Patrick Brown’s involuntary treatment plan for those suffering mental health & addiction crises criticized by Peel councillors 

A push by Brampton Mayor Patrick Brown to create an involuntary treatment program for those suffering mental health and addictions crises in Peel was met with intense criticism from his fellow members of regional council on Thursday. 

Councillors highlighted the lack of resources available for such a program (Brown often makes claims about issues that draw national attention without explaining how he would pay for his proposals); the capacity issues in existing mental health and addiction services to house involuntary patients; and the lack of information and evidence to support Brown’s notions about the benefits of these treatment programs. 

Many studies have found such programs do not work, and can actually contribute to further overdoses, requiring more police and medical resources. The heavy-handed treatment of individuals has also raised questions about the rights of those forced into involuntary programs.

Brown and his key council ally in Brampton, Rowena Santos, have come under fire for their harsh treatment of the city’s most vulnerable residents, forcing many living in encampments out of their shelters which were cleared on orders from the mayor that might have violated the rights of individuals.

Meanwhile, Brown has forced severe budget cuts and both he and Santos have failed to fund critical programs to help some of Brampton’s most vulnerable community members.

Now, Brown wants to force many of them into treatment programs, even if it’s against their will. But regional councillors were having none of it, after he sought their support to ask the provincial government to establish and fund a pilot program for involuntary treatment “to stem the rising tide of preventable overdoses and alleviate unsustainable use of frontline police resources.” 

During a special meeting of Brampton council on Wednesday, clearly anticipating pushback from regional council—his motion was amended to request the establishment of such a program, but only within Brampton.

Councillor Rowena Santos and Mayor Patrick Brown are pushing for the establishment of involuntary mental health and addiction treatment. Evidence clearly shows these programs fail.

(YouTube/City of Brampton)

On Thursday, Mississauga and Regional Councillor Martin Reid questioned the practicalities of how such a program would work in Peel’s already overburdened healthcare system. He questioned where these patients would be taken for involuntary treatment; whether there was existing capacity for them; which experts would be involved in the creation of a program and what other wrap-around services would be funded to ensure individuals get full support. He highlighted that regional council has failed to invest in such support in the past. 

“An ounce of prevention is worth a pound of cure. We say that, until we have to put money in front of it,” he said.

Brown remained silent throughout the pushback. 

Similar criticism of the lack of response to the ongoing overdose crisis and the growing mental health crisis was levelled by Mississauga and Regional Councillor Natalie Hart. She asked about the existing wait times for the voluntary mental health and addictions programs in Peel. 

Acting Medical Officer of Health Gayane Hovhannisyan explained the current wait times for community mental health supports are over 12 months, including help for addiction issues; and waits for psychiatric care can be more than 9 months. Councillor Hart urged the Region to focus on closing the gap in these voluntary programs before decision makers begin thinking about forcing people into treatment. 

“A year? I’m sorry that is wildly inappropriate,” she said. “We should all be ashamed of that collectively.”

Despite pushing for budget cuts since his election in 2018 Brown described the wait times for current services which have grown worse under his leadership as “appalling”. His main supporter around the council table was Santos who has been Brown’s biggest supporter when cuts to a range of community building initiatives were made. 

“We have to try something new,” Santos said. She has come under fire from Brampton residents who say she has divided community members and tried to mislead them around the issue of encampments (where many vulnerable residents found shelter). Her claim that involuntary treatment programs are new belies reports about the use of these programs in places such as Europe that date back more than a decade. 

Despite the claims of Brown and Santos, research suggests the approach may be more harmful than helpful. Studies indicate that involuntary treatment often fails to produce long-term results, with some patients becoming more vulnerable to drug use after leaving these involuntary arrangements. 

These programs have tragically been associated in certain circumstances with an increased risk of fatal overdoses once patients are released from treatment facilities back into the community from which they were removed.

During the City council meeting on Wednesday, October 9th, Brown said many individuals use opioids, particularly fentanyl, in public areas such as parks and encampments around the downtown area. Brown cancelled tens of millions of dollars approved prior to his arrival in Brampton so the downtown could be revitalized. Now, he wants to address the very problems he exacerbated with his dramatic budget cuts by taking aggressive action such as forced removal of encampments and his idea of involuntarily placing individuals into treatment programs, even against their will. 

Patrick Brown has called security to break up encampments in Brampton while forcing budget cuts that have made the situation worse.

(Alexis Wright/The Pointer)

He called it a "compassionate intervention" approach. Despite acknowledging controversial aspects of his plan, he claimed proven benefits.

It’s unclear what Brown based his claims on. A 2023 study of 17 years of data on individuals ordered into compulsory care, found little evidence of success. 

“Although compulsory care is often advocated as a life-saving intervention, our findings do not provide strong support for this claim,” the study’s conclusion states.
“On the contrary, our findings show that admission to compulsory care is associated with a higher risk of substance use-related mortality. Factors such as compulsory care often not including any medical or psychological therapy, together with relapse and overdose after discharge, may be possible contributing factors to these findings.”

A study released in 2018 by Ishrat Husain, MD, Peter B. Bradley, Soo Min Lim, and Kwame McKenzie, MD, at the Centre of Addiction and Mental Health (CAMH) in Toronto, titled "Effectiveness of Involuntary Treatment for Individuals with Severe Mental Illness," indicated that although involuntary treatment may result in short-term compliance, it is not very effective in producing lasting mental health improvements. Following the treatment period, many patients experience a relapse, and the compulsory nature of the program undermines trust and ongoing engagement with healthcare providers. Consequently, involuntary treatment can heighten the risk of harm after completion, with the study proposing that voluntary, patient-centered care could offer superior long-term outcomes.

“There is little evidence of the effectiveness of compulsory treatment in sustaining drug use remission,” the study states.

A research paper titled "Ethicolegal Analysis of Involuntary Treatment for Opioid Use Disorders" by Farhad R. Udwadia and Judy Illes from Neuroethics Canada at the University of British Columbia examined evidence from a 2020 study that highlighted the moral and legal issues surrounding involuntary treatment for opioid use disorders. Important ethical principles like patient autonomy, privacy, and dignity are commonly violated by the sorts of programs the researchers studied. The research demonstrated that individuals who discontinue treatment programs run a higher risk of overdose and relapsing and that forced therapy is frequently ineffective in treating opioid use disorders.

The research strongly supports the idea of voluntary, patient-focused care as a more efficient and ethically sound option. Involuntary treatment centers are criticized in the study for frequently failing to offer necessary care like medication-assisted treatment (MAT), which ultimately reduces the effectiveness of these programs. The authors advocate for a change toward voluntary harm-reduction strategies, which they believe would more effectively deal with the challenges of opioid addiction while honouring the rights of patients.

Michelle Bilek, a co-founder of the Peel Alliance to End Homelessness, stressed that council should conduct thorough research and consult with experts before considering such a program which if done improperly would cause more harm than good. 

“This is more of a public relations stunt and a voter apathy experiment than anything compassionate,” she said Thursday, criticizing Brown’s ill-advised idea. 

Contrary to Brown’s claims about providing relief to police, paramedics and emergency departments, studies have shown that involuntary treatment would do very little to alleviate this burden in the long-term, and could, at best, create more work for the very services Brown claims to want to help, and at worst, lead to more overdose deaths. 

There are also concerns about the potential financial burden on Brampton taxpayers, putting money into a project without a positive outcome could mean wasting resources, especially when there are proven alternatives like the Mobile Crisis Rapid Response Team (MCRRT) that consistently deliver beneficial outcomes. In 2021, Peel Regional Police estimated it was spending $1.8 million in officer salaries while they sat around hospitals waiting for those apprehended under the Mental Health Act to be admitted. 

The MCRRT program launched in 2020 and partners a crisis worker with a uniformed officer. It has proven to reduce the number of individuals taken to the emergency room due to mental health issues. This saves officer time, reduces the strain on Brampton’s already cramped emergency room, and can even help connect that individual with further social services or treatment if they are willing. 

Increasing funding for the MCRRT program would not only alleviate the pressure on law enforcement, paramedics, and emergency services, enabling them to address other pressing issues, it would also offer significant advantages to patients by establishing a more supportive and trustworthy treatment setting.

Brown has failed to support the expansion of the MCRRT program through his budget decisions. 

He and Santos did not respond to requests for comment.

At Wednesday’s meeting, Brampton Councillor Gurpartap Singh Toor voiced support for Brown’s involuntary treatment pilot idea, but stressed that strengthening the city’s frontline healthcare system must be a priority. He questioned how involuntary treatment could succeed in the ongoing healthcare crisis the city has faced. 

The Region of Peel is one of the lowest funded areas, per capita, when it comes to healthcare and public health. According to the 2023 annual report from Peel Public Health, the agency received approximately $34 per capita, compared to $49, $49, and $39 for Toronto, Hamilton, and Ottawa. The study underscored how Peel's population growth has far outpaced provincial healthcare funding.

At Thursday’s meeting, regional councillors passed an amended version of Brown’s original motion which now asks for support to increase access to naloxone for individuals who are awaiting treatment to prevent overdoses; to work closely with the Province of Ontario, Peel Paramedics and Peel Public Health to ensure that naloxone, including nasal naloxone, is readily available; and for the Medical Officer of Health to convene a roundtable with provincial and community leaders to establish best practices for addressing the opioid crisis. 

The motion also directs the Region to send a letter to the provincial government to share details of the long wait times for mental health and addictions support in Peel, highlighting the critical need for increased provincial healthcare support.

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