The following are three common ways that a person may be involuntarily admitted to a psychiatric facility (unit) in Ontario for a 72-hour observation period:
Police brings person to physician
When a person is acting in a disorderly manner, the Act allows the police to take someone already in custody to a designated psychiatric facility for examination by a physician if they believe that the person is an immediate danger to themself, an immediate danger to others, or not able to care for themselves to an extent that physical impairment will result. The officer must believe, implicitly, that the immediate nature of the threat precludes the use of section 16 (Bringing Information before a justice of the peace). [1]
In situations where there is no immediate danger, anyone can bring evidence to a justice of the peace that the person is a danger to themselves, a danger to others, or is not able to care for themselves. The justice of the peace can then order a person to be examined by a physician [2] and fill out a Form 2 authorizing the police to take the person to a physician for examination. [3]
A justice of the peace, in making a determination as to whether there is reasonable cause to believe that someone is apparently suffering from a mental disorder of the sort described in section 16, is performing a judicial function and, as such, is not a compellable witness where summonsed to testify at a coroner's inquest. [4]
Physician orders assessment
Third, where a physician examines a person and has reasonable cause to believe that the person,
(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself; (b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or (c) has shown or is showing a lack of competence to care for himself or herself,
and if in addition, the physician is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,
(d) serious bodily harm to the person; (e) serious bodily harm to another person; or (f) serious physical impairment of the person,
the physician may make an application in the prescribed form for a psychiatric assessment of the person. [5]
Or, where a physician examines a person and has reasonable cause to believe that the person,
(a) has previously received treatment for mental disorder of an ongoing or recurring nature that, when not treated, is of a nature or quality that likely will result in serious bodily harm to the person or to another person or substantial mental or physical deterioration of the person or serious physical impairment of the person; and (b) has shown clinical improvement as a result of the treatment,
and if in addition the physician is of the opinion that the person,
(c) is apparently suffering from the same mental disorder as the one for which he or she previously received treatment or from a mental disorder that is similar to the previous one; (d) given the person’s history of mental disorder and current mental or physical condition, is likely to cause serious bodily harm to himself or herself or to another person or is likely to suffer substantial mental or physical deterioration or serious physical impairment; and (e) is incapable, within the meaning of the Health Care Consent Act, 1996, of consenting to his or her treatment in a psychiatric facility and the consent of his or her substitute decision-maker has been obtained,
the physician may make application in the prescribed form for a psychiatric assessment of the person. [6]
The physician fills out a Form 1 authorizing the police to bring the person in for a psychiatric assessment. [7]
Involuntary admissions
Once a person has been brought to a psychiatric facility to be assessed, the physician may hold them there for up to 72 hours on an application for psychiatric assessment (Form 1). This form allows the person to be held at a psychiatric facility for assessment, but does not itself permit any treatment without the person's consent.
Consent to treatment is not covered under the Mental Health Act but rather the Health Care Consent Act . The physician must also fill out a Form 42 [8] to notify the person and inform them of why they're being held. [9]
At the end of the 72 hours permitted by a Form 1, the person must either be released, be admitted as a voluntary patient, or continue to be held as an involuntary patient with a certificate of involuntary admission (Form 3). [10]
The physician who signs the Form 3 must be different than the physician who signed the initial Form 1. [11]
A Form 3 allows the patient to be held for two weeks and the patient must be notified with a Form 30.
At the end of the two weeks, if the facility is to continue to keep the patient on an involuntary basis, a certificate of renewal (Form 4) must be filled out. The first time a Form 4 is filled out, it is valid for one month, the second time it is filled out it is valid for two months, each time after that, it is valid for three months. [12] Each time a Form 4 is filled out, another Form 30 must be filled out, notifying the patient.
Rights of the patient
A physician who places a person on a Form 3 or Form 4 is required to notify a rights adviser [13] who is required to meet with the patient and explain to the patient what his or her rights are. [14] If the patient requests it, a rights adviser will also help the patient apply for an appeal or acquire legal services. [15]
If a patient is placed on a Form 3 or Form 4, they have the right to appeal the decision to a Consent and Capacity Board which will hear the patient's and physician's case. [16] A patient's involuntary status is reviewed by the Board every year whether the patient requests it or not. [17]
The board is composed, at the minimum, of a lawyer, a psychiatrist, and a member of the community (often a family member of someone with mental illness). [18]
If the patient or physician disagrees with the Board's decision, they may appeal to the Ontario Superior Court of Justice. [19]
The Act states that "the purpose of a community treatment order is to provide a person who suffers from a serious mental disorder with a comprehensive plan of community-based treatment or care and supervision that is less restrictive than being detained in a psychiatric facility. ... [and] to provide such a plan for a person who, as a result of his or her serious mental disorder, experiences this pattern: The person is admitted to a psychiatric facility where his or her condition is usually stabilized; after being released from the facility, the person often stops the treatment or care and supervision; the person’s condition changes and, as a result, the person must be re-admitted to a psychiatric facility." [20]
When a physician decides that a patient meets the criteria for a community treatment order, a treatment plan is developed with the involvement of all people involved in the plan. In addition to the physician and the patient, people involved in the plan may include other health care workers, social workers, family members, the substitute decision-maker, or others. Once the treatment plan is agreed to by all parties, the patient is required to follow the plan while living in the community. Failing to follow the plan can result in the person being readmitted to the hospital on a Form 47. One notable aspect of the community treatment orders is that it allows anyone who is named in the treatment plan to communicate with each other for the purpose of providing treatment, care, or supervision of the person. [21] By removing barriers to communication between members of the health care team, appropriate interventions can be quickly applied when the person is at risk.
A community treatment order lasts six months and can be renewed if needed. [22] A person on a community treatment order has the right to see a rights advisor and to appeal to the Consent and Capacity Board. [23] The Board will review community treatment order every year whether the patient requests it or not. [24]
Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily. This treatment may involve the administration of psychoactive drugs, including involuntary administration. In many jurisdictions, people diagnosed with mental health disorders can also be forced to undergo treatment while in the community; this is sometimes referred to as outpatient commitment and shares legal processes with commitment.
Outpatient commitment—also called assisted outpatient treatment (AOT) or community treatment orders (CTO)—refers to a civil court procedure wherein a legal process orders an individual diagnosed with a severe mental disorder to adhere to an outpatient treatment plan designed to prevent further deterioration or recurrence that is harmful to themselves or others.
Psychiatric hospitals, also known as mental health hospitals or behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, such as schizophrenia, bipolar disorder, eating disorders, dissociative identity disorder, major depressive disorder and many others. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short-term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent containment of patients who need routine assistance, treatment, or a specialized and controlled environment due to a psychiatric disorder. Patients often choose voluntary commitment, but those whom psychiatrists believe to pose significant danger to themselves or others may be subject to involuntary commitment and involuntary treatment. Psychiatric hospitals may also be called psychiatric wards/units when they are a subunit of a regular hospital.
Mental health law includes a wide variety of legal topics and pertain to people with a diagnosis or possible diagnosis of a mental health condition, and to those involved in managing or treating such people. Laws that relate to mental health include:
Voluntary commitment is the act or practice of choosing to admit oneself to a psychiatric hospital, or other mental health facility. Unlike in involuntary commitment, the person is free to leave the hospital against medical advice, though there may be a requirement of a period of notice or that the leaving take place during daylight hours. In some jurisdictions, a distinction is drawn between formal and informal voluntary commitment, and this may have an effect on how much notice the individual must give before leaving the hospital. This period may be used for the hospital to use involuntary commitment procedures against the patient. People with mental illness can write psychiatric advance directives in which they can, in advance, consent to voluntary admission to a hospital and thus avoid involuntary commitment.
The Lanterman–Petris–Short (LPS) Act regulates involuntary civil commitment to a mental health institution in the state of California. The act set the precedent for modern mental health commitment procedures in the United States. The bipartisan bill was co-authored by California State Assemblyman Frank D. Lanterman (R) and California State Senators Nicholas C. Petris (D) and Alan Short (D), and signed into law in 1967 by Governor Ronald Reagan. The Act went into full effect on July 1, 1972. It cited seven articles of intent:
Psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. These include: neurodevelopmental disorders, schizophrenia, schizoaffective disorder, mood disorders, addiction, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self-harm.
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior. Psychiatric emergency services are rendered by professionals in the fields of medicine, nursing, psychology and social work. The demand for emergency psychiatric services has rapidly increased throughout the world since the 1960s, especially in urban areas. Care for patients in situations involving emergency psychiatry is complex.
The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom. It covers the reception, care and treatment of mentally disordered people, the management of their property and other related matters, forming part of the mental health law for the people in England and Wales. In particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in a hospital or police custody and have their disorder assessed or treated against their wishes, informally known as "sectioning". Its use is reviewed and regulated by the Care Quality Commission. The Act was significantly amended by the Mental Health Act 2007. A white paper proposing changes to the act was published in 2021 following an independent review of the act by Simon Wessely.
Involuntary treatment refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in some countries when overseen by the judiciary through court orders; other countries defer directly to the medical opinions of doctors.
Therapeutic privilege refers to the decision of a healthcare practitioner to withhold information from a patient when there is a justified belief that disclosure may cause serious mental or physical harm to them. As of 2022, this defence is permissible in countries such as Australia, Canada, England, Netherlands and Wales as an exception to the standard consent process. Despite this, there are very limited cases in which therapeutic privilege has been upheld. This is mainly due to the complex ethical and legal ramifications in withholding information from a patient and how to define someone as being at sufficient risk to fall into this category wherein therapeutic privilege should prevail. Another challenge in enacting therapeutic privilege is the consideration of other professionals involved in patient care, such as where there is a multidisciplinary care team. However, in withholding information, there is also a denial of patient autonomy
The Florida Mental Health Act of 1971, commonly known as the "Baker Act", allows the involuntary institutionalization and examination of an individual.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, and perceptions.
The obligatory dangerousness criterion is a principle present in the mental health law of many developed countries. It mandates evidence of dangerousness to oneself or to others before involuntary treatment for mental illness. The term "dangerousness" refers to one's ability to hurt oneself or others physically or mentally within an imminent time frame, and the harm caused must have a long-term effect on the person(s).
Starson v Swayze, 2003 SCC 32, [2003] 1 S.C.R. 722 was an important case at the Supreme Court of Canada that considered the legal requirements for determining if a person is capable of making decisions regarding their medical treatment.
The following outline is provided as an overview of and topical guide to psychiatry:
Mental health in Russia is covered by a law, known under its official name—the Law of the Russian Federation "On Psychiatric Care and Guarantees of Citizens' Rights during Its Provision", which is the basic legal act that regulates psychiatric care in the Russian Federation and applies not only to persons with mental disorders but all citizens. A notable exception of this rule is those vested with parliamentary or judicial immunity. Providing psychiatric care is regulated by a special law regarding guarantees of citizens' rights.
The Health Care Consent Act (HCCA) is an Ontario law concerned with the capacity to consent to treatment.
A mental health tribunal is a specialist tribunal (hearing) empowered by law to adjudicate disputes about mental health treatment and detention, primarily by conducting independent reviews of patients diagnosed with mental disorders who are detained in psychiatric hospitals, or under outpatient commitment, and who may be subject to involuntary treatment.
Involuntary commitment or civil commitment is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hospital (inpatient) where they can be treated involuntarily.
