“No Forced Hospitalization: Nurses Speak Out”,

The NDP government of BC recently amended the Mental Health Act to create a new pathway where nurse practitioners can certify involuntary detention. However, nurses working in mental health and substance use have expressed concern over this move. They have been monitoring the NDP’s response to the drug poisoning crisis, which has been responsible for almost 12,000 deaths in BC since 2016. The NDP’s response is to involuntarily admit and detain people who use substances under BC’s Mental Health Act.

The number of people admitted and detained against their will under the Mental Health Act has been steadily increasing in BC, reaching 20,000 in 2020 alone. However, BC does not currently report the number of people who are certified under the Act due to their substance use. Pivot Legal Society, in a recently released position statement, noted the practice exists and warned of its expansion in the current political climate. This echoes the findings of a recent study, which found that substance use accounted for the greatest increase in involuntary hospitalizations in BC between 2008 and 2018.

Nurses are alarmed by the NDP’s persistent framing and normalizing of involuntary hospitalization as a “needed response” to the mental health and drug poisoning crises. Nurse practitioners working in primary care settings being tasked with admitting and detaining patients against their will and without adequate community-based services for voluntary care raises significant ethical implications. Involuntary hospitalization can cause health and social harms, which disproportionately affect people who experience systemic racism and colonial violence in health care. Available evidence also points to the ineffectiveness and inappropriateness of involuntary care for people who use substances.

Nurse practitioners have a critical role to play in scaling up and supporting low-barrier and voluntary mental health and substance use care, including safe supply prescribing. They can also contribute to improving population-level mental health by engaging in prevention, early intervention, and mental health promotion. Strengthening and integrating accessible, preventative community mental health services, addressing core housing needs, and improving the social safety net are mandatory to help prevent mental and physical deterioration and support health and well-being.

Nurses urge elected officials, policymakers, and nurse practitioners to approach BC’s expanded pathway to involuntary hospitalization with caution. They ask that they continue focusing on addressing long-standing gaps in voluntary and equity-informed approaches that meet people where they are at. As essential, highly skilled members of the healthcare workforce, nurses want to ensure their work is used for good and not harm.