top of page
Search
Writer's pictureAngie Raza

Navigating Mental Health Care: Understanding the Mental Health Act and healthcare system to support your loved one.




Police, ‘sectioned’, hospital, Mental Health Act, ‘certified’… these terms and systems can seem overwhelming and scary, not to mention difficult to understand in a time of crisis. Unfortunately, it is usually in these times of crises and high emotion when children/youth/families have to begin to understand these systems and how to navigate them. To better comprehend these relevant terms and services, this article will break down the steps and systems that a youth may encounter when suicidal.


How to get to the hospital?

If your loved one is willing to have you take them to the hospital, that may be the best option as they remain in constant contact with someone they trust, may feel more in control of this decision, can walk into the hospital willingly, and possibly be admitted voluntarily under the Mental Health Act as well. 


However, if you’re loved one refuses to go to the hospital and remains actively suicidal and refusing to safety plan, it may be necessary to call police for assistance. If a police officer believes that your loved one “(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”, they “may apprehend and immediately take a person to a physician or nurse practitioner for examination”. This protocol is outlined in section 28, ‘Emergency Procedures’ of the Mental Health Act. When police take a person to a hospital for a psychiatric assessment under these criteria, they may refer to this person as being “sectioned”. Please keep in mind, police will likely attend the residence in uniform and require the person struggling with their mental health to be in the backseat of the police car while handcuffed, and on their own for safety reasons. Consider your child’s behaviour and willingness to comply to determine which form of transport is the most appropriate way for your loved one to arrive at the hospital.


Psychiatric Assessment and the Mental Health Act

Upon arrival at the hospital, the child/youth and parent/police officer will meet with a triage nurse who will gather some general information about the child/youth and brief summary of the events upon hospital presentation. After registering as a patient, the triage nurse will request a physician to see the patient. During this waiting period, the child/youth is either in the care of the parent or of the police officer. The police officer cannot leave until the physician has done an initial psychiatric assessment. Once the physician initiates the assessment, this is the moment the patient’s care is transferred from the police officer to the physician.


As per the Mental Health Act and Guide to the Mental Health (2005), “Young persons 16 years of age or over are regarded as adults if they are mentally capable to admit themselves to hospital and give consent for treatment. Children under age 16 may be admitted by their parent or guardian as voluntary patients under the Mental Health Act if the admitting physician and director agree. Form 1, Request for Admission (Voluntary Patient), must always be filled out by the parent or guardian. This is also the case for Form 2, Consent for Treatment (Voluntary Patient), assuming that the child does not qualify as a “mature minor” under the Infants Act.” A ‘mature minor’ is a child under the age of 19 who can provide informed consent to treatment as long as they can demonstrate understanding of the risks and benefits of treatment, in agreement with the physician’s opinion.

Typically, if the patient attends the Emergency department, they will be seen by the Emergency Physician (not necessarily a psychiatrist). The physician will initiate an involuntary admission under the Mental Health Act if the physician is of the opinion that the patient:

  1. has a disorder of the mind that requires treatment and which seriously impairs the person’s ability to react appropriately to his/her environment or to associate with others

  2. requires treatment in or through a designated facility,

  3. 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

  4. cannot suitably be admitted as a voluntary patient.

When all these criteria have been met, the physician or nurse practictioner will document their opinion of each criteria on a Form 4.1 – First Medical Certificate. This form allows for detainment and/or transfer to a designated facility where they can obtain psychiatric treatment if the current facility does not offer psychiatric care. When the Form 4.1 has been completed, this is often referred to as being ‘Certified’ or ‘Certified x1’. The Form 4.1 can keep a patient detained and treated for up to 48 hours. Once at a designated facility, a second physician can be requested to conduct another psychiatric assessment if it is believed the patient will likely need a longer stay than 48 hours. This second physician is often an ER physician or psychiatrist. Again, if the second physician/psychiatrist believes the patient continues to meet all four criteria, they will fill out a Form 4.2 - Second Medical Certificate. This is often referred to as being ‘Certified x2’  and can keep the patient in hospital up to a month from the initial admission date.


Once the involuntary admission process has been initiated (ie. After the physician has completed the First Medical Certificate Form 4.1), the physician and director delegate (an authorized person who can give consent on behalf of the government/Mental Health Act) will complete the Form 5 – Consent to Treatment. This form outlines the psychiatric care that the patient will receive. It will outline psychiatric medications, intrusive interventions (ie. sedative, restraints, Clonazapine, ECT), and describe any other relevant psychiatric treatment. The physician creates the treatment plan while the Director Delegate consents to fair process.


Clinical staff (ie. bedside nurse, social worker, etc.) will meet with the patient to read them their rights on Form 13/14 – Notification to Involuntary Patient of Rights/Notification to a Patient Under Age 16, Admitted by a Parent or Guardian. Patients will be given the opportunity to sign the form consenting that they heard their rights, if they wish. Clinical staff will inquire with the patient of whom they would like to be informed of their involuntary hospital admission under the Mental Health Act. If the patient does not wish to volunteer this information, often staff will appoint a contact listed as the ‘Person to Notify’ or ‘Next of Kin’. If there is nobody to nominate, the Public Guardian and Trustee will be appointed. Once this information has been recorded on the Form 15 – Nomination to a Near Relative, this contact information will be transferred onto the Form 16 – Notification to a Near Relative. This Form 16 will be signed off by a Director Delegate and the original will be mailed off to the near relative identified on the form. If the near relative is a contact who is accompanying/visiting the patient at the hospital, this form may be handed to them directly. This form outlines the patient’s rights, as well as ways to advocate for the patient if needed.

Once all five forms have been filled out, the Involuntary admission is complete. Unlike medical care under the Health Care Consent and Care Facility Admission Act, psychiatric care is solely directed by the physicians/psychiatrists. There is no process to elect a ‘Temporary Substitute Decision Maker’ in terms of guiding treatment decisions. Family and patients can volunteer information and their wishes, however the treatment plan is determined by the physicians/psychiatrists. If the physician/psychiatrist believes that the patient will need a longer course of treatment in hospital, they may choose to renew the involuntary hospitalization status by completing a Form 6. 


As noted on the Form 13 (Notification of Involuntary Patient Rights) and Form 16 (Notification to a Near Relative), a patient can request a second medical opinion from another physician about the treatment plan and they can apply for a Review Panel or appeal to court to challenge the hospital admission for potential discharge.


Each day the patient will be reassessed to ensure that they still meet the criteria as an involuntary patient. If not, the patient may be able to be de-certified and transitioned as a voluntary patient which will require new forms to be completed. The patient may be decertified and discharged home. If the psychiatric team believes that the imminent risk has reduced and could benefit from returning to their routines in the community, however the patient remains mildly to moderately unwell and could be at risk of deteriorating if left unsupervised and discharged from the hospital, they may choose to release the patient from hospital on Extended Leave.  A Form 20 – Extended Leave is a process that allows a patient to be discharged from the hospital back into the community with explicit conditions that are expected to be maintained (ie. must take medication regularly, must attend specific mental health supports in the community, etc.). If a patient on extended leave is not complying with their condition, a physician or director can recall the patient to hospital for reassessment.


Often patients may not have returned to a ‘happy’ state when discharged from the hospital, however their mental state and/or medications have been stabilized from the crisis and they no longer meet criteria for an involuntary admission.  Again, treatment for mental health is not as simple or efficient as receiving stitches or other medical interventions. Instead, discharge planning often includes referrals to counselling and other community resources to promote ongoing support for these complex issues.



Guide to the Mental Health Act (currently being updated):

General MHA fact info sheet

Rights under the Mental Health Act

Detained: Rights of Children and Youth Under the Mental Health Act

6 views0 comments

Comentários


bottom of page