INVOLUNTARY ADMISSION

Kwantlen Polytechnic University By: Heidi Halm, Anne Siba, Emily Jhinku, Supreen Kang & Gurman Jatana

WHAT IS INVOLUNTARY ADMISSION? FORM 4 CASE STUDY

Involuntary admission occurs when an individual is :
• Not willing to OR unable to seek treatment
• Experiencing a degree of mental illness so severe, that they are
unable to manage their lives in a safe manner (Fraser Health, 2018)
There are 3 methods in which involuntary admission can be
arranged.
1. Through a physician’s medical certificate (Form 4)
2. Through police intervention; when an individual refuses to go to a
hospital or physicians office, or when a physician cannot visit the
individual requiring treatment
3. Through an order by a judge
As per the British Columbia Ministry of Health (2005), the first
method is the preferred method
Form 4 is a medical certificate for involuntary admissions which is
required to get the individual certified in order to provide
treatment. A form 4 must be filled out by a physician.
If a form 4 is filled out by a physician, the individual is required to
stay at the designated facility for 48 hours for assessment. If
another physician assesses the individual and signs a secondary
form 4 the individual is then required to stay for at least 30 days. A
second opinion by another physician is always required in order
for an individual to become certified.
Case study illustration
• Mr. Smith was found to have lethal means and suicidal
ideation upon his mental health team check-in visit and this
team further convinced him to go to the emergency
department
• Mr. Smith was found to be at high risk for self-harm
• The Psychiatrist placed Mr. Smith under the involuntary
admission section of the Mental Health Act (Form 4) and under
the consent for treatment section (Form 5) in order to ensure
his safety and proper treatment
• The RPN on duty explains these forms to Mr. Smith such as
the Form 4 requirement that he must stay in the inpatient unit
he is further assessed - in 48 hours. The RPN also explains
what Form 5 entails involving the administration of
psychotropic medications
• Once a Psychiatrist re-assesses Mr. Smith, he will either be
re-certified under another form 4 to stay for further treatment
or be discharged; depending on the situation

WHAT MAKES SOMEONE Important considerations for the RPN caring for Mr. Smith
INVOLUNTARY? • Conduct a mental status examination and a safety risk
assessment immediately
• Ensure clear and assertive communication regarding the
Currently, in B.C., the criteria which bases the decision for
Mental Health Act and what will be occurring over the next 48
involuntary admission to a designated facility includes the
hours
following four considerations;
• Provide a safe and supportive environment that ensures the
safety of the patient and others
• The individual is experiencing a mental illness which is impairing
• Avoid giving false reassurance, encourage the expression of
their ability to function or respond appropriately in their
feelings, identify support systems, and identify strengths and
environment
abilities
• The need for treatment
(Halter, 2014)
• Displaying harm or potential for harm towards themselves or
others A map to help understand the process of involuntary admission:
• As an alternative to harm, the potential for mental or physical (Ministry of Health, 2017) .
deterioration

(Fraser Health, 2018) FORM 5

Chart displaying criteria for involuntary admission across
Canadian provinces:
Form 5 is a consent form for treatment
• Is required upon filling out a form 4
• States that the patient is aware and acknowledges the reasons
for their treatment and potential benefits and side effects
• Can either be filled out by the physician or the patient them self

• If the form is filled out by the patient, then there needs

to be a witness present
• If the form is filled out by the physician, the form does
not need to be signed by the individual
• The physician has deemed that the individual is
incapable of understanding their treatment and giving
consent at this time
(Gray et al., 2016) (British Columbia Ministry of Health, 2005)
(British Columbia Ministry of Health, 2005)