How to Get a Psychiatric Assessment

Note: This is provided for general information only and is not medical or legal advice.

 


 

When a person appears to be suffering from a mental disorder or experiencing symptoms, perceived to be a danger to self or other,  fails to care for his/her own needs, and is unwilling to obtain help, a Psychiatric Assessment may be necessary.  There are options for people who want to get an assessment for someone who is refusing to have one voluntarily.

Encourage the Person to Get an Assessment

  • A person, who is ill in the opinion of others, but not in his or her own judgment, will sometimes agree to see a doctor if requested or encouraged to do so by someone they trust or respect. It is important to consider whether this trusted person should be the spouse or parent. Alternatively, a friend, clergy member, therapist or other individual may be more convincing and comfortable speaking with him/her.
  • Start by identifying a friend or relative who might have enough influence.
  • The friend or relative would probably need to accompany the person to an appointment or to the Hospital Emergency Department.

By Order of a Physician

  • Physicians practicing in Ontario have the right to sign an Application for Psychiatric Assessment (Form 1), "which authorizes the apprehension, detention and assessment of a person" who meets certain criteria under the Mental Health Act.
  • If a person has seen a physician for any reason, that physician may — within 7 days of seeing the person — complete a Form 1 which specifies what symptoms the doctor observed and/or what information was provided by someone else.
  • Once the person is brought to a Schedule 1 Hospital under a Form 1, the person must be assessed within 72 hours and a decision made. The decision will be either that the person MUST be admitted (involuntary status) or SHOULD be admitted (voluntary status), or that the individual does not require admission and therefore will be released from hospital.
  • If neither of the above apply, the alternative is to seek a Justice of the Peace Order

Justice of the Peace Order (in our local area)

  • Any person may apply for a Justice of the Peace Order (Form 2) that requires the apprehension and transport of the person to a physician. The physician can then determine if the patient requires an involuntary psychiatric assessment (Form 1) and if this is the case, the patient will be required to be brought to a Schedule 1 Hospital where psychiatric examinations can be performed on a 24-hour per day, seven-day per week basis.
  • The person applying for the Form 2 must provide enough information for the Justice of the Peace to be assured of the necessity of the Form 2. There are four categories of relevant information:
    1. Evidence of mental illness — by history, or if no diagnosis has been made, by description of symptoms and behaviour (e.g., responding to voices, delusions, bizarre and/or disorganized behaviour).
    2. Danger to self or others — made suicidal statements, gestures or behaviours, threatened or assaulted others, or behaviour that has made the applicant fear people may be assaulted/at risk.
    3. Failure to care for his/her own needs — concrete examples such as no coat or socks in winter, no food in kitchen, looks weak or dehydrated, refusing food because of fear of poison, a medical condition not attended to (e.g., refusing cast on broken arm, ignoring infection) because of psychiatric symptoms.
    4. There is an additional page where you will be asked for your name and phone number and a blank portion for your written concerns. Please provide all of your phone numbers and ensure Emergency Department staff can reach you. PLEASE provide written details in this blank portion to assist Emergency Department Staff to understand your concerns. The blank portion is your opportunity to state your concerns clearly and in writing. It is especially helpful if you attach a letter outlining your concerns.
    5. Details of the Justice of the Peace process are found in the Mental Health Act:
      http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90m07_e.htm#s16s1

Once a Form 2 is Issued

  • When the Justice of the Peace Order (Form 2) is in hand, it should be immediately taken to the police station.
  • Provide the following:
    1. Phone number to contact you.
    2. If person has been treated at a particular hospital, request that he be taken to that hospital where medical record already exists.
    3. Written Summary of Illness for receiving doctor and of any other conditions, stapled to Form.
    4. As much information as possible about any history of violence, the presence of weapons (type & location), and any other information for the safety of the person being apprehended and the police.
    5. As much information as possible about person's probable whereabouts.
  • Keep a copy of the Form.
  • Get the Occurrence number and/or Case number from Police.

Some Other Points

  • If you locate person first, call the police to inform them.
  • Call the Emergency at the designated hospital to tell them your person is being brought in and make them aware of your willingness to provide supplementary information.
  • Police carry out this duty with 2 uniformed officers.
  • No one is required to call the family of a person apprehended under a Form 2 order to advise them that the individual has been taken to hospital. It is therefore prudent to check with police from time to time.
  • A Form 2 can be requested in the following circumstance to prevent things from getting really bad: if a person was treated before, got better, went off medication, is showing symptoms of illness again.

If Form 2 is NOT Issued

  • Review information presented for factual detail in the 4 categories of relevant information — go back the next day. If you feel that you left out relevant information — add it to a new application for a Form 2. If the situation has changed, or the risk to harming him or herself or another person is increased — explain this in a letter.

Getting Help Outside Office Hours

  • Police who respond to a 911 call have to decide if the situation can be defused, or if a person should be placed under arrest and taken to jail, or if the person should be taken to a Hospital Emergency Department.
  • Not all police have experience with psychiatric emergency calls; you may need to explain your concerns and specifically request that the person be assessed.
  • Note: Previously a policeman had to observe behaviour which suggested illness. The Mental Health Act has been CHANGED to permit apprehending and taking a person to hospital based on information presented by others.