As the conversation around forced treatment heats up across the country, it’s crucial to consider what that really means for those involved, especially through a trauma-informed lens. Drawing from my four years as a youth counselor in a treatment facility in British Columbia, I’d like to share some insights.
Legal Context and Coercion in Treatment
Currently, there are three main situations when someone might be forced into treatment:
Under the Mental Health Act: This applies when healthcare professionals determine that a person is at high risk of harming themselves or others and isn’t able to make fully informed decisions about their care.
Drug Treatment Court: Here, adults facing certain drug-related charges, especially non-violent offences, might be required to complete a drug treatment program as part of their sentencing.
Youth Probation Conditions: In some cases, young people may be required to attend treatment as part of their probation. This can happen when the legal system sees treatment as a way to support rehabilitation and reduce the likelihood of re-offending. Instead of traditional punitive measures, treatment can be added to probation conditions for young people involved in situations where substance use or mental health issues are factors in their legal challenges.
But even outside of these situations, "voluntary" treatment can often feel anything but voluntary. Many young people are offered “choices” that are, in reality, not real choices at all. They can feel pressured into treatment when, for instance, guardians threaten to kick them out if they refuse, or when they see treatment as a safer housing option compared to their current living situation. For youth with no other safe place to go, is that really a choice?
Throughout this discussion, we’ll keep coming back to the issue of housing. The need for safe, stable housing often shapes people’s decisions about treatment, and this theme will pop up again and again as we look at how housing and treatment are deeply connected. Recognizing this link is essential to offering real support for anyone struggling with substance use in ways that respect their autonomy and meet their actual needs.
The Impact of Coercive Practices on Autonomy and Mental Health
When young people feel they lack real options, it erodes their sense of autonomy and negatively impacts their mental health. I often saw this dynamic play out: families might sign agreements for prompt pick-up if the youth decides to leave treatment, yet some guardians would delay their arrival—claiming they have no transportation or even going on vacation—hoping their youth would change their mind. This can lead to feelings of abandonment, especially when families leave vulnerable individuals feeling isolated. Being forced into care can deteriorate trust in healthcare providers and strain family relationships. Many young people internalize feelings of unworthiness, believing they don’t deserve love and support.
Beyond the Carrot: The Complications of Bribery
Bribery complicates matters further. Some youth are promised material rewards, like a car or a trip, to encourage them to complete treatment. While these offers may seem superficial, they represent a pathway to escape toxic environments and gain independence. Many young people living in unsafe home situations aspire to secure a Youth Agreement with the Ministry of Children and Family Development, which would provide vital support such as housing and financial assistance so they can live independently. However, I’ve also seen social workers dangle the carrot of a Youth Agreement, promising it only if the youth completes treatment. I have also seen treatment being used as a get-out-jail card. In British Columbia, youth may have the option to avoid jail time if they agree to participate in drug treatment programs. The Youth Criminal Justice Act (YCJA) encourages rehabilitation over punishment for young offenders.
Genuine recovery depends on a person's willingness to engage in the process; when coercion comes into play, it fosters resentment and disengagement, which doesn't support long-term recovery. Too many time I've seen youth do the absolute bare minimum, just enough so that they do not get discharged. In contrast, fostering an environment where youth can set collaborative goals significantly boosts their motivation and sense of ownership over their recovery journey, laying a stronger foundation for lasting change.
Challenges Upon Returning Home
Many young people find healing in supportive treatment settings but encounter significant challenges when they return to the same environment that may have contributed to their substance use. We've seen exploited youth go through treatment, do well and then they were sent back into their community where they are again having to engage with their exploiters, their abusers, their negative influences, whether that is someone in their family or in their community. For those without stable, safe housing, questions about post-treatment support become critical.
Re-traumatization and Misalignment with Trauma-Informed Practices
Many programs operate in ways that can be harmful and misaligned with trauma-informed practices. I will discuss some of many ways treatment lack trauma-informed care:
Many treatment agreements often prohibit youth from contacting friends or family outside their guardians for the first month. This approach disregards the fact that some individuals rely on chosen family, who may offer healthier support than biological relatives. This also means their potentially abusive guardian have say in who they are allowed to talk to, isolating these youth from their vital networks can lead to loneliness and despair, complicating their recovery.
Many treatment programs take a "one-size-fits-all" approach, overlooking the unique needs each person brings—especially around trauma. Everyone is expected to complete treatment within a set timeframe, even though some people may need more time and flexibility to truly heal.
Youth are often expected to go through treatment in a cookie-cutter way, without much room for individual needs. Group settings can be especially tough, as participants are often asked to share personal stories in front of others, which can feel unsafe or invasive for those with trauma. Additionally, staff may lack trauma-sensitive training, so signs of distress might be met with frustration or even punishment instead of understanding. This approach can leave young people feeling misunderstood and unsupported in their healing process.
Programs often focus heavily on compliance, enforcing strict rules and punishments if participants don’t follow them. For instance, missing sessions or failing to complete specific tasks can lead to being discharged from the program. This approach doesn’t take into account trauma-related symptoms like anxiety or avoidance, which can leave participants feeling controlled instead of supported.
Cultural Humility and Inclusion
While I saw some efforts toward cultural humility, they often fell short. Many youth of colour struggled to navigate a predominantly white-centric environment, where they were presented with unfamiliar foods that their bodies did not react well to. For instance, I witnessed Indigenous youth grapple with the contrast between the processed foods provided in the treatment facility and the organic meats they were accustomed to on the reservation. Additionally, they faced challenges adapting to the noise pollution and air quality of an urban setting after spending most of their lives in a quiet, nature-filled environment. I’ve also seen Black youth who lacked support for hair care—a significant aspect of their culture and identity—leading to feelings of disconnection. Furthermore, the underrepresentation of staff of colour can exacerbate these challenges, as youth may feel less trustful as they lack relatable role models and advocates in their healing process.
Neurodivergence and Accessibility
Ultimately, treatment isn’t a one-size-fits-all solution. It’s crucial to recognize that neurodivergence is often overlooked. Many young people entering treatment are neurodivergent, impacting their ability to engage with conventional learning methods. Some may struggle in group settings or have difficulties with traditional reading, writing, and processing. Unfortunately, many staff members lack the training needed to effectively support neurodivergent youth, limiting the accessibility and effectiveness of treatment. Additionally, the facility itself isn’t wheelchair accessible, and most, if not all, of the programming is designed with able-bodied participants in mind. This lack of accessibility creates further barriers to inclusivity.
The Interconnectedness of Issues
As many of us understand, addiction often doesn’t exist in isolation; it frequently co-occurs with mental health issues like depression, anxiety, PTSD, and more. Unfortunately, many treatment programs lack the resources and specialized professionals needed to address these interconnected challenges. Instead, they tend to focus excessively on substance use, viewing it as a moral failing rather than a symptom of broader mental health struggles. This narrow focus ignores the home environment and other factors that may contribute to a young person’s situation, placing all the responsibility on the youth and their addiction as the sole problem.
I’ve seen youth discharged for challenges like eating disorders and social anxiety. This often stems not just from conflicts with program agreements that require participation in group meals but also from staff being unequipped
to support youth with concurrent disorders. This approach fails to recognize the complexities of their lives and can lead to feelings of shame and isolation when their other struggles are overlooked.
My Conclusion
In conclusion, adopting a trauma-informed approach means prioritizing autonomy, understanding, and support in treatment. Instead of pushing individuals into care, we need to create environments that empower them to make choices about their recovery. As we reflect on these critical aspects of compassionate care, we must also confront the practical realities that make forced treatment unrealistic, including the lack of resources and the challenges surrounding housing stability. In my next blog, I’ll dive into these logistical issues and explore why a more holistic approach is essential for fostering true recovery and resilience.
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