Ontario Mental Health Act
Encyclopedia
The Ontario Mental Health Act (OMHA) is an Ontario
law which regulates the administration of Mental Health
Care. The main purpose of the law is to regulate the involuntary admission of people into a psychiatric hospital. Since the changes brought about in 2000 under Bill 68 (often referred to as Brian's Law, named after Brian Smith who was shot dead in 1995 by a person suffering from paranoid schizophrenia), the act allows for a community treatment order by the attending physician. This order is intended to provide comprehensive treatment outside of a psychiatric facility.
manner, the act allows the police
to take someone to be examined by a physician
if they believe that the person is a danger to himself or herself, a danger to others, or the person is not able to care for himself or herself.
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 and fill out a Form 2 authorizing the police to take the person to a physician for examination.
(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.
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.
The physician fills out a Form 1 authorizing the police to bring the person in for a psychiatric assessment.
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 to notify the person and inform them of why they're being held.
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).
The physician who signs the Form 3 must be different than the physician who signed the initial Form 1.
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. Each time a Form 4 is filled out, another Form 30 must be filled out, notifying the patient.
If a patient is placed on a Form 3 or Form 4, they have the right to appeal the decision to a Consent and Capacity Board which will hear the patient's and physician's case. A patient's involuntary status is reviewed by the Board every year whether the patient requests it or not.
The board is composed, at the minimum, of a lawyer, a psychiatrist, and a member of the community (often a family member of someone with mental illness).
If the patient or physician disagrees with the Board's decision, they may appeal to the Ontario Superior Court of Justice
.
When a physician decides that a patient meets the criteria for a community treatment order, a treatment plan is developed with the involvement of all people involved in the plan. In addition to the physician and the patient, people involved in the plan may include other health care workers, social workers, family members, the substitute decision maker, or others. Once the treatment plan is agreed to by all parties, the patient is required to follow the plan while living in the community. Failing to follow the plan can result in the person being readmitted to the hospital on a Form 47. One notable aspect of the community treatment orders is that it allows anyone who is named in the treatment plan to communicate with each other for the purpose of providing treatment, care, or supervision of the person. By removing barriers to communication between members of the health care team, appropriate interventions can be quickly applied when the person is at risk.
A community treatment order lasts six months and can be renewed if needed. A person on a community treatment order has the right to see a rights advisor and to appeal to the Consent and Capacity Board. The Board will review community treatment order every year whether the patient requests it or not.
Ontario
Ontario is a province of Canada, located in east-central Canada. It is Canada's most populous province and second largest in total area. It is home to the nation's most populous city, Toronto, and the nation's capital, Ottawa....
law which regulates the administration of Mental Health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
Care. The main purpose of the law is to regulate the involuntary admission of people into a psychiatric hospital. Since the changes brought about in 2000 under Bill 68 (often referred to as Brian's Law, named after Brian Smith who was shot dead in 1995 by a person suffering from paranoid schizophrenia), the act allows for a community treatment order by the attending physician. This order is intended to provide comprehensive treatment outside of a psychiatric facility.
Assessment orders Form 1
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
When a person is acting in a disorderlyDisorderly conduct
Disorderly conduct is a criminal charge in most jurisdictions in the United States. Typically, disorderly conduct makes it a crime to be drunk in public, to "disturb the peace", or to loiter in certain areas. Many types of unruly conduct may fit the definition of disorderly conduct, as such...
manner, the act allows the police
Police
The police is a personification of the state designated to put in practice the enforced law, protect property and reduce civil disorder in civilian matters. Their powers include the legitimized use of force...
to take someone to be examined by a physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
if they believe that the person is a danger to himself or herself, a danger to others, or the person is not able to care for himself or herself.
Person lays information before Justice of Peace
In situations where there is no immediate danger, anyone can bring evidence to a justice of the peaceJustice of the Peace
A justice of the peace is a puisne judicial officer elected or appointed by means of a commission to keep the peace. Depending on the jurisdiction, they might dispense summary justice or merely deal with local administrative applications in common law jurisdictions...
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 and fill out a Form 2 authorizing the police to take the person to a physician for examination.
Physician orders assessment
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.
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.
The physician fills out a Form 1 authorizing the police to bring the person in for a psychiatric assessment.
Involuntary admissions
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 to notify the person and inform them of why they're being held.
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).
The physician who signs the Form 3 must be different than the physician who signed the initial Form 1.
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. Each time a Form 4 is filled out, another Form 30 must be filled out, notifying the patient.
Rights of the patient
A physician who places a person on a Form 3 or Form 4 is required to notify a rights adviser who is required to meet with the patient and explain to the patient what his or her rights are. If the patient requests it, a rights adviser will also help the patient apply for an appeal or acquire legal services.If a patient is placed on a Form 3 or Form 4, they have the right to appeal the decision to a Consent and Capacity Board which will hear the patient's and physician's case. A patient's involuntary status is reviewed by the Board every year whether the patient requests it or not.
The board is composed, at the minimum, of a lawyer, a psychiatrist, and a member of the community (often a family member of someone with mental illness).
If the patient or physician disagrees with the Board's decision, they may appeal to the Ontario Superior Court of Justice
Ontario Superior Court of Justice
The Superior Court of Justice is the superior court of general jurisdiction for the Province of Ontario, Canada. It is the successor to the former Ontario Court of Justice , and was created on April 19, 1999...
.
Community treatment orders
The OMHA states that "the purpose of a community treatment order is to provide a person who suffers from a serious mental disorder with a comprehensive plan of community-based treatment or care and supervision that is less restrictive than being detained in a psychiatric facility. ... [and] to provide such a plan for a person who, as a result of his or her serious mental disorder, experiences this pattern: The person is admitted to a psychiatric facility where his or her condition is usually stabilized; after being released from the facility, the person often stops the treatment or care and supervision; the person’s condition changes and, as a result, the person must be re-admitted to a psychiatric facility."When a physician decides that a patient meets the criteria for a community treatment order, a treatment plan is developed with the involvement of all people involved in the plan. In addition to the physician and the patient, people involved in the plan may include other health care workers, social workers, family members, the substitute decision maker, or others. Once the treatment plan is agreed to by all parties, the patient is required to follow the plan while living in the community. Failing to follow the plan can result in the person being readmitted to the hospital on a Form 47. One notable aspect of the community treatment orders is that it allows anyone who is named in the treatment plan to communicate with each other for the purpose of providing treatment, care, or supervision of the person. By removing barriers to communication between members of the health care team, appropriate interventions can be quickly applied when the person is at risk.
A community treatment order lasts six months and can be renewed if needed. A person on a community treatment order has the right to see a rights advisor and to appeal to the Consent and Capacity Board. The Board will review community treatment order every year whether the patient requests it or not.
Miscellany
- Under the OMHA it is not permitted to administer psychosurgeryPsychosurgeryPsychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...
to a patient who is considered incompetent to consent to treatment.
See also
- Ministry of Health and Long-Term Care (Ontario)Ministry of Health and Long-Term Care (Ontario)The Ministry of Health and Long-Term Care is the Government of Ontario ministry responsible for administering the health care system and providing services to the province of Ontario...
- Ontario Health Care Consent Act
- Ontario Substitute Decisions ActOntario Substitute Decisions ActThe Substitute Decisions Act establishes the legal criteria determining when a person has the ability to make decisions that are fundamental to his/her well-being. The ability to make these types of decisions is termed capacity and the decisions are termed consent...
- Ontario Mental Hospitals Act
- Revised Statutes of OntarioRevised Statutes of OntarioRevised Statutes of Ontario is a consolidated list of public acts in the province of Ontario.The list of acts are published every 10 years to cover changes to acts and printed by the Queen's Printer for Ontario....
- Psychiatric Patient Advocate Office
- Consent and Capacity Board