Mental Health Act: Involuntarily Admitted Patients (14:VII)

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by the Law Students' Legal Advice Program on 31 July 2026.

Patients admitted to a mental health facility without their consent are admitted involuntarily. The MHA provides mechanisms for both short-term and long-term admissions. The HCCFA or the Representation Agreement Act and all of their requirements regarding consent to treatment do not apply to the psychiatric treatment of involuntarily admitted patients. Therefore, involuntarily admitted patients have relatively few legislated rights.

Section 22(1) of the MHA provides that a person may be admitted involuntarily and detained for up to 48 hours on completion of one involuntary patient certificate (Form 4.1 of the BC MHR). The person must be examined by a doctor, and the doctor must provide a medical certificate stating they are of the opinion that the person has a mental disorder which requires treatment to prevent “the substantial mental or physical deterioration” of the person or to protect that person or others. Per section 22(2), a second doctor must provide a second certificate (Form 4.2 under the BC MHR) if the person is to be detained for longer than the initial 48 hours and up to one additional month.

The leading case in this area, Mullins v Levy 2009 BCCA 6 [Levy] at paras 105–110, applied a broad definition of “examination”, stating that the MHA does not require a personal interview of the patient in every instance. However, a patient is entitled to request a Review Panel hearing after the second certificate is completed, in accordance with section 25 of the MHA. The involuntary detention can be renewed for subsequent periods of one, three, and six months. The involuntarily detained patient has a right to apply for a Review Panel hearing within each renewal period.

When the patient is re-evaluated, the facility must determine whether the involuntary admission criteria still apply and whether there is a significant risk that, if the patient is discharged, they will be unable to follow the prescribed treatment plan and be involuntarily admitted again in the future.

The MHA also allows involuntarily committed patients to be granted leave or extended leave under certain conditions, as authorized by their doctor. This means that the patient may be permitted to live outside of the facility, but they will still be considered to be involuntarily committed and will remain subject to the provisions of the MHA.

CLAS’s Mental Health Law Program (MHLP) assists involuntarily admitted patients that qualify for Legal Aid BC by providing representation at Mental Health Review Board (Review Panel) hearings. The IRAS can inform those facing involuntary detain of their rights under the MHA.

A. Restraint and Seclusion While Detained Under the MHA

British Columbia’s MHA is silent on the issues of restraint and seclusion. Section 32 provides that every patient detained under the MHA is subject to the discipline of the director and staff members of the designated facility. Issues surrounding restraint and seclusion have yet to be thoroughly considered in BC, and there are few cases in Canada that address them. In Levy, the plaintiff sued a hospital and its staff for negligence, false imprisonment, and battery after he was detained and medicated for five days against his wishes when doctors decided he required treatment for mania. Although the plaintiff argued that his Charter rights were violated and challenged the MHA and the HCCFA as unconstitutional, the Court did not rule on the Charter arguments. The plaintiff’s claim was denied at the BC Court of Appeal on factual grounds, and the Supreme Court of Canada declined to hear his appeal.

In this context, provincial policy plays an important role. The Provincial Quality, Health & Safety Standards and Guidelines for Secure Rooms in Designated Mental Health Facilities provide direction on the use of seclusion. Although these guidelines are not legally binding, they may establish a standard of care and could be relevant in medical negligence or institutional liability claims.

This leaves the patient’s rights in the hands of facility policymakers. Such policy focuses on the benefits seclusion may provide a patient for treatment, and regard is given to the safety of hospital staff. The uncertainty of the law in this area, combined with a serious potential for the deprivation of patients’ rights, leaves open the possibility of a Charter argument to uphold patients’ rights in the future.

B. Short-Term, Long-Term, and Emergency Admissions

Under section 12 of the HCCFA, a patient may be given emergency treatment and may be admitted without consent in case of emergencies under section 24. However, per section 2(b), the HCCFA ceases to apply to any patient who is involuntarily admitted under the MHA.

Short-term apprehension and emergency detention under the MHA often develop into longer-term involuntary admissions. A person can be admitted to a facility by the director of a provincial health facility on receipt of two medical certificates (Forms 4.1 and 4.2 under the MHR) completed in accordance with section 22(2), (3), and (5). Form 4.1 can be completed by either a physician or nurse practitioner, whereas Form 4.2 must be completed by a physician within 48 hours of 4.1 being filled out. The patient will be discharged one month after admittance unless the detention is renewed (Form 6 under the MHR) in accordance with section 24 of the MHA.

1. Authority of a Police Officer

If a police officer believes a person has an apparent mental disorder and is acting in a manner likely to endanger that person’s own safety or the safety of others, the police officer may apprehend the person and take them to a physician or nurse practitioner for examination and potential admission to a psychiatric facility for examination by a physician at the facility. (MHA, s 28(1)).

A person apprehended under section 28(1) of the MHA must be released if a physician or nurse practitioner does not complete a medical certificate in accordance with the involuntary admissions provisions of the MHA.

2. Authority of a Provincial Court Judge

Anyone may apply to a Provincial Court judge for a warrant authorizing an individual’s involuntary admission to a mental health facility for a period not exceeding 48 hours. To grant this warrant, the judge must be satisfied that the applicant has reasonable grounds to believe that the section 22(3)(a)(ii) and (c) of the MHA describe the condition of the individual, and that involuntary admission without a warrant would cause unreasonable delays.

C. Contents of Medical Certificates (MHA, s 22 (3))

The certificates must contain:

1. A physician’s or nurse practitioner’s statement that

a) the individual was examined on the date or dates set out, and

b) the physician or nurse practitioner is of the opinion that the person to be admitted has a mental disorder;

2. An explanation of the reasons for this opinion; and

3. A separate statement that the physician or nurse practitioner believes the individual requires medical treatment in a provincial mental health facility

a) to prevent the person’s substantial mental or physical deterioration,

b) to protect the person, or to protect others, and

c) that the individual cannot be suitably admitted as a voluntary patient.

For involuntary admission to be valid, the physician or nurse practitioner who examined the person must sign the medical certificate (Form 4.1) and must have examined the patient not more than 14 days prior to the date of admission. For a second medical certificate (Form 4.2) to be valid, it must be completed within 48 hours of the patient’s admission. The MHA does not provide guidance about the type of examination required, nor does it require that the patient be informed of the purpose of the examination or that the examination is even being conducted. This practice has been the subject of a Charter challenge in the past, but the case was dismissed for other reasons (see Levy).

The MHA undergoes frequent revisions, which may affect the list of requirements with respect to medical certificates needed for involuntary admissions. Please consult the Table of Legislative Changes to see updates on the MHA.

D. Consent to Treatment

The Council of Canadians with Disabilities v. British Columbia (Attorney General), 2026 BCSC 1416 [CCD] decision invalidates the use of section 8 for consent — 6 months suspension period at the time of writing. This means section 8 may continue to apply until either the suspension date passes or the government amends the MHA. The impact of the decision remains unclear at the time of writing and users of this guide should be aware that there are likely to be amendments or new legislation in the coming year. For Further information see section IV.J: The Charter above.

Under section 8 of the MHA, a patient who is involuntarily detained can receive treatment given with the authority of the director. The director’s authorization will override any decisions made by a patient’s committee, personal guardian, temporary substitute decision maker, or representative. The director’s authorization of treatment through section 8 has replaced the previous usage of ‘deemed consent.’ The former ‘deemed consent’ provisions were repealed during the course of the CCD litigation.

Each patient should have a Form 5 which outlines their approved treatment plan. Form 5 should itemize the level of treatment, therapies, and different drugs the patient receives.

Prior to CCD decision which found section 8 invalid, there was an untested legal theory that if the patient receives treatment that was not on listed their Form 5, there was a potentially a claim for battery. Following the CCD decision, it is arguable that any treatment provided under section 8 could be considered battery.

It is worth noting that the CCD decision does not impair the authority to detain a person under the Mental Health Act. It only affects forced treatment without consent.

An involuntary patient, or someone acting on their behalf, may request a second medical opinion on the appropriateness of the treatment authorized by the director. Under section 31(2), a patient may request a second opinion once during each detention period. Under section 31(3), upon receipt of the second medical opinion, the director need only consider whether changes should be made in the authorized treatment for the patient.

E. Right to Treatment

The CCD decision has found the use of section 8 for consent invalid, but as the decision is suspended, the previous mechanism using section 8 is still apparently in place at time of writing. Users of this guide should be aware that there are likely to be amendments or new legislation in the coming year.

Section 8 of the MHA requires directors to ensure patients are provided with “treatment appropriate to the patient’s condition and appropriate to the function of the designated facility.” However, what constitutes “appropriate treatment” is not clearly set out by the MHA, leaving the parameters uncertain. It is unclear what would constitute a failure to provide treatment, and whether a facility would be bound to discharge a patient should a failure be found.

A patient held without any treatment whatsoever may be able to claim civil damages on the basis of non-administration of treatment, constituting a breach of a statutory duty. Decisions regarding what amounts to appropriate treatment fall within the discretion of the institution. However, it is important to note that the common law of medical malpractice applies to treatment administered in a mental health facility, thus imposing certain limitations on that discretionary power. Nurses and Staff are not liable if they are providing treatment that was specified on form 5.

F. Right to be Advised of One’s Rights

Pursuant to section 34 of the MHA and Form 13 under the MHR, directors must inform patients orally and in writing of their section 10 Charter rights and of the MHA provisions relating to duration, review, and renewal of detention, review hearings, deemed consent and requests for second opinions, and court applications for discharge. Directors are bound to ensure that patients are able to understand these rights.

Under Part 5 of the MHA, involuntarily admitted individuals can meet with and access support from an independent rights advisor through IRAS if they request it. This service is available in treatment facilities across BC (see Section II.B.3: Resources for contact information).

G. Transfer of Patients or Extended Leave

Section 35 of the MHA gives the director authority to transfer a patient from one facility to another when the transfer is beneficial to the welfare of the patient. Under section 37, a patient may be given leave from the facility; the MHA specifies no minimum or maximum periods. Often conditions are given to the patient that they must follow to be continue being allowed leave. There is not a limit on how stringent or relaxed the conditions should be.

Under section 38, a patient may also be transferred to an approved home under specific conditions. Section 38 does not appear to have been put into use and no homes have been approved for this purpose thus far.

A person released from a provincial mental health facility on leave or transferred to an approved home is still considered to be admitted to that facility and held subject to the same provisions of law as if they were continuing to reside at the mental health facility (MHA, s 39(1)). The patient is still detained under the MHA and will be subjected to treatment authorized by the director, which is still deemed to be given with the consent of the patient. If the conditions of the leave or transfer are not met, the patient may be recalled to the facility they are on leave or were transferred from, or they may be sent to another authorized facility (MHA, s 39(2)). There is no statutory obligation on the facility to inform the patient that the leave is conditional or has expired, raising the possibility that a patient may unknowingly violate the terms of their leave.

When a person is recalled from an extended leave that has lasted six months or longer, under s 39(4) they would need to be admitted under s 22(1), meaning only Form 4.2 would need to be completed for admission, and Form 4.1 would continue to apply from their previous detention.

A patient released into the community on extended leave has the right to speak to an independent rights advisor when they are considering applying for a Review Panel hearing.

Under section 25(1.1), if a patient has been on leave or in an approved home for more than 12 consecutive months without a request for a review panel hearing, their treatment record must be reviewed by the Mental Health Review Board. If the Mental Health Review Board believes there is a reasonable likelihood that the patient could be discharged, a Review Panel must be conducted. In practice, however, the Review Panel ordinarily contacts the patient to ask if they would like a hearing.

H. Discharge of Involuntary Patients

1. Through Normal Hospital Procedure

The director, or their delegate such as the treating psychiatrist, may discharge or grant leave to a person from an institution at any time (MHA, ss 36(1) and 37). Under section 23, “a patient admitted under s 22 may be detained in a provincial mental health facility for one month after the date of their admission, and they shall be discharged at the end of that month unless the authority for their detention is renewed in accordance with s 24”.

S 24 requires that a doctor review the involuntary patient’s certificates at regular intervals and decide whether they wish to renew the certificate of involuntary patient status by completing a Form 6 Medical Report on Examination of Involuntary Patient (Renewal Certificate), or allow the certification to lapse and allow the patient to be discharged. Renewals of involuntary patient status are valid for increasing lengths of time: the first renewal is valid for one month, then three months, and all subsequent renewals for six months at a time

When released, it is recommended the patient request a form 19 certificate of discharge when they are released as is allowed by s 36(3). Form 19 can be useful for the patient to keep records of their treatment.

2. Through a Review Panel Hearing

An involuntary patient is entitled to a Review Panel hearing before a Mental Health Review Board (MHRB). Generally, a patient is entitled to one hearing during each period of involuntary detention. The application for a Review Panel hearing may be made by the patient or by someone acting on the patient’s behalf (MHA, s 25). The application is completed by filling out an “Application for Review Panel Hearing” (Form 7 under the MHR). Section 6 of the MHR sets out the requirements for scheduling a Review Panel hearing.

A Review Panel hearing takes place before a MHRB panel of three people, which, according to section 24.1(3) of the MHA, must include

a medical practitioner or a person who has been a medical practitioner,
a member in good standing with the Law Society of British Columbia or a person with equivalent training, and
a person who is not a medical practitioner or a lawyer.

Under the MHA, the Minister appoints the Chair and all the legal, medical, and community members authorized to sit as MHRB members. The Chair serves full-time, and the members serve part-time. The Chair appoints three members for each Review Panel hearing from the list of people previously chosen by the Minister.

To maintain a quasi-judicial character, it is policy that MHRB members do not have access to the patient prior to the hearing. Decisions are based on evidence and testimony presented at the hearing only. Section 24.3 of the MHA gives the MHRB the power to compel witnesses and order disclosure of information.

The hospital’s position is usually presented by another medical practitioner acting as the hospital’s representative; this case presenter is ordinarily the involuntarily detained person’s attending psychiatrist. The involuntary patient has a right to representation by a lawyer or trained legal advocate who can present the patient’s position at the hearing.

MHRB panellists generally rely on the case presenter and the patient’s counsel to provide documents and evidence during the hearing. However, the MHRB may order disclosure of records that are relevant to making a decision. Under the MHA, the MHRB has the authority to order the production of documents, while the parties appearing before the MHRB have document disclosure obligations under the Rules of Practice and Procedure.

Procedure at review panel hearings is subject to the principles of fundamental justice under section 7 of the Charter and to due process under the common law, as well as the provisions of the Administrative Tribunals Act listed under section 24.2 of the MHA. Patients also must know the evidence that will be presented at the Review Panel hearing with sufficient time in advance of their hearing in order to have an opportunity to prepare a response and challenge that evidence.

The MHRB has also developed its own Rules of Practice and Procedures, and Practice Directions, which are available on the MHRB website.

a) Patients’ Rights at Review Panel Hearings

Legal Representation

If a patient is represented, the MHRB and facility will communicate with the patient representative on all issues regarding the hearing. This representative need not be a lawyer. Representation at a panel is provided free of charge by CLAS’ Mental Health Law Program for those eligible for legal aid (see Section II.B.2: Resources for contact information). There is a section on Form 7 which allows you to ask for representation.

Patients may be represented by advocates from the Mental Health Law Program (MHLP). Patients may also choose to hire a lawyer or ask a family member, friend, or other person to represent them.

Review Panel Hearing Attendance

Most review panel hearings occur by video, via an online platform such as Zoom. Accommodations for disabilities or other reasons that would make a video hearing inappropriate can be sought by application to the Chair.

The principles of fundamental justice dictate that one has a right to appear at one’s own hearing. However, under section 25(2.6) of the MHA, the chair of the Review Panel may exclude the patient from the hearing or any part of it if they are satisfied that exclusion is in the patient’s best interests. This power is rarely exercised; when it is, it is often done in accordance with the patient’s wishes, as Review Hearings may cause a lot of distress.

The patient or counsel can call witnesses to give evidence in support of the patient’s argument for discharge. A patient representative who wants to call a witness must make arrangements for their attendance. A witness may attend in person or by electronic means.

Document Disclosure

Presumptively, patients also have the right to access all documents regarding their hearing prior to the hearing. For self-represented patients, under Rule 15 of the MHRB Rules of Practice and Procedure, the facility must provide the patient adequate time and an appropriate location for document review prior to the hearing.

The Mental Health Review Board Rules of Practice and Procedure are available online.

Facilities have an obligation to disclose copies of all relevant records in their possession or control as early as possible and no later than 24 hours before the start of the hearing, or in exceptional circumstances, no later than 30 minutes prior to the start of the hearing. Facilities’ disclosure obligations are triggered after receiving a hearing notice from the MHRB. If a facility has decided to limit disclosure, it must notify and explain to the patient or their representative the exceptional circumstances that justify limits on disclosure.

Documents obtained through the disclosure process are confidential and must only be used for the purposes of the hearing, except with the consent of the patient, or by order of the MHRB. More information about disclosure can be found online.

A patient representative who wants to refer to a document at a hearing must provide a copy of that document to the facility as early as possible and no later than 24 hours before the start of the hearing, or in exceptional circumstances, no later than 30 minutes prior to the start of the hearing.

Case Note

A facility must provide a written summary of the evidence it intends to present at a hearing to the patient or their representative no later than 24 hours before the start of the hearing, or in exceptional circumstances, no later than 30 minutes prior to the start of the hearing. This summary is known as a case note. When all or part of a hearing proceeds by electronic means, the facility must make every effort to disclose a copy of the case note to the MHRB and any participant no later than 24 hours prior to the scheduled hearing.

Documents to Be Disclosed prior to Review Panel Hearings

Any document referred to or relied on in a case note or by a case presenter is considered a Relevant Document and must be disclosed 24 hours in advance of the hearing. A non-exhaustive list of Relevant Documents may include:

Forms (Forms 4.1, 4.2, 6, 11, 12, 20, and 21)
Medical reports, including attending physician reports
Past admission/discharge notes and summaries
Psychiatric Progress reports
Mental Health Team assessments
Attending physician notes
Therapy notes
Any document that will be referred to or relied on in the case note and presentation

Review Panel Hearing Postponement

A patient or a patient representative may apply to postpone a hearing. Unless the Board otherwise directs, an application to postpone made within two business days of a scheduled hearing must be in writing and state:

(a) why the request is reasonable; and

(b) why granting the request will not unduly prejudice the other participants.

At the request of a patient or patient representative, the Board will reschedule a postponed hearing as soon as reasonably practicable thereafter, but not later than:

(a) 14 days in a one-month certification period; and

(b) 28 days in a three-month or six-month certification period.

Review Panel Decision

Within 48 hours of the hearing, the Review Panel must decide (by majority vote) whether the patient’s involuntary detention should continue. Decisions must be in writing. Reasons must be provided no later than 14 days after the hearing. Section 25(2.9) of the MHA compels the panel to deliver a copy of the decision without delay to the mental health facility’s director as well as to the patient or their counsel. If the decision is that the patient be discharged, the director must immediately serve a copy of the decision on the patient and discharge them.

b) What the Review Panel Must Consider

Involuntary Patient Status

Under section 25(2) of the MHA, the Review Panel is authorized to determine whether the detention of the patient should continue. The patient’s detention must continue if sections 22(3)(a)(ii) and (c) continue to describe the patient. Section 22(3)(a)(ii) requires that the person or patient is a person with a mental disorder.

The MHA defines a person with a mental disorder as a person who has a disorder of the mind that requires treatment and seriously impairs the person’s ability to either react appropriately to the person’s environment or to associate with others. Section 22(3)(c) adds three more criteria that are required for involuntary patient status. That is, the patient is a person with a mental disorder who

(i) Requires treatment in or through a designated facility,

(ii) Requires care, supervision and control in or through a designated facility to prevent the person’s or patient’s substantial mental or physical deterioration or for the protection of the person or patient or the protection of others, and

(iii) Cannot suitably be admitted as a voluntary patient.

A Review Panel hearing must be conducted notwithstanding any defects in authority (Forms 4.1, 4.2, and 6) for the initial or renewed detention pursuant to section 22 of the MHA.

In A.A. v Lions Gate Hospital (Director), 2024 BCSC 464, the BC Supreme Court held that the four criteria above are insufficient for permanent detention of an individual. Rather, the court finds the MHA requires regular reviews to justify and reassess a patient’s status as involuntary. Once one or more of the four criteria are no longer met, a patient can no longer be involuntarily admitted.

For more information about legal practice regarding the MHRB, you can contact CLAS (see Section II.B.2 for contact information)

Compliance with Treatment Plans

The Review Panel must consider the history of the patient, including their past compliance with treatment plans. The panel must assess whether there is a significant risk that the patient will not comply with treatment prescribed by the director. Presumably, if the panel concludes that there is a significant risk that the patient will not comply with the director’s treatment plan, they may conclude that sections 22(3)(a)(ii) and (c) continue to describe the patient. The MHA amendments have made the criteria for detention broader, likely making it more difficult for patients to end their detention under the MHA.

Serious Impairment

Note that the following information is subject to change due to ongoing litigation.

The BC Court of Appeal has held that MHRB Review Panellists must determine whether the legal criteria for involuntary admission are met at the time of the hearing, not at any point in the past (see A.T. v. British Columbia (Mental Health Review Board), 2023 BCCA 283 [A.T.]).

Additionally, the court found the status of “person with a mental disorder” under section 1 of the MHA would be granted if it is demonstrated “the patient have a disorder of the mind, the disorder is one ‘that requires treatment’ and the disorder is one that ‘seriously impairs’ the patient’s ability to react appropriately to their environment or to associate with others.” (A.T. at para 49). This decision affects patients who might be asymptomatic during their review panel hearings but have been experiencing active, seriously impairing symptoms that are likely to manifest again. In addition, an involuntary patient may meet the definition of “person with a mental disorder” when there is a significant risk that they will fail to follow their treatment plan if discharged. It also confirms that a significant risk of not following a treatment plan after discharge may be considered part of the assessment of serious impairment under section 1 of the MHA.

3. Through Court Proceedings

A person may apply to the Supreme Court for a writ of habeas corpus, which is an order requiring a detained person to be brought before a court to evaluate the lawfulness of their detention based on documents used to support the detention. This is most suitable where there were procedural defects in the patient’s admission or defects in the involuntary detention certificates (Forms 4.1, 4.2, and 6 under the MHR). The case AH v Fraser Health Authority, 2019 BCSC 227 is an example of a case involving a writ of habeas corpus. If the Court finds that the detaining authority did not adhere to the statutory requirements for involuntary detention, this may constitute grounds for an action in false imprisonment and civil battery for unauthorized treatment, and the patient may be entitled to an award of damages (Ketchum v Hislop (1984), 54 BCLR 327 (SC)).

Under section 33 of the MHA, a request can be made to the Supreme Court for an order prohibiting admission or directing the discharge of an individual. This request may be made by a person or patient whose application for admission to a mental health facility is made under section 20(1)(a)(ii) or section 22, by a near relative of a person or patient, or by anyone who believes that there is not sufficient reason for the admission or detention of an individual.

I. Escapes from Involuntary Detention

1. Apprehension without a Warrant

A patient involuntarily detained in a mental health facility who leaves the facility without authorization is, within 48 hours of escape, liable to apprehension notwithstanding that there has been no warrant issued (MHA, s 41(6)).

2. Warrant Constituting Authority for Apprehension

Where a person involuntarily detained has been absent from a mental health facility without authorization, the director of the facility may, within 60 days, issue a warrant for apprehension; this warrant serves as authority for the apprehension and conveyance of the person back to the facility (MHA, s 41(1)).

3. Patient Considered Discharged After 60 Days

A patient is deemed to have been discharged if they have been absent from the facility for over 60 days without the issuance of a warrant (MHA, s 41(3)). However, if the patient is “charged with an offence or liable to imprisonment or considered by the director to be dangerous to [themselves] or others,” the person is not deemed discharged and a warrant may still be issued.

4. Aiding Escapees

Under section 17 of the MHA, any person who helps an individual leave or attempt to leave a mental health facility without proper authority, or who does or omits to do any act that assists a person in so leaving or attempting to leave, or who incites or counsels a patient to leave without proper authority, commits an offence under the Offence Act, RSBC 1996, c 338.