Seeking Professional Help

In general, it is a good idea to seek professional help for a mental health problem when:

• A symptom becomes severe or disruptive to your daily living or routine
• A symptom becomes a continuous or permanent pattern of behaviour and does not respond to self-care
• Symptoms become numerous, affect all areas of your life, and do not respond to self-care or communication efforts
• You are unable to manage your feelings, are extremely anxious or deeply depressed
• You are thinking about hurting yourself or someone else
• 9-8-8: National Suicide Prevention and Mental Health Crisis Hotline - Dial or text 9-8-8; 24/7 voice or text support for mental health crisis and suicide prevention. Visit 988.ca for more information.
• Visit local crisis support or call 911 or visit your closest emergency department.

How to help a family member or friend with mental health concerns who doesn't realize he/she needs help

Emergencies

• Contact their family physician
• Contact your mental health clinic
• Call HealthLine at 811
• Call 911 if someone is at risk of harming themselves or others
• Visit your nearest emergency department

After-hours

• Visit local crisis support and emergency/rapid access services in Saskatchewan.

Get help and support for mental health issues:

• Access mental health and addictions service through Saskatchewan Health Authority intake lines. Contact information for the intake line closest to you is available.
• Healthline 811 (telephone)
• Mental Health Agencies and Associations in Saskatchewan
  
  • Canadian Mental Health Association - National
  • Canadian Mental Health Association - Provincial
  • Schizophrenia Society of Saskatchewan
    
• The University of Regina offers free Online Cognitive Behaviour Therapy for adults for a number of mental health concerns. You can learn more by visiting their Online Therapy Unit website or by phoning 306-337-3331.
• Rapid access counselling is available for free throughout Saskatchewan through Family Services Saskatchewan.
• A more comprehensive list of services in Saskatchewan, as well as navigation support, can be found through Saskatchewan 211 (telephone) or online.

Section 15 of the Canadian Charter of Rights and Freedoms says people must be treated as equal. That means no one is allowed to discriminate against you for any reason, including a mental disability.

• People must take an individual’s ability into account.
• They must treat all individuals fairly and equally.
• Mental health services must be provided with the same consideration for all people.

Agreeing to Receive Mental Health Services

Any person may ask for and receive mental health services in Saskatchewan. An individual has the right to ask for, accept or refuse services. They must also give consent before they can be examined or treated.

If an individual cannot understand what this means, their nearest relative may explain this to them, or if an individual has appointed someone else in a health care directive, or applied to a judge to name someone else, that person may give permission.

If an individual is a voluntary inpatient and wishes to leave treatment, a nurse can require them to stay for up to three hours for a doctor's examination, if the nurse thinks it is necessary.

Services Provided Without Consent

It maybe possible that an individual needs care and treatment for their mental health condition, but they are unable or unwilling to ask for or accept help. Under exceptional circumstances, The Mental Health Services Act allows an individual to receive care and treatment without their consent. The Act also protects an individual’s rights when they are unable or unwilling to ask for or accept help.

Examination Conducted Without Consent

An individual may be ordered under The Mental Health Services Act to be examined by a psychiatrist.

This can happen in the following ways:

• If a doctor in a clinic or emergency department or a prescribed health care professional examines the individual and believes they have a mental disorder and require inpatient treatment. They can issue a certificate indicating the individual must be examined by a psychiatrist. The person must then be conveyed to an emergency department of a hospital that has an inpatient mental health unit to be assessed by a psychiatrist to determine if they can be detained involuntarily.
• If an individual believes a person has a mental disorder, has recently deteriorated and is unwilling to accept treatment/assessment of his/her/their condition, they can make an appointment with a provincial court judge to determine if the person needs to be conveyed for assessment to a hospital with an inpatient mental health unit to be assessed by a psychiatrist to determine if they can be detained involuntarily. If the judge agrees, they write an order to apprehend the individual (mental health warrant) directing that the individual be examined by a psychiatrist. Contact your closest provincial court for more information on mental health warrants.
• If a police officer believes an individual has a mental disorder which will likely make them harm themselves or others, or make their illness get worse if they are not treated, they can convey the individual to an emergency department of a hospital that has an inpatient mental health unit to be assessed by a psychiatrist to determine if they can be detained involuntarily.

Other special circumstances:

• An individual being charged with an offence; a judge can order that the individual be examined by a psychiatrist.
• An individual being held under the Criminal Code, and the individual has to be examined.
• An individual under a Community Treatment Order and has not complied with its terms. A physician says the individual who has not complied with the Community Treatment Order must be examined.

The examination must be done promptly.

Under The Mental Health Services Act, all individuals have the right to:

• be told the reasons for the examination;
• legal advice and support on their rights; and
• receive a copy of any certificate, warrant, or order that says the individual must be examined.

Temporary Hold for Voluntary Patients

A voluntary patient on an inpatient mental health unit can be detained for up to three hours if:

• a nurse believes that a voluntary patient intends to leave the mental health centre; and
• the nurse believes, on reasonable grounds, that the patient should be held because they meet the involuntary admission criteria.

A psychiatrist will assess the patient within the three hours to determine if they need to be detained involuntarily.  A physician’s order is required during the three hour hold to give the nurse the authority to treat the patient with medications.

Inpatient Admission Without Patient Consent

An individual may be admitted to a mental health unit in a hospital and held there against their will, otherwise known as certified under The Mental Health Services Act.

This can happen in three ways:

• under medical certificates;
• under orders where an individual has been charged or convicted of a criminal offence; or
• under a court order for long-term detention.

• To be detained involuntarily, two different certificates are signed by two different physicians. At least one physician must be a psychiatrist or a resident in psychiatry.

Both doctors must certify that:

• The individual has a mental illness and needs treatment and supervision which can only be provided in an inpatient mental health centre.
• An individual’s mental illness keeps them from understanding that treatment and supervision are required, therefore the individual cannot make an informed decision regarding treatment.
• An individual’s mental illness is likely to make the individual harm themselves or others, or make the individual’s illness get worse if they are not treated.

The first certificate detains an individual for up to 72 hours and in that time frame another certificate may be completed which detains and individual involuntarily for up to 21 days on an inpatient mental health unit.

If a physician believes an individual needs to stay longer than 21 days, two more certificates may be completed to detain an individual for another 21 days.

Treatment Without Permission

If an individual’s mental illness keeps them from understanding the reasons for treatment, and they won't give permission, they may be treated without their permission in the following situations:

• An individual is certified in an inpatient mental health centre in a hospital.
• An individual is being held under a court order for long-term detention.
• An individual is placed under a Community Treatment Order.

There are rules that must be followed when an individual is treated without their consent:

• Their physician must explain the treatment and consider their views.
• Before electronconvulsive therapy (ECT) is given, two psychiatrists must examine you and write special certificates.
• Psychosurgery and experimental treatments are not allowed.

Electroconvulsive therapy (ECT) is a procedure used to treat severe depression. It may be used in people who have symptoms such as delusions, hallucinations, or suicidal thoughts. It's also used when other treatments such as psychotherapy and antidepressant medicines have not worked. And it can be used for other psychiatric and neurological conditions, such as schizophrenia and Parkinson's disease.

Community Treatment Order

What is a Community Treatment Order?

A community treatment order (CTO) is a type of physician’s order written by a psychiatrist that requires certain treatment conditions to be met by an individual being treated for a mental health condition. The CTO process is established in The Mental Health Services Act. Community treatment orders are viewed as useful for people who need treatment, care and supervision in the community to stay well and avoid relapses and hospitalization, but who do not voluntarily comply with their treatment plan.

How Community Treatment Orders Work

A person who meets the criteria for a CTO is provided with a treatment plan, usually including medication and regular reviews of progress. The CTO requires the person to comply with the treatment plan but it also requires mental health staff to follow up with the individual rather than not following up when they do not attend appointments. These requirements help people adhere to the treatment plan. If the person does not comply with the terms of the CTO, they can be hospitalized.

An individual’s psychiatrist may place them under a Community Treatment Order (CTO).

This can only happen if:

• The individual has a mental illness and needs treatment and supervision in the community and they do not need to be in hospital.
• An individual has been hospitalized in the last two years including the current admission.
• An individual’s mental illness could make them harm themselves or others, or make their illness get worse if they are not treated.
• The services the individual needs are available in the community.
• The individual’s mental illness keeps them from understanding that they need treatment and supervision, therefore they cannot make an informed decision.
• The individual is able to co-operate with the community treatment order.

If a second doctor examines the individual and supports the CTO written by the individual’s psychiatrist, a CTO is issued for up to six months and can be renewed by one doctor for six month periods. The individual must comply with the order, including following prescribed medical treatment and attending appointments with their psychiatrist and/or case manager.

Protection Under The Mental Health Services Act

When an individual is certificated on an inpatient mental health unit, they have the right to legal advocacy provided by Official Representatives under The Mental Health Services Act.

Official Representatives

Official representatives are usually lawyers with expertise in the mental health field. They have been appointed by the Minister of Health to help people who have been detained under The Mental Health Services Act understand their rights.

An official representative:

• Will visit the individual if they are being treated, transferred to another mental health centre, or ordered to receive Electroconvulsive therapy (ECT) without the patient’s consent. The official representative will visit the individual within 24 hours if the person is being detained involuntarily.
• Is notified if the individual is examined without their consent. The representative may contact the individual.
• Is notified if the individual is placed under a community treatment order. The representative may contact the individual.

All Individuals who are certified in an inpatient mental health unit may ask to speak with an official representative at any time.

Review Panel

Each mental health centre in Saskatchewan has a review panel to investigate appeals. There are three people on the panel. The chairperson is a lawyer, the vice chairperson is a doctor, and the third person is a citizen. There is no charge for official representative or review panel services.

• An individual may appeal to the review panel if they disagree with being held, transferred to another mental health centre, or are to be treated with Electroconvulsive Therapy (ECT) without their consent.
• If an individual appeals, the review panel will hold a hearing. This will happen within three business days of the individual’s application.
• An appeal will be sent to the review panel for an individual automatically if they are held for longer than 21 days and they did not appeal the first set of certificates. If the individual is under a community treatment order for longer than six months, an appeal will be sent to the review panel automatically.
• An individual may also appeal to the review panel if the doctor has ordered ECT. ECT is not allowed to be used while the review panel is looking at the individual’s appeal.

An Individual’s Rights at a Hearing under The Mental Health Services Act

An individual has the right to:

• be present at an appeal hearing;
• give evidence;
• see and hear all evidence given by others;
• cross-examine people;
• be represented by any other person; and
• ask an official representative to accompany them and provide help.

Authority of the Review Panel

The review panel can over-rule decisions which have been made.

This includes decisions to:

• keep and treat an individual in hospital;
• transfer an individual to another mental health centre;
• give an individual Electroconvulsive therapy (ECT); or
• give an individual treatment in the community without their consent.

The review panel has three business days to give an individual its decision.

If an individual does not agree with a decision made by the review panel on any matter except Electroconvulsive therapy (ECT), the individual has the right to appeal to the Court of King's Bench.

Confidentiality

All information about an individual’s diagnosis and treatment is confidential.

Information will only be released:

• to persons who need it to give an individual treatment;
• to other persons with the individual’s written consent; and
• otherwise as required by law.

All individuals have a right to information about themselves. Information may be kept private only if there are safety concerns regarding the release of the information. In case of dispute, all individuals may appeal to the Privacy Commissioner for an order to release the information.

For more information about rights under The Mental Health Services Act:

• ask a psychiatrist or other mental health professional;
• ask an official representative in the Saskatchewan Health Authority; or
• contact Saskatchewan Health Authority Mental Health Services in your area.