A Form 1 (Application by Physician for Psychiatric Assessment) is a provision under the Ontario Mental Health Act that allows a physician to detain a patient for a psychiatric assessment for up to 72 hours at a Schedule 1 Facility. A Form 42 (Notice to Person) is always given to a patient to notify them that they are under a Form 1.
Since a Form 1 is only for an assessment and not an involuntary admission per se, the threshold to issue a Form 1 can be low. In order for a Form 1 to be valid, there needs to be evidence of two things: (1) a risk (harm to self, to others, or physical impairment) and (2) evidence of a mental disorder that is related to (or causing) that risk. There does not need to be a pre-existing or formal psychiatric diagnosis for a Form 1 to be valid. A mental disorder is defined as any psychiatric disorder or neurocognitive disorder (including dementia and other neurodegenerative disorders).
Most physicians will issue a Form 1 based on Box A (“Serious Harm Test”) criteria. The patient must meet at least 1
out of 3 criteria:
In addition to meeting at least 1
out of 3 criteria, the Form 1 can only valid if there is evidence of a mental disorder. This evidence is based on two “tests”:
Test | What it means | “My own observations” | “Communication by others” |
---|---|---|---|
Past/Present Test (Risk) | • This is where you document the evidence of risk or dangerous behaviour | • Think of this as the “History of Presenting Illness” • Examination may (and can) be brief. (For example, if the patient is uncooperative or dismissive, can document this) • Again, evidence or even mentioning of mental disorder NOT required in this section • Mention any dangerous behaviour or evidence of inability to care for self as you are assessing the patient right now • Example: Patient screaming at nurse and pacing down hallway | • Think of this as the “Past Psychiatric History” • Now you can talk about the condition/diagnosis. • What will happen in the future if the patient is not detained? • Example: Past diagnosis of schizophrenia, admitted to psychiatric unit in 2010, past history of suicide attempts as documented in chart |
Future Test (Evidence of Mental Disorder) | • This is where you document the evidence to support findings of a mental disorder that is causing the risk you mentioned | • Think of this as the “Mental Status Exam” • Use psychiatric terms here! • Example: Endorsing auditory hallucinations, visual hallucinations, responding to internal stimuli, active suicidal ideation, homicidal ideation, thought blocking, paranoid delusions, hopelessness, depressed, etc… | Think of this as the “Collateral History” • This is information communicated to you by family, police, ER staff, friends, community supports, etc. • Document findings from others that suggest risk to self, others, or inability to care for self (e.g. - suicidal behaviour or ideation, violent behaviour or threats, and not caring for self to point of danger) • Example: Mother reports patient attempted to hang self last night |
The Box B Criteria is more complicated in an ER setting and therefore not commonly completed. In order to meet Box B criteria, the patient must have previously received treatment for the same or similar mental disorder in the past, and they must be presenting with symptoms suggestive of that same or similar mental disorder right now. Additionally, they must also have a history of improvement with treatment and evidence that they are likely to improvement with treatment again. Finally, the individual must also have a finding of incapacity and their substitute decision maker (SDM) must also have consented to treatment (i.e. - you have contacted the SDM). The eligibility threshold for Box B is thus much higher compared to Box A. In Box A, a patient needs to pose a serious and imminent risk to themselves or others. With Box B criteria, you must always do a capacity assessment and have a finding of incapacity (i.e. - also issue a Form 33).
In order for a patient to meet Box B criteria, they must meet all of the criteria set out in each of the following conditions.
1
or more):Form 42
A Form 42 (Notice to Person under Subsection 38.1 of the Act of Application for Psychiatric Assessment under Section 15 or an Order under Section 32 of the Act) is given to a patient to notify them you are detaining them under a Form 1. This must be given to the patient immediately if the patient is in a Schedule 1 Facility. If they are not in a Schedule 1 Facility, then the Form 42 can be delayed and issued to the patient once they arrive at a Schedule 1 Facility and are assessed by a physician.