Our Psychiatric Ward

Persons who are diagnosed to be suffering from mental illness, and are thought to be a danger to themselves or others, are taken in at the Psychiatric Ward of the Princess Margaret Hospital and kept there until they are considered ready to return to society and had what is said to be a normal life. Their admission, detention and discharge are governed by the Mental Health Act, Chap 40:62 of our Laws. The Act was passed and went into operation on December 31, 1987. And, in February of the following year, regulations were made to guide the implementation of the Act.

There are three categories of such patients. These are (a) voluntary patients, (b) medically recommended patients, and (c) hospital order patients. A voluntary patient, first of all, is one who of his or her own accord requests admission or on whose behalf someone else requests admission. Where the person is under 18 years of age request for admission may be made by his or her parent or guardian. Such a request must be made in writing "in such form" as the Minister of Health approves. Secondly, that volunteer in the opinion of the Consultant Psychiatrist "is or appears to be" suffering from "a mental disorder". The Consultant Psychiatrist is described in the Act as "the member of the medical staff responsible for the medical care and treatment of the patients" of the ward.

By comparison, a person is admitted as a medically recommended patient upon two conditions. Where he or she, upon examination by a doctor, is found to be suffering from a mental disorder, and it is recommended that "in the interest of his own health or safety or with a view to the protection of other persons" that person should be admitted. The recommendation is made in the form of a Medical Certificate approved by the Minister of Health. Importantly, the doctor issuing the Certificate must not be employed at the hospital; nor must he or she be a relative of the patient. Further, the Certificate must state the facts on which the doctor's opinion is based; these facts must be separate from information provided by others. Notably, the Certificate must be completed within 24 hours of examination of the patient and he or she will not be admitted "if more than seven days have elapsed since he was last examined. The second condition is that a parent or guardian of the patient must make and sign an application for admission to the hospital.

A hospital order patient is taken into the Psychiatric Ward in two situations. The first is by order of a Court made in circumstances where the Court is of the view that an accused person charged before it "is or appears to be" suffering from a mental disorder. Such an Order may direct admission of that accused person for "a period not exceeding three weeks".

The second situation is as a result of intervention by the Police and is provided for under Section 8(3) of the Act. We quote it at length: "A person who, on a highway or public place by reason of his general appearance or by his conduct or conversation, causes a member of the Police Service who has been so notified by a Mental Health Officer or Consultant Psychiatrist, reasonably to believe that the person is suffering from a mental disorder and ought to be taken into custody in the interest of his own health or safety or with a view to the protection of others may be taken into custody without a warrant by a member of the Police Service not below the rank of Sergeant or by a member of the Police Service of lower rank acting under the authority of a Sergeant or officer of higher rank and conveyed directly to a psychiatric hospital".

The power of police officers to determine conduct and behavior of citizens "mental disorder" extends to private buildings and premises as well as public buildings and premises that are not classified as "public places." In that case, the officer "may, if necessary" obtain a warrant to enter there. The Section is silent as to the circumstances in which a warrant is or is not necessary. In effect, the police officer in question is left with ultimate authority to make a determination.

In making what is essentially a psychiatric evaluation, the would-be excesses of police officers, intentionally or otherwise, are restrained by three factors. One is that the person must be taken to the psychiatric ward within twenty-four (24) hours of his or her placement into custody. The second is that, "as soon as possible thereafter," the relatives of the victim are to be informed of "the events leading up to, and including, his or her admission to the hospital and the reasons" for taking that person into custody. And the third is that arrangements must be made for relatives to communicate with the patient.

The Act invests the Consultant Psychiatrist with authority to change the status of a patient. For example, the Consultant Psychiatrist may move a voluntary patient to the category of medically recommend patient. To do so, two things are required. First, the Psychiatrist, following discharge of voluntary patient, determines that, that patient is in need of "further medical treatment." Then, a medical Certificate to that effect is obtained "within twenty-four hours of the re-admission" from a doctor who is not employed at the hospital. That is provided for under Section 6(6) of the Act. By the same token, Section 7(8) allows the Consultant Psychiatrist to change the status of a medically recommended patient to that of a voluntary patient. All that is required is a Certificate in writing to that effect. Further, by Section 8(6) of the Act, a hospital order patient may be moved to the category, medically recommended patient. This may be done where, upon examination, the Consultant Psychiatrist finds that patient to be in need of "further treatment."

There is a further situation in which a citizen may be detained at our Psychiatric Ward. It is referred to as detention during the President's pleasure. And it arises where a person on trial before the High Court is found "unfit to plead" or is believed to be suffering from insanity". In the event, the Court must order that person to be detained in our psychiatric ward "until the President's pleasure is known".

Copyright (c) William Para Riviere, May 2013