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Psychiatric Emergencies and Crises in Primary Care

Summary: Is your patient imminently suicidal, homicidal, or at risk of substantial physical impairment due to a mental disorder? Classic situations include your patient is acutely suicidal due to major depression; your patient is suffering from an acute episode of mania or psychosis, and as a result, is at risk of serious harm.

If so, your patient may benefit from an emergency mental health assessment….

Options in Ontario include:

1) Filling out a Form 1 if you have seen your patient within the past 7-days, otherwise
2) Asking the family to consider seeing a Justice of the Peace with their concerns, and/or
3) Calling the local crisis line, mobile crisis or 911 during an acute crisis.
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Is your patient able to go voluntarily?

Ideally your patient agrees to voluntarily go to an Emergency Department, in which case you may be able to have your patient brought by family or an ambulance.

If your patient unable to go voluntarily?

1. Form 1

More...

 

2. Justice of the Peace

  • If you have not seen your patient within the past 7 days (i.e. a Form 1 is not possible), then consider asking family members to contact a Justice of the Peace
  • Anyone (usually family members, but can also include physicians) can present themselves to the local Courthouse, and be seen by a Justice of the Peace, who can issue a Form 2, which gives police the authorization to take the individual to a hospital for an assessment
  • Here is a list of local Courthouses in Ontario http://www.attorneygeneral.jus.gov.on.ca/english/courts/Court_Addresses/

3. Call 911

  • If your patient is acutely suicidal, homicidal or psychotic, consider emergency medical services (i.e. 911)

Where to Send your Patient in Ontario

This is the official list of Schedule 1 facilities maintained by the Ministry of Ontario

http://www.health.gov.on.ca/en/common/system/services/psych/designated.aspx

 

Note: This is a list of Schedule 1 facilities, which means they have inpatient services, but note that not all have an Emergency Department. If you are looking to send a patient to an Emergency Department, check the hospital before hand to see if it has an Emergency Department.

 

Location

Name

Ajax

Rouge Valley Health System - Ajax and Pickering Health Centre Site

Barrie

Royal Victoria Regional Health Centre

Bath

Regional Treatment Centre (Ontario) - Millhaven Institution Site

Bath

Regional Treatment Centre (Ontario) – Bath Institution Site

Belleville

Quinte Healthcare Corporation - Belleville General

Brampton

William Osler Health Centre - Brampton Civic Hospital

William Osler Health Centre - Brampton Hospital Campus

Brantford

The Brantford General Hospital

Brockville

Brockville General Hospital - Charles Street Site and Garden Street Site.

Brockville

Brockville Mental Health Centre - Member of the Royal Ottawa Health Care Group, including the Forensic Treatment Unit

Brockville

St. Lawrence Valley Correctional and Treatment Centre, Secure Treatment Unit

Burlington

Joseph Brant Hospital

Cambridge

Cambridge Memorial Hospital

Chatham

The Public General Hospital Society of Chatham

Cornwall

Cornwall General Hospital

Goderich

Alexandra Marine and General Hospital

Guelph

Homewood Health Centre Inc.

Hamilton

Hamilton Health Sciences Corporation -

Hamilton General Hospital Site,

Chedoke Hospital Site,

McMaster University Medical Centre Site,

Henderson General Hospital Site

Hamilton

St. Joseph's Healthcare Hamilton -

West 5th Campus

Charlton Campus

Kenora

Lake of the Woods District Hospital

Kingston

Kingston General Hospital

Kingston

Providence Care Centre: Mental Health Services Site. <br/> (former Kingston Psychiatric Hospital)

Kitchener

Grand River Hospital Corporation - Kitchener-Waterloo Site

Grand River Hospital Corporation - Freeport Site

Lindsay

Ross Memorial Hospital

London

St. Joseph's Health Care London, Parkwood Institute, Mental Health Care Building

London

London Health Sciences Centre - University Campus, Victoria Campus

Markham

Markham Stouffville Hospital

Mississauga

Trillium Health Partners - Credit Valley Hospital

Mississauga

Trillium Health Partners - Mississauga Hospital

Newmarket

Southlake Regional Health Centre

North Bay

North Bay Regional Health Centre

Oakville

Halton Healthcare Services Corporation - Oakville - Trafalgar Memorial Hospital Site

Orillia

Orillia Soldiers' Memorial Hospital

Oshawa

Lakeridge Health Corporation - Oshawa Site

Ottawa

Children's Hospital of Eastern Ontario

Ottawa

Hôpital Montfort

Ottawa

Queensway Carleton Hospital

Ottawa

Royal Ottawa Mental Health Centre - Member of the Royal Ottawa Health Care Group – Does not have an Emergency Department

Ottawa

Regional Children's Centre Royal Ottawa Hospital,

a division of the Royal Ottawa Health Care Group – Does not have an Emergency Department

Ottawa

The Ottawa Hospital - Civic Campus, General Campus

Owen Sound

Grey Bruce Health Services - Owen Sound Site

Penetanguishene

Waypoint Centre for Mental Health Care

Peterborough

Peterborough Regional Health Centre - Hospital Drive Site

Richmond Hill

Mackenzie Health

St. Catharines

Niagara Health System - St. Catharines Site

St. Thomas

Southwest Centre for Forensic Mental Health Care, St. Joseph's Health Care London

St. Thomas

St. Thomas Elgin General Hospital

Sarnia

Bluewater Health

Sault St. Marie

Sault Area Hospital

Stratford

Stratford General Hospital

Sudbury

North Bay Regional Health Centre (Kirkwood Place)

Sudbury

Hôpital régional de Sudbury Regional Hospital

Thunder Bay

St. Joseph's Care Group, Lakehead Psychiatric Hospital Site

Thunder Bay

Thunder Bay Regional Health Sciences Centre

Timmins

Timmins & District Hospital L'Hopital De Timmins et Du District

Toronto

Rouge Valley Health System - Centenary Health Centre Site

Toronto

The Scarborough Hospital -

General Division Site,

Grace Division Site

Toronto

North York General Hospital - General Division Site

Toronto

Humber River Regional Hospital -

Finch Avenue Site,

Church Street Site,

Keele Street Site

Toronto

Centre for Addiction and Mental Health

Toronto

Baycrest Hospital

Toronto

William Osler Health Centre - Etobicoke Hospital Campus

Toronto

Sinai Health System -

Mount Sinai Hospital Site

Toronto

St. Joseph's Health Centre

Toronto

St. Michael's Hospital -

Bond St. Site,

Wellesley Central Site

Toronto

Sunnybrook Health Sciences Centre

Toronto

The Toronto East General and Orthopaedic Hospital Inc.

Toronto

University Health Network -

Toronto General Hospital Site,

Toronto Western Hospital Site,

Ontario Cancer Institute / Princess Margaret Hospital Site

Whitby

Ontario Shores Centre for Mental Health Sciences

Windsor

Hôtel-Dieu Grace Healthcare – Tayfour Campus

Windsor

Windsor Regional Hospital

Woodstock

Woodstock General Hospital

Summary of Involuntary Psychiatric Assessment

  • You have assessed the patient, and believe that an emergent Psychiatric Assessment is required, and the patient is not willing to go voluntarily
  • Ensure the patient is in a safe place, accompanied by family or staff.
  • In some circumstances, if the patient is acutely agitated (e.g. psychotic episode), it may be helpful to give the patient a PRN medication if available.
  • Fill out a Form 1.
  • Contact the police (or ambulance service) to see if they can accompany your patient to the hospital.
  • While awaiting the police
    • Have someone let the Emergency Department triage know about the patient
    • Write a note that includes:
      • Summary of why you believe the patient needs to be seen in hospital
      • Medications and dosages
      • A telephone number where you can be reached at.
  • Wait for the police to arrive…

About this Document

Written by members of the eMentalHealth.ca Primary Care Team, which includes Drs Mireille St-Jean (Family Physician, Ottawa Hospital), Eric Wooltorton (Family Physician, Ottawa Hospital), Farad Motamedi (Family Physician, Ottawa Hospital), M. Cheng (Psychiatrist, Children’s Hospital of Eastern Ontario).

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from a health professional. Always contact a qualified health professional for further information in your specific situation or circumstance.

Creative Commons License

You are free to copy and distribute this material in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/

Date Posted: Sep 24, 2015
Date of Last Revision: Oct 12, 2015

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