Last month, BC NDP Premier David Eby announced his party would expand prisons and hospital psychiatric wards under the facade of “compassionate, secure care” and “public safety” to involuntarily incarcerate those with various types of brain injuries, adverse mental health experiences, and/or people who use drugs (PWUD). This policy, like other displacement tools, will target unhoused and precariously housed people.
Critique and resistance to the proposed expansion have been swift. More than twenty civil society organizations, including the BC Civil Liberties Association, Harm Reduction Nurses Association, Moms Stop the Harm, Care Not Cops, Surrey Union of Drug Users, Spring Socialist Network, and the BC Association of Social Workers, came out in opposition to any expansion to involuntary treatment.
Since mid-September, rallies against the proposal have taken place in Vancouver, Prince George and Kelowna. Care Not Cops and Students for Sensible Drug Policy Vancouver started a refusal of practice campaign among healthcare workers.
On Aug. 22, community members in Vancouver held a banner outside of the Canadian Academy for Addiction Psychiatry (CAAP) conference and distributed flyers about what lurks under the surface of a speakers list that included involuntary treatment promoters, such as Daniel Vigo, who was appointed by Eby.
Resistance to new forms of involuntary treatment is not limited to the violence of apprehension, detention, the often traumatic interventions, nor the increased risk of overdose after discharge during an endless public health emergency. The resistance is a broader refusal of fascist tactics that expand the grasp of the carceral state through the criminalization of poverty and disability. It is a movement against the revival of patient-prisoners, the rise of police discretion, and the increase of carceral violence through healthcare.
In a press release for the Vancouver rally, Committee Organizing for Prohibition Abolition wrote, “Forced detention does not work as treatment for those who experience it, but that there are people and entities with economic interests who benefit from larger prisons, increased apprehensions and more displacement, such as land speculators.”
BC’s endless unregulated drug supply emergency
The overdose and toxic supply crisis did not happen overnight. The crisis can be attributed to decades of drug legislation undergirded by the power relations of racial capitalism and settler colonialism. Drug and alcohol prohibition and its legacy in Canada are intertwined with the violent colonization of Indigenous Peoples and their land by European and British settlers. Settlers upholding values rooted in Protestantism and other modes of white Christian civility framed drugs and those who used them as immoral and corrupt.
Those benefiting most from colonial power strategically sought to exert control over racialized communities by framing some drug use (whether medicinally or otherwise) as “contagion brought to the west by racialized outsiders.” The construction of drug use as a threat to white settler morality helped lay the foundation for prohibition and the war on drugs in Canada. The development of anti-drug legislation in Canada was in part motivated by anti-Indigenous and anti-Chinese racism seen in the implementation of the 1876 Indian Act and the 1908 Opium Act in Vancouver that followed, which ignited wider crackdowns against drug users and sellers across the country.
The intersecting threads of racial capitalism and settler colonial power have not only created but maintained the endless toxic supply crisis, which has taken more than 15,000 lives in BC since 2016.
This crisis of prohibition continues to take Indigenous lives at incredibly high rates in BC. South Asian people are also disproportionately dying in the single analysis that has been released, and it has been reported that international students are dying from the unregulated supply, but the BC government is not tracking their deaths. Criminalization related to the drug war, including street check rates in Vancouver, convictions of drug-related charges across Canada, severity of sentences, as well as police public relations continue to reflect the anti-Indigenous and racist power Canada’s prohibition laws were founded on.
The scope of prohibition and other drug laws is not restricted to drug use or possession. Business in the unregulated drug market is enforced through violence. Simultaneously, the market’s criminalization sees police power expand and our kin and communities severed through incarceration and court-imposed conditions. The forced detention of drug users is another tool that will displace, kill, and see another transfer of funding from care to carceral and colonial power.
History of involuntary “care” and medical incarceration
Involuntary treatment is rooted in the dehumanization of people and can be understood as a continuation of settler colonial violence and racial capitalism embedded in Canada’s origins. Involuntary treatment is a violent strategy used to scapegoat and invisibilize those who are systematically excluded from society.
Today’s proposed expansion is a continuation of the regressive, racist, and ableist policies and practices that saturate Canada’s history. During the eugenics movement of the 19th and 20th centuries, approximately 60 institutions run by private and public organizations operated in Canada, where children and adults who were disabled, Mad, chronically ill and/or classified as “dangerous” — often Black, Indigenous, people of colour, women, queer, trans, unhoused people, drug users — were involuntarily incarcerated, many never knowing a life outside of an institution.
The first permanent psychiatric institution, The Beauport Asylum, was opened in 1845 in Québec to house “idiots, imbeciles, maniacs, and melancholics” who were often transferred into their facility from local jails. Shortly thereafter, similar institutions opened across Canada, including the Victoria Lunatic Asylum, British Columbia’s first facility for “mentally ill patients,” which was located on the Songhees First Nations reserve. In 1873, one year after the Victoria asylum opened, British Columbia passed the Insane Asylums Act, paving the way for the Indian Act, Hospitals for the Insane Act, and the 1964 Mental Health Act.
These institutions were created as part of the “solution” to the systemic issues that permeated Canadian society. Through the processes of scapegoating, exclusion, removal and confinement, the government sought to disappear “deviant” people rather than investigate the source of the issues Canadians encountered. These processes were not exclusive to a single type of institution and can be seen throughout Canada’s attested implementation of abhorrent laws and policies to further expand the colonial project. Other examples of this violence are embedded in immigration laws, involuntary sterilization, marriage laws, voting restrictions, provincial Mental Health Acts, and the Indian Act — including through the residential school system and Indian hospitals.
In response to the atrocities transpiring within these institutions and the further development of mental health legislation, various advocacy groups formed throughout Canada, otherwise known as the consumer/survivor/ex-patient movement. Despite the anecdotal evidence presented by psychiatric survivors and their unrelenting advocacy, stakeholders continue to invest in carceral forms of “care”. Under the guise of “care”, involuntary treatment and medical incarceration are intrinsically connected to the dominion and punishment of any person who deviates from norms produced by settler colonialism, racial capitalism, and cis-heteropatriarchal power.
On surplus, disability and capital
Disability and madness are not biological categories; they are socially constructed labels that are rooted in assumptions that are racialized, gendered and classed regarding worth, desirability, normality, and danger. Disability is not based on illness or wellness; the state categorizes disability largely in relation to an individual’s capacity to work.
Capitalism requires a “reserve army of labour” (which refers to those who are under or unemployed), to be readily available to work during economic expansion or to be disposed of during economic contraction. Under these frameworks, disabled, Mad, and unhoused people are some of the groups first deemed a “surplus” by a capitalist state – a population of those who are unable to contribute to the workforce in the ways systematically sought by the few who benefit from racial capitalism.
Capitalism requires surplus populations to generate profit. While disabled, Mad, and unhoused peoples are framed to be “burdens” on the state as unproductive members of society, they are simultaneously commodified. The state creates and funds industries such as nonprofits, healthcare, foster care, rehabilitation, and long-term care, that extract profit from surplus populations.
Expanding on Ruth Wilson Gilmore’s theory “organized abandonment,” Adler-Bolton and Vierkant employ “extractive abandonment” to connect the social relations between health, disability, and capital: “In a political economy built on systems of extractive abandonment, the state exists to facilitate a capacity for profit, balanced always against the amount of extractable capital or health of the individual subject.”
Not only does capitalism create disability, it is also dependent on the existence of disabled individuals and groups to both extract from and represents an omnipresent threat toward other workers that could be categorized as “surplus.” This can stifle solidarity in demanding workers’ rights. The working and surplus classes must be united to fight this effectively.
Involuntary treatment is one facet of an extensive system that criminalizes, incarcerates, and generates profit off of the surplus population. Under capitalism, everyone has proximity to becoming surplus. Therefore, we need to center the surplus population in our organizing. Dignified alternatives to the current healthcare system have always existed, and there has never been a greater need than now to listen to our calls to action.
Alternatives exist
The threat of involuntary treatment alone can drive people away from healthcare. This exclusion can reinforce or worsen existing health outcomes and perpetuate premature death across stratifications of inequities. As long as we fund these carceral models, the more they siphon resources away from evidence-based community models of care while increasing overall harm toward people who use drugs. Each of these funding decisions further sanctions state violence through criminalization and policing, which makes it more difficult to dismantle and invest in dignified alternatives.
Communities resisting the expansion of involuntary treatment have been consistent in their calls for alternative and more dignified options.
Alternative solutions to the harms associated with unregulated drug use are simple: increased access to dignified housing; adequate income security provision; access to voluntary, regulated, and culturally affirming treatment; community belonging; and undercutting the toxic supply. These solutions would not only reduce the harm to the public, they would also ease the strain on healthcare, emergency and social welfare systems.
For years, our demands for alternatives have been continuously ignored and overlooked by BC’s government. Forced detention will only result in more death and more criminalization. The resistance to increased detention will continue under any political party and at any level of government — because care is not forced.
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