A lot of people approach me for advice about how to assist their friend or family member experiencing a mental health crisis when they are unwilling to seek help, usually because they don’t realize they are suffering from a mental illness.
Involuntary hospital admission for the mentally ill is a subject that needs to be treated very carefully. British Columbia’s Mental Health Act has outlined some very specific guidelines governing when and how involuntary admission can occur. These are intended to protect an individual’s rights while also preventing ill people from harming themselves or others.
According to the Act, there are three methods by which a person can be involuntarily admitted to hospital. These include admission under a physician’s medical certificate, police intervention or by order of a judge.
In order for a physician to sign a medical certificate, the doctor must examine the individual to ensure four specific criteria are met.
First, the patient must be suffering from a psychiatric disorder that seriously impairs his or her ability to react appropriately to the environment or others. The patient must also need psychiatric treatment as well as care, supervision and control to prevent substantial mental or physical deterioration or to protect the patient or others. Finally, the individual must not be suitable as a voluntary patient.
Once a medical certificate is obtained, a mentally ill person can be taken by police to the nearest mental health facility and admitted for up to 48 hours. In order to keep a person hospitalized for longer than 48 hours, a second physician must also examine the patient and agree with the initial assessment. With a second certificate, a person can be kept in care for up to one month before being re-certified.
Protection from bodily harm or violence is not the only reason to commit someone with a mental illness.
For example, during an acute manic episode some people decide to spend or give away large sums of their money and do not believe they are ill or in need of medical help. Individuals in this situation might qualify for involuntary hospitalization in order to protect them from putting themselves or their dependents into financial hardship.
Police intervention is another way for a mentally ill person to be brought into medical care on an involuntary basis. A police officer can take a person into custody for a medical examination if satisfied the individual is likely to endanger his or her own safety or that of others and if the person is apparently mentally ill.
Notice that this requires a more selective interpretation; there must be “endangerment” as opposed to “impairment of his or her ability to react appropriately to the environment or others”. In practice there is considerable variation in the willingness of police officers to exercise their responsibility under the mental health act.
When the police take someone into custody, they must bring the individual immediately to a physician for examination.
A judge can also order an individual into psychiatric care when it is not possible for a physician or the police to intervene. In such instances, anyone with good reason to believe the individual meets committal criteria, can apply to a judge or justice of the peace to have the person admitted involuntarily. This is a more time consuming and bureaucratic way to proceed and is much less often used.
If the judge finds the usual methods cannot be used without dangerous delay, a warrant can be issued allowing authorities to admit the individual for a 48-hour observation period and physician evaluation.
If you are concerned about a loved one who is behaving erratically and putting him or herself or others at risk – whether physically, socially or financially—there may be a legal way to help.
Speak to your doctor about your options or contact the local mental health service, advocacy groups or hospital psychiatric ward or emergency room. If you encounter an urgent situation and it is not possible to get a doctor’s advice or examination, contact the police.
For more information about the law surrounding involuntary hospital admission, you can access the Mental Health Act online here.
Although it is sometimes necessary, involuntary hospital admission is not an act that should be taken lightly or used without discretion.