Two decades ago, B.C. closed one of the last large mental institutions in the province. The institution, known as Riverview Hospital in Coquitlam, had at its peak housed nearly 5,000 patients across a sprawling campus.

There, patients with mental illnesses were subjected to a range of inhumane treatments, city records show. These included coma therapy, induced seizures, lobotomies and electroshock therapy.

When the province transferred patients out of institutions like Riverview during the 1990s and early 2000s, it promised them access to community-based mental health care instead. But that system never materialized.

“There was not a sustained commitment to seeing [the deinstitutionalization process] through,” said Julian Somers, a professor at Simon Fraser University who specializes in mental health, addiction and homelessness.

“[B.C.] did not put forward a clear vision of what we were trying to achieve and how we were going to get there. So we languished.”

Today, amid a sharp rise in involuntary hospitalizations, experts say B.C. risks repeating the mistakes of the past. The province is using coercive forms of care to treat individuals with mental health and substance use disorders, while failing to build community supports.

“We’re essentially doing the same thing we did with institutions,” said Somers, who began his clinical career at Riverview Hospital in the 1980s.

“[We’re] creating a system that doesn’t actually help people and may make things worse.”

ECT machines and electrodes from the Riverview Hospital Artifact Collection. | City of Coquitlam

Riverview’s legacy

B.C.’s push for deinstitutionalization was driven by growing evidence that large psychiatric institutions were harmful, and that community-based care was more humane and cost effective.

Nationally, advances in antipsychotic medication, rising civil rights concerns and growing financial pressures were also spurring a shift away from institutional care.

A 2006 Senate report showed community care could match institutional care in both effectiveness and cost — provided it was properly funded.

“There was sufficient evidence demonstrating that people with severe mental illness had better outcomes in community settings,” said Somers.

Somers says people who stay long term in institutions can develop “institutionalization syndrome,” characterized by increased dependency, worse mental health outcomes and greater social decline.

At the time, B.C. was restructuring its health system, promising to replace institutions like Riverview with a regional network of mental health services.

The problem was, that network never fully materialized.

Marina Morrow, a professor at York University’s School of Health Policy and Management who tracked B.C.’s deinstitutionalization process, says the province placed patients in alternative care. But these providers were not always well-equipped to manage psychiatric patients.

“Nobody left Riverview directly to the street,” Morrow said. “But some … might have ended up being homeless over time.”

A 2012 study led by Morrow found that older psychiatric Riverview patients who were relocated to remote regional facilities strained overburdened and ill-equipped staff, leading to poor patient outcomes.

Somers says B.C. abandoned its vision of a robust, community-based system.

“We allowed BC Housing to have responsibility for mental health and addiction housing,” he said. “And no one explained to BC Housing how they ought to best fulfill that responsibility.”

Somers says the province’s reliance on group housing was part of the problem. Group housing isolates residents from broader society, instead of integrating them into a community. A 2013 study by Somers shows people tend to have better outcomes if they get to live in “scattered-site housing,” where tenants live in diverse neighbourhoods while still receiving personalized support.

“All of us … are influenced substantially by where we live, what we do, and who we do things with,” he said.

Somers says a greater investment in community care would have emphasized better housing, nutrition, education, work and social connection. “Those are all way more important than medical care in terms of the health of the population,” he said.

“We closed institutions having no [alternative] functioning model.”

Reinstitutionalization

Despite B.C.’s efforts to deinstitutionalize, the practice of institutionalizing certain patients never truly went away.

“We institutionalize way more people now than we ever did, even at peak Riverview population,” said Laura Johnston, legal director at Health Justice, a B.C. non-profit focused on coercive health laws.

Between 2008 and 2018, involuntary hospitalizations rose nearly 66 per cent, while voluntary admissions remained flat.

In the 2023-24 fiscal year, more than 25,000 individuals were involuntarily hospitalized at acute care facilities, down only slightly from 26,600 the previous year, according to B.C.’s health ministry. These admissions involved about 18,000 unique patients, indicating many individuals were detained more than once.

In September 2024, a string of high-profile attacks in Vancouver by individuals with histories of mental illness reignited public calls to reopen Riverview Hospital.

That month, B.C. Premier David Eby pledged to further expand involuntary care. Currently, B.C. has 75 designated facilities that can hold individuals admitted under the Mental Health Act. The act permits individuals to be involuntarily detained if they have a mental disorder requiring treatment and are significantly impaired. These existing facilities host about 2,000 beds for involuntary patients.

Eby’s pledge was to add another 400 hospital-based mental health beds, and two new secure care facilities within correctional facilities.

Johnston, of Health Justice, says Eby’s announcement merely continues the same flawed approach. It “[ties] access to services with detention and an involuntary care approach, rather than investing in the voluntary, community-based services that we’re so sorely lacking in B.C.”

Kathryn Embacher, provincial executive director of adult mental health and substance use with BC Mental Health & Substance Use Services, says additional resources are needed to support those with complex needs.

“We continue to work with the provincial government to increase the services we are providing,” Embacher said. “Having enough resources to serve the most seriously ill clients is important to provide access to all clients.”

θəqiʔ ɫəwʔənəq leləm’ (the Red Fish Healing Centre for Mental Health and Addiction) is for clients with complex and concurrent mental health and substance use disorders. | BC Mental Health and Substance Use Services website

Inertia

If B.C. wants to avoid repeating the mistakes of its past, it needs to change its approach, sources say.

One concern Johnston has is with Section 32 of the Mental Health Act. Largely unchanged since 1964, it grants broad powers to medical professionals to detain and control patients.

“It grants unchecked authority,” she said.

Data obtained by Health Justice show one in four involuntarily detained patients in B.C. is subjected to seclusion or restraint. And even this figure may understate the problem. B.C. only began reliably tracking its seclusion and restraint practices in 2020, and only collects data on the first three days of detention.

A B.C. health ministry spokesperson told Canadian Affairs that involuntary care is sometimes necessary when individuals in crisis pose a risk to themselves or others.

“It’s in these situations where a patient, who meets very specific criteria, may need to be held involuntarily under the Mental Health Act,” the spokesperson said.

But York University professor Morrow says those “specific criteria” are applied far too broadly. “We have this huge hammer [involuntary care] that sees everything as a nail,” she said. “Involuntary treatment was meant for rare, extreme cases. But that’s not how it’s being used today.”

Morrow advocates for reviving interdisciplinary care that brings psychiatry, psychology and primary care together in community-based settings. She pointed to several promising models, including Toronto’s Gerstein Crisis Centre, which provides community-based crisis services for those with mental health and substance use issues.

Somers sees Alberta’s recovery-oriented model as a potential blueprint. This model prioritizes live-in recovery communities that combine therapeutic support with job training and stable housing, and which permit residents to stay up to one year. Alberta has committed to building 11 such communities across the province.

“They provide people with respite,” Somers said.

“They provide them with the opportunity to practice and gain confidence, waking up each day, going through each day without drugs, seeing other people do it, gaining confidence that they themselves can do it.”

Johnston advocates for safeguards on involuntary treatment.

“There’s nothing in our laws that compels the health system to ensure that they’re offering community-based or voluntary based services wherever possible, and that they are not using involuntary care approaches without exhausting other options,” she said.

“There’s inertia in a system that’s operated this way for so long.”

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.

By Adam Zivo

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]

Is drug prohibition racist? Many left-wing institutions seem to think so. But their argument is historically illiterate—and it contradicts recent polling data, too, which show that minorities overwhelmingly reject that view.

Policies and laws are tools to establish order. Like any tool, they can be abused. The first drug laws in North America, dating back to the late nineteenth and early twentieth centuries, arguably fixated on opium as a legal pretext to harass Asian immigrants, for example. But no reasonable person would argue that laws against home invasion, murder, or theft are “racist” because they have been misapplied in past cases. Absent supporting evidence, leaping from “this tool is sometimes used in racist ways” to “this tool is essentially racist” is kindergarten-level reasoning.

Yet this is precisely what institutions and activist groups throughout the Western world have done. The Drug Policy Alliance, a U.S.-based organization, suggests that drug prohibition is rooted in “racism and fear.” Harm Reduction International, a British NGO, argues for legalization on the grounds that drug prohibition entrenches “racialized hierarchies, which were established under colonial control and continue to dominate today.” In Canada, where I live, the top public health official in British Columbia, our most drug-permissive province, released a pro-legalization report last summer claiming that prohibition is “based on a history of racism, white supremacy, paternalism, colonialism, classism and human rights violations.”

These claims ignore how drug prohibition has been and remains popular in many non-European societies. Sharia law has banned the use of mind-altering substances since the seventh century. When Indigenous leaders negotiated treaties with Canadian colonists in the late 1800s, they asked for “the exclusion of fire water (whiskey)” from their communities. That same century, China’s Qing Empire banned opium amid a national addiction crisis. “Opium is a poison, undermining our good customs and morality,” the Daoguang emperor wrote in an 1810 edict.

Today, Asian and Muslim jurisdictions impose much stiffer penalties on drug offenders than do Western nations. In countries like China, Saudi Arabia, Iran, Singapore, and Thailand, addicts and traffickers are given lengthy prison sentences or executed. Meantime, in Canada and the United States, de facto decriminalization has left urban cores littered with syringes and shrouded in clouds of meth.

The anti-drug backlash building in North America appears to be spearheaded by racial minorities. When Chesa Boudin, San Francisco’s former district attorney, was recalled in 2022, support for his ouster was highest among Asian voters. Last fall, 73 percent of Latinos backed California’s Proposition 36, which heightened penalties for drug crimes, while only 58 percent of white respondents did.

In Canada, the first signs of a parallel trend emerged during Vancouver’s 2022 municipal election, where an apparent surge in Chinese Canadian support helped install a slate of pro-police candidates. Then, in British Columbia’s provincial election last autumn, nonwhite voters strongly preferred the BC Conservatives, who campaigned on stricter drug laws. And in last month’s federal election, within both Vancouver and Toronto’s metropolitan areas, tough-on-crime conservatives received considerable support from South Asian communities.

These are all strong indicators that racial minorities do not, in fact, universally favor drug legalization. But their small population share means there is relatively little polling data to measure their preferences. Since only 7.6 percent of Americans are Asian, for example, a poll of 1,000 randomly selected people will yield an average of only 76 Asian respondents—too small a sample from which to draw meaningful conclusions. You can overcome this barrier by commissioning very large polls, but that’s expensive.

Nonetheless, last autumn, the Centre for Responsible Drug Policy (a nonprofit I founded and operate) did just that. In partnership with the Macdonald-Laurier Institute, we contracted Mainstreet Research to ask over 12,000 British Columbians: “Do you agree or disagree that criminalizing drugs is racist?”

The results undermine progressives’ assumptions. Only 26 percent of nonwhite respondents agreed (either strongly or weakly) that drug criminalization is racist, while over twice as many (56 percent) disagreed. The share of nonwhite respondents who strongly disagreed was three times larger than the share that strongly agreed (43.2 percent versus 14.3 percent). These results are fairly conclusive for this jurisdiction, given the poll’s sample size of 2,233 nonwhite respondents and a margin of error of 2 percent.

Notably, Indigenous respondents seemed to be the most anti-drug ethnic group: only 20 percent agreed (weakly or strongly) with the “criminalization is racist” narrative, while 61 percent disagreed. Once again, those who disagreed were much more vehement than those who agreed. With a sample size of 399 respondents, the margin of error here (5 percent) is too small to confound these dramatic results.

We saw similar outcomes for other minority groups, such as South Asians, Southeast Asians, Latinos, and blacks. While Middle Eastern respondents also seemed to follow this trend, the poll included too few of them to draw definitive conclusions. Only East Asians were divided on the issue, though a clear majority still disagreed that criminalization is racist.

As this poll was limited to British Columbian respondents, our findings cannot necessarily be assumed to hold throughout Canada and the United States. But since the province is arguably the most drug-permissive jurisdiction within the two countries, these results could represent the ceiling of pro-drug, anti-criminalization attitudes among minority communities.

Legalization proponents and their progressive allies take pride in being “anti-racist.” Our polling, however, suggests that they are not listening to the communities they profess to care about.

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