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teaching:on-mha:consent-capacity-board-hearings [2019/07/30 09:05]
psychdb [Involuntary Admission]
teaching:on-mha:consent-capacity-board-hearings [2020/04/30 22:17] (current)
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 ====== Consent and Capacity Board (CCB) Hearings ===== ====== Consent and Capacity Board (CCB) Hearings =====
 +{{INLINETOC}}
 ===== Primer ===== ===== Primer =====
-In the province of Ontario, the **Consent and Capacity Board (CCB)** is an independent government review panel that holds hearings to determine whether a patient meets the criteria for incapacity to treatment and/or involuntary hospitalization. The CCB is independent of the physician and the hospital, and is a quasi-judicial body. The CCB also maintains independence from the Ministry of Health and Long-Term Care.+In Ontario, the **Consent and Capacity Board (CCB)** is an independent government review panel that holds hearings to determine whether a patient meets the criteria for incapacity to treatment and/or involuntary hospitalization. The CCB is independent of the physician and the hospital, and is a quasi-judicial body. The CCB also maintains independence from the Ministry of Health and Long-Term Care.
  
 ===== For Physicians ===== ===== For Physicians =====
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 If you are requesting the CCB to uphold a finding of incapacity for a patient'​s incapacity, you must then explain to the CCB which branch of the [[teaching:​on-mha:​consent-capacity|capacity test]] you believe the patient does not meet. If you are requesting the CCB to uphold a finding of incapacity for a patient'​s incapacity, you must then explain to the CCB which branch of the [[teaching:​on-mha:​consent-capacity|capacity test]] you believe the patient does not meet.
  
-<panel type="​default"​ title="​Example"​ icon="​fa fa-comments">​ +<panel type="​default"​ title="​Example"​ icon="​fa fa-comments" no-body="​true">​ 
-"I am basing the finding of incapacity for the patient failing the first (understanding) AND/OR second (appreciation) branch of the capacity test."</​panel>​+"I am basing the finding of incapacity for the patient failing the first (understanding) AND/OR second (appreciation) branch of the capacity test." ​
 +</​panel>​
 ==== Involuntary Admission ==== ==== Involuntary Admission ====
 If you are requesting the CCB to continue an involuntary admission, you must explain to the CCB whether you are relying on [[teaching:​on-mha:​form-1-42#​box-a-criteria|Box A]] and/or [[teaching:​on-mha:​form-1-42#​box-b-criteria|Box B criteria]] (you can use one or both). The CCB also does have a right to consider whether the patient meets either criteria as well, independent of the physician (i.e. - the CCB may ask you questions to see if the patient meets other criteria based on available evidence, even if you do not bring it up yourself). If you are requesting the CCB to continue an involuntary admission, you must explain to the CCB whether you are relying on [[teaching:​on-mha:​form-1-42#​box-a-criteria|Box A]] and/or [[teaching:​on-mha:​form-1-42#​box-b-criteria|Box B criteria]] (you can use one or both). The CCB also does have a right to consider whether the patient meets either criteria as well, independent of the physician (i.e. - the CCB may ask you questions to see if the patient meets other criteria based on available evidence, even if you do not bring it up yourself).
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 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
-<panel type="​default"​ subtitle="​Box A" title="​Example"​ icon="​fa fa-comments">​ +<panel type="​default"​ subtitle="​Box A" title="​Example"​ icon="​fa fa-comments" no-body="​true">​ 
-"I am basing the involuntary admission under Box A criteria, [explain which Box A criteria is met]."</​panel>​+"I am basing the involuntary admission under Box A criteria, [explain which Box A criteria is met]." ​
 +</​panel>​
 </​WRAP>​ </​WRAP>​
 <WRAP half column> <WRAP half column>
-<panel type="​default"​ subtitle="​Box B" title="​Example"​ footer="​(Important:​ you must demonstrate to the CCB that a finding of incapacity was made, and that a substitute decision maker was obtained PRIOR to certifying a patient under Box B criteria.)"​ icon="​fa fa-comments">​ +<panel type="​default"​ subtitle="​Box B" title="​Example"​ footer="​(Important:​ you must demonstrate to the CCB that a finding of incapacity was made, and that a substitute decision maker was obtained PRIOR to certifying a patient under Box B criteria.)"​ icon="​fa fa-comments" no-body="​true">​ 
-"I am basing the involuntary admission under Box B criteria, [explain why each of the 6 criteria under Box B have been met]. "+"I am basing the involuntary admission under Box B criteria, [explain why each of the 6 criteria under Box B have been met]." ​|
 </​panel>​ </​panel>​
 </​WRAP>​ </​WRAP>​
 </​WRAP>​ </​WRAP>​
  
-<callout type="​question"​ title="​What If Someone Has Improved With the Use of PRN Medications ​by the Time the Hearing Is Held? Are They Still Incapable or Involuntary?"​ icon="​true">​While waiting for a CCB hearing, a patient who contests the finding of incapacity may not be treated involuntarily. Therefore, a patient ​with schizophrenia and psychosis cannot receive regular treatment prior to the CCB hearing. However, they may be given emergency PRN medications (e.g. - antipsychotics or benzodiazepines) due to imminent ​and emergency ​safety concerns (to self or others). ​Thus if there is consistent and ongoing PRN use, it may actually indirectly ​treat the underlying mental disorder ​by the time the hearing is held. Over time, the patient may improve the symptoms may abate. In this case, this is important to state to the CCB if it is your clinical opinion that regular PRN use has led to this improvementand that it otherwise would not have occurred. It would be important to stress to the board that the patient'​s current presentation does not mean they do not have a mental disorder, but rather, that they have been treated partially with PRN medications,​ which led to the current improvement.+<callout type="​question"​ title="​Improvement on PRN Medications?​ Are They Still Incapable or Involuntary?"​ icon="​true">​What if someone has improved with just the use of PRN medications while waiting for a CCB hearing? ​While waiting for a CCB hearing, a patient who contests the finding of incapacity ​**may not be treated involuntarily** (with one exception). However, they may be given emergency PRN medications (e.g. - antipsychotics or benzodiazepines ​for psychosis) due to imminent safety concerns (harm to self or others). ​One can imagine ​if there is consistent and ongoing PRN use for this reason, it is actually indirectly ​treating ​the underlying mental disorder. Over time, the patient may improve, and the symptoms may abate by the time the hearing is held. In this case, this is important to state to the CCB if it is your clinical opinion that regular PRN use has led to this improvement ​(and that this improvement ​otherwise would not have occurred). It would be important to stress to the board that the patient'​s current presentation does not mean they do not have a mental disorder, but rather, that they have been treated partially with PRN medications,​ which led to the current improvement.
 </​callout>​ </​callout>​
 ===== Witnesses ===== ===== Witnesses =====