Mental Health Legal Forms

You Should Be Familiar With: Beginners Guide

The purpose of the Mental Health Care Act is to regulate the treatment of people in psychiatric hospitals. All the forms mentioned below fall under the guidelines of the Mental Health Care Act.

Form 1: Application by Physician for Psychiatric Assessment

When a person seeks help at the emergency psych unit at your local hospital, a physician may want to examine them to determine whether they need to be admitted, involuntarily or voluntarily. A physician will complete an Application by Physician for Psychiatric Assessment: Form 1.

There must two elements present for this form to be valid: “a risk (harm to self, to others, or physical impairment) and evidence of a mental disorder that is related to (or causing) that risk._¹

Did You Know (Click Here)

• If admitted, the patient needs to be admitted to the nearest Designated psychiatric facilities or hospital. If you took your loved one to a hospital not listed on the link above, they will be transferred.
• Once the patient is detained, they will only be held for 72 hours
• Form 1 is effective for 7 days after it is signed. If the patient is not admitted after the application is signed, it will lapse.

Form 2: Order For Examination

What if the person poses a risk to self or perhaps others? In this case, a Form 2 can be ordered by a Justice of the Peace to allow for Police to take someone into custody. This might have come about because a physician provided information about the patient that concerned them.

How do you know if a Form 2 should be considered?

• Are they neglecting their daily hygiene? Are they showering, changing, etc
• Is their living situation unmanageable? i.e. are they living with a bug infestation?
• Are they acting out of character? Giving away belongings, reckless behaviour?
• Extreme change in physical appearance? Extreme Weight loss?
• Overconsumption of drug or alcohol
• Psychosis? I.e. delusions, hallucinations

Did You Know? (Click here)

• Upon being detained after the Order, the patient must still go to a hospital to be examined by a physician who will order a Form one
• Just because they have been issued a Form 2, it only means they will get taken to the hospital, not a guarantee of admission.
• The Form 2 is effective for 7 days
• Anyone, like a family member, can fill out the form if they are worried about their loved one, but it needs a Justice of the Peace to initiate the form.

Form 3: Certificate of Involuntary Admission

After a psychiatrist has assessed the patient, they might find that your loved one meets the criteria to be admitted under an involuntary status. This admission usually lasts for 2 weeks (13 days after signing the form).

*something to remember
Being assigned a Form 3 does not mean that your loved one will be forced into treatment. These forms refer to detaining. If the patient is not in immediate danger and not considered an emergency, they can still refuse treatment. A patient can still be considered “capable,” meaning they understand what issues they are facing, and what treatment they want to used.

Form 4: Certificate of Renewal

If your loved one’s medical team determines that there needs to be more time to assess your loved one as an involuntary patient, they will issue a Form 4.

Each renewal of Form 4 is done in 30 day increments.

What Is A Rights Advisor?

When a patient is admitted to the hospital, they are assigned a Rights Advisor. Each time a patient’s status changes, so do their rights.

The Rights Advisor will:

• explain how the change affects your rights
• discuss the doctor’s decision with you to see if you agree with the decision
• help you apply to the Consent and Capacity Board for a hearing if you don’t agree with the doctor’s decision
• help you apply for legal aid if you need it

above list taken from: Psychiatric Patient Advocate Office

Other Helpful Definitions

Voluntary: this is someone who is admitted on their own choice and with their own consent

Involuntary: this is someone who is admitted to the hospital after it is decided that they meet the criteria under the Mental Health Act.

What is the Criteria?

• serious harm to oneself
• serious harm to others
• they are in a state of deterioration, usually unintentional. This may include risky or dangerous behaviour, unsafe living conditions, lack of care (hygiene or weightloss), or concerning behaviour from psychosis.

Consent: this is the term when someone gives permission for a health care professional to administer treatment. Whenever there is a change in treatment, or medication, consent must still be given from the patient

Community Treatment Order (CTO):  “A Community Treatment Order (CTO), is a provision under the Ontario Mental Health Act that allows a physician to mandate supervised treatment on a patient when they are discharged from hospital. The overall goal of CTOs is to prevent mental health deterioration due to medication non-compliance. This is especially applicable in patients with a history of deteriorating when off medication, and show improvement when they are back on medications.”²

Substitute Decision Maker: “A person identified by the Health Care Consent Act (HCCA) who may make a treatment decision for someone who is incapable of making his/her own decision. The HCCA provides a hierarchy to determine who is eligible to be a substitute decision maker. The substitute decision-maker is usually a spouse, partner or relative. A power of attorney for personal care is not necessarily required to act as a substitute decision-maker.” ³

References and Resources

1. Form 1 – PsychDB
2. CTO – PsychDB
3. Practice Guideline – Consent (cno.org)
4. Psychiatric Patient Advocate Office
5. Legal Issues in Mental Health Care in Ontario, Continuing Professional Development, Faculty of Medicine, University of Toronto and the Centre for Addiction and Mental Health.