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 years of age or older can ask to be admitted for treatment to a psychiatric unit in a general hospital or a psychiatric hospital in British Columbia. If a doctor who examines that person and believes the person needs psychiatric treatment, that person can be admitted hospital. People under the age of 16 need a parent or guardian to apply on their behalf.

Hospitals can only treat voluntary patients if the patient consents to the specific treatment. If they are incapable of consenting, someone else can act as a temporary substitute decision maker (a “TDSM”) to consent for them. In order of priority, a TDSM could be their spouse, child, parent, brother, sister, grandparent, grandchild, any other person related to them by birth or adoption, a close friend, or a person immediately related to them by marriage. 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. Consult script 428 on “Adults and Consent to Medical Care”, for details on consenting to medical treatment and substitute consent. Also consult script 426 on “Committeeship”, and script 180 on “Power of Attorney and Representation Agreements”.

What if a voluntary patient wants to leave the hospital? To leave a hospital, voluntary patients need only inform the nursing staff that they wish to be discharged, and in most cases that person will be free to leave. However, 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 that person’s will are stricter. A person can become an involuntary patient via a doctor’s certificate or via court order. As well, the police can take a person to hospital in an emergency—discussed later in this script.

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 the 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 that person doesn’t want to be hospitalized or treated. However, the doctor must believe the person needs to be hospitalized for psychiatric treatment, to prevent substantial mental or physical decline, or to protect that person or others. The suspected mental disorder must seriously impair the person’s ability to react appropriately to their environment or to get along with others, though the person does not have to be dangerous to others to be admitted involuntarily.

2. Court order Anyone, including family members and neighbours, who reasonably believes a person has a mental disorder that requires hospitalization for the safety of that person or others can apply to the court for an order to have that person hospitalized. Also, the court can issue a warrant that allows the police to take the person to hospital for assessment.

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 at 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 keep a mentally ill person in 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 a hospital unless a doctor discharges that person either permanently or on extended leave. Also, a doctor can change that person’s status to voluntary, allowing the person to leave as they please. If an involuntarily admitted patient wants to leave the hospital and his or her doctor won’t discharge that person, the patient (or someone acting for them) can ask a panel of the Mental Health Review Board to review the decision to keep them in hospital. Panels and reviews are explained in the next section. The Review Board is independent of government in making its decisions.

Some involuntary patients may leave 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 Mental Health Review panel review their hospitalization after they are involuntarily admitted and after each renewal of their hospitalization. This process is not automatic, as the patient (or someone acting for them) must request the review by completing an application form, available on the Board website (www.mentalhealthreviewboard.gov.bc.ca), at the Board office (accessible via telephone at 604.524.7220), or at the hospital itself.

A panel of three people (including 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 Review Board receives the application, depending on how long the person in question is being hospitalized for. A patient has the right to have a lawyer, friend, or advocate speak on their behalf.

Following review of the application, the panel decides whether the hospital should keep or release the patient. If the patient is not satisfied with the panel’s decision, he or she 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 legally and procedurally complicated, and the assistance of a lawyer is highly recommended.

Where can you get more information?

Check the website of the Mental Health Review Board for detailed information. Seek help from a health professional, a lawyer, or the Mental Health Law Program at the Community Legal Assistance Society—call 604.685.3425 in the lower mainland or 1.888.685.6222 elsewhere in BC. Check the Ministry of Health website. 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 May 2015]

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This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Jack Montpellier.