Our Psychiatric Ward
Discharging a Patient
The Consultant Psychiatrist has full authority to discharge a mental patient from detention at the Psychiatric Ward of the Princess Margaret Hospital. Or, on the initiative of the patient, he may be forced to do so. A voluntary patient is entitled to be discharged either upon his or her application in writing or, in the case of a patient under the age of eighteen (18) years, upon the application of a parent or guardian who requested the minor's admission. But, as stated earlier, the Consultant Psychiatrist may change the patient's status and, following his or her discharge, immediately re-admit the patient.
In the case of a medically recommended patient, Section 7(6) of the Act mandates that his or her situation "must" be reviewed "within the first month of admission and thereafter at least once in every six months". Yet, the medical certificate by virtue of which the patient was admitted is valid for a period of twelve (12) months. And, his or her discharge before this period has expired is no bar to the Consultant Psychiatrist re-admitting the patient "without the issue of a fresh medical certificate". Of course, these stipulations apply to persons admitted as hospital order patients and whose status is changed thereafter to that of medically recommended patient.
A hospital order patient admitted by order of the Court "may" be discharged "only after" approval by that Court. What this means is that the Court does not have authority to discharge a patient, the subject of its order, on its own volition. First, the Consultant Psychiatrist proposes discharge. Then, the Court is left to approve or disapprove the proposal. If the discharge is approved, the Court, in doing so, may impose conditions to be satisfied by the patient.
As to patients admitted and detained at the pleasure of the President, the word of the Consultant Psychiatrist is once again decisive. The final decision to discharge is made by the President. But before an order to do so is made, the Consultant Psychiatrist must review the case of the patient and make a report to the President.
Quite importantly, the Act makes provision for a patient who considers his or her detention or continued detention at the Hospital to be "unreasonable" to cause an application for release to be made above the head, so to speak, of the Consultant Psychiatrist. The application is made by someone acting on behalf of the concerned patient to a body called the Mental Health Review Board, set up under Section 13 of the Act. The Board consists of seven (7) persons. Three of them are appointed by the Minister of Health from among persons having such knowledge of social services, or other qualifications or experience "as the Minister considers suitable". Two members are "chosen from" the legal profession and appointed by the Minister. The remaining two members are "chosen from" the medical profession and appointed by the Minister. The Board's Chairman and Deputy Chairman are appointed by the Minister. And a panel to consider applications for release must comprise one of the legal members, one of the medical members, and one of the members who are neither legal nor medical members. Further, any two members shall form a quorum.
Notwithstanding the Board's authority to regulate its own procedure, Section 13(4) provides guidelines as to the hearing of an application. Within twenty-eight (28) days of receipt of the application the following must be done. The patient must be brought before the Board for questioning. The Board must ascertain the reasons why the patient was detained, and examine the grounds on which the patient seeks release from the hospital. If it is thought necessary, further medical examination of the patient must be made. And further evidence relating to the application must be heard.
Two options are available to the Board. It may dismiss the application. Or, it may order the immediate discharge of the patient, and award him or her costs "as it considers just". A person who is aggrieved by a decision of the Board has a right of appeal to the High Court. This must be done within fourteen (14) days of the Board's decision.
The Act goes on to protect persons involved in the admission and detention and discharge of patients. It provides that a person who "in good faith" causes another to be admitted to or discharged from our Psychiatric Ward shall not be held liable for any loss or damage suffered as a result of that detention or discharge. This immunity from court action also applies to someone who "in good faith" carries out the instructions of a person with authority under the Act to cause another to be admitted as a patient there.
In conclusion, this much can be said. In small-populated communities like ours, where gossip is the order of the day, the admission and detention of a person on grounds of mental disorder is sufficient to cause irreparable and lasting damage to the patient's life. There is a need, therefore, for the imposition of checks and balances against those charged with responsibility for diagnosing mental illness and causing those deemed mentally ill to be taken away from society and detained in a psychiatric hospital. Concern has been voiced at the fact that the Act has failed to impose either checks or balances against the unbridled power of the Consultant Psychiatrist. We regard this as a legitimate concern. And we ask: "To which person or body is the Consultant Psychiatrist accountable in the exercise of his authority to admit and detain patients and veto their discharge? On this, the Act is silent. There is further concern that the Act gives Police Officers, who are not as a rule trained in Psychiatry, too much latitude to decide, without any checks or balances, whether the conduct and behavior of citizens is "reasonably" to be attributed to mental disorder.
Concern has equally been raised at the role played by the Minister of Health in the appointment of members to the Mental Health Review Board. The question is being asked: Where is the provision in the Act which serves to prevent a desperate Government assisted by its Mental Health Review Board, an over-ambitious Police Officer, and a vulnerable Consultant Psychiatrist, from inventing the mental disorder of a feared Opposition figure and causing that person to be removed from political circulation for as long as is thought necessary? The idea may sound far-fetched. And we hope it is. But, elsewhere, it has happened in the past and is happening in the present. Such perversity is the material with which regimes that rule by absolute power, rather than democratic practice, are made. For this reason, an independently-constituted Board, divorced from Government control, would go a long way in winning the confidence of the public in respect of Board decisions.
In fact, the question may be raised as to whether the provisions of the Act which empower the Consultant Psychiatrist to keep patients at the Psychiatric Ward against their will are strictly in accordance with our Constitution. Not only is a person's right to personal liberty enshrined as a fundamental right and freedom under the Constitution. The Constitution goes, further, to stipulate that, except in certain situations, the law must come to the assistance of all citizens to protect the enjoyment by them of that right to personal liberty. The exception relevant to this discussion is stated under Section 3(1)(h) to be where "in the case of a person who is, or is reasonably suspected to be, of unsound mind", that person is detained "for the purpose of his care or treatment or the protection of the community". Two things are at issue here. The first is the meaning of "reasonable suspicion", for purposes of the Act. The second is whether, in the case of a particular patient, the 'diagnosis' of the Consultant Psychiatrist or the 'hunch' of this or that Police Officer is, on the facts, "reasonable".
The constitutional question apart, it is our opinion that in all the circumstances of the admission, detention and discharge of patients at the Psychiatric Ward of Princess Margaret Hospital, the Mental Health Act stands in need of comprehensive amendment. And we advise our legislators to act accordingly.
Copyright © William Para Riviere, May 2013