The brutal stabbing last month of a 58-year-old city employee in Nanaimo, B.C., made national headlines. The man was stabbed multiple times with a syringe after he asked two men who were using drugs in a public park washroom to leave.

The worker sustained multiple injuries to his face and abdomen and was hospitalized. As of Jan. 7, the RCMP were still investigating the suspects.

The incident comes on the heels of other violent attacks in the province that have been linked to mental health and substance use disorders.

On Dec. 4, Vancouver police fatally shot a man armed with a knife inside a 7-Eleven after he attacked two staff members while attempting to steal cigarettes. Earlier that day, the man had allegedly stolen alcohol from a nearby restaurant.

Three months earlier, on Sept. 4, a 34-year-old man with a history of assault and mental health problems randomly attacked two men in downtown Vancouver, leaving one dead and another with a severed hand.

These incidents have sparked growing calls from politicians, police and residents for governments to expand involuntary care and strengthen health-care interventions and law enforcement strategies.

“What is Premier Eby, the provincial and federal government going to do?” the volunteer community group Nanaimo Area Public Safety Association said in a Dec. 11 public statement.

“British Columbians are well past being fed-up with lip-service.”

‘Extremely complex needs’

On Jan. 5, B.C.’s newly reelected premier, David Eby, announced the province will open two involuntary care sites this spring. One will be located at the Surrey Pretrial Centre in Surrey, and the other at the Alouette Correctional Facility in Maple Ridge, a city northeast of Vancouver.

Eby said his aim is to address the cases of severe addiction, brain injury and mental illness that have contributed to violent incidents and public safety concerns.

Involuntary care allows authorities to mandate treatment for individuals with severe mental health or substance use disorders without their consent.

Amy Rosa, a BC Ministry of Health public affairs officer, confirmed to Canadian Affairs that the NDP government remains committed to expanding both voluntary and involuntary care as a solution to the rise in violent attacks.

“We’re grappling with a growing group of people with extremely complex needs — people with severe mental health and addictions issues, coupled with brain injuries from repeated overdoses,” Rosa said.

As part of its commitment to expanding involuntary care, the province plans to establish more secure facilities and mental health units within correctional centres and create 400 new mental health beds.

In response to follow-up questions, Rosa told Canadian Affairs that the province plans to introduce legal changes in the next legislative session “to provide clarity and ensure that people can receive care when they are unable to seek it themselves.” She noted these changes will be made in consultation with First Nations to ensure culturally safe treatment programs.

“The care provided at these facilities will be dignified, safe and respectful,” she said.

Maffeo Sutton Park, where on Dec. 10, 2024, a Nanaimo city worker was stabbed multiple times with a syringe; Sept. 1, 2024. [Photo credit: Alexandra Keeler]

‘Health-led approach’

Nanaimo Mayor Leonard Krog says involuntary care is necessary to prevent violent incidents such as the syringe stabbing in the city’s park.

“Without secure involuntary care, supportive housing, and a full continuum of care from detox to housing, treatment and follow-up, little will change,” he said.

Elenore Sturko, BC Conservative MLA for Surrey-Cloverdale, agrees that early intervention for mental health and substance use disorders is important. She supports laws that facilitate interventions outside of the criminal justice system.

“Psychosis and brain damage are things that need to be diagnosed by medical professionals,” said Sturko, who served as an officer in the RCMP for 13 years.

Sturko says although these diagnoses need to be given by medical professionals, first responders are trained to recognize signs.

“Police can be trained, and first responders are trained, to recognize the signs of those conditions. But whether or not these are regular parts of the assessment that are given to people who are arrested, I actually do not know that,” she said.

Staff Sergeant Kris Clark, a RCMP media relations officer, told Canadian Affairs in an emailed statement that officers receive crisis intervention and de-escalation training but are not mental health professionals.

“All police officers in BC are mandated to undergo crisis intervention and de-escalation training and must recertify every three years,” he said. Additional online courses help officers recognize signs of “mental, emotional or psychological crisis, as well as other altered states of consciousness,” he said.

“It’s important to understand however that police officers are not medical/mental health professionals.”

Clark also referred Canadian Affairs to the BC Association of Chiefs of Police’s Nov. 28 statement. The statement says the association has changed its stance on decriminalization, which refers to policies that remove criminal penalties for illicit drug use.

“Based on evidence and ongoing evaluation, we no longer view decriminalization as a primary mechanism for addressing the systemic challenges associated with substance use,” says the statement. The association represents senior police leaders across the province.

Instead, the association is calling for greater investment in health services, enhanced programs to redirect individuals from the justice system to treatment services, and collaboration with government and community partners.

Vancouver Coastal Health’s Pender Community Health Centre in East Hastings, Vancouver, B.C., Aug. 31, 2024. [Photo credit: Alexandra Keeler]

‘Life or limb’

Police services are not the only agencies grappling with mental health and substance use disorders.

The City of Vancouver told Canadian Affairs it has expanded programs like the Indigenous Crisis Response Team, which offers non-police crisis services for Indigenous adults, and Car 87/88, which pairs a police officer with a psychiatric nurse to respond to mental health crises.

Vancouver Coastal Health, the city’s health authority, adjusted its hiring plan in 2023 to recruit 55 mental health workers, up from 35. And the city has funded 175 new officers in the Vancouver Police Department, a seven per cent increase in the force’s size.

The city has also indicated it supports involuntary care.

In September, Vancouver Mayor Ken Sim was one of 11 B.C. mayors who issued a statement calling on the federal government to provide legal and financial support for provinces to implement involuntary care.

On Oct. 10, Conservative Party Leader Pierre Poilievre said a Conservative government would support mandatory involuntary treatment for minors and prisoners deemed incapable of making decisions.

The following day, Federal Minister of Mental Health and Addictions Ya’ara Saks said in a news conference that provinces must first ensure they have adequate addiction and mental health services in place before discussions about involuntary care can proceed.

“Before we contemplate voluntary or involuntary treatment, I would like to see provinces and territories ensuring that they actually have treatment access scaled to need,” she said.

Some health-care providers have also expressed reservations about involuntary care.

In September, the Canadian Mental Health Association, a national organization that advocates for mental health awareness, issued a news release expressing concerns about involuntary care.

The association highlighted gaps in the current involuntary care system, including challenges in accessing voluntary care, reports of inadequate treatment for those undergoing involuntary care and an increased risk of death from drug poisoning upon release.

“Involuntary care must be a last resort, not a sweeping solution,” its release says.

“We must focus on prevention and early intervention, addressing the root causes of mental health and addiction crises before they escalate into violent incidents.”

Sturko agrees with focusing on early intervention, but emphasized the need for such interventions to be timely.

“We should not have to wait for someone to commit a criminal act in order for them to have court-imposed interventions … We need to be able to act before somebody loses their life or limb.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

Kensington Market Overdose Prevention Site in Toronto, Dec. 18, 2024. [Photo credit: Alexandra Keeler]

By Alexandra Keeler

Critics says Ontario’s plan to replace supervised consumption sites with HART Hubs will exacerbate harms to drug addicts and strain the health-care system

The operator of a Toronto overdose prevention site is challenging Ontario’s decision to prohibit 10 supervised consumption sites from offering their services.

In December, Neighbourhood Group Community Services and two individuals launched a constitutional challenge to Ontario legislation that imposes 200-metre buffer zones between supervised consumption sites and schools and daycares. The Neighbourhood Group will be forced to close its site in Toronto’s Kensington Market as a result.

In its court challenge, the organization is arguing site closures discriminate against individuals with “substance use disabilities” and increase drug users’ risk of death and disease.

The challenge is the latest sign of growing opposition to Ontario’s decision to either shutter supervised consumption sites or transition them into Homelessness and Addiction Recovery Treatment (HART) Hubs. The hubs will offer drug users a range of primary care and housing solutions, but not supervised consumption, needle exchanges or the “safe supply” of prescription drugs.

Critics say the decision to suspend supervised consumption services will harm drug users and the health-care system.

“We’re very happy that the HART Hubs are being funded,” said Bill Sinclair, CEO of Neighbourhood Group Community Services. “They’re a great asset to the community.”

“[But] we want HART Hubs and we want supervised consumption sites.”

‘Come under fire’

On Thursday, the Ontario government announced that nine of the 10 supervised consumption sites located near centres with children would transition into HART Hubs. The Neighbourhood Group’s site is the only one not offered the opportunity to transition, because it is not provincially funded.

Laila Bellony, a harm reduction manager at a supervised consumption site at the Parkdale Queen West Community Health Centre in Toronto, says she is worried that drug users may avoid using HART Hubs altogether if they do not facilitate the use of drugs under the supervision of trained staff.

Data show this oversight can prevent deaths by facilitating immediate intervention in the event of an overdose.

Bellony is also concerned the site closures will increase the strain on other health-care services. She predicts longer wait times and bed shortages in hospital emergency rooms, as well as increased paramedic response times.

“I think the next thing that will happen is the medical or health-care system is going to come under fire for being sub-par. But it’s really all starting here from this decision,” she said.

She questions how the HART Hubs will meet demand for detox and recovery services or housing solutions.

Parkdale Queen West Community Health Centre and its sister site, the Queen West Site, serve hundreds of clients, Bellony says. By contrast, Ontario’s HART Hub rollout plan indicates all 19 hubs will together provide 375 new housing units across the province.

“The HART Hub model is not a horrible model,” said Bellony. “It’s the way that it’s being implemented that’s ill-informed.”

In a response to requests for comment, a media spokesperson for the Ontario Ministry of Health directed Canadian Affairs to its August news release. That release lists proposals for increased safety measures at remaining sites, and a link to a HART Hub “client journey.”

On Dec. 3, the Auditor General of Ontario, Shelley Spence, released a report criticizing the health ministry’s “outdated” opioid strategy, noting it has not been updated since 2016.

National data show a 6.7 per cent drop in opioid deaths in early 2024. But experts caution it is too soon to call it a lasting trend. Opioid toxicity deaths in 2023 were up 205 per cent from 2016.

“We concluded that the Ministry does not have effective processes in place to meet the challenging and changing nature of the opioid crisis in Ontario,” the auditor general’s report says.

“The Ministry did not … provide a thorough, evidence-based business case analysis for the 2024 new model … [HART Hubs] to ensure that they are responsive to the needs of Ontarians.”

Parkdale Queen West Community Health Centre’s Queen West Site in Toronto, Dec. 18, 2024. [Photo credit: Alexandra Keeler]

‘Ill-informed’

Ontario has cited crime and public safety concerns as reasons for blocking supervised consumption sites near centres with children from offering their services.

“In Toronto, reports of assault in 2023 are 113 per cent higher and robbery is 97 per cent higher in neighbourhoods near these sites compared to the rest of the city,” Ontario Health Minister Sylvia Jones’ office said in an Aug. 20 press release.

The province has also cited concerns about prescription drugs dispensed through safer supply programs being diverted to the black market.

Police chiefs and sergeants in the Ontario cities of London and Ottawa have confirmed safer supply diversion is occurring in their municipalities.

“We are seeing significant increases in the availability of the diverted Dilaudid eight-milligram tablets, which are often prescribed as part of the safe supply initiatives,” London Police Chief Thai Truong said at a Nov. 26 parliamentary committee meeting examining the effect of the opioid epidemic and strategies to address it.

But Bellony disputes the claim that neighbourhoods with supervised consumption sites experience higher crime rates.

“Some of the things that [the ministry is] saying in terms of crime being up in neighborhoods with safe consumption sites — that’s not necessarily true,” she said.

In response to requests for information about the city’s crime rates, Nadine Ramadan, a senior communications advisor for the Toronto Police Service, directed Canadian Affairs to the service’s crime rate portal.

The portal shows assaults, break-and-enters and robberies in the West Queen West neighborhood have remained relatively stable since the Queen West supervised consumption site opened in 2018.

In contrast, crime rates are higher in some nearby neighbourhoods without supervised consumption sites, such as The Junction.

“While I can’t speak to perceptions about a rise in crime specifically around supervised consumption sites, I can tell you that violent crime is increasing across the GTA,” Ramadan told Canadian Affairs. She referred questions about Jones’ statements about crime data to the health minister’s office.

Jones’ office did not respond to multiple follow-up inquiries.

Mixed feelings

In July, Canadian Affairs reported that business owners in the West Queen West neighbourhood were grappling with a surge in drug-related crime.

Rob Sysak, executive director of the West Queen West Business Improvement Association, says there are mixed feelings about their neighbourhood’s site ceasing to offer safe consumption services.

“I’m not saying [the closure] is a positive or negative decision, because we won’t know until after a while,” said Sysak, whose association works to promote business in the area.

Sysak says he has heard concerns from business owners that needles previously used by individuals at the site may now end up on the street.

Bellony supports the concept of HART Hubs offering addiction and support services. But she says she finds the province’s plan for the hubs to be unclear and unrealistic.

“It seems very much like they kind of skipped forward to the ideal situation at the end,” she said. “But all the steps that it takes to get there … are unaddressed.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.