Hospitalizing a Mentally Ill Person

Anyone who wants psychiatric help can ask to be admitted to hospital for psychiatric treatment. The BC Mental Health Act also allows authorities to send people to hospital even if they don’t want to go. This script explains both cases.

Voluntary admission to hospital

Anyone 16 or older can ask to be admitted for treatment to a psychiatric unit in a general hospital or a psychiatric hospital. A doctor who examines them and believes they need psychiatric treatment can admit them to hospital. People under 16 need a parent or guardian to apply for them.

Hospitals can treat voluntary patients only if the patient consents to the specific treatment. If they are incapable of consenting, someone else can act as a temporary substitute decision maker (TDSM) to consent for them. It could be their spouse, child, parent, brother or sister, grandparent, grandchild, a person related to them by birth or adoption, a close friend, or a person immediately related to them by marriage—in that order. The TSDM must be at least 19 years old, must get along with the patient, and must have been in contact with the patient in the past 12 months.

The decision maker could also be the adult’s representative or committee. Check script 428, called “Adults and Consent to Medical Care”, for details on consenting to medical treatment and substitute consent. Also check scripts 426, called “Committeeship” and 180, called “Power of Attorney and Representation Agreements”.

What if a voluntary patient wants to leave the hospital?

Voluntary patients can just tell the nurse in charge that they want to leave (or be discharged), and in most cases, they’ll be free to go. The hospital may ask the person to sign a “Discharge against Medical Advice” form.

Involuntary admission to hospital

The rules for hospitalizing a person against their will are stricter. A person can become an involuntary patient by doctor’s certificate or court order. As well, the police can take a person to hospital in an emergency—see below for details.

While a voluntary patient may be admitted to any hospital with psychiatric services, involuntary patients can be admitted only to certain hospitals in BC. If a hospital doesn’t have a bed available, they may not be able to admit a person. In that case, the person would be sent, under supervision, to another hospital that has room.

1. Doctor’s certificate

This is the most common way people are hospitalized against their will. A doctor who believes a person has a mental disorder, as defined in the Mental Health Act, can complete a certificate to admit the person to hospital, even if the person doesn’t want to be hospitalized or treated. The doctor must believe the person needs to be hospitalized for psychiatric treatment, to prevent substantial mental or physical decline, or to protect the person or other people. The mental disorder must seriously impair the person’s ability to react appropriately to their environment or to get along with others. The person does not have to be dangerous to be admitted involuntarily.

2. Court order

Anyone, including family members and neighbours, who reasonably believes a person has a mental disorder and needs to be hospitalized can apply to court. The court can issue a warrant that allows the police to take the person to hospital, where they will be assessed.

3. Police action in an emergency

The police can act in an emergency when family members or health professionals need help getting a person to see a doctor. If the police believe a person has a mental disorder and their behaviour is likely to endanger their own safety or the safety of others, the police can immediately take the person to a doctor—usually in a hospital. If the person needs to be hospitalized, a doctor will complete a certificate to admit them.

How long can involuntarily patients be kept in hospital?

A doctor’s certificate to send a mentally ill person to hospital is valid for up to 14 days prior to admission. Involuntary patients can be kept in hospital for only 48 hours after they are admitted, based on one doctor’s certificate. To keep the patient longer, the hospital must get a second doctor to examine the patient and produce a second certificate within the 48 hours. The patient is then certified and can be kept for up to one month. That term may be renewed for another month, then three months, then six months, and then every six months—each time with a doctor’s certificate based on an examination and written report. The examination must conclude that the criteria for involuntary admission continue to be met.

The hospital director must give the patient written and oral notice that they are being hospitalized—at the start of the hospitalization and at each renewal of it. If the director believes that the patient does not understand the notice, the director must give the notices again as soon as they think the patient can understand it. The written notice must also go to the patient’s near relative (which includes a representative). If there’s no information available on a relative, then the notice must go to the Public Guardian and Trustee.

Can involuntary patients be treated without their consent?

Yes, because they may not understand or realize that they need psychiatric treatment. If they refuse treatment or are incapable of consenting, the hospital director consents to treatment for them. The patient (or a family member or someone else acting for them) can ask for a second medical opinion on whether the treatment is appropriate.

Can involuntary patients leave the hospital on their own?

No—an involuntary patient cannot leave the hospital unless their doctor discharges them (lets them go) permanently or on extended leave, or changes their status to voluntary. If they want to leave the hospital and their doctor won’t discharge them, they (or someone acting for them) can ask a panel of the Mental Health Review Board (the Board) to review the decision (panels and reviews are explained in the next section). The Board is independent of government in making its decisions.

Some involuntary patients leave the hospital on extended leave and still have involuntary outpatient treatment that the hospital director authorizes. These patients have the right to periodic hearings by a panel—as if they had stayed in the hospital as involuntary patients.

How do reviews work?

Involuntary patients have the right to have a Board panel review their hospitalization—after they are involuntarily admitted and after each renewal of their hospitalization. It’s not automatic—they (or someone acting for them) have to ask for it. To do that, the patient (or someone acting for them) must complete an application form available on the Board website (www.mentalhealthreviewboard.gov.bc.ca), at the Board office (call 604.524.7220), and at the hospital.

A panel of three people (a medical doctor, a lawyer, and a person who is not a doctor or lawyer) performs the review. The panel must hold a hearing within 14 to 28 days after the Board receives the application, depending on how long the person is being hospitalized for. A patient has the right to have a lawyer, friend, or advocate speak for them.

The panel decides whether the hospital should keep or release the patient. A patient can apply to court for judicial review of the panel’s decision. A patient can also bypass a review hearing and go directly to court. In both cases, the procedures are complicated, so they’ll need a lawyer.

Where can you get more information?

• Check the website of the Mental Health Review Board (www.mentalhealthreviewboard.gov.bc.ca) for detailed information.
• Seek help from a health professional, a lawyer, or the Mental Health Law Program at the Community Legal Assistance Society (www.clasbc.net) — call 604.685.3425 in the lower mainland or 1.888.685.6222 elsewhere in BC.
• Check the Ministry of Health website at www.healthservices.gov.bc.ca/mhd. Specifically, see the “Guide to the Mental Health Act” under the “Mental Health Act” link.
• The Mental Health Act is available at www.bclaws.ca.

[updated September 2013]

---

---

In law, to formally deliver documents to a person in a manner that complies with the rules of court. Service may be ordinary (mailed or delivered to a litigant's address for service), personal (hand-delivered to a person), or substituted (performed in a way other than the rules normally require). See "address for delivery," "ordinary service," "personal service" and "substituted service."

In family law, the natural or adoptive father or mother of a child; may also include stepparents, depending on the circumstances and the applicable legislation; may include the donors of eggs or sperm and surrogate mothers, depending on the circumstances and the terms of any assisted reproduction agreement. See "adoptive parent," "assisted reproduction," "natural parent" and "stepparent."

(1) A person charged with the legal care of someone under a legal disability. (2) A term under the Family Law Act referring to a person, including a parent, who is responsible for the care and upbringing of a child through the exercise of parental responsibilities. See "disability," "parental responsibilities" and "parenting time."

(1) Intentionally doing a thing, or (2) a law passed by a government, also called "legislation" or a "statute." See "regulations."

In law, (1) a judge's conclusions after hearing argument and considering the evidence presented at a trial or an application, (2) a judgment, or (3) the judge's reasons. A judge's written or oral decision will include the judge's conclusions about the relief or remedies claimed as well as their findings of fact and conclusions of law. A written decision is called the judge’s "reasons for judgment." See "common law," "conclusions of law" and "findings of fact."

(1) Agreement, or (2) the giving of permission for a thing to happen or not happen.

Under the Divorce Act, either of two people who are married to one another, whether of the same or opposite genders. Under the Family Law Act, spouse includes married spouses, unmarried parties who have lived together in a marriage-like relationship for at least two years, and, for all purposes of the act other than the division of property or debt, unmarried parties who have lived together for less than two years and have had a child together. See "marriage" and "marriage-like relationship."

A person who is younger than the legal age of majority, 19 in British Columbia. See "age of majority."

In family law, the act or process of taking another person's child as one's own. The child becomes the adopting parent's legal child as if the child were the adopting parent's natural child, while the natural parent loses all rights and obligations with respect to the child. See "natural parent."

A legal relationship between two persons, whether of the same or opposite genders, that is solemnized by a marriage commissioner or licenced religious official and gives rise to certain mutual rights, benefits, and obligations. See also "conjugal rights," "consortium," and "marriage, validity of."

A mandatory direction of the court that is binding and enforceable upon the parties to a court proceeding. An "interim order" is a temporary order made following the hearing of an interim application. A "final order" is a permanent order, made following the trial of the court proceeding or the parties' settlement, following which the only recourse open to a dissatisfied party is to appeal. Failing to abide by the terms of an order may constitute contempt of court. See "appeal," "consent order," "contempt of court," "decision" and "declaration."

Under the Family Law Act, a term that describes the time a person who is not a guardian of a child, including a parent who is not a guardian, has with that child. Under the Divorce Act, a term that describes the time a person who is not a married spouse has with a child. See "guardian" and "parental responsibilities."

(1) In law, a court proceeding; a lawsuit; an action; a cause of action; a claim. (2) A historic decision of the court; case law. See "action," "case law, " "court proceeding," and "precedent."

A court proceeding in which one party sues another for a specific remedy or relief, also called a "lawsuit" or a "case." An action for divorce, for example, is a court proceeding in which the claimant sues the respondent for the relief of a divorce order.

In law, (1) a lawyer's advice to their client, (2) a lawyer's analysis of a legal problem, or (3) the views of an expert on an issue in an action. See "expert evidence" and "opinion evidence."

In law, the re-examination of a term of an order or agreement, usually to determine whether the term remains fair and appropriate in light of the circumstances prevailing at the time of the review. In family law, particularly the review of an order or agreement provided for the payment of spousal support. See "de novo," "family law agreements," "order" and "spousal support."

A request to the court that it make a specific order, usually on an interim or temporary basis, also called a "chambers application" or a "motion." See also "interim application" and "relief."

A person licensed to practice law in a particular jurisdiction by that jurisdiction's law society. See "barrister and solicitor."

In law, any proceeding before a judicial official to determine questions of law and questions of fact, including the hearing of an application and the hearing of a trial. See "decision."

(1) A lawyer or a person other than a lawyer who helps clients with legal issues, or (2) to argue a position on behalf of someone.

In family law, a legal document in which a person gives up a right or a claim, or the entitlement to enforce a right or advance a claim; a waiver. Releases are usually signed following the settlement of a court proceeding or legal dispute. See "action" and "claim."