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Glossary of Mental Health Act - Guest Speaker

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Created by daisy497

Agenda for Mental Health Act:
- Highlights of the new Mental Health Care and Treatment Act
- a focused discussion looking at ROLES & RESPONSIBILITIES
- a review of MATERIALS & RESOURCES available to STAFF to support you in implementing the requirements of the act
- It is LAW to follow this legislation
- Nurses have a primary role to implement this act



MOTIVATION for CHANGE:
- To provide for the RIGHTS of people who experience INVOLUNTARY DETENTION & TREATMENT
- To REVISE the ELIGIBILITY CRITERIA that are used to determine what situations/individuals BENEFIT from the AUTHORITY of the Act
- To EXPAND the RANGE of INTERVENTIONS/SERVICES available under the act

**You need to make sure they MEET THE CRITERIA to be CERTIFIED because once certified, the RIGHTS ARE GONE
*the OLD act: was more INVOLVED with DETENTION (they stayed in hospital)
*the NEW act: takes into account the RIGHTS of the PATIENT (not necessarily hospitalized if they have a mental illness)

**"Die by suicide" is better than saying, "commit suicide"







PURPOSE of the Mental Health Act (s.3)
1. To provide TREATMENT & PROTECTION for persons suffering from a SEVERE mental disorder to the degree that:
- they are at risk of HARMING THEMSELVES/OTHERS or PHYSICAL DETERIORATION WITHOUT TREATMENT
2. To provide for APPREHENSION, TREATMENT, etc in LEAST RESTRICTIVE manner to ACHIEVE PURPOSES above (*the LUTHER REPORT was a driving force for this)
3. To PROVIDE for the RIGHTS OF PERSONS who come under the act

- police couldn't bring people in unless they SAW the behaviour but the people would hold in their behaviour
- NOW: caregivers can ASK the police to bring them in for ASSESSMENT
- if they don't VOLUNTARILY come in, the police can FORCE them with hand cuffs
- if you are CERTIFIED, you don't have to come by police (depends on their RISK of ELOPEMENT - taking off)









KEY CHANGES of the MENTAL HEALTH ACT:
1. NEW eligibility CRITERIA & PROCESS for INVOLUNTARY admission
2. "FACILITIES" & "PSYCHIATRIC UNITS" (there are 2 SIGNATURES on CERTIFICATION. The 1st one can come from anywhere [ex. emergency - which is a facility] Then TRANSPORTED & ASSESSED in PSYCHIATRIC UNIT (***the 2nd signature MUST be received within 72 HOURS of the 1st to be certified)
3. PROVISION of a range of patient/individual rights & protections but substitute decision-making not available
4. Expanded roles for nurses, nurse practitioners & peace officers
5. TREATMENT
6. LEAVE
7. Changes to the ROLE & OPERATION of MHCT Review Board
8. Provision of Community Treatment Orders (when certified patient is in community)
9. MANDATORY REIVEW of Act within 5 YEARS







Mental Health Act addresses an individual's procedural right to (s.11):

(RIGHTS BASED APPROACH)

1. Know WHERE & WHY he/she is being detained (right from the beginning - if picked up by police, they start with this process)
2. Be given a COPY of CERTIFICATE, ORDER, or other AUTHORIZATION (the certificate must be photocopied and given to the patient - now they leave them in the chart and patients can ask to see it whenever they want)
3. ACCESS a TELEPHONE & VISITORS (can call lawyer whenever they like. Note: if in seclusion room, they cannot come out. Therefore, if you don't let them out, you have violated this right so you need to DOCUMENT why - that it was a safety issue.)
4. Send/receive CORRESPONDENCE (they can write letters)
5. Retain & instruct counsel (legal aid)
6. Access their representative and rights advisor
7. Have input (& representative input) into treatment decisions (the ultimate decision come down to the psychiatrist)





Rights ADVISOR (s. 13, 14, 15):
- Appointed by MINISTER (NOT patient). Accessed through 1-800 number (leave certain info: patients name, unit, date & time they were certified)
- Responsible for meeting with persons detained in Psychiatric Unit (NOT facility) or CTO AND the representatives of these persons (rights advisor has 24 hours to meet with patient once they have arrived; important for nurse to inform rights advisor when they come)
- Responsible for providing information and advice with respect to a person's status as an involuntary patient, the exercise of rights, the retention of counsel and applications to and hearings by the review board

*NOT Eastern Health employees - they work for the government
*they have no access to patient information [they are NOT an advocate for the patient; we provide a safe location for them to meet]
- Rights advisor MUST have government photo id to get on unit





PATIENT REPRESENTATIVE (s. 2 (1) (t))
...a person, other than a rights advisor, who is 19 or OLDER and is MENTALLY COMPETENT
- designated by PATIENT who has AGREED to act on behalf of, a person and may include the next of kin, legal counsel or guardian (could be teacher or friend)
- if no one is designated, the representative shall be the next of kin (s. 2 (m)) unless patient objects.
- the patient can REFUSE to have a representative (every 2nd day they are asked if they want one)
- they have to provide phone # so we can call them to see if they are willing to be the patient representative

**if married at 18, your wife/husband CANNOT be the patient representative





CERTIFICATION CRITERIA (s. 17):
1. The individual is suffering from a mental disorder and is likely to cause HARM to SELF or OTHERS, or is likely to suffer SUBSTANTIAL MENTAL or PHYSICAL deterioration WITHOUT TREATMENT
2. Is unable to fully appreciate the nature & consequences of the disorder and make informed decision on treatment and care, and
3. Needs treatment which is only available in a psychiatric unit

***All 3 have to be present in order to be certified







DEFINITION of MENTAL DISORDER:
- a disorder of thought, mood, perception, orientation or memory that IMPAIRS:
1. JUDGMENT or BEHAVIOUR
2. The CAPACITY to recognize REALITY
OR
3. The ABILITY to meet the ordinary DEMANDS of life

- and in respect of which psychiatric treatment is advisable





CERTIFICATION PROCESS:
- requires SEPARATE ASSESSMENTS (by 2 clinicians) verifying that the individual meets the criteria for involuntary admission (1st and 2nd certificates)
- Physicians and nurse practitioners may sign the 1st certificate. (1st one can be anywhere - ex. home visit, community, etc.)
- Psychiatrist completes the 2nd certificate
- Police apprehend - take them to 1st certificate clinician
- Judge can order person to be examined by 1st certificate clinician



1st Certificate Consequences:
- person can be apprehended and conveyed (transported) WITHOUT consent to a facility, preferably a psychiatric unit, for the 2nd involuntary psychiatric assessment by a psychiatrist
- person can be OBSERVED, DETAINED and CONTROLLED during his or her apprehension and conveyance
- Person who signed 1st certificate can AUTHORIZE treatment (2nd signature is not needed for treatment)

FIRST Certificate Consequences:
- person can be apprehended and conveyed (transported) WITHOUT consent to a facility, preferably a psychiatric unit, for the 2nd involuntary psychiatric assessment by a psychiatrist
- person can be OBSERVED, DETAINED and CONTROLLED during his or her apprehension and conveyance
- Person who signed 1st certificate can AUTHORIZE treatment (2nd signature is not needed for treatment)
- person can be DETAINED, RESTRAINED, TREATED and OBSERVED WITHOUT his/her consent for a period of up to 72 HOURS from the time of arrival in the facility or psychiatric unit
- Conveyance should happen as soon as possible but the 1st certificate is VALID for 7 DAYS (ex. for more Northern areas due to weather)

*if it goes past the 72 hours, patient becomes VOLUNTARY





SECOND certificate:
- The psychiatrist signing has personally conducted a psychiatric assessment within past 72 hours
- Time & date of assessment
- It is recommended where appropriate that the 2nd certificate be conducted by a psychiatrist at a psychiatric unit

SECOND CERTIFICATE TREATMENT:
- Treatment WIHOUT consent must take into account of patient's "BEST INTERESTS"
- Physician or other clinician MUST consult, "where appropriate," with patient and/or representative
- must EXPLAIN diagnostic or treatment procedures and "give consideration to the views of the patient and representative"

TIMELINES (placed on nursing checklist):
- The Act provides specific timelines for:
1. Certification (2nd 72 HOURS AFTER admission)
2. Renewal of certificates (30 DAYS AFTER FIRST; 30, 60, 90 repeating) **if still certifiable 30 days after signing 1st certificate, this is good for another 30 days; then enter 2nd renewal which is good for 60 days; 3rd renewal is good for 90 days - MOST people don't make it past the 1st renewal
3. Changing the status of a voluntary patient to an involuntary one (4 HOURS nurse hold) - *nurse can hold for 4 hours to do a stat psychiatric consult to see if they are certifiable
4. Transporting a patient: as soon as possible. 1st certificate EXPIRES after 7 DAYS
5. DETENTION pending conveyance: 7 DAYS with 2 certificates in "appropriate place" (see regulation)
6. *****ASKING for a REVIEW by the MHCT Review Board. Decision within 15 clear days. (Application to be DECERTIFIED)





MHCT REVIEW BOARD STRUCTURE:
- 13 member, quasi-judicial review board appointed by the MINISTER
- Operates in panels of 3:
1. LAWYER
2. PHYSICIAN
3. Another INTERESTED person



MHCT REVIEW BOARD MANDATE:
- On request review (& approve or revoke) a patient's certification or CTO, on the day of the hearing
- Conduct AUTOMATIC REVIEWS on ALL individuals held more than 60 DAYS
- Review and make RECOMMENDATIONS in situations of allegations of unreasonable denial of a right

POWERS OF THE BOARD:
- same as COMMISSIONER under PUBLIC INQUIRES ACT (can OVERRIDE the decision of the physician)
- Require attendance of WITNESSES and production of DOCUMENTS
- Arrange for the INVOLUNTARY patient to be EXAMINED by a psychiatrist
- Engage INDEPENDENT experts to present evidence or make submissions
- Can meet with INVOLUNTARY patient in PRIVATE
- Board will be accessed centrally through the Board Chair




Community Treatment Orders:
- Section 40-54
- Provides a NEW TREATMENT option for a difficult-to-serve group in the NL system
- ***Involves a mandated treatment and care in the community under the supervision of the treating psychiatrist and usually an assertive case management team
- the ACT team (once patient goes into the community)

- *ran into trouble with this because of the conditions for CTOs




Conditions for CTOs:
- Required: 3 INVOLUNTARY admissions in last 2 years; meets certification criteria, services available, capable of complying, community treatment plan
- 6 months, renewable; return to hospital if not complying (people will be following them around. So people thought it would just be easier to stay in the hospital)
- There is no ACT team in rural areas so we have to figure out what resources are needed for them to go home (People have to agree to take them on which is hard sometimes)

*in 5 years, only 4 patients used this



PHYSICIAN/NURSE Practitioners:
- Can sign the 1st certificate
- Provides patient with rights including copy of 1st certificate AND copy to representative
- May order transport, treatment, medication or other intervention as appropriate
- Arranges for 2nd certificate examination


PEACE OFFICER (RNC/RCMP):
- Can apprehend individual - on "REASONABLE GROUNDS" (the person living with the individual will see the deterioration 1st. So we need to listen to these people)
- Must advise individual detained or apprehended under the Act of their rights
- Stay until told by the person conducting the psychiatric assessment that custody is NO LONGER required (if the police pick someone up and the person says "I'm going to kill myself", they must take them to the psych unit and the police officer MUST stay with them until the physician says they can leave)
- Arrange for someone to return patient if not certified - could be taxi, bus, plane, etc. (see policy manual)


PSYCHIATRIC/MENTAL HEALTH NURSE
- Rights information (if delegated) (ex. certificates)
- **Monitoring adherence to timelines (the checklist)
- In cases where a voluntary patient wishes to leave the psychiatric unit, and the nurse observes that there is mental and physical deterioration, the nurse can hold the patient for 4 hours pending a psychiatric assessment

ADMINISTRATOR:
- "Administrator" means the person or designate charged with the administrative functions within a psychiatric unit (usually the NURSE in CHARGE)
- Determine if patient has a representative
- Provide patient rights and share with representative
- Notify Rights Advisors of admission, etc.
- Party in Review Board hearings



CONFIDENTIALITY:
- between the patient and their representative
- between the staff and patient
- between the Review Board and the patient and/or their representative
- between the patient and the rights advisor


MHCTA Branding
- Any information related to the new Act and its implementation at the REGIONAL level will be identified by this wordmark
- This word mark, along with using the blue and green colours for covers and binders, etc. will help identify the forms and materials you will use in your daily work
- the leaf represents a new beginning for mental health services

POLICY MANUAL
- paper cover available in ALL regions
- Electronic copy available
- Covers policy and practice
- Includes the required forms for procedures (certification, transport, etc.)


MHCTA Website:
- Facts Sheets (brochures)
- Policy Manual
- Forms
- Web Links


ACTIVE REVIEW:
- Your observations of how this process unfolds are important. The Act will be reviewed EVERY 5 YEARS
- It is important to recognize what is working well and what needs to be improved

**For more information on the Mental Health Act:
www.gov.nl.ca/health/mhcta



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