Caught Between Care and Control: Confessions of a Nurse Working in the BC Mental Health System

What even is a mental health nurse? The role of a mental health nurse in British Columbia in 2025 is as complex as it is vital. The profession, rooted in compassion and advocacy, finds itself at the crossroads of seismic shifts in health policy, resourcing, and the broader social landscape. Rapid regulatory changes, ongoing crises in workplace safety, and deepening debates about the ethics of involuntary psychiatric treatment have created a reality where nurses are both carers and regulators, advocates and enforcers. Living within these tensions can be deeply challenging and, at times, profoundly disheartening.

The Regulatory Landscape and Coercive Change

Mental health nursing in BC has long been shaped by the province’s Mental Health Act, which mandates both voluntary and, critically, involuntary treatment for people experiencing mental health crises. Recent years have seen increased scrutiny and revision of this legal framework, with the language and practice of “protection,” for both patients and the public, justifying expansions in the use of coercion for those deemed vulnerable, incapable, or dangerous. These changes reverberate through every aspect of daily practice.

Expanded Authority for Involuntary Treatment: Nurses are more than ever involved in authorizing and delivering involuntary care, including administering medications without consent, enforcing seclusion or restraint, and overseeing treatment under “extended leave” provisions. While intended safeguards are in place, they can often be insufficient, leaving nurses wrestling with the ethics of their role.

Policy Focus on Risk: The language of risk, both to clients and the wider community, tends to dominate, sometimes eclipsing narratives of recovery, autonomy, and patient rights. The legitimization of coercive strategies is embedded in daily routines and documentation, subtly incentivizing compliance over collaboration.

A Day in the Life: Professional and Emotional Realities

Workforce Pressures and Safety Concerns

The surge in involuntary admissions, greater complexity of cases, and continued under-resourcing have left many workplaces chronically understaffed and under-supported. According to recent surveys, nearly all nurses in BC report working short-staffed, and rates of verbal and physical abuse have spiked, over 50% have experienced violence in the workplace each month. Exposure to emotional trauma, weapons, and illicit substances is now part of the backdrop for many psychiatric nurses.

Burnout and Retention: The psychological and physical toll of this environment is immense. Large numbers of nurses report symptoms consistent with post-traumatic stress disorder, and more than one-third are seriously contemplating leaving the profession or actively making plans to do so.

Moral Distress: The feeling of being forced to act against one’s values—whether by restraining a patient, upholding a policy seen as unjust, or lacking the resources needed to provide quality care—has become a regular feature of practice.

Coercion in Focus: Substance Use and Return-to-Work Policies

Beyond patient care, coercive trends extend to nurses themselves. Substance use policies for nurses in BC have come under fire for their punitive and dehumanizing nature. Nurses who experience substance use issues often sign stringent monitoring agreements with their employers or licensing body as a condition of keeping their jobs. Critics argue these contracts are based on stigma and fear, rather than evidence, and risk pushing highly-qualified professionals out of the field. Instead of support, nurses feel isolated, surveilled, and stripped of the basic autonomy accorded to other citizens.

Navigating the Ethics of Consent and Autonomy

Mental health nurses are acutely aware of the power they hold—and the moral complexities embedded in it. The erosion of patient consent, formalized in statute and reinforced by workplace culture, sits in stark contrast with the traditional nursing ethos of partnership, empowerment, and self-determination.

Patient Advocacy Versus Systemic Compliance: Some nurses persistently advocate for the rights of service users—informing patients of their rights, pushing for timely review of involuntary status, and modeling collaborative decision-making wherever possible. Others, feeling the weight of institutional expectation, default to a more rigid compliance model, rarely questioning or contesting policies that constrain patient autonomy.

Cultural Safety and Equity: There is a growing (but still often aspirational) commitment to antiracist and culturally safe practice. Indigenous nurses and clients, long marginalized by the current approach, remain at heightened risk of coercion and rights violations. Educational programs and recruiting pathways, launched with the hope of promoting cultural humility, are a small corrective but systemic barriers linger.

The Emotional Terrain: Resilience and Hope Amid Uncertainty

Despite the daily challenges, mental health nurses in British Columbia continue to find meaning and resilience in their work. The formation of therapeutic relationships, however fleeting or constrained by the system, is a source of hope—for both nurse and client. Many nurses lean on each other for support, share hard-won strategies for de-escalation, and participate in advocacy coalitions that push for reform on issues ranging from workplace violence to equitable substance use policies.

Reimagining Nursing’s Role: Some are reimagining what it means to be a mental health nurse within a coercive system, not as passive functionaries but as critical insiders, working to bend the arc toward justice from within.

Advocacy for Reform: There is an urgent call for legislative, regulatory, and cultural change. Nurses are advocating for better safety measures, more humane substance use policies, and an overhaul of the Mental Health Act to restore true informed consent and autonomy.

So, What Now? 

It is 2025, and being a mental health nurse in British Columbia means living with constant contradiction. You are both protector and enforcer, advocate and agent of the state. The coercive changes underway, while often justified as necessary for safety and care, risk undermining the very heart of what draws people to mental health nursing: respect for autonomy, dignity, and the healing power of relationship. Yet, within this fraught terrain, mental health nurses continue to persist, adapt, and advocate for a future in which coercion is the exception, not the norm. The work is hard, the stakes are high, and the need for change is urgent.