Hereafter, to simplify the text, the Act respecting the protection of persons whose mental state presents a danger to themselves or to others will be referred to as the “Act respecting the protection of persons” or the “ARPP,” and the Act respecting health services and social services will be referred to as the “ARHSSS.”
In what situations does the ARPP apply?
The ARPP may only be applied by health and social services professionals and only in exceptional cases. A professional who applies it does so to ensure the safety of the individual concerned and that of his close relatives. In concrete terms, its application is the equivalent of detention at a health and social services institution; the individual is not authorized to leave the institution. In Nunavik, the institution may be a CLSC (nursing station) or a hospitalization unit (in Kuujjuaq or Puvirnituq).
The ARPP may be applied only when the following criteria exist concurrently:
- the individual presents a serious and imminent danger to himself or to others due to his altered mental state;
- the individual does not consent to receiving assistance to ensure his safety and that of others.
The danger must result from the individual who is the subject of application of the ARPP and must be based on concrete and current facts.
Below are some examples of danger resulting from an altered mental state:
- an individual hears voices (in his head) telling him to attack his close relatives;
- an individual has taken a large dose of medication or product for the purpose of taking his own life;
- an individual has not slept for several days, has begun having visions of deceased persons and wishes to join them (considering taking his own life).
What constitutes a serious and imminent danger?
The danger normally results from an action. However, the danger can also result from an omission, that is, not carrying out an action. The following examples are not meant to cover all situations of serious and imminent danger; they serve solely to facilitate comprehension of these legal notions:
- danger to oneself: serious self-mutilation (such as lacerations that lead to heavy bleeding), suicidal behaviour or attempts, etc.;
- danger to others: death threats, assault (such as hitting someone), etc.;
Note: If the violent behaviour toward another person is not caused by an altered mental state, the Criminal Code is the legislation that applies to protect the victim or avoid an assault. The police are therefore the ones to intervene.
- danger resulting from an omission: going outdoors at -40°C without a winter coat, refusing to eat for a prolonged period due to a belief of being poisoned, etc.
Meaning of the notions “serious” and “imminent”:
- serious: the anticipated consequence must be sufficiently serious, with the probability of a death being the ultimate level of seriousness;
- imminent: the danger is in the immediate present. The greater the probability that the danger will occur sooner, the more urgent it becomes to intervene. A period of 24 to 48 hours is usually considered as imminent.
On the contrary, if, for example, an individual verbalizes that he might attack his brother with a slingshot in six months, that situation involves few facts and the danger is low (criterion of seriousness) and not imminent (six months in the future). It would therefore be possible to take actions other than application of the ARPP before the danger materializes.
Reminder: Even in a situation where the individual presents a serious and imminent danger to himself or to others due to his mental state, as long as he consents to a plan to ensure his safety, it is not necessary to apply the ARPP.
What are the different types of confinement under the ARPP?
- Preventive confinement:
- total duration of 72 hours
- aims to ensure the safety of the individual who presents a serious and imminent danger due to his perturbed mental state and who does not consent to receiving the assistance offered
- equivalent of detention in an institution (CLSC); the individual therefore may not leave
- no other care or service (medical or psychosocial) may be given to the individual without his consent
- can only be initiated by a physician
- no other medical or psychiatric evaluation necessary
- no court authorization necessary
- Provisional confinement:
- duration of 48 to 96 hours
- aims to oblige an individual to undergo psychiatric evaluation (that the individual refuses or to which he is incapable of consenting)
- court authorization necessary
- the individual must submit to two psychiatric evaluations, performed by two different physicians
- the evaluations aim to determine whether the individual still presents a danger and therefore whether or not he must remain confined
- no other care or service may be given to the individual without his consent
- Authorized confinement:
- duration (variable) is determined by the court
- after the provisional confinement and the two psychiatric evaluations, if both psychiatrists consider there is still a danger and that it is necessary to confine the individual, an application is thus submitted to the court for the purpose of confining the individual for a longer period
- legal measure ordered by a judge of the Court of Québec, ordering an individual to remain in hospital
- the court is the only entity with the authority for such a measure, if and only if it has serious reasons to believe that the individual is dangerous and must be confined
A confinement shall end immediately in the following situations:
- the physician provides a certificate attesting that the confinement is no longer justified;
- a psychiatric-examination report is not produced within prescribed periods;
- the period set for the confinement in the judgment that ordered it ends;
- the Administrative Tribunal of Québec renders a decision ending the confinement;
- a decision by a legal court orders an end to the confinement.
The health centre must then inform the user immediately of the end of the confinement period.