What Form 4.1 is for
Form 4.1 is the first of the two medical certificates that support involuntary admission under section 22 of BC’s Mental Health Act. On one certificate, the director of a designated facility can admit and detain a person for up to 48 hours for examination and treatment. A completed certificate is also authority for anyone to apprehend the person and take them to a designated facility.
It is often confused with Form 4.2, the second certificate, which must be done within 48 hours of admission to extend detention to one month. Form 5, consent for treatment, is a separate form again.
Who completes it
A physician or nurse practitioner who has personally examined the person completes Section 1. Every field in Section 1 is required. The Mental Health Act director of the designated facility, or their delegate, completes Section 2, and that person can’t be the examining professional. Section 2 isn’t needed when the person is detained in a correctional centre or youth custody centre.
How to fill in Section 1
Person examined and examination site
Print the person’s first and last name, their Personal Health Number if available, the examination date, and the name and address of the site. Tick whether you examined them in a designated facility or at another site. The 14-day clock runs from the examination, so the date matters.
The four opinions
The form asks for your reasons for four separate opinions: that the person has a disorder of the mind that requires treatment and seriously impairs their ability to react appropriately to their environment or associate with others; that they require treatment in or through a designated facility; that they require care, supervision and control there to prevent substantial mental or physical deterioration or to protect themselves or others; and that they can’t suitably be admitted as a voluntary patient. Write reasons for each in summary form, using what you observed and what you were told, and say who told you.
The fourth criterion
The voluntary admission opinion needs reasons of its own. Say why voluntary admission won’t work, for example that the person refuses admission or has left voluntary care before. A restated diagnosis doesn’t answer it.
Signature block
Print your name, tick physician or nurse practitioner, and add your phone number, College ID number, the date and the time signed in 24-hour format. Tick whether the person was brought to you by police under section 28, whether the summary continues on the back, and whether the patient was given a copy. If you use the back page, repeat the name, PHN, site, date and time at its top.
Common reasons it’s questioned
- A reason missing under one of the four opinions, or one reason copied into all four.
- Reasons that state a diagnosis without the behaviour or risk behind it.
- An examination more than 14 days before admission.
- Missing College ID, time signed, or the section 28 answer.
- Section 2 completed by the same person who signed Section 1.
Submitting and who pays
The certificate goes with the person to the designated facility, where the director or delegate reviews it and completes Section 2. From that point, involuntary admission lasts up to 48 hours unless a Form 4.2 is completed, and Form 13 is used to help the patient understand their rights. Physicians bill MSP under the Mental Health Act fee items in the MSC Payment Schedule. The patient isn’t charged.