Mental Health Act

BC MHA Guide Summarized.docx


Voluntary Admission

Most hospitals just admit voluntary patients under HOSPITAL ACT vs MENTAL HEALTH ACT, in which case you don’t need any forms.


Age < 16, “Voluntary” (guardian wants, patient doesn’t want)

Section 20 (1) (a) (ii) of the Act

Legal decision-making rests with legal guardian (unless “mature minor” under Infants Act).

If guardian wants admission but child DOES NOT, it’s technically “voluntary” (though child is going involuntarily)

  • These admissions are under Mental Health Act to protect patient’s rights (e.g. regular reviews, access to Review Panel, etc)

  • Need:

    • Form 1 (Request for Voluntary Admission), filled by guardian

    • Form 2 (Consent for Voluntary Treatment), filled by guardian

    • Form 3 (Medical Report, Exam for < 16), filled by MD

  • Basically, a “non-cert” certification for this case

    • i.e. an “I agree with parents this patient has a mental illness and needs admission”

Age < 16, Voluntary (guardian wants, patient wants)

If guardian wants admission AND CHILD WANTS, regular voluntary admission. Still recommend under Mental Health Act

    • i.e. need Form 1 and 2.

Patient is voluntary, when do you admit as INVOLUNTARY anyway?

Patient too ill to be legally capable to request admission or consent to treatment, or if risks too great if they decide to leave.

Involuntary Admission

Criteria: Information must be based on exam, but can include collateral:

  1. Suffering from a MENTAL DISORDER that seriously IMPAIRS the person’s ABILITY TO REACT appropriately to his or her environment or to ASSOCIATE with others;

  2. Requires psychiatric treatment in or through a designated facility;

  3. Requires care, supervision and control in or through a designated facility to prevent the person’s substantial mental or physical deterioration or for the person’s own protection or the protection of others; and

    • protection can be from harms that relate to “social, family, vocational, or financial life” (section 2, page 9, guide to MHA)

  4. Not suitable as a voluntary patient


3 ways to arrange:

  1. Physician’s – Form 4

  2. Police – Section 28

  3. Judge -

METHOD 1 (Physician): 1st Form 4

  • 14 day window: MD must sign form, and patient must be admitted within, 14 days of examination

  • Legal authority to admit for 48 hrs from ADMISSION time (from the chart), NOT from when form signed

  • If certified in community, anyone has the right to bring patient in (police, EHS, family). If acting in good faith, people who assist have legal protections against liability (Section 16)

  • Patient must meet ALL criteria

  • “Examination” can include observation if patient refuses


METHOD 2 (Police): Section 28(1) of MHA

  • Not an arrest, no crime required, police do not need a warrant to enter private dwelling

  • Criteria: person is “likely to endanger their safety or the safety of others”

  • This “safety” element is a higher standard to meet than the criteria used by physicians

  • Information can be from observation or others

  • Danger must be secondary to mental disorder

METHOD 3 (Judge)

  • Provincial Court judge or justice of the peace can sign a Form 10 (Warrant)

  • Need to apply for one by Form 9 (Application for Warrant)

  • Then all peace officers can apprehend patient

GIVE FORM 16 TO NEAR RELATIVE

  • Also applies to patients < 16 admitted by guardian

Treatment

  • Regular mental health treatment

  • Certification is for “psychiatric treatment” and includes “any procedure necessarily related to the provision of psychiatric treatment”. Not medical treatment.

  • If capable, need to listen to patient

  • If incapable, need to use Health Care (Consent) and Care Facility (Admission) Act

  • Voluntary needs Form 2 (if using MHA, and not using regular hospital admission)

  • Involuntary needs Form 5

  • EMERGENCY treatment

  • Section 12(1) gives authority to provide urgent/emergency care (including restraint) without consent to adults if:

  • Necessary without delay to preserve life, prevent serious physical/mental harm (self/others), or to alleviate severe pain

  • Adult impaired by drugs/alcohol, reduced consciousness for any reason, or otherwise incapable of giving/refusing consent

  • No authorized SDM available

  • Need and incapability confirmed by second health care provider (if possible)

  • Common law recognizes this applies to any age

Patient and Relative Rights

The Mental Health Act does not address these issues. The Freedom

of Information and Protection of Privacy Act allows patients access to

their medical file information unless:

• to do so “could reasonably be expected to result in immediate and

grave harm to the (patient’s) safety or mental or physical health”;

• to do so “could reasonably be expected to threaten anyone else’s

safety or mental or physical health or interfere with public safety”.

Unless the third party gives permission, third party information

must be deleted from the copy of the file the patient is allowed to

see.


The patient’s consent is normally required to release medical

information to relatives or others. However, there are exceptions.

For example, information may be released if the purpose for the

release is the same as or consistent with the purpose for which the

information was collected.


This might enable a person involved in a patient’s care to obtain the information on a “need to know” basis to provide care. Compelling

circumstances that affect someone’s health or safety may also be

reason enough to permit release of the information. (See Appendix

13)

Involuntary Care

RENEWAL PERIODS

  • 48 hrs, +1 month, +1 month, +3 months, +6 months

    • ie

        • 1. Form 4 #1 --> 48 hrs

        • 2. Form 4 #2 --> 1 month

    • AFTER THIS, Form 6s for all other periods

        • 3. Form 6 #1 --> 1 month

        • 4. Form 6 #2 --> 3 months

        • 5. Form 6 #3 --> 6 months

  • ADMISSION date is the key date upon which all future forms are based on

    • When forms are signed has NOTHING TO DO WITH RENEWAL DATES (not the first F4, renewal F6, etc)

    • “Months” are based on calendar month minus one day, ending at midnight. NOT by days (ie not + 30 or 31 days).

    • I.e. Involuntary admission date = March 15

      • +1 month (first) of hospitalization = March 15 to April 14, “midnight” (11:59)

      • +1 month (second one) of hospitalization = April 15 to May 14 midnight

      • +3 months of hospitalization = May 15 to Aug 14 midnight

      • +6 months of hospitalization = Aug 15 to Feb 14 midnight

When there is no corresponding date in the month the period ends, the Interpretation Act directs that the last day of that month be used.

In the example of a month starting on January 31, the one month period of hospitalization will end at midnight on February 28 (or 29 in a leap year), with the next period beginning on March 1. From that point, all further renewal periods would take effect from the 1st of the month in perpetuity. The calculation reverts to the original rule in that there will always be a corresponding day in the next month.


WHEN TO EXAMINE FOR RENEWAL

  • Within ONE MONTH before period ends

  • Consider:

    • History of mental disorder, of hospitalizations, of compliance in community

    • Risk of deterioration and re-hospitalization due to non-compliance

WHICH FORMS

    • Form 4s used for ADMISSION

    • Then Form 6 for RENEWALS

    • New form does not activate on date of signing; starts after the last form ends

    • Looks like:

        • 1. Form 4 #1 --> 48 hrs

        • 2. Form 4 #2 --> 1 month

        • 3. Form 6 #1 --> 1 month

        • 4. Form 6 #2 --> 3 months

        • 5. Form 6 #3 --> 6 months


ALSO CHECK:

  • Form 5 (consent to treatment) – make sure a valid one is there

  • Form 13 (right’s advice) – explain rights at each renewal, provide Form 13, file in health record

  • Form 14 for patient < 16 admitted by guardian (“voluntary”)

  • Form 15 (nomination of near relative) – provide if requested, file copy in chart

  • Form 11 (second opinion) – if requested, make available

  • Track review panel requests

Involuntary care - Leaves

< 14 days = therapeutic leave

  • Written permission required

  • Hospital still responsible for care

> 14 days = extended leave

  • Form 20 required

  • Liaise with community (“accepting”) physician

  • Patient does not HAVE to sign

  • Community physician takes over care

  • Don’t need a new Form 20 unless:

    • Conditions change

    • Physician changes

    • Admitted to hospital and discharged again on extended leave

EXTENDED LEAVE RECALLS

  • Form 21 issued

  • IF 6 MONTHS OR MORE ON EXTENDED LEAVE…

    • Date of recall becomes NEW involuntary admission date

    • All calculations and renewals reset (+1, +1, etc) and use this date

    • Don’t need new Form 4’s (the 48 hr ones) to admit this recalled patient, though you do give Form 13/14 (right’s advice)

  • If LESS THAN 6 MONTHS…

    • No new forms, involuntary status continues, renewals keep time periods as previous

  • If new Form 4s issued accidentally, can disregard

  • * Note: does NOT count as a recall if, while on extended leave:

    • patient taken to hospital for routine administration of a prescribed psychiatric medication

    • patient presents to hospital for a medical issue unrelated to the person's mental health (e.g. has a COPD exacerbation)

Involuntary Care - Review Panels

  • Inform near relative using Form 18

  • Can be applied for by adults or the “voluntary” < 16s (ie, guardian admitted them, they are involuntary)

  • Hearing happens:

    • within 14 days of application receipt for 1 month periods

    • within 28 days of application receipt for 3+ month periods

  • So long as 90 days since last hearing:

    • Can apply for Review Panel following each renewal (Review Panel Chair can shorten this at their discretion)

    • You CAN re-certify a patient after the Review Panel discharges (Greggor v. Riverview Hospital), but you’d have to document pretty specific circumstances


Involuntary care - AWOLs

  • < 48 h, cops can bring back without warrant

  • < 60 days, Form 21 can be issued for cops to bring back

  • After 60 days, person considered discharged unless the director issues a warrant (Form 21) because one of the conditions are met:

    • Patient was charged with an offence

    • Patient is liable to imprisonment

    • Patient is considered to be a danger to self or others

    • Subjective note: I guess how this differs from the < 60 day situation is the criteria, ie here you can warrant for crime stuff, and you can NOT warrant for deterioration

For kids admitted by parents (“voluntary”):

  • If emergency, cops can bring back

  • If non-emergency, can bring back if patient is certified

  • As usual, by MD who has seen them within 14 days, pt must be admitted within 14 days of that exam

Involuntary care - Discharge

  • Make sure you give FORM 17 (notification of discharge of involuntary patient) to near relative

Mental Health Forms