BC Centre on Substance Use statement on proposed amendments to the Mental Health Act

published on June 29, 2020

Addressing the unique harms experienced by youth who use substances is of critical importance. While there have been important steps made in recent years, there remain large gaps across the province within existing youth substance use services that prevent access to withdrawal management, evidence-based treatment, recovery services, and addiction specialist consultation – to name a few – that must be urgently closed.

This pressing need is highlighted by government’s recent announcement regarding proposed amendments to the Mental Health Act, which present criteria and processes for up to seven days involuntary stabilization for youth under the age of 19 following a drug overdose.

There has long been debate and discussion about the need for – or indeed the merits of – what has been termed “secure care”. Several Canadian jurisdictions have enacted secure care laws, aimed at protecting youth who use drugs and/or may be at risk of other harms and exploitation. The BCCSU has reviewed the scarce evidence behind the concept and practice, and has expressed concerns that as practised in Canada, harms may outweigh benefits. While engagement in treatment and completion rates may be higher, there may be potential adverse and unintended consequences such as relapse and overdose and a reduced likelihood of subsequently engaging in social and health services.

The proposed approach in B.C. may be less rigid than other jurisdictions, and the amendments to the Mental Health Act build upon a pilot carried out at BC Children’s Hospital in Vancouver where youth at risk were assessed, stabilized, and referred to ongoing treatment. Although long-term health outcomes are currently unavailable, these preliminary observational findings show potential promise. However, researchers, including those at the BCCSU, have previously documented that marginalized youth who use substances may have experienced institutional or intergenerational trauma and demonstrate a mistrust of engaging in health and social services; coercive approaches may risk further undermining our ability to connect them to the services they need. This evidence – even with its limitations – must be carefully considered in the context of the ongoing overdose public health emergency and speaks to the need for careful evaluation of policy changes.

To support youth – and all people who use substances – B.C. must continue to carefully develop and implement a full evidence-based youth and adult substance use system of care that spans prevention, screening, harm reduction, treatment, and recovery services. Development and implementation planning must engage all stakeholders, prioritizing access to effective interventions and maximizing the health and social benefits of substance use care while also identifying and addressing any potential for unintended consequences. Understanding and implementing the evidence base for best approaches to support youth after an overdose event is a key piece of this strategy.

While changes to the Mental Health Act could be one component of this strategy, services that are being considered for involuntary stabilization must ensure evidence-based practice, and carefully evaluating its implementation and avoiding unintentionally creating further harms is paramount.

If changes are incorporated into the Mental Health Act, they must be considered as part of larger systems planning for cohesive and responsive substance use services for youth. This planning must include:

• Meaningful engagement of stakeholders, which centres youth and their families who have lived and living experience of substance use
• Development of clinical guidance and care pathways for health care providers that clearly articulate evidence where it exists to guide best practices particularly transition out of involuntary stabilization into ongoing overdose prevention and addiction care
• Health care provider education on best practices for providing evidence-based care for high risk youth who use substances including those with substance use disorder
• Establishment of accessible evidence-based youth substance use services
• Service planning that centres and builds on cultural safety, humility, competence, and trauma-informed care for treating both substance use and co-occurring conditions, and investments in education for those services
• Employing a human rights approach where the rights of youth who use substances are upheld
• Continued scaling-up voluntary youth substance use services from prevention, screening, treatment, harm reduction and recovery
• Continued rural and remote service planning

The BCCSU is ready to work with government, health authorities, and other stakeholders to ensure that designated hospitals and clinicians are comprehensively prepared to meet the needs of these youth and that regional health authorities have the necessary community resources to support them pre- and post-discharge with an evaluative process in place.

B.C. must focus on planning, building, and measuring success of a comprehensive substance use system of care in the province that is patient-centred and accessible to everyone, including youth. We are committed to working together to ensure these critical and urgently needed steps to improve all services for youth who use substances, so we don’t risk failing young British Columbians when they need care and support the most.