The Disturbing Rise of involuntary “Care” as a Solution to Homelessness

For an explanation of complex care and involuntary detainment, read our short article here.

On April 27, 2021 Julian Daly, CEO of Our Place Society, published an op-ed praising the Province of BC’s efforts toward opening complex care facilities for those “individuals who wander our streets in obvious and alarming distress” so “unwell” that they "fail to retain housing.” On May 23rd, Jeff Bray, the Executive Director of the Downtown Victoria Business Association supported Daly’s call stating that, “For some with severe trauma, mental illness, and/or addictions [...] there is need for involuntary, 24-hour, secure care to properly support their journey to recovery.” Mayors across BC, housing providers, and business associations are united in shifting the blame for visible poverty, from the failures of the state and the market, to the backs of those failed and betrayed by our systems. 

 

Calls for complex care are gaining traction in BC with the rationale that there are some living on the streets that are just too “mentally ill” for regular housing who require an “involuntary” approach to care. Building on our statement against displacement and warehousing, VTAG condemns this crude woke-washing of incarceration, which dehumanizes, medicalizes, and criminalizes people living in poverty. Rather than pathologize and incarcerate more of our neighbours to protect the wealth and power of developers and land owners, all levels of government must commit to a solution which addresses the root of the issue, by building and sustaining adequate, affordable, accessible, and autonomous housing for all. 

Rights are lost not gained in complex care 

According to mayors from across BC, complex care facilities are “small, specialized locations” for 30-50 people living with severe mental health and addictions issues not currently served by supportive housing. While acknowledging “involuntary care” as a key feature, proponents of these facilities are careful to point out that they are not the institutions of old. Although there is recognition of the inhumane and abusive conditions that inspired the deinstitutionalization movement, there is no elaboration as to how they will be different aside from being rebranded with friendlier language. The BC Mental Health Act, which overrides the Charter of Rights and Freedoms to permit involuntary detainment, has been identified as problematic for having no oversight and for being discriminatory toward people with disabilities. There is currently no requirement to track or publish information on involuntary admissions, no mechanism for automatic review, and no regulated accountability measures. Yet, Daly and others who call for complex care manipulate the rhetoric of rights to argue for involuntary care. According to Daly, “[...] we believe it is the right thing to compel care. We believe that in doing so their rights are recognized – the right to be safe, the right to be housed, and the right to good health.”

 

As housing increasingly becomes framed as medical and health related, residents in these facilities lose their regular tenant rights. This means they lose mechanisms to hold service providers/landlords accountable for tenant violations. Proponents of complex care target people who are “simply too unwell” and who “fail to retain” shelter and transitional housing, but this framing ignores what residents have been saying for years about the living conditions in these places. People living in shelters, transitional and supportive housing often face meagre living conditions and restrictive policies that deny autonomy and dignity while enforcing dangerous conditions of isolation, as well as discriminatory practices and structures rooted in racism, colonialism, ableism, sexism, and other oppressive forces. 

 

Involuntary committals are the logical extension of current trends toward medicalized and institutionalized affordable housing. This is a deeply troubling direction. When people vanish from view into confinement, they become even more vulnerable to mistreatment and abuse. The very act of institutionalization is itself traumatic. The Province, the mayors, and well-paid nonprofit executives are making it abundantly clear that they believe disabled and mentally ill people do not matter, have no rights, no voice, and no choice. Involuntary committals do not break cycles of harm and trauma, they deepen existing trauma and cause further pain, humiliation, and risk. Further, involuntary confinement does not address the roots of homelessness or poverty. Only supportive, community-based systems and relationships grounded in respect for people’s autonomy can break with these cycles.

 

Complex care shifts the blame from the system to individuals failed by it 

Bray argues the need to, “strike a balance between accommodating individual rights and protections and preventing our present reality: people dying in despair - and literally dying - in the streets.” Deaths from criminalization and a toxic drug supply; unavailable and inadequate housing; legislated poverty from abhorrently low disability and income assistance rates; racism in health and social services; these are mobilized to argue that involuntary care is for people’s own good. Rather than making the logical changes to systems causing illness and death (such as the decriminalization of drugs and a regulated safe supply), involuntary care situates the solution and problem in individuals who are blamed for their suffering, and early deaths. Why does this happen? Enacting real solutions would require the state to acknowledge its responsibility and its failures and use its power to regulate the wealthy and the privileged. It is far easier to impose violent, oppressive non-solutions upon people who have been made vulnerable by the state. 

 

People who have fallen through the flimsy social safety net should not be further punished and marginalized by incarceration or institutionalization. Daly’s reference to individuals facing extreme challenges with housing as “unfortunate outliers,”  implies that these circumstances result from bad luck, rather than the governing logics of a racist, ableist colonial occupation. “Outliers” implies that these are exceptions to a system that otherwise works. We know this is not true. We live in a government-sanctioned capitalist housing market that protects speculative housing values and fails again and again to meet the needs of those in our communities who are  poor, disabled, working class, students, seniors, and others.

 

More adequate housing and support, not involuntary care

Complex care is the newest re-branding, pinning the problem of the housing crisis and visible poverty on homeless people. It is another strategy for displacing and disappearing people rather than dealing with the root causes of homelessness and the lack of community-based supports for people who need it. Cloaked in the language of compassion, proponents of complex care would disappear members of our community into indefinite confinement for the sake of convenience and aesthetics. As a structural issue, homelessness requires solutions that address the root causes, such as the serious deficit of affordable housing, poverty, colonialism, discrimination, barriers to health and social services, and gender-based violence. 

 

Complex care advocates stoke fears about violent or arsonistic unhoused people, which is an age-old tactic that has been used to dehumanize and justify inhumane treatment of marginalized people throughout history. The reality is that violence exists within every demographic, and that unhoused people regularly face violence and hate from their housed neighbours. In fact, people with serious mental illness, who are identified as the target demographic for involuntary “care,” are more likely to be the victims of violence than the perpetrators of violence. Research shows that the vast majority of violence is committed by people without mental illness and that people with serious mental illness face rates of violence 2.5 times higher than the rest of society. 

 

Rather than referring to people as “unfortunate outliers” in need of forcible confinement, Daly and others could advocate for adequate financial assistance for those in poverty. Money would be better spent raising social assistance and Persons With Disabilities (PWD) rates. As it currently stands, these so-called “supports” and caps on earning trap recipients in poverty. In the 2018 Report on BC Homeless Counts, more than one quarter (29%) of survey respondents reported their source of income as disability benefits. While PWD shelter rates have been frozen since 2007, housing costs have increased dramatically, with the average monthly rent in BC rising by 48% in the last three years, from $1,248 in 2018 to $1,850 in 2021. The $375 shelter allowance (often paid directly to landlords) is wholly inadequate. 

 

Regardless of the trauma we have experienced in our past or the generational poverty that overwhelms us - everyone deserves to live with safety, dignity, meaningful community connections, with our material needs met. We challenge society and the government to move beyond the dominant models of medicalization and criminalization of poverty, mental health, and substance use which restrict meaningful participation in decision making. Instead of promoting models of care that strip people of their rights and dignity, VTAG demands that the Government of Canada, Government of British Columbia, and municipal governments in the CRD provide the real, material support that is required for all members of the community to exercise self-determination and autonomy in their homes and lives.

Still not clear on what complex care is? Check out our explainer here.

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