Second medical opinions under BC’s Mental Health Act

Involuntary patients over the age of 16 have the right to ask for a second medical opinion from a doctor who’s not on their treatment team. My interviews with former involuntary patients and with clinicians seem to show that both groups are confused about how this right works, so this post aims to answer some of the most common questions about it.

A cartoon showing a doctor examining a patient on a bed.

The rest of this post speaks to patients.

Involuntary patients lose the right to make decisions about their psychiatric care, so if you’re certified under the Mental Health Act, you may not agree with your treatment.

Patients have many possible reasons for disagreeing with their treatment. Here are just a few examples:

  • The dosage of a medication you’re taking might be causing side effects you can’t handle.
  • You might be allergic to a drug your treatment team has prescribed.
  • You’ve been on a different drug that works well for you and want to take that instead of what your treatment team has prescribed.

If you disagree with your treatment plan, talk to your treatment team first.

Try to explain what you want to change and why. If you have  trouble expressing yourself, a family care partner, peer support worker, or social worker might be able to help.

If you’ve talked with your treatment team and you still aren’t happy with your treatment plan, then you can apply for a second medical opinion under the Mental Health Act.

A second medical opinion might be especially helpful if you have a family doctor or psychiatrist out in the community who knows your health well and has a good relationship with you.

Who can apply for a second medical opinion?

You or anyone on your behalf can apply for a second medical opinion.

How do I apply for a second medical opinion?

Fill out Form 11 and give it to your treating doctor or someone else on your treatment team.

Who can give a second medical opinion?

Any doctor licensed to practise in BC can give a second medical opinion.

You can choose a doctor to give the second medical opinion. Form 11 lets you put down the names of up to 2 doctors. If your first choice can’t examine you, the hospital will try to contact your second choice.

If you don’t choose the doctor to give you a second medical opinion, you can ask the director of the psychiatric hospital or unit to choose for you. Be aware that they may choose another psychiatrist in the same hospital to give the second medical opinion. Some patients are OK with that possibility. Others may feel that a doctor in the same hospital will not be objective or independent enough. You’ll have to consider how you feel about it.

What happens after I apply for a second medical opinion?

The hospital will ask the doctor you’ve chosen, or one the director has chosen, to examine you for a second medical opinion.

If that doctor agrees to give a second medical opinion, the hospital has to give them access to you. That doctor doesn’t need to have admitting privileges to that hospital to examine you.

After the doctor examines you, they will write their findings and recommendations on Form 12, which they must give to the director within 2 days after the examination.

The director will read Form 12 and decide if your treatment should change. If the director is not a doctor, they may ask a doctor at the hospital for input to decide. If the treatment changes, you may be asked to sign a new Form 5 (Consent for Treatment).

When can I apply for a second medical opinion?

You can apply for a second medical opinion as an involuntary patient after two Form 4s (Medical Certificates) have been completed.

How often can I apply for a second medical opinion?

You can apply once every certification period. For more information about certification periods, see our rights materials.

Does the examination for the second Form 4 count as a second medical opinion?

The doctor who signs your second Form 4 should be different from the doctor who signs your first Form 4. That means that if two Form 4s are completed, two doctors believe you meet the criteria for certification. (See our rights materials for more information about the four criteria for certification.)

But that second Form 4 doesn’t count as a second medical opinion under the Mental Health Act. You can still apply for a second medical opinion from another doctor after two Form 4s have been completed.

I asked for a second opinion, and another doctor examined me, but I never filled out a form, and I didn’t get to choose my doctor. What happened?

It’s possible that someone else, like a family care partner, filled out Form 11 on your behalf. It’s also possible that your treating doctor wanted to get you the second opinion you asked for without going through the formal process of applying for one. Ask your treatment team which of these happened.

Technically, if your doctor arranged a second opinion without going through the formal process, you still have the right to apply for a second medical opinion by filling out Form 11 and asking for a BC-licensed doctor of your choice. Ask yourself if you want to take this route or if you’re satisfied with the second opinion that your doctor arranged informally.

If a Form 11 was filled out on your behalf, you’ll have to wait until your next certification period to apply again.

What’s the difference between a review panel hearing and a second medical opinion?

Here are the main differences between asking for a review panel hearing and asking for a second medical opinion:

Review panel hearingSecond medical opinion
About certificationAbout treatment
Decision is bindingOpinion is not binding
No cost to youYou may have to pay travel fees
Has to be scheduled within a certain timeframeNo required timeframe
Decision given to the patient and the hospitalOpinion given to the hospital
Explicitly available to all patients detained under the Mental Health Act
Explicitly available to involuntary patients over the age of 16

A review panel hearing is about certification. A second medical opinion is about treatment.

A review panel hearing is the most widely accessed of the Mental Health Act rights. A review panel’s only function is to decide if an involuntary patient meets the four criteria for certification. If you don’t believe you meet those criteria and think you should be discharged, but your treatment team disagrees, apply for a review panel hearing.

A second medical opinion does not decide if you should stay certified. It is only to see if your treatment is appropriate. If you think your medications should be changed or your dosages should be adjusted, but your treatment team disagrees, apply for a second medical opinion.

A review panel decision is binding. The second medical opinion is not binding.

If a review panel decides you don’t meet the four criteria for certification, you will be decertified. If a review panel decides you do meet the four criteria for certification, you will have to stay certified.

In contrast, your treatment team isn’t required to follow the recommendations of the second medical opinion. That decision is up to the director of the psychiatric hospital or unit.

There is no cost for a review panel hearing. You may have to pay some costs for a second medical opinion.

As a patient, you don’t have to pay for a review panel hearing. If your income is low, you can get free representation through the Mental Health Law Program.

If you ask for a second medical opinion from another doctor, the provincial government pays for that doctor’s time. But if the doctor has to travel far to examine you, you may have to pay for their travel costs.

A review panel hearing has to be scheduled within a certain timeframe. A second medical opinion does not.

If you apply for a review panel hearing, it must happen

  • within 14 days from the time you apply, if you’re in a 1-month certification period, or
  • within 28 days from the time you apply, if you’re in a 3- or 6-month certification period.

If you apply for a second medical opinion, the Mental Health Regulation says it should happen “as soon as reasonably practicable,” but what that means depends on interpretation and on the situation.

It might take a while to make arrangements with another doctor to give the second medical opinion. A second medical opinion might happen quickly, or you might have to wait a long time, and the law doesn’t say that it must happen within a certain timeframe.

A review panel’s decision is given to the patient and the hospital. The second medical opinion is given only to the hospital.

If you have a review panel hearing, you have the right to know what they decide. They will write their decision on Form 8 and should give you and the hospital a copy.

If you have an examination for a second medical opinion, the doctor who examines you must write their findings and recommendations on Form 12 and give it to the hospital. You can ask to see Form 12, but the hospital isn’t required to show it to you.

(According to the Mental Health Review Board’s Rules of Practice and Procedure, patients have the right to see any Form 12s in their records if they apply for a review panel hearing.)

Review panel hearings are an explicit right for all patients detained under the Mental Health Act, including children and youth. Second medical opinions are an explicit right for involuntary patients over age 16.

Involuntary patients over age 16 should receive Form 13, which tells them what their rights are under the Mental Health Act. These include:

  • the right to ask for a review panel hearing AND
  • the right to ask for a second medical opinion.

Patients under age 16 receive rights information on Form 14, and asking for a review panel hearing is one of the rights on that form, but asking for a second medical opinion isn’t.

There’s some controversy about why this difference exists and what it means. Some people think it happened because of an oversight when the forms were made. Other people say that children and youth are technically admitted as voluntary patients by their parents or guardians, and voluntary patients always have the right to ask for a second medical opinion.

If you’re under age 16, you might still be able to get a second medical opinion if you want one. If you ask for one, or if your parent or guardian asks for one, the hospital may be able to arrange one for you. But be aware that different hospitals may have different interpretations about how the second medical opinion works for children and youth.

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