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 (http://www.mentalhealthreviewboard.gov.bc.ca 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]

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