What is Complex Care?
Complex care is an umbrella term for a form of accommodation with 24-hour nursing staff caring for people whose needs can no longer be met while living independently or in an assisted living residence. Complex care includes institutions that provide long-term care, mental health services, and addiction services. The Government of BC defines long-term care as being for people who:
have severe behavioural problems on a continuous basis;
are cognitively impaired, ranging from moderate to severe;
are physically dependent, with medical needs that require professional nursing care, and a planned program to retain or improve functional ability; or
are clinically complex, with multiple disabilities and/or complex medical conditions that require professional nursing care, monitoring and/or specialized skilled care.
Involuntary “care” is a form of complex care in which a person is forced into a complex care institution without their consent. While involuntary “care” violates the Charter of Rights and Freedoms around issues of consent and involuntary treatment, it is overridden by the BC Mental Health Act, which allows for involuntary admission and treatment of people who have serious mental health issues and have been declared to be a risk to themselves and/or others. There is no oversight of this law, which is discriminatory to people with disabilities, as well as no requirement to track or publish statistics or reports on involuntary admissions, no mechanism for automatic review, and no regulated accountability measures. A single doctor has the power to hospitalize individuals for 48 hours, and the approval of a second doctor allows for an additional month of detainment, which can be extended for many months or years based on filling out paperwork. People who have been involuntarily detained can be forced to undergo specific treatments, including Electroconvulsive Therapy, against their consent and that of their family or other advocate.
Calls for complex care for BC’s unhoused population have been vague in the details of what they will include. However they are clear about the possibility of holding people against their will, and they are clear about the target demographic, which includes people who either refuse or “fail to retain” the shelter or transitional housing offered to them by the government. The assumption that people refuse or are evicted from these spaces because they are “simply too unwell” overlooks the many other factors at play. People living in shelters and transitional 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.
Even when it is consensual, complex care is not a solution to homelessness. As a structural issue, homelessness requires solutions that address the root causes, such as the serious deficit of affordable housing, poverty, colonialism, discrimination, and gender-based violence. The emphasis on mental health or addiction treatment as a strategy to combat homelessness falsely situates the cause of homelessness in the individual, rather than recognizing the effect of enforced poverty through insufficient social assistance and disability assistance rates, divestment of federal funding from housing, and the general erosion of the social safety net as major contributing factors to increased poverty, homelessness, physical and mental health issues, and substance use issues. Harm reduction and mental health supports are important and should be accessible to everyone including people who are unhoused, but these approaches are not a solution on their own. They must be understood as complementary to the structural change that is necessary to end homelessness and the housing crisis. For people to have their needs met at home, they need a home to live in.
Read our statement on the disturbing rise of involuntary "care"
as a solution to homelessness