What Form H.4 is for
Under The Mental Health Services Act, a psychiatrist can issue a community treatment order so a person can be treated outside a mental health centre. The order on Form H.3 must state the facts behind the criteria, the services and treatment, and the people who’ll make sure the person receives the services. Section 24.4 then requires a certificate in support from a second practitioner. Once you issue it, the certificate validates the order.
Who completes it
A psychiatrist other than the one who issued the order completes Form H.4 after examining the person. Where no other psychiatrist is reasonably available in the region, a regional director can designate a physician to do the examination. There’s no patient part.
How to fill in the certificate
Your details and the examination
Give your full name and qualifications, the date and place of your examination, and the person’s full name and residence. The Act requires the examination within the 72 hours before the certificate, so the date matters.
Your grounds
Record the reasonable grounds from your examination and any other pertinent facts communicated to you. Write what you found yourself. Restating the issuing psychiatrist’s findings doesn’t show an independent examination.
The six criteria
The form lists them, and your grounds should support each one: a mental disorder needing treatment or care and supervision that can be provided in the community; an admission to a mental health centre, or a previous CTO, in the past two years; a likelihood of harm or substantial deterioration without community treatment; services that exist, are available and will be provided; inability to fully understand and make an informed decision about the need for treatment; and capability of complying with the order. Check the two-year history against the record, with dates.
The order and your concurrence
You certify that you have probable cause to believe the order was issued in accordance with section 24.3, including its stated facts, examination date and witnessed signature, and that you concur with the treatment and services it sets out. Read the H.3 before you sign.
Common reasons a CTO isn’t validated
- A supporting certificate from the same psychiatrist who issued the order.
- An examination more than 72 hours before the certificate.
- No admission or prior CTO within the past two years recorded.
- Services named that aren’t confirmed as available to the person.
- Grounds copied from the order rather than from your own examination.
Submitting and who pays
The form’s distribution line sends copies to the patient, the nearest relative, any proxy, any personal guardian and the official representative. Once the order is validated, the attending physician must give a copy of it to the same people. The form carries no fee line. Bill your examination as you normally would.