FAQ

In BC, a person can be certified only if a doctor has examined them and has determined that they meet all four of these criteria:

• the patient suffers from a disorder of the mind that seriously impairs their ability to react appropriately to their environment or to associate with others.
• the patient requires psychiatric treatment in or through a designated facility.
• the patient requires care, supervision and control in or through a designated facility to prevent their substantial mental or physical deterioration or for their own protection or the protection of others.
• the patient cannot be suitably admitted as a voluntary patient.

You can download a printable copy of the legal test.

If you have been certified in BC, it means that you have been admitted involuntarily to a designated facility based on a medical certificate (Form 4) completed by a doctor. When you are certified you cannot leave the facility without your doctor’s permission. You are also deemed to consent to treatment, therefore you cannot refuse treatment. However, you or someone on your behalf can request a second medical opinion.

The words certified, involuntarily detained, and committed are often used interchangeably.

A doctor can admit a person against their will based on the doctor’s assessment of the person’s mental condition. The doctor will need to complete a form called “Form 4 – Medical Certificate (Involuntary Admission)” for this to happen. When a doctor admits a person this way, the person is admitted involuntarily, i.e., involuntary patient.

The medical certificate provides legal authority for an involuntary admission for a 48-hour period. A second medical certificate by a different physician must be completed within 48 hours of the initial admission. Once the second medical certificate is completed the person may be admitted as an involuntary patient for up to a month from the day of initial admission.

To extend involuntary detention beyond the first month, a physician must examine the patient and complete a renewal certificate before current certificate period expires. A renewal certificate is known as “Form 6: Medical Report on Examination of Involuntary Patient (Renewal Certificate)”.

If an involuntary patient requires continued hospitalization beyond the first one month period, the length of the next detention is one month. If hospitalization is required beyond this second one month period, the length of the next detention is three months. Beyond this three month period all successive periods of involuntary hospitalizations are six months in length.

Summary of detention periods:

No. The criteria in section 22 of the Mental Health Act do not contain the word “dangerousness”. The criteria specify that detention is to prevent substantial mental or physical deterioration or for the person’s own protection or the protection of others. While the Act does not define “protection”, this term includes more than risk of bodily harm. Mr. Justice Donald’s ruling in the British Columbia Supreme Court case of McCorkell v. Riverview Hospital (Director)(1993), 81 B.C.L.R. (2d) 273 (S.C.) interpreted what protection means. The judge stated:

“I agree with [the]…argument that the Manitoba criteria bear a close similarity to the British Columbia standard. In the Manitoba legislation, “serious harm” is not qualified; it can include harms that relate to the social, family, vocational or financial life of the patient as well as the patient’s physical condition. The operative word in the British Columbia Act is “protection” which necessarily involves the notion of harm.”

A review panel consists of three appointed members of the Mental Health Review Board; a physician member, a legal member, and a community member. Typically, the legal member chairs the review panel hearing.

The review panel decides whether the patient’s certification / involuntary detention should continue based on the four criteria. The review panel does not have authority to make any other decisions, including with regards to treatment or privileges.

Designated facility refers to specific hospitals or other facilities where a person may be admitted under authority of the Mental Health Act. Generally, a designated facility is a hospital for involuntary inpatients and a community mental health team for patients living in the community on extended leave.

Here is an updated list of designated facilities which admit and treat involuntary patients.

Involuntary patients with appropriate support may be authorized to live in the community under specific conditions; this is referred to as extended leave.

To learn more about the BC Mental Health Act check the provincial Guide to the Mental Health Act (2005) .

The Mental Health Law Program (MHLP) of the Community Legal Assistance Society provides patients with information and assistance regarding review panels, and provides free representation to patients at review panel hearing throughout the Province. Many patients who are represented at review panel hearings are represented by advocates from the MHLP.

Access Pro Bono’s Mental Health Program Telephone Clinic offers 30 minutes of free legal advice about certification and Mental Health Act rights. Their webpage also lists other resources you may find helpful.

Patients are also free to contact a lawyer or advocate of their choosing at any time. The patient is responsible for making those arrangements, including any fees associated with those services.

You can go to “Getting Help” page for more information.

The Board is committed to conducting procedurally fair hearings where:

• You have a chance to give information and evidence to support your position and to know and respond to the information given by the other side
• You have information about the decision-making criteria and process
• Your decision-makers are impartial
• You receive a decision within the statutory deadlines
• You receive reasons explaining the decision
• You are informed of any appeal or review procedures available

To apply for a review panel hearing, a patient or someone on their behalf must complete a Form 7 Application for Review Panel Hearing and submit the form to the Board office.

For more details see Apply for a Hearing.

The review panel process is free for patients.

An involuntary patient or someone on their behalf may apply for a review panel hearing using Form 7 Application for Review Panel Hearing.

For more details see Apply for a Hearing.

Generally, a patient is entitled to apply for a review panel hearing once during each certification period. This means after two Form 4 Medical Certificates are completed and then again following each Form 6 renewal certificate.

During six-month renewal periods, when it is in the best interests of the patient or where new information becomes available, the Board chair may shorten the time between applications. A patient interested in this should submit a request or have his/her advocate submit a request to the chair of the Mental Health Review Board.

For more details see Apply for a Hearing.

Hearings are required to be held as follows:

• during the first period (one month) of detention, within 14 days after a completed Form 7: Application for Review Panel Hearing is delivered to the Review Board office;
• during the second period (one further month) of detention, within 14 days after a completed Form 7 is delivered to the Review Board office;
• during the third period (three further months) of detention, within 28 days after a completed Form 7 is delivered to the Review Board office; and
• during the fourth and subsequent periods (six further months) of detention, within 28 days after a completed Form 7 is delivered to the Review Board office, provided that 90 days have elapsed since the conclusion of any previous hearing.

The Board chair has authority to shorten the time period during the fourth or subsequent periods above. This may occur if the chair considers it to be in the best interests of the patient or where new information about the patient’s detention becomes available.

Within a day or two of receiving the request for a hearing, the Board’s office staff will contact the hospital ward or community mental health team to schedule a hearing. Usually on the same day, staff will set the date, time, and place of hearing and communicate this information to the hospital or community mental health team.

Review panel procedures are less formal and the hearings and decisions usually occur sooner than a court proceeding. Review panels are specialized in applying the criteria under the Mental Health Act to determine whether a person should continue to be an involuntary patient. Unlike applying to the courts, there is no charge for a review panel hearing.

The Board office can arrange for a qualified interpreter to attend the hearing. It is important that you make the request to the Board office at the time of applying for a hearing or at least 3 business days prior to the scheduled hearing. There is no cost to the patient.

A patient may withdraw their request for hearing at any time before the hearing starts. If a patient withdraws their application for hearing or cancels the hearing, the hearing will not be rescheduled. If the patient wants to request another hearing during the same certification period they must submit a new application in Form 7.

If a patient wants to postpone a hearing, reasons are required if the request is within two business days of the hearing. If a postponement is granted, the hearing will be rescheduled.

For more details on cancellations or postponements, please go to “What to Expect at a Hearing” page.

Mandatory reviews are a safeguard against long-term detention of patients who are unaware of their right to a review panel hearing or are unable to assert their right. A mandatory review is a file review conducted by the Chair of the Mental Health Review Board, or the Chair’s delegate under section 25(1.1) of the Mental Health Act, to determine whether there is a reasonable likelihood that the patient would be decertified following a review panel hearing; if so, the Chair orders a review panel hearing for that patient.

A patient who has been on extended leave for 12 or more consecutive months and has not had a review panel hearing within that period is entitled to have their file reviewed, but may waive this right by indicating so on an Extended Leave Review Panel Hearing Directive. On the Directive, patients may select from 3 options: request to have their file reviewed, waive their right to have their file reviewed, or request a review panel hearing.

Facilities must submit to the Board an Extended Leave Review Panel Hearing Directive for each patient who has been on extended leave for 12 months or more and who has not had a review panel hearing during that period. In addition, the Directive must be submitted to the Board after every 12 months a patient continues to be on extended leave and has not had a review panel hearing during that time.

Ordinarily, the hearing will be held in a conference room at the designated facility where the patient is located. When a patient is on extended leave, the hearing is usually scheduled in the community where the patient resides. Occasionally, the hearing is conducted by video or teleconference if panel members are not available in the general area or where otherwise appropriate to ensure a just and timely hearing.

For more information see “Apply for a Hearing“

In general, the review panel process is as follows:

1. Panel Chair introduces participants and explains the process and purpose of the hearing.
2. Facility Presentation and Questions for Case Presenter.
3. Patient Presentation and Questions for the Patient.
4. Closing submissions.
5. Oral decision.
6. Written Reasons for Decision

For more information see “What to Expect at a Hearing“.

All participants in the review panel process must comply with the Rules of Practice and Procedure. The Rules cover a number of important areas including representation and communications, applying for hearing, disclosure before a hearing and hearing processes. The purpose of the Rules is to provide a fair, just, accessible and understandable process for everyone involved.

The review panel applies the following criteria to reach a decision at the hearing:

• Does the patient suffer from a disorder of the mind that seriously impairs their ability to react appropriately to their environment or to associate with others?
• Does the patient require psychiatric treatment in or through a designated facility?
• Does the patient require care, supervision and control in or through a designated facility to prevent their substantial mental or physical deterioration or for their own protection or the protection of others?
• Can the patient be suitably admitted as a voluntary patient?

You can download a printable copy of the legal test.

If a majority of the review panel is satisfied by the evidence presented at the hearing that all four criteria continue to describe the condition of the patient, the detention of the patient must be continued. If the majority of the review panel concludes that not all of the criteria are met, then the patient must be decertified and discharged from involuntary status under the Mental Health Act.

The criteria for involuntary admission are set out in sections 22(3)(a)(ii) and (c) of the Mental Health Act.

A review panel makes a decision on only one issue – whether the patient continues to meet the criteria to remain as an involuntary patient. The review panel has no authority to decide other issues such as the appropriateness of the patient’s treatment regime or whether the patient ought to be transferred to another hospital or granted additional passes.

A patient or someone on the patient’s behalf can request a second medical opinion on the appropriateness of the patient’s treatment. See Patient Rights section below.

Requests to accommodate other wishes that the patient or family members may have can be made to the physician or hospital authority. If a patient, relative or other person has a complaint about the treatment provided to an involuntary patient, such complaints may be brought to the attention of the patient’s physician, the director of a designated facility, the hospital administration, the patient care quality officer (a service available at all hospitals in BC to deal with patient complaints), the health authority, the College of Physicians and Surgeons of B.C., the College of Registered Nurses of B.C., the College of Licensed Practical Nurses of B.C., the College of Registered Psychiatric Nurses of B.C., or the provincial Ombudsperson.

The review panel does not inquire into whether a patient’s initial certification was justified. A patient, near relative, or anyone who believes there was insufficient reason or legal authority for a certificate may apply to the Supreme Court of British Columbia under section 33(2) of the Mental Health Act.

The review panel has no jurisdiction over constitutional questions, including those relating to the Canadian Charter of Rights and Freedoms, and has discretion to decline jurisdiction to apply the Human Rights Code in any matter before it.

Before the hearing starts, the facility has to provide a summary of the evidence it intends to present at the hearing. This is called the “case note” and it is prepared by a doctor treating the patient.

For more information about the case note including contents, format and its disclosure see Practice Direction – Guidelines for Preparing a Case Note.

At the hearing, a “case presenter” from the facility attends to provide evidence in support of the facility’s case for continued certification. The case presenter is often the treating psychiatrist, but could be another member of the mental health team who is knowledgeable of the patient’s history and condition. The facility’s presentation includes details of the patient’s history of mental disorder, hospitalization and compliance with treatment.

For more information about case presenters including a sample template for a case presentation see Practice Direction – Guidelines for Case Presenters.

A patient may be represented at the hearing by a lawyer, advocate or anyone chosen by the patient to speak on their behalf. The role of the patient representative is to provide advocacy and present the patient’s case for discontinuing certification.

For more information on legal representation see “Representation – Lawyer, Non-lawyer or otherwise” section below.

You can also review the Practice Direction – Guidelines for Patient Representative.

At the hearing evidence is usually given by the patient directly through oral testimony. There can also be witnesses speaking in support of the patient. Witnesses for the patient can give evidence in person, by phone/teleconference, or in writing to support the patient’s argument for decertification / discharge from involuntary status. For more information go to “How to Prepare for a Hearing” page.

Review panel decisions are based on evidence presented only at the hearing. Information from the following documents is usually presented as evidence by the facility at the hearing:

• Case note prepared for the hearing
• Admission/renewal certificates
• Admission note by the physician (or discharge note in the case of patients on extended leave)
• Current and relevant psychology, social work and nursing reports, doctors’ progress notes/orders and psychiatric assessments from the file, including patient’s response to medication.
• Other documents referred to or relied on in the case note
• Any other relevant information in support of each of the four criteria for continued certification.

The patient may also provide other evidence including calling witnesses to give evidence that support their argument in favour of discharge. The evidence may be submitted in writing or presented orally at the hearing in person, by phone/teleconference, or a combination of the two.

A person who wishes to provide information in support of certification of the patient should contact the facility to provide the information to the attending physician.

A person with information in support of the patient’s discharge should contact the patient or the patient’s lawyer or advocate. The person providing the information may be asked to attend the review panel hearing or make a written submission to provide at the review panel hearing.

All  information presented at a hearing will be shared with the case presenter and the patient at the hearing.

In addition, the Mental Health Act allows for any person who believes they have important information for the hearing to request the review panel to allow them to give evidence or make submissions at the hearing.

This question was considered in a court case Greggor v. Riverview Hospital (Director), [1992] B.C.J. No. 694 (S.C.)) in which a patient was recertified three days after a review panel found he should not continue to be detained and before he had left the hospital. The court noted that immediate re-admission seemed unusual. Nevertheless, the judge found there is nothing prohibiting re-admission for any particular period of time after a review panel has made its findings.

There is nothing in the Mental Health Act prohibiting re-admission of a patient for any particular period of time after discharge by the hospital itself.

A patient is entitled to see documents that will be relied on or referred to at the hearing, include the case note prepared by the patient’s treating physician for the hearing.  For more information on the facility’s responsibility regarding the case note, please see Practice Direction – Guidelines for Preparing a Case Note.

If a patient wants to review or obtain copies of his/her medical records for the purpose of preparing for the hearing, the patient must make a request to the hospital as soon as possible before the scheduled hearing. Hospitals have a duty to disclose relevant documents to the patient or their representative. For more information about disclosure please see Practice Direction – Guidelines for Disclosure.

If a patient has documents that he/she wishes to rely on or refer to at the hearing, the patient should bring a copy for the hospital’s case presenter.

If you want to review or obtain copies of your medical records for the purpose of preparing for the hearing, you must make a request to the facility as soon as possible before the scheduled hearing. Facilities have a duty to disclose relevant documents to you or your representative.

For more information, please review Practice Direction – Guidelines for Disclosure.

Yes – anyone under the age of 16 who has been admitted to hospital under the Mental Health Act as a voluntary patient, on the request of his/her parent or guardian, can apply for a review panel hearing.

Children and youth who are involuntary patients can also apply for a review panel hearing.

See the Practice Directive for Children.

As a patient, you have the right to

• a review panel hearing;
• know the reason why you are certified;
• contact a lawyer;
• know the name and the location in which you are detained;
• be examined regularly by a medical doctor to see if you still need to be an involuntary patient;
• apply or appeal to the court regarding your certification and review panel decision; and
• request a second medical opinion.

For more information, please review Form 13 – Notification to Involuntary Patient of Rights Under the Medical Health Act.

You can also get more information on our “Getting Help” page.

Yes.

Although the law provides that medical treatment authorized by the director of a facility is deemed to be given with the consent of the patient, it also states that a patient or someone on the patient’s behalf can request a second medical opinion on the appropriateness of the patient’s treatment.

To request a second medical opinion, the patient or patient representative must complete the Form 11 – Request for Second Medial Opinion and give it to the hospital staff. The Board does not have the jurisdiction in this regard.

Yes only with the consent of the patient and the review panel.

Please visit our “I am a Family or a Support Person for a Patient” page for more information.

A family member may present evidence as a witness at a hearing for the patient’s continued certification or discharge from involuntary status.

• Family members who wish to provide information in support of further certification of the patient should contact the attending physician.
• Those with information in support of the patient’s discharge should contact the patient or the patient’s representative.
• If neither party wishes to call the family member as a witness, the Mental Health Act states that any person who satisfies the review panel that the person has a material interest in, or knowledge of, matters relevant to the hearing may give evidence or make submissions at the hearing.

Please visit our “I am a Family or a Support Person for a Patient” page for more information.

When a patient applies for a review panel hearing, the facility such as a hospital must immediately notify a near relative of the patient’s choosing.

If you are the near relative named by the patient, you should expect to receive a copy of “Form 18: Notification to Near Relative” informing you that a review panel hearing has been requested by the patient or somebody on their behalf.

Please visit our “I am a Family or a Support Person for a Patient” page for more information.

It may be a good idea to have a representative at a review panel hearing, but it is not required. You may choose to attend the hearing without a representative and present your own case – this is referred to as “self-representation.”

You may also choose to be represented by someone else, such as a family member, friend, near relative or anyone you trust.

For more information, please review the “Getting Help” page.

To read more about the role and responsibilities of a patient representative see Practice Direction for Patient Representatives.

The Mental Health Law Program (MHLP) provides patients advocates to represent patients at review panel hearing throughout the Province. Many patients who are represented at review panel hearings are represented by advocates from MHLP. This is a free service.

Please be advised that MHLP does not provide information or legal advice to individuals.  MHLP staff only speak with involuntary patients who have already completed a Form 7, had review panel hearings scheduled, and have been assigned to represent the patients at the scheduled review panel hearings.

Access Pro Bono’s Mental Health Program Telephone Clinic offers 30 minutes of free legal advice about certification and Mental Health Act rights. Their website also lists other resources you may find helpful.

To learn more about the BC Mental Health Act check the Mental Health Guide by Ministry of Health 2005.

For more information, please visit “Getting Help” page.

The role of a patient’s representative to provide advocacy by representing the patient’s interests at a hearing, and to present the patient’s case for discontinuing certification.

To read more about the role and responsibilities of a patient representative see Practice Direction – Guideline for Patient Representatives.

For more information, please visit “Getting Help” page.

The role and responsibilities of a patient representative is to provide advocacy by representing the interests of a patient and presenting the patient’s case for discontinuing certification under the Mental Health Act.

To read more about the role and responsibilities of a patient representative see Practice Direction – Guideline for Patient Representatives.

For more information, please visit “I am an Advocate for a Patient” page.

Participants at a review panel hearing may include:

• Review panel
• Patient
• Patient representative
• Case presenter from the facility
• Other representative for the facility
• Witnesses for the patient and/or facility

A case presenter is a representative of a facility and a participant at a review panel hearing. The purpose of the hearing is to determine whether the criteria for certification still apply to the patient. A case presenter’s role at the hearing is to present the facility’s case for the patient’s continued certification under the Mental Health Act.

A case presenter may give evidence at a hearing and should be knowledgeable of the patient’s history and condition, including relevant medical records. Case presentations are often conducted by a patient’s treating physician. However, the facility may assign another individual to be the case presenter, such as a case manager, nurse, mental health clinician or social worker. The facility may also assign co-presenters.

For more details, please go to “I am a Representative for a Mental Health Facility” page.

Please go to “I am a Representative for a Mental Health Facility“ page for more information.

Before the hearing begins, the patient and the review panel will receive a summary of the evidence to be presented by the hospital. This is called a case note. A case note is prepared by the treating physician and outlines how the four criteria for certification are met.

The case note is prepared for presentation to the review panel by the attending physician, summarizing the patient’s history of hospitalization, as well as successful and unsuccessful treatment. It may also include the patient’s compliance with treatment plans in the community. The note also provides an assessment of whether the patient is likely to comply with the treatment plan in the community.

For more information, please review Practice Direction – Guideline for Preparing a Case Note.

If a patient wants to review or obtain copies of his/her medical records for the purpose of preparing for the hearing, the patient must make a request to the facility as soon as possible before the scheduled hearing.

Mental health facilities have disclosure obligations which are ongoing and relevant records that are acquired or generated between the time of initial disclosure and the hearing must also be disclosed promptly before the hearing where reasonably practicable. For more information, please review Practice Direction – Guidelines for Disclosure.

Facilities create, compile and or retain patient medical and health information records that are relevant to the review panel legal proceedings.

Disclosure of relevant records, include the case note held by facilities allows the patients to know the case they have to meet and effectively prepare for the hearing.

For more information, please review Practice Direction – Guidelines for Disclosure.

After the review panel hears the arguments from both sides, the review panel will meet in private to make its decision. Generally, the review panel will inform you verbally at the hearing of its decision on your certification status.

The review panel will issue its decision within 48 hours. The panel will also issue written reasons explaining its decision as soon as possible and no later than 14 days after the decision is issued.

Yes.

Although there is no formal appeal process at the Mental Health Review Board, after a review panel has issued its decision, if you believe the decision was wrong or the hearing process was unfair, you have other options:

• An application to the courts for a judicial review – There is a time limit for applying for a judicial review and the role of a reviewing court is limited.
• A separate application to the courts may be made under section 33(2) of the Mental Health Act for an order prohibiting admission or directing the discharge of an individual.
• A request to the Mental Health Review Board to reopen your application under section 25.1(5) of the Mental Health Act.  You may wish to seek legal advice about this option.

While it is possible to pursue a judicial review or an application to courts without a lawyer, you are strongly encouraged to have legal representation should you decide to do this.

For more details, please see Appeal Review and Complaint Procedures.