Premier announces 100 involuntary care beds after mayors call for action
“A psychiatric hospital for the severely mentally ill is a foundation in the healthcare system. If you don’t have that foundation, the building just collapses.”
—Barbara Kane
Two and a half years after the David Eby government promised to expand the province’s flagship treatment centre to locations across the province and 13 months after hiring a scientific advisor to devise care for those in most serious need, a psychiatrist-led community campaign in Prince George and an impassioned call for action by B.C.’s mayors converged, dragooning the NDP into action.
Last week, 50 mayors and councillors gathered in front of the legislature combining their collective political might with the influential grassroots Save our Streets association to demand consequences for crimes by prolific offenders and mandatory care for citizens incapacitated by mental illness, addictions and brain injuries.
“Vulnerable people who pose a danger to themselves and others are left cycling between the streets, shelters, hospitals and jails. This is not compassionate. It is not safe and it is not fair to those individuals,” said Kelowna mayor Tom Dyas. “We need senior levels of government to address the root causes of these issues… because the time for action is now.”
Two days after this unprecedented show of collective resolve, Premier David Eby announced his government will build 100 new beds to provide involuntary addictions and mental health care in Surrey and Prince George. Eby also said there are more beds on the way at pre-existing facilities elsewhere.
“We feel a huge urgency around the need for this kind of care, for people to expand beds, both in the north and Lower Mainland, on the island and in the interior, we’re going to ensure that we’re opening beds everywhere across the province,” Eby told reporters following the announcement in his keynote address to hundreds of mayors and councillors at the Union of BC Municipalities (UBCM) convention.
“We feel a huge urgency around the need for this kind of care.”
David Eby
According to senior health and B.C. government sources, the Prince George beds will be located in a youth correctional facility currently sitting mostly empty with capacity for 60 patients. The facility will be repurposed as a sort of mini-psychiatric hospital that is intended to provide end-to-end care, from crisis stabilization and assessment, to involuntary residential treatment for “as long as they need it” or until they can, as soon as possible, safely transition to voluntary care or living in community.
“[We’re] identifying sites with facilities that we can open quickly to provide support and care for people who are unable or unwilling to help themselves, struggling with mental health, addiction and brain injury,” Eby said.
“This has been the focus of our work with Dr. Vigo and it’s really hitting the ground now, and I’m very excited about where we’re going. It’s going to provide a big quality of life improvement for people who are really struggling in our streets, but also for the broader community.”
The premier hired psychiatrist and UBC associate professor, Dr. Daniel Vigo, as his chief scientific advisor in June 2024, with a mandate to improve care for British Columbians suffering concurrent severe mental illness, addictions and brain injuries. Vigo estimates about 2,500 people in the province meet that criteria, with some portion of those requiring involuntary residential care to ensure they are not a danger to themselves or others.
The province is increasing both voluntary and involuntary capacity, according to Vigo, and half of the 400 involuntary care beds he has been tasked by Eby to build out, have already been identified, including 20 beds announced last spring at Surrey Pre-Trial and Alouette corrections in Maple Ridge.
Psychiatrist pushes for secured psychiatric facility
About the same time Vigo joined the premier’s office, Prince George psychiatrist Dr. Barbara Kane began calling for a secure psychiatric facility in Prince George to treat the most severely afflicted patients whose needs are not being met by the health care system.
“I’ve come to the realization it’s an essential part of the health care system to have a long-term psychiatric hospital. Because people don’t get better in two weeks with severe illnesses. They need long stays, and we can’t do that right now, at least not very easily,” Kane said in a July interview.
The former department head of psychiatry at the University Hospital of Northern BC (UHNBC), Kane has been the medical lead for Northern Health’s mental health program since 2018 and a practicing psychiatrist in the north for nearly 40 years.
She is also the driving force behind the local campaign to build out an involuntary care psychiatric facility in Prince George.
More than a year ago, Kane wrote former B.C. health minister, Adrian Dix, suggesting an underutilized youth correctional centre in Prince George could be refurbished to treat individuals needing safe, secure, long-term addictions and mental health care. When Kane presented the idea to city council, veteran Prince George Citizen reporter Ted Clarke wrote about her quest, generating public interest, which snowballed into a petition with thousands of signatures.
BC Health and Northern Health officials, including the premier’s scientific advisor, Vigo, took notice and toured the facility earlier this year. But despite the internal recommendation that the facility be funded, as of early last week, no one seemed to know for sure whether the project would be green lit or when.
But by week’s end, after an effective full-court-press by the province’s mayors – who seemed poised for rebellion if the province didn’t do something to curb repeat offending and implement mandatory care – Eby signed off on the project.
New facility will ease pressure on healthcare resources
“It’s great,” said Kane, when asked about the news.
It will reduce the burden on staff and resources at the University Hospital of Northern BC in Prince George and “take the pressure off hospitals in Terrace and Dawson Creek,” she said.
People with the most severe drug addiction, mental illness and brain injuries cycle from the hospital to the street, to shelters, supportive housing, to the hospital, to the street, and on. Their most frequent point of contact with the healthcare system is during extreme medical or mental health crisis in the emergency department, such as psychosis when they are apprehended under the Mental Health Act by police because they pose a danger to themselves or others.
Theoretically, after Prince George’s involuntary care beds are open, these patients could avoid the hospital emergency room altogether, and be brought directly to the secured care facility for stabilization and involuntary treatment until they could be assessed and a care plan formulated.
Kane also expects having a secured psychiatric facility in Prince George will allow patients originally from the north now being treated in Red Fish Healing Centre in Coquitlam – the province’s flagship treatment facility for people battling concurrent mental illness, addictions and brain injury – to return to their home region.
And even just 60 involuntary beds in Prince George is expected to have an outsized impact on reducing street disorder and crime, and easing the workload of healthcare staff and first responders, she said. In B.C., as elsewhere, a small group of people are responsible for a disproportionate amount of crime. So-called prolific offenders often suffer from mental illness, addictions and brain injury themselves.
Some people don’t belong in hospitals
Some of the most troubled people being cared for long-term in hospitals do not belong there, Kane said. Others who could be helped by care on the psychiatric floor can’t get in because the ward is full. And some who should be in secured care are being temporarily placed in other wards not designed for their intense health care and behavioural needs.
One current patient of Kane’s at the UHNBC had more than 100 police interactions between January and June of last year. He was in and out of jail, on the streets, in the hospital, around-and-around in circles. “We finally, I guess, gave up and kept him in care,” says Kane.
He’s still in hospital, but he belongs in secure long-term care, she said.
Another patient had a long history of violence and unpredictable violence. One day he was in the hospital TV room with other patients, talking calmly with staff, when he went over the whiteboard and wrote ‘God bless.’
“Then he threw a chair through the window. No warning, nothing that you could see that that was going to happen.”
“Then he threw a chair through the window.”
Barbara Kane
Patients sometimes tell staff they don’t feel safe from their violent peers, she said. “Which is not what you’re expecting when you go on to a psychiatric ward to get help for yourself. You’re not expecting that you’re going to see somebody throw a chair through the window and threaten all the other patients. That kind of stuff happens. It’s unsettling for the other patients as well. It’s not the way that it should be.”
A psychiatric hospital for the severely mentally ill is a foundation in the healthcare system, said Kane. “If you don’t have that foundation, the building just collapses. And it’s collapsing on the street. You can see that [in the] homelessness and the violence, and the violence in the hospitals.”
‘We have nowhere to send them’
Kane remembers when patients in mental distress wouldn’t usually spend more than a couple of days on her hospital’s psychiatric ward in Prince George before they’d be on their way to Riverview psychiatric hospital in Coquitlam, an 800-bed facility that once served as a last resort for B.C.’s most challenging patients.
‘We can look after violent people for the short term, so we would have violent people come in, they’d be in our seclusion lockup rooms for a few days, and then they’d go down to Riverview.
“Nowadays, those patients, we have nowhere to send them…. So we’re getting all these really violent people… and our ward isn’t built for that kind of violence,” Kane said.
“We’re getting all these really violent people… and our ward isn’t built for that kind of violence.”
Barbara Kane
Nor is it built to keep those patients in.
“So, we’ve had some patients escape recurrently. And we’ve had the police complain, ‘Like, what are you doing? Why are they getting out all the time?’ Because when people get out of the hospital and they’re committed, we can send out a warrant to the police and the police can bring them back,” said Kane.
“You really do need a psychiatric hospital for those sorts of things.”
Nurses are reluctant to have patients like that on a regular hospital ward, she said. “They’d rather have them in the locked area, which I totally understand.”
If these same patients were in a place like Riverview, they wouldn’t have to be in the locked room, because they’d be on a locked ward.
“They’d have more freedom in a place like Riverview, actually.”
Involuntary care necessary for some, say doctors
For those who oppose involuntary care, Kane said this: “Some people can be managed in the community, but… there’s a subset of psychiatric patients that are severe. They don’t get better enough.”
Often, they won’t voluntarily get treatment, because they don’t know they’re ill. “That’s part of the mental illness.”
And some people have such serious mental illness, addictions and brain injuries, they “are not going to get better, they just aren’t.”
One problem plaguing some people’s perceptions of involuntary care because the province has been over-utilizing it in the wrong way, according to Vigo.
Instead of using the measure to admit a patient, involuntarily stabilize them and develop a comprehensive healthcare treatment plan tailored to their needs, they were simply stabilized and released back into the community, he said.
For some reason… involuntary care was seen by many healthcare professionals as “some sort of negative controlling intervention,” instead of “a therapeutic tool when it was absolutely required,” Vigo told a room full of local officials during a UBCM public safety panel last week.
“Well, that is slowly changing, now that the government has indicated that this is the policy.”