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teaching:on-mha:form-1-42 [2019/11/05 15:11]
psychdb [Primer]
teaching:on-mha:form-1-42 [2020/05/01 17:42] (current)
psychdb
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 ====== Form 1 and Form 42 (Psychiatric Assessment) ====== ====== Form 1 and Form 42 (Psychiatric Assessment) ======
 +{{INLINETOC}}
 ===== Primer ===== ===== Primer =====
 +<WRAP group>
 +<WRAP twothirds column>
 A **Form 1** (//​Application by Physician for Psychiatric Assessment//​) is a provision under the [[teaching:​on-mha:​home|Ontario Mental Health Act]] that allows a physician to detain a patient for a psychiatric assessment for up to 72 hours at a [[http://​www.health.gov.on.ca/​en/​common/​system/​services/​psych/​designated.aspx|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.  A **Form 1** (//​Application by Physician for Psychiatric Assessment//​) is a provision under the [[teaching:​on-mha:​home|Ontario Mental Health Act]] that allows a physician to detain a patient for a psychiatric assessment for up to 72 hours at a [[http://​www.health.gov.on.ca/​en/​common/​system/​services/​psych/​designated.aspx|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 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 risk //and// evidence of a mental disorder that is related to that risk. There does not need to be an actual psychiatric diagnosis or formal psychiatric assessment for a Form 1 to be valid. A mental disorder is defined as any psychiatric disorder and neurocognitive disorder (including dementia and other neurodegenerative disorders).+Since a Form 1 is a only //​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 an actual psychiatric diagnosis or formal psychiatric assessment for a Form 1 to be valid. A mental disorder is defined as any psychiatric disorder and neurocognitive disorder (including dementia and other neurodegenerative disorders). 
 +</​WRAP>​ 
 +<WRAP third column>​ 
 +<panel type="​info"​ title="​Download Form 1 and 42" icon="​fa fa-download"​ no-body="​true">​ 
 +| <button type="​success"​ block="​true"​ icon="​fa fa-download">​[[http://​www.forms.ssb.gov.on.ca/​mbs/​ssb/​forms/​ssbforms.nsf/​GetAttachDocs/​014-6427-41~1/​$File/​6427-41_.pdf|Form 1]]</​button> ​  | 
 +| <button type="​success"​ block="​true"​ icon="​fa fa-download">​[[http://​www.forms.ssb.gov.on.ca/​mbs/​ssb/​forms/​ssbforms.nsf/​GetFileAttach/​014-1787-41~1/​$File/​1787-41_.pdf|Form 42]]</​button> ​ | 
 +</​panel>​ 
 +<panel type="​warning"​ title="​Quick Start Guide" icon="​fa fa-question"​ no-body="​true">​ 
 +| <button type="​primary"​ icon="​fa fa-download"​ block="​true">​[[http://​www.psychdb.com/​_media/​form_1_and_42_-_explained.pdf | Learn in 5 minutes]]</​button>​ | 
 +</​panel>​ 
 +</​WRAP>​ 
 +</​WRAP>​ 
 + 
 +<​HTML>​ 
 +<script async src="//​pagead2.googlesyndication.com/​pagead/​js/​adsbygoogle.js"></​script>​ 
 +<ins class="​adsbygoogle"​ 
 +     ​style="​display:​block;​ text-align:​center;"​ 
 +     ​data-ad-layout="​in-article"​ 
 +     ​data-ad-format="​fluid"​ 
 +     ​data-ad-client="​ca-pub-8020066590182443"​ 
 +     ​data-ad-slot="​3544422091"></​ins>​ 
 +<​script>​ 
 +     ​(adsbygoogle = window.adsbygoogle || []).push({});​ 
 +</​script>​ 
 +</​HTML>​
  
 ===== Form 1 ===== ===== Form 1 =====
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   - **Harm to Others**   - **Harm to Others**
     * Physical Harm (e.g. - throwing, spitting, punching), //OR//     * Physical Harm (e.g. - throwing, spitting, punching), //OR//
-    * Psychological Harm, but the threshold is much higher (e.g. - pacing all night, ​psychotic, demanding, and parents are locking ​themselves in bedroom. If threats are enough to intimidate the family member, particularly if there is a history of violence) +    * Psychological Harm, but the threshold is much higher (e.g. - an individual is actively ​psychotic ​and threatening parents, and parents are scared enough to lock themselves in their bedroom. If threats are enough to intimidate the family member, particularly if there is a history of violence, this would meet criteria
-  - **Physical Impairment** (e.g. - risk of death by not eating, kidney failure by not drinking, untreated ​infection)+  - **Physical Impairment** (e.g. - risk of death by not eating, kidney failure by not drinking, untreated ​infections, etc.)
  
 </​WRAP>​ </​WRAP>​
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   - **Future Test (Evidence of Mental Disorder)** ​   - **Future Test (Evidence of Mental Disorder)** ​
  
-<callout type="​tip"​ icon="​true"​ title="​Quick Start Guide">​ 
-<button type="​success"​ icon="​fa fa-pencil">​ 
-\\ 
-[[http://​www.psychdb.com/​_media/​form_1_and_42_-_explained.pdf | How To Fill a Form 1 and Form 42 (PDF)]]</​button>​ 
-</​callout>​ 
 </​WRAP>​ </​WRAP>​
 </​WRAP>​ </​WRAP>​
  
 <panel title="​Box A Criteria: Past/​Present Test and Future Test" no-body="​true">​ <panel title="​Box A Criteria: Past/​Present Test and Future Test" no-body="​true">​
-^                          ^ Past/​Present Test (Risk) ​                                                                                                                                                                                                                                                                                                                                                                                                                           ^ Future Test (Evidence of Mental Disorder) ​                                                                                                                                                                                                                                                                                                                               +^                          ^ Past/​Present Test (Risk) ​                                                                                                                                                                                                                                                                                                                                                                                                                                                                ​^ Future Test (Evidence of Mental Disorder) ​                                                                                                                                                                                                                                                                                       
-^ What it means            | <​HTML><​ul><​li>​This is where you document the evidence of <b>risk</​b> ​or <b>dangerous</​b> ​behaviour</​li></​ul></​HTML> ​                                                                                                                                                                                                                                                                                    <​HTML><​ul><​li>​This is where you document the evidence to support findings of a <b>mental disorder</​b> ​that is causing the risk you mentioned</​li></​ul></​HTML> ​                                                                                                                                           ​+^ What it means            | • This is where you document the evidence of risk or dangerous behaviour ​                                                                                                                                                                                                                                                                                                                                                                                                                ​• This is where you document the evidence to support findings of a mental disorder that is causing the risk you mentioned ​                                                                                                                                                                                                       
-^ My own observations ​     | <​HTML><​ul><​li>​Think of this as the "​History of Presenting Illness"​</​li><​li>​Examination may (and can) be brief. (For example, if the patient is uncooperative or dismissive, can document this)</​li><​li>​Again, evidence or even mentioning of mental disorder NOT required in this section</​li><​li>​Mention any dangerous behaviour or evidence of inability to care for self as you are assessing the patient ​<i>right now</​i></​li><​li><​b>​Example:</​b> ​Patient screaming at nurse and pacing down hallway, yelling loudly</​li></​ul></​HTML> ​ ​| ​<​HTML><​ul><​li>​Think of this as the "​Mental Status Exam"</​li><​li>​Use psychiatric terms here!</​li><​li><​b>​Example</b>: Endorsing auditory hallucinations,​ visual hallucinations,​ responding to internal stimuli, active suicidal ideation, homicidal ideation, thought blocking, paranoid delusions, hopelessness,​ depressed, etc…</​li></​ul></​HTML>  ​+^ My own observations ​     | • **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, yelling loudly ​ | • **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… ​                   
-^ Communication by others ​ | <​HTML><​ul><​li>​Think of this as the "​Collateral History"​</​li><​li>​This is information communicated to you by family, police, ER staff, friends, community supports, etc.</​li><​li>​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)</​li><​li><​b>​Example</b>: Mother reports patient attempted to hang self last night</​li></​ul></​HTML> ​                                                                                                                        <​HTML><​ul><​li>​Think of this as the "Past Psychiatric History"​</​li><​li><​b>​Now</​b> ​can you talk about the condition/​diagnosis.</​li><​li>​What will happen in the future if the patient is not detained?</​li><​li><​b>​Example</b>: Past diagnosis of schizophrenia,​ admitted to psychiatric unit in 2010, past history of suicide attempts as documented in chart</​li></​ul></​HTML> ​                                                   ​|+^ Communication by others ​ | • **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                               ​• **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  |
 </​panel>​ </​panel>​
 ==== Box B Criteria ==== ==== Box B Criteria ====
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 </​WRAP>​ </​WRAP>​
 <WRAP half column> <WRAP half column>
-<callout type="​question"​ title="​Reasons Fill Box B Instead of Box A" icon="​true">​+<callout type="​question"​ title="​When Do You Use Box B Instead of Box A?" icon="​true">​
   * Prevents a "​revolving door" effect of chronically ill patients going in and out of hospital   * Prevents a "​revolving door" effect of chronically ill patients going in and out of hospital
   * Decrease the seriousness of deterioration -- a patient can be admitted when they start showing early signs and symptoms of illness   * Decrease the seriousness of deterioration -- a patient can be admitted when they start showing early signs and symptoms of illness
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 </​callout>​ </​callout>​
  
-<callout type="​info"​ title="​What do I do if I Notice The Form 1 is Filled Incorrectly?"​ icon="​true">​ 
-There can be implications to filling out a Form 1 incorrectly,​ including the potential for a $25,000 fine for knowingly contravening the Mental Health Act. Plus, the patient could be considered to be detained “illegally” (thus leading to the potential for civil suit, though this is rare). Therefore, if you notice the Form 1 is filled out incorrectly by another physician, you need to re-do the Form 1 correctly under //your// name. The maximum time of detention remains 72 hours regardless of when you noticed the error (i.e. - you cannot add another 72 hours at the time you correct the form. You must respect of the spirit of the Form 1!). The technical //best practice// should be to do the correct Form 1 plus a [[teaching:​on-mha:​form-3|Form 3]] immediately afterwards so a patient is not issued a Form 1 twice. 
-</​callout>​ 
- 
-</​WRAP>​ 
-<WRAP half column> 
 <callout type="​danger"​ title="​The Form 1 Only Allows for Detention, Not Treatment"​ icon="​true">​The Form 1 only allows for the physical detention of an individual. It does not allow you to force treatment without a patient'​s consent. Only emergency treatment is allowed in the event of significant morbidity or mortality. Therefore, if there is no emergency and a patient refuses treatment, you must respect the wishes of the patient even if they are on a Form 1. **However**,​ if a patient on a Form 1 is found incapable (i.e. - given a [[teaching:​on-mha:​form-33|Form 33]]), and this is //not// appealed by the patient, you can start involuntary treatment. <callout type="​danger"​ title="​The Form 1 Only Allows for Detention, Not Treatment"​ icon="​true">​The Form 1 only allows for the physical detention of an individual. It does not allow you to force treatment without a patient'​s consent. Only emergency treatment is allowed in the event of significant morbidity or mortality. Therefore, if there is no emergency and a patient refuses treatment, you must respect the wishes of the patient even if they are on a Form 1. **However**,​ if a patient on a Form 1 is found incapable (i.e. - given a [[teaching:​on-mha:​form-33|Form 33]]), and this is //not// appealed by the patient, you can start involuntary treatment.
 </​callout>​ </​callout>​
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 <callout type="​danger"​ icon="​true"​ title="​The Patient Must Have Physically Been Seen">​The physician must have physically seen the patient in order to fill out a Form 1. If, for example, you spoke to the patient over the phone, you **cannot** fill out a Form 1 (unless you have previously physically seen the patient in the last 7 days).</​callout>​ <callout type="​danger"​ icon="​true"​ title="​The Patient Must Have Physically Been Seen">​The physician must have physically seen the patient in order to fill out a Form 1. If, for example, you spoke to the patient over the phone, you **cannot** fill out a Form 1 (unless you have previously physically seen the patient in the last 7 days).</​callout>​
  
 +
 +</​WRAP>​
 +<WRAP half column>
 +<callout type="​question"​ title="​What if the Form 1 is Filled Incorrectly?"​ icon="​true">​
 +There can be implications to filling out a Form 1 incorrectly,​ including the potential for a $25,000 fine for knowingly contravening the Mental Health Act. Plus, the patient could be considered to be detained “illegally” (thus leading to the potential for civil suit, though this is rare). Therefore, if you notice the Form 1 is filled out incorrectly by another physician, you need to re-do the Form 1 correctly under //your// name. The maximum time of detention remains 72 hours regardless of when you noticed the error (i.e. - you cannot add another 72 hours at the time you correct the form. You must respect of the spirit of the Form 1!). The technical //best practice// should be to do the correct Form 1 plus a [[teaching:​on-mha:​form-3|Form 3]] immediately afterwards so a patient is not issued a Form 1 twice.
 +</​callout>​
 <callout type="​question"​ icon="​true"​ title="​What if a Patient AWOLs on a Form 1?">​ <callout type="​question"​ icon="​true"​ title="​What if a Patient AWOLs on a Form 1?">​
   * Only physicians who have seen the patient in the past 7 days can fill out a Form 1 again to request the police apprehend the patient   * Only physicians who have seen the patient in the past 7 days can fill out a Form 1 again to request the police apprehend the patient
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   * A photocopy of the Form 42 stays in the patient'​s chart   * A photocopy of the Form 42 stays in the patient'​s chart
  
 +===== Resources =====
 +{{page>​teaching:​on-mha:​home#​resources&​nouser&​noheader&​nodate&​nofooter}}
  
 {{tag>​form}} {{tag>​form}}