Request for a Psychiatric Evaluation

Assistance for procedure

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 the 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.

To Remember:
1. A request for a psychiatric evaluation always entails that a mentally ill person is an immediate danger to himself/herself or others and refuses to seek medical help for his/her mental health.

2. A court must decide if the urgency and the seriousness of the situation override the Canadian Charter of Rights and Freedoms, and thus necessitate the revocation of the right of the mentally ill person to consent.

3. A request for a psychiatric evaluation can be presented to a judge without a lawyer and at no cost.

4. A form to request a psychiatric evaluation can be obtained at Friends for Mental Health, at CLSCs, at the court house and from certain mental health community organizations.

5. In summary, the request process includes or deals with the following:

A. The identity of the people concerned: – the name of the applicant : the person making the request, his/her relationship to the mentally ill person; – the name of the person to be evaluated; – the name of an interested party: a person other than the applicant that is familiar with the situation and can corroborate the request by signing the form (mandatory) and indicating his/her relationship to the mentally ill person;

B. Proof of danger: A description of the situation which has led to the strong conclusion that the mentally ill person represents an immediate danger to himself/herself and others by reason of his/her mental condition.

C. Specifics in the request: In filling out the request for a psychiatric evaluation form the applicant specifies the hospital where treatment should take place and the obligation for the affected person to cooperate without delay with the hospital administration and the physicians responsible for implementing the order. The hospital specified is usually the one closest to the affected person’s home or one where he/she is already being treated.

D. Exemption of usual procedures: Informing the mentally ill person of the request and interrogating him/her is usually dispensed with when it could be harmful to his/her health or safety or that of others. Mention must be made if it is an emergency situation and if the person has fled or cannot be found.

E. The order to undergo an evaluation

F. The required signatures

G. The required affidavit for an oath before the court

6. You can go to the court house (Palais de justice – room 1461) and obtain a court order the same day. However, it is highly recommended to fill out the request form and make an appointment for the next day at 8:30 a.m. (393-2000, extension 51867).

7. Once the judge accepts the request, he issues a court order. It is then your responsibility to bring it to the police station where the ill person lives. You can also advise the hospital so that the staff is aware of the arrival of the ill person as well as of your interest and your availability.

8. A request for a psychiatric evaluation does not necessarily imply that the mentally ill person will be institutionalized. Two psychiatrists must render an opinion on the state of the person affected, and if they concur that he/she represents an imminent danger, they make a request for confinement in an institution to the court. It is the doctors who make this type of request.

9. The request for a psychiatric evaluation does not include treatment (nor does confinement in an institution).

10. A request for forced treatment can be presented to Superior Court. When it considers it judicious, it is usually the hospital who takes this step and defrays the cost. It must be proven that the mentally ill person is incapable of consent to the treatment necessary for his/her health and safety. The ability to agree to treatment refers to the degree of autonomy and awareness of a person in understanding the information, reasoning, evaluating the consequences of a choice on his/her health and expressing a precise decision. Whether the decision is sound or not is not the issue. The choice could appear to be erroneous or not reasonable, but it is valid as long as the person is competent to make it.

11. A minor of 14 years or older can refuse treatment without parental approval. The family can force him/her with a court order reversing the decision.

12. Everyone has the right to expect that information which concerns them will be kept confidential. However, family members can benefit from being informed of the treatments and follow-ups of a relative who is ill. It is often in the best interest of the person affected to consent to having the health team share some pertinent information pertinent to his/her condition and treatment.