Script 425 gives information only, not legal advice. If you have a legal problem or need legal advice, you should speak to a lawyer. For the name of a lawyer to consult, call Lawyer Referral at 604.687.3221 in the lower mainland or 1.800.663.1919 elsewhere in British Columbia.

Anyone who wants psychiatric help can ask to be admitted to hospital for psychiatric treatment. The BC Mental Health Act also allows authorities to send people to hospital even if they don’t want to go. This script explains both cases.

Voluntary admission to hospital
Anyone 16 or older can ask to be admitted for treatment to a psychiatric unit in a general hospital or a psychiatric hospital. A doctor who examines them and believes they need psychiatric treatment can admit them to hospital. People under 16 need a parent or guardian to apply for them.

Hospitals can treat voluntary patients only if the patient consents to the specific treatment. If they are incapable of consenting, someone else can act as a temporary substitute decision maker to consent for them. It could be the patient’s spouse, adult child, parent, or other person who is, or becomes, their adult guardian. That person is either a “representative” or a “committee,” or an “attorney” appointed under a power of attorney. Refer to script 428, called “Adults and Consent to Medical Care,” for details on consenting to medical treatment and substitute consent.

What if a voluntary patient wants to leave the hospital?
Voluntary patients can just tell the nurse in charge that they want to be discharged, and in most cases, they’ll be free to go. The hospital may ask the person to sign a “Discharge against Medical Advice” form.

Involuntary admission to hospital
The rules for hospitalizing a person against their will are stricter. A person can become an involuntary patient by doctor’s certificate or court order. As well, the police can take a person to hospital in an emergency - see below for details.

While a voluntary patient may be admitted to any hospital with psychiatric services, involuntary patients can be admitted to only certain hospitals in BC. If a hospital doesn’t have a bed available, they may not be able to admit a person. In that case, the person would be sent, under supervision, to another hospital that has room.

1. Doctor’s certificate
   This is the most common way people are hospitalized against their will. A doctor who believes a person has a mental disorder, as defined in the Mental Health Act, can complete a certificate to admit the person to hospital, even if the person doesn’t want to be hospitalized or treated. The doctor must believe the person needs to be hospitalized for psychiatric treatment, or to prevent substantial mental or physical decline, or to protect the person or other people. The mental disorder must seriously impair the person’s ability to react properly to their environment or to get along with others.
   
   The person does not have to be dangerous to be admitted involuntarily. For example, a person who has a serious manic episode and gives away a lot of money would probably be admitted.

2. Court order
   Anyone, including family members and neighbours, who reasonably believes a person has a mental disorder and needs to be hospitalized can apply to court. The court can issue a warrant that allows the police to take the person to hospital, where they will be assessed.

3. Police action in an emergency
   The police can act in an emergency when family members or health professionals need help getting a person to see a doctor. If the police believe a person has a mental disorder and their behaviour is likely to endanger their own safety or the safety of others, the police can immediately take the person to a doctor - usually in a hospital. If the person needs to be hospitalized, a doctor will complete a certificate to admit them.

How long can involuntarily patients be kept in hospital?
A doctor’s certificate to send a mentally ill person to hospital is valid to admit the person to hospital for 14 days. Involuntary patients can be kept in hospital for only 48 hours after they are admitted, based on the doctor’s certificate. To keep the patient longer than 48 hours, the hospital must get a second doctor to examine the patient and produce a second certificate within the 48 hours. Then they can keep the person for up to one month. That term may be renewed for another month, then three months, then six months, and then subsequent six-month terms - each time with a doctor’s certificate, which must be based on an examination and written report.

The hospital director must give the patient written and oral notice that they are being hospitalized - at the start of the hospitalization and at each renewal of it. If the director believes that the patient does not understand the notice, the director must give the notices again as soon as they consider that the patient can understand it. The written notice must also go to the patient’s near relative (which includes a representative). If there’s no information available on a relative, then the notice must go to the Public Guardian and Trustee.

Can involuntary patients be treated without their consent?
Yes, because they may not understand or realize that they need psychiatric treatment. If they refuse treatment or are incapable of consenting, the hospital director consents to treatment for them. The patient (or a family member or someone else acting for them) can ask for a second medical opinion on whether the treatment is appropriate.

Can involuntary patients decide to leave the hospital?
No, unless their doctor discharges them permanently or on extended leave, or changes their status to voluntary. Some involuntary patients leave the hospital on extended leave and still have involuntary outpatient treatment that the hospital director authorizes. These patients have the right to periodic review panel hearings - as if they had stayed in the hospital as involuntary patients.

If an involuntary patient wants to leave hospital and their doctor won’t let them, they (or someone acting for them) must ask for a review by the Review Panel. They can ask for a review after they’ve been involuntarily admitted and after each renewal of their hospitalization.

How do reviews work?
A patient has the right to a review by the Review Panel of their hospitalization if they (or someone acting for them) request it. To do that, the patient or the person acting for them must complete an application form available at the hospital or from the Review Panel Office (call 604.524.7220). A panel of three people hears the review, which must be held within 14 to 28 days after the Review Panel Office receives the application, depending on the case. A patient has the right to have a lawyer, friend, or advocate speak for them.

The Review Panel decides whether the patient should be kept or released. A patient can apply to court for judicial review of the Panel’s decision, but they’ll need a lawyer for this. A patient can also bypass a review hearing and go directly to court, but the procedures are complicated, so they’ll also need a lawyer for this.

Where can you get more information?
From a health professional, a lawyer, or from the Mental Health Law Program at the Community Legal Assistance Society - call 604.685.3425 in the lower mainland or 1.888.685.6222 elsewhere in BC. You can also check its website at www.clasbc.net. For information on mental health services in BC, check the Ministry of Health website at www.healthservices.gov.bc.ca/mhd.

[updated September 2008]

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