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Psychiatry and Justice
When a mentally ill person commits a minor offense, access to the appropriate mental health services is important. It is crucial that police officers be made aware that the individual is suffering from a mental illness, so that medical rather than criminal attention is received. Entering a detention centre and appearing before the courts should be avoided whenever possible.
Urgences psychosociales, or l’equipe de soutien aux urgencies psychosociales, is a joint collaboration between Montreal police and an intervention team at CSSS Jeanne-Mance. Together, they work in joint collaboration and intervene when there is a crisis that involves a mentally ill individual. This service is open 24/7, all year round, and is linked with 911 operators. A person in distress may call a 911 operator and the operator will contact the police, or a person may directly call a police officer at time of crisis. This service is available to all citizens of Montreal.
When someone with mental illness is brought before a court, a doctor must decide whether he is able to undergo trial. A judge can order a psychiatric evaluation of the person’s mental state and keep him under observation for a period of 30 days. The individual can regain his freedom any time during this process if the judge so decides. As with psychiatric examinations, psychiatric treatment cannot be imposed without the person’s consent. However, if he is declared incapable of undergoing trial, the courts can decide, on the basis of a doctor’s testimony, to override the consent and submit the person to treatment which would allow him to be tried.
When a person is judged permanently inept or found not responsible for a criminal act due to mental illness, he may be placed in detention in a hospital centre. Those hospital centres capable of receiving clients sent by the justice system are designated by ministerial decree. Patients are detained there for as long as the Administrative Tribunal of Quebec (TAQ) decides and released under conditions established by the Review Board. A detained individual is said to be under OCE status (ordonnance de la Commission d’examen des troubles mentaux). This status does not permit the detaining hospital to treat someone against his will unless the TAQ has specifically granted that right in the supervision order.
Please click HERE for more information on the Administrative Tribunal of Quebec.
If incarceration cannot be avoided and the person finds himself in a detention centre such as Bordeaux or Tanguay, he could have access to psychiatric care. The Philippe-Pinel Institute and its affiliated Legal Psychiatric Centre of Montreal both offer specialized psychiatric services for agitated and violent clients. The referrals may come from the judicial or health network.
Involuntary Admission (court order)
It is always better to go to the hospital voluntarily. However, a person may not understand that he needs care and it is not always possible to convince him of the need for treatment. If he is already being followed by a psychiatrist or other mental health professional, you may ask for assistance in trying to convince him to enter the hospital voluntarily. If he still refuses, those close to the person become responsible for determining whether an involuntary psychiatric assessment for admission is necessary. Individuals can be admitted to a hospital involuntarily when they present a danger to themselves and/or others.
In case of immediate danger, call 911 and state there is a psychiatric emergency. Upon arrival, the police will assess the situation. If they judge that the person requires an urgent psychiatric assessment in the ER, they will call Urgences Santé for transportation to the hospital.
If the police decide that there is no immediate crisis requiring hospitalization, but you still think that your relative poses a danger to himself and/or others, you can fill out a court order for involuntary psychiatric assessment. The order must be completed by an applicant and a witness who can testify to the person’s disturbed behaviour or thinking. Note that the court order is not designed to treat anyone against his will but simply to have him assessed in the hospital ER.
Court order forms can be obtained at your local CLSC or family association, where assistance in filling out the motion may also be provided. Court orders can be requested at the Palais de Justice every day during office hours. A same-day appointment can be made if you call in the morning.
Palais de Justice
1, rue Notre-Dame Est
Palais de Justice de Laval
2800 boul. Saint-Martin O.
Laval, Quebec H7T 2S9
After the court
If a court order has been granted, the signed form must be brought as soon as possible to the police station nearest the domicile of the ill person. The police will call an ambulance to escort the individual to the designated hospital. If the individual has fled or cannot be found, the police will open a file. The court order will remain valid until the individual is located.
Once in hospital, the person must be examined by two psychiatrists within a maximum period of 24 hours. Upon evaluation the psychiatrists will decide whether the person meets the criterion of grave and immediate danger and will either release or retain him for further treatment. A second assessment must be completed within 96 hours.
If the decision is for further confinement in hospital, the hospital must obtain its own court order permitting the person to be kept as an inpatient for up to 21 days. The court order may be lifted at any time during this period if the individual no longer presents a danger. This court order gives the hospital the right to retain the patient, but does not give them the right to administer involuntary treatment.
Rights and Recourses
The Quebec Charter of Human Rights and Freedoms guarantees each person the right to dignity and respect for private life and protects him from discrimination and exploitation (Health and Social Services Act).
According to the Charter, a sick person has the right to accept or refuse treatment, either totally or in part. This is called the right to consent to treatment. “No one may be given care without their informed consent. A person recognized as being able to give free and informed consent may thus refuse surgery that could save his life. While in some circumstances such a decision may seem to run counter to common sense, this right must nevertheless be respected by health professionals.”
The situation is different if the person is considered unable to consent or refuse the care required by his state of health. In such a case the hospital will seek to obtain the consent of a legally authorized person – the mandatory, tutor, curator, spouse, close relative or person who shows a special interest in the person of full age (Civil Code, art. 15). The same procedure can be used when a person of full age categorically refuses care even if he has been declared inept, or incapable (Civil Code, art. 16).
The right to accept or refuse treatment also includes a right to receive adequate information so that the choice is meaningful. This right is known as “informed consent” or “consentement éclairé.” The information provided should include the nature and goals of the treatment, its effects, the procedures used, the possible risks and side effects, viable alternatives and their respective risks, as well as the expected consequences of a refusal or non-intervention.
In the case of a person who is unable to consent, a representative is entitled to the same right to information concerning treatment. This is your right: don’t be afraid to ask questions.
People who have been admitted voluntarily have a right to leave the hospital whenever they choose, even though this may be against medical advice.
Rights of the Hospitalized Individual
Though a person admitted under confinement is deprived of his freedom, he nevertheless retains all his legal rights. These rights are guaranteed in the Mental Health Protection Act, Loi P-38.001, which also guarantees access to a lawyer and provides for written notification and legal recourse for the patient.
As previously stated, even if a person is under confinement in an institution, he has the right to refuse treatment, in whole or in part, unless he has been declared incapable of consent. “Any person who is dissatisfied with a decision rendered under this act with regards to himself or anyone related or allied to him may request the Commission des Affaires Sociales to review the decision.” (M.P.P.A., s. 30.)
The decision of confinement in an institution may be contested at any point by a written request explaining the person’s or the third party’s dissatisfaction. When placed under confinement in an institution, the patient receives information about how to launch such proceedings.
No hospital may confine a person for more than 21 days without a new examination by two psychiatrists confirming the necessity for continued confinement. Another examination must be performed after three months and every six months thereafter.
The person has the right to an exchange of confidential correspondence with certain people: a lawyer, a notary, the Public Curator, the Commission des Affaires Sociales, a member of the National Assembly, a doctor, the protecteur du citoyen, the institution, the Régie Régionale and the Complaints Commissioner.
Right to Access to Information
The Health and Social Services Act guarantees (R.S.Q., c.42) access to information. A person may be allowed to consult his own medical file unless it contains certain information that would harm him to know. It is also possible to have certain facts corrected in the medical file. All medical reports and files remain confidential. This means that if the person does not want his family to see his medical files, they cannot access them. The right to confidentiality applies to everyone including those admitted under confinement in an institution.
The law also recognizes that each person has the right to choose the professional he deals with or the institution where he receives treatment or social services. This right is nonetheless subject to the institution’s constraints regarding its organization, operations and resources. Except in the case of an emergency, a professional also has the right to accept or refuse to treat a patient.
Right to Services in English
All emergency services must be able to assist English-speaking people. In Montreal, certain institutions are specifically designated, or specific services in other institutions are indicated to provide non-emergency services to anglophones. These designations have been made by the Ministry of Health and Social Services and are found in the Montreal Regional Access Plan. It is also possible to obtain the services of an interpreter if the patient speaks another language.
Click HERE to find institutions that provide services in English.
“English-speaking persons are entitled to receive health services and social services in the English language, in keeping with the organizational structure and human, material and financial resources of the institutions providing such services and to the extent provided by an access program referred to in section 348.”
Section 348: “Each agency, in collaboration with institutions, must develop a program of access to health services and social services in the English language for the English-speaking population of its area in the centres operated by the institutions of its region that it indicates or, as the case may be, develop jointly, with other agencies, such a program in centres operated by the institutions of another region…”
Right to Agree or Refuse to Participate in Research
People have the right to agree or refuse to participate in a scientific research program or an education project. As in treatment, if the person is incapable of consenting to research or education, another person who is authorized by law may do so, provided the study involves a minimum risk or inconvenience. In the absence of a representative, a court could give its authorization under certain conditions.
Right to Lodge a Complaint
In every hospital, you may obtain information regarding the rights of users and the complaints examination procedure from the ombudsperson. Psychiatric institutions must have a user committee to help their patients and assist them in their attempts to defend their rights (see below or visit the Legal section of our resource list by clicking HERE).
This does not mean that a user cannot select a person of his own choice to help him defend his rights. Family support organizations and self-help groups play a key role in endorsing the rights of the mentally ill and providing vital information.
These laws concern the person affected by mental illness, his family, and his trustees.
Copies of these official documents are available in French and usually in English at Les Publications du Québec, Tel. 1-800-463-2100. Copies of federal laws are available at Government Publications, 1185 University Street, Montreal, Tel. 514-954-1633.
Mental Patients Protection Act — La loi sur la protection des personnes dont l’état mental présente un danger pour elles-mêmes ou pour autrui (Loi P-38.001)
Public Health Protection Act — La Loi sur la protection de la santé publique (R.S.Q., c. P-35)
An Act Respecting Health Services and Social Services — La Loi sur les services de santé et les services sociaux (R.S.Q., c. 42)
Quebec Charter of Human Rights and Freedoms — Le Charte des droits et libertés de la personne (R.S.Q., c. C-12)
Youth Protection Act — La Loi sur la protection de la jeunesse (R.S.Q., c. P-34.1)
An Act Respecting the Public Curator and Amending the Civil Code and Other Legislative Provisions — La Loi sur le curateur public et modifiant le Code civil et d’autres dispositions législatives (R.S.Q., c. C-80)
An Act to Amend the Criminal Code (Mental Disorders) and to Amend the National Defence Act and the Young Offenders Act in Consequence Thereof (S.C., c. 43)
An Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information (R.S.Q., c. A-2.1)