Difference between revisions of "Hospitalizing a Mentally Ill Person"

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{{REVIEWEDPLS | reviewer = Diana Juricevic, Mental Health Review Board |date= October 2017}} {{Dial-A-Law TOC|expanded = health}}
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Anyone who wants help with a mental illness can ask to be admitted to a facility for treatment. The law also allows people to be involuntarily admitted in certain situations.


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.
==What you should know==


==Voluntary admission to hospital==
===If someone asks to be admitted to a mental health facility===  
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.
In BC, [https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-288/latest/rsbc-1996-c-288.html#sec20_smooth the ''Mental Health Act''] is the law that describes what happens when someone who is living with a mental illness needs treatment and protection for themselves or others. Under this law, anyone aged 16 or older can ask to be admitted to a “designated mental health facility.” There are several dozen treatment centres and hospital psychiatric units in the province designated under this law.


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.
If a doctor who examines the person believes they have a mental disorder requiring treatment, the person can be admitted to hospital. People under the age of 16 need a parent or guardian to apply on their behalf.


The decision maker could also be the adult’s representative or committee. Check script [[Adults and Consent to Medical Care (Script 428)|428]], called “Adults and Consent to Medical Care”, for details on consenting to medical treatment and substitute consent. Also check scripts [[Committeeship (Script 426)|426]], called “Committeeship” and [[Power of Attorney and Representation Agreements (Script 180)|180]], called “Power of Attorney and Representation Agreements”.
====Treatment of a voluntary patient====
Mental health facilities can treat voluntary patients only if the patient consents to the specific treatment. If the patient is incapable of consenting, someone else can act as a '''temporary substitute decision maker''' (TSDM) to consent for them. In order of priority, a TSDM 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.


==What if a voluntary patient wants to leave the hospital?==
The TSDM could also be the adult’s '''representative''' (appointed under a representation agreement) or '''committee''' (appointed by the court to make personal, medical, legal and financial decisions). We have information on [[Adults and Consent to Health Care|consent to medical treatment and substitute consent]]. We also explain [[Powers of Attorney and Representation Agreements|what is a representative]] and [[Committeeship|a committee]].
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==
====If a voluntary patient wants to leave the facility====
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.
To leave a mental health facility, a voluntary patient need only inform the facility staff they want to be discharged. In most cases the patient will be free to leave. The facility may ask them to sign a '''discharge against medical advice''' form.


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.
===To admit someone to a hospital against their will===
The rules for hospitalizing a person against their will are stricter. A person can become an '''involuntary patient''' through a doctor’s certificate or a court order. As well, the police can take a person to hospital in an emergency.


===1. Doctor’s certificate===
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.
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===
====Through a doctor’s certificate====
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.
The most common way people are hospitalized against their will is through a '''doctor’s certificate'''. A doctor who believes a person has a '''mental disorder''', [https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-288/latest/rsbc-1996-c-288.html#sec22_smooth as defined in the ''Mental Health Act''], can complete a certificate to admit the person to hospital, even if they don’t want to be hospitalized or treated. The doctor must believe the person:


===3. Police action in an emergency===
* Is suffering from a mental disorder that seriously impairs their ability to react appropriately to their environment or to associate with others.
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.
* Requires psychiatric treatment in a designated facility.
* Requires care and supervision in a facility to prevent the person’s substantial mental or physical deterioration or to protect themselves or others.
* Is not suitable to be a voluntary patient.


==How long can involuntarily patients be kept in hospital?==
The person does not have to be dangerous to others to be admitted involuntarily.
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.
====Through a court order====
Anyone, including family members and neighbours, who reasonably believes a person has a mental disorder that requires hospitalization for the safety of themselves or others can apply to court for an '''order''' to have the person hospitalized. Also, the court can issue a warrant allowing the police to take the person to hospital for assessment.


==Can involuntary patients be treated without their consent?==
====Police action in an emergency====
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.
The police can act in an emergency to take a person to a doctor for examination. 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 can complete a certificate to admit them.


==Can involuntary patients leave the hospital on their own?==
===How long involuntary patients can be kept in hospital===
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.
A doctor’s certificate to keep a person with a mental disorder in hospital is valid for up to 14 days before admission. Involuntary patients can be kept in hospital for '''only 48 hours''' after they are admitted, based on one doctor’s certificate.


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.
To keep the patient longer, the hospital must get a second doctor to examine the patient and produce a second doctor’s certificate within the 48 hours. The patient can then be kept for up to '''one month'''.


How do reviews work?
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.
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 hospital director must give the patient written and oral notice they are being hospitalized — at the start of the hospitalization and at each renewal of it. If the director believes the patient does not understand the notice, the director must give the notice again as soon as they consider the patient is capable of understanding 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.


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.
===Involuntary patients can be treated without their consent===
If an involuntary patient refuses treatment or is incapable of consenting, the hospital director can consent to treatment for them. The director must complete a consent for treatment form.


==Where can you get more information?==
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.
*Check the website of the Mental Health Review Board ([http://www.mentalhealthreviewboard.gov.bc.ca 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 ([http://www.clasbc.net 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 [http://www.healthservices.gov.bc.ca/mhd 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 [http://www.bclaws.ca www.bclaws.ca].


===Involuntary patients cannot leave the hospital on their own===
An involuntary patient cannot leave a hospital unless a doctor discharges them either permanently or on extended leave.


[updated September 2013]
A doctor can change an involuntary patient’s status to voluntary, allowing the patient to leave as they please.


If an involuntarily admitted patient wants to leave the hospital and their doctor won’t discharge them, the patient (or someone acting for them) can ask for a review of the decision to keep them in hospital. We explain this process next.


----
===Involuntary patients can request a review of their hospitalization===
----
Involuntary patients have the right to have a panel of the Mental Health Review Board '''review their hospitalization''' after they are involuntarily admitted and after each renewal of their hospitalization. The patient (or someone acting for them) must request the review by completing an application form, [https://www.bcmhrb.ca/ available on the Review Board website], from the Review Board office (phone 604-660-2325), or at the hospital.


The Mental Health Review Board is independent of government in making its decisions. 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 is being hospitalized for. A patient has the right to have a lawyer, friend, or advocate speak for them. After the hearing, the Review Board panel makes a decision on whether the hospital should keep or release the patient.


{| class="wikitable"
|align="left"|'''Tip'''
An involuntary patient may be discharged from hospital on extended leave on the basis they follow outpatient treatment. These patients have the right to periodic hearings by a Review Board panel — as if they had stayed in the hospital as involuntary patients.
|}
===Applying to court to be discharged from a hospital===
[https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-288/latest/rsbc-1996-c-288.html#sec33_smooth Under section 33 of the ''Mental Health Act''], a patient or a person acting for them can apply to court for an order that the patient be discharged from a mental health facility. The application is brought to BC Supreme Court. This is a complicated area of law and patients should get legal advice if they want to do this.
==Who can help==
===With your case===
The '''Community Legal Assistance Society''' (CLAS), through their Mental Health Law Program, provides representation to people who have applied to review their involuntary detention under the ''Mental Health Act'' at a hearing before the Mental Health Review Board.
* Call 604-685-3425 (Lower Mainland) or 1-888-685-6222 (toll-free)
* [https://clasbc.net/ Visit website]
===More information===
The '''Mental Health Review Board''' conducts reviews of hospitalizations after a person is involuntarily admitted and after each renewal of their hospitalization.
* Call 604-660-2325
* [https://www.bcmhrb.ca/ Visit website]
The '''BC government'''’s website includes information and options for support on mental health issues.
* [http://gov.bc.ca/mentalhealth Visit website]
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Latest revision as of 00:25, 8 October 2020

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Diana Juricevic, Mental Health Review Board in October 2017.

Anyone who wants help with a mental illness can ask to be admitted to a facility for treatment. The law also allows people to be involuntarily admitted in certain situations.

What you should know

If someone asks to be admitted to a mental health facility

In BC, the Mental Health Act is the law that describes what happens when someone who is living with a mental illness needs treatment and protection for themselves or others. Under this law, anyone aged 16 or older can ask to be admitted to a “designated mental health facility.” There are several dozen treatment centres and hospital psychiatric units in the province designated under this law.

If a doctor who examines the person believes they have a mental disorder requiring treatment, the person can be admitted to hospital. People under the age of 16 need a parent or guardian to apply on their behalf.

Treatment of a voluntary patient

Mental health facilities can treat voluntary patients only if the patient consents to the specific treatment. If the patient is incapable of consenting, someone else can act as a temporary substitute decision maker (TSDM) to consent for them. In order of priority, a TSDM 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 TSDM could also be the adult’s representative (appointed under a representation agreement) or committee (appointed by the court to make personal, medical, legal and financial decisions). We have information on consent to medical treatment and substitute consent. We also explain what is a representative and a committee.

If a voluntary patient wants to leave the facility

To leave a mental health facility, a voluntary patient need only inform the facility staff they want to be discharged. In most cases the patient will be free to leave. The facility may ask them to sign a discharge against medical advice form.

To admit someone to a hospital against their will

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

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.

Through a doctor’s certificate

The most common way people are hospitalized against their will is through a doctor’s certificate. 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 they don’t want to be hospitalized or treated. The doctor must believe the person:

  • Is suffering from a mental disorder that seriously impairs their ability to react appropriately to their environment or to associate with others.
  • Requires psychiatric treatment in a designated facility.
  • Requires care and supervision in a facility to prevent the person’s substantial mental or physical deterioration or to protect themselves or others.
  • Is not suitable to be a voluntary patient.

The person does not have to be dangerous to others to be admitted involuntarily.

Through a court order

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

Police action in an emergency

The police can act in an emergency to take a person to a doctor for examination. 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 can complete a certificate to admit them.

How long involuntary patients can be kept in hospital

A doctor’s certificate to keep a person with a mental disorder in hospital is valid for up to 14 days before 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 doctor’s certificate within the 48 hours. The patient can then 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 they are being hospitalized — at the start of the hospitalization and at each renewal of it. If the director believes the patient does not understand the notice, the director must give the notice again as soon as they consider the patient is capable of understanding 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.

Involuntary patients can be treated without their consent

If an involuntary patient refuses treatment or is incapable of consenting, the hospital director can consent to treatment for them. The director must complete a consent for treatment form.

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.

Involuntary patients cannot leave the hospital on their own

An involuntary patient cannot leave a hospital unless a doctor discharges them either permanently or on extended leave.

A doctor can change an involuntary patient’s status to voluntary, allowing the patient to leave as they please.

If an involuntarily admitted patient wants to leave the hospital and their doctor won’t discharge them, the patient (or someone acting for them) can ask for a review of the decision to keep them in hospital. We explain this process next.

Involuntary patients can request a review of their hospitalization

Involuntary patients have the right to have a panel of the Mental Health Review Board review their hospitalization after they are involuntarily admitted and after each renewal of their hospitalization. The patient (or someone acting for them) must request the review by completing an application form, available on the Review Board website, from the Review Board office (phone 604-660-2325), or at the hospital.

The Mental Health Review Board is independent of government in making its decisions. 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 is being hospitalized for. A patient has the right to have a lawyer, friend, or advocate speak for them. After the hearing, the Review Board panel makes a decision on whether the hospital should keep or release the patient.

Tip

An involuntary patient may be discharged from hospital on extended leave on the basis they follow outpatient treatment. These patients have the right to periodic hearings by a Review Board panel — as if they had stayed in the hospital as involuntary patients.

Applying to court to be discharged from a hospital

Under section 33 of the Mental Health Act, a patient or a person acting for them can apply to court for an order that the patient be discharged from a mental health facility. The application is brought to BC Supreme Court. This is a complicated area of law and patients should get legal advice if they want to do this.

Who can help

With your case

The Community Legal Assistance Society (CLAS), through their Mental Health Law Program, provides representation to people who have applied to review their involuntary detention under the Mental Health Act at a hearing before the Mental Health Review Board.

  • Call 604-685-3425 (Lower Mainland) or 1-888-685-6222 (toll-free)
  • Visit website

More information

The Mental Health Review Board conducts reviews of hospitalizations after a person is involuntarily admitted and after each renewal of their hospitalization.

The BC government’s website includes information and options for support on mental health issues.

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