Hello! Following last week’s blog post on Canada’s Mental Health Act, this week we will dive into how the Mental Health Act protects individual rights and privacy to provide them with mental health treatment.

Understanding Mental Health Act Canada: A Primer on Key Provisions

Starting with a refresher of Ontario’s Mental Health Act, the Mental Health Act Ontario [1] comprises 5 sections: Standards, Hospitalization, Estates, Veterans, etc., and Miscellaneous. The Mental Health Act lays out the standards and terms for hospitalized individuals with a mental health condition. It protects their rights regarding treatment, management of affairs, and standard of care. Each province governs Mental health treatment individually, so some processes differ slightly amongst areas in Canada [2]. Some groups of people also monitor and deliver treatment by the federal government, including veterans, Indigenous peoples, the military, inmates in federal prisons, the RCMP, arriving immigrants, and federal public servants [3]. Canada follows a deinstitutionalization method of mental health treatment focusing on community-based treatments and mental health services outside institutions and hospitals [3]. For people living with mental health conditions or support those who live with a mental health condition, the Mental Health Act is essential to understand as the process for assessment, institutionalization, release, and treatment are described throughout the Mental Health Act and must be followed to preserve the rights and freedoms of individuals undergoing treatment. During voluntary and involuntary treatment, you are entitled to the rights set out in the Ontario Mental Health Act, which have been shaped in accordance with your rights under the Health Care Consent Act, the Health Promotion and Protection Act, the Personal Health Information Protection Act, the Criminal Code of Canada, the Substitute Decisions Act and most importantly, the Canadian Charter of Rights and Freedoms.

Navigating Your Rights: Informed Consent and Privacy Protections

            The Mental Health Act of Ontario is structured to corroborate your rights under the acts mentioned above. The Regulated Professions Act ensures that credible professionals oversee patient treatment, being transparent with patients and informing them of everything they need to know, including their right to privacy. The Mental Health Act upholds this policy to ensure professionals are held accountable and provide patients with all the knowledge they need to make informed choices and get their complete consent [4]. There are two main ways to get treatment: voluntary or involuntary treatment, where the individual is brought to the hospital until they are no longer considered a threat to themselves or others [5].

           The Health Care Consent Act helps to maintain the autonomy of individuals by providing individuals with the total capacity to consent to treatment if they can. This provides the standard for obtaining consent and when a practitioner can conduct treatment without consent. An individual’s ability is decided if they can understand all the information to make an informed choice for themselves about their treatment while also being able to understand risks and consequences. Consent must be related to the treatment, informed, voluntary, and obtained without fraud or misinterpretation. Patients should be informed about the full extent of treatment needed, including risks, benefits, side effects, alternative courses of action, and consequences of having and not having the treatment. Consent can be implied or expressed, and a practitioner can presume to consent to treatment when there have been changes, or it must be conducted in a different location. If the person is capable, which can vary depending on the type of treatment, they can withdraw from treatment at any time. Unless the person is deemed incapable of consenting, no treatment can be administered without the patient’s consent [6].

           The Personal Health Information Protection Act (PHIPA) ensures your right to privacy through the Mental Health Act. This regards information about your physical and mental health, identifying information, health care and treatment, substitute decision maker, and payment options. This act ensures that unless explicit consent is given or is required by PHIPA or the law to be shared, that health information should not be collected or shared by a healthcare custodian. They may only use the information if they disclose it to the individual or gather more information than necessary. While this information cannot be used for marketing purposes without consent, health information can be used for provincially and federally funded resources for health or governing bodies [7].

Access to Care: Exploring Treatment Options and Voluntary Admission

Under voluntary care, many treatment options are available to you when seeking mental health care through the Mental Health Act. This type of treatment must be completed and consented to by the patient and can be withdrawn at any time; patients under voluntary admission at a psychiatric institute are never to be detained unless there has been a change of treatment from voluntary to involuntary. Voluntary treatment is a mental health treatment that the individual seeks out or consents to voluntarily and may consist of a hospital setting, community-based treatment, a family doctor, and more [5]. Voluntary treatment is always preferred over involuntary treatment. It can be much less restrictive than involuntary admission, where you can get support from your community, family, friends, and public resources. You can speak with your family doctor about options for treatment, which may include medication, community-based treatment, public support groups, self-care methods, and much more. A psychiatric assessment can be voluntary or involuntary, where if a physician believes that you may be of harm to yourself or others or have an inability to care for yourself, they can apply for psychiatric assessment. Admission into a psychiatric facility for treatment can be voluntary if recommended by a family doctor or physician and can be sustained for a period of up to 3 months. There are also situations where a voluntary admission status can be changed to involuntary by the patient’s physician when completing a certification of change of treatment [1].

Involuntary Admission: Balancing Rights and Public Safety

Involuntary admission is a heavily regulated legal process involving individuals, under a physician’s prescription, being detained in a mental health facility until stabilization. The conditions of involuntary hospitalization include deterioration without treatment, having improved previously with treatment, high likeliness of harm to themselves or others, or being incapable of consenting to their treatment. Patients under involuntary admission cannot be held in a psychiatric facility for longer than two weeks; after two weeks, they must be changed to a voluntary patients with a certificate of renewal to remain in care, with a maximum of three months.

Community Treatment Orders (CTOs) are an example of a prescribed treatment that, if voluntary, patients can withdraw from at any time unless otherwise prescribed by a physician. Capacity assessments are done frequently to reconsider whether the CTO must remain in place. It allows patients to receive care for mental health conditions with the support of people around them and without the formal setting of a mental hospital. People outside a facility supervise the individual to ensure that they remain stable and on their course of treatment to ensure improvement. This can help patients stay on their treatment plan, with freedom outside of a supervised facility, as they can rely on their closest family and friends to support them and help them on their journey.

Individual rights are fundamental during the involuntary admission process, which is why there is a two-week limit. The concerns of others can be considered when doctors are prescribing an automatic admission order, but it must come from multiple physicians who all agree on the course of treatment. The physicians must determine whether they fit the conditions for involuntary admission. While the person can be initially committed for 72 hours involuntarily, the extension must come directly from a physician’s order and a psychiatric assessment [1].

Advocating for Your Well-Being: Resources and Support Networks

The Mental Health Act endorses using your family physician to discover resources and treatment options around you and learn about your rights and how they are being upheld in treatment. There are lots of advocacy resources available to you to provide you with ways to support your mental well-being and that of those around you. The Canadian Mental Health Association (CMHA) is a federally endorsed program with dozens of ways to seek treatment, support groups, advocacy, research, help for family and friends, understanding of policy, and events and ways to get involved. The Psychiatric Patient Advocate Office of the Ontario government also provides ways to advocate for yourself and others, seek education about your rights, and provide services for people and families living with a mental health condition. Make sure to keep up with your provincial health ministry and British Columbia’s Ministry of Mental Health and Addictions for updates to legislation regarding mental health and where to seek help if you or someone you know needs support for mental health.