The hospitalization process

Hospitalization typically occurs when a crisis or severe disruption arises. The primary objective of hospitalization is to manage the crisis situation and identify ways to restore the person’s well-being. It allows for the protection and observation of the person in a controlled environment and makes it possible to establish a diagnosis and treatment.

Hospital admission

Voluntary admission
The decision to voluntarily go to the emergency room is the best case scenario for everyone. It ensures faster care since the person consents to being hospitalized and treated.

Involuntary admission
The person with a mental disorder may not always be on board with this choice. Sometimes they may be unaware of their condition and refuse to be treated in a hospital. In cases where the person’s mental state presents a danger to themselves or others, action must be taken to ensure everybody’s safety. To force the person to undergo a psychiatric evaluation, you must contact the Court of Quebec and file a petition for clinical psychiatric examination.

This action must be taken seriously, as it deprives the person affected of their fundamental right to freedom. The petition for clinical psychiatric examination will be granted only if it is proven that their mental state represents a danger to themselves or to others. To accomplish this, you can seek help from a lawyer, a notary or our organization. In the petition, you must prove, through observation and concrete facts, that the person’s mental state presents a danger. Ideally, this petition will be accompanied by a physician’s letter confirming the urgency of the situation.

The following are examples of different levels of dangerousness :

Danger to themselves
A person’s mental state may present a danger to their safety.
Example : The person has suicidal thoughts or behaviour.

Grave and immediate danger
A person’s mental state presents a grave and immediate danger.
Example : They have a very specific suicide plan, and their behaviours suggest that they intend to carry it out.

Danger to others
A person’s mental state may present a danger to the safety of others.
Example : The person is threatening to others, is agitated and has assaulted someone around them.

However, in an emergency situation where grave and immediate danger is present, the law allows this protocol to be bypassed and the person to be taken to the emergency room without their authorization or that of the court.

In this case, you should contact the police (9-1-1) so they can take the person in crisis to the hospital emergency room. Once there, they will wait for them to be seen by the doctor on duty. However, the police officers on duty may determine that your loved one’s mental state is not dangerous, but that they require care. In this case, they may suggest that you request a psychiatric clinical evaluation.

When you call the police, inform them immediately that your loved one needs psychiatric care. They will be better prepared to intervene if they know the state your loved is in.

Types of confinement

Preventive confinement
This type of confinement lasts a maximum of 72 hours and is requested by the on-duty emergency room doctor. This exceptional measure makes it possible to hold the person in an institution as a preventive measure, despite their opposition and without court authorization. However, it does not allow for psychiatric evaluation. In short, if your loved one is admitted to the emergency room and their mental state is deemed dangerous, they may be placed in preventive confinement for up to 3 days. This means they will remain in the hospital until the psychiatrist deems them fit for discharge. However, if their mental state is deemed safe, they may choose whether or not they wish to be treated.

Temporary confinement
If the patient’s mental state presents a danger to themselves or others during the three days of observation in preventive confinement, a psychiatrist will submit a request for temporary confinement in order to proceed with a psychiatric evaluation. If the patient refuses to be evaluated, a court order authorizing clinical examination must be obtained.

Psychiatric evaluation is conducted via two examinations. The first examination must be performed within 24 hours of admission. If it finds that confinement is necessary, a second examination will be performed by a different psychiatrist. Each examination includes the following :

• The examination date.
• The diagnosis, even if it is preliminary.
• The psychiatrist’s opinion of the severity of the person’s mental state and its consequences.
• The reasons and facts upon which the psychiatrist’s opinion and diagnosis are based.
• The need for confinement if dangerousness is established.
• The person’s ability to care for themselves.

Institutional confinement
If both psychiatric examinations conclude that the patient is dangerous, institutional confinement will be requested. This form of confinement requires the patient to remain in a facility for clinical monitoring and observation, but it does not require the person to receive treatment. The court determines the duration of confinement. As stipulated in the Act Regarding the Protection of Persons Whose Mental State Presents a Danger to Themselves or to Others, any person has the right to refuse institutional confinement or psychiatric evaluation. The only way to bypass this law is to establish the dangerousness of the person’s mental state or their inability to consent.

Institutional confinement ends when :

• A certificate stating that confinement is no longer warranted is issued by the physician.
• No psychiatric examination reports were ordered within a given time frame.
• The period defined in the court order expires.
• The Administrative Tribunal of Quebec delivers an order ending the confinement.
• A court order is issued to terminate confinement.

The hospital stay

If the emergency room physician determines that your loved one needs psychiatric care, they will request a consultation. The liaison nurse will be informed of this request and meet with the person. They will do a pre-assessment and deliver their findings to the attending psychiatrist who, in turn, will conduct an evaluation. At the end of this process, they will decide if psychiatric hospitalization is necessary. If this is the case, the patient will initially remain in the UETT (Unit for Evaluation and Transitional Treatment). If the person is found to need extended hospitalization, they will be transferred to the psychiatric unit.

They will then be assigned to a care team including a psychiatrist, nurses, an occupational therapist, a social worker, attendants, etc. After establishing a diagnosis, the psychiatrist, in collaboration with the team, will determine a care plan to treat all aspects of the illness.

The patient will be seen regularly by the different members of this team. Positive cooperation is an essential part of effective care. In addition, family involvement, if desired by the patient, can be very beneficial in the therapeutic process. The nurse is the person most involved in treatment, as they become the liaison between the treatment team, the patient and the family.

Before leaving the hospital, you will need to discuss next steps with the health care team. Will my loved one go to a day centre? Where will they live? Will they be able to return to work? Will they receive therapy? Will someone make sure they take their medication?

The assigned social worker will be able to answer most of your questions. The social worker’s main function is to find resources that will be of benefit to the individual with the mental illness. During your loved one’s hospital stay, the social worker will ensure that suitable living arrangements are found for them. He or she will also ensure that they have a source of income and will provide them with resources to facilitate their reintegration into society. With your participation, the social worker can also initiate a curatorship with the attending physician. If you have any questions about your loved one’s well-being after discharge from the hospital, you can refer to the social worker.

 

Source : Excerpt from A Guide for Families Affected by Mental Illness: Support for Life’s Difficult Moments. | Éclusier du Haut-Richelieu