OTTAWA—The mayors of some of Ontario’s largest cities are pleading with the province to explore options for involuntary addiction treatment as a tool to fight the current homelessness and drug crisis.
“We need to not be afraid of having the difficult conversations,” said Burlington Mayor Marianne Meed Ward, also chair of the Ontario’s Big City Mayors caucus, which represents 29 of the province’s largest municipalities.
“We are ready to have a conversation without prescribing what the outcome of that conversation will be,” she added, noting that provinces like Alberta have introduced involuntary treatment models that could be looked at.
“There are many perspectives around what is the most effective,” approach, she said.
In downtown Ottawa, while the annual Association of Municipalities of Ontario (AMO) conference gathered nearby, Meed Ward and other big city mayors said the desperate scenes playing out in Ontario cities are ones they are struggling to solve on their own.
The big city mayors want the province to review and consult on potential changes to health laws, Meed Ward said Sunday, but with safeguards to protect the “rights, dignity and well-being” of individuals as well.
Does involuntary treatment actually work?
Involuntary or compulsory treatment is “really having a moment” in Canada, said Gillian Kolla, a public health researcher, drug policy expert and assistant professor at Memorial University.
Kolla pointed to how Alberta, Saskatchewan and Manitoba have all introduced legislation to allow for involuntary treatment or detaining people who are under the influence.
Alberta and Saskatchewan’s models are focused on residential treatment, but have not been fully implemented, while Manitoba’s legislation is concentrated on detaining intoxicated people for up to 72 hours to prevent them from harming themselves or others, spurred by a crystal methamphetamine crisis in the province.
Alberta’s model allows adult family members, legal guardians, health-care professionals and police or peace officers to request placing someone into treatment. A three-person panel reviews the individual’s circumstances and ultimately decides. In Manitoba, patients are assessed by a physician, then taken to the detox centre by police.
In a joint statement from the Canadian Mental Health Association Ontario, Addictions & Mental Health Ontario, and The Centre for Addiction and Mental Health, the organizations said evidence “does not suggest involuntary treatment is effective, let alone more effective than voluntary treatment.”
“In fact, evidence indicates that involuntary treatment may create further potential harms to individuals, including a higher risk of overdose upon discharge, and reduced motivation to participate in mental health and addictions services going forward.”
Ontario already has involuntary treatment options
Involuntary treatment is not a new concept. There are existing avenues in Ontario through which people can be ordered into treatment, whether it’s via the courts, child-welfare agencies or employers.
However, there’s already a lack of capacity in residential treatment facilities, in Ontario and elsewhere, said Elaine Hyshka, an associate professor at the University of Alberta and Canada Research Chair in Health Systems Innovation.
“People that desperately want help are not able to get help in a timely way in Alberta and in Ontario,” Hyshka said. “The net effect is that we lose capacity for people that actually want to go to treatment.”
The average wait time for community-based addictions treatment in Ontario has nearly tripled from 44 days in 2021 and 2022 to 124 days last year and this year. Wait times for bed-based substance use treatment have almost doubled, from 36 days in 2022 and 2023 to 61 days last year and this year, according to data from the Ministry of Health.
In some cases, the courts have taken issue with the approach, with the British Columbia Supreme Court ruling that the province’s involuntary treatment model was too broad and ultimately unconstitutional because it violated patients’ Charter equality rights and rights to life, liberty and security of the person.
Kolla said cases like this highlight the importance of bodily autonomy in Western medicine.
“There’s lots of cases where people will refuse medical treatment or care that might have been otherwise helpful for them. But we let that happen because we understand that people have a right to decide what’s going to happen to their bodies,” Kolla said.
What the province is saying about the option
In his speech at the AMO conference on Monday Premier Doug Ford did not mention involuntary treatment.
In a statement, Health Minister Sylvia Jones’s spokesperson declined to say whether the province is open to the discussion, instead listing the billions of dollars the province has already put into housing, recovery beds and the Homelessness and Addiction Recovery Treatment (HART) Hubs program.
“Our government is making record investments in mental health and addiction support to give people the tools they need to break the tragic cycle of addiction — but municipalities also have an important role to play in responding to homelessness,” said the minister’s spokesperson, Lily Barnes.
Meed Ward said the mayors were also asking the province to declare a state of emergency, establish a standalone ministry and significantly increase investments in voluntary treatment for homelessness, as well as mental health and addiction, including supportive housing capacity. They also want to see the HART Hubs program expanded.
What Toronto does instead
Oshawa Mayor Dan Carter said at Sunday’s press conference that he is an example of “compassionate intervention.”
“It was 35 years ago that my sister intervened and saved my life,” Carter said. “As a severe alcoholic and drug addict living on the streets, it was because of her compassion … (that) was able to save my life.”
Carter said his sister died by suicide in 2000. “I honour her by making sure that I speak as loud as I possibly can on behalf of people that don’t have a voice,” he said.
Toronto Mayor Olivia Chow declined to endorse involuntary treatment, and instead said she will continue backing other methods, pointing to supportive housing models that also offer mental health and addiction services, like Dunn House.
“Let’s make sure there’s treatment first,” Chow said Monday when asked about involuntary treatment. “The provincial government owes the city about $20 million because we have these supportive housing (projects), and people inside it need health care … And the city has been providing the funding for it.”
Coun. Chris Moise, who’s also Toronto’s board of health chair, said the mayors’ request reflects an emergency crisis in what cities and their residents are facing right now, and the province has been too slow to respond.
“Cities can no longer manage the fallout that we are witnessing on our streets alone,” Moise said.
