week 12

Question 1

what is ethics

Answer 1

expression of values and beliefs that guide practice

Question 2

bioethics

Answer 2

used in relation to ethical dilemmas surrounding health care

Question 3

legislation (foundation of legal obligations)

Answer 3

• means used within society to meet objectives and consolidate values
• type and form of legislation varies between countries and provinces/territories
  -> distinction exist w regard to involuntary admission criteria, the right to refuse treatment, and who has the authority to authorize treatment. refer to specific provincial or territorial act.

Question 4

6 principles of bioethics

Answer 4

1. autonomy
2. nonmaleficence
3. beneficence
4. justice
5. principle of impossibility
6. fidelity

Question 5

what is autonomy

Answer 5

respecting the rights of others to make their own decisions

Question 6

nonmaleficence

Answer 6

doing no wrong to a pt (minimize harm)

Question 7

beneficence

Answer 7

duty to promote good

Question 8

justice

Answer 8

duty to distribute resources of care equally

Question 9

principle of impossibility

Answer 9

rights or obligations that cannot be met in the circumstances are no longer obligations

Question 10

fidelity

Answer 10

maintaining loyalty and commitment to performing your duties

Question 11

3 main acts of the ontario mental health laws

Answer 11

1. mental health act
2. health care consent act
3. substitute decisions act

Question 12

what is the mental health act

Answer 12

set of rules decided by the ontario legislature that gives doctors and psychiatric facilities certain powers and gives patients particular rights

Question 13

health care consent act

Answer 13

deals with rules for consenting, or agreeing, to treatment

Question 14

substitute decisions act

Answer 14

how decisions can be made for a person and the appointment of powers of attorney for personal care and property

Question 15

what is the ontario mental health act

Answer 15

deal w many inpt issues:
- when someone can be taken and admitted to psychiatric facility involuntarily
- how a person can be kept in the hospital
- who can see a pt’s records in the facility and how to arrange to see them
- a pt’s right to information and right to appeal being involuntarily admitted

• regulates involuntary admission of people into a psychiatric hospital

Question 16

what is “treatment” not?

Answer 16

1. assessment for the purpose of HCCA of a persons capacity
2. assessment or exam of person to determine general nature of condition
3. taking a person’s health history
4. communication of an assessment or diagnosis
5. admission of a person to a hospital or other facility
6. personal assistance service
7. anything prescribed by the regulations as not constituting treatment

Question 17

what is a fundamental principle in healthcare about consent

Answer 17

treatment shall not be provided without consent. if a pt is capable, then that patient will decide whether to consent to, or refuse, the proposed treatment. if a pt is not capable, then a SDM will be asked to make the decisions on their behalf.

Question 18

describe capacity to consent to treatment and the considerations involved

Answer 18

an evaluation of capacity to consent to treatment involves a 2 part test with considerations of:
1. is the person able to understand the information relevant to making a decision about the treatment; and
2. is the person able to appreciate the reasonably foreseeable consequences of their decisions or their lack of decision

• a person may be incapable if they do not meet one part of the test or both

Question 19

describe an SDM

Answer 19

when a person is incapable SDM makes decisions on their behalf.

to make decisions someone must be “qualified” to act as their SDM

there is a hierarchy for determining who gets it:
1. incapable person’s guardian w appropriate legal authority
2. attorney for personal care if conferred authority
3. representative appointed by the board under s. 33 CRB
4. spouse or partner
5. child or parent of incapable person
6. parent if the incapable person who only has right of access
7. brother or sister
8. any other relative

Question 20

describe assessment and hospitalization under the mental health act

Answer 20

MHA provides legal framework for admission into Schedule 1 Psychiatric Facilities

term “mental disorder” is defined broadly in the MHA to mean “any disease or disability of the mind”

MHA provides psychiatric facilities with the power to lawfully detain persons who have been found upon examination by a physician to meet certain prescribed criteria

Question 21

what is a schedule 1 facilities

Answer 21

psychiatric facility like KGH or PCH

Question 22

what is a voluntary pt

Answer 22

person who has agreed to be admitted to a psychiatric facility for care, observation, and treatment

Question 23

informal patient

Answer 23

person who has been admitted pursuant to a SDM consent under section 24 of the Health Care Consent Act (HCCA)6

Question 24

involuntary patient

Answer 24

(a person who is the subject of a Form 3, 4, or 4A)
a person who has been assessed by a psychiatrist and found to meet certain criteria set out in section 20 of MHA, following which the person is admitted and detained as an involuntary patient

Question 25

what is a pt admitted under court order (what form)

Answer 25

form 6 or 8

Question 26

3 ways person is involuntarily admitted to psychiatric facility in ontario for 72 hour hold

Answer 26

1. police and other healthcare provider bring person to physician (form 1) 2. person lays information before justice of peace (form 2) 3. physician orders assessment (form 1)

Question 27

form 1

Answer 27

takes effect on date that it is signed by the physician, and that must be within 7 days of the physicians last examination of the person who is subject of the application once signed, the form 1 is effective for 7 days and provides authority for any person to take the person to a psychiatric facility where they may be detained, restrained, observed, and examined for no more than 72 hours.

Question 28

form 2

Answer 28

1. family member or friend who has come into contact w person who believes person requires mental health care 2. justice of the peace in jurisdiction is contacted 3. info by person bringing "form 2" order is sworn an oath before the justice of peace (either oral or written) 4. justice of peace determines if box A or Box B criteria is met 5. order signed by justice of the peace 6. order taken to police jurisdiction where "Form 2" order was signed 7. police execute "form 2" order 8. person named in the order is taken to the ED or physicians office for examination 9. person is detained under a Form 1 and sent to a Schedule 1 facility for further examination. if not filed under a form one the person is released back into the community. 10. person not detained and released back into the community

Question 29

what happens after form 1 (72 hour observation period)

Answer 29

- person must be either released, be admitted as a voluntary patient, or continue to be held as an involuntary pt with a certificate of involuntary admission (form 3 certificate of involuntary admission - Form 3 allows the pt to be held for 2 wks - *must be completed by a diff doctor than Form 1

Question 30

after 2 wks of involuntary hold what happens

Answer 30

to keep pt on an involuntary basis, a certificate of renewal (form 4) must be filled out 1st time a form 4 is filled out, it is valid for 1 mo 2nd time it is valid for 2 mo, each time after that it is valid for 3 mo each time a form 4 ia filled out, form 30 must be filled out, notifying pt

Question 31

form 5

Answer 31

change of voluntary status means pt does not need to be kept voluntarily anymore, and can be done anytime before end of form 3 or 4

Question 32

form 14

Answer 32

consent to disclosure, transmittal or examination of a clinical record used when pt wants to give another person permission to see or get a copy of their record

Question 33

form 28

Answer 33

request to examine or to copy clinical record used by a person who wants to get a copy of his or her own record

Question 34

is consent to treatment covered under the mental health act

Answer 34

not but it is under the health care consent act the physician must also fill out a form 42 to notify the person and inform them of why they are being held

Question 35

how does consent and rights of the pt work if the pt is placed on a form 3 or 4

Answer 35

- physician is required to notify a rights advisor who meets w the pt and explain his or her rights - pt can appeal decision at a CCB - if pt or physician disagrees w board's decision, they may appeal to the ontario superior court of justice

Question 36

what is the psychiatric pt advocate office

Answer 36

- created 1983 post charter - previously lawyers were employed to advise ppl of their rights - has community based rights advisors and facility based rights advisors who respond within 24 hours of a form being issued to a pt - rights advisors provide 3 options: stay in hospital, talk to doctor, ask for a review w the CCB

Question 37

what is the form for being made involuntary

Answer 37

form 3

Question 38

what is the form for renewal of involuntary status

Answer 38

form 4

Question 39

what is the form for certificate of continuation

Answer 39

form 4A

Question 40

what is the form for finding of incapacity to manage property

Answer 40

form 21

Question 41

what is the form for finding of incapacity to manage property continued in the community

Answer 41

form 24

Question 42

what is the form for when a client is found "incapable"

Answer 42

form 33 finding of incapacity to consent to treatment of a mental disorder *notification that they have a substitute decision maker

Question 43

what form is used for a community treatment order (CTO)

Answer 43

form 49

Question 44

what are CTOs

Answer 44

- provides a comprehensive plan of community based treatment that is less restrictive than being detained in a psychiatric facility - when a physician decides that a pt should have a CTO a treatment plan is developed - last 6 mo and can be renewed if needed - a person has a right to see a rights advisor and to appeal to the CCB - used for ppl who come in contact w the mental health sys repeatedly but do not continue treatment after leaving the hospital

Question 45

if a pt does not follow a CTO what happens

Answer 45

can result in the person being readmitted to the hospital under a Form 47

Question 46

can CTOs treat ppl against their will

Answer 46

CTOs cannot be used to treat ppl against their will while they are in the community if someone does not follow the requirements of the CTO, that person can be brought against their will to see the psychiatrist issuing the CTO and could possibly be hospitalized.

Question 47

what law introduced CTOs

Answer 47

brian's law (bill 68)

Question 48

what is the CCB

Answer 48

- legislated body set up to review decisions of physicians under Ontario Health Legislation - consists of doctor, lawyer, and community member - hearing within 7 days of receiving application - decision within 24 hours

Question 49

what are 3 things the criminal justice system can incorporate if the individual has mental illness

Answer 49

1. mental health court - assessment of a mental health issue - goes to mental health diversion - options for sentencing are broader 2. not fit to stand trial - needs an assessment, or a MAKE FIT order or a treatment order 3. NOT CRIMINALLY RESPONSIBLE - NCR - may be placed in the Ontario Review Board System permanently

Question 50

why are mental health pts treated diff for crimes

Answer 50

- is the crime a result from their illness - did the person understand what they were doing wrong criminal charge 1) "mens rea" - intention to commit the crime, or ability to appreciate the crime 2) "actus rea" - the actual act of the crime - does the person understand the rights they have to defend against this crime

Question 51

what is a fitness assessment

Answer 51

- 5-30 days generally - assessed by a psychiatrist to determine whether the accused is fit to stand trial - can they understand the process? can they instruct their lawyer? - do they understand what has happened?

Question 52

what is the mental health sys

Answer 52

network of ppl and services that care for people w mental illness

Question 53

what is the criminal justice sys

Answer 53

includes courts, institutions, and professionals that deal w people accused or convicted of crimes

Question 54

what does forensic mean

Answer 54

"connected to law or the courts" i.e ppl who have a mental illness and come into contact w the criminal justice system. place where mental health sys and criminal justice sys meet

Question 55

what does NCR mean

Answer 55

not criminally responsible

Question 56

what happens when a person is found NCR

Answer 56

- will be referred to the Ontario Review Board (ORB) and ordered to a forensic unit of a mental health facility - ORB will schedule an initial hearing within 45 days if the court has not made a disposition or 90 days if the court has made a disposition - locked wards - privileges to go out if deemed safe - day passes, or longer Leaves of Absences, or no privileges outside the hospital

Question 57

describe mental health act section 21 and 22 examination

Answer 57

section 22: a judge can order an accused who is in custody to be admitted to a psychiatric facility for an examination if the accused has not been released on bail, the accused will remain in custody during the examination. judge can also use section 21 of the MHA to order an accused who is not in custody to attend a psychiatric facility for an examination.

Question 58

what happens at a fitness hearing (step 2 under MHA)

Answer 58

- at the fitness hearing court will hear from the accused lawyer, look at the assessment report and decide if the accused is: 1) unfit to stand trial 2) fit to stand trial 3) unsure: needs a "make fit order" or a "treatment order"

Question 59

1. what does NCR mean 2. what section is this defined in 3. what does it state 4. how are they treated 5. if found NCR, what is the pt placed under

Answer 59

1. not criminally responsible 2. defined in section 16 of criminal code 3. states that "a person is not criminally responsible (NCR) for something that he or she did if - they were suffering from mental illness at the time and: - the mental illness made impossible for him/her to understand the nature and quality of what they did; OR - the mental illness made it impossible for them to understand that what they did was morally wrong (not just legally wrong) 4. if someone is NCR, they are treated in a forensics unit not in a correctional/prison facility 5. the authority of the ORB while maintains responsibility of making one of the following orders x1 yr: a) absolute discharge b) conditional discharge c) detention order