Involuntary hospital admission of mentally ill people and length of stay

Region: Ontario Answer # 703

Generally, there are two ways for someone to end up in a mental health care or psychiatric facility — voluntarily or involuntarily. In each province, there are guidelines governing who can request or order admittance to these facilities, how long individuals may stay or be kept, and the procedures for reviewing findings of mental incompetence.

Typically, individuals are admitted to a psychiatric or mental health facility when they pose a threat to the personal safety of themselves or others.

Involuntary admission

The Mental Health Act sets out several reasons that a person may be held as an involuntary patient. The two most common reasons are:

  1. The person is a danger to themselves, another person, or may unintentionally injure themselves, or
  2. The person’s condition is deteriorating and they require hospitalization.

To become an involuntary patient, a doctor must decide that the person meets one of the requirements of the Act and then sign a Certificate of Involuntary Admission. If the person was an involuntary patient already, and the term of the Certificate was expiring, the doctor can keep the person in the facility involuntarily by signing a Certificate of Renewal.

In addition, involuntary admission arises when a court orders a psychiatric assessment of an individual. Once the person is admitted, the review process is the same and a doctor will have to determine whether the person should be kept in the facility.

A person may also be admitted as a patient involuntarily upon recommendation of a physician. In Ontario, any doctor may make an application for a psychiatric assessment of an individual and the public authorities (police, hospital officials, etc.) are obliged to detain the person. The physician must give that person written notice of the application and cite reasons.

The detention may be for no more than 72 hours. In that time, a different physician must assess the condition of the patient. Any patient detained involuntarily is entitled to a hearing before the province’s Consent and Capacity Board. The patient has a right to retain counsel.

Two opinions are needed to maintain the detention. A first psychiatric assessment must be performed within 24 hours of admittance and a second assessment must be performed within 96 hours.


How long can a person be kept in a facility based on a Certificate?

The term of a Certificate of Involuntary Admission lasts for up-to two weeks. A Certificate of Renewal is valid as follows:

  • the first Certificate, up-to one month,
  • the second Certificate, up-to two months,
  • the third Certificate, up-to three months.

At any time, the doctor may decide that you no longer need to be an involuntary patient and may revoke the Certificate.

After the third Certificate expires, the individual will receive an automatic hearing before the Consent and Capacity Board. The Board is independent of the hospital.  Although the individual is not obligated to attend the hearing, they may wish to do so if they are trying to show that they should no longer be subject to the Certificate and should be allowed to leave the hospital.


Issues of consent

Except in emergencies, the consent of a guardian or substitute decision-maker is needed to conduct medical or psychiatric treatment of a patient found to be mentally incompetent. A patient’s guardian, lawyer, spouse, adult child, sibling, or nearest relative may also be able to give consent for a medical or psychiatric procedure on any involuntary patient under 16 years of age.

In Ontario, treatment may not be provided to a person found incapable if that person informs health practitioners of his or her intention to apply to the Consent and Capacity Board for a review of the incapacity finding.

For more information regarding involuntary hospital admission and the mentally ill, visit the Canadian Mental Health Association (CMHA) website.

For legal assistance, contact a lawyer.


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