[36] Bill 29 Original (PDF)
Bill 29
Bill 291998
An Act to amend the Mental Health Act
Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:
1. (1) Clause 15 (1) (f) of the Mental Health Act is amended by striking out "imminent and" at the beginning.
(2) Section 15 of the Act is amended by adding the following subsection:
Same
(1.1) A physician who has examined a person may make application in the prescribed form for a psychiatric assessment of the person if,
(a)the physician has reasonable cause to believe that the circumstances described in clause (1) (a), (b) or (c) exist;
(b)the person has previously received medical treatment for a mental disorder and the person responded well to the treatment;
(c)the physician is of the opinion that,
(i)the person is suffering from the same mental disorder as the one for which he or she previously received medical treatment or from a mental disorder that is similar to the previous one, and
(ii)the person is likely to suffer serious deterioration if he or she does not receive medical treatment; and
(d)the physician believes, on reasonable grounds, that the person is incapable, within the meaning of the Health Care Consent Act, 1996, of consenting to his or her admission to a psychiatric facility and the consent of his or her substitute decision-maker has been obtained.
2. Clause 16 (1) (f) of the Act is amended by striking out "imminent and" at the beginning.
3. Clause 17 (f) of the Act is amended by striking out "imminent and" at the beginning.
4. (1) Subclause 20 (1) (c) (iii) of the Act is amended by striking out "imminent and" at the beginning.
(2) Section 20 of the Act is amended by adding the following subsection:
Same, involuntary admission
(1.1) The attending physician, after observing and examining a person who is the subject of an application for assessment under section 15 or who is the subject of an order under section 32, shall admit the person as an involuntary patient by completing and filing with the officer in charge a certificate of involuntary admission if,
(a)the person has previously received medical treatment for a mental disorder and the person responded well to the treatment;
(b)the attending physician is of the opinion that,
(i)the person is suffering from the same mental disorder as the one for which he or she previously received medical treatment or from a mental disorder that is similar to the previous one,
(ii)the person is likely to suffer serious deterioration if he or she does not receive medical treatment, and
(iii)a psychiatric facility is the best place for treatment given the person's medical history and current medical condition; and
(c)the person has been found incapable, within the meaning of the Health Care Consent Act, 1996, of consenting to his or her admission to a psychiatric facility and the consent of his or her substitute decision-maker has been obtained.
(3) Subclause 20 (5) (a) (iii) of the Act is amended by striking out "imminent and" at the beginning.
5. The Act is amended by adding the following sections:
Leave agreement
33.1 (1) To provide a patient with psychiatric treatment that is less restrictive and less intrusive to the patient than being detained in a psychiatric facility, a physician and either the patient or his or her substitute decision-maker may, subject to subsection (2), enter into a leave agreement according to which the patient is entitled to live outside the facility subject to such terms or conditions as may be set out in the agreement.
Criteria for entering into agreement
(2) A physician may enter into a leave agreement under this section with a patient or with his or her substitute decision-maker if,
(a)during the previous two-year period, the patient,
(i)has been a patient in a psychiatric facility on three or more separate occasions, or
(ii)has entered into a previous leave agreement under this section;
(b)the patient or his or her substitute decision-maker, the patient's attending physician in the psychiatric facility and any other health professional or person involved in the patient's care or treatment have developed a treatment plan for the patient; and
(c)within the 72-hour period before entering into the agreement, the physician has examined the patient and is of the opinion, based on the examination and any other relevant facts communicated to the physician, that,
(i)the patient is suffering from a mental disorder for which he or she needs continuing treatment or care and continuing supervision while living in the community,
(ii)if the patient does not receive continuing treatment or care and continuing supervision while living in the community, he or she is likely, because of the mental disorder, to cause serious bodily harm to himself or herself or to another person or to suffer serious deterioration or physical impairment,
(iii)the patient is able to comply with the treatment plan contained in the leave agreement, and
(iv)the treatment or care and the supervision required under the terms of the leave agreement are available in the community.
Content of agreement
(3) A leave agreement shall indicate,
(a)the date of the examination referred to in clause (2) (c);
(b)the facts on which the physician formed the opinion referred to in clause (2) (c);
(c)a description of the treatment plan referred to in clause (2) (b); and
(d)an undertaking by the patient to comply with his or her obligations as set out in subsection (4) or an undertaking by the patient's substitute decision-maker to ensure that the patient complies with those obligations.
Patient's obligations
(4) If a patient or his or her substitute decision-maker enters into a leave agreement under this section, the patient shall,
(a)attend appointments with the attending physician, or with any other health professional referred to in the agreement, at the times and places scheduled from time to time; and
(b)comply with the treatment plan described in the agreement.
Copy to patient and others
(5) If a leave agreement is made under this section, the physician who enters into the agreement shall give a copy of it to,
(a)the patient;
(b)the patient's substitute decision-maker, where applicable;
(c)the officer in charge; and
(d)any other health professional involved in the treatment plan.
Termination of agreement
(6) A leave agreement is terminated six months after the day it is made, subject to an earlier termination in accordance with section 33.2.
Subsequent agreements
(7) Upon termination of a leave agreement, the parties may enter into a subsequent leave agreement if the requirements of subsection (2) are met.
Early termination of leave agreement
33.2 (1) At the request of a patient who is subject to a leave agreement, of his or her substitute decision-maker or of a person involved in the patient's care or treatment, the attending physician shall review the patient's condition to determine if the patient is able to continue to live in the community without being subject to the leave agreement.
Same
(2) If the attending physician determines, upon reviewing a patient's condition, that the circumstances described in subclauses 33.1 (2) (c) (i) and (ii) no longer exist,
(a)the attending physician and the patient or his or her substitute decision-maker shall terminate the leave agreement;
(b)the attending physician shall notify the patient that he or she may live in the community without being subject to the leave agreement; and
(c)the attending physician shall inform the persons referred to in clauses 33.1 (7) (b), (c) and (d) that the leave agreement is cancelled.
Breach of leave agreement
33.3 (1) Subject to subsection (2), a patient's attending physician may file a notice of breach of the terms of a leave agreement with the officer in charge if he or she believes on reasonable grounds that the patient has failed to comply with his or her obligations under subsection 33.1 (4).
Condition for filing of notice
(2) A physician shall not file a notice under subsection (1) unless,
(a)he or she is of the opinion that, because of the patient's mental disorder, the patient is likely to cause serious bodily harm to himself or herself or to another person or to suffer serious deterioration or physical impairment; and
(b)reasonable efforts have been made to,
(i)locate the patient,
(ii)inform the patient of the failure or, if the patient is incapable within the meaning of the Health Care Consent Act, 1996, inform the patient's substitute decision-maker of the failure,
(iii)inform the patient of the possibility that the attending physician will file a notice of breach of a term of a leave agreement, which would result in the patient's return to the psychiatric facility for assessment, and
(iv)provide assistance to the patient to comply with the terms of the leave agreement.
Return to facility
(3) A notice filed under subsection (1) is sufficient authority, for 30 days after it is filed, for a peace officer to take the patient named in it into custody and then promptly to the psychiatric facility where the physician who filed the notice attends.
Assessment on return
(4) Promptly on the patient's return to a psychiatric facility, the attending physician shall examine the patient to determine whether,
(a)the patient should be admitted to the facility in accordance with section 20;
(b)the patient, or his or her substitute decision-maker, and the physician should enter into another leave agreement; or
(c)the patient should be discharged from the facility.
6. Clause 39 (1) (c) of the Act is amended by striking out "imminent and" at the beginning.
Commencement
7. This Act comes into force on the day it receives Royal Assent.
Short title
8. The short title of this Act is the Mental Health Amendment Act, 1999.
EXPLANATORY NOTE
The purpose of the Bill is to facilitate the admission of a person to a psychiatric facility where the person suffers from a mental disorder for which he or she has been previously treated and that has responded well to treatment in the past. A person who suffers from such a mental disorder may be admitted to a psychiatric facility on an involuntary basis if his or her substitute decision-maker consents to the admission. The Bill also provides for patients to be allowed to live outside of the psychiatric facility under a leave agreement. The bill outlines the circumstances under which a leave agreement may be made and the consequences of breaching the terms of the agreement.