October 24, 2025 • 31 mins
Episode 18: Involuntary Care
Presented by: Beam Credit Union
Host: Jessica Samuels
Guest: Mike Gawliuk, CEO, CMHA Kelowna
Episode Overview
In this episode, Jessica Samuels speaks with CMHA Kelowna CEO Mike Gawliuk about the complex and often divisive topic of involuntary care in British Columbia’s mental health system. Together, they unpack what involuntary care means under the BC Mental Health Act, explore how and when it’s used, and discuss why it continues to spark debate around human rights, compassion, and the need for a stronger voluntary care system.
Mike offers insight into the legal framework, current practices, and the growing conversation around compassionate mandated care—especially in the context of the province’s drug poisoning crisis and rising homelessness. The conversation also touches on concerns about overrepresentation of marginalized groups and what safeguards and accountability measures exist within the system.
Key Takeaways
- Understanding the Mental Health Act: The Act defines how involuntary and voluntary mental health treatment occurs in BC, with four key criteria determining if someone can be certified for involuntary care.
- Checks and balances: Certification requires medical assessment and multiple approvals, but review mechanisms like the Mental Health Review Board are underused.
- Human rights and consent: BC is the only province with a “deemed consent” clause, meaning individuals certified under the Act are considered to have consented to treatment decisions made by their care team.
- The role of the drug crisis: Rising substance use and homelessness have led to increased use of involuntary care as a response to complex community issues.
- Need for stronger voluntary care: A lack of accessible, early, and voluntary mental health services may be driving reliance on involuntary interventions.
- Evidence and evaluation: Research on involuntary care shows mixed results, underscoring the need for better data on outcomes and long-term support.
- Equity and representation: There is concern about disproportionate impacts on Indigenous and marginalized communities.
- A last resort: CMHA Kelowna supports involuntary care as a necessary but last-resort option, emphasizing that it must exist alongside a robust voluntary care system.
Resources Mentioned:
What is involuntary care
https://www.healthjustice.ca/fast-facts-mha
https://bc.cmha.ca/news/charter-challenge-on-bcs-mental-health-act/
https://www.youtube.com/watch?v=1pEp16qiCGE - Mayor Krog’s comment at the end is interesting.
How it works
https://www.bcmhsus.ca/about-us/who-we-are/governance/mental-health-act
https://thetyee.ca/News/2021/11/23/BC-Forced-Mental-Health-Treatment-Spikes/
https://vancouversun.com/health/does-involuntary-care-work-three-bc-residents-share-their-personal-stories
Your Rights under BC's Mental Health Act | Here to Help
Does It work
https://bc.cmha.ca/news/involuntary-care-in-bc/
https://thetyee.ca/Opinion/2024/09/24/Involuntary-Care-What-BC-Should-Do-Instead/
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jessica Samuels (00:00):
Hello, I'm Jessica Samuels, and welcome to
(00:02):
A Way Forward presented by BeamCredit Union. This podcast takes
place on the ancestraltraditional and unseated lands
of the Okanagan Silicz people.Our topic today involuntary
care, and CMHA Kelowna CEO MikeGullick joins me to discuss
about what takes place withinvoluntary care today, the
(00:24):
ongoing discussion and why itcan be such a divisive topic.
Bean Credit Union is proud tosponsor today's episode. With
deep roots in BC and acommitment to your financial
journey, Beam believes wellness,mental and financial starts with
support you can count on.
Mike, thanks for being here totackle this tough and somewhat
(00:47):
divisive topic. Why don't westart from the top? Let's talk
about the definition ofinvoluntary care as it stands
right now.
Mile Gawliuk (00:53):
Okay. So, I mean, first of all, to get to
involuntary care, we need totalk about the Mental Health Act
that exists in BC. And theMental Health Act is basically
the legislation that defines howmental health treatment is to
happen. And that includes bothinvoluntary care and voluntary
(01:18):
care as it comes to facilitiesand those pieces. Involuntary
care, currently, someone can becertified and put into an
involuntary care facility basedon criterion within the Mental
Health Act.
(01:39):
And there's four key elements ofthat.
Jessica Samuels (01:41):
So what are they?
Mile Gawliuk (01:42):
Well, again, the first is that there is the
presence of a a mental healthdisorder. So that has to has to
be there. That could be adiagnosed mental health
disorder. The currentconversation is around substance
use. Now, substance use disorderis a disorder that's identified
(02:05):
in the DSM-five, right?
Along with brain injury. Sothere has to be a mental
disorder
Jessica Samuels (02:13):
that's diagnosed or perceived.
Mile Gawliuk (02:15):
Yes. Okay. Yeah. That the person is deemed to
need psychiatric treatment in afacility is the second factor.
And that the person needs care,support and supervision to
(02:35):
protect themselves or others orto prevent them from
deteriorating further.
And then finally, that thattreatment can't be offered
voluntarily because the personmay not have the capacity to
understand or the insight orthose pieces.
Jessica Samuels (02:57):
So four criteria. Well explained. Thank
you. For me, I hear thosethings. And the first thing that
is popping in my head is who isdeciding this in real time.
So it's great to have these onpieces of paper and theory and
the diagnosis. We are in realtime. And maybe my idea of when
and how somebody would certifybe certified is incorrect. If
(03:21):
you're encountering anindividual that meets those
criteria. In the moment, how canall of that be verified?
How can you know all of thosethings?
Mile Gawliuk (03:32):
Well, I mean, ultimately, the certification
process involves an assessmentfrom either a nurse practitioner
or a doctor. They review theinformation, they may
communicate with the individual,and based on their assessment,
(03:54):
they can certify the individualfor up to forty eight hours. So
it's that medical professionalwho ultimately makes the
decision or determines whetheror not they'll be certified.
They need in order to continueto be certified within forty
eight hours, there needs to beanother doctor that signs off.
(04:19):
Then that would mean they couldcontinue to be certified for a
month.
That can be extended for anothermonth, could be extended for
three months after that. Andthen after that, it could be six
months and it can be ultimatelyongoing. But ultimately, it's
medical provider who does theassessment and assesses whether
(04:43):
or not the individual meets thecriteria for being certified
under the Mental Health Act.
Jessica Samuels (04:49):
Okay, so if people in community are
encountering an individual likethis and whether it's a PACT or
Circle team or ICART team orwhoever is responding in that
moment, and they're determinedthat they, let's say, are danger
to themselves or somebody else,what would be happening in that
(05:11):
meantime while they're decidingon while these professionals are
deciding on certification?
Mile Gawliuk (05:18):
Well, I mean, ultimately, if one of those
teams were to meet with anindividual, you know, they would
they would take the individualto the hospital ultimately is
where that assessment is likelyto take place. Yeah.
Jessica Samuels (05:35):
All right. And so what are the checks and
balances associated with thoseassessments? Because it does
sound robust and I'm kind ofputting you into a corner here
and you probably know where I'mgoing. But what are the checks
and balances in place? And Ithink this is important so folks
understand that if involuntarycare is not showing up in a van
(06:02):
with people in white lab coatspulling you from your home, that
I'm trying to dispel perhaps, animage that some folks might have
out there.
Yeah. Okay. So the checks andbalances associated with being
certified?
Mile Gawliuk (06:17):
Well, I mean, there are a number of checks and
balances in place. I mean, thefirst is the process around
second signature, those pieces.I think there's a few things
here that are important to speakto as well that are specific to
BC, and I may end up answeringyour question sort of backwards.
(06:39):
What's also important to know isthat in BC, we've got the
highest number of certificationsunder the Mental Health Act than
any other province in Canada.Recent stats tell us that 20,000
people with 30,000certifications happen within
(07:03):
this province.
And what's some of the criteriathat's leading to that has been
an increased number of peoplebeing certified under the Mental
Health Act related to substanceuse. Now, terms of the checks
and balances in place, itbecomes this is where it also
(07:26):
becomes controversial becausethere is a section of the Mental
Health Act. I believe it'sSection 31 where there's a term
deemed consent. Again, it's theonly we're the only province in
Canada to have this. And thedeemed consent provision
(07:46):
basically assumes that theindividual has consented to
treatment.
How it plays out is when someoneis certified, they don't have a
say over what treatment theyreceive. That is decided by
(08:07):
their care team, their medicalteam. They don't have the
ability to shape that. Theirfamily doesn't have the ability
to shape that. And so it startsto go into the question of human
rights.
Jessica Samuels (08:27):
That's the involuntary part of
Mile Gawliuk (08:28):
the That's the involuntary part is that if
you're under involuntary care,you've deemed to give consent to
any treatment. You have no sayover that. And the treatment
team ultimately decides whattreatment you'll receive.
Jessica Samuels (08:44):
See, that's the scary part, I think.
Mile Gawliuk (08:47):
Well, I think certainly it's one of the things
that is is concerning, you know,you know, like again, hearing
about certain situations wheresomeone has been certified and
have been put on a certainmedication, which makes them
extremely groggy and drowsy anddoesn't allow them to function
(09:11):
very well. You know, even thatconversation. It's up to the
doctor to make the decisionwhether there's a med change or
anything else, Right. So it isscary. The checks and balances
that are built into the systemare that people do have rights
(09:36):
for those that are involuntarilydetained.
There is the ability to requesta hearing with a review board,
and that's made up of a lawyer,a doctor and a citizen from the
community. Now, if you look atthose numbers of 20,000 people,
(10:02):
I looked up data from 2024 andthe number of requests for
hearing that came to the reviewboard was around two eighty
seven. And I believe the numberof cases that were heard were
around 140. So that's amechanism that's in place, but
(10:24):
it's not being well utilized.
Jessica Samuels (10:26):
No, we don't know why it's not being well
utilized, though.
Mile Gawliuk (10:29):
No, we I mean, we don't know. There's the reality
that as well when people are,you know, detained, they're to
be made aware of their rightsunder the Mental Health Act.
That is one of those. There'salso the ability to get a lawyer
(10:53):
and to go to court as well. Butagain, what we know is those
mechanisms that are in placearen't necessarily being
utilized in a robust waycompared to the number of people
that are ending up withininvoluntary care.
Jessica Samuels (11:11):
Let's go back to that twenty thousand number
every year being detained 30,000times. What does that number say
to you? That seems really high.And is before we, I don't know,
I don't want to judge and saylike, that's a good or bad
number. What does that reflectabout what's happening in
(11:35):
community?
I mean, you certainly talkedabout substance use. But also, I
guess what's going on that thesystem, the health care system,
the resources that we haveavailable?
Mile Gawliuk (11:48):
Yeah, I mean, I think it's likely multifaceted
and I'm not necessarily going tohave the correct answer. But
what I'm going to suggest is afew things. You know, the world
changed dramatically when thedrug poisoning crisis started,
(12:11):
like having been in this fieldbefore, being in the field after
that has changed things sodramatically. That's a factor
that wasn't there. Again, basedon the 20,000, 30,000 piece,
(12:31):
what's what's been identifiedagain is there's increased
certification around people whouse substances.
So I think one of theconnections that you can make is
the drug crisis that we'recurrently facing. I think it
(12:53):
also speaks to, and this will bepart of the conversation, that
we don't necessarily have arobust enough voluntary care
system. So that means anythingfrom what we talk about
prevention to early interventionto counseling to specific care
(13:20):
teams that focus on individualswith diagnosed mental illnesses
and up to bed based care.There's a lack of those
resources within our province.And so as a result, there
becomes some reliance on aninvoluntary approach to care.
Jessica Samuels (13:43):
Do you think this is because folks are not
able to get the treatment, earlyenough that they are then in a
situation where involuntary careis required? Or do you think
it's because involuntary it'sit's it's an either or it the
folks who are responding toscenarios and situations that
(14:06):
you mentioned have the kind ofthe single thing that they can
rely on to try and get thisindividual the help they need?
Mile Gawliuk (14:14):
I mean, I think I think I would say ultimately in
a scenario where we don't have arobust voluntary care system,
people end up getting sick andthey end up getting sicker and
they get to the point where thatbecomes the choice. In an ideal
(14:44):
scenario, you have thoseservices so that you get to
people sooner, you help in termsof their health and the rest of
it. It doesn't have to go downthat road ultimately. As far as
increased use of that as a tool,practitioner, I'm not so I'm not
(15:09):
just going to say that this isthe only tool that being used. I
would say, again, it's more areflection of not having a full
system of voluntary servicesavailable.
Right. Yeah.
Jessica Samuels (15:28):
We were talking about, we started this
conversation of what involuntarycare looks like today and thank
you, gave a really kind ofin-depth background, a kind of a
state of what we're facing.What's interesting to me as this
topic, which in the not sodistant past really was had such
a negative connotation to it.And that is no longer the case.
(15:51):
In fact, this is, you know, wein recent months, we have
service providers and we havepolitical entities calling for,
an increase in, the involuntarycare system. There's some very
specific caveats, associatedwith this.
(16:12):
So, let me ask you with, do youthink this is in response to,
you said the drug crisis and thedrug poisoning crisis? Like what
has perpetuated now the statewhere we are, where involuntary
care is being proposed andactually pushed in our province.
Mile Gawliuk (16:35):
Yeah, I mean, certainly in part. And so this
isn't just in British Columbia,like Alberta is moving quickly
in that direction. I think itgoes hand in hand with the fact
that there's been an increase inthe number of people who are
(16:56):
unhoused. That has a role toplay. You visibly see people
struggling.
And I think in some cases, youknow, where compassion and
compassionate people have becometired. You know, we talked
(17:19):
earlier before we started aroundbusiness owners. And I get it if
you're a downtown business ownerand you've had your place broken
into or your vehicle has beenbroken into or you had someone
on your doorstep and they'rereally struggling. Compassion
(17:43):
has sort of shifted and there'sa level of exhaustion and
fatigue. And I think people arelooking for the answer.
They're looking for the solutionto, again, a very complex
problem. I think it'sinteresting how it's been
(18:06):
described because some peoplesay involuntary care. Some are
saying compassionate mandatedcare. At the end of the day, I
think they're both the samething. I would hope that any
individual that enters thesystem and receives mandated
(18:30):
care is treated with compassion.
I would also want to see thatthat system is set up in such a
way that evidence based servicesthat we know are effective and
have impact are part package. OfFor example, when it comes to
(18:50):
substance use, the gold standardtreatment at this point for
opioids happens to be opioidagonists, so methadone,
Suboxone, those kinds of things.People talk about people, well,
just go to detox and get better.In the case of opioids, what is
(19:11):
known and understood is that ifyou come off of opioids and you
don't replace it with one ofthose other options, you have a
ninety eight percent chance ofrelapsing. And when you go from
where you are, what you've doneis you've taken your drug
(19:34):
tolerance when you went in washere.
Your drug tolerance has now comedown to here. And if we know
that you have a ninety eightpercent chance of using drugs,
you're loading the gun. I havefaith that evidence based
(19:56):
treatments, like what I justdescribed, will be part of a
mandated compassionate careprocess. But begs some
questions. Think the other pieceis we hear about people with
mental health issues, peoplewith substance use issues and
(20:19):
people with brain injury.
And so I think there needs to bea level of precision in regards
to who it is that qualifies forthis level of care. And we're
hearing announcements andcertainly we're seeing the
advocacy that's coming aroundthese Well, it was announced by
(20:44):
our premier. 50 units in PrinceGeorge and 50 units in Surrey
are getting added and there'smore to come. So I would suggest
that what we've seen in ourcommunities as far as a
burgeoning population ofunhoused people, combined with
some fairly high profileincidents like physical attacks.
(21:12):
There was that incident inVancouver during that festival
where tragically eight peoplewere killed.
They got run over by somebody. Ithink the seriousness of those
kinds of scenarios also demandssome level of intervention and
(21:32):
is also a driving force behindthis kind of approach and
legislation. And thenultimately, all communities in
British Columbia, big and small,are grappling with this issue of
public safety. So this as wellbecomes, in theory, an approach
(22:00):
that could impact public safetyin communities.
Jessica Samuels (22:04):
What's the track record for this approach
as it stands now to actuallywork or success? I don't know
language to describe it, butthat folks stabilize their lives
and enter into recovery, whetherwe're talking about substance
use or mental health issues.
Mile Gawliuk (22:22):
Well, I think I mean, what I would say first is
the question of how do we knowit works? Yeah. It's an
interesting question because interms of when the person is in
an involuntary setting, ifthey're safe, recovering, then
(22:45):
for that time that they're inthat system, that works. The
research and certainly in takinga look at things, there has been
research that's been done.There's challenges with the
(23:10):
research in terms of methodologyand other things, but the
research has indicated thatultimately an involuntary
approach has had either sort ofno effect or a negative effect.
In that case, it becomes anissue where, again, what works?
(23:35):
What happens afterwards? I thinkthe research good research
hasn't been done in terms ofcomparing those in the
involuntary system and those inthe voluntary system and those
that get no help at all toassess well what that looks
(23:56):
like. But ultimately, theresearch hasn't demonstrated a
whole lot of positive impactdown the road. And you hear
people talk about their ownexperiences and people that have
been under involuntary care.
(24:17):
Some people will indicate thatthat's the thing that saved
their life. Others will indicatethat, no, in fact, it created a
greater distrust of the healthcare system and it reduced that
person's ability, motivation topresent themselves to the health
(24:44):
care system when they had aneed, right? Or I was listening
to a mom who struggled with ateen who was using substances.
And for the longest time, theyreally were pushing for
voluntary care. I believethey're from Alberta.
Alberta has specific legislationfor youth around substance use.
(25:10):
Their daughter ended up detainedtwice under that legislation.
After she was discharged, Ithink it was within a month, she
tragically died of a drugoverdose. So what works? I would
(25:31):
say what's necessary is there'show you got into involuntary
care in the first place.
And then there's the keyquestion about what happens when
you move on from that thatresource. So you're maybe
stable, you're well, you're onmedication, whatever that looks
like. There has to be a systemthere. And we can talk about
(25:57):
when people step down from thatlevel of care. What does that
look like?
Who is the who is the teamthat's attached to that person?
What does the ongoing follow-upcare look like for that
individual? And I think whenthat's in place, the chances of
(26:20):
people being successful longerterm is possible. I think when
that's not in place, the realityis it leads to challenges.
Discharge from institutionalcare like hospitals, youth that
age out of foster care is showsthat there's a lot of people
(26:42):
that when they're dischargedfrom those institutions are
discharged back intohomelessness and being unhoused.
So again, I would hope the goaland the outcome of that is that
and this is why, again, having avoluntary care system is going
to be important on the back endof someone who has been either
(27:06):
involuntary detained or hasreceived compassionate mandated
care in order to maintain alevel of wellness. What I would
suggest that I don't know, Ihaven't heard, but be really
interesting as this model growswithin the province is what kind
(27:29):
of evaluation research is goingto be attached to it as well. I
think there's an opportunityhere to take a look at it and
study this approach to createsome evidence around does it
work, doesn't it work, the restof it. And I think ultimately
that's important. I don't knowwhere that fits within the plan,
(27:50):
but I think it's ultimatelynecessary.
Jessica Samuels (27:52):
And also to make sure that we don't have
overrepresentation ofmarginalized groups.
Mile Gawliuk (27:57):
For sure. I think that's again one of the
concerns. One of the risksultimately is certainly in the
justice system, you see an overrepresentation of Indigenous
people when we're looking atunhoused people and point in
time counts that are being doneacross the province. Indigenous
(28:18):
people, again, areoverrepresented in those
population groups. So I think wehave to also consider the
reality that marginalized groupsmay be further marginalized by
this.
That's something that really hasto be paid attention to, that
(28:40):
we're not replicating colonialapproaches. Yeah, so that's
definitely a concern.
Jessica Samuels (28:51):
Okay. Yeah. So as we wrap up, Mike, and I feel
as usual, I feel like there's somuch that we could talk about
more. I just want to ask youthen. So do you and CMHA
Kelowna, do you feel that thereis a place for this model of
care, involuntary care, when wetalk about the spectrum of care
for folks who are struggling?
Mile Gawliuk (29:11):
Yeah, I mean, what I would what I would say is that
there is absolutely a place forinvoluntary care. I'd say we see
it as a last resort, ultimately,when a voluntary care system has
(29:32):
been exhausted. But there is nodoubt that there are people who
are struggling, who are unwell,who require that level of care.
Again, as it's been mentionedacross the province, it's been
identified that it's a verysmall number of people that
(29:52):
require that. So in that case,again, as a last resort, there's
a need for that approach forsure.
Again, in advocating again tobuild out that voluntary care
system. And the concern thatthat, you know, again, lean into
(30:18):
involuntary approaches and thatbecomes the solution. I think
it's all part of a biggerpicture and it needs to be taken
in context of that biggerpicture. But yes, if you ask me
if there's a place for it again,as a last resort, there are
people that are going to need alevel of care that isn't
(30:44):
currently available in thevoluntary system that will
require an involuntary approach.
Jessica Samuels (30:51):
All right, Mike, thank you so much.
Mile Gawliuk (30:53):
Thank you.
Jessica Samuels (30:55):
Big topic, lots to talk about. We will include a
lot of these links, includingthe Mental Health Act, some
information about the currentstatus of involuntary care and
some of these expansions thatare coming out across the
province, as well as the MentalHealth Review Board, which is
the method or the resource thatindividuals could use if they
(31:16):
want to, I guess, protest orhave a review of their
certification. We will includeall of that on the A Way Forward
podcast page at cmhacolona.org.And if you have any questions
about this topic or any of ourtopics, you can always email me
awayforwardcmhacolona dot org.In the meantime, please do take
(31:41):
good care.
This episode is supported byBeam Credit Union. With deep
roots in BC and a commitment toyour financial journey, Beam
proudly backs mental healthconversations that help build
stronger, healthier communities.
Hello, I'm Jessica Samuels, and welcome to
(00:02):
A Way Forward presented by BeamCredit Union. This podcast takes
place on the ancestraltraditional and unseated lands
of the Okanagan Silicz people.Our topic today involuntary
care, and CMHA Kelowna CEO MikeGullick joins me to discuss
about what takes place withinvoluntary care today, the
(00:24):
ongoing discussion and why itcan be such a divisive topic.
Bean Credit Union is proud tosponsor today's episode. With
deep roots in BC and acommitment to your financial
journey, Beam believes wellness,mental and financial starts with
support you can count on.
Mike, thanks for being here totackle this tough and somewhat
(00:47):
divisive topic. Why don't westart from the top? Let's talk
about the definition ofinvoluntary care as it stands
right now.
Mile Gawliuk (00:53):
Okay. So, I mean, first of all, to get to
involuntary care, we need totalk about the Mental Health Act
that exists in BC. And theMental Health Act is basically
the legislation that defines howmental health treatment is to
happen. And that includes bothinvoluntary care and voluntary
(01:18):
care as it comes to facilitiesand those pieces. Involuntary
care, currently, someone can becertified and put into an
involuntary care facility basedon criterion within the Mental
Health Act.
(01:39):
And there's four key elements ofthat.
Jessica Samuels (01:41):
So what are they?
Mile Gawliuk (01:42):
Well, again, the first is that there is the
presence of a a mental healthdisorder. So that has to has to
be there. That could be adiagnosed mental health
disorder. The currentconversation is around substance
use. Now, substance use disorderis a disorder that's identified
(02:05):
in the DSM-five, right?
Along with brain injury. Sothere has to be a mental
disorder
Jessica Samuels (02:13):
that's diagnosed or perceived.
Mile Gawliuk (02:15):
Yes. Okay. Yeah. That the person is deemed to
need psychiatric treatment in afacility is the second factor.
And that the person needs care,support and supervision to
(02:35):
protect themselves or others orto prevent them from
deteriorating further.
And then finally, that thattreatment can't be offered
voluntarily because the personmay not have the capacity to
understand or the insight orthose pieces.
Jessica Samuels (02:57):
So four criteria. Well explained. Thank
you. For me, I hear thosethings. And the first thing that
is popping in my head is who isdeciding this in real time.
So it's great to have these onpieces of paper and theory and
the diagnosis. We are in realtime. And maybe my idea of when
and how somebody would certifybe certified is incorrect. If
(03:21):
you're encountering anindividual that meets those
criteria. In the moment, how canall of that be verified?
How can you know all of thosethings?
Mile Gawliuk (03:32):
Well, I mean, ultimately, the certification
process involves an assessmentfrom either a nurse practitioner
or a doctor. They review theinformation, they may
communicate with the individual,and based on their assessment,
(03:54):
they can certify the individualfor up to forty eight hours. So
it's that medical professionalwho ultimately makes the
decision or determines whetheror not they'll be certified.
They need in order to continueto be certified within forty
eight hours, there needs to beanother doctor that signs off.
(04:19):
Then that would mean they couldcontinue to be certified for a
month.
That can be extended for anothermonth, could be extended for
three months after that. Andthen after that, it could be six
months and it can be ultimatelyongoing. But ultimately, it's
medical provider who does theassessment and assesses whether
(04:43):
or not the individual meets thecriteria for being certified
under the Mental Health Act.
Jessica Samuels (04:49):
Okay, so if people in community are
encountering an individual likethis and whether it's a PACT or
Circle team or ICART team orwhoever is responding in that
moment, and they're determinedthat they, let's say, are danger
to themselves or somebody else,what would be happening in that
(05:11):
meantime while they're decidingon while these professionals are
deciding on certification?
Mile Gawliuk (05:18):
Well, I mean, ultimately, if one of those
teams were to meet with anindividual, you know, they would
they would take the individualto the hospital ultimately is
where that assessment is likelyto take place. Yeah.
Jessica Samuels (05:35):
All right. And so what are the checks and
balances associated with thoseassessments? Because it does
sound robust and I'm kind ofputting you into a corner here
and you probably know where I'mgoing. But what are the checks
and balances in place? And Ithink this is important so folks
understand that if involuntarycare is not showing up in a van
(06:02):
with people in white lab coatspulling you from your home, that
I'm trying to dispel perhaps, animage that some folks might have
out there.
Yeah. Okay. So the checks andbalances associated with being
certified?
Mile Gawliuk (06:17):
Well, I mean, there are a number of checks and
balances in place. I mean, thefirst is the process around
second signature, those pieces.I think there's a few things
here that are important to speakto as well that are specific to
BC, and I may end up answeringyour question sort of backwards.
(06:39):
What's also important to know isthat in BC, we've got the
highest number of certificationsunder the Mental Health Act than
any other province in Canada.Recent stats tell us that 20,000
people with 30,000certifications happen within
(07:03):
this province.
And what's some of the criteriathat's leading to that has been
an increased number of peoplebeing certified under the Mental
Health Act related to substanceuse. Now, terms of the checks
and balances in place, itbecomes this is where it also
(07:26):
becomes controversial becausethere is a section of the Mental
Health Act. I believe it'sSection 31 where there's a term
deemed consent. Again, it's theonly we're the only province in
Canada to have this. And thedeemed consent provision
(07:46):
basically assumes that theindividual has consented to
treatment.
How it plays out is when someoneis certified, they don't have a
say over what treatment theyreceive. That is decided by
(08:07):
their care team, their medicalteam. They don't have the
ability to shape that. Theirfamily doesn't have the ability
to shape that. And so it startsto go into the question of human
rights.
Jessica Samuels (08:27):
That's the involuntary part of
Mile Gawliuk (08:28):
the That's the involuntary part is that if
you're under involuntary care,you've deemed to give consent to
any treatment. You have no sayover that. And the treatment
team ultimately decides whattreatment you'll receive.
Jessica Samuels (08:44):
See, that's the scary part, I think.
Mile Gawliuk (08:47):
Well, I think certainly it's one of the things
that is is concerning, you know,you know, like again, hearing
about certain situations wheresomeone has been certified and
have been put on a certainmedication, which makes them
extremely groggy and drowsy anddoesn't allow them to function
(09:11):
very well. You know, even thatconversation. It's up to the
doctor to make the decisionwhether there's a med change or
anything else, Right. So it isscary. The checks and balances
that are built into the systemare that people do have rights
(09:36):
for those that are involuntarilydetained.
There is the ability to requesta hearing with a review board,
and that's made up of a lawyer,a doctor and a citizen from the
community. Now, if you look atthose numbers of 20,000 people,
(10:02):
I looked up data from 2024 andthe number of requests for
hearing that came to the reviewboard was around two eighty
seven. And I believe the numberof cases that were heard were
around 140. So that's amechanism that's in place, but
(10:24):
it's not being well utilized.
Jessica Samuels (10:26):
No, we don't know why it's not being well
utilized, though.
Mile Gawliuk (10:29):
No, we I mean, we don't know. There's the reality
that as well when people are,you know, detained, they're to
be made aware of their rightsunder the Mental Health Act.
That is one of those. There'salso the ability to get a lawyer
(10:53):
and to go to court as well. Butagain, what we know is those
mechanisms that are in placearen't necessarily being
utilized in a robust waycompared to the number of people
that are ending up withininvoluntary care.
Jessica Samuels (11:11):
Let's go back to that twenty thousand number
every year being detained 30,000times. What does that number say
to you? That seems really high.And is before we, I don't know,
I don't want to judge and saylike, that's a good or bad
number. What does that reflectabout what's happening in
(11:35):
community?
I mean, you certainly talkedabout substance use. But also, I
guess what's going on that thesystem, the health care system,
the resources that we haveavailable?
Mile Gawliuk (11:48):
Yeah, I mean, I think it's likely multifaceted
and I'm not necessarily going tohave the correct answer. But
what I'm going to suggest is afew things. You know, the world
changed dramatically when thedrug poisoning crisis started,
(12:11):
like having been in this fieldbefore, being in the field after
that has changed things sodramatically. That's a factor
that wasn't there. Again, basedon the 20,000, 30,000 piece,
(12:31):
what's what's been identifiedagain is there's increased
certification around people whouse substances.
So I think one of theconnections that you can make is
the drug crisis that we'recurrently facing. I think it
(12:53):
also speaks to, and this will bepart of the conversation, that
we don't necessarily have arobust enough voluntary care
system. So that means anythingfrom what we talk about
prevention to early interventionto counseling to specific care
(13:20):
teams that focus on individualswith diagnosed mental illnesses
and up to bed based care.There's a lack of those
resources within our province.And so as a result, there
becomes some reliance on aninvoluntary approach to care.
Jessica Samuels (13:43):
Do you think this is because folks are not
able to get the treatment, earlyenough that they are then in a
situation where involuntary careis required? Or do you think
it's because involuntary it'sit's it's an either or it the
folks who are responding toscenarios and situations that
(14:06):
you mentioned have the kind ofthe single thing that they can
rely on to try and get thisindividual the help they need?
Mile Gawliuk (14:14):
I mean, I think I think I would say ultimately in
a scenario where we don't have arobust voluntary care system,
people end up getting sick andthey end up getting sicker and
they get to the point where thatbecomes the choice. In an ideal
(14:44):
scenario, you have thoseservices so that you get to
people sooner, you help in termsof their health and the rest of
it. It doesn't have to go downthat road ultimately. As far as
increased use of that as a tool,practitioner, I'm not so I'm not
(15:09):
just going to say that this isthe only tool that being used. I
would say, again, it's more areflection of not having a full
system of voluntary servicesavailable.
Right. Yeah.
Jessica Samuels (15:28):
We were talking about, we started this
conversation of what involuntarycare looks like today and thank
you, gave a really kind ofin-depth background, a kind of a
state of what we're facing.What's interesting to me as this
topic, which in the not sodistant past really was had such
a negative connotation to it.And that is no longer the case.
(15:51):
In fact, this is, you know, wein recent months, we have
service providers and we havepolitical entities calling for,
an increase in, the involuntarycare system. There's some very
specific caveats, associatedwith this.
(16:12):
So, let me ask you with, do youthink this is in response to,
you said the drug crisis and thedrug poisoning crisis? Like what
has perpetuated now the statewhere we are, where involuntary
care is being proposed andactually pushed in our province.
Mile Gawliuk (16:35):
Yeah, I mean, certainly in part. And so this
isn't just in British Columbia,like Alberta is moving quickly
in that direction. I think itgoes hand in hand with the fact
that there's been an increase inthe number of people who are
(16:56):
unhoused. That has a role toplay. You visibly see people
struggling.
And I think in some cases, youknow, where compassion and
compassionate people have becometired. You know, we talked
(17:19):
earlier before we started aroundbusiness owners. And I get it if
you're a downtown business ownerand you've had your place broken
into or your vehicle has beenbroken into or you had someone
on your doorstep and they'rereally struggling. Compassion
(17:43):
has sort of shifted and there'sa level of exhaustion and
fatigue. And I think people arelooking for the answer.
They're looking for the solutionto, again, a very complex
problem. I think it'sinteresting how it's been
(18:06):
described because some peoplesay involuntary care. Some are
saying compassionate mandatedcare. At the end of the day, I
think they're both the samething. I would hope that any
individual that enters thesystem and receives mandated
(18:30):
care is treated with compassion.
I would also want to see thatthat system is set up in such a
way that evidence based servicesthat we know are effective and
have impact are part package. OfFor example, when it comes to
(18:50):
substance use, the gold standardtreatment at this point for
opioids happens to be opioidagonists, so methadone,
Suboxone, those kinds of things.People talk about people, well,
just go to detox and get better.In the case of opioids, what is
(19:11):
known and understood is that ifyou come off of opioids and you
don't replace it with one ofthose other options, you have a
ninety eight percent chance ofrelapsing. And when you go from
where you are, what you've doneis you've taken your drug
(19:34):
tolerance when you went in washere.
Your drug tolerance has now comedown to here. And if we know
that you have a ninety eightpercent chance of using drugs,
you're loading the gun. I havefaith that evidence based
(19:56):
treatments, like what I justdescribed, will be part of a
mandated compassionate careprocess. But begs some
questions. Think the other pieceis we hear about people with
mental health issues, peoplewith substance use issues and
(20:19):
people with brain injury.
And so I think there needs to bea level of precision in regards
to who it is that qualifies forthis level of care. And we're
hearing announcements andcertainly we're seeing the
advocacy that's coming aroundthese Well, it was announced by
(20:44):
our premier. 50 units in PrinceGeorge and 50 units in Surrey
are getting added and there'smore to come. So I would suggest
that what we've seen in ourcommunities as far as a
burgeoning population ofunhoused people, combined with
some fairly high profileincidents like physical attacks.
(21:12):
There was that incident inVancouver during that festival
where tragically eight peoplewere killed.
They got run over by somebody. Ithink the seriousness of those
kinds of scenarios also demandssome level of intervention and
(21:32):
is also a driving force behindthis kind of approach and
legislation. And thenultimately, all communities in
British Columbia, big and small,are grappling with this issue of
public safety. So this as wellbecomes, in theory, an approach
(22:00):
that could impact public safetyin communities.
Jessica Samuels (22:04):
What's the track record for this approach
as it stands now to actuallywork or success? I don't know
language to describe it, butthat folks stabilize their lives
and enter into recovery, whetherwe're talking about substance
use or mental health issues.
Mile Gawliuk (22:22):
Well, I think I mean, what I would say first is
the question of how do we knowit works? Yeah. It's an
interesting question because interms of when the person is in
an involuntary setting, ifthey're safe, recovering, then
(22:45):
for that time that they're inthat system, that works. The
research and certainly in takinga look at things, there has been
research that's been done.There's challenges with the
(23:10):
research in terms of methodologyand other things, but the
research has indicated thatultimately an involuntary
approach has had either sort ofno effect or a negative effect.
In that case, it becomes anissue where, again, what works?
(23:35):
What happens afterwards? I thinkthe research good research
hasn't been done in terms ofcomparing those in the
involuntary system and those inthe voluntary system and those
that get no help at all toassess well what that looks
(23:56):
like. But ultimately, theresearch hasn't demonstrated a
whole lot of positive impactdown the road. And you hear
people talk about their ownexperiences and people that have
been under involuntary care.
(24:17):
Some people will indicate thatthat's the thing that saved
their life. Others will indicatethat, no, in fact, it created a
greater distrust of the healthcare system and it reduced that
person's ability, motivation topresent themselves to the health
(24:44):
care system when they had aneed, right? Or I was listening
to a mom who struggled with ateen who was using substances.
And for the longest time, theyreally were pushing for
voluntary care. I believethey're from Alberta.
Alberta has specific legislationfor youth around substance use.
(25:10):
Their daughter ended up detainedtwice under that legislation.
After she was discharged, Ithink it was within a month, she
tragically died of a drugoverdose. So what works? I would
(25:31):
say what's necessary is there'show you got into involuntary
care in the first place.
And then there's the keyquestion about what happens when
you move on from that thatresource. So you're maybe
stable, you're well, you're onmedication, whatever that looks
like. There has to be a systemthere. And we can talk about
(25:57):
when people step down from thatlevel of care. What does that
look like?
Who is the who is the teamthat's attached to that person?
What does the ongoing follow-upcare look like for that
individual? And I think whenthat's in place, the chances of
(26:20):
people being successful longerterm is possible. I think when
that's not in place, the realityis it leads to challenges.
Discharge from institutionalcare like hospitals, youth that
age out of foster care is showsthat there's a lot of people
(26:42):
that when they're dischargedfrom those institutions are
discharged back intohomelessness and being unhoused.
So again, I would hope the goaland the outcome of that is that
and this is why, again, having avoluntary care system is going
to be important on the back endof someone who has been either
(27:06):
involuntary detained or hasreceived compassionate mandated
care in order to maintain alevel of wellness. What I would
suggest that I don't know, Ihaven't heard, but be really
interesting as this model growswithin the province is what kind
(27:29):
of evaluation research is goingto be attached to it as well. I
think there's an opportunityhere to take a look at it and
study this approach to createsome evidence around does it
work, doesn't it work, the restof it. And I think ultimately
that's important. I don't knowwhere that fits within the plan,
(27:50):
but I think it's ultimatelynecessary.
Jessica Samuels (27:52):
And also to make sure that we don't have
overrepresentation ofmarginalized groups.
Mile Gawliuk (27:57):
For sure. I think that's again one of the
concerns. One of the risksultimately is certainly in the
justice system, you see an overrepresentation of Indigenous
people when we're looking atunhoused people and point in
time counts that are being doneacross the province. Indigenous
(28:18):
people, again, areoverrepresented in those
population groups. So I think wehave to also consider the
reality that marginalized groupsmay be further marginalized by
this.
That's something that really hasto be paid attention to, that
(28:40):
we're not replicating colonialapproaches. Yeah, so that's
definitely a concern.
Jessica Samuels (28:51):
Okay. Yeah. So as we wrap up, Mike, and I feel
as usual, I feel like there's somuch that we could talk about
more. I just want to ask youthen. So do you and CMHA
Kelowna, do you feel that thereis a place for this model of
care, involuntary care, when wetalk about the spectrum of care
for folks who are struggling?
Mile Gawliuk (29:11):
Yeah, I mean, what I would what I would say is that
there is absolutely a place forinvoluntary care. I'd say we see
it as a last resort, ultimately,when a voluntary care system has
(29:32):
been exhausted. But there is nodoubt that there are people who
are struggling, who are unwell,who require that level of care.
Again, as it's been mentionedacross the province, it's been
identified that it's a verysmall number of people that
(29:52):
require that. So in that case,again, as a last resort, there's
a need for that approach forsure.
Again, in advocating again tobuild out that voluntary care
system. And the concern thatthat, you know, again, lean into
(30:18):
involuntary approaches and thatbecomes the solution. I think
it's all part of a biggerpicture and it needs to be taken
in context of that biggerpicture. But yes, if you ask me
if there's a place for it again,as a last resort, there are
people that are going to need alevel of care that isn't
(30:44):
currently available in thevoluntary system that will
require an involuntary approach.
Jessica Samuels (30:51):
All right, Mike, thank you so much.
Mile Gawliuk (30:53):
Thank you.
Jessica Samuels (30:55):
Big topic, lots to talk about. We will include a
lot of these links, includingthe Mental Health Act, some
information about the currentstatus of involuntary care and
some of these expansions thatare coming out across the
province, as well as the MentalHealth Review Board, which is
the method or the resource thatindividuals could use if they
(31:16):
want to, I guess, protest orhave a review of their
certification. We will includeall of that on the A Way Forward
podcast page at cmhacolona.org.And if you have any questions
about this topic or any of ourtopics, you can always email me
awayforwardcmhacolona dot org.In the meantime, please do take
(31:41):
good care.
This episode is supported byBeam Credit Union. With deep
roots in BC and a commitment toyour financial journey, Beam
proudly backs mental healthconversations that help build
stronger, healthier communities.
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