Involuntary psychiatric patients on P.E.I. often not informed of rights, auditor general finds

Health P.E.I. has failed to show it adequately informs involuntary patients in psychiatric facilities of their rights under the Mental Health Act, the province's auditor general Darren Noonan says in a new report filed Friday in the legislature.

Spurred by a complaint from a concerned citizen, the findings are part of a new performance audit report of the province's Mental Health Review Board and the rights of involuntary patients during a two-year period from 2021 to 2023.

Health P.E.I. and the board have already begun implementing several of the report's recommendations. 

The report looked at P.E.I.'s three main psychiatric facilities: Hillsborough Hospital, Prince County Hospital and Queen Elizabeth Hospital. 

Involuntary patients are people who refuse to or can't consent to being admitted voluntarily to a psychiatric facility. A psychiatrist must first determine the person can't be treated safely in the community, and is a safety risk to themself or others.

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Each facility has an administrator responsible for informing involuntary patients of their rights as soon as reasonably possible after they're admitted. 

Those include: 

• The right to retain legal counsel.
• The right to communicate with their family or guardian.
• The right to be advised they may appeal their involuntary status to a higher body called the Mental Health Review Board and to have that case heard in a timely fashion.

Lack of policies, procedures and paper trail

P.E.I.'s Mental Health Review Board is chaired by a lawyer and includes a psychiatrist and a third member who is neither a lawyer nor a doctor. It's required to hold a hearing and make a decision within 10 days of receiving an application.

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That board held 19 hearings in the 2021-2022 fiscal year and 21 hearings in the 2022- 2023 fiscal year, the auditor said, most of which were to review a patient's involuntary status. The audit focused on patients involuntarily admitted to a psychiatric facility or who were held for an involuntary psychiatric assessment. 

The report found:

• Documentation was not maintained to show that Health P.E.I. had informed involuntary patients of their right to be released after 72 hours, or of any other rights.
• Health P.E.I. did not have documented policies or procedures for informing involuntary patients of their rights. 
• The letter used by Health P.E.I. to inform involuntary patients of their rights did not include their right to retain legal counsel.
• Health P.E.I. did not display a summary of patients' rights in psychiatric facilities, as they are supposed to by law. 

The audit also looked at the workings of the Mental Health Review Board, and found several "weaknesses."

Those included a lack of documentation to support when it received applications. It also didn't always receive applications in a timely manner from Health P.E.I., it didn't always hold hearings and make decisions within legislated timeframes, there was no process to identify all appropriate parties to an application (such as parents), and parties were not always given three days' notice of hearings so that they could prepare. 

It also found a lack of paperwork to show that doctors, patients and guardians had been informed of the board's decisions. Also, the board didn't formally track the dates applications were received and hearings held, nor cancelled hearings or the reason for any cancellations.

Changes already undertaken

Health P.E.I. has already responded to the audit and begun to implement fixes for several of its findings. It has set deadlines to achieve the changes, the latest of which is January 2025.   

"Patient rights are paramount in health care, and Health P.E.I. is committed to respecting them and ensuring we have processes in place to guard them," Health P.E.I. CEO Melanie Fraser told CBC News in an email. 

She said Health P.E.I. accepts and appreciates all the recommendations from the auditor general. 

"Key actions being undertaken include ensuring staff have the required training and materials to inform patients and representatives of their rights, and the addition of a new administrative role responsible for ensuring consistent, timely and thorough documentation and implementation of processes related to involuntary patients and the Mental Health Review Board."

Health P.E.I. has also committed to creating posters outlining patients' rights and putting them in common areas and lobbies of all acute inpatient mental health units and in hospital emergency departments, Fraser wrote.

The board said it has already implemented set weekly hearing dates, which has helped patient appeals be heard in a timely manner, and has a better method to inform appropriate parties such as guardians of hearings and subsequent decisions.

However, the board and the Department of Health did not agree with a recommendation that the board report annually to Health P.E.I. to show it is following procedures. The department said it cannot support that because the board is an independent body.