Opinion: Vancouver’s tragedy underscores the tension between mental health and criminal justice

With 11 people dead and 13 still in hospital (including four in critical condition as of late last week), the Lapu-Lapu festival deaths are an enormous tragedy for the families affected, the local Filipino community, and the larger Canadian public, left reeling from the fallout of the violent attack.

A suspect with a long history of mental illness and numerous interactions with police is going to spark some difficult and long-overdue conversations, particularly at a time when there have been ever-louder demands for mandatory treatment for people living with severe mental illness and/or substance-use disorders.

B.C. Premier David Eby has already promised an overhaul of the provincial Mental Health Act. He has also committed to a public inquiry after the criminal trial of the accused, Kai-Ji Adam Lo.

That’s if there is a criminal trial. The suspect, who suffers from schizophrenia, could enter a plea of “not criminally responsible on account of mental disorder.”

So far, Mr. Lo has made one brief court appearance. The judge ordered a psychiatric assessment to determine if he’s fit to stand trial.

There have long been complex and often uncomfortable tensions between mental health and criminal justice issues, and a case like this one promises to lay them bare.

Here’s what we know so far about Mr. Lo’s interactions with police and the mental health system prior to the deadly attack he is alleged to have perpetrated: Over the past two decades, the 30-year-old suspect has had more than 100 interactions with police, but he did not have a criminal record. He is now charged with eight counts of second-degree murder for the April 26 attack.

Most of the police interactions were initiated by Mr. Lo – meaning he called the police, making all kinds of claims. This is evidence of paranoia and delusion, common symptoms of untreated schizophrenia. Let’s not forget that, in B.C., about one-third of all police calls are related to dealing with people with mental health issues.

The most recent call Mr. Lo made to police was the day before the festival attack.

We know he was involuntarily hospitalized at least twice, once in 2023 and again in 2024 after his brother was murdered. That event seems to have triggered a deterioration in the state of his mental health. There are reports Mr. Lo resisted taking his medication.

At the time of the alleged attack, Mr. Lo was on “extended leave,” meaning he was detained under the terms of the Mental Health Act, but supervised in the community rather than hospitalized.

Details have not yet emerged as to how strict or frequent that supervision was, but the system will be under intense scrutiny. Who was responsible for monitoring?

Postmedia has reported that the day of the attack, a member of Mr. Lo’s family called a local psychiatric facility to say he needed help. We don’t know (yet) what the response was.

The case has already exposed some hard truths – first and foremost that timely access to mental health treatment is hard to come by, even when you’re already under court-ordered care, and your family begs for help.

In B.C. alone, there are about 3,000 people on extended leave. If we’re going to treat many more involuntarily (especially those living on the streets with addiction), where exactly are they going to be treated? Who is going to oversee their mandatory treatment in a mental health system that’s already overwhelmed?

There is also the inconvenient reality that people have rights. Time and time again, the courts have ruled that people can refuse care.

B.C.’s Mental Health Act was first adopted in 1964, at a time when mass deinstitutionalization was under way. The law is designed to ensure that people under active psychosis can be hospitalized and treated – briefly.

It was not written for a current reality, where some people live with a complex combination of severe mental illness, addiction and brain damage. Many of them need long-term care, not a revolving door.

While governments are vowing to make involuntary treatment easier, advocacy groups are challenging already lax laws for being too harsh.

A constitutional challenge of B.C.’s Mental Health Act, for example, has been before the courts for a decade, and proceedings will resume later this month.

Should we have the freedom to be sick? Or the right to be well? Are safe streets a right?

Getting the balance right between protecting sick people from harming themselves and others, and respecting their right to not be incarcerated for being ill, is a tricky one.

But we must get it right. Because when we get it wrong, the price paid is sometimes senseless slaughter.