Difference between revisions of "Hospitalizing a Mentally Ill Person"

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{{Dial-A-Law TOC|expanded = health}}
{{Dial-A-Law TOC|expanded = health}}
Anyone who wants psychiatric help can ask to be admitted to hospital for psychiatric treatment. The BC ''[http://www.bclaws.ca/civix/document/id/complete/statreg/96288_01 Mental Health Act]'' also allows authorities to send people to hospital even if they don’t want to go. This script explains both cases.
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.  


==Voluntary admission to hospital==
==Understand the legal framework==
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 believes the person needs psychiatric treatment, that person can be admitted to hospital. People under the age of 16 need a parent or guardian to apply on their behalf.


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'' (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.  
===If someone asks to be admitted to a mental health facility===
In BC, the ''[https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-288/latest/rsbc-1996-c-288.html#sec20_smooth 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.  


The TDSM could also be the adult’s ''representative or committee'' (a person appointed by court to make personal, medical, legal, and financial decisions for someone who is mentally incapable and cannot make those decisions). Script [[Adults and Consent to Health Care (Script 428)|428]] on “Adults and Consent to Medical Care”, has details on consenting to medical treatment and substitute consent. Script [[Committeeship (Script 426)|426]] explains committees and script [[Power of Attorney and Representation Agreements (Script 180)|180]] explains powers of attorney and representation agreements.
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.


==What if a voluntary patient wants to leave the hospital?==
====Treatment of a voluntary patient====
To leave a hospital, voluntary patients need only to inform the nursing staff that they want 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.
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.


==Involuntary admission to 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). Our information on [[Adults and Consent to Medical Care (Script 428)|adults and consent to medical care (no. 428)]] has details on consenting to medical treatment and substitute consent. We explain what is a [[Power of Attorney and Representation Agreements (Script 180)|representative (in no. 180)]] and [[Committeeship (Script 426)|committee (in no. 426)]].
The rules for hospitalizing a person against that person’s 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—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.  
====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.


==1. Doctor’s certificate==
===To admit someone to a hospital against their will===
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.  
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.


==2. Court order==
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.
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==
====Through a doctor’s certificate====
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.
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 ''[https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-288/latest/rsbc-1996-c-288.html#sec22_smooth 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.


==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 keep a mentally ill person 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 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 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 their doctor won’t discharge them, 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.
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 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.  
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 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 [http://www.mentalhealthreviewboard.gov.bc.ca/ Board website], at the Board office (phone 604.660.2325), or at the hospital.  


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.  
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 reviews the application and decides whether the hospital should keep or release the patient.  
===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.  


==Applying to court==
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.
Under [http://www.bclaws.ca/civix/document/id/complete/statreg/96288_01#section33 section 33] of the ''Mental Health Act'', a patient or a person acting for them can apply to BC supreme court for an order that a person not be apprehended or that they be discharged from a facility. It’s a complicated area and patients should get legal advice if they want to do this.


==More information==
===Involuntary patients cannot leave the hospital on their own===
* Check the [http://www.mentalhealthreviewboard.gov.bc.ca/ Mental Health Review Board website].  
An involuntary patient cannot leave a hospital unless a doctor discharges them either permanently or on extended leave.
* Seek help from a health professional, a lawyer, or the Mental Health Law Program at the [http://www.clasbc.net/ 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 [http://www2.gov.bc.ca/gov/content/health/managing-your-health/mental-health-substance-use website on mental health].
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 (at [https://www.bcmhrb.ca/ bcmhrb.ca]), 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===
Under [https://www.canlii.org/en/bc/laws/stat/rsbc-1996-c-288/latest/rsbc-1996-c-288.html#sec33_smooth 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.
 
==Get 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.
:Telephone: 604-685-3425 in the Lower Mainland
:Toll-free: 1-888-685-6222
:Web: [http://www.clasbc.net/ clasbc.net]
 
===More information===
The '''BC government'''’s website includes information and options for support on mental health issues.
:Web: [http://gov.bc.ca/mentalhealth gov.bc.ca/mentalhealth]




Line 60: Line 89:
[updated October 2017]
[updated October 2017]


'''The above was last edited by John Blois.'''
'''The above was last reviewed for legal accuracy by Diana Juricevic, Mental Health Review Board.'''
 
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Revision as of 06:46, 14 February 2019

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.

Understand the legal framework

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). Our information on adults and consent to medical care (no. 428) has details on consenting to medical treatment and substitute consent. We explain what is a representative (in no. 180) and committee (in no. 426).

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 (at bcmhrb.ca), 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.

Get 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.

Telephone: 604-685-3425 in the Lower Mainland
Toll-free: 1-888-685-6222
Web: clasbc.net

More information

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

Web: gov.bc.ca/mentalhealth


[updated October 2017]

The above was last reviewed for legal accuracy by Diana Juricevic, Mental Health Review Board.



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