March 2019 By PsychDB.com

Emergency Capacity Assessments

Sometimes, you may be paged about an urgent capacity issue while on call, and a patient wants to leave. The following 2×2 table can help guide your decisions on whether a patient should leave. When in doubt, always use a Form 1! It is called an Application for Psychiatric Assessment for a reason!

2x2 Capacity Decision Table

Capable Incapable
Wants to stay - • There is no requirement for for Mental Health Act Detention. Patient is neither voluntary nor involuntary.
• SDM consulted for treatment decisions
• INFORMALLY admitted to hospital per HCCA
Wants to leave • Consider Mental Health Act Detention (Form 1/Form 3) if mental health disorder contributing to safety risk requiring psychiatric admission for safety
• Remember you cannot treat medical issues against a patient's will if capably refusing
• SDM consulted for medical treatment decisions/plan of care that includes hospitalization if needed to enable required treatment
• If the physical risks of patient leaving AMA without treatment meet a serious risk, then consider if patient is suitable for informal status via HCCA, and/or
• If admission is a concurrent medical and psychiatric admission, and the Form 3 criteria are met, issue a Form 3
Detailed Approach