General Regulations
These regulations designate three psychiatric facilities and prescribe the forms used under the Mental Health Act.
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General Regulations
These regulations designate three psychiatric facilities and prescribe the forms used under the Mental Health Act.
t MENTAL HEALTH ACT GENERAL REGULATIONS PLEASE NOTE This document, prepared by the Legislative Counsel Office, is an office consolidation of this regulation, current to February 1, 2024. It is intended for information and reference purposes only. This document is not the official version of these regulations. The regulations and the amendments printed in the Royal Gazette should be consulted on the Prince Edward Island Government web site to determine the authoritative text of these regulations. For more information concerning the history of these regulations, please see the Table of Regulations on the Prince Edward Island Government web site (www.princeedwardisland.ca). If you find any errors or omissions in this consolidation, please contact: Legislative Counsel Office Tel: (902) 368-4292 Email: legislation@gov.pe.ca General Regulations Table of Contents GENERAL REGULATIONS Table of Contents Section Page 1. Psychiatric facilities ................................................................................................................................. 5 2. Forms ....................................................................................................................................................... 5 SCHEDULE 6 FORM 1 6 ORDER FOR INVOLUNTARY PSYCHIATRIC ASSESSMENT 6 FORM 2 7 ORDER FOR INVOLUNTARY PSYCHIATRIC ASSESSMENT 7 FORM 3 8 CERTIFICATE OF INVOLUNTARY ADMISSION 8 FORM 4 9 CERTIFICATE OF RENEWAL OF INVOLUNTARY ADMISSION 9 FORM 5 10 CERTIFICATE OF LEAVE 10 FORM 6 10 CERTIFICATE OF CANCELLATION OF LEAVE 10 FORM 7 11 CERTIFICATE OF INCAPACITY 11 FORM 8 12 COMMUNITY TREATMENT ORDER 12 FORM 9 13 RENEWAL OF COMMUNITY TREATMENT ORDER 13 FORM 10 14 ORDER FOR PSYCHIATRIC ASSESSMENT 14 FORM 11 15 NOTICE OF REVOCATION OF COMMUNITY TREATMENT ORDER 15 c t Current to: February 1, 2024 Page 3 General Regulations MENTAL HEALTH ACT CHAPTER M-6.2 GENERAL REGULATIONS Pursuant to section 37 of the Mental Health Act R.S.P.E.I. 1988, Cap. M-6.2, Council made the following regulations: 1. Psychiatric facilities For the purpose of clause 1(t) of the Act, the following facilities are designated for the assessment, care and treatment of persons who have or may have a mental disorder: (a) Hillsborough Hospital; (b) Prince County Hospital; (c) Queen Elizabeth Hospital. (EC35/24) 2. Forms The forms prescribed for the purposes of the Act are set out in the Schedule to these regulations and form part of these regulations. (EC35/24) c t Current to: February 1, 2024 Page 5 General Regulations SCHEDULE FORM 1 ORDER FOR INVOLUNTARY PSYCHIATRIC ASSESSMENT (Section 8, Mental Health Act) I, _____________________ (name and designation of medical practitioner or nurse practitioner), personally examined __________________ (name or description of person) of _________________ (person’s address) on __________ (mm/dd/yy) at ___________(time) at __________________ (name of health facility). It is my opinion that (a) the person has a mental disorder; and (b) as a result of the mental disorder, the person (check, as appropriate) ___ has caused or is likely to cause harm to the person or to others, or ___ is likely to suffer substantial physical or mental deterioration or impairment. I confirm that the person refuses or is unable to consent to a psychiatric assessment. Supporting information: (e.g. details of examination, observations, basis for opinion): _________________________________________________________________ _________________________________________________________________ Based on the foregoing, I, by this order, refer the person to a psychiatrist for an involuntary psychiatric assessment. This order is sufficient authority (a) for a peace officer to apprehend the person who is named or described in the order and take the person to a psychiatric facility; and (b) for a psychiatrist to (i) detain, restrain and observe the person in a psychiatric facility for not more than 72 hours, and (ii) conduct an involuntary psychiatric assessment of the person. Dated ________ (mm/dd/yy) at ________ (time) ____________________ (signature of practitioner) (EC35/24) Page 6 Current to: February 1, 2024 t c General Regulations FORM 2 ORDER FOR INVOLUNTARY PSYCHIATRIC ASSESSMENT (Section 9, Mental Health Act) I, Dr. _________________(name of attending psychiatrist), am responsible for the care and treatment of ___________________(name or description of patient) of______________ (patient’s address), who is currently a voluntary patient at ___________________ (name of psychiatric facility), from which the patient has requested to be discharged. I have reasonable grounds to believe that (a) the person has a mental disorder; and (b) as a result of the mental disorder, the person (check, as appropriate) ___ has caused or is likely to cause harm to the person or to others; or ___ is likely to suffer substantial physical or mental deterioration or impairment. I confirm that the patient refuses or is unable to consent to a psychiatric assessment. Supporting grounds (e.g. mental disorder, details of voluntary care and treatment, observations): _________________________________________________________________ _________________________________________________________________ Based on the foregoing, I order that the patient undergo an involuntary psychiatric assessment. This order is sufficient authority for the attending psychiatrist to (a) detain, restrain and observe the patient in a psychiatric facility for not more than 72 hours; and (b) conduct an involuntary psychiatric assessment of the patient. Dated ______ (mm/dd/yy) at _______ (time) ________________ (signature of attending psychiatrist) (EC35/24) c t Current to: February 1, 2024 Page 7 General Regulations FORM 3 CERTIFICATE OF INVOLUNTARY ADMISSION (Section 10, Mental Health Act) I, Dr._________________ (name of psychiatrist), have personally conducted a psychiatric assessment of ____________________ (name or description of person) of _______________ (person’s address), within the previous 72 hours at _______________ (name of psychiatric facility) from _____(time) on __________ (mm/dd/yy) to ________ (time) on _______ (mm/dd/yy). I have made careful inquiry into all the facts necessary as to the nature of the person’s mental condition and it is my opinion that (a) the person has a mental disorder; and (b) as a result of the mental disorder, the person (check, as appropriate) ___ has caused or is likely to cause harm to the person or to others; or ___ is likely to suffer substantial physical or mental deterioration or impairment; and (c) the person requires care and treatment in a psychiatric facility. I confirm that the person refuses or is unable to consent to admission to a psychiatric facility. Description of the facts and personal observations upon which I have formed my opinion: _________________________________________________________________ Description of information received from other sources (identify sources): _________________________________________________________________ Based on the foregoing, I admit this person to a psychiatric facility as an involuntary patient under section 10 of the Mental Health Act. This certificate expires 30 days from the date it is issued unless sooner cancelled by the attending psychiatrist. Date issued: ___________ (mm/dd/yy) ___________________________ (signature of psychiatrist) (EC35/24) Page 8 Current to: February 1, 2024 t c General Regulations FORM 4 CERTIFICATE OF RENEWAL OF INVOLUNTARY ADMISSION (Section 11, Mental Health Act) I, Dr. _________________ (name of attending psychiatrist), have personally conducted a psychiatric assessment of __________________ (name or description of patient) of ______________ (person’s address), within the previous 72 hours at _________________ (name of psychiatric facility) from ________ (time) on ________ (mm/dd/yy) to _______ (time) on ________ (mm/dd/yy). I have made careful inquiry into all the facts necessary as to the nature of the patient’s mental condition and it is my opinion that (a) the person has a mental disorder; and (b) as a result of the mental disorder, the person (check, as appropriate) ___ has caused or is likely to cause harm to the person or to others; or ___ is likely to suffer substantial physical or mental deterioration or impairment; and (c) the person requires care and treatment in a psychiatric facility. I confirm that the patient refuses or is unable to consent to admission to a psychiatric facility. Description of the facts and personal observations upon which I have formed my opinion: _________________________________________________________________ Description of information received from other sources (identify sources): _________________________________________________________________ Based on the foregoing, I hereby continue the involuntary admission of the patient in a psychiatric facility under section 11 of the Mental Health Act. This certificate is the patient’s ___ first certificate of renewal and expires 30 days from the date it is issued, unless sooner cancelled by the attending psychiatrist; ___ second or third certificate of renewal and expires 90 days from the date it is issued, unless sooner cancelled by the attending psychiatrist; or ___ fourth or subsequent certificate of renewal and expires 12 months from the date it is issued, unless sooner cancelled by the attending psychiatrist. Date issued: _____________ (mm/dd/yy) ___________________ (signature of attending psychiatrist) (EC35/24) c t Current to: February 1, 2024 Page 9 General Regulations FORM 5 CERTIFICATE OF LEAVE (Section 15, Mental Health Act) I, Dr. ______________ (name of attending psychiatrist), hereby authorize ______________ (name or description of patient) of _______________ (patient’s address), who is an involuntary patient at _______________ (name of psychiatric facility), to be absent from the psychiatric facility from ________ (time) on ___________ (mm/dd/yy) to ________ (time) on ____________ (mm/dd/yy). The following conditions apply in respect of this authorization: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Date issued _________ (mm/dd/yy) _____________________ (signature of attending psychiatrist) (EC35/24) FORM 6 CERTIFICATE OF CANCELLATION OF LEAVE (Section 15, Mental Health Act) I, Dr. ___________________ (name of attending psychiatrist), hereby cancel the Certificate of Leave issued on ______ (mm/dd/yy) in respect of __________________ (name or description of patient) of ____________ (patient’s address), an involuntary patient at __________ (name of psychiatric facility). It is my opinion that (check, as applicable) ____ as a result of the mental disorder, the patient has caused or is likely to cause harm to the patient or others while on leave; or ____ the patient has failed to comply with the terms and conditions of the Certificate of Leave. Supporting information: _________________________________________________________________ _________________________________________________________________ This certificate is sufficient authority for a peace officer to apprehend the involuntary patient named or described in the certificate and take the involuntary patient back to the psychiatric facility. Date issued ________ (mm/dd/yy) ________________________ (signature of attending psychiatrist) (EC35/24) Page 10 Current to: February 1, 2024 t c General Regulations FORM 7 CERTIFICATE OF INCAPACITY (Section 17, Mental Health Act) I, Dr. _________________ (name of attending psychiatrist), am of the opinion that ______________ (name or description of patient) of _________________ (patient’s address) is not capable in accordance with Part II of the Consent to Treatment and Health Care Directives Act R.S.P.E.I. 1988, Cap.C-17.2, in respect of treatment, as outlined below. I performed a capacity assessment of the patient on ________ (mm/dd/yy) of the following nature: _________________________________________________________________ It is my opinion that the scope of the patient’s incapacity is as follows: _________________________________________________________________ The reasons for my opinion are as follows: _________________________________________________________________ Date issued ________ (mm/dd/yy) ______________________ (signature of attending psychiatrist) (EC35/24) c t Current to: February 1, 2024 Page 11 General Regulations FORM 8 COMMUNITY TREATMENT ORDER (Section 18, Mental Health Act) I, Dr. _________________ (name of psychiatrist), hereby issue this community treatment order for ___________________ (name or description of person) of ___________________ (person’s address). I confirm the following conditions are met: (a) within the previous two years, the person has been (check, as applicable) ___ admitted as an involuntary patient in a psychiatric facility on two or more separate occasions, for a total of at least 30 days, or ___ the subject of a prior community treatment order; (b) I have conducted a psychiatric assessment of the person within the previous 72 hours and it is my opinion that (i) the person has a mental disorder, (ii) as a result of the mental disorder, the person (check, as applicable) ___ has caused or is likely to cause harm to the person or others, or ___ is likely to suffer substantial physical or mental deterioration or impairment; (iii) the person requires community treatment, and (iv) the person is not capable of giving or refusing consent to community treatment, but is able to comply with a community treatment order; (c) the community treatment the person requires exists in the community and is available and will be provided to the person; (d) the person’s substitute decision-maker has consented on behalf of the person to the community treatment plan. Supporting facts: _________________________________________________________________ The community treatment plan for the person is attached or as follows: _________________________________________________________________ The person who is subject to this community treatment order shall comply with this order. I am responsible for the supervision and management of this order but may appoint another psychiatrist to be responsible, where necessary. This order expires on __________ (mm/dd/yy). Date issued ________ (mm/dd/yy) ________________________________ (signature of psychiatrist) (EC35/24) Page 12 Current to: February 1, 2024 t c General Regulations FORM 9 RENEWAL OF COMMUNITY TREATMENT ORDER (Section 20, Mental Health Act) I, Dr. _____________________ (name of responsible psychiatrist), hereby renew the community treatment order issued on _________ (mm/dd/yy) and expiring on ________ (mm/dd/yy) for ___________________ (name or description of person) of ___________________ (person’s address). I confirm the following conditions are met: (a) I have conducted a psychiatric assessment of the person within the previous 72 hours and it is my opinion that (i) the person has a mental disorder, (ii) as a result of the mental disorder, the person (check, as applicable) ___ has caused or is likely to cause harm to the person or others, or ___ is likely to suffer substantial physical or mental deterioration or impairment; (iii) the person requires community treatment, and (iv) the person is not capable of giving or refusing consent to community treatment, but is able to comply with a community treatment order; (b) the community treatment the person requires exists in the community and is available and will be provided to the person; (c) the person’s substitute decision-maker has consented on behalf of the person to the community treatment plan. Supporting facts: _________________________________________________________________ The community treatment plan for the person is attached or as follows: _________________________________________________________________ The person who is subject to this community treatment order shall comply with this order. I am responsible for the supervision and management of this order but may appoint another psychiatrist to be responsible, where necessary. This order expires on __________ (mm/dd/yy). Date issued ________ (mm/dd/yy) _______________________________ (signature of psychiatrist) (EC35/24) c t Current to: February 1, 2024 Page 13 General Regulations FORM 10 ORDER FOR PSYCHIATRIC ASSESSMENT (Section 22, Mental Health Act) I, Dr. ________________ (name of psychiatrist), am the responsible psychiatrist for the community treatment order issued on __________ (mm/dd/yy) for ___________________ (name or description of person) of _____________________ (address of person). I hereby order an involuntary psychiatric assessment of the person on the basis that (a) either (check, as applicable) ____ despite reasonable efforts to assist the person, the person does not comply with the community treatment order, or ____ the revocation of the community treatment order is required under section 23 of the Act; (b) I have reasonable grounds to believe that (i) the person has a mental disorder, and (ii) as a result of the mental disorder, the person (check, as applicable) ____ has caused or is likely to cause harm to the person or others, or ____ is likely to suffer substantial physical or mental deterioration or impairment; and (c) the person refuses or is unable to consent to a psychiatric assessment. Supporting information and grounds: _________________________________________________________________ _________________________________________________________________ This order is valid for 30 days and is sufficient authority for (a) a peace officer to apprehend the person who is named in the order and take the person to a psychiatric facility; and (b) a psychiatrist to (i) detain, restrain and observe the person in a psychiatric facility for not more than 72 hours, and (ii) conduct an involuntary psychiatric assessment of the person. Dated ___________ (mm/dd/yy) _______________________ (signature of responsible psychiatrist) (EC35/24) Page 14 Current to: February 1, 2024 t c General Regulations FORM 11 NOTICE OF REVOCATION OF COMMUNITY TREATMENT ORDER (Section 23, Mental Health Act) I, Dr. _____________ (name of psychiatrist), am the responsible psychiatrist for the community treatment order issued on __________ (mm/dd/yy) for ________________ (name or description of person) of ______________ (address of person). The community treatment order is hereby revoked on the following basis (check, as appropriate): ____ I am of the opinion that one or more of the following criteria are no longer met: (circle) (i) the person has a mental disorder, (ii) as a result of the mental disorder, the person (A) has caused or is likely to cause harm to the person or others, or (B) is likely to suffer substantial physical or mental deterioration or impairment; (iii) the person requires community treatment, and (iv) the person is not capable of giving or refusing consent to community treatment, but is able to comply with a community treatment order; ____ the community treatment the person requires no longer exists in the community or is no longer available or provided to the person; or ____ the person’s substitute decision-maker no longer consents to the community treatment plan. Supporting information: ________________________________________________________________ ________________________________________________________________ (EC35/24) c t Current to: February 1, 2024 Page 15
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