Mental Health Act Flashcards
Emergency medical treatment may be given to a patient, without _____, if there is imminent and serious danger to the patient’s life or to a limb or vital organ and the patient,
consent
Emergency psychiatric treatment – Given to a patient without ______, if there is imminent and serious danger to self or others
consent
Right to equality and non-discrimination
Right to privacy
Right to individual autonomy
Freedom from inhumane and degrading treatment
Care in the least restrictive environment
Right to information and participation
Human Rights
Canada is committed to ensuring the promotion and protection of ______ of all persons, including people who experience disabilities and mental illness
human rights
Sets out in law admission & treatment requirements for clients in designated psychiatric facilities.
Manitoba Mental Health Act
does not apply to admission or residence in other types of facilities such as personal care homes or medical unit within a hospital.
The Manitoba Mental Health Act (MMHA)
Substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to or ability to meet the ordinary demands of life
Mental Illness/ Mental Disorder
Persons experiencing intellectual disability
Persons living in a personal care home or other care faculty
Vulnerable Person’s Act
______ to consent to or refuse admission
______ to consent to or refuse treatment
Levels of competence to manage own affairs
Competence; Competence
The age of Consent in Manitoba is __
16
Application for an order for involuntary medical examination
Form 1
Order for involuntary medical examination
Form 2
Notice to person in custody
Form 3
Application by physician for involuntary psychiatric assessment
Form 4
Application by attending physician for change of patients status from voluntary to involuntary
Form 5
Involuntary admission certificate
Form 6
Renewal certificate
Form 7
Certificate of change of status to voluntary patient
Form 8
Certificate of incompetence to make treatment decisions
Form 9
Notice of Cancelation of Certificate of Incompetence
Form 11
Request for discharge by voluntary patient
Form 13
Order for return of patient absent without permission
Form 14
Leave certificate or extension of leave
Form 15
Patient’s application to mental health review board
Form 18
There are two types of admission: ______ & ______
Voluntary; Involuntary
Directly from a physician’s office or community-based program
Directly from an emergency department
Family and friends can begin the process by completing a Form 1 - Application for an Order of Involuntary Medical Examination
How does a person become admitted to an acute care unit?
Under the MMHA a person must be assessed as competent to agree to voluntary admission to hospital.
A person must be 16 or older to give consent to admission to hospital and treatment.
A legal guardian must give consent to admission to hospital and treatment if 15 and under.
Anyone who is considered voluntary and wishes to leave a facility contrary to medical advice must first sign a request for discharge.
Voluntary Admission
A person may voluntarily be admitted to a psychiatric faculty and then change their mind and request to leave
To leave against medical advice, the person must complete a _____ - Request for Discharge by Voluntary Client
Client must be assessed by physician within 24 hours, following assessment several options are possible:
Client changes their mind & stays voluntarily
Client is discharged
Physician applies to change client status to involuntary
Form 13
Application by Physician for Involuntary Assessment
Max 72 hours
Form 4
Involuntary Admission Certificate
Max 3 weeks
Form 6
Renewal Certificate
Max 3 months
Can be renewed
Form 7
Involuntary Admissions – Acute Psychiatric Facility
Form 4, Form 6, Form 7
Came into effect in 1998
Manitoba Mental Health Act
Completed by any community member to request person be compelled to have a medical examination.
Has a mental disorder
Is likely to cause harm to self or others
Needs to be examined by a physician
Refuses to be medically examined
In writing and under oath.
Form 1
Justice of the peace (Judge) may complete a ______
The police now take the person involuntarily for medical examination
Form 2
Police must inform the person in writing as to where they are being taken
That it is for an involuntary medical examination
That they have a right to legal counsel
Form 3
A physician can complete this form if they have examined the person with the last 2 days.
Person can now be admitted involuntarily to a psychiatric facility for assessment.
Allows for a 72-hour assessment period.
Form 4
Believed or known to have a mental disorder
Because of the mental disorder is at risk:
For serious harm to self
Serious harm to others
And/or at risk of substantial deterioration if untreated
Would benefit from treatment at a psychiatric facility
Refuses voluntary admission or is not competent to consent to a voluntary admission
Criteria for Form 4
Involuntary admission
Valid for 21 days
Form 6
Involuntary admission
Valid for 3 months
Form 7
At any time during the client’s admission, attending physician can apply to change status from voluntary to involuntary
Client must be examined by a psychiatrist within 72 hours of _____ being signed
If client has already been in hospital 72 hours when Form 5 signed, client must be examined within 24 hours
Psychiatrist can then complete a Form 6 – Involuntary Admission Certificate if they believe the person meets the criteria
Form 5
Involuntary clients must have:
Form 4 - Application by Physician for Involuntary Assessment
OR
Form 5 - Change of Status
AND
Form 6 – Involuntary Admission Certificate
Followed by a Form 7 is lengthy admission and client remains unable to consent to stay voluntary
An involuntary client (form 4 or 5, 6, 7) retains the right to refuse treatment.
Involuntary Admission
A clients status can change from involuntary to voluntary by physician/psychiatrist completing a Form 8 - Certificate of Change of Status to Voluntary client
Status is also changed:
Automatically when discharged
MMHA forms (4 or 5, 6, & 7) are allowed to lapse – not renewed
Form 8
Emergency Medical Treatment
Emergency Psychiatric Treatment
Form 9 – Certificate of Incompetence to Make Treatment Decisions
No treatment without consent unless
If assessed as unable to make treatment decisions due to illness:
Usually a family member will be asked to act as a legal proxy (substitute decision maker) for client & give their consent for treatment
Proxy can be a Public Trustee
Clients must be informed of status, right to appeal & right to a lawyer
Decision maker must be deemed to be acting in the best interest of the client
Form 9
Attending Physicians Statement that a Person in Psychiatric Facility has Regained Competence
When a person is well enough to consent for treatment the Form 9 should be cancelled.
Form 12
is completed prior to discharge as part of discharge planning
Collaborative plan of care made with client
Consented to by client or proxy is required at discharge
Duration 6 months (can be renewed)
Client agrees to follow treatment plan in community
If client breaches agreement, they can be return to hospital involuntarily & examined by psychiatrist for possible involuntary admission
Form 15
If any client leaves the hospital or does not return after a pass, the psychiatrist can complete a _____ and ask the police to return the client to facility
Form 14
The psychiatrist is legally responsible to inform a client in writing about:
Status under the MMHA
Right to appeal to Mental Health Review Board
Right to a lawyer
Right to speak with an ombudsman
Duty to Inform
Patient’s Application to Mental Health Review Board
A person may apply to appeal involuntary status and/or decision of incompetence (
Review board consists of – lawyer, psychiatrist, and a member of the public
The person may have legal representation during the Review Board Hearing
Form 18
Facilities Application to Mental Health Review Board
When a person has been assessed an incompetent to make treatment decisions, and the person authorized to make treatment decisions on their behalf (family member or public trustee) has refused to consent to treatment.
Form 19
Treatment or restraint by force must be recorded in detail in client’s clinical record:
(a)Medication used route, dosage, frequency
(b)Force or mechanical means:
(i)means of restraint,
(ii)period of time during which the client was or is expected to be restrained, and
(iii)a description of the behaviour that required the client to be restrained or to continue to be restrained.
Imminent risk
Certificate of Incompetence to Manage Property
Form 10
Notice of Cancelation of Certificate of Incompetence
Form 11
Authorization to Transfer
Form 20
Certificate of Incapacity
Form 21
Order of Committeeship
Form 22
Physicians Statement that the Patient is No Longer Capable of Managing Properties
Form 23
Notification of Cancellation of Certificate of Incapacity or Committeeship
Form 24
Oversees the MMHA
Promoting proper interpretation and application of MMHA
Administering the Orders of Committeeship Program, including issuing/canceling Orders of Committeeship
Issuing Authorizations of Transfer
Director of Psychiatric Services
Clients have limited rights to see and correct their medical record
Must apply in writing
Medical Director can refuse and ask Mental Health Review Board for permission to withhold
Right to View Medical Record
Ensure that client understands their rights under the MMHA.
Status under MMHA
Right to appeal to review board
Right to a lawyer
Advocates for client’s rights under the MMHA.
Inquires about Health Care Directives.
Provides education around importance of Health Care Directives.
Documentation
Psych Nursing Roles
A person may be transferred from a correctional facility for observation, assessment, diagnosis and/or treatment
Assessment of fitness to stand trial
Assessment to inform responsibility
Transfer from prison for treatment
The admission would be deemed involuntary
Criminal Code Admission
