Mental Health Act (BC)

Primer

The British Columbia Mental Health Act (MHA) provides physicians and hospitals with the legal authority to admit and detain patients with a mental disorder (which may include primary psychiatric disorders such as bipolar disorder, depression, schizophrenia, and neuropsychiatric disorders such as traumatic brain injury, Parkinson’s disease, Alzheimer’s, or dementia) in a designated facility if they meet certain specified criteria. The law also has patient protections and rights to ensure the law is applied in an appropriate manner.

History

British Columbia's Mental Health Act (MHA) became law in 1964, and there have been several legislative updates since then. The purpose of the MHA is to guide the treatment of individuals with mental disorders who require protection and care. Protection as defined by BC law includes not just physical protection, but also social, family, work, or financial life of the patient. The MHA also dictates how treatment and care can be provided if an individual is not willing to accept it.

Involuntary Care

Involuntary Admission

There are 3 methods through which a person can be involuntarily transported or admitted to a designated facility:

  1. Through a physician's Medical Certificate (Form 4), this is the most common method used to initiate involuntary interventions
  2. Through police intervention (Section 28)
  3. Through an order by a judge (Form 10)

Criteria

In order for an individual to be admitted involuntarily, a physician must be of opinion that all of the following four criteria must be met:

  1. Is suffering from an apparent mental disorder that seriously impairs their ability to react appropriately to his or her environment or to associate with others;
  2. Requires psychiatric treatment in or through a designated facility
  3. Requires care, supervision, and control in (or through) a designated facility to prevent the person's substantial mental or physical deterioration, or for the person's own protection, or for the protection of others; and
  4. Is not suitable as a voluntary patient

Treatment Consent and Capacity under the MHA

  • Unlike for the consent and capacity for medical treatments (which are covered by the Health Care (Consent) and Care Facility (Admission) Act (HCCCFAA) (BC), a person may be involuntarily admitted and treated at a psychiatric facility for their mental disorder without any need to obtain consent, if the physician is of the opinion that the person “has a disorder of the mind that requires treatment and seriously impairs the person’s ability to react appropriately to the person’s environment, or associate with others,” and that the person meets all of the four criteria for involuntary hospitalization (see above). Once an individual has been admitted to hospital involuntarily, the MHA allows for compulsory psychiatric treatment (i.e. - without patient consent). Remember, the BC MHA applies only to psychiatric treatment.
  • Consent under the BC MHA operates on a deemed consent model, that is, “treatment authorized by the director [of the designated facility] is deemed to be given with the consent of the patient.”[1] Thus, individuals who have been involuntarily admitted to a psychiatric facility under the MHA are exempted from the same legal rights afforded by the Health Care (Consent) and Care Facility (Admission) Act (HCCCFAA) (BC). This means even individuals with an advance directive (made while one is capable and not subject to involuntary admission) or representation agreement cannot give or refuse consent to psychiatric treatment if one is later involuntary admitted.[2]
  • Medical and non-psychiatric issues cannot be treated against the will of an involuntary patient.

Forms and Responsibilities

The following describes a general timeline of when Forms are completed for an involuntary hospital admission, and who is responsible for completion of the Form. At a bare minimum, the following Forms must be completed immediately on any involuntary admission, regardless of the length of a patient's involuntary admission:

  • Form 4 (1st Medical Certificate)
    • This Form sets out why the patient can be involuntarily admitted for up to 48 hours
  • Form 5 (Consent for Treatment)
    • This Form sets out the proposed psychiatric treatment, and either the patient or director must consent before treatment begins
  • Form 13 (Notification of Rights)
    • This Form provides information about patient’s rights and must be read to the patient and a copy provided to them
    • If a patient not capable of understanding the Form 13 on admission, the Form must be provided again once patient is capable of understanding. The physician should document that the patient was not capable of understanding the Form 13.
  • Form 15 (Nomination of Near Relative)
    • This Form allows a patient to nominate a near relative to be notified of admission and detention
  • Form 16 (Notification to Near Relative)
    • This Form notifies the near relative of the patient’s admission, detention and rights. If there is no known near relative, form is sent to the Public Guardian and Trustee.

Example Timeline of Admission of Involuntary Adult Patient

Form Name Form # When to complete Responsible party
1st Medical Certificate Form 4 On decision to involuntarily admit Physician
2nd Medical Certificate Form 4 Within 48 hours Physician
Consent for Treatment Form 5 Immediately upon admission Physician/designate
Medical Certificate for Involuntary Admission Form 6 If patient requires admission > 1 month Physician
Notification of Involuntary Patients of Rights Under the Mental Health Act Form 13 Immediately upon admission RN
Nomination of Near Relative Form 15 Immediately upon admission Director/Patient/RN
Notification to Near Relative (Involuntary Patient/Patient Under Age Sixteen) Form 16 Immediately upon admission Director/RN/unit clerk
Notification of Near Relative, Discharge of Involuntary Patient Form 17 On discharge from hospital Physician/team
Certification of Discharge - at Patient's Request Form 19 On discharge from hospital Physician
Leave Authorization Form 20 On extended leave Physician
Director's Warrant, Apprehension of Patient Form 21 Upon AWOL Director/designate
Risk Assessment Form - Upon AWOL Director/designate

Resources

For Providers
For Patients
Articles

References

1) BC MENTAL HEALTH ACT [RSBC 1996] CHAPTER 288
2) Deemed Consent to Psychiatric Treatment in BC