I say he's crazy; therefore, he must go through an evaluation.
February 1, 2009 9:37 AM   Subscribe

Australian (and U.S.) Mental Health/Legal Filter. Can you just go and talk your GP into having someone put through a psychiatric evaluation?

One of my close friends is studying medicine here in Melbourne, Australia, and in one of his various internships, a psychiatrist told him that anyone can recommend someone get a psychiatric evaluation, through their GP. In other words, if you wanted to, you could go through the process against another person, like so:

Go to your local GP. Talk to him about the person you consider to be mentally ill, and, if the GP agrees with you that this sounds like a mental illness that could cause harm to that person or those around him, that person must, by law, go through a psychiatric evaluation.

Psychiatrist telling him this or not, I call bullshit on it--at least some of it. It seems like, surely, there must be some evidence (other than words/hearsay) that a random individual has to provide for a GP to sign this off. Moreover, it would seem the GP would actually have to see said mentally ill individual, not just hear what some other person has to say about him.

If not, I can very easily imagine people doing this just to disturb someone they don't like/broke up with/fired, etc. It seems too easy: pick a mental illness, go speak with a GP, get him to agree with you, and in no time at all, the person you're saying is mentally ill has to go in for an evaluation. Talk about stressing someone out, if you're lying!

Is this true? If so, under what law? I've not been able to find it through searching. I'm looking for laws and policies, if possible, though anecdotal evidence is okay, too.

Extra Question: I know a bit about involuntary commitment and the like under U.S. law, and I know that a doctor himself can recommend involuntary commitment for one of his own patients that he deems a danger to himself or others, but is there anything similar to the above?

If these laws do exist in either or both countries, what provisions are there to protect individuals from being evaluated wrongfully? I.e., suing doctors and the like.
posted by metalheart to Law & Government (14 answers total)
I am not an expert in this area at all, but i do know that the Mental Health Act allows for a person to be detained if they are a danger to themselves or others. Obviously there are specific requirements required for the law to apply. It appears these are state, rather than federal laws, at least from my minimal googling.

Mental Health Act of Victoria, 1986 Might be a good place to start investigating further
posted by chromatist at 10:00 AM on February 1, 2009

Response by poster: Hi, chromatist, that's what my friend said to look at as well, but I couldn't find anything in it about psychiatric evaluations or what evidence one had to have to get a GP to recommend someone go through it. The psychiatrist who told him this seemed to suggest that all one had to do was convince the GP that the other person was a harm to himself or others. That's not really a difficult thing to do if all the evidence needed is your random word.

Also, on the endangerment to oneself and/or others, that still seems like it would need some evidence (i.e., that someone couldn't just go and convincingly speak to a GP). I think that in U.S. law, the medical practitioner has to see the possibly mentally ill person (not someone who knows him) to recommend a psychiatric evaluation or commitment. From searching, that seems to be right.
posted by metalheart at 10:21 AM on February 1, 2009

Best answer: This law does not exist in the U.S. A random person cannot be forced to go to a primary care provider or random psychiatirist for a mental health evaluation against their will. A treating physician can *receive* anyone's statements about a patient that is already seeing them of their own free will, and then use that information to help make a determination about that person's competence. But in order to force an evaluation of a random crazy person in society, the process has to start with the police, which of course implies that something illegal, or at least disruptive, has already occurred.

Here's on involuntary commitment works in Washington state: If a treating physician determines that their patient poses an immediate danger to themselves or others (note that the presence of severe mental illness is not justification enough), they can recommend that the patient be evaluated for a 72 hour involuntary commitment and inpatient psychiatric evaluation. At that point, a state appointed mental health professional will take over and do a more detailed assessment. My experience is that, even when a physician believes the patient is not safe to be living freely in society, the MHP commits them in only a small minority of cases (<10%, total guess). The hurdle for taking away someone's civil liberty if very high and when it comes to balancing a mentally unstable person's safety against their liberty, the law gives much more weight to their liberty.
posted by Slarty Bartfast at 10:27 AM on February 1, 2009

That should read: "Here's *how* an involuntary..."
posted by Slarty Bartfast at 10:28 AM on February 1, 2009

Response by poster: @Slarty: Thanks so much for that information. What you stated for Washington is what I understood to be the case in most of the states. (I was last living in TN, and pretty well exactly the same stuff existed there, from what I know.)

@MLIS: Thanks for the links, but they're a no go. Nothing on psychiatric evaluations in either of them, really, other than to say people who have committed crimes can be evaluated for a number of things, which, of course, makes sense.

Still looking into this! Thanks for the help I've received so far.
posted by metalheart at 11:11 AM on February 1, 2009

Best answer: WA Mental Health Legal Centre Patient Rights Guide:

An involuntary patient is a person against whom an involuntary
patient order has been made. As an involuntary patient you are
required to accept psychiatric treatment even if it is against your will.

Patients who are treated involuntarily may be either detained in an
authorised hospital or treated at home or at a mental health clinic on a
Community Treatment Order (CTO). There is more about CTOs on
pages 17-22.

Certain health professionals have the power to refer you to a hospital
for assessment but only psychiatrists have the power to make you an
involuntary patient and authorise treatment against your will. The
Mental Health Act 1996 (WA) sets out the conditions that must be
satisfied before you can be made an involuntary patient. As an
involuntary patient you still have rights. One right is that you must be
told both in writing and verbally about your legal status. For more
information on your rights see pages 11-15.

Being made an involuntary patient

Any doctor, a psychiatrist, a general practioner or an authorised
mental health practitioner can refer a person to a mental health service
for assessment. You may be given a copy of the referral (Form 1) but
are not automatically entitled to a copy. This assessment will
determine whether you should be admitted as an involuntary detained
patient or put on a CTO. When an order for involuntary detention is
made you must be given a copy. The maximum length of the first
order to be a detained patient is 28 days. However it is important to
know that the order may be extended.

It appears that it's the case in Western Australia.
posted by zamboni at 11:27 AM on February 1, 2009

Response by poster: Thanks for that, zamboni! It makes sense to me that a medical professional can refer someone for assessment, according to what he or she perceives as an issue in an individual. What doesn't make sense to me (and what doesn't appear to be mentioned in that quote) is whether another person, a third party, could go to a professional and convince them that someone else needs a psychiatric evaluation without the doctor ever meeting said person face-to-face. This is what the psychiatrist my friend was around seemed to suggest.

Having looked over that WA health code, it seems to suggest that the doctor actually has to see the potentially mentally ill person face-to-face, as is the case in U.S. law.

Seeing that the word "involuntary" was used mainly in the WA policy, I've tried again with the Victorian one. Here's something it says:

A person may be admitted to and detained in an approved mental health service as an involuntary patient upon production of....(b) a recommendation in the prescribed form by a registered medical practitioner following a personal examination of the person made not more than three clear days before the admission of the person.

Of course, this is all involuntary commitment, which is a little different from psychiatric evaluation. Still, though, this all seems to suggest that the doctor actually has to meet the person said to be mentally ill. Someone convincing a doctor that you're crazy doesn't seem to meet the criteria for you to be carted off. I reckon that's good!

I'm pretty satisfied with this, overall, but if anyone knows anything more specifically about the rights of individuals to get doctors to recommend other people for psychiatric evaluations, that'd be cool.
posted by metalheart at 12:15 PM on February 1, 2009

If these laws do exist in either or both countries, what provisions are there to protect individuals from being evaluated wrongfully? I.e., suing doctors and the like

I don't know what the case is in Australian law specifically but I'd assume that defamation laws would come into play here. You can't go around telling lies about someone to your doctor any more than you can to someone else, and if it results in someone being sent for a psych assessment when they're clearly sane then you've got a pretty clear case of damage being caused by the false statements. So maybe try looking up your local laws for slander and the like?
posted by shelleycat at 12:16 PM on February 1, 2009

Response by poster: @Shelleycat: My friend and I discussed that as well. We guessed if that occurred, the doctor would be the one sued, though, as confidentiality laws would probably prevent him from saying which patient of his had discussed another person with him. However, if no real evidence is necessary for someone to try to convince a doctor of another person's alleged illness, I guess a doctor could just use a cop out and say his patient must have misunderstood the situation or something.

It's a very strange thing. I can't imagine why the psychiatrist would tell my friend this if it weren't true, but perhaps he doesn't understand the law himself, or just [very] poorly communicated it.
posted by metalheart at 1:00 PM on February 1, 2009

Best answer: I can offer some Canadian perspective. Here in Ontario, the major instrument for getting someone a psychiatric evaluation against their will is a Form 1. If a physician has examined a patient within the past 7 days, he/she can fill out a Form 1 and have the patient remanded for assessment for a maximum of 72 hours. Once assessed, the psychiatrist may fill out another form to have them admitted involuntarily for a longer period if necessary.

The other route is when a member of the public thinks another person be at risk of self-harm or harm to others. In that case, you'd have to bring sworn evidence to a justice of the peace, who then fills out a Form 2, advising the police to bring the named person to any physician, who can then decide whether to fill out a Form 1 and start the whole process. So I guess the deterrent for false claims is perjury in this case.
posted by greatgefilte at 3:23 PM on February 1, 2009

Best answer: In Ohio it is possible for a lay person to petition (file an affidavit with) the Probate Court and ask the Probate Judge to issue an order for the County Sheriff to detain the person and be taken for involuntary emergency evaluation. In practice this is hardly ever done--Probate Judges usually insist that the person first be examined by an approved MH professional before an order of detention is issued. This provision is in the law I believe) to enable an interested citizen (family member,etc.) to intervene with a mentally ill person whose behavior is dangerous to self or others but will not voluntarily seek evaluation or who is not subject to observation/access by police or other MH professionals (e.g.depressed/paranoid/ reclusive person locked in own apartment and refusing food,etc.) As I said, it is very very seldom done--usually the Judge will also ask certain MH professionals (designated by law) to either evaluate the person or attest to the possibility the person is in imminent danger. The intervention by the Court is to assure due process and guard against abuse..
posted by rmhsinc at 4:20 PM on February 1, 2009

Best answer: It is very difficult to get somebody assessed in Australia. My aunt suffered from schizophrenia for years - dropped out of several unis because the lecturers hated her, or the assessment was a trick, doctor shopped until all her kids were on meds for ADHD and various other conditions, flew to Sydney and rang her husband on a public phone to say that she was investigating a police conspiracy, etc etc. Her husband and siblings spent years trying to get some form of help for her, but because nothing she was doing was illegal, they couldn't. After she disappeared for a few days on an impromptu trip to Melbourne to escape some 'government organisation', somehow they finally got her to a hospital and got her diagnosed and she got some form of mental health order, where somebody visited her twice a day or whatever to enforce her medication.

In other words, your friend is completely, absolutely, incorrect. If that was how it worked she would have been on meds some ten years earlier.
posted by jacalata at 6:49 PM on February 1, 2009

Response by poster: Thanks, everyone. I'm going to tag this as "resolved."

Having dealt with someone mentally ill in my own personal life (in the U.S.), I know it's not easy to get any authority to agree with involuntary commitment or assessment. I found it highly unlikely that it'd be any different in a country that has many of the same laws.

Thanks again!
posted by metalheart at 8:48 PM on February 1, 2009

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