MENTAL HEALTH MENTAL HEALTH FUNDAMENTALS IN POLICY FUNDAMENTALS IN POLICY

AND PRACTICEAND PRACTICESWRK1036SWRK1036

George Brown CollegeGeorge Brown College

Sara Kirkup, M.S.W., RSWSara Kirkup, M.S.W., RSW

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AGENDAAGENDAWEEK 2WEEK 2

Review week 1Review week 1 QUESTIONSQUESTIONS re: readings up to date re: readings up to date ConfidentialityConfidentiality

PHIPA (Personal Health Information Protection PHIPA (Personal Health Information Protection Act)Act)

Importance of DocumentationImportance of Documentation Mental Health Act (MHA)Mental Health Act (MHA)

Brian’s law Mental Health Legislative Reform, Brian’s law Mental Health Legislative Reform, 20002000

Small Group WorkSmall Group Work

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SCHOOL OF COMMUNITY AND SOCIAL SERVICESSCHOOL OF COMMUNITY AND SOCIAL SERVICESSOCIAL SERVICE WORKER PROGRAMSOCIAL SERVICE WORKER PROGRAM

Mental Health: Fundamentals in Policy and PracticeMental Health: Fundamentals in Policy and Practice SWRK 1036SWRK 1036

REVIEWREVIEWWEEK 1WEEK 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

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CONFIDENTIALITYCONFIDENTIALITY

Each individual has the right to keep their Each individual has the right to keep their Personal Health Information confidential.Personal Health Information confidential.

PHIPA is a law that ensures this.PHIPA is a law that ensures this.

Typically pronounced ‘Pee-hip-ah’ or ‘Fi - Typically pronounced ‘Pee-hip-ah’ or ‘Fi - pa’pa’

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PHIPA Acronyms!PHIPA Acronyms!PHIPPHIP

AAPersonal Health Information Personal Health Information Protection Act Protection Act -This is the name of the legislation / this is the This is the name of the legislation / this is the Law on how society deals with the mentally ill in Law on how society deals with the mentally ill in OntarioOntario

PHIPHI Personal Health InformationPersonal Health Information-This is a person’s health recordThis is a person’s health record

HICHIC Health Information CustodianHealth Information Custodian-This is the doctor, agency or hospital that This is the doctor, agency or hospital that provided medical / psychiatric treatementprovided medical / psychiatric treatement

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PHIPAPHIPA PERSONAL HEALTH INFORMATION PERSONAL HEALTH INFORMATION

PROTECTION ACT, 2004PROTECTION ACT, 2004

PHIPA came into force on PHIPA came into force on November 1, 2004.November 1, 2004.

Purpose:Purpose: Rules for how one’s health record Rules for how one’s health record

is:is: CollectedCollected UsedUsed SharedShared

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HIC – Health Information CustodianHIC – Health Information CustodianWho are Who are HICsHICs::

Health Care PractitionersHealth Care PractitionersRegulated – need to be certified with their collegeRegulated – need to be certified with their college Examples: Registered Nurses, Physicians, Examples: Registered Nurses, Physicians,

Occupational TherapistsOccupational Therapists Unregulated - as long as they are Unregulated - as long as they are

providing health care for paymentproviding health care for payment Social Workers, PsychotherapistsSocial Workers, Psychotherapists

Minister of Health and Long-Term Care Minister of Health and Long-Term Care MOHLTC plans & funds Ontario’s health servicesMOHLTC plans & funds Ontario’s health services They need PHI to make decisions about where to They need PHI to make decisions about where to

allocate health $; statisticsallocate health $; statistics

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PHIPAPHIPAWho are NON-HICs?Who are NON-HICs?

Services, Agencies, Individuals who do not Services, Agencies, Individuals who do not provide Health Care Servicesprovide Health Care Services

Examples: Examples: Police ConstablesPolice Constables LawyersLawyers Insurance CompaniesInsurance Companies Probation/ParoleProbation/Parole Family / Support people Family / Support people (unless they have legal authority to (unless they have legal authority to

act on behalf of the client, such as acting as the client’s act on behalf of the client, such as acting as the client’s substitute decision-maker)substitute decision-maker)

Housing (except if provides health care)Housing (except if provides health care) EmployersEmployers School BoardsSchool Boards CourtsCourts Consent and Capacity Board Consent and Capacity Board

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An individual’s network of health care providers.An individual’s network of health care providers.

Who do you have in your Circle of Care?Who do you have in your Circle of Care? DENTISTDENTIST DOCTORDOCTOR

PHYSIOTHERAPISTPHYSIOTHERAPIST CHIROPRACTOR CHIROPRACTOR COUNSELLOR COUNSELLOR MOHLTC MOHLTC

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CONSENTCONSENT

PHIPA requires HICs to post a statement that PHIPA requires HICs to post a statement that outlines what happens to the PHIoutlines what happens to the PHI

: why they are collecting the info: why they are collecting the info: what it will be used for: what it will be used for: who it will be shared with: who it will be shared with: only relevant information will be documented: only relevant information will be documented: d: describe exceptions to confidentiality -escribe exceptions to confidentiality -

The patient, by accepting treatment accepts that The patient, by accepting treatment accepts that this is what will happen with their PHI.this is what will happen with their PHI.

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CONSENTCONSENT

You give consent the HIC to:You give consent the HIC to: Collect the information about youCollect the information about you To allow that information to be recorded To allow that information to be recorded

in a document that has your name on itin a document that has your name on it To allow the information to be used for To allow the information to be used for

statistical purposes, funding evaluationstatistical purposes, funding evaluation Allow sharing amongst your Circle of Allow sharing amongst your Circle of

Care HICsCare HICs

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CONSENTCONSENTThe HIC ‘promises’ to:The HIC ‘promises’ to: Collect only relevant informationCollect only relevant information

collect as little PHI as needed (eg. If a celebrity you cannot collect as little PHI as needed (eg. If a celebrity you cannot be ‘nosy” and ask questions not related to presentation)be ‘nosy” and ask questions not related to presentation)

Keep your PHI secureKeep your PHI secure protect it from:protect it from:

being lost, stolen or inappropriately accessedbeing lost, stolen or inappropriately accessed unauthorized copying, modification and disposalunauthorized copying, modification and disposal

report back to the patient if the PHIreport 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 EX: if someone views a medical record who was not authorized them must report to individual)them must report to individual)

Share your information only with your consent to Share your information only with your consent to do sodo so

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TYPES OF CONSENTTYPES OF CONSENT

CONFIDENTIALITY:CONFIDENTIALITY:

Your PHI is protected from being Your PHI is protected from being shared with others. shared with others.

PHI can be shared only if you give your PHI can be shared only if you give your consent.consent.

2 TYPES OF CONSENT2 TYPES OF CONSENT

1.1. Express Express

2.2. ImpliedImplied

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ExpressExpress

Must get express consent if:Must get express consent if: Giving PHI to non-HICsGiving PHI to non-HICs Giving PHI to someone for a Giving PHI to someone for a

purpose unrelated to health carepurpose unrelated to health care Eg. to a nurse who reviews claims for Eg. to a nurse who reviews claims for

an insurance companyan insurance company

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EXPRESS CONSENTEXPRESS CONSENT

EXPRESS ConsentEXPRESS Consent Written – form to be signed and Written – form to be signed and

placed in the PHIplaced in the PHI

Verbal – documented and placed in Verbal – documented and placed in the PHIthe PHI

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Implied ConsentImplied ConsentIMPLIED: does not have to be explicitly written or statedIMPLIED: does not have to be explicitly written or stated

HICs have an obligation to post explanation about PHI and HICs have an obligation to post explanation about PHI and consent.consent.

The patient, by accepting this explanation and receiving The patient, by accepting this explanation and receiving treatment becomes aware that their PHI can be shared with treatment becomes aware that their PHI can be shared with other HICs who are in their CIRCLE OF CARE with only their other HICs who are in their CIRCLE OF CARE with only their IMPLIED CONSENTIMPLIED CONSENT

EXCEPTIONS!EXCEPTIONS! patient has specifically withdrawn or withheld the consentpatient has specifically withdrawn or withheld the consent You should never rely on implied consent if you have You should never rely on implied consent if you have

reason to believe that the clientreason to believe that the client• • would not give consent, orwould not give consent, or• • gave consent previously but has since withdrawn itgave consent previously but has since withdrawn it

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Personal Health Information Personal Health Information Protection Act, 2004Protection Act, 2004

Non-HICNon-HICProbation ParoleProbation Parole

Non-HICNon-HICToronto PoliceToronto Police

HICHICSpecialistSpecialist

HICHICPsychiatristPsychiatrist

HICHICCounselorCounselor

HICHICFamily DoctorFamily Doctor

“Circle of Care”Person

Non-HICNon-HICLawyerLawyer

Insurance agentInsurance agent

Types of Consent

Implied

Expressed

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Disclosing PHI without consentDisclosing PHI without consentIN SOME CASES A CLINICIAN’S IS REQUIRED TO REPORT WITHOUT CONSENT…IN SOME CASES A CLINICIAN’S IS REQUIRED TO REPORT WITHOUT CONSENT… Children’s Aid SocietyChildren’s Aid Society

Mandatory reporting - communicable diseases to public health authoritiesMandatory reporting - communicable diseases to public health authorities

In court or tribunalIn court or tribunal

ResearchResearch

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 individualCoroner / Police Officer- for investigation eg. death of an individual

Patient who died in the hospitalPatient who died in the hospital

Planning and management of the health systemPlanning and management of the health system

Placement in a facility for health care purposesPlacement in a facility for health care purposes

Placement in custodial setting (under the Placement in custodial setting (under the Criminal Code Criminal Code mental disorder provisions)mental disorder provisions)

College of a regulated health care to report malpracticeCollege of a regulated health care to report malpractice

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““LOCKBOX”LOCKBOX”The term “lockbox” does not appear in PHIPA, but is widely The term “lockbox” does not appear in PHIPA, but is widely

used to refer to the ability of clients to control their PHI.used to refer to the ability of clients to control their PHI.

Clients have the right to “lock” their PHIClients have the right to “lock” their PHI1.1. EXPRESSLY withdraw IMPLIED CONSENT for a specific part EXPRESSLY withdraw IMPLIED CONSENT for a specific part

of their PHIof their PHI

When does it apply?When does it apply? Only in limited circumstancesOnly in limited circumstances NOT in circumstances wherein in HIC is required to report NOT in circumstances wherein in HIC is required to report

without consent. (previously slide)without consent. (previously slide) What is locked?What is locked? EX: A client in counselling may ask that you not share EX: A client in counselling may ask that you not share

the info with their family doctor the info with their family doctor

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Duty to Warn and ProtectDuty to Warn and Protect

Suicide Risk Suicide Risk Homicidal RiskHomicidal Risk HIV / AIDS: clients who knowingly engage HIV / AIDS: clients who knowingly engage

in unsafe sexual practices or needle in unsafe sexual practices or needle sharingsharing

What are the obligations of the clinician who What are the obligations of the clinician who learns that the client harbors aggressive learns that the client harbors aggressive thoughts/feelings toward others?thoughts/feelings toward others?

How does this potential danger relate to the How does this potential danger relate to the issue of confidentiality and the client-issue of confidentiality and the client-clinician relationship?clinician relationship?

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Tarasoff CaseTarasoff Case

This led to the case in which the This led to the case in which the California Supreme Court found for the California Supreme Court found for the first time that mental health first time that mental health professionals had a:professionals had a:

- Duty to Protect- Duty to Protect, , not just a not just a - Duty to Warn- Duty to Warn3rd parties of danger from their 3rd parties of danger from their patientspatients

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Mental Health Act MHAMental Health Act MHA

How Society deals with Mentally Ill peopleHow Society deals with Mentally Ill people How in the past?How in the past?

Asylums, lobotomies, cagingAsylums, lobotomies, caging

The MHA provides the framework for the care, The MHA provides the framework for the care, treatment and hospitalization of those people treatment and hospitalization of those people who are suffering from a mental health problem.who are suffering from a mental health problem.

Aim to balance the right to:Aim to balance the right to: autonomy (independence) & self-determinationautonomy (independence) & self-determination to care, protection and treatmentto care, protection and treatmentas well as the as well as the safety for the communitysafety for the community..

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Mental Health Act MHAMental Health Act MHA

Guides us to deal with Mentally Ill people Guides us to deal with Mentally Ill people in a civilized and accountable mannerin a civilized and accountable manner

Accounts for individuals rightsAccounts for individuals rights Allows us a vehicle to dispute if we are Allows us a vehicle to dispute if we are

admitted to a psychiatric unit involuntarilyadmitted to a psychiatric unit involuntarily What if you found yourself in a psych ward What if you found yourself in a psych ward

one day and you know you weren’t crazy?one day and you know you weren’t crazy? How would you convince others?How would you convince others?

YOU HAVE RIGHTS!YOU HAVE RIGHTS!

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Mental Health Act MHAMental Health Act MHA

The Mental Health Act in Ontario is a The Mental Health Act in Ontario is a lawlaw Governs how people are admitted to Governs how people are admitted to

psychiatric facilitiespsychiatric facilities How their mental health records are How their mental health records are

kept and accessedkept and accessed Their financial affairs are handledTheir financial affairs are handled How people can be released into the How people can be released into the

community. community.

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MHAMHA

If someone is:If someone is:

1.1. Harm to selfHarm to self

2.2. Harm to othersHarm to others

3.3. Cannot take care of selfCannot take care of self

OROR

Has the potential for one or all of the Has the potential for one or all of the above…above…

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MHAMHA

There are 3 There are 3 mainmain ways to have ways to have someone taken into a psychiatric someone taken into a psychiatric facility involuntarily:facility involuntarily:

1.1. FORM 1:FORM 1: An Application for a An Application for a psychiatric assessmentpsychiatric assessment

2.2. FORM 2:FORM 2: Justice of the Peace orders Justice of the Peace orders the psychiatric evaluationthe psychiatric evaluation

3.3. SECTION 17 MHA Police SECTION 17 MHA Police ApprehensionApprehension

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MHAMHA

After Assessment:After Assessment:

Person deemed safe, voluntaryPerson deemed safe, voluntary

Person deemed unsafe, involuntary Person deemed unsafe, involuntary and to be admitted to a Schedule 1 and to be admitted to a Schedule 1 facility (can restrain) – hospitalfacility (can restrain) – hospital

Person given a FORM 42 to inform of Person given a FORM 42 to inform of involuntary statusinvoluntary status

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Rights AdviseRights Advise

Once person is admitted to hospital a Once person is admitted to hospital a Rights Advisor explains how they can Rights Advisor explains how they can if they wish to, dispute the decision.if they wish to, dispute the decision.

IF person wishes to then a Review IF person wishes to then a Review Hearing takes place and person has Hearing takes place and person has opportunity to present their point of opportunity to present their point of viewview

Lawyers, treating physician and other Lawyers, treating physician and other health care providers are presenthealth care providers are present

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Brian’s Law Mental Health Brian’s Law Mental Health Legislative Reform, 2000Legislative Reform, 2000

The MHA was revised in 2000. The MHA was revised in 2000. The Reform was called Brian’s Law after the The Reform was called Brian’s Law after the

death of sportscaster Brian Smith who was death of sportscaster Brian Smith who was fatally shot on August 1, 1995 by Jeffery fatally shot on August 1, 1995 by Jeffery Arenburg who was diagnosed with Arenburg who was diagnosed with Schizophrenia – heard voices in his head Schizophrenia – heard voices in his head which he believed were broadcast by the which he believed were broadcast by the media – he targeted the media and media – he targeted the media and encountered Brian Smith that day.encountered Brian Smith that day.

Arenburg was found to be Not Criminally Arenburg was found to be Not Criminally Responsible.Responsible.

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CTOCTO

Community Treatment Order FORM 45Community Treatment Order FORM 45 A voluntary commitment by individual (when A voluntary commitment by individual (when

they are well) to comply with treatment when they are well) to comply with treatment when released into the community.released into the community.

Must report regularly to Mental Health providersMust report regularly to Mental Health providers Must agree to a case managerMust agree to a case manager Must take medicationMust take medication

If do not comply then the CTO Physician can issue If do not comply then the CTO Physician can issue a Form 47 “Order for Examination” which a Form 47 “Order for Examination” which authorizes police to bring individual into authorizes police to bring individual into hospital involuntarily.hospital involuntarily.

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MHAMHA

With the new MHA Brian’s Law –With the new MHA Brian’s Law – The word The word imminentimminent was removed –person was removed –person

can be deemed possibly dangerous in can be deemed possibly dangerous in future if not in immediate danger.future if not in immediate danger.

Police no longer have to Police no longer have to observe observe disorderly misconduct they can now disorderly misconduct they can now intervene if they have reasonable and intervene if they have reasonable and probable grounds to believe that it has probable grounds to believe that it has happened (ie. Can take 3happened (ie. Can take 3rdrd party report) party report)

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Next week…Next week…

Models of Mental Health Disorders Models of Mental Health Disorders

Readings: see course outlineReadings: see course outline