Hospitalizing a Mentally Ill Person

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by Diana Juricevic, Mental Health Review Board in October 2017.

Anyone who wants help with a mental illness can ask to be admitted to a facility for treatment. The law also allows people to be involuntarily admitted in certain situations.

Understand the legal framework

If someone asks to be admitted to a mental health facility

In BC, the Mental Health Act is the law that describes what happens when someone who is living with a mental illness needs treatment and protection for themselves or others. Under this law, anyone aged 16 or older can ask to be admitted to a “designated mental health facility”. There are several dozen treatment centres and hospital psychiatric units in the province designated under this law.

If a doctor who examines the person believes they have a mental disorder requiring treatment, the person can be admitted to hospital. People under the age of 16 need a parent or guardian to apply on their behalf.

Treatment of a voluntary patient

Mental health facilities can treat voluntary patients only if the patient consents to the specific treatment. If the patient is incapable of consenting, someone else can act as a temporary substitute decision maker (TSDM) to consent for them. In order of priority, a TSDM could be their spouse, child, parent, brother, sister, grandparent, grandchild, any other person related to them by birth or adoption, a close friend, or a person immediately related to them by marriage. The TSDM must be at least 19 years old, must get along with the patient, and must have been in contact with the patient in the past 12 months.

The TSDM could also be the adult’s representative (appointed under a representation agreement) or committee (appointed by the court to make personal, medical, legal and financial decisions). Our information on adults and consent to medical care (no. 428) has details on consenting to medical treatment and substitute consent. We explain what is a representative (in no. 180) and committee (in no. 426).

If a voluntary patient wants to leave the facility

To leave a mental health facility, a voluntary patient need only inform the facility staff they want to be discharged. In most cases the patient will be free to leave. The facility may ask them to sign a “discharge against medical advice” form.

To admit someone to a hospital against their will

The rules for hospitalizing a person against their will are stricter. A person can become an involuntary patient through a doctor’s certificate or a court order. As well, the police can take a person to hospital in an emergency.

While a voluntary patient may be admitted to any hospital with psychiatric services, involuntary patients can be admitted only to certain hospitals in BC. If a hospital doesn’t have a bed available, they may not be able to admit the person. In that case, the person would be sent, under supervision, to another hospital that has room.

Through a doctor’s certificate

The most common way people are hospitalized against their will is through a doctor’s certificate. A doctor who believes a person has a mental disorder, as defined in the Mental Health Act, can complete a certificate to admit the person to hospital, even if they don’t want to be hospitalized or treated. The doctor must believe the person:

• Is suffering from a mental disorder that seriously impairs their ability to react appropriately to their environment or to associate with others.
• Requires psychiatric treatment in a designated facility.
• Requires care and supervision in a facility to prevent the person’s substantial mental or physical deterioration or to protect themselves or others.
• Is not suitable to be a voluntary patient.

The person does not have to be dangerous to others to be admitted involuntarily.

Through a court order

Anyone, including family members and neighbours, who reasonably believes a person has a mental disorder that requires hospitalization for the safety of themselves or others can apply to court for an order to have the person hospitalized. Also, the court can issue a warrant allowing the police to take the person to hospital for assessment.

Police action in an emergency

The police can act in an emergency to take a person to a doctor for examination. If the police believe a person has a mental disorder and their behaviour is likely to endanger their own safety or the safety of others, the police can immediately take the person to a doctor — usually at a hospital. If the person needs to be hospitalized, a doctor can complete a certificate to admit them.

How long involuntary patients can be kept in hospital

A doctor’s certificate to keep a person with a mental disorder in hospital is valid for up to 14 days before admission. Involuntary patients can be kept in hospital for only 48 hours after they are admitted, based on one doctor’s certificate.

To keep the patient longer, the hospital must get a second doctor to examine the patient and produce a second doctor’s certificate within the 48 hours. The patient can then be kept for up to one month.

That term may be renewed for another month, then three months, then six months, and then every six months — each time with a doctor’s certificate based on an examination and written report. The examination must conclude that the criteria for involuntary admission continue to be met.

The hospital director must give the patient written and oral notice they are being hospitalized — at the start of the hospitalization and at each renewal of it. If the director believes the patient does not understand the notice, the director must give the notice again as soon as they consider the patient is capable of understanding it. The written notice must also go to the patient’s near relative (which includes a representative). If there’s no information available on a relative, then the notice must go to the Public Guardian and Trustee.

Involuntary patients can be treated without their consent

If an involuntary patient refuses treatment or is incapable of consenting, the hospital director can consent to treatment for them. The director must complete a consent for treatment form.

The patient (or a family member or someone else acting for them) can ask for a second medical opinion on whether the treatment is appropriate.

Involuntary patients cannot leave the hospital on their own

An involuntary patient cannot leave a hospital unless a doctor discharges them either permanently or on extended leave.

A doctor can change an involuntary patient’s status to voluntary, allowing the patient to leave as they please.

If an involuntarily admitted patient wants to leave the hospital and their doctor won’t discharge them, the patient (or someone acting for them) can ask for a review of the decision to keep them in hospital. We explain this process next.

Involuntary patients can request a review of their hospitalization

Involuntary patients have the right to have a panel of the Mental Health Review Board review their hospitalization after they are involuntarily admitted and after each renewal of their hospitalization. The patient (or someone acting for them) must request the review by completing an application form, available on the Review Board website (at bcmhrb.ca), from the Review Board office (phone 604-660-2325), or at the hospital.

The Mental Health Review Board is independent of government in making its decisions. A panel of three people (including a medical doctor, a lawyer, and a person who is not a doctor or lawyer) performs the review. The panel must hold a hearing within 14 to 28 days after the Review Board receives the application, depending on how long the person is being hospitalized for. A patient has the right to have a lawyer, friend, or advocate speak for them. After the hearing, the Review Board panel makes a decision on whether the hospital should keep or release the patient.

Tip An involuntary patient may be discharged from hospital on extended leave on the basis they follow outpatient treatment. These patients have the right to periodic hearings by a Review Board panel — as if they had stayed in the hospital as involuntary patients.

Applying to court to be discharged from a hospital

Under section 33 of the Mental Health Act, a patient or a person acting for them can apply to court for an order that the patient be discharged from a mental health facility. The application is brought to BC Supreme Court. This is a complicated area of law and patients should get legal advice if they want to do this.

Get help

With your case

The Community Legal Assistance Society (CLAS), through their Mental Health Law Program, provides representation to people who have applied to review their involuntary detention under the Mental Health Act at a hearing before the Mental Health Review Board.

Telephone: 604-685-3425 in the Lower Mainland

Toll-free: 1-888-685-6222

Web: clasbc.net

More information

The BC government’s website includes information and options for support on mental health issues.

Web: gov.bc.ca/mentalhealth