Law360 Canada (May 11, 2026, 10:34 AM EDT) --

Anita Szigeti

Three and a half years ago, I wrote in this column about the dangers of forcing treatment on people with serious mental health issues as a condition of keeping them living in the community.

In that two-part series, I examined the explosion of such community treatment orders in Ontario over the last 25 years. That’s how long the legislative regime establishing physicians’ authority to do this has been in place under the province’s Mental Health Act. While being forcibly administered medications against their will is certainly bad enough, at least those individuals are living their lives outside of psychiatric detention, albeit under pain of threatened readmission if they fail to comply with treatment as prescribed.

But what’s happening across the country now to people who use drugs is arguably even worse. It’s not a contest, but the severity of legislation affecting civil rights of drug users in some Canadian provinces should alarm all of us who care about vulnerable individuals in this country. The common theme to all this activity in legal reform is creating mechanisms for the detention of people who use drugs in locked facilities, whether hospitals or jails, in order to force “treatment” on them.

New Brunswick was the first to propose forced treatment laws, while Alberta and now Saskatchewan have actually enacted such provisions. British Columbia has begun creating “involuntary care beds” in correctional facilities and Ontario regularly muses out loud about doing the same. No doubt other provinces will hop on the bandwagon.

The problem is that coercion ultimately doesn’t work, doesn’t help anybody, but instead does a great deal of harm in many ways. It certainly drives people wanting help away from seeking it because they’re legitimately afraid of being locked up. These superficially attractive laws are absolutely wrong-headed and are rightly opposed not just by human rights lawyers but also by many in the medical profession, and perhaps most importantly by drug users, all based on evidence of what does and doesn’t work for those who use drugs.

Much has been said elsewhere about this escalating movement toward coercion masquerading as care. Opposition from all corners generally highlights the same major themes. First are the Charter rights violations — deprivation of liberty and infringement of autonomy in the face of a health care concern rather than criminal conduct. Second, the reality that forced abstinence programs do not support long-term recovery and indeed expose subjects to risk of overdose death upon release from the program as their tolerance for the drug has been reduced. Third, the simultaneous removal of supports that have been proven to save lives, such as safe consumption sites and a clean drug supply, while failing to decriminalize and legalize drug use, despite decades of calls for these measures by knowledgeable advocates. And fourth, the systemic discrimination that both drives and results in the wake of such measures, disproportionately affecting marginalized, and in particular racialized individuals who use drugs. Finally, everyone agrees that before turning to coercion, provincial governments should ensure that people who already seek voluntary treatment options have meaningful access to them.

What I can contribute to this ongoing dialogue is three decades of experience watching the same approach applied to people living with serious mental health conditions. Over the course of my long career devoted to the representation of this client population, I have witnessed the expansion of involuntary committal criteria from a dangerousness-based threshold for detention to a “treatment needs” lens. In other words, rather than a concern for the safety of the individual or others, the state can remove someone from society and lock them up because others believe they need treatment of a condition we’ve determined is bad for them, whether or not they agree with either of those assessments.

In the mental disorder context, from where I sit, adding ever increasing opportunities and mechanisms for forced treatment has been nothing but an abject failure. Expensive hospital beds are filled with people who do not want to be there, are held against their will, based on a perceived concern their mental state might deteriorate without medications they would otherwise reject. A very low threshold for psychiatric certification we added to the Mental Health Act in 2000.

Meanwhile, people in serious and immediately acute mental health crises, who are knocking on the hospital’s door, cannot come in because there is no longer any room at the inn. The people desperately trying to access urgent care are denied it, despite a pressing need because they are deemed to have sufficient insight to seek help. But there is no voluntary help available within or outside locked facilities any longer because involuntary compulsion has replaced voluntary treatment access. The pool of available resources has not changed, and the already too scarce programs are now forced upon those who never wanted them in the first place. This is equally the case for both inpatient and outpatient services.

The irony is that our existing mental health legislation likely would already permit involuntary detention and treatment of those who have a substance abuse disorder diagnosis, and if those provisions are rarely, if ever used, there’s good reason for that. Mainly the evidence-based appreciation that forced abstinence doesn’t work for those who are not seeking that result themselves, and indeed any such coercion can cause more harm than good. The traumatic impact of psychiatric detention and forced administration of mind-altering drugs is often ignored but cannot be overstated. It’s real and should be avoided at all costs. Instead, provincial governments are touting this approach as a panacea with no regard for the psychological impact on the subjects, or for the long-term harm caused.

The other reason forced treatment of drug use is not often employed, even where legally potentially available, is the universal reality that the people who are actively seeking treatment for addictions simply cannot access them. I’ve seen my clients who are already detained in psychiatric facilities for other reasons, for whom there are no programs or services to address their use of substances, even when they are asking for help in that regard. If the programs and services people want are chronically underfunded and unavailable, should we not start by rectifying that glaring problem? Because coercion certainly isn’t care.

Anita Szigeti is the principal lawyer at Anita Szigeti Advocates, a boutique Toronto law firm specializing in mental health justice litigation. She is the founder of two national volunteer lawyer associations: the Law and Mental Disorder Association and Women in Canadian Criminal Defence. Find her on LinkedIn, follow her on BlueSky and on her blog.

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