Locking Kids in Hospital “Coercion Units” Reflects the Government’s Failure to Create a Comprehensive and Voluntary Addiction Care System
Intake Workers from $10,000 per month religious bootcamps will be lined up at the hospital doors, fighting over who gets to drag away the next kid thats being untied from their hospital bed.
Last week as part of their strategy to address addiction and the overdose crisis, the British Columbia government announced Bill 22–2020: The Mental Health Amendment Act. If made into law, it will mean that children under the age of 19 who are taken to hospital for a drug overdose, could be detained involuntarily in hospital “stabilization units” for up to 7 days. That says a lot about the state of health care in BC for people with substance use disorders.
In Canada, we have a publicly funded health care system and citizens are supposed to be able to access medically necessary health care services regardless of their ability to pay.
However, that is not the case when it comes to accessing treatment for a substance use disorder. Canadian provinces have allowed inpatient addiction treatment centres to operate outside of the publicly funded system and have failed to regulate the efficacy or safety of the services they provide or the fees that they charge.
In 2016, CBC investigative journalists phoned every drug rehab centre in British Columbia and discovered a “confusing patchwork of options with no clear path”. They found that the majority of centres adhere to a faith based 12-step approach and reject harm reduction despite compelling science. Some facilities ban patients from using Opioid Agonist Therapy (OAT) despite that provincial treatment guidelines for opioid use disorder recommend OAT as the first line treatment in order to prevent overdose death and improve quality of life. Some centres ban medications altogether including anti-depressants. The investigation found that rehab centers charge up to $10,000 per month.
Shortly after the CBC report came out, the BC Humanist Association appeared in front of the Select Standing Committee on Health of the BC Legislature and called on the government to begin regulating addiction treatment centres in BC and require that they provide evidence-based health care free from religious coercion.
In 2017 Judy Darcy was appointed as BC’s first Minister of Mental Health and Addiction. She promised to “create a seamless and coordinated mental health and addictions system in BC so people can get the help they need, when they need it.” The Ministry even released a written plan for achieving their goals (A Pathway to Hope).
So, in June 2020 when I called the BC Alcohol and Drug Information and Referral Service listed on the Government of BC website, and asked for a referral to an inpatient addiction treatment centre, I expected that things would have changed over the past 4 years. I expected to be referred to evidence-based medical care.
In response to my request, the government referral service sent me an email which gave a description of 15 rehab centres in and around Vancouver. I read through the information and phoned each centre. (see below for a description of each rehab facility)
Some of the rehab centers I was referred to are private for-profit organizations, some are non-profits, and some are funded and operated by the provincial health authorities. What they all have in common is that they all purport to provide treatment services for a medical condition- “substance use disorder”.
After going through the list of referrals it became clear to me that the Ministry of Mental Health and Addictions has done absolutely nothing in the last four years to regulate the rehab industry in BC. Some of the facilities are at best a scam, and at worst are harmful, and a contributing factor to the overdose crisis.
Of the facilities that I was referred to, seven have no medical staff. (One of those facilities is funded by the Vancouver Coastal Health Authority (VCHA)). Four of the facilities have a nurse or physician visit the center one or more times per week. Two facilities have a single nurse on site. And only two of the 15 rehab centers that I was referred to has a full medical team on site.
You would think that having a medical team would be a basic requirement for operating an addiction treatment centre, yet the government of BC has failed to create or enforce standards for facilities that claim to be providing treatment services for addiction.
Five of the facilities I was referred to do not allow patients to take OAT. (One of those facilities claims to receive some funding from the Fraser Health Authority (FHA)). Another five facilities allow some forms of OAT but not other forms. The government’s failure to require treatment facilities to offer patients potentially life saving medications is unacceptable.
Three of the treatment centres I was referred to are based on Christianity. (One of those facilities reports receiving funding from the FHA). Four of the facilities are based on the religious 12-step model. An additional three claim not to be based on the 12-step model but include mandatory 12-step meetings. (One of those is funded by VCHA and one is funded by FHA).
A total of ten of the fifteen treatment centers that I was referred to have some sort of mandatory religious activity in their program. Not too long ago the Canadian government forced religion on Indigenous people and prohibited them from practicing their own cultures. So for the BC government to be allowing coercive religious practices in health care today is reprehensible.
Treatment centers rooted in religion often have an outdated understanding of addiction and fail to provide patients with current scientifically proven treatments. By allowing treatment centers to mandate religious practices, the government is restricting treatment options for anyone who doesn’t want to mix their medical care with God.
Some facilities that I was referred to are staffed by people who don’t have any credentials beyond their own lived experience. Most of the facilites follow a one size fits all approach and don’t give patients any choice in the type of therapy that they participate in. The training of the therapists varies from none to a University Masters Degree. The government has not set any standards for the qualifications that a person needs to work at a treatment center.
The costs to attend one of the treatment centers ranges from $35 per day to $380 per day.
Of the 15 treatment centres that I was referred to, only 3 meet all of these criteria: has medical staff, prescribes OAT, is non-religious, and charges less than $270 per day.
Rehab centers for youth in BC are highly problematic as well. Stories are frequently told in the media about parents who are unable to find an inpatient addiction rehab center for their child because of a lack of appropriate services, a lack of beds in appropriate facilities, long wait times, and insane costs.
In written statements about the proposed amendment to the Mental Health Act, which would allow Hospitals to lock kids up for up to 7 days after they are hospitalized for an overdose, BC’s Chief Coroner, BC’s Representative for Children and Youth, BC’s Health Justice Organization, and the Harm Reduction Nurses Association all point out the BC government’s failure to create a fully funded comprehensive system of voluntary, evidence-based, accessible, culturally appropriate and trauma informed substance-use treatment services for both adults and youth.¹
Since their inception 4 year ago, the Ministry of Mental Health and Addictions has done absolutely nothing to regulate addiction treatment centers in BC. The government is putting peoples lives at risk by failing to ensure that they deliver quality care. And even worse, the government is referring people to and providing funding for some of these deeply flawed facilities.
So, when the Minister of Mental Health and Addictions, Judy Darcy tabled Bill 22–2020, I wondered what the purpose of the proposed law is.
I assume the purpose of detaining children in these so called “Stabilization Units”, is at least in part to try to convince them to accept some sort of addiction treatment. I worry that physicians will confuse a child’s choice and right not to accept treatment with the child being “unstable”. This would lead to longer periods of unnecessary detainment for children who aren’t interested in treatment. Its wrong to detain a child just because they choose not to engage in treatment.
It’s inevitable that some kids will agree to treatment just so they can get the hell out of the hospital. That cannot be considered consensual treatment.
These shouldn’t be called Stabilization Units, they should be called “Coercion Units”. Intake Workers from $10,000 per month religious bootcamps will be lined up at the hospital doors, fighting over who gets to drag away the next kid thats being untied from their hospital bed.
Even if you ignore the fact that coercive treatment is unethical, what is the point of detaining children against their will and coercing them into treatment programs, if those programs are non-existent, too expensive, ineffective and even harmful?
Not only is there no comprehensive system of addiction treatment in BC, there’s inadequate housing, and no safe drug supply. So for some kids it would be a revolving door of getting locked up…being kicked to the street…overdosing again…and getting locked up again. That’s inhumane.
BC’s Chief Coroner Lisa Lapointe, BC’s Representative for Children and Youth Jennifer Charlesworth, the former BC Provincial Health Officer Dr Perry Kendall, the Health Justice Organization, the Harm Reduction Nurses Association, the Pivot Legal Society and the BC Civil Liberties Association have all condemned the proposed law as being harmful and suggest that it could actually lead to an increase in overdose fatalities.¹
In 2017 the Community Legal Assistance Society (CLAS BC) wrote a 180 page report describing the ways in which “the BC Mental Health Act and the Mental Health Regulation are outdated, deeply flawed, and inadequate to fulfill the rights guaranteed by the Canadian Charter of Rights & Freedoms and the United Nations Convention on the Rights of Persons with Disabilities”. CLAS BC recommends a complete overhaul of the Mental Health Act and the Mental Health Regulation.¹
However instead of giving people more rights and freedoms, the government now wants to lock up the kids with drug problems that they have failed to help.
If Bill 22–2020 is made into law, it would supposedly only allow hospitals to “detain” and “stabilize” children who have overdosed. Hospitals would not be allowed to administer involuntary “treatment”. However children who were detained in hospital after overdosing could still be subjected to all of the other rights deprivations described in the CLAS BC report including being stripped of their clothes and personal belongings, strapped to a bed, put in seclusion, forcibly administered medications (Bill 22–2020, sec. 55), no right to an independent hearing to challenge their detention, no provision to access legal services, denied visitors and denied access to a phone and the internet.
In an Op-Ed in the Vancouver Sun, Kendra Milne and Laura Johnston, lawyers from the Health Justice Organization, say that the experience of involuntary care (which is disproportionately used with Indigenous youth and girls and young women) can be so negative or traumatic that there is little therapeutic benefit from the services and it makes them avoid health services in the future for fear of being detained again.
I also worry that the stigma of having a mental health certification on their health care record, could further impact how a child is treated in a health care system that even the BC Minister of Health (in a recent interview) admitted is plagued by systemic racism.
Instead of locking kids up and further traumatizing them, the Province of BC should do what they said they were going to do 4 years ago and create a seamless and coordinated mental health and addictions system in BC so people can get the help they need when they need it. That includes providing people with a safe drug supply so they don’t overdose in the first place and nobody would be proposing disturbing ideas like tying kids to hospital beds.
Treatment should be voluntary and publicly funded. The government should set and enforce standards for addiction treatment facilities in the province and require that they provide a range of secular, evidence-based, culturally appropriate and trauma informed treatment options. Treatment centres must give patients the autonomy to make their own health care decisions. Treatment should be provided by qualified health care practitioners.
Not only does there need to be a regulated treatment system, there needs to be a full range of harm reduction services including a safe drug supply. There needs to be housing and people who use drugs should be decriminalized. These are the things that will actually help people.
The Government’s proposal to lock kids up in hospitals is a reflection of the Ministry of Mental Health and Addiction’s failure to create a publicly funded and readily available system of care for people with substance use problems.
1.
*BC Chief Coroner’s statement on the proposed amendments to the Mental Health Act: https://tinyurl.com/y9hezqjp
*BC Representative for Children and Youth, statement on the proposed amendments to the Mental Health Act: https://tinyurl.com/yausoupd
*Pivot Legal Society, statement on the proposed amendment to the Mental Health Act: https://tinyurl.com/yarx4t4m
*Harm Reduction Nurses Association, statement on the proposed amendments to the Mental Health Act: https://tinyurl.com/y8p3g5u9
*Former BC Provincial Health Officer, journal article on the harms of secure care: https://tinyurl.com/yajvv5am
*BC Health Justice Organization, article on the proposed amendments to the Mental Health Act: https://tinyurl.com/yco285xd
*BC Civil Liberties Association, comments on the proposed amendment to the Mental Health Act: https://tinyurl.com/y9r6xyqr
*Community Legal Assistance Society: Operating in Darkness: BC’s Mental Health Act Detention System: https://tinyurl.com/y4pbctma
List of (Adult Male) Addiction Treatment Centers that the Government of BC “Alcohol and Drug Information and Referral Service” referred me to:
Adult/Teen Challenge (Adult)- (Chilliwack, FHA region): No medical staff. OAT not allowed. Christian program. Cost $1000 intake fee plus $1000 per month (~$35/day). Reports receiving some funding from Fraser Health Authority.
Union Gospel Mission (Vancouver, VCHA region): No medical Staff. OAT not allowed. Christian & 12-step model. Most patients pay through social assistance.
Wagner Hills Farm Society (Fort Langley, FHA region): No medical staff. OAT not allowed. Christian program. Cost: $100 per day
Cwenengitel Aboriginal Society (Surrey): No med medical staff. OAT not allowed. Incorporates Indigenous Culture.
John Volken (Surrey, FHA region): Nurse practitioner on-site once a week. OAT not allowed. (Does not accept patients on Methadone or Kadian. Patients on Suboxone must taper off.) “Therapeutic Community” Cost: $5,000
Turning Point (North Vancouver, VCHA region): No medical staff. Methadone/Suboxone allowed. Kadian not allowed. Mandatory 12-step meetings. Cost: $250/day. Funded by Province of BC and Vancouver Coastal Health. Referrals through VCHA Central Addiction Intake Team.
Together We Can (Vancouver, VCH region): A physician visits facility 3 times per week. Allows Suboxone and Methadone but not Kadian. 12-step model. Cost is $7,500 for 30 days. ($250 per day) Private facility. Five percent of patients can receive government funding through Vancouver Coastal Health. Referrals through VCHA Central Addiction Intake Team.
Together We Can- All My Relations Indigenous Recover & Wellness Program (Surrey, FNHA): No medical staff. Allows all forms of OAT. 12-step model. Incorporates Indigenous cultural and spiritual practices. Cost: $1600 per month ($53 per day) Some patients can get funding through First Nations Health Authority.
Night and Day (Surrey, FHA region): No medical staff. Accepts patients on Methadone and Suboxone but not Kadian. 12-step model. Cost: $1200 per month ($35.90 per day).
King-haven (Abotsford, FHA region): Nurse visits facility daily. Physician visits facility once a week. Accepts patients on Methadone and Suboxone Mandatory 12-step meetings. Funded by Fraser Health Authority. Cost is $3,150 for 70 days. ($40 per day).
Pacifica (Vancouver, VCHA region): Nurse on site weekdays. Doctor on site once a week. All forms of OAT allowed. Mandatory 12-step meetings. Cost: $7500 per month ($250 per day) Can get funded through FHA. Facility is funded by Vancouver Coastal Health Authority.Referrals through VCHA Central Addiction Intake Team.
Fraser Valley Detox & Treatment (Abotsford, FHA region): Nurse on site. Physician on call 24hrs. Accepts patients on all forms of OAT. “A non-12-step facility”. Cost is $11,500 for 30 days, $17,500 for 60 days, and $24,500 for 90 days ($270-$380/day) and an administrative fee of $4000. Private Centre. No subsidized beds.
Burnaby Center for Mental Health and Addiction (Burnaby, FHA region): Doctors/Nurses on site. Methadone/Suboxone allowed (Not Kadian). Not based on the 12-step model. No mandatory 12-step meetings. For individuals with substance use disorder as well as a severe mental illness. Operated/funded by the Provincial Health Services Authority. No cost.
Central City Lodge (Vancouver, VCHA region): Nurse/Physcians visit once a week. All forms of OAT allowed. Not based on the 12-step model. No mandatory 12-step groups, VCHA. Cost: $40 per day. Receive some funding from VCHA. Some patients funded through VCHA. Referrals Through Central Addictions Intake Team.
Maple Ridge Treatment Centre (Maple Ridge, FHA region): Physician once a week. Nursing team on site. All forms of OAT allowed. No based on the 12-step model. No 12-step meetings. $160 per day. $40 per day with Fraser Health referral. Funded by Fraser Health Authority.
List of (Youth) Addiction Treatment Centers that the Government of BC “Alcohol and Drug Information and Referral Service” referred me to:
Venture (Kelowna): For youth 13–18. No medical staff. OAT not allowed. Live with trained host family and spend the day at the treatment facility. $390 per day. Private facility. No funding available. ($1500 Admission fee)
Westminster House (New Westminster, FHA region): For female youth age 15–18. Addiction physician visits once a week. All forms of OAT allowed. Based on the 12-step model. Cost: ($275 per day). Minimum stay 65 days ($17,875), “recommended stay is 90 days” ($24,750). Some Fraser Health Authority funded beds available- “long wait list”.
Last Door Youth: (New Westminster, FHA region): For male youth age 14–18. No medical staff on site. Doctor visits over the phone or at a community clinic. Based on “Social Peer” / 12-step model. Cost: $325 per day. Some Fraser Health Authority funded beds available.
Daughters & Sisters (Surrey): For female youth ag 12–18 who are on probation. No medical staff. OAT allowed. One 12-step meeting per week. Live with trained host family and spend the day at the treatment facility. Can get full funding through MCFD.
Youth & Family Inhalent Program-Nenqayni Wellness Centre (Williams Lake, FNHA): For First Nation & Inuit Youth age 13–17. Resident physician visits once a week. OAT is allowed. “There is a 12-step aspect to the program”. Culturally based healing. Funded by First Nations Health Authority.
‘Am’ut Aboriginal Full-Time Attendance Program (Surrey, Elizabeth Fry Society): For aboriginal girls aged 12–18 who are involved with criminal justice system. No medical staff. Patients are followed by physician/social worker in the community. All forms of OAT allowed. Client choice- no mandated 12-step meetings. Funded by Ministry of Child and Family Development and Ministry of Public Safety.
Peak House (Vancouver, Pacific Youth and Family Services Society): Youth age 13–18. Nurse Practitioner visits twice a week. OAT allowed. Not based on the 12-step model. 12-step meetings. No cost.
Vancouver Youth Support Recovery (Vancouver, VCHA): For youth age 16–24. Nurse visits once a week. All forms of OAT allowed. No 12-steps. Free for youth under 19. Referrals through VCHA Central Addictions Intake Team.
Young Bears Lodge (Vancouver, VCHA): For female Indegenous youth age 13–18. Nurse visits once a week. OAT is allowed. Harm reduction model. No 12-steps. Incorporates Indigenous culture. No cost. Funded by VCHA. Referrals through VCHA Central Addiction Intake Team.
Carlile Youth concurrent Disorders Center, Hope Center, Lions Gate Hospital (North Vancouver, VCHA): For youth age 13–18 with serious mental health and substance use issues. Locked hospital unit. Some patients are voluntary some are certified under the Mental Health Act. Physicians, Nurses, Social Workers, Psychiatrists on site. Suboxone and Methadone allowed. Can’t initiate Methadone because physicians not licensed to prescribe Methadone but if already taking Methadone can continue. No 12-steps. Funded through public health care system. Referrals through VCHA Central Addictions Intake Team.
Directions Youth Haven (Vancouver, VCH): For youth age 16–19. Youth are followed by VCHA case management team. Nurse practitioner visits. All forms of OAT allowed. No 12-steps. Low Barrier harm reduction approach. No Cost. Referrals through VCHA Central Addictions Intake Team.
Additional Treatment Centers:
Harbour Light, Salvation Army (Vancouver): Adults. Physician visits once per week. OAT allowed. Christian. 12-step model. Cost: $45 per day.
Orchard Recovery Center (Bowen Island): For adults. Full medical team. OAT allowed. 12-step Model. Cost: $16,750/28 days, $21,900/42 days, $32,400/90 days ($360–598 per day). Private facility. No funded beds.
Sunshine Coast Treatment Center (Powell River): Adults. Full medical team. Suboxone allowed. They want patients on Methadone to switch to Suboxone. No 12-steps. Cost: $25,650/30days, $35,310/42 days.
Emerge Addiction Recovery Program, City Center Care Society (Vancouver): OAT allowed. Based on Cognitive Behavioural Therapy, First Nations Talking Circle and SMART. Cost: $45 per day. Funding available through VCHA. Referrals through VCHA Central Addiction Intake Team.
