Understanding the path
People with mental health and substance use-related disabilities are routinely subjected to physical control and use of force. It goes well beyond high-profile situations reported in the media. It also goes beyond the police, with the health system increasingly relying on security guards. Detention and involuntary treatment are held up as tools that will keep a person “safe,” but there is little space allowed for anyone to share their experience of harm. To understand how the reliance on police and security guards in the mental health system shapes a person’s experiences, we need to understand how force is threatened or used throughout a person’s entire path within the system.
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In Canada, police have the authority to preserve the peace and protect life and property without a warrant permitting them to do so. In the mental health and substance use context, police are often positioned as first responders to complaints or concerns. They then make subjective decisions about whether there is a risk to life or property. That decision-making can easily be influenced by well-documented bias and discrimination in policing. Wellness checks often expose the lack of case law and guidance determining police authority in general and police authority in the context of the Mental Health Act.
Our engagement revealed that police interactions in community often lead to fear, escalation, or a perception of a lack of compassion, empathy, or skill.“The power imbalance where weapons are involved, it will always be there… People fear weapons for a reason. It’s not just guns, it’s tasers, rubber bullets, etc. The officer holds the power to kill you. How is that appropriate on a health call? Mental health is health. We need compassion and care, not the threat of death.” — Lived Experience Expert
“I would say most aspects are particularly harmful - police presence can instigate a situation (particularly, armed and suited officers). Police often have limited or no understanding of mental health, don’t know how to talk or interact with the person directly, and if they are doing so, use force to detain/subdue. Often police speak to people experiencing a crisis as if they are not people, or do not understand what is happening. They also interact with them as though they’ve committed an offence.” — Health care worker -
Under section 28(1) of BC’s Mental Health Act, police are authorized to apprehend a person (detain and transport them without their consent) to a physician or nurse practitioner for health examination in specific situations. The police officer must be satisfied that the individual appears to be someone with a mental disorder who is acting in a way that endangers their own safety or the safety of others. The police officer can base this conclusion on their own observations or from information they have received from other sources. There is very little additional guidance for police about the scope of this power and very little publicly available information about how and when this power is used.
“Transport is a big thing. I had a friend who was taken by police, and they just threw him in a back of a van without a seatbelt, and he was flying around in the back of the van. That’s not protecting him or helping him.”— Lived Experience Expert
People with lived and living experience also described the physical injuries that resulted from their experiences with police. These included:
extensive bruising
bleeding wrists from handcuffs that were too tight
scrapes from being dragged across pavement
injuries from implant taser probes that stayed in their body for hours
health impacts of taser shocks with a pre-existing cardiac condition
PTSD
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After police apprehend a person under the Mental Health Act, they take them to be examined by a physician or nurse practitioner. Police stay until the examination because they have the legal power to “detain” the person and stop them from leaving until a legal form is completed authorizing detention in the health facility.
We heard that the transition from the detention authority of police to the health care system is often violent and includes experiences of:
use of physical force
mechanical restraints
forced administration of medications
forced clothing removal
the use of seclusion rooms
Reliance on security guards has become widespread during the initial examination period. After transfers from police, security guards often become involved to administer physical force.
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The Mental Health Act authorizes staff to involuntarily administer treatment, which includes “safe and effective psychiatric treatment and includes any procedure necessarily related to the provision of psychiatric treatment.” There is little guidance on:
the scope of what falls within a “procedure necessarily related” to treatment
how involuntary treatment can be delivered
how much or what kinds of force can be used in the process
The Mental Health Act also contains a section that states that all involuntary patients are subject to the “direction and discipline” of staff as authorized by the director while they are detained. This section may then be used as authority for staff to use tools like physical restraint, mechanical restraint, and seclusion for disciplinary or behavioral compliance reasons that are completely disconnected from treatment. There are no limitations on the meaning of “direction and discipline,” no accompanying safeguards, and no oversight to understand how this power is used.
We heard many examples of the use or threat of physical force by groups of security guards to forcibly move a person into seclusion or to allow for the administration of a forced injection of medication. The lasting trauma and fear created by these experiences is clear.
“Those things don’t go away. Being pinned down by 6 guys as a youth, one guy in your face and grinning like it’s fun. Security is in collusion, who do you complain to, who investigates who? It’s a cycle of trauma, but especially when you’re a youth or a child. The trauma sticks. I am so terrified of hospitals as a result, who do you trust there? I almost don’t trust that I could see the inside of the hospital for a physical health or medical issue. To this day, I don’t feel safe.” — Lived Experience Expert
We also heard that the risk of police violence was constantly present as a reminder about the consequences of not complying.
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Under the Mental Health Act, a person can be discharged from a detaining facility to community. They are usually subject to conditions they have to comply with, and are still subject to involuntary treatment under the Act. This is called “extended leave.” If a person does not comply with the conditions of their leave, they can be apprehended by police and returned to detention in the hospital. There is no oversight over how this occurs or the ability to review a decision to recall someone from extended leave.
Some people placed on extended leave are followed by a mental health team. This could be a clinician team to provide services in community, an Assertive Community Treatment Team (ACT team) or, Intensive Case Management Team (ICM team). Some of these teams may have police embedded within them.
We heard that the power to return someone to detention is often used by health care service providers in community who threaten to have a person apprehended and returned to detention in order to gain their compliance.
“I would say that I haven’t had even extensive direct experiences with police. They’ve been in some ways really present in my experiences, and in some ways I’ve been lucky… I’ve had them called once, but more of my experiences are with the threat of having them called. Health workers say, ‘We will call the police if you do this’ or ‘You will be shot by the police if you do this,’ or ‘We will have the police take you to hospital.” — Lived Experience Expert
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The final space of interaction with police and security in mental health services is through the enforcement of warrants under the Mental Health Act. The Act allows Provincial Court Judges and Justices of the Peace to issue warrants in emergency situations, which may be enforced by police. The Act also authorizes the director of a detaining facility to issue a warrant if a person leaves a detaining facility without permission (commonly called going “AWOL”). This warrant authorizes police, within some parameters, to apprehend and transport the individual back to the facility.
We heard that the enforcement powers to return someone to a hospital can come with significant use of force. This can leave people with lifelong fear and trauma.
“I was 18 years old. I must have been about 105 pounds and this big man chases me with this car in an alley… a Vancouver Police officer. I just went into an alley not knowing where the alley led, I didn’t know all the alleys in Vancouver, and they chased me into that. He got out of his car, and I ended up against a wall then he ended up putting me in a chokehold. I remember what he did -- I couldn’t breathe. I really thought he was trying to kill me. It was awful. I was a little girl. It was terrible. And it wasn’t like that was really explained, like, don’t ever leave because this could happen. You could get beaten up by a cop, you could think you’re gonna die. And it’ll be with you for the rest of your entire life that you never wear any tight necklaces or shirts or anything.” — Lived Experience Expert
Understanding the cycle
The role of police and security guards in BC’s mental health system has significant consequences that inform the overall accessibility of services. This ranges from whether people trust services and engage with them at all, to stigma and discrimination experienced by people with mental health and substance use-related disabilities. Best practices to engage people with mental health and substance use-related disabilities in health care involve building trust, comfort, and rapport between the service provider and the person accessing services. These are core components of a recovery and evidence-based approach to providing mental health services. Patients who feel punished, disempowered, threated, or dehumanized are unsurprisingly more likely to have negative views of their treatment and may be less willing to engage with or trust services in the future.
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We heard during our engagement that one of the most consistent impacts of the intertwining of police and security guards with mental health services is that people feel criminalized, shamed, and punished.
“In all instances, I felt and was treated as if I had committed some sort of wrongdoing, like I was criminalized.”— Lived Experience Expert
Front-line health care workers explained that the very reliance on police and security guards as a normalized part of mental health services is stigmatizing, regardless of how and when it occurs.
“I think that the aspects that are harmful are the lack of training and understanding of mental health and substance use, the punitive approach that is rooted in criminalizing/punishing people who are struggling, and the uniforms that often have reminders for folks who have had other experiences interacting with the system. I think that this does not apply to all officers, but are damaging. I also think that using force and handcuffs when someone is unwell is not the way that any other health issue is approached, for good reason. It has the impact of making a person with lived experience feel that their mental health and/or substance use concerns are reason to be treated like a criminal at the hands of the system. I think we are in a tricky spot systemically because there is no one else to call. In terms of helpfulness, I think I have felt unsafe in my work before and haven’t had the tools to maintain my safety, but it is not an ideal answer.” — Health care worker
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Another impact of the reliance on carceral systems is that police, security guards, and use of force became interconnected with and are understood as a normalized part of the health care system. Police and health systems are experienced as inseparable, and, crucially, the use of force becomes an ever-present part of mental health services.
“The presence of police seems normalized. It was like the police were always there as a punishment, like, if you don’t cooperate, the police will come get you—and that was part and parcel of healthcare. There’s this punishment built in. It became very normal to hear those stories, like, “Oh, you know, the police was dragging me by the hair.” It made you feel like you just have to keep your head down, so the police won’t do whatever to you. And then with security as well, this is just a thing that becomes very normalized, people being put in restraints and strapped down nonstop around you. It’s so much a part of the environment. It feels so pervasive and such a baseline level of violence. You see so much of it. Even if it happens to you only once or twice, it’s all around you, and it makes you feel like you have to keep your head down.” — Lived Experience Expert
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People with lived and living experience repeatedly shared that their experiences with police and security guards as part of mental health services left them with deep and lasting trauma, harm, and often caused new mental health issues.
“To this day, the trauma is so bad in my body that I have issues around certain situations. Yeah, because I didn't know that they would do such things.” — Lived Experience Expert
Harmful and traumatic experiences are often not recognized by service providers or by the mental health system, and no support is offered to process or heal from them:
“The experience would have been less traumatic if I had been able to articulate to the healthcare providers involved in my treatment that it was traumatic. Like, I didn’t know, ‘Is this normal??’” — Lived Experience Expert
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The most common impact of BC’s reliance on police and security guards was that people who experienced the use or threats of force developed strong mistrust and fear of accessing mental health and substance use services.
“Thinking about the healthcare system specifically, whenever I’ve gone for a physical or mental health thing that wasn’t a crisis, I’ve noticed that how I approach things changes, and I become very quiet. That threat comes back to me. Even with police outside of the healthcare system… Like, I’d seen a car accident, they asked for my statement, and when I talked to them, I noticed how scared I was of them and how small and feeble they made me feel. I don’t think with any of the experiences I’ve had with police I felt like they were protecting me.” — Lived Experience Expert
“She has no trust in the police or security guards or the health care system as she has been isolated so many times and physically harmed by security guards.” — Family member of a person with lived experience
A front-line health care worker talked about how information sharing between police and health services can undermine trust:
“To be blunt, if treatment is linked with enforcement then how can there be trust? What viable treatment role do the police have? If there is active information sharing between the police and treatment services how can you trust that system?” — Health care worker
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Mental health and substance use services can weaponize this fear and turn it into an indication that the person is unwilling to access treatment services. They are then often assumed to have a lack of capacity for decision-making and compliance with treatment.
This pattern creates a cycle of escalating coercion and use of force. People are more fearful and distrustful of services, and services then use more force to compel them to comply with treatment. Fear escalates and leads to people resisting this coercion.
One person described that every time they see handcuffs, it triggers a trauma response that can result in a fight or flight response. People described experiencing long-term impacts from PTSD as a result of their experiences with police and security, feeling willing to do anything to escape the hospital to keep themselves safe, and stating that the hospital is the last place they want to go when they’re unwell.
The 5 core themes
There were five core themes from what we heard during our engagement.
Use of force occurs throughout mental health and substance use services. It is not limited to wellness checks or apprehensions by police in community.
There is lack of transparency and oversight with respect to how force is used. Use of force us not monitored at a provincial level.
Use of force is not a rare or extraordinary occurrence. It is a normalized, everyday experience.
The force and violence experienced are often erased and unacknowledged.
The indirect or direct threat of force is used regularly to gain compliance in involuntary and voluntary services.
Related work
Our submissions to the Special Committee on Reforming the Police Act
Our submissions to the BC Office of the Human Rights Commissioner’s Use of Force Inquiry
