RESOURCES & INFORMATION

What families need to know

Accessing treatment can be challenging, so BCSS provides a wide range of information, tools, and resources to help families understand and navigate the Mental Health Act.

• Criteria for Involuntary Admission

  The BC Mental Health Act exists to help someone with an apparent serious mental illness who refuses to obtain necessary treatment. Families should encourage their loved one to obtain treatment voluntarily. However, with some illnesses, the person cannot be persuaded to accept treatment voluntarily. The only alternative is involuntary admission and treatment under the BC Mental Health Act.

  A person can only be admitted involuntarily if a physician finds that the person meets all of the following four criteria:

  1. Meets the definition of a mental disorder: “disorder of the mind that requires treatment and seriously impairs the person’s ability  (a) to react appropriately to the person’s environment, or (b) to associate with others”).
  2. Is at risk of deterioration or harm: “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.”
  3. Requires psychiatric treatment: “requires [psychiatric] treatment in a designated facility.”
  4. Is not suitable as a voluntary patient.

  Note: The concept of “protection” in #2 above can refer to different types of harm, not just physical danger. Included is harm “that relates to the social, family, vocational or financial life of a patient.”

  It is helpful to provide a copy of Section 22 of the Mental Health Act, which sets out the admission criteria above, as well as a copy of Form 4 from the Guide to the Mental Health Act, to a physician, judge, or justice of the peace, in case they are not familiar with the BC Mental Health Act.

• OPTIONS FOR OBTAINING INVOLUNTARY ADMISSION

  If a person is unwilling to undergo voluntary examination and admission, there are three options for obtaining involuntary admission. We advise attempting them in the following order, if possible:

  1. Physician: You may be able to have a mental health team physician visit the ill person, or persuade the person to see a general practitioner, or take the ill person to the emergency department of a hospital. This is the best way of proceeding, but if there is any concern about physical danger, the police have the authority to intervene.
  2. Police: If there is an urgent situation or a likelihood of violence apparently as the result of mental illness, call 911 and ask for police assistance.The Mental Health Act states that: “A police officer or constable may apprehend and immediately take a person to a physician for examination if satisfied from personal observations, or information received that the person (a) is acting in a manner likely to endanger that person’s own safety or the safety of others, and (b) is apparently a person with a mental disorder”.The police officer may work with a crisis mental health team, but this is not necessary. Police officers are trained to understand this as part of their duty to serve and protect. The ill person is usually escorted to the emergency room of any hospital for examination by a physician.
  3. Judge or Justice of the Peace: When direct examination by a physician or police intervention is not possible, a provincial court judge (or a justice of the peace if a judge is not available) can help.If there are reasonable grounds to believe that the physician criteria apply, anyone, including a family member, may use Form 9 from the Guide to the Mental Health Act to apply to a judge for an order to apprehend the ill person. If the judge agrees, a warrant is issued for the police to take the person to hospital for a physician examination.If a person is concerned about backlash from the person with the illness, Form 9 provides guidance to the judge. If the written application could “reasonably be expected to result in harm to your safety or mental or physical health, you may ask the judge for permission to present your information verbally instead of completing this form, or for restrictions on the release of the information that forms the basis of this application”. We advise you to consult with someone who is knowledgeable about this process.

• Admission and Stay at Psychiatric Unit

  When admission to a psychiatric unit is being considered, families can provide important collateral information to the physician, police officer, or judge involved.

  It helps to use the following headings to make notes of symptoms and behaviours as they happen:

  1. Symptoms of a mental disorder: hallucinations, delusions, depression, irrational thoughts, etc.
  2. Prevention of mental or physical deterioration: previous episodes and similar symptoms that are recurring or developing (e.g., not-adherence to medications, not eating, etc.).
  3. Need for protection of self or others: threats, paranoid delusions, deteriorating physical condition, irrational waste of money, the likelihood of losing job or family, suicidal thoughts or gestures, etc.
  4. Need for psychiatric treatment: previous diagnosis and treatment and current symptoms that may indicate a need for psychiatric reassessment.
  5. Unwillingness to accept voluntary treatment: you or others have tried to persuade the person to see a physician for examination and assessment but were unsuccessful.

  In a crisis, you may want to also seek advice or observations from a mental health clinic, family doctor, hospital psychiatric unit, police, urgent care teams, etc.

  The first physician’s certificate admits the patient for up to 48 hours. The second certificate holds the patient for up to one month. After this, the certificate must be renewed.

  During the admission process, information about the patient’s rights is provided to the patient and a near relative. This includes how to access the Review Panel, how to obtain a lawyer, how to request a second opinion on treatment, etc.

  Families can often provide the physician with important information about the efficacy of previous treatments, problems with side effects, the patient’s preferences, etc.

  Treatment is authorized by the patient if the patient is capable and in agreement with the treatment or by the Director if the patient is incapable.

  If a family has a Representation Agreement including treatment preferences, it can be considered, but it does not apply to treatment under the Mental Health Act. That decision is made by the director of the psychiatric unit on the advice of the treating physician.

• Discharge and Extended Leave

  Physician Discharge: A person who does not meet admission criteria must be discharged. However, discharging physicians must consider whether “there is a significant risk that the patient, if discharged, will as a result of the mental disorder fail to follow the treatment plan … necessary to minimize the possibility that the patient will again be detained under section 22”. The person discharged from involuntary status can continue as a voluntary patient if the physician agrees.

  Review Panel Discharge: A review panel uses the same criteria as a discharging physician.

  Extended Leave (Compulsory Community Treatment)

  “Extended Leave” is available under the BC Mental Health Act and can help people adhere to their treatment plan in the community.

  Section 37 of the Mental Health Act states: “if the director considers that leave would benefit a patient detained in a designated facility, the director may release the patient from the designated facility providing appropriate support exists in the community to meet the conditions of the leave”.

  The patient must continue to meet admission criteria, with renewal examinations following the same time periods as for inpatients. Responsibility for certificates can be delegated to community physicians who are part of a community mental health team.

  If the extended leave conditions are broken, the patient returns to the hospital.

  Families can recommend to an authorizing physician that a patient be put on extended leave, especially if relapses recur due to not taking medication. Families can also provide information regarding the conditions of extended leave and may participate in monitoring medication and compliance with other conditions (e.g., safe and stable residence, regular physician care, etc.).

• REVIEW PANEL AND OTHER RIGHTS

  If a patient wants to be discharged from hospital or from extended leave against their physician’s advice, the patient (or anyone else acting on the patient’s behalf) can appeal to a Review Panel. If the appeal is successful, the patient must be released.

  A Review Panel includes a lawyer, a physician, and a person who is neither. All are independent of the hospital. Patients and their near relative are informed of their right to a Review Panel hearing on admission.

  Details on how families can be involved with a Review Panel hearing if they oppose the desire of the patient to be released can be found on the Review Board website.

  If a patient appeals to the Review Panel, the near relative (often a family member) is informed of the date of the hearing. Family members who want to provide information in support of further detention of the patient must contact the attending physician.

  In addition to providing information relevant to involuntary admission, a family member may have important information for the Review Panel. The Mental Health Act states:

  “A hearing by a review panel must include:

  (a) consideration of all reasonably available evidence concerning the patient’s history of mental disorder including (i) hospitalization for treatment, and (ii) compliance with treatment plans following hospitalization, and

  (b) an assessment of whether there is a substantial risk that the discharged patient will as a result of the mental disorder fail to follow the treatment plan the director or a physician authorized by the director considers necessary to minimize the possibility that the patient will again be detained under section 22.”

  The “near relative” receives notice of admission, review panel application, discharge, and rights. They may exercise rights on the patient’s behalf for the following:

  • renewal certificate examinations
  • second opinion on appropriateness of treatment plan (patient or family request)
  • review panels or courts for discharge

• Confidentiality

  Family members often have knowledge about the patient that would be helpful for clinicians responsible for admission, treatment plans, or discharge planning. Conversely, family members often need information from the medical team because the family is usually involved with supporting the person after discharge. If a patient consents to this information exchange, the clinician has authority to comply.

  Sometimes a clinician will not provide information because the patient has not given specific consent. However, the Freedom of Information and Protection of Privacy Act allows for the following: “Public bodies [clinicians] may release necessary personal information to third parties without the consent of the client where disclosure is required for continuity of care or for compelling reasons if someone’s health or safety is at risk.”

  Some clinicians believe that patient confidentiality is absolute. They are unaware of important exceptions pertaining to the Freedom of Information and Protection of Privacy Act. Reference to Appendix 13 of the Guide to the Mental Health Act can help physicians better understand these important legal exceptions. When everyone has the facts, essential information can flow both ways, allowing clinicians and families to work together to provide the best possible care and support for the patient.

  Note: The Mental Health Act refers to a “near relative” who receives rights and other information. A patient can appoint anyone as a “near relative” including non-relatives. If no one is appointed by the patient, a person may be appointed by the physician from a list of relatives. It is possible that the closest relative (e.g., wife or husband) may not be appointed as the “near relative” by the patient even though that person is also the caregiver. The Guide to the Mental Health Act points out that physicians may also send notices to family members who have not been appointed as a “near relative”.