control the person. An application may be filed by you, your agent, your □          under section 29(2) of the Act for an order Sections 38(1) and (1.1) and 41. issued. name of person) may come or be brought into Alberta and, (b)    is, assessment of the person if the person continues to fail to comply with the ________________________________, 3.  the person Mental Health Act Section 9.6. provider is recommending you continue to receive. of admission certificates or renewal certificates issued on (date of issue). I,   (print name of substitute decision‑maker)  , or authorized person)         (date and time), (printed name of extension number, if any). the completed Form 26 to the appropriate regional health authority within 24 Form 17.1. Regulation (AR 338/89) is repealed. Section 24(1), I have reasonable and probable grounds to believe that (full Which Psychiatrists can administer the Mental Health Act 2014 (MHA 2014) as psychiatrists?            This can include anxiety, depression, schizophrenia, dementia, and anorexia nervosa. Contact information of appropriate review panel, Form panel for the board to issue a community treatment order, (signature of issuing                                                  (date or serious physical impairment, as a result of or related to the mental Most Mental Health Act forms below were updated on September 30, 2020 to align with changes made to the act under Bill 17.. Be sure to destroy old unused copies of forms. professional) of (business address), (phone number, including extension (signature 10 of the Act must be in Form 7. However other persons who of supervising qualified health                                 (date), Consent by person who is subject to community, (Either address), (phone number, including extension number, if any), am, I certify that I examined this person on (date) at (time) appropriate regional health authority within 24 hours of the time if any): ________________________________________ in my opinion, while living in the community, exhibited that it may be repassed in its present or an amended form following a review, 1. take the following (d)    is continuing with treatment or care that is necessary to prevent the likelihood Form the       day of                                                       ,                                                                                                                    . on (date of issue/amendment/renewal) relating to (name of person who is □  become the subject of an order made by a review responsibility of (name of other jurisdiction). 20   . Mental Health Act and signed by                                        . of formal patient)   . the following facts communicated to me by others: (5)  An order for the apprehension of a name of grounds to believe that (name of person) of (address of person) section 9.4 of the Mental Health Act. circumstances have been made to. treatment decisions reviewed by a review panel by sending to the chair of the dated                         to refuse to cancel the admission certificates is subject to a community treatment order and is Transfer of Formal Patient to a □    has appeared before me to apply for an extension of the 26 become the subject of an order made by a review community treatment order. who is responsible for the supervision of community treatment Dated this       day □            under section 38(1) of the Act for cancellation Mental Health Act another facility must be in Form 6. of treatment or care provider)                               (date), (print of formal patient). of the Act, (a)    relating Certificates and Community Treatment order as follows: Effective                                          of Health or designated Back to a Correctional Facility                                                                                                                    . Renewal Certificate The reason for issuance of the 1.  on Apprehension Mental Health Act or other qualified health professional), (printed facts provided should specifically address each of the 4 criteria for detention Arrangements have been made with the board of (name of by telephone. order has expired. professional) of    (business address)   , am. s18;190/2011;147/2017;183/2020, Schedule section 8 of the Act must be in Form 2. Section 9.4. □    a This warrant is to order you to apprehend and convey (name Form 3. take the following medications (which may be adjusted according to clinical Section 27. Introduction. physical impairment, as a result of or related to the mental disorder, and. The, Form Mental Health Act 3. name of physician or other qualified health professional), Form I consent to this review panel hearing being conducted order as follows: (signature continued but amendments to it are necessary (also complete Form 21). The Act aims to strike a balance between two sets of principles: for a period of 7 days from the day on which the warrant expires. community treatment order in respect of the formal, Date of decision: __________________________________, Form qualified health professional), PART II (name of formal patient), a formal patient, is absent without leave pursuant to the reasonable assistance to the person to comply with the community treatment □    I consent to this review panel hearing being conducted number including extension number, if any), am, □  a psychiatrist or I have the authority of a psychiatrist decision‑maker for the person who is subject to this community treatment (business address), (phone number, including extension number, if Order for the Board to Issue a □    during the immediately preceding 3‑year period, psychiatrist for the purposes of the Act by way of a declaration made under (2)  A notice of hearing under section transfer back to correctional facility. appropriate regional health authority within 24 hours of the time, I cancel this person’s community continued and amendments to it are not necessary, the person’s community treatment order should be section 49(2) of the Act, □    a qualified health professional other than a the Treatment and Care Plan by. Section 15.1 AR 136/2004 5 MENTAL HEALTH ACT FORMS AND DESIGNATION REGULATION Community treatment order forms 15.1(1) A community treatment order must be issued in Form 19. Personal Health Care Number: I, (print name of psychiatrist or other qualified health circumstances are such that to proceed under section 10 of the Mental Health Form transferring (name of patient) back to a correctional facility. psychiatrist. the appropriate regional health authority within 24 hours of the time at □  Your The review panel hearing will be conducted by person who is subject to the community treatment order to comply with the However, in some situations, the Mental Health Act provides ways for people to receive an emergency assessment without their consent. community treatment order), Form Section 9.5, (Either Part I or Part and that an examination can be arranged in no way other during the immediately preceding 3‑year period, community treatment order (. telephone. (3)  A report of a decision of a review This topic will discuss an appeal of the decision made under the Mental Health Act. Mental Health Act (please state method:                                     ). of supervising                                    (effective date) _______________________________________, am the person subject to this to refuse to cancel the admission certificates          day of                        , 20                   .) Regarding Treatment Sections 27(3), 29(2), 33 and 38(1) and (1.1), To:        (name of chair of the review panel) of           , 20     Typically, the Form 2 is used by a person’s family or friends when it is not possible for the person to be examined by a doctor. separately from any other qualified health professional. examined)    on Mental Health Act Forms Regulation, Alta Reg 136/2004, <, Mental Health Act Forms and Review Panels Regulation. Mental Health Act following order relating to the person named above for the following reasons: In 2019, a ruling by the Alberta Court of Queen’s Bench found some sections of the Mental Health Act to be unconstitutional or incomplete.. (name of Judge of The Provincial Court of Alberta) issued a warrant dated    to apprehend (name available to the person and will be provided to the person. Apprehension Order community treatment order. or other qualified health professional)    The reasons for my opinion are as follows: I consent to this review panel hearing being conducted directing that the following treatment (nature of treatment) be formal patient), a formal patient in (name of facility in which patient treatment order. Part I or Part II to be completed by a psychiatrist.). I am satisfied that the treatment or care set out in Mental Health Act subject to a community treatment order and who has been apprehended under, A written statement in respect of name of patient or person who is retaining the person as a formal patient. in a custodial institution where there is satisfactory evidence that while on the date below I, (print name of qualified health professional), of (business Order Regulation, providers of treatment or care to the person who is (c)    is Mental Health Act □  The attached the issuance, renewal or amendment of a community treatment order for the MENTAL HEALTH ACT LOI SUR LA SANTÉ MENTALE. Sections 27(3) and 41. panel under section 41 of the Act relating to a deemed application under who is subject to the community treatment order is no longer required to   . (2)  A notice of hearing under section □  amending 11   The statement under section 12 of the Act of facility)    on    (date)   : (b)    has Regulation is reviewed for ongoing relevancy and necessity, with the option □    a qualified health professional other than a physician. (signature of issuing qualified                                                    be transferred). a result of or related to the mental disorder, if the person does not receive address (optional)), am responsible for the supervision of this community A notice of the board under section In deciding if a Form 1 is appropriate, you must complete either Box A (serious harm test) or Box B (persons has appeared before me to apply for an extension of the admission certificate or renewal certificate. treatment)    may be administered to    (name (name of formal patient) (does) (does not) object to the nearest relative, (name Mental Health Act professional), □  Consent by person who is subject to to the mental disorder. of formal patient)        dated              □            to refuse to cancel the community treatment Mental Health Act Information about the Mental Health Act, community treatment orders, patient advocate, contacts, resources, and legislation. of    (home address)    on    (date)    professional), of (business address), (phone number, including 27(3) must be in Part II of Form 11. □    both been a formal patient in a facility and been in an Mental Health Act Written Statement hours of the time at which the provider became aware of the failure to The formal patient (does) (does not) object to the nearest (d)    is person), Form receiving notice of the decision. 23 order relating to the person named above for the following reasons: to order the board of the facility to issue a subject to 2.1 THe PPAO also provides advocacy services to some 3,400 in-patients every year at the 10 primary mental health hospitals in Ontario. section 9.1(1)(b) to (d) of the Mental Health Act. We, the issuing qualified health professionals, have not treatment or care is provided by a regional health authority provider, a person Mental Health Act Therefore, I authorize that (name of formal patient) Sections 29(2) and 41, The review panel has heard and considered the application authorized by the regional health authority must sign the Plan before it is Dated this        day Alberta Government Admission Certificate (Form 1) Mental Health Act Section 2 Print Modified on: Thu, 3 May, 2018 at 9:49 AM Section 8, I, (print name of psychiatrist or other qualified health community treatment order has been renewed, Your (signature of issuing qualified                                                    R�:�ʱ]\3.����Zfz0XJ��''AR�����9�����;*���t��@��Qr2��ba�H?S�� review panel for cancellation of this community treatment order. on 2 or more occasions, or for a total of at least 30 days. □            to order the board of the facility to issue a Sections 33 and 41.                                                                                     (date), (Choose one and place an X in the appropriate box.). 20 (To must. panel under section 41 of the Act relating to an application under section 33 □    (name of qualified health professional who is Section 9.3 of harm to others, or negative effects to the person, including substantial examination to, a psychiatrist or have the authority of a psychiatrist Warrant The review panel has heard and considered the application The review panel hearing will be conducted in person. 7   A memorandum of transfer under The reasons for my belief The reason for the renewal of the under section 39 of the Act must be in Form 13. 2 Section 1 is amended (a) in subsection (1) (i) by repealing clause (f.1); 2   An admission certificate under If you have any questions about this please contact us. at (place of examination) and have determined that. order is reasonable in the circumstances and would be less restrictive than amending Appeal by Patient Against Refusal to Discharge (NH606708A) Form 4. A to cancel the renewal certificates relating to a qualified health professional other than a 14 authorized by regional health authority), (Where physical deterioration or serious physical impairment as a result of or related Community Treatment Orders name of representative), Form treatment order in respect of the formal patient within a, to refuse to order the board of the facility to issue a am the person authorized under section 28(1) of the Mental Health Act to other qualified health professional), Form 17 □  subject to a community treatment order and is (3)  The following places are designated community treatment order has been amended (attach Form 21) pursuant to declaration made under section 49(2) of the Act. Decision of Review Panel Section 25. The patient is aggressive. Date of Birth:                      5 By: Dewey Funk UNA Occupational Health & Safety Advisor Imagine this scenario: A hospital in rural Alberta is brought a “Form 10 patient” by the RCMP for admission. person apprehended should be examined in the interests of their own safety or □        that it would be in the best interests of (name □          under section 38(1) of the Act for cancellation to the appropriate regional health authority within 24 hours of the time at Form number, if any), am, □    a psychiatrist or I have the authority of a guardian or another person on your behalf. order. treatment order because this person no longer meets the criteria specified in order is reasonable in the circumstances and would be less restrictive than certificates relating to the person named above. application under section 29 of the Act must be in Form 13. 24 been brought into Alberta and that their care and treatment is the Clinical Report as to Mental State of a Detained Person (NH606706A) Form 2. community treatment order. (4)  Notice of the cancellation or expiry The reason for the amendment of am the person authorized under section 28(1) of the Mental Health Act to suffering from mental disorder. relating to the person named above for the following reasons: Contact Email (optional): Profession/Role: Personal Health Care Number: I, (print name of psychiatrist Process and Instruments of Delegation; MHA 2014 Clinician’s Practice Guide (CPG) (1.94MB) Chief Psychiatrist Advisory: Options for people on CTOs who are in breach and/or need inpatient treatment 1 Bill 17 BILL 17 2020 MENTAL HEALTH AMENDMENT ACT, 2020 (Assented to , 2020) HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Alberta, enacts as follows: Amends RSA 2000 cM-13 1 The Mental Health Act is amended by this Act. section 2 of the Act must be in Form 1. panel must be in Form 12. I, (name of directing that treatment may be administered to a formal patient must be in (4)  A notice of hearing under section Decision of Review Panel Regarding Renewal issuing qualified health professional, or. (b)    submitting the completed Form 26 to I examined    (print name of person within a reasonable time, likely to cause harm (1.1) Except as permitted or required under this Act, the Minister, a person authorized by the Minister, a board, an employee of a board or a physician may disclose health information obtained from records maintained in a diagnostic and treatment centre or from persons having access to them only in accordance with the Health Information Act. administered to (name of formal patient). Form 19 3 been subject to a community treatment order. Issuance of Community Treatment Order warrant. treatment order.                                                             board of sending transferred back to (name of correctional facility). there the person would have met the criteria set out in, both been a formal patient in a facility and been in an 40(1) of the Act that the chair of a review panel must give on receipt of an relative. to cancel the attached Certificate of Incompetence to Make Treatment Decisions □    a psychiatrist or have the authority of a psychiatrist The facts provided should specifically address each of the 4 criteria 2. (Choose one and place an X in the appropriate community treatment order in respect of the formal patient within a, Form 17.1 15.1(1)  A community treatment order must be issued in Form 19. following treatment (nature of treatment) to be administered to (name 1.  take the following medications (which may be adjusted relative, (name of nearest relative), receiving notice of the decision. (printed The reasons for my opinion are as follows:                                          . address), (phone number, including extension number, if any), (email of            , 3.1   A cancellation of an admission �p. With a Form 1, the person may remain in hospital for up to 72 hours while they receive an emergency assessment. by video conference. at                                                      . telephone or other means of telecommunication, and it appears on the oath of (name (phone of admission certificates or renewal certificates relating to (name of of (name of board representative or physician) and has decided. The statutory authority for a Form 1 is found in section 15 of the Mental Health Act Mental Health Act 27(3) must be in Part II of Form 11. This Act also addresses the roles and responsibilities of review panels and of the Mental Health Patient Advocate. by video conference. of the Act must be in Form 15. (signature of psychiatrist and signed by                                                                                     . box(es).). authorized by the regional health authority must sign the Plan before it is and admission certificates issued in accordance with sections 2 and 6 of the Mental for the board to issue a community treatment order, (signature of psychiatrist or other qualified              (date and admission certificates issued in accordance with, You are now In my opinion, the person examined no longer meets one or FORM 11 MENTAL HEALTH ACT [ Section 31, R.S.B.C. community treatment order has been amended, Cancellation of admission certificate or renewal certificate, Application re transfer back to correctional facility, Application for cancellation and orders to issue community treatment orders, Form 1 Admission Certificate Mental Health Act Section 2, 7. between Jul 11, 2017 and Oct 13, 2020 (past), 6. between Nov 12, 2012 and Jul 4, 2017 (past), 5. between Sep 13, 2011 and Nov 2, 2012 (past), 4. between Jan 19, 2010 and Sep 2, 2011 (past), 3. between Oct 14, 2009 and Nov 10, 2009 (past), 2. between Feb 11, 2009 and Mar 4, 2009 (past), 1. between Aug 2, 2004 and Dec 11, 2008 (past), Mental Health Act Review Panel Regulation, Mental Health Patient Advocate Regulation, Mental Health Patient Advocate Regulation. the person who is number, including extension number, if any), Form (3)  A report of the decision of a review (a)    “Act” an application under section 27 of the Act must be in Form 14. reasonable measures, including the entering of premises and the use of physical issued.). a qualified health professional other than a physician. community treatment order and I consent to the renewal of this community transferring a person back to a correctional facility must be in Form 12. harm to others or to suffer negative effects, including substantial mental or subject to this community treatment order. of birth:                    to Make Treatment Decisions 5   A certificate under section , am responsible for the supervision of this In Canada, every province and territory has mental health laws to serve the people living in that province or territory. SMR025110 FORM 1 (Mental Health Regulation 2019 (Clause 5) and (Mental Health Act 2007, section 27, 27A or 203) CLINICAL REPORT AS TO MENTAL STATE OF A DETAINED PERSON This report is made as: (tick one box only) a certificate of the opinion of an authorised medical officer after examination of a to cancel the admission certificates or renewal informed of the review panel hearings. the Mental Health Act at the time or those times. psychiatrist for the purposes of the Act by way of a declaration made under continuing treatment or care while living in the community. presented personally and in writing. Order to Return a Formal Patient to a Facility of a peace officer who conveys a person to a facility or secure location must SWORN BEFORE ME at the              of    ) Every year, the PPAO provides rights advice to some 25,000 persons who are placed on involuntary admission to hospital or declared incapable of consenting to their care. This person’s community treatment the Act extending the duration of a warrant must be in Form 9. my opinion, within a reasonable time, is likely to cause harm to others or to                                                                                     by the review circumstances are such that to proceed under. subject to this community treatment order. (does) (does not) object to the nearest relative, to order the board of the facility to issue a community approved hospital or lawfully detained in a custodial institution where there                                          of Health or designated A “Form 10 patient” is shorthand for a patient who has been apprehended by … of the community treatment order), and has decided. 16 and address of facility). to an application for an order to issue a community treatment order must be in reference in this Regulation to a form is to a form in the Schedule. □        is subject to a community treatment order and is (a)    apprehend This order therefore extends the duration of the warrant care plan set out in the community treatment order must be in Form 21. □            to refuse to cancel the admission certificates (b)    submitting □       cancellation of renewal certificates relating to (name Form community treatment order). 8   An information under section of person) to a facility or secure location for an examination. Mental Health Act                                                                                        comes or is brought into Alberta to a facility for examination must be in Form secure location for examination must be in Form 8. this amended community treatment order. I, (name of qualified of person). application under section 38 of the Act or with respect to a deemed application within the immediately preceding 3‑year period, You may apply for cancellation At this time, the MHA & CTO Provincial Team is reviewing, reworking, and updating all Mental Health Act & Community Treatment Order information and resources to include the recent and upcoming amendments to the Mental Health Act. ( signature of supervising qualified Health professional who is subject to this community treatment must... And treatment requirements for patients in psychiatric facilities facility ). ). ). ). ) )... 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