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“My sister is getting worse but she refuses to get help…”

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Families often witness the struggles of their loved ones and want to help. There are times when someone who is ill does not want to accept help – this leads to frustration by those closest to them.  In these times, concerned family members often wonder why we can’t confine or impose care upon their relative.

Here’s the reality.  Mental health law ensures that the rights of capable individuals with mental illness are protected and that they are able to make their own choices about how to address their illness. The law also recognizes that there are times when seriously ill people refuse help, and it provides direction on what to do in those situations.

Involuntary Hospitalization:

When a person is ill and refuses help, Ontario’s civil mental health law identifies three primary ways s/he can be brought to hospital for an inpatient psychiatric assessment.  If a person is seriously ill and refuses, or is unable, to consent and is likely to suffer harm or deterioration outside hospital:

  • A physician can complete an application for a psychiatric assessment.
  • A family member or concerned citizen can go to a Justice of the Peace, who may order the person to be sent for a psychiatric assessment.
  • A police officer can bring the person to hospital for a psychiatric assessment.

After a psychiatric assessment, which lasts up to 72 hours, a physician can determine if the patient is likely to require further hospitalization. If psychiatric admission is necessary, a person can be admitted voluntarily or involuntarily  A person can be involuntarily hospitalized if a physician determines that they are still likely to suffer harm or deterioration outside hospital.  In this case, the person will be required to stay in hospital for up to two weeks (or longer, if necessary and the legal criteria are met).

Treatment and Informed Consent:

Once a person is hospitalized at CAMH, we want to start them on their road to recovery and reintegration into the community as soon as possible, by developing a personalized treatment plan. Under the law, however, individuals must give their informed consent to treatment.  They also have the right to refuse treatment.

If a physician determines that an individual is not capable of making this decision, the physician must identify a Substitute Decision Maker to make treatment decisions on behalf of the person. It’s important to note that when an individual is found incapable, they are offered rights advice and may choose to apply for a review. Their treatment can be delayed during the review and appeal process.

The law, mental health and CAMH:

Mental health law is not perfect. In fact, the Mental Health Act has gone through certain amendments since 1990, including major changes in 2000.  The latest amendments were made in 2010 and a government committee recently recommended that certain aspects of the Act be further reviewed. Legislators are constantly striving to find the right balance between individual autonomy, effective clinical intervention and public and personal safety. It’s a difficult task, and sometimes the law can emphasize some areas over others.
Regardless of any future changes that may be made to the law, CAMH will continue to provide leadership in education to families and other stakeholders about mental health law, to ensure that people with mental illness receive help when they need it.

Resources for families:

Having a loved one with a mental illness can be overwhelming. There are places where families can find information and support specifically geared to them, such as the Family Resource Centre at CAMH and the organization Family Outreach and Response. There are also mobile crisis teams of mental health professionals that can provide support to families by telephone and at home if their loved one is experiencing a mental health crisis.

It’s a tough decision, but if you are fearful that your loved one may cause harm to themselves or others, you should call 911. Many police divisions have a Mobile Crisis Intervention Team where a police officer will respond to the call with a mental health professional.

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