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Lecture 2

NURS 3524 Lecture Notes - Lecture 2: Nursing Assessment, Mental Disorder, Mood Disorder

Course Code
NURS 3524
Mavoy Bertram

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 2
HH/NUR 3524 6.0
Psychiatric & Mental Health Nursing For Canadian Practice
Legal Considerations - Safety and Risk - Mental Health Act
Assessment, Mental Status Exam
Mood Disorders, Suicide and Self Harm
Chapter 10-11
Chapter 19
Chapter 22
Legal Aspects of Caring for the Mental Health Population
Most clients with mental health issues are treated in the community
o Cheaper and effective since treatment might be long term
Admission into hospital occurs at a time when there is a crisis or danger to the client
o Doctor would put them on a form (72 hours by the time they were put on form 1)
Need for Hospitalization
Client feeling unsafe
o Having lost control of self to stay safe
Lost any will to live
Increased self harm behaviours or made a suicidal attempt
o Has failed many trials of medication
Experiencing symptoms of psychosis
o Threat to own safety and others
Client expresses suicidal/homicidal thoughts
Symptoms creating inability to care for self, poor judgement, dangerous behaviours
Crisis situation
Types of Hospital Admissions
How does one get admitted into the mental health/psychiatric ward/ hospital?
By 2 ways:
o Civil Committal
Voluntary - physician admits, come through ER, GP, Psych
Involuntary Psychiatrist by the Mental Health Act
From form 1 from the ER
In 7 days, a doctor can issue a form 1 from the date of assessment
The family can go to the justice of peace and get a form 2
police can bring them in
Informal substitute decision-maker agrees
o Forensic system
Deemed not criminally responsible due to mental disorder
First must go through mental health court
These decides don’t mean the individual loses the right to refuse medication
o Form 33: is where the patient loses the right to refuse meds
*Can appeal the decision to the appeal board takes 48 hours

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 2
HH/NUR 3524 6.0
During that time, they can’t meds while the appeal is in process
Can inly give meds as chemical restraint if needed
Voluntary Admission Status
are seeking help
may agree to be admitted into hospital to appease family/ friends
may agree to admission, but may be reluctant to take medication or treatment
Involuntary admission status expired, agreed to continue inpatient treatment
Involuntary Admission Status
Clients who are admitted into hospital are done so under the Ontario Mental Health Act
Form 1:
o completed by a physician who has assessed the client in the last 7 days
o Valid only for 72 hours, and is used to assess the client further under a psychiatrist’s care
Form 2:
o Completed by the Justice of the Peace
o Brought to the attention by family or friend
o Stating the individual is displaying dangerous activity to self or others
o Only for an ER Evaluation
Assessment & Admission Criteria (MHA, s. 15, 16, 17)
One or more criteria that warrant an inpatient admission for a psychiatric assessment:
Danger to self or others
Risk of serious physical impairment of the person
Context of mental illness, previous psychiatric history (Note: addiction included)
For Form 1 or 2, additionally:
o previous treatment has been helpful &
o likely to cause harm or substantial physical or mental deterioration if not treated &
o person is incapable & SDM consents
Psychiatric Assessment at the Hospital (MHA s. 20)
Psychiatrist must assess person within 72 hours
o form 1 always comes with a form 42 and it notifies the patient that they are being put on a form 1
Person can be
a) discharged if does not meet admission criteria,
b) admitted voluntarily
o if the patient wants to stay for treatment and etc
c) admitted involuntarily
o if the patient condition gets worse and form 3
form 1 and form 3 has to be done by a different doctor each time
With an involuntary admission must continue to meet one of three criteria. Placed on additional form
as per MHA:
o Form 3: 2 weeks duration (14 days); after Form 3 expires:
o Form 4: 1 month, then signed for 2 months, then for 3 months. (it comes with a form 30 to
notify the patient of a form)
Form 30: accompanies both Form 3 or 4, Notice to Patient

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HH/NUR 3524 6.0: Individuals and Families in Child and Mental Health Settings WEEK 2
HH/NUR 3524 6.0
Remember form 1 = hours; form 3 = days (if admitted at 10pm) it counts has
a day at 12am
Form 3 can be discontinuing anytime the patient is getting better
Form 5: cancels form 3 and 4
Every time you issue another form 4 after the 4th renewal, you must go to the
review board
If the patient escape on a form 1: the police can go, get them on the basis on that
form 1
If the patient escape on a form 3/4 a form 9 (good for 1 month and is order for
return) has to be issued for the police can go, get them
Form 4 doesn’t count the actual days; you – 1 day for each month passed; Jan 27
March 25
Why is there a need for all of these legalities?
Important liberty rights are curtailed
Constitution allows infringement of liberty only if processes of fundamental justice are followed
Special measures are required to ensure rights for vulnerable people
Notices & advice allow people to exercise rights
Forms hold authorities (including doctors) accountable to ensure their actions are lawful
Client Rights While Under a Hospital Admission
Review of committal & incapacity decisions
Rights advice
o Form 50 will show that they have been given legal advice (for form 3,4 (33))
o Review Board Hearing
to contest Forms 3, 4 and 33
Legal proceeding in Hospital
results occur within 2 business days
Appoint a representative to make decisions if incapable
Privacy and Confidentiality
o Don’t ever give information over the phone and only share information within the circle of care
Access to own health record (and request corrections)
Communication, with some limits
Treatment (Health Care Consent Act)
All treatment requires consent
Consent rules same for community and hospital admission, but no rights advice obligation in community
If person is not capable, substitute decision-maker makes the decisions
Personal guardians and Powers of Attorney (POA)
Goals of Hospitalization
1. Safety
a. Priority
i. Remove things that can be used as a weapon
ii. Close observation 1:1
1. Don’t give privacy when going to the washroom
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