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In Ontario, admission to a psychiatric facility is governed by a piece of legislation called the Mental Health Act. The Mental Health Act outlines the powers and obligations of psychiatric facilities in Ontario. It also governs the admission process, the different categories of patient admission, as well as directives around assessment, care and treatment.
The following describes the ways in which a patient may receive admission and/or care at one of the designated facilities.
Voluntary Patient: Both the physician and the patient agrees that an admission for observation and treatment is needed
Involuntary Patient: An individual is admitted to hospital for treatment and/or assessment after meeting the criteria for admission under the Mental Health Act
Court Order Patient: An individual is admitted when a judge determines that he/she is unable to stand trial or is criminally responsible for the act
Outpatient: A person who is registered in a psychiatric facility for observation or treatment but has not been admitted as a patient and is not the subject of an application for assessment (form 1), therefor, does not have to stay overnight, but does have to engage in services during the day.
Involuntary Admissions
When a person is admitted to a hospital as a patient under the order of someone else, the person initiating the admission (typically a medical professional), must provide written notice of the reason for the admission. The patient will be placed on a “Form” and given reason as to why they are being held for observation, treatment or assessment. The following are the most common forms a person may encounter while a patient in a psychiatric facility.
Form 1, 3 and 4:
A Form 1 begins the pathway to involuntary admission to a psychiatric facility. A physician will issue a Form 1 if they believe a person may be at risk of harm to themselves or to others, allowing the physician to admit a person to the hospital for up to 72 hours for assessment and observation. Once the assessment is completed, a physician will either allow the person to voluntarily leave the hospital, initiate a voluntary admission at the person’s request, or place the person on a Form 3 which will extend the involuntary stay for up to an additional 14 days. A Form 3 can be renewed indefinitely in 30-day increments using a Form 4.
Form 2:
If a person is concerned for the safety or mental health of a family member/friend, a request for an “Order of Examination” can be made through a Justice of the Peace. If the Justice of the Peace agrees that the individual is a threat to themselves or to others based on criteria set forth in the Mental Health Act, they will issue a Form 2 (in appendix). This form is valid for seven (7) days including the day the form was signed, and allows the police to apprehend the person and take them to the hospital, for assessment. Once at the hospital, a physician will assess the individual and issue a Form 1 if s/he deems it necessary.
While a Form 2 does get the person to the hospital for assessment, it does not guarantee admission. As caregivers/family members, it is important to weigh the potential benefits and consequences of invoking a Form 2 as it does have the possibility of negatively affecting the relationship you have with your loved one.
Obtaining a Form 2:
- Locate the Justice of the Peace in your jurisdiction Find an Ontario court – Ministry of the Attorney General (gov.on.ca)
- Contact the courthouse for details on how to apply (in person or online)
- You will be required to complete a written application to provide to the judge. When filling out the application, provide as much information as you can regarding your loved ones mental health and reasons why you want them to be assessed. The following are some examples:
- Refusing to eat or drink
- Dressing inappropriately for weather conditions
- Unkempt living arrangements ie: no food, bug infestation
- Refusing to have contact with others and locking self in room
- Giving away money or personal belongings
- Sleeping more often than usual
- Dramatic changes in weight and eating patterns
- Indication of delusions and hallucinations
- Appears confused during conversations
- Refuses to return home on a false belief ie. people are waiting outside the home to harm them
In the event that the Form 2 is not issued and you still are concerned for the welfare of your loved one, go home and redo the application providing additional information and request the Form 2 again.
Rights of an Involuntary Patients
If a patient is being held involuntarily under a Form 1, the law requires a physician to provide him/her with written notice advising of the reason for the detention. This notice is provided via a Form 42.
If a patient is involuntarily admitted to the hospital (through a Form 3 or 4) a physician is required to provide written notice advising of the reason for the admission. This is issued via a Form 30 and the patient must also be given notice of their rights via a Form 50. A patient has the right to request the services of a ‘Rights Advisor’ and to appeal the involuntary admission decision made by the physician.
For more detail information: The Patient Advocates office at Home – PPAO (gov.on.ca)
For an in depth document on the Ontario Mental Health Act, visit: https://www.oha.com/Legislative%20and%20Legal%20Issues%20Documents1/OHA_Mental%20Health%20and%20the%20Law%20Toolkit%20-%20Revised%20(2016).pdf
Navigating the Mental Health System from the Voice of Lived Experience
Expect the unexpected because anything can happen when your loved one enters the hospital. Depending on the situation, you may not be able to influence the outcome.
- Advocate to be part of the circle of care because you know your loved one the best.
- Be prepared! Bring documentation of your loved one’s history in case you are unable to speak to the doctor. Don’t expect free and open dialogue with the physician as consent laws may make this impossible.
- It is easy to get frustrated when your loved one is not admitted to the hospital. Keep strong and remember to take care of you. “It’s a marathon not a sprint!“
- Never hesitate to act when safety is involved – it trumps everything else.
- Ask your loved one how you can be involved and support them. Do this during a period of stability and with empathy.
- Reach out for support, you do not have to do this alone.
Video links:
The Mental Health Act 101: What families need to know to navigate the mental health system
From: The Royal (Ottawa)