Guidelines for Admitting Patients with Mental Health Concerns

All admitted patients require a complete history, mental status exam and physical exam. Alternative diagnosis that can manifest themselves similarly to mental health problems should be considered (head injuries, seizure, stroke, delirium, TB meningitis, etc.). Any patient who is admitted for psychiatric reasons should have mental health involved – either at the time of admission, or, if in the middle of the night, by entering an urgent inpatient MH referral in Meditech.

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Form 1 – Any patient who is admitted and meets criteria for involuntary admission under the MHA will need a “Form 1” completed which allows for involuntary admission. Again, this should be strongly considered for any patient medevaced to the QGH under a MHA form.

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Form 25 – This form must be completed and given to the patient. It explains that a form 1 has been completed and what their rights are. Involuntarily admitting a patient is taking away their rights and freedoms and this is a safeguard to ensure that patient is informed of this and of their rights.

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MHA Admission Orders – There is a preprinted order set that includes medications as needed both for comfort and for acute agitation or aggression. All patients admitted under Form 1 will have a guard to ensure their safety. Definitive pharmacotherapy can often be initiated by the hospitalist.

Privileges – Rather thinking of it as “giving privileges”, we should consider what are the minimum rights and freedoms that need to be removed for the patient to be safe. Initially, a patient may require a lockdown room (1 in ER and 2 on the inpatient ward) with no telephone or smoking access for their safety.