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 Involuntary Patients

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This Info guide has been prepared by the Psychiatric Patient Advocate Office in the Ministry of Health and Long-Term Care for general Informational purposes only.  It does not contain legal advice.  If you have a question of would like advice about your specific legal situation, you should contact a lawyer.

June 2016

What does it mean to be an “involuntary patient”?

  • If you are an involuntary patient in a psychiatric facility, you are detained in the facility under a certificate of involuntary admission, a certificate of renewal or a certificate of continuation. This means that you are not free to leave the hospital without permission. If you leave without permission, the doctor can have you returned to the hospital by the police.

 

How do I become an involuntary patient?

  • You became an involuntary patient when a doctor assessed you and signed a Certificate of Involuntary Admission (Form 3). Before the Form 3 expires, a doctor may renew the certificate by signing a Certificate of Renewal (Form 4). Additional forms (Form 4 or 4A) may be signed by a doctor before the expiry of the previous form. These forms give the doctor the legal authority to detain you in the psychiatric facility. You must be assessed by a doctor each time a Form 3, 4 or 4A is signed.
  • The Mental Health Act sets out two reasons that you may be held as an involuntary patient:
    • The symptoms of your mental disorder make it likely that you or another person will suffer harm if you are not detained in a psychiatric facility; or
    • You need to be detained in a psychiatric facility to receive treatment for an ongoing or recurring mental disorder that, when not treated, will likely result in certain harms, but that shows improvement when treated. The specific legal requirements for involuntary admission in the Mental Health Act are very detailed. The Form 30 (Notice to Patient) you will receive will specify the reason the doctor is detaining you as an involuntary patient under Form 3, 4 or 4A.

 

How long can I legally be kept in the hospital on a Form 3, Form 4 or Form 4A?

  • As an involuntary patient, you may be detained, restrained, observed and examined in a psychiatric facility:
    • For not more than two weeks under a Certificate of Involuntary Admission (Form 3);
    • For not more than,
      • one additional month under a first Certificate of Renewal (Form 4);
      • two additional months under a second Certificate of Renewal (Form 4);
      • three additional months under a third Certificate of Renewal (Form 4);
      • For not more than three additional months under a first or subsequent Certificate of Continuation (Form 4A).
  • After the first and every fourth Form 4A is signed, you will be deemed to have applied to the Consent and Capacity Board for a review of your involuntary status. The Consent and Capacity Board is a tribunal that is independent of the hospital. You are not required to attend this hearing but you can if you wish. Your doctor may decide at any time that you no longer meet the test for involuntary admission to a psychiatric facility, and may revoke the Form 3, Form 4 or Form 4A.

 

Does the doctor have to tell me why the Form 3, Form 4 or Form 4A was completed?

  • Yes. The Mental Health Act states that if the doctor completes a Form 3, a Form 4 or Form 4A for you, you must be advised in writing that your legal status has changed and that you are an involuntary patient. This is provided in a Form 30, "Notice to the Patient". The Form 30 will let you know that you are being detained as an involuntary patient under a Form 3, 4 or 4A, when the Form 3, 4 or 4A was completed, when it will expire, and the reason that your status was changed.

 

Do I get Rights Advice?

  • Yes. As soon as the doctor signs a Form 3, a Form 4 or a Form 4A, he or she must "promptly" notify the Rights Adviser of the change in your legal status. The Rights Adviser will receive the Form 30, "Notice to the Patient" and will promptly meet with you to discuss your legal options and rights as an involuntary patient.

 

How can the Rights Adviser help me?

  • The Rights Adviser will talk to you about your rights and options. For example, you have the right to apply for a hearing before the Consent and Capacity Board to review your status as an involuntary patient. The Rights Adviser can help you by completing the appropriate application for a Consent and Capacity Board hearing, assist you to apply for Legal Aid, and assist you in contacting a lawyer to represent you. The Rights Adviser will ask you to sign an Authorization Form giving him or her permission to assist you with each of these tasks. Rights Advisers will not choose a lawyer for you but will supply you with a list of lawyers that have special training in mental health law and who accept Legal Aid as payment for their services.

 

Will the Rights Adviser tell the doctor what we talked about?

  • No. The Rights Adviser will not tell your doctor what you spoke about or any details of your conversation unless you instruct the Rights Adviser to do so. There are some exceptions when a Rights Adviser may disclose information without consent, for example, if you threaten to harm yourself or someone else or plan to elope. By law the Rights Adviser must leave the doctor a "Confirmation of Rights Advice" form (Form 50). This confirms that rights advice was provided and informs the doctor if you applied for a hearing.

 

What are my options if I disagree with the doctor’s findings?

  • You have several options that you can pursue if you disagree with the doctor's findings that you need to be detained in the psychiatric facility as an involuntary patient. First, you can do nothing at all and allow the form to expire. Second, you can talk to the doctor to see if he or she is willing to change your status from involuntary to voluntary after assessing you. Third, you can apply for a hearing before the Consent and Capacity Board to review the doctor's findings.

 

Can the doctor cancel the Form3, Form 4 or Form 4A?

  • Yes. The doctor can cancel the Form 3, Form 4 or Form 4A if he or she believes that you no longer meet the criteria for admission as an involuntary patient. If the doctor agrees to change your status from involuntary to voluntary, a "Change to Informal or Voluntary Status" form (Form 5) is completed. You should be advised that you are a voluntary patient.

 

Can I apply to the Consent and Capacity Board?

  • Yes. You can apply to the CCB once on a Form 3 and then each time a Form 4 or Form 4A is signed. You have the right to only one hearing before the CCB per form.

 

How long will it take to get a Hearing?

  • The Consent and Capacity Board must hold the hearing within seven days of receiving your application. The hearing can be held beyond the seven days if you consent to this. For more information about the Consent and Capacity Board visit the website www.ccboard.on.ca or ask your Rights Adviser for additional information.

 

How long will it take for the Board to make a decision?

  • The Board will make a decision on your case within one day of the end of your hearing. The Consent and Capacity Board may either “confirm” the doctor’s decision to make you an involuntary patient or “rescind” the involuntary status. If the involuntary status is rescinded, you are a voluntary patient. The decision will be given to you in writing. If you would like to receive "reasons for the decision," you must request these from the Consent and Capacity Board within 30 days of your hearing.

 

Can I appeal a Consent and Capacity Board decision?

  • Yes. If you believe that the Consent and Capacity Board has made an error in fact or law, you may appeal the decision to the Superior Court of Justice. You must serve and file your appeal with the Court within seven days of receiving the Consent and Capacity Board decision.

 

Questions?

  • If you have questions, contact your local Patient Advocate or Rights Adviser or call the central office of the Psychiatric Patient Advocate Office at 1-800-578-2343. 
   

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