbc.ca slash podcasts.