How to Get Help for Someone with Mental Illness? - Part 1

I had a reader ask me this question, and it is an excellent one. I'm surprised this subject hadn't come to mind for this column given how often I have fielded this question from my own family members and other physicians. Please keep in mind, the following applies only in Ontario, Canada, though other jurisdictions may have something similar.

The first question I would have is, does the person want help? If the answer is yes, then this is the best case scenario. You are now figuring out what kind of help the person needs. And it can be any number of interventions: having a friend or family member check regularly, signing up for a gym membership, seeing a therapist or starting a medication to name a few. If there are more urgent safety concerns, the emergency room at your nearest hospital would be the most appropriate place to seek help, but the patient must agree to go the emergency room with you.

For people looking for mental health supports in the community, the main triage point for these resources in the Ottawa region can be accessed through the website: AccessMHA.org. People can refer themselves. A physician is not needed.

The more complicated issues arise when the answer to the question above is no, the person does not believe he/she/they is unwell and is not wanting any outside help or support. We are then looking at whether or not this person is ill enough to warrant action against their will. In mental health, we call these involuntary patients.

If you are a concerned family member or friend, there are three ways of having your loved one assessed for involuntary treatment or admission to hospital. In no particular order, the people who can make this assessment are: 1) the police, 2) physicians, 3) the Justice of the peace.

In cases where police are the first responders, should they believe the person's behaviors are symptoms of a mental illness, under something called a section 17, they can be detained by police and brought to hospital. Here the patient will then be reassessed by a physician to see if they meet criteria for a Form 1, a document that establishes that a physician has evaluated the patient and has established patient to be at risk of harm to self or others, or at risk of physical impairment that is considered imminent, life-threating and best modified by a an inpatient psychiatric admission. The Form 1 gives specific hospitals the ability keep a patient for 72 hours for observation.

The form 1 also addresses how a physician can force a patient to see a psychiatrist. The only additional detail I might add is that any physician can fill out a Form 1 and you do not need to be in an emergency room. In the community, after a Form 1 is filled in by a physician, it is then faxed to the police who will send someone to escort the person to hospital. This step reflects the significant degree of concern the physician must have for the patient, that they can not be trusted to make their own way to hospital.

The last way of getting a person to hospital involuntarily is through the Justice of the Peace. A family member or loved one goes to see the Justice of the Peace and if there is compelling evidence of safety concerns due to a mental illness, the Justice of the Peace fills out a Form 2, which acts similarly to a Form 1. Police are notified to escort the person of concern to the nearest hospital for evaluation.

So there you have it, when and why someone may find him/herself in hospital, seeing a psychiatrist against his/her will. The elephant in the room however is that many, many people with moderate to severe mental illness do not qualify for an involuntary stay in hospital. This is often because the risk for serious harm does not meet the threshold for a form 1. Unfortunately, despite our desperate wishes for loved ones to accept treatment, if there is no serious harm, the law tells us it is not our right. In addition, a Section 17, Form 1 and Form 2 do not mandate treatment, only evaluation by a psychiatrist with possible 72 hour detainment for observation. Further criteria must be met and steps taken to allow the medical system to enforce treatment. More on that next week.