REQUESTING A PSYCHIATRIC EVALUATION
BY DIANE GRENIER, FAMILY PROGRAM

Requesting a psychiatric evaluation is a simple legal process available to everyone. Its goal is preventative -- helping a sick person in impending danger for his/her life or that of others who refuses all assistance (i.e. going to a hospital emergency). The request for a psychiatric evaluation is presented to the court where a judge determines if the person shows enough danger signs to override his/her right to make decisions. It is an exception to the rules of the Charter of Personal Rights and Freedoms which ensures that everyone has the right to make their own decisions. The judge can rule that the person be temporarily kept in hospital against his/her will to be evaluated by two psychiatrists. If they find the person is a danger to himself/herself or others, the patient will be kept in hospital for as long as the danger remains. A request to keep the patient will then be presented to the court by the hospital and a treatment program put forth. Because an institution cannot force treatment the patient can accept or refuse the treatment. If the patient is judged to be no longer dangerous at the time of the psychiatric evaluation, he/she can leave the hospital and will have the choice to accept or refuse treatment.

When someone is considering making a request for the psychiatric evaluation of a loved one who has a mental illness, the situation is serious and desperate. More often than not, the person's condition will have been gradually deteriorating and their behaviour showing increasing signs of danger to themselves and others: drives dangerously, stops eating or eats very little, stays barricaded without going out for days at a time, acts violently (throws things), easily fights with strangers who could retaliate; makes death or suicide threats, etc. This type of behaviour is often accompanied by psychosis. It's unpredictability greatly increases the risks of lesser acts such as burning papers, sleeping with a knife under the bed, wanting to travel to a distant land, etc. Relatives and friends will often hesitate before taking legal measures. They fear the anger of the person with mental illness as well as losing his/her trust. Nevertheless one must consider the dire consequences these behaviours could have. The seriousness and the urgency of the situation should be a guide when seeking the help of social and institutional authorities. This could eventually help the person with the mental illness become more responsible and aware of the extreme impact of the illness and of the importance of seeking treatment.

The request form is easy to fill out. You can obtain a copy at the offices of Friends for Mental Health and receive support for this difficult situation. You can be helped to put the process in motion by completing the form so that the dangers of the situation are clearly explained to a judge. Once the form is completed, an appointment at the Court House must be arranged. The judge hears the case and issues an order. The person making the request must then bring copies of the order to the hospital and the police station, describe the patient's behaviour to the emergency personnel and discuss with the police how to approach the patient with the utmost patience and respect. The patient will then be driven to the hospital in a patrol car or by ambulance (with or without the person making the request). The hospital will conduct a psychiatric evaluation and take all necessary steps according to the norms and time limits provided by law.

In an emergency situation when there is no time to submit a request to the court, one must dial 911. This approach can be more uncertain because there is no court order when the person arrives at the hospital. If, when seen by the doctor on duty in the emergency department, the patient's condition has improved, he/she will not receive a psychiatric evaluation and will not be kept in the hospital.
For more information, call Friends for Mental Health or consult the Practical Guide to Mental Health Rights from the Ministère de la santé et des services sociaux du Québec.