Patient Rights Advisor Services

In 2005 Nova Scotia passed the Involuntary Psychiatric Treatment Act. Under this act a patient can access an advisor whose job is to advise them of their rights.

The mental health branch of the Department of Health is responsible for:

developing and maintaining the standardized education program for the Patient Advisor Service and Patient Advisors
providing the first education session; subsequent education sessions will be the responsibility of the Patient Advisors Service
determining the role and qualifications of Patient Advisors in accordance with the Involuntary Psychiatric Treatment Act
auditing and evaluating the Patient Advisor Service
establishing a minimum standard of performance

The patient-advisor service may offer advice and assistance to:

a person who is undergoing an involuntary psychiatric assessment upon request of patient or substitute-decision maker;
an involuntary patient who is subject to a declaration of involuntary admission;
a patient who is on a 'community treatment order';
an involuntary patient who is subject to a 'certificate of leave';
a substitute decision-maker of a patient involved in any of the above conditions.

What is Rights Advice?

Rights advise is a standard form of information provided to patients in Nova Scotia who experience a change in legal status, for example upon being made involuntary, incapable of consenting to treatment etc.

Rights advice provides protection to individuals who are experiencing a loss of freedom to make their own decisions. This protection takes the form of explaining the loss, the options available to the affected individual with respect to having the decision reviewed and obtaining legal representation if requested.

Who Provides Rights Advice?

Under the IPTA a qualified individual who is employed by the Patient Rights Advisor Service and has successfully completed the training program provides rights advice. The individual can not be an employee of the District Health Authority or IWK.

Patient Rights Advisor

Qualifications

Only persons who meet the following requirements may be designated to perform the functions of a patient advisor under the Act:

must be knowledgeable of mental health and illness as well as the range services available to those with mental illnesses;
must have previous experience in dealing with individuals with mental illnesses;
must be knowledgeable of the review board, including role and function;
must be knowledgeable of access, application, policy and procedures of Review Board;
must be knowledgeable in obtaining legal services;
criminal and Child Abuse Registry clearance
must have necessary communications skills to perform designated functions effectively;
must complete a training course approved by the Minister and receive certification.

Patient Rights Advisor Role

meet promptly with the involuntary patient or substitute decision- unless they object
explain to patient the significance of their situation
identify available options including the right to have status reviewed by review board, if there is disagreement with the physician's decision
communicate in a neutral, non-judgmental manner
assist patient to make application to review board if requested
assist patient to obtain legal counsel or legal aid, if requested
maintain confidentiality
assist patient in carrying out his/her decisions, but shall not make decisions for patients
accompany the patient to review board hearings, upon request of patient or substitute - decision maker

Confidentiality

Rights advisors must safeguard the patient’s right to privacy. The patient often reveals sensitive personal information to the treatment team. The fact that a patient is receiving psychiatric care is a private matter. In this context, maintaining confidentiality means that confidential information should only be shared among members of the treatment team. However, it is important to remember that the rights advisor is not a member of the treatment team. Therefore, to maintain confidentiality, a rights advisor must not share information obtained in confidence from the client, even with the treatment team.

Since rights advice is not a clinical activity, it is not an activity that is documented in the patient’s record of personal health information. However, a rights advisor will complete "A Request for Right Advice Form" and give the form to a member of the treatment team. The form informs the staff that rights advice has been provided.

Unlike "solicitor-client-privilege," client confidentiality between a rights advisor and a patient is not protected by law. Therefore, a rights advisor could be subpoenaed to attend court with his or her records, and to testify. In addition, the rights advisor’s duty to maintain confidentiality does not apply when the client reveals an intention to cause physical harm to him, herself or to others and that risk may not already be known to the treatment team. A client-centered approach in this situation is to inform the client that the treatment team must be told of this possibility and encourage the client to make the disclosure. However, unless the rights advisor is satisfied that the client has indeed made the disclosure, the rights advisor must inform a member of the treatment team.

It should be remembered that client confidentiality is for the benefit of the client, and can be waived by the client at any time. The client may make a decision to waive confidentiality and request the rights advisor to pass information on to a social worker.