What’s a near relative?

One of the questions we get most often is “How can family and friends help involuntary patients exercise their rights?” We’ll cover that topic in more depth in a future blog post, but before we can get there, we have to lay the groundwork by clarifying what a near relative is.

The rest of this blog post speaks to patients.

Choosing a near relative

If you’re admitted as an involuntary patient (certified), a member of the staff, usually a nurse, will ask you to choose someone to be your near relative. This near relative will be informed:

• when you’re first admitted,
• if you apply for a review panel hearing, and
• when you are decertified.

You can nominate someone to be your near relative by filling out Form 15.

Some hospitals will send out notices to near relatives by mail only, so it would be helpful for you to know your near relative’s mailing address.

The back of our wallet card has a place for you to write down the name and phone number of someone you’d like to be your near relative. You can ask hospital staff to call them and get their mailing address if you don’t know it.

According to the Guide to the Mental Health Act (p. 34), a copy of your Form 15 will be put in your medical records. You can also ask for a copy of your Form 15.

Your near relative can be:

• a spouse or partner
• a parent
• a grandparent
• an adult child
• a sibling or half-sibling
• a caregiver
• a friend

Your near relative doesn’t have to be related to you. Choose someone you trust. Often patients will choose a family member or friend who is involved in their care.

A near relative does NOT:

• get a copy of your medical records, or
• make healthcare decisions for you.

A near relative is not the same thing as a substitute decision maker or legal guardian, but the same person can be both your near relative and your substitute decision maker or legal guardian.

The law does NOT require the hospital to tell your near relative:

• when your certification is renewed
• if you are released on extended leave

but the hospital might still give this information to your near relative if they are heavily involved with your care. (See the Guide to the Mental Health Act, pp. 26 and 32.)

If you can’t or don’t want to choose a near relative, the doctor will choose someone for you.

The Guide to the Mental Health Act (2005, p. 43) also says:

In addition to the person selected by the patient, the director may, if the director considers it to be in the best interests of the patient or the safety of others, send the notice to any other near relative.

This means your doctor can add someone else as a near relative if they think it’s your best interest. This other person will also be contacted when you’re admitted, if you apply for a review panel hearing, and when you’re decertified.

If you don’t have anyone who can be your near relative, the hospital will send the notices that a near relative is supposed to receive to the Public Guardian and Trustee.

Notices to near relatives

Notice of admission

When you’re certified, your near relative should get Form 16, usually by mail, to tell them you’ve been admitted as an involuntary patient.

Form 16 also has a list of what your rights are. (These are the same rights you can find in our rights pamphlet and on Form 13.) This list tells your near relative that you have:

• the right to be examined by a doctor at least once in each certification period,
• the right to apply for a review panel hearing,
• the right to ask a judge to review your case, and,
• if you are over age 16, the right to ask for a second medical opinion.

Your near relative can help you exercise any of these rights. For example, they can apply for a review panel hearing or a second medical opinion on your behalf.

Notice of an application to a review panel

If you ask for a review panel hearing, or someone asks for one on your behalf, your near relative should get Form 18, usually by mail, to let them know (unless they applied for you).

The purpose of this notice is to give them time to prepare if they want to be involved in your hearing.

Your near relative would have to contact the Mental Health Review Board to find out when your hearing is scheduled.

Your near relative might help you by:

• helping you prepare your case
• representing you at the review panel hearing
• finding a lawyer or legal advocate to represent you or
• testifying as a witness for you.

Be aware that if your near relative thinks you should stay certified, they might testify as a witness for the doctor or hospital instead of supporting your case.

Notice of discharge

When you’re discharged from certification, your near relative should get Form 17 by fax, by mail, or in person, or be told about your discharge over the phone. The hospital may send Form 17 shortly before your discharge date so that your near relative has time to prepare for your discharge.

The Guide to the Mental Health Act (2005, p. 52) explains the point of Form 17:

Patient, relatives and others involved in the patient’s care in the community should be included in discharge planning and informed of the discharge date. This will provide support for vulnerable persons upon discharge and is important to continuity of care.

Unfortunately, this form doesn’t make a clear distinction between discharge from hospital and decertification. Some patients may be decertified because they don’t meet the four criteria for involuntary hospitalization, but they might stay in hospital as voluntary patients. (See our rights materials for more information about the four criteria.) It’s not clear if the near relative would get Form 17 in that case.

Again, your near relative doesn’t legally have to be told if you are being discharged on extended leave, but your treatment team might decide to share that information with them anyway.

Near relatives’ other rights and responsibilities

The Mental Health Act mentions near relatives in section 34.2, which covers all of the notifications we’ve discussed above, and in section 19, “Admission of female person.” This section says:

The person who requests or applies for the admission of a female person to a Provincial mental health facility must arrange for her to be accompanied by a near relative or a female person between the time of the request or application and her admission to a Provincial mental health facility.

But the Guide to the Mental Health Act (p. 93) goes on to say:

This section does not apply to police or paramedics who convey female patients to a psychiatric unit or an observation unit or who transfer a female patient from a psychiatric unit to a Provincial mental health facility.

I included this part because it’s the only other place near relatives are mentioned in the Mental Health Act, but its impact seems narrow. In what situations would a female person be taken for involuntary admission by someone other than a friend or family member, police, or an ambulance? I’m also not sure if this section applies to trans women.

If anyone has a better understanding of this section of the Mental Health Act, please share your knowledge in a comment below!

Planning with a near relative

Being certified can be scary, and it’s something you may not want to think about, but if you believe there’s a chance you might be hospitalized as an involuntary patient under the Mental Health Act, you may want to talk to someone in your life about being your near relative.

Being a near relative comes with rights and responsibilities, and it might be a good idea to make sure the person you name as your near relative (a) won’t be surprised and (b) is willing to take on those responsibilities.

Talking with the person you want as your near relative will also give you the chance to make sure you get their contact information, including their phone number and mailing address, so that hospital staff know where to send Forms 16, 17, and 18.

Unanswered questions about near relatives

As I did research for this post, I had a lot of questions about near relatives that I didn’t find the answer to. For example:

• Can someone who is nominated to be a near relative refuse to accept?
• Can the doctor or hospital stop a patient from nominating someone they believe might cause the patient harm or otherwise be inappropriate?
• Are there geographic restrictions on who can be named a near relative? Can they be out of the province? Out of the country?
• Is there a legal or practical limit to the number of near relatives a patient can name?
• If a patient changes their mind and nominates someone else, is the first near relative told they will no longer get notices?
• Is a near relative told if a review panel hearing is cancelled?

I’ve sent these and a few other questions to people who might know the answers, and I’ll share what I learn in a future post.

In the meantime, if you know the answers to these questions, or if you have other questions about near relatives, please leave them in the comments!