Changes to Mental Health Act rights

The information in the rights materials available on this site will soon be out of date because of the following changes:

The Form 4 medical certificate is being replaced by Forms 4.1 and 4.2

The province has now empowered nurse practitioners to examine people to see if they meet the criteria for involuntary hospitalization. 

Before this change, only a physician could authorize involuntary hospitalization. If the physician believed that the person they examined met the criteria for involuntary hospitalization, the physician would complete the Form 4 medical certificate, which would allow a designated facility to keep the person in the facility for up to 48 hours. If a second physician examined the person and believed that they met the criteria for involuntary hospitalization, this physician could complete a second Form 4 medical certificate, which would allow a designated facility to hold the person for up to 1 month.

Now, nurse practitioners as well as physicians can perform the first examination and authorize involuntary hospitalization for up to 48 hours using the new Form 4.1 first medical certificate.

Only a physician can perform a second examination and authorize involuntary hospitalization for up to 1 month, and they would do so using the new Form 4.2 second medical certificate.

The existing Form 4 is still valid until January 31, 2024, and some health authorities are continuing to use it.

Nurse practitioners and physicians are required to write down an explanation of how an involuntary patient meets the four criteria for involuntary hospitalization on these forms. If you’re an involuntary patient and want to understand why you are being held under the Mental Health Act, you can ask your care team to see your Form 4 medical certificates. They might show you Forms 4.1 and 4.2 if they have started using the new system.

Access Pro Bono has changed its phone number for Mental Health Act legal advice

Involuntary patients or their family members can call Access Pro Bono to make an appointment for 30 minutes of free legal advice over the phone about the Mental Health Act from a lawyer. Access Pro Bono used to offer this service through a dedicated phone number for their Mental Health Program Telephone Clinic, but now they have merged it with their Summary Advice Program.

Currently, if you dial the old number for the Mental Health Program Telephone Clinic, the recorded message will give you the new phone number to call for an appointment for summary advice. It’s unclear how long they will keep this recorded message and discontinue the old number completely.

Involuntary patients will soon have the right to ask for rights advice

The Ministry of the Attorney General is establishing a new independent rights advice service, which will be run by the Canadian Mental Health Association, BC Division (CMHA BC), in partnership with Health Justice, the Community Legal Assistance Society and Métis Nation BC.

When this service launches in fall 2023, involuntary patients will have the right to ask to speak to a rights advisor. The rights advisor will meet with patients to give them information about their rights, answer their rights questions, discuss their options, and help them access their rights, like applying for a review panel hearing or applying for a second medical opinion.

What do these changes mean for the rights materials on this site?

The rights materials on this site: 

  • have the old Access Pro Bono phone number, 
  • refer to Form 4 and not Forms 4.1 and 4.2, and
  • do not tell people of their right to a rights advisor.

Until the independent rights advice service launches, the information in the materials on this site is still valid, although people will be redirected to the new Access Pro Bono if they call the old number. This site remains the only place we’re aware of that offers reliable access to BC Mental Health Act rights information in languages other than English.

We currently have no plans to update the materials, for a few reasons. 

  • First, when the independent rights advice service launches, it will likely develop its own materials with up-to-date information. 
  • Second, the Ministry of Health will also have to update their Form 13, which gives involuntary patients rights information, to include the new right to speak to a rights advisor. If they make that form easy for people to understand, our plain language materials might no longer be needed. 
  • Finally, the materials on this site were developed and translated using research funding that ended in 2018. We have no other sources of funding to update the materials, and this site is maintained thanks to a small annual donation.

Vancouver Coastal Health providers can try asking the Patient Health Education Materials office to update the materials. They have access to the original design files and should be able to make changes to the print resources.

Island Health providers can try contacting Mental Health & Substance Use Services leadership to have the materials updated on the health authority’s intranet.

After January 31, 2024, if there is demand from the community for us to update our rights materials and make them available on this site, we might be able to offer new print materials. We will not have the capacity to update our video. 

We’re grateful to have been part of the effort to make Mental Health Act rights more accessible to more people, and we’re happy to see that the issue is being taken seriously by decision makers in the mental health system.

Will forcing health authorities to complete all Mental Health Act forms help patients better understand their rights?

Poor form completion rates

In the recently released report, Committed to Change, the BC Office of the Ombudsperson detailed disturbing findings that involuntary patients aren’t consistently told about their rights under the Mental Health Act. Further, family care partners aren’t always told that their loved ones have been detained. These stories are appalling, but will enforcing better record keeping prevent these scenarios from happening?

According to the Mental Health Act, when a person is admitted as an involuntary patient under a medical certificate (Form 4):

  • They’re supposed to learn their rights by being read and given Form 13.
  • They’re supposed to nominate a near relative to notify about their hospitalization, using Form 15.
  • Their care team is supposed to send Form 16 to that near relative. Form 16 tells the near relative that the person (a) has been detained and (b) has rights under the Mental Health Act. This form is supposed to be sent or given to the near relative immediately after the person has been admitted.

The BC Office of the Ombudsperson found:

  • Form 13 in only 49% of patient files,
  • Form 15 in only 43% of patient files, and
  • Form 16 in only 32% of patient files.

In response to these poor compliance rates, the Office of the Ombudsperson issued this recommendation:

Recommendation 9: By June 30, 2019, the Ministry of Health and the Ministry of Mental Health and Addictions work together with the health authorities to establish clear and consistent provincial standards aimed at achieving 100 percent compliance with the involuntary admissions procedures under the Mental Health Act through the timely and appropriate completion of all required forms.

In other words, these three forms should appear in 100% of patient files. But will mandating 100% compliance solve the problem of patients and family care partners not knowing patients’ rights?

I don’t believe they will. Continue reading “Will forcing health authorities to complete all Mental Health Act forms help patients better understand their rights?”

Mental Health Act rights materials now available in eight languages other than English

The unmet need

In a series of focus groups, members of our research team asked clinicians about the barriers they face when giving involuntary patients rights information. One barrier participants mentioned over and over was that many of their patients didn’t understand English.

Form 13, the document clinicians use to to tell patients about their rights, seems to be available only in English.

Translated rights materials

To help fill the gap in availability of Mental Health Act rights information in other languages, we’ve translated:

into eight of BC’s most commonly spoken languages other than English:

  • Arabic
  • Chinese (Traditional and Simplified)
  • Farsi
  • French
  • Korean
  • Punjabi
  • Spanish
  • Vietnamese

Continue readingMental Health Act rights materials now available in eight languages other than English”

Committed to Change—the Ombudsperson’s critical new report about involuntary patients’ rights

Over 2017 and 2018, the BC Ombudsperson’s Office investigated whether hospitals in the province were meeting their Mental Health Act obligations to safeguard involuntary patients’ rights by filling out the required forms at admission. On March 7, 2019, the report of this investigation, Committed to Change, was made public.

Cover of the Ombudsperson's report "Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act" showing the title superimposed on a photo of a long hospital corridor.

Continue readingCommitted to Change—the Ombudsperson’s critical new report about involuntary patients’ rights”

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.
Continue reading “Second medical opinions under BC’s Mental Health Act

Clinicians: What questions do you have about Mental Health Act rights?

Cartoon of clinicians sitting around a table. One of them is talking. A researcher listens.

In response to clinician demand arising from our rights information sessions, some members of our team are working with clinical staff to develop a LearningHub module about Mental Health Act rights so that healthcare providers across BC will have access to our content.

To make sure we address clinicians’ most pressing questions about Mental Health Act rights, we’re reaching out!

Questions can be about:

  • the Mental Health Act rights themselves
  • your obligations under the Mental Health Act to give rights information
  • the rights-notification process
  • Forms 13 & 14 and other rights information tools

…or any other concerns related to Mental Health Act rights.

If you’re a nurse, social worker, physician, or other healthcare provider who works with the Mental Health Act and are wondering about any rights-related issues, please contact us with your questions by December 20, 2018.

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.

Cartoon showing two people holding hands outside of the hospital doors.
Illustration by Jonathon Dalton

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: Continue reading “What’s a near relative?”