Updates from SLT - Psychiatry

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Updates from SLT - Psychiatry

30-Nov-2015

When the Health Care Directives and Substitute Health Care Decision Maker Act Should be Used

From time to time psychiatrists are asked to issue Form Gs for hospital in-patients who are in acute care units other than inpatient mental health units to receive medical treatment. These patients do not have the capacity to make an informed decision regarding required treatment and/or communicate an informed consent for such treatment. This practice contravenes The Mental Health Services Act. Use of certification under The Mental Health Services Act is intended to apply only to those circumstances where individuals with acute mental illnesses require an involuntary admission to an inpatient mental health unit. For patients who are on a medical unit and do not have capacity to make a decision regarding treatment and/or communicate an informed consent the appropriate vehicle to insure treatment is “the Health Care Directives and Health Care Decision Makers Act”. Section 16(4) of this Act states:

Substitute health care decision-making

16 (4) Where there is no nearest relative or where a reasonable attempt to find the nearest relative has been made but the nearest relative cannot be found, and a person requiring treatment lacks the capacity to make a health care decision, a treatment provider may provide treatment in a manner and to the extent that is reasonably necessary and in the best interests of the person without receiving a health care decision from the nearest relative if:

(a) the treatment provider believes that the proposed treatment is needed; and

(b) another treatment provider agrees in writing that the proposed treatment is needed.

This Section of the Health Care Directives and Substitute Health Care Decision Makers Act gives clear authority to a physician to proceed as necessary when a patient’s lack of capacity is determined and no relative or guardian is available to consent on his or her behalf. In this circumstance, the physician would simply document the absence of capacity, the need for the proposed treatment, and the corroboration of this opinion by a second physician.

Psychiatry Consultant-Liaison Psychiatric Nurse

As a result of the increasing numbers of consultations, inpatient mental health has made some improvements to augment this service.

A consultant-liaison psychiatric nurse has joined this team (November 2015) in efforts to improve consultation services, as well as improve average length of stay, and provide inpatient services when required.

This additional resource to consulting services will provide:

  • assessment, to collect relative and collateral data
  • psychosocial support
  • medication review
  • provide recommendations, as well as
  • provide follow-up care as required by the consulting team that further supports a mental health service plan.

The team will huddle daily Monday to Friday to prioritize the consults as reflected in the Medical Staff Rules in relation to the urgency of the consultation. Through the initial stages the nurse consultant will provide the following services in a soft roll-out:

  • RGH medical / surgical units
  • Pasqua Hospital will join after 3 months
  • Introduction to geriatric psychiatry consultation services will be added
  • Introduction to adolescent / child psychiatry consults will follow
  • Effective Monday November 23, 2015 please fax all psychiatry consultations 306-766-4116

To expedite consultation services, please complete the consult request (medication review, reason, psychiatric evaluation/assessment). If the clinical situation is urgent and the response is required before the next working day, the MRP should contact the on-call psychiatrist directly as per Medical Staff Rules.

Submitted by:

Jamie Ash, Director of Inpatient Mental Health Services
Jamie.Ash@rqhealth.ca

Lionel Tancrede, Manager, Inpatient Mental Health Services
Lionel.Tancrede@rqhealth.ca

Mental Health and Addiction Services
Regina Qu’Appelle Health Region
Regina General Hospital
1440- 14th Ave – Level 0D
Regina, SK S4P 0W5
T- (306) 766-4608 F- (306) 766-3227