Involuntary psychiatric care in British Columbia is shaped by systemic constraints with limited access to upstream, voluntary and community-based alternatives, highlighting the need for system-level reform to reduce reliance on coercive practices.
Key Findings
Background
Involuntary psychiatric treatment in British Columbia has been increasing over the past 15 years, providing the context for this qualitative investigation.
British Columbia's Mental Health Act permits involuntary detention and treatment of individuals meeting specific criteria.
The study was conducted across two health organizations in British Columbia, Canada.
The increasing trend in involuntary admissions motivated the study's focus on lived experiences of both recipients and providers.
Methods
Five focus groups were conducted with 23 individuals who had previously received involuntary psychiatric treatment, facilitated by peers with lived experience.
All focus group participants had previously received involuntary psychiatric treatment at a facility operated by one of the two health organizations.
Sessions were facilitated by individuals with lived experience of involuntary psychiatric treatment, reflecting a peer-informed methodology.
Semi-structured interviews were also conducted with 11 clinical staff and 10 non-clinical support personnel involved in delivering involuntary psychiatric treatment or associated services.
Data were analyzed using reflexive thematic analysis guided by an equity-oriented care framework.
Results
Seven themes were generated from the data describing the experiences of receiving and providing involuntary psychiatric treatment.
Themes included the limited availability of voluntary care options.
Themes included the compounding role of social determinants of health in mental health crises.
Themes included the lack of conclusive evidence supporting involuntary psychiatric treatment.
Themes included the negative impacts on both patients and providers.
Themes included the importance of peer support.
Results
Participants described limited access to voluntary, upstream, and community-based care alternatives as a key driver of reliance on involuntary psychiatric treatment.
Across themes, participants described involuntary psychiatric care as shaped by systemic constraints.
Limited access to upstream, voluntary, and community-based alternatives was identified as a structural factor shaping the use of coercive care.
Both patients and providers described being 'backed into a corner,' suggesting a lack of viable alternatives.
The framing suggests involuntary treatment was often used by default rather than by preference.
Results
Social determinants of health were identified as compounding factors in mental health crises leading to involuntary treatment.
The role of social determinants of health was identified as one of the seven major themes.
Participants indicated that underlying social and structural factors contributed to mental health crises.
The equity-oriented care framework used in analysis highlights that these factors disproportionately affect marginalized populations.
The findings suggest that mental health crises leading to involuntary treatment are not solely clinical but are embedded in broader social conditions.
Results
Involuntary psychiatric treatment was described as having negative impacts on both patients and providers.
Negative impacts on patients and providers constituted one of the seven themes generated through analysis.
Both clinical staff and non-clinical support personnel participated in interviews, capturing provider perspectives on harm.
The study design captured dual perspectives by including 23 patients and 21 staff members across clinical and non-clinical roles.
The negative impacts theme suggests that coercive care is experienced as harmful not only by those receiving it but also by those delivering it.
Results
Peer support was identified by participants as an important element in the context of involuntary psychiatric treatment.
The importance of peer support was one of the seven themes generated from the data.
The study itself employed peer facilitation, with focus groups led by individuals with lived experience of involuntary psychiatric treatment.
This finding aligns with the study's methodological emphasis on centering lived experience.
Peer support was highlighted as a meaningful component of care within the current system and as a potential element of reform.
Discussion
The findings highlight the need for system-level reform to reduce reliance on coercive psychiatric practices and expand voluntary, community-based supports.
Authors call for expansion of access to voluntary, community-based mental health supports.
Reform recommendations include addressing the underlying social and structural factors contributing to mental health crises.
The study frames the problem as systemic rather than individual, supporting structural rather than clinical solutions.
The lack of conclusive evidence supporting involuntary psychiatric treatment was identified as a theme, further motivating the call for reform.
What This Means
This research suggests that when people in British Columbia are hospitalized in psychiatric facilities against their will, the experience is shaped less by clinical necessity alone and more by a lack of available alternatives. The study interviewed 23 people who had been involuntarily hospitalized, as well as 21 staff members who work in these settings. Participants — including both patients and providers — described feeling 'backed into a corner,' meaning involuntary treatment was often used because other options, such as voluntary community-based care or early intervention services, were simply not available. Social factors like poverty, housing instability, and other inequities were also identified as key contributors to the crises that led to involuntary hospitalization in the first place.
The study also found that involuntary psychiatric treatment had negative impacts on both the people receiving it and the people providing it, and that there is limited evidence it is actually effective. Peer support — help from others who have had similar experiences — was highlighted as a meaningful and valued resource. The research was conducted in a way that centered lived experience, with focus groups facilitated by people who had themselves been through involuntary hospitalization.
This research suggests that the growing use of involuntary psychiatric hospitalization in British Columbia reflects gaps in the broader mental health and social support system rather than simply increasing rates of mental illness. The authors call for reforms that would reduce reliance on coercive care by investing in voluntary, community-based services and addressing the social conditions — like poverty and lack of housing — that contribute to mental health crises. The findings indicate that meaningful change requires system-level action, not just improvements within psychiatric facilities themselves.
Snow M, Salmon A, Banjo J, Morrow M, Varcoe C. (2026). "Backed into a Corner": Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia's Mental Health Act.. PloS one. https://doi.org/10.1371/journal.pone.0329049