MENTAL HEALTH FUNDAMENTALS IN POLICY AND PRACTICE SWRK1036 George Brown College Sara Kirkup, M.S.W., RSW

2 AGENDA WEEK 2 Review week 1 Review week 1 QUESTIONS re: readings up to date QUESTIONS re: readings up to date Confidentiality Confidentiality PHIPA (Personal Health Information Protection Act) PHIPA (Personal Health Information Protection Act) Importance of Documentation Importance of Documentation Mental Health Act (MHA) Mental Health Act (MHA) Brian’s law Mental Health Legislative Reform, 2000 Brian’s law Mental Health Legislative Reform, 2000 Small Group Work Small Group Work

3 SCHOOL OF COMMUNITY AND SOCIAL SERVICES SOCIAL SERVICE WORKER PROGRAM Mental Health: Fundamentals in Policy and PracticeSWRK 1036 REVIEW WEEK 1 Understanding Mental Illness: WHAT IS IT? WHO? WHEN? WHY? Types of Disorders, Prevalence Bio Psycho Social Framework to understand each individual Treatments Recognizing a Problem Stigma, Values, Attitudes & Labeling

4 CONFIDENTIALITY Each individual has the right to keep their Personal Health Information confidential. PHIPA is a law that ensures this. Typically pronounced ‘Pee-hip-ah’ or ‘Fi - pa’

5 PHIPA Acronyms! PHIP A Personal Health Information Protection Act - This is the name of the legislation / this is the Law on how society deals with the mentally ill in Ontario PHI Personal Health Information - This is a person’s health record HIC Health Information Custodian - This is the doctor, agency or hospital that provided medical / psychiatric treatement

6 PHIPA PERSONAL HEALTH INFORMATION PROTECTION ACT, 2004 PHIPA came into force on November 1, Purpose: Rules for how one’s health record is: Rules for how one’s health record is: Collected Collected Used Used Shared Shared

7 HIC – Health Information Custodian Who are HICs : Health Care Practitioners Health Care Practitioners Regulated – need to be certified with their college Examples: Registered Nurses, Physicians, Occupational Therapists Examples: Registered Nurses, Physicians, Occupational Therapists Unregulated - as long as they are providing health care for payment Unregulated - as long as they are providing health care for payment Social Workers, Psychotherapists Social Workers, Psychotherapists Minister of Health and Long-Term Care MOHLTC plans & funds Ontario’s health services MOHLTC plans & funds Ontario’s health services They need PHI to make decisions about where to allocate health $; statistics They need PHI to make decisions about where to allocate health $; statistics

8 PHIPA Who are NON-HICs? Services, Agencies, Individuals who do not provide Health Care Services Services, Agencies, Individuals who do not provide Health Care Services Examples: Examples: Police Constables Police Constables Lawyers Lawyers Insurance Companies Insurance Companies Probation/Parole Probation/Parole Family / Support people (unless they have legal authority to act on behalf of the client, such as acting as the client’s substitute decision- maker) Family / Support people (unless they have legal authority to act on behalf of the client, such as acting as the client’s substitute decision- maker) Housing (except if provides health care) Housing (except if provides health care) Employers Employers School Boards School Boards Courts Courts Consent and Capacity Board Consent and Capacity Board

9 An individual’s network of health care providers. Who do you have in your Circle of Care? DENTIST DOCTOR PHYSIOTHERAPIST CHIROPRACTOR COUNSELLOR MOHLTC DENTIST DOCTOR PHYSIOTHERAPIST CHIROPRACTOR COUNSELLOR MOHLTC

10 CONSENT PHIPA requires HICs to post a statement that outlines what happens to the PHI : why they are collecting the info : what it will be used for : who it will be shared with : only relevant information will be documented : d escribe exceptions to confidentiality - The patient, by accepting treatment accepts that this is what will happen with their PHI.

11 CONSENT You give consent the HIC to: Collect the information about you Collect the information about you To allow that information to be recorded in a document that has your name on it To allow that information to be recorded in a document that has your name on it To allow the information to be used for statistical purposes, funding evaluation To allow the information to be used for statistical purposes, funding evaluation Allow sharing amongst your Circle of Care HICs Allow sharing amongst your Circle of Care HICs

12 CONSENT The HIC ‘promises’ to: Collect only relevant information Collect only relevant information collect as little PHI as needed (eg. If a celebrity you cannot be ‘nosy” and ask questions not related to presentation) collect as little PHI as needed (eg. If a celebrity you cannot be ‘nosy” and ask questions not related to presentation) Keep your PHI secure Keep your PHI secure protect it from: protect it from: being lost, stolen or inappropriately accessed being lost, stolen or inappropriately accessed unauthorized copying, modification and disposal unauthorized copying, modification and disposal report back to the patient if the PHI report back to the patient if the PHI Has been accessed unlawfully Has been accessed unlawfully EX: if someone views a medical record who was not authorized them must report to individual) EX: if someone views a medical record who was not authorized them must report to individual) Share your information only with your consent to do so Share your information only with your consent to do so

13 TYPES OF CONSENT CONFIDENTIALITY: Your PHI is protected from being shared with others. PHI can be shared only if you give your consent. 2 TYPES OF CONSENT 1. Express 2. Implied

14 Express Must get express consent if: Giving PHI to non-HICs Giving PHI to non-HICs Giving PHI to someone for a purpose unrelated to health care Giving PHI to someone for a purpose unrelated to health care Eg. to a nurse who reviews claims for an insurance company Eg. to a nurse who reviews claims for an insurance company

15 EXPRESS CONSENT EXPRESS Consent Written – form to be signed and placed in the PHI Written – form to be signed and placed in the PHI Verbal – documented and placed in the PHI Verbal – documented and placed in the PHI

16 Implied Consent IMPLIED: does not have to be explicitly written or stated HICs have an obligation to post explanation about PHI and consent. The patient, by accepting this explanation and receiving treatment becomes aware that their PHI can be shared with other HICs who are in their CIRCLE OF CARE with only their IMPLIED CONSENT EXCEPTIONS! patient has specifically withdrawn or withheld the consent patient has specifically withdrawn or withheld the consent You should never rely on implied consent if you have reason to believe that the client You should never rely on implied consent if you have reason to believe that the client would not give consent, or would not give consent, or gave consent previously but has since withdrawn it gave consent previously but has since withdrawn it

17 Personal Health Information Protection Act, 2004 Non-HIC Probation Parole Non-HIC Toronto Police HICSpecialist HICPsychiatrist HICCounselor HIC Family Doctor “Circle of Care” Person Non-HICLawyer Insurance agent Types of Consent Implied Expressed

18 Disclosing PHI without consent IN SOME CASES A CLINICIAN’S IS REQUIRED TO REPORT WITHOUT CONSENT… Children’s Aid Society Children’s Aid Society Mandatory reporting - communicable diseases to public health authorities Mandatory reporting - communicable diseases to public health authorities In court or tribunal In court or tribunal Research Research Risk situations (to eliminate or reduce a significant risk of serious bodily harm) Risk situations (to eliminate or reduce a significant risk of serious bodily harm) Coroner / Police Officer- for investigation eg. death of an individual Coroner / Police Officer- for investigation eg. death of an individual Patient who died in the hospital Patient who died in the hospital Planning and management of the health system Planning and management of the health system Placement in a facility for health care purposes Placement in a facility for health care purposes Placement in custodial setting (under the Criminal Code mental disorder provisions) Placement in custodial setting (under the Criminal Code mental disorder provisions) College of a regulated health care to report malpractice College of a regulated health care to report malpractice

19 “LOCKBOX” The term “lockbox” does not appear in PHIPA, but is widely used to refer to the ability of clients to control their PHI. Clients have the right to “lock” their PHI 1. EXPRESSLY withdraw IMPLIED CONSENT for a specific part of their PHI When does it apply? Only in limited circumstances Only in limited circumstances NOT in circumstances wherein in HIC is required to report without consent. (previously slide) NOT in circumstances wherein in HIC is required to report without consent. (previously slide) What is locked? EX: A client in counselling may ask that you not share the info with their family doctor EX: A client in counselling may ask that you not share the info with their family doctor

20 Duty to Warn and Protect Suicide Risk Homicidal Risk HIV / AIDS: clients who knowingly engage in unsafe sexual practices or needle sharing HIV / AIDS: clients who knowingly engage in unsafe sexual practices or needle sharing What are the obligations of the clinician who learns that the client harbors aggressive thoughts/feelings toward others? How does this potential danger relate to the issue of confidentiality and the client-clinician relationship?

21 Tarasoff Case This led to the case in which the California Supreme Court found for the first time that mental health professionals had a: This led to the case in which the California Supreme Court found for the first time that mental health professionals had a: - Duty to Protect, not just a - Duty to Warn 3rd parties of danger from their patients

22 Mental Health Act MHA How Society deals with Mentally Ill people How Society deals with Mentally Ill people How in the past? How in the past? Asylums, lobotomies, caging Asylums, lobotomies, caging The MHA provides the framework for the care, treatment and hospitalization of those people who are suffering from a mental health problem. Aim to balance the right to: autonomy (independence) & self-determination autonomy (independence) & self-determination to care, protection and treatment to care, protection and treatment as well as the safety for the community.

23 Mental Health Act MHA Guides us to deal with Mentally Ill people in a civilized and accountable manner Guides us to deal with Mentally Ill people in a civilized and accountable manner Accounts for individuals rights Accounts for individuals rights Allows us a vehicle to dispute if we are admitted to a psychiatric unit involuntarily Allows us a vehicle to dispute if we are admitted to a psychiatric unit involuntarily What if you found yourself in a psych ward one day and you know you weren’t crazy? What if you found yourself in a psych ward one day and you know you weren’t crazy? How would you convince others? How would you convince others? YOU HAVE RIGHTS!

24 Mental Health Act MHA The Mental Health Act in Ontario is a law The Mental Health Act in Ontario is a law Governs how people are admitted to psychiatric facilities Governs how people are admitted to psychiatric facilities How their mental health records are kept and accessed How their mental health records are kept and accessed Their financial affairs are handled Their financial affairs are handled How people can be released into the community. How people can be released into the community.

25 MHA If someone is: 1. Harm to self 2. Harm to others 3. Cannot take care of self OR Has the potential for one or all of the above…

26 MHA There are 3 main ways to have someone taken into a psychiatric facility involuntarily: 1. FORM 1: An Application for a psychiatric assessment 2. FORM 2: Justice of the Peace orders the psychiatric evaluation 3. SECTION 17 MHA Police Apprehension

27 MHA After Assessment: Person deemed safe, voluntary Person deemed unsafe, involuntary and to be admitted to a Schedule 1 facility (can restrain) – hospital Person given a FORM 42 to inform of involuntary status

28 Rights Advise Once person is admitted to hospital a Rights Advisor explains how they can if they wish to, dispute the decision. Once person is admitted to hospital a Rights Advisor explains how they can if they wish to, dispute the decision. IF person wishes to then a Review Hearing takes place and person has opportunity to present their point of view IF person wishes to then a Review Hearing takes place and person has opportunity to present their point of view Lawyers, treating physician and other health care providers are present Lawyers, treating physician and other health care providers are present

29 Brian’s Law Mental Health Legislative Reform, 2000 The MHA was revised in The Reform was called Brian’s Law after the death of sportscaster Brian Smith who was fatally shot on August 1, 1995 by Jeffery Arenburg who was diagnosed with Schizophrenia – heard voices in his head which he believed were broadcast by the media – he targeted the media and encountered Brian Smith that day. Arenburg was found to be Not Criminally Responsible.

30 CTO Community Treatment Order FORM 45 Community Treatment Order FORM 45 A voluntary commitment by individual (when they are well) to comply with treatment when released into the community. A voluntary commitment by individual (when they are well) to comply with treatment when released into the community. Must report regularly to Mental Health providers Must report regularly to Mental Health providers Must agree to a case manager Must agree to a case manager Must take medication Must take medication If do not comply then the CTO Physician can issue a Form 47 “Order for Examination” which authorizes police to bring individual into hospital involuntarily.

31 MHA With the new MHA Brian’s Law – The word imminent was removed –person can be deemed possibly dangerous in future if not in immediate danger. The word imminent was removed –person can be deemed possibly dangerous in future if not in immediate danger. Police no longer have to observe disorderly misconduct they can now intervene if they have reasonable and probable grounds to believe that it has happened (ie. Can take 3 rd party report) Police no longer have to observe disorderly misconduct they can now intervene if they have reasonable and probable grounds to believe that it has happened (ie. Can take 3 rd party report)

32 Next week… Models of Mental Health Disorders Models of Mental Health Disorders Readings: see course outline