The following are three common ways that a person may be involuntarily admitted to a psychiatric facility in Ontario for a 72 hour observation period:
Police bring person to physician[edit]
When a person is acting in a disorderly manner, the act allows the police to take any person to a hospital or physician for assessment if they have grounds to believe that the person is an immediate danger to himself or herself, an immediate danger to others, or not able to care for himself or herself to an extent that physical impairment will result. The officer must also believe that the immediate nature of the threat precludes the use of section 16 (Bringing Information before a Justice of the Peace).[1]
Person lays information before Justice of Peace[edit]
In situations where there is no immediate danger, anyone can bring evidence to a justice of the peace that the person is a danger to himself or herself, a danger to others, or is not able to care for himself or herself. The judge can then order a person to be examined by a physician[2] and fill out a Form 2 authorizing the police to take the person to a physician for examination.[3]
A justice of the peace, in making a determination as to whether there is reasonable cause to believe that someone is apparently suffering from a mental disorder of the sort described in section 16, is performing a judicial function and, as such, is not a compellable witness where summonsed to testify at a coroner's inquest.[4]
Physician orders assessment[edit]
Third, where a physician examines a person and has reasonable cause to believe that the person,
(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;
(b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or
(c) has shown or is showing a lack of competence to care for himself or herself,
and if in addition the physician is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,
(d) serious bodily harm to the person;
(e) serious bodily harm to another person; or
(f) serious physical impairment of the person,
the physician may make application in the prescribed form for a psychiatric assessment of the person.[5]
Or, where a physician examines a person and has reasonable cause to believe that the person,
(a) has previously received treatment for mental disorder of an ongoing or recurring nature that, when not treated, is of a nature or quality that likely will result in serious bodily harm to the person or to another person or substantial mental or physical deterioration of the person or serious physical impairment of the person; and
(b) has shown clinical improvement as a result of the treatment,
and if in addition the physician is of the opinion that the person,
(c) is apparently suffering from the same mental disorder as the one for which he or she previously received treatment or from a mental disorder that is similar to the previous one;
(d) given the person’s history of mental disorder and current mental or physical condition, is likely to cause serious bodily harm to himself or herself or to another person or is likely to suffer substantial mental or physical deterioration or serious physical impairment; and
(e) is incapable, within the meaning of the Health Care Consent Act, 1996, of consenting to his or her treatment in a psychiatric facility and the consent of his or her substitute decision-maker has been obtained,
the physician may make application in the prescribed form for a psychiatric assessment of the person.[6]
The physician fills out a Form 1 authorizing the police to bring the person in for a psychiatric assessment.[7]
Involuntary admissions[edit]
Once a person has been brought to a psychiatric facility to be assessed, the physician may hold them there for up to 72 hours on an application for psychiatric assessment (Form 1). This form allows the person to be held at a psychiatric facility for assessment, but does not itself permit any treatment without the persons consent.
Consent to treatment is not covered under the Mental Health Act but rather the Health Care Consent Act. The physician must also fill out a Form 42[8] to notify the person and inform them of why they're being held.[9]
At the end of the 72 hours permitted by a Form 1, the person must either be released, be admitted as a voluntary patient, or continue to be held as an involuntary patient with a certificate of involuntary admission (Form 3).[10]
The physician who signs the Form 3 must be different than the physician who signed the initial Form 1.[11]
A Form 3 allows the patient to be held for two weeks and the patient must be notified with a Form 30.
At the end of the two weeks, if the facility is to continue to keep the patient on an involuntary basis, a certificate of renewal (Form 4) must be filled out. The first time a Form 4 is filled out, it is valid for one month, the second time it is filled out it is valid for two months, each time after that, it is valid for three months.[12] Each time a Form 4 is filled out, another Form 30 must be filled out, notifying the patient.
