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The British Columbia government is releasing new guidance for clinicians when it comes to treating youth with overlapping mental health and substance use issues, clarifying the need to use coercive care in the process.
In a guidance document released Friday, the province directs doctors notify parents and possibly forcibly detain youth if they cannot or do not want to seek help themselves.
It follows the updated manual involuntary adult care with severe cases of mental health and substance use disorders, published earlier this year by Dr. Daniel Vigo, the province's chief advisor on psychiatry, substance abuse and related disorders.
Vigo, Prime Minister David Eby and other officials were joined at a news conference Friday by parents who have lost their children to drug overdoses.
The province is making progress in improving care for people with intersecting mental health and substance use issues. For some, this may involve forced withdrawal. As Chad Pawson reports, the health secretary and special adviser are proposing new guidelines for medical personnel.
“To put it bluntly, we should only do this [involuntary care] if the child’s brain or life is in serious danger,” Vigo said.
“But if this is the case, then we should not hesitate and should always involve parents or guardians in planning next steps.”
According to previous guidelines, Vigo explained that a vocal 15-year-old with drug use could be assessed as a “mature minor.” An adult minor is a person under 19 years of age who makes own health decisions regardless of the will of their parents or guardians.
But that is no longer the case, he added.
BC Health Minister Josie Osborne says the new “home-based” custodial care facility at Alouette Homes in Maple Ridge is for people who are certified for long-term custodial care under the British Columbia Mental Health Act. Johnny Morris, CEO of the British Columbia chapter of the Canadian Mental Health Association, told BC Today host Michelle Eliot that the province needs to determine exactly who is eligible for this type of help — whether it's people taken off the streets or those already in the system but in need of a better alternative.
Vigo says many of his fellow doctors interpreted Mental Health Act – which allows forced care – is different when it comes to whether they can take in a child against their will if a parent asks them to do so.
“Many of my colleagues… genuinely thought they couldn't use it at a parent's request,” the consultant said.
“And now I make it clear that yes, we can and yes, we should, when there is a medical indication for it – that is, a child who has developed an addiction to opioids and is at risk of, you know, death, brain damage.”
While toxic drug deaths in British Columbia overall are trending downward this year, last digits Data from the BC Coroners Service shows that from January to October this year, 21 youth under the age of 19 died from illicit drugs.
This is more than the 17 young people who died during the same period last year.
Since 2016—the year British Columbia declared a public health emergency due to toxic drugs—222 people under the age of 19 have died from illicit drugs.
Parents speak out after son's death in 2018
Parents speaking at Friday's event included Brock Yurchuk and Dr. Rachel Staples, whose 16-year-old son Elliot Yurchuk died of an opioid overdose in April 2018.
A coroner's jury investigation into Elliot's death ruled it was an accident and recommended improved identification, treatment and transition plans for youth with mental health and substance abuse problems in schools.
“Elliot was in the hospital for over a month, and the caregivers were completely disconnected from Elliot — and Rachel and me — in terms of advising us and helping us,” Yurchuk said.
“And I think Elliot at 15 and 16 years old said, 'I don't want my parents to have any of this information,' out of fear that they were in a legal environment and might get in trouble for sharing medical information about Elliot with Rachel and me.”
Interested lawyers
Previous attempts to expand compulsory assistance for young drug users have been abandoned province in 2022due to concerns that youth would be at greater risk of overdose after stopping treatment.
Dr Ryan Herriot, co-founder of Doctors for Safer Drug Policies and a family and addictions physician in Victoria, said in his experience parents who have had their child involuntarily admitted for drug use are often left disappointed with the results.
The new guidance, he said, “represents a bold and dark experiment, frankly, on young people and with likely catastrophic consequences that could be felt for years.”
Leslie McBain, who founded the advocacy group Moms Stop The Harm after her 25-year-old son Jordan died of an opioid overdose in 2016, said there needs to be a careful look at how coercive care is used for young people.
She said the government should focus on expanding voluntary treatment, counseling and aftercare services rather than compulsory care.
“The facts show that forced help doesn't work for… reasons of mistrust in the system, breakdown of relations with family,” she said.
“I know in the case of my own son, who died from an accidental overdose of prescription drugs, if he had been involuntarily detained, it would have been catastrophic for me.”
