What to Expect at a Hearing

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

Review panel hearings are held in private to protect the privacy of the patients. Family members and others wishing to observe the hearing without participating in it may normally do so only with the consent of the patient and the review panel.

A review panel consists of three appointed members of the Mental Health Review Board. The review panel decides whether you should be discharged from involuntary status or should continue to be detained. The panel is comprised of a physician member independent of your treating physician, a legal member, and a community member. Typically, the legal member chairs the review panel hearing.

A review panel makes a decision on only one issue: whether you, the patient, continue to meet the criteria to remain as an involuntary patient. The panel considers only the evidence presented at the hearing.

There are four criteria the panel must consider:

• Are you suffering from a disorder of the mind that requires treatment and seriously impairs your ability to react appropriately to your environment or to associate with others?
• Do you require psychiatric treatment in or through a designated facility?
• Do you require care, supervision and control in or through a designated facility to prevent your substantial mental or physical deterioration or for your own protection or the protection of others?
• Are you unsuitable to be a voluntary patient?

This is a legal test that is set out under section 22 of the Mental Health Act. The panel is required to apply this test on a balance of probabilities.

A hearing by a review panel must include

• (a)consideration of all reasonably available evidence concerning the patient’s history of mental disorder including
  • (i)hospitalization for treatment, and
  • (ii)compliance with treatment plans following hospitalization, and
• (b)an assessment of whether there is a significant risk that the patient, if discharged, will as a result of mental disorder fail to follow the treatment plan the director or a physician authorized by the director considers necessary to minimize the possibility that the patient will again be detained under section 22.

The hospital or community mental health team assigns a case presenter to attend the hearing. The case presenter’s job is to provide information about your detention and explain why the mental health team believes you continue to meet the detention criteria to remain involuntarily detained. The case presenter will answer questions about the case from you or your representative and the review panel.

The case presenter can be your treating psychiatrist, another doctor, a case manager, nurse, social worker or somebody else knowledgeable of your history and condition.

You can review the Practice Direction: Guidelines for Case Presenters.

The hearing process is flexible and can be adapted to meet the needs of you or other participants.

In the course of a hearing, there may be applications and rulings about various procedural or evidentiary issues such as:

• Determining the relevancy of evidence;
• Excluding evidence;
• Adjourning the hearing;
• Maintaining order at the hearing; and
• Others.

The role of the review panel is to ensure that the patient receives a procedurally fair hearing.

Generally, the stages of the hearing are in the following order:

1. Case Note

Before the hearing begins, you 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 your treating physician and outlines how the criteria for certification/involuntary detention are met.

2. Introduction

The review panel chair will start the hearing and advise the participants that the hearing is being recorded. The recording is to protect you and every participant at the hearing.  The Board keeps the recording for one year.

Everyone present at the hearing will introduce themselves and the review panel chair will explain the purpose and process of the hearing.

3. Facility Presentation

The case presenter usually speaks first. The case presenter will read out the Medical Certificates (commonly known as Form 4) associated with admission, and the latest Medical Report on Examination of Involuntary Patient (commonly known as Form 6), if there is one. The case presenter will then explain why the mental health team believes your certification / involuntary detention should continue. The case presenter will provide information to the review panel including the circumstances of the admission, your history of mental disorder including past hospitalizations for treatment.

The case presenter should have a copy of the patient’s medical records and may refer to or rely on documents including:

• Admission/renewal certificates, e.g., Form 4’s and 6’s
• Admission note by the physician or discharge note in the case you are on extended leave
• The Case Note – see above for more details
• Current and relevant psychology, social work and nursing reports, doctors’ progress notes/orders and psychiatric assessments from the file, including your response to medication.

Review panels do not review patient treatment records before or after a review panel hearing and only consider evidence, including hospital records, presented at the hearing.

4. Questions for the Case Presenter

After the case presenter finishes his/her presentation, you or your representative can ask the case presenter questions. The review panel will ask questions too.

5. Patient Presentation

Now, it is your opportunity to explain to the review panel why you no longer meet the criteria for detention/involuntary status. You or your representative may give evidence and call witnesses to give evidence in support of your argument for discharge from involuntary status. Evidence from a witness may be submitted in writing or presented orally at the hearing, in person, by phone/teleconference.

6. Questions for the Patient

After you or your representative present your case, the case presenter may ask you or your representative questions. The review panel will ask questions too.

7. Closing arguments

After you and the facility have had a chance to present evidence, there will be an opportunity to make closing arguments (also referred to as final submissions). The purpose of closing arguments is to permit you or your representative to summarize your case.

Yes, you can.

Before you decide, make sure you discuss this with your representative, friends, family members or near relative.

When you withdraw your application, the hearing is considered cancelled. The hearing will not be rescheduled. If you want another hearing during the same certification period, you must submit a new application form, i.e., Form 7: Application for Review Panel Hearing and the Board will schedule a new hearing as soon as reasonably possible in accordance with Rule 12 of the Rules of Practice and Procedure.

If you decide to withdraw your application for a hearing:

• You must notify the Board in writing or by telephone before the hearing starts, preferably 24 hours prior to your scheduled hearing.
• Only you or your representative can withdraw your application.

Yes, you can if you cannot attend your scheduled hearing due to illness or you need more time to gather evidence or find a representative. You should notify the Board as soon as possible in writing or by telephone.

There are conditions for granting a postponement:

• You do not need to give us a reason if you make the request more than two business days before the hearing.
• You must provide a valid reason for the request if you make the request within two business days of the hearing.

When your postponement request is approved by the Board, your hearing will be rescheduled for another date in accordance with Rule 21 of the Rules of Practice and Procedure.

If you do not appear at the scheduled time, the review panel will wait 30 minutes for you to arrive. In the absence of any other information, the review panel will cancel the hearing after 30 minutes. A cancelled hearing will not be rescheduled.

If you want another hearing during the same certification cycle, you must contact the Board as soon as you can and provide reasons for not attending. The Board will schedule a new hearing during the same certification cycle if it is fair and reasonable in the circumstances in accordance with Rule 23 of the Rules of Practice and Procedure.