Involuntary Psychiatric Treatment Regulations

made under Section 83 of the

Involuntary Psychiatric Treatment Act

S.N.S. 2005, c. 42

O.I.C. 2007-239 (effective July 3, 2007), N.S. Reg. 235/2007

amended to O.I.C. 2024-309 (effective August 13, 2024), N.S. Reg. 161/2024

Table of Contents

Please note: this table of contents is provided for convenience of reference and does not form part of the regulations.
Click here to go to the text of the regulations.

Citation

Definitions

Interpretation

Designated psychiatric facilities

Patient rights

Examination by second psychiatrist

Treatment plans

Electronic examinations and assessments

Written hearings

Electronic hearings

Written decisions of Review Board

Review Board’s annual report

Forms

Instructions for Form 1: Detainment of Voluntary Patient

Form 1: Detainment of Voluntary Patient

Instructions for Form 2: Certificate for Involuntary Psychiatric Assessment—Part 1

Form 2: Certificate for Involuntary Psychiatric Assessment—Part 1

Instructions for Form 3: Certificate for Involuntary Psychiatric Assessment—Part 2

Form 3: Certificate for Involuntary Psychiatric Assessment—Part 2

Instructions for Form 4: Declaration of Involuntary Admission

Form 4: Declaration of Involuntary Admission

Instructions for Form 5: Declaration of Renewal of Involuntary Admission

Form 5: Declaration of Renewal of Involuntary Admission

Instructions for Form 6: Declaration of Change of Status

Form 6: Declaration of Change of Status

Instructions for Form 7: Certificate of Leave

Form 7: Certificate of Leave

Instructions for Form 8: Certificate of Cancellation of Leave

Form 8: Certificate of Cancellation of Leave

Instructions for Form 9: Community Treatment Order

and Community Treatment Plan

Form 9: Community Treatment Order

Instructions for Form 10: Renewal of Community Treatment Order

Form 10: Renewal of Community Treatment Order

Instructions for Form 11: Termination of Community Treatment Order

Form 11: Termination of Community Treatment Order

Instructions for Form 12: Application for Review

Form 12: Application for Review

Instructions for Form 13: Notice of Hearing

Form 13: Notice of Hearing

Citation

1 These regulations may be cited as the Involuntary Psychiatric Treatment Regulations.

Definitions

2 In these regulations,

“Act” means the Involuntary Psychiatric Treatment Act;

“agent” in Section 72 of the Act means a person appointed by the patient to be the patient’s representative;

“capacity” means capacity as defined in the Adult Capacity and Decision-making Act;

“declaration” does not mean a declaration as defined in the Interpretation Act or the Evidence Act;

“support” means support as defined in the Adult Capacity and Decision-making Act;

“witnesses” in subsection 74(1) of the Act does not include a patient.

Interpretation

2A These regulations must be read and applied in a manner consistent with Canada’s accepted obligations under the United Nations Convention on the Rights of Persons with Disabilities.

Designated psychiatric facilities

3 (1) The following hospitals, or parts of hospitals, are designated as psychiatric facilities:

(a) Queen Elizabeth II Health Sciences Centre;

(b) Izaak Walton Killam Health Centre;

(d) Cape Breton Regional Hospital;

(e) Colchester East Hants Health Centre;

(f) East Coast Forensic Hospital;

(g) St. Martha’s Regional Hospital;

(h) South Shore Regional Hospital;

(i) Valley Regional Hospital;

(j) Yarmouth Regional Hospital.

(2) A medical examination or involuntary psychiatric assessment may be conducted at any hospital, health centre or location within a community, including, but not limited to, the designated psychiatric facilities named in subsection (1).

Patient rights

4 (1) When a patient is admitted to a psychiatric facility under the Act, a Declaration of Renewal of Involuntary Admission is issued for a patient or a patient’s status is changed to that of an involuntary patient, the patient and the patient’s substitute decision-maker must be given notice of the following rights orally and in writing in the form approved by the chief executive officer:

(a) the name and location of the psychiatric facility in or through which the patient is being detained;

(b) the patient’s right to be discharged if a declaration for renewal of the detention is not issued;

(d) the Review Board’s functions and the patient’s right to have their status reviewed by the Review Board or a court;

(e) the patient’s right to an oral explanation of any document or written communication that affects the patient.

(2) A psychiatric facility must assist a patient or person who is unable to read or understand a document or written communication that affects them and who wants an oral explanation of the document or written communication.

(3) A psychiatric facility must post a listing of patients’ rights, as set out in subsection (1), in a place in the psychiatric facility where it can [be] seen by a persons undergoing psychiatric assessments and treatment.

Examination by second psychiatrist

5 If the Review Board arranges for a patient to be examined by a second psychiatrist under subsection 74(2) of the Act, the Review Board must try to engage a psychiatrist who has not been involved with the patient’s case.

Treatment plans

5A (1) In addition to the requirements in the Act, a treatment plan made under Section 20A of the Act must include all of the following:

(a) the patient’s diagnosis;

(b) a list of medications prescribed for the patient and rationale for prescribing each medication for the patient;

(d) the name of and contact information for the patient’s attending psychiatrist;

(e) the name of and contact information for the substitute decision-maker who provided consent to the treatment plan;

(f) the date of the substitute decision-maker’s consent.

(2) The psychiatrist may vary any part of the treatment plan.

(3) Any variation made by the psychiatrist to a treatment plan must be in writing and provided promptly to the patient and the patient’s substitute decision-maker.

(4) The patient’s substitute decision-maker must consent to a variation of the treatment plan.

(5) The patient and the patient’s substitute decision-maker may request the attending psychiatrist to review the treatment plan.

Electronic examinations and assessments

5B (1) A medical examination or involuntary psychiatric assessment may be held by electronic means if all of the following conditions are met:

(a) the psychiatrist determines it is in the best interests of the patient in accordance with subsection (2);

(b) the decision to conduct an electronic medical examination or involuntary psychiatric assessment and supporting reasons are documented in writing;

(c) the psychiatrist uses a secure electronic platform to conduct the medical examination or involuntary psychiatric assessment;

(d) all clinicians involved maintain the confidentiality of the patient’s personal health information and advise the patient of any known limitations on confidentiality or privacy before the patient undergoes the electronic medical examination or involuntary psychiatric assessment;

(e) the electronic medical examination or involuntary psychiatric assessment is capable of being conducted in a manner consistent with accepted professional practice standards.

(2) A psychiatrist must consider all of the following factors when determining whether an electronic medical examination or involuntary psychiatric assessment is in a patient’s best interests:

(a) whether there are adequate human resources and physical resources for the electronic medical examination or involuntary psychiatric assessment, taking into consideration accessibility and timeliness of access;

(b) any public health mandates or concerns;

(d) the patient’s right to privacy and confidentiality.

Written hearings

5C (1) The Review Board may conduct a written hearing for any of the following types of hearings or under any of the following circumstances:

(a) a renewal hearing;

(b) an uncontested hearing;

(d) if a patient or their legal counsel requests a written hearing.

(2) A written hearing must meet all the following requirements:

(a) all parties to the hearing must agree to a written hearing;

(b) the hearing panel must meet to consider the written evidence and make a decision;

(3) When conducting a written hearing, the Review Board is subject to the provisions of the Act and the regulations respecting all of the following:

(a) written decisions, in Section 6;

(b) panels, in Section 66 of the Act;

(d) conduct of hearings, in Section 69 of the Act;

(e) notice, in Section 70 of the Act;

(f) closed hearings, in Section 71 of the Act;

(g) entitlement to representation, in Section 72 of the Act;

(h) evidence, in Section 73 of the Act;

(i) powers of the Review Board during a hearing, in Section 74 of the Act;

(j) the Public Inquiries Act, in Section 75 of the Act;

(k) decisions, in Section 76 of the Act;

(l) onus of proof, in Section 77 of the Act;

(m) standard of proof, in Section 78 of the Act;

(n) appeals, in Section 79 of the Act.

(4) Any party to a hearing or the Review Board may request a full oral hearing at any time before the scheduled hearing date.

Electronic hearings

5D (1) The Review Board may conduct a full oral hearing by electronic means except when an in-person hearing is requested by the patient or their legal counsel.

(2) A hearing held by electronic means must be conducted through a secure electronic platform.

(3) If a party to a hearing held by electronic means experiences technological or connectivity issues, the hearing must be held in abeyance until all parties are reconnected.

Written decisions of Review Board

6 A written decision of the Review Board must include all of the following:

(a) a summary of the facts of the case;

(b) the Board’s decision;

Review Board’s annual report

7 The Review Board’s annual report must contain all of the following:

(a) statistics of the Review Board’s activities;

(b) recommendations to the Minister.

Forms

8 The following forms must be used in accordance with the Act:

Form No.	Form title	Section of the Act
1	Detainment of Voluntary Patient	7
2	Certificate for Involuntary Psychiatric Assessment—Part 1	9
3	Certificate for Involuntary Psychiatric Assessment—Part 2	10(2)
4	Declaration of Involuntary Admission	17, 18 and 19
5	Declaration of Renewal of Involuntary Admission	21
6	Declaration of Change of Status	24(2)
7	Certificate of Leave	43
8	Certificate of Cancellation of Leave	44
9	Community Treatment Order	47
10	Renewal of Community Treatment Order	52
11	Termination of Community Treatment Order	55, 56 and 57
12	Application for Review	68
13	Notice of Hearing	70

________________________________________________________________

Instructions for Form 1: Detainment of Voluntary Patient

(Section 7, Involuntary Psychiatric Treatment Act)

The actions and decisions to be documented on this form, which forms a part of the Involuntary Psychiatric Treatment Regulations, are to be undertaken in a manner consistent with Canada’s accepted obligations under the United Nations Convention on the Rights of Persons with Disabilities and in accordance with the guiding principles set out in subsection 2(1) of the Act.

When to use this form:

• To detain and, if necessary, restrain a voluntary patient requesting to be discharged.

When filling out the form:

• A voluntary patient at this facility, who is requesting discharge, must meet all 3 of the criteria for involuntary admission listed on the form.

• The patient must meet at least 1 of the criteria under number 2. (Check all that apply)

Notes:

• A patient who is detained under subsection 7(1) of the Act must be examined by a physician within 3 hours of being detained.

• A patient may be detained under subsection 7(1) of the Act for no more than 3 hours at any hospital, health centre or community care centre of Nova Scotia Health or IWK Health, including, but not limited to, the designated psychiatric facilities named in subsection 3(1) of the regulations.

________________________________________________________________

Form 1: Detainment of Voluntary Patient

(Section 7, Involuntary Psychiatric Treatment Act)

I, _______________________________________ (full name), a member of the treatment staff at __________________________________ (name of facility), believe on reasonable grounds that _________________________________ (full name of patient), a voluntary patient, who is requesting discharge, meets all of the following criteria:

1. the patient has a mental disorder

2. because of the mental disorder, if the patient leaves the facility, the patient is likely to (check all that apply)

❑ cause serious harm to themself or to another person

❑ suffer serious mental deterioration

❑ suffer serious physical deterioration

3. the patient needs to have a medical examination conducted by a physician

Therefore, I am detaining the patient at this facility for no more than 3 hours to allow for examination by a physician.

❑ By checking this box, I confirm I have informed the patient and the patient’s substitute decision-maker of the patient’s right to retain and instruct legal counsel.

		(dd/mm/yyyy)
(date of signature)			(signature of treatment staff member)
	a.m./p.m.
(time of signature)			(staff member’s name—printed)

________________________________________________________________

Instructions for Form 2: Certificate for Involuntary Psychiatric Assessment—Part 1

(Section 9, Involuntary Psychiatric Treatment Act)

When to use this form:

• To document the medical examination of a person who is the subject of a Detainment of Voluntary Patient (Form 1).

• Two copies of this form from 2 separate physicians (1 from each physician) are required to initiate a Declaration of Involuntary Admission (Form 4).

• A second Form 2 is not needed if a Certificate for Involuntary Psychiatric Assessment—Part 2 (Form 3) is completed.

When filling out the form:

• The patient must meet all 3 of the criteria listed on the form.

• The patient must meet at least 1 of [the] criteria under number 2. (Check all that apply)

• In accordance with Section 9 of the Act, this certificate must be signed by the physician who examined the person and is not effective unless it is signed within 72 hours after the time of the examination.

• This form, once completed, must be filed with the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records.

Notes:

• A person cannot be taken into custody or detained unless this certificate is accompanied by 1 of the following certificates:

• a second Certificate for Involuntary Psychiatric Assessment—Part 1 (Form 2) signed by another physician, or

• a Certificate for Involuntary Psychiatric Assessment—Part 2 (Form 3) signed by the same physician who signed Part 1

• The 72-hour hold for an involuntary psychiatric assessment starts when a person is detained under the second Form 2.

• If the person is already at the place where they are to be detained, it starts when the second Form 2 is signed.

• If Form 3 is used and there is no second Form 2, it starts when the first Form 2 is signed.

• If the person is not physically present to be detained when the second Form 2 or Form 3 is issued, the 72-hour hold starts when the person is detained.

• Time spent under detention before the second Form 2 (or Form 3, if applicable) is issued does not count towards the 72 hours.

• In accordance with subsection 10(1) of the Act, 2 certificates for involuntary psychiatric assessment are sufficient authority for the following actions:

• any peace officer to take the person into custody as soon as possible and to a suitable place for an involuntary psychiatric assessment as soon as possible;

• the person to be detained, restrained and observed for not more than 72 hours; and

• a psychiatrist to conduct an involuntary psychiatric assessment.

• A medical examination or involuntary psychiatric assessment may be conducted at any hospital, health centre or location within the community, including, but not limited to, the designated psychiatric facilities named in subsection 3(1) of the regulations.

________________________________________________________________

Form 2: Certificate for Involuntary Psychiatric Assessment—Part 1

(Section 9, Involuntary Psychiatric Treatment Act)

I, Dr. __________________________________________ (full name), a physician, personally examined __________________________________________ (full name of person) on the following date and at the following time and location:

Date (dd/mm/yyyy)

Time

Location

Method

❑ a.m.

❑ p.m.

❑ in person

❑ video call

❑ telephone

If by video or telephone, state rationale:

Having made careful inquiry into the facts relating to the case of the person, I have reasonable and probable grounds to believe that the person meets all of the following criteria (as set out in Sections 7 and 8 of the Act):

1. the person apparently has a mental disorder

2. the person, as a result of the mental disorder, (check all that apply)

❑ is threatening or attempting to cause serious harm to themself or has recently done so

❑ has recently caused serious harm to themself

❑ is seriously harming or is threatening serious harm towards another person or has recently done so

❑ will suffer serious physical impairment

❑ will suffer serious mental deterioration

3. the person would benefit from psychiatric inpatient treatment in a psychiatric facility and is not suitable for inpatient admission as a voluntary patient

The following reasons and information support my belief that this person has a mental disorder and meets the criteria above:

Reasons, based on my observations and examination of the person:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Information from other sources:

Information: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please identify sources:

		(dd/mm/yyyy)
			(signature of physician)
	a.m./p.m.
(time of signature)			(physician’s name—printed)

This form, once completed, must be filed with the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records.

________________________________________________________________

Instructions for Form 3: Certificate for Involuntary Psychiatric Assessment—Part 2

(subsection 10(2), Involuntary Psychiatric Treatment Act)

When to use this form:

• If the physician determines compelling circumstances exist and a second physician is not readily available to examine the person and execute a second certificate.

• This form, once completed, must be filed with the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records.

Notes:

• This form must be accompanied by a Certificate for Involuntary Psychiatric Assessment—Part 1 (Form 2) signed by the same physician.

________________________________________________________________

Form 3: Certificate for Involuntary Psychiatric Assessment—Part 2

(subsection 10(2), Involuntary Psychiatric Treatment Act)

I, Dr. _______________________________________ (full name), a physician, signed the attached Certificate for Involuntary Psychiatric Assessment—Part 1 for _______________________________________ (full name of person).

Compelling circumstances exist for the involuntary psychiatric assessment of the person and a second physician is not readily available to examine the person and complete a second Certificate for Involuntary Psychiatric Assessment—Part 1.

		(dd/mm/yyyy)
(date of signature)			(signature of physician)
	a.m./p.m.
(time of signature)			(physician’s name—printed)

This form, once completed, must be filed with the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records.

________________________________________________________________

Instructions for Form 4: Declaration of Involuntary Admission

(Sections 17, 18 and 19, Involuntary Psychiatric Treatment Act)

When to use this form:

• To admit a person as an involuntary inpatient.

When filling out the form:

• The person must meet all of the criteria listed in Section 17 of the Act.

• The person must meet at least 1 of the criteria under number 3. (Check all that apply)

• This form, once completed, must be filed with the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records.

Notes:

• Clause 3(q) of the Act defines mental disorder as “a substantial disorder of behaviour, thought, mood, perception, orientation or memory that severely impairs judgement, behaviour, capacity to recognize reality or the ability to meet the ordinary demands of life, in respect of which psychiatric treatment is advisable.”

• In accordance with Section 17 of the Act, this form must be filed with the chief executive officer or their designate.

• In accordance with clause 22(a) of the Act, an involuntary patient may be detained, observed and examined in a psychiatric facility for not more than 30 days under a declaration of involuntary admission.

• In accordance with Section 26 of the Act, when a declaration of involuntary admission is filed, the patient and the patient’s substitute decision-maker must be promptly informed in writing of the reasons for the patient’s admission, their right to legal counsel, and all other rights and information listed in subsection 26(1) of the Act.

• A completed Form 4: Declaration of Involuntary Admission requires a transfer of the person to 1 of the psychiatric facilities designated in the regulations.

________________________________________________________________

Form 4: Declaration of Involuntary Admission

(Sections 17, 18 and 19, Involuntary Psychiatric Treatment Act)

I, Dr. _____________________________________ (full name), a psychiatrist on the staff of _____________________________________ (name of facility), personally examined

_____________________________________ (full name of person), on the following dates and at the following times and locations:

Date (dd/mm/yyyy)	Time		Location	Method
		❑ a.m. ❑ p.m.		❑ in person ❑ video call ❑ telephone
If by video or telephone, state rationale:
		❑ a.m. ❑ p.m.		❑ in person ❑ video call ❑ telephone
If by video or telephone, state rationale:
		❑ a.m. ❑ p.m.		❑ in person ❑ video call ❑ telephone
If by video or telephone, state rationale:

I have conducted an involuntary psychiatric assessment of this person and I have reasonable and probable grounds to believe that the person meets all of the following criteria:

1. the person has a mental disorder

2. the person is in need of psychiatric treatment provided in a psychiatric facility

3. as a result of the mental disorder, the person (check all that apply)

❑ is threatening or attempting to cause serious harm to themself or has recently done so

❑ has recently caused serious harm to themself

❑ is seriously harming or is threatening serious harm towards another person or has recently done so

❑ will suffer serious physical impairment

❑ will suffer serious mental deterioration

4. the person requires psychiatric treatment in a psychiatric facility and is not suitable for inpatient admission as a voluntary patient

5. as a result of the mental disorder, the person does not have the capacity to make admission and treatment decisions

In determining that reasonable and probable grounds exist that the person does not have the capacity to make admission and treatment decisions, I have assessed whether the patient has the ability, with or without support, to understand all of the following:

• the nature of the condition for which the specific treatment or admission is proposed

• the nature and purpose of the specific treatment

• the risks and benefits involved in undergoing the specific treatment

• the risks and benefits involved in not undergoing the specific treatment or admission

I have also considered whether the person’s mental disorder affects the person’s ability, with or without support, to appreciate the reasonably foreseeable consequences of making or not making a decision, including the reasonably foreseeable consequences of the decision to be made.

The following reasons and information support my determination that reasonable and probable grounds exist that this person has a mental disorder and meets the criteria as described above:

Reasons, based on my observations and examination of the patient:

Information from other sources:

Please identify sources:

❑ By checking this box, I confirm I have informed the patient and the patient’s substitute decision-maker of the patient’s right to retain and instruct legal counsel, and the steps the patient may follow to obtain legal counsel. I acknowledge that checking this box does not relieve me of the obligation to promptly inform the patient and the patient’s substitute decision-maker, in writing and in language that the patient is likely to best understand, of the information set out in Section 26 of the Act.

Therefore, I declare that this person meets the criteria of Section 17 of the Involuntary Psychiatric Treatment Act and is to be admitted to ___________________________ (name of psychiatric facility) as an involuntary patient.

This declaration is effective on the date it is signed and expires on ___/___/_____ (dd/mm/yyyy—no later than 30 days after date signed).

		(dd/mm/yyyy)
(date of signature)			(signature of psychiatrist)
	a.m./p.m.
(time of signature)			(psychiatrist’s name—printed)

This form, once completed, must be filed with the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records.

________________________________________________________________

Instructions for Form 5: Declaration of Renewal of Involuntary Admission

(Section 21, Involuntary Psychiatric Treatment Act)

When to use this form:

• To renew a patient’s status as an involuntary inpatient.

• A new Form 5 must be completed for each renewal.

When filling out the form:

• The patient must meet all of the criteria listed in Section 17 of the Act.

• Unless otherwise specified, renewal dates follow the effective declaration date on Form 4.

• This form, once completed, must be filed with the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records.

• If it is associated with a mandatory hearing, this form, once completed, must also be filed [with] the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

• It is the facility’s responsibility to track patient involuntary treatment status and inform IPTA Administration at the Office of Addictions and Mental Health at IPTAadmin@novascotia.ca when mandatory hearings are due.

Notes:

• In accordance with Section 26 of the Act, when a declaration of involuntary admission is filed, the patient and the patient’s substitute decision-maker must be promptly informed in writing of the reasons for the patient’s admission, their right to legal counsel and all other rights and information listed in subsection 26(1) of the Act.

• In accordance with Section 21 of the Act, this form must be filed with the chief executive officer or their designate.

• In accordance with Section 22 of the Act, a declaration of renewal may be issued for the following terms:

Renewal	Term
1st renewal	up to 30 days
2nd renewal	up to 60 days
3rd and subsequent renewals	up to 90 days

• A renewal is effective from the expiry date given on Form 4, or the previous renewal, unless otherwise specified by the psychiatrist.

• If this form is not filled out, the attending psychiatrist must fill out Form 6: Declaration of Change of Status.

________________________________________________________________

Form 5: Declaration of Renewal of Involuntary Admission

(Section 21, Involuntary Psychiatric Treatment Act)

I, Dr. ___________________________________ (full name), a psychiatrist on the staff of __________________________ (name of psychiatric facility), am the attending psychiatrist of _____________________________ (full name of patient), an involuntary patient at the facility.

This declaration of renewal renews the Declaration of Involuntary Admission dated ___/___/_____ (dd/mm/yyyy), which expires/expired on ___/___/_____ (dd/mm/yyyy).

This is the ______ (1st, 2nd, 3rd, etc.) renewal of that declaration and expires on ___/___/_____ (dd/mm/yyyy).

If this is a second or subsequent renewal, the previous declaration of renewal expires on ___/___/_____ (dd/mm/yyyy).

I personally examined this patient on the following date and at the following time and location:

Date (dd/mm/yyyy)

Time

Location

Method

❑ a.m.

❑ p.m.

❑ in person

❑ video call

❑ telephone

If by video or telephone, state rationale:

I have conducted an involuntary psychiatric assessment of this patient and I have reasonable and probable grounds to believe that the patient meets all of the following criteria:

• the patient has a mental disorder

• the patient is in need of psychiatric treatment provided in a psychiatric facility

• as a result of the mental disorder, the patient (check all that apply)

❑ is threatening or attempting to cause serious harm to themself or has recently done so

❑ has recently caused serious harm to themself

❑ is seriously harming or is threatening serious harm towards another person or has recently done so

❑ is likely to suffer serious physical impairment

❑ is likely to suffer serious mental deterioration

• the patient requires psychiatric treatment in a psychiatric facility and is not suitable for inpatient admission as a voluntary patient

• as a result of the mental disorder, the patient does not have the capacity to make admission and treatment decisions

In determining that reasonable and probable grounds exist that the patient does not have the capacity to make admission and treatment decisions, I have assessed whether the patient has the ability, with or without support, to understand all of the following:

• the nature of the condition for which the specific treatment or admission is proposed

• the nature and purpose of the specific treatment

• the risks and benefits involved in undergoing the specific treatment

• the risks and benefits involved in not undergoing the specific treatment or admission

I have also considered whether the patient’s mental disorder affects the patient’s ability, with or without support, to appreciate the reasonably foreseeable consequences of making or not making a decision, including the reasonably foreseeable consequences of the decision to be made.

The following reasons and information support my determination that reasonable and probable grounds exist that this person has a mental disorder and meets the criteria as checked above:

Reasons, based on my observations and examination of the patient:

Information from other sources:

Please identify sources:

❑ A written, individualized treatment plan has been prepared for the patient in accordance with Section 20A of the Involuntary Psychiatric Treatment Act within 30 days of involuntary admission.

❑ A copy of this written individualized treatment plan has been promptly provided to the patient and the patient’s substitute decision-maker on ___/___/_____ (dd/mm/yyyy) in accordance with subsection 20A(3) of the Involuntary Psychiatric Treatment Act.

❑ By checking this box, I confirm I have informed the patient and the patient’s substitute decision-maker of the patient’s right to retain and instruct legal counsel, and the steps the patient may follow to obtain free legal counsel. I acknowledge that checking this box does not relieve me of the obligation to promptly inform the patient and the patient’s substitute decision-maker, in writing and in language that the patient is likely to best understand, of the information set out in Section 26 of the Involuntary Psychiatric Treatment Act.

Therefore, I declare that the patient’s status as an involuntary patient is renewed, effective on the date this declaration is signed.

	(dd/mm/yyyy)
(date of signature)		(signature of attending psychiatrist)

		(attending psychiatrist’s name—printed)

This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

It is the facility’s responsibility to track patient involuntary treatment status and inform the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca when mandatory hearings are due.

________________________________________________________________

Instructions for Form 6: Declaration of Change of Status

(subsection 24(2), Involuntary Psychiatric Treatment Act)

When to use this form:

• When the patient no longer meets the requirements of Section 17 of the Act and the patient’s status is changed to that of a voluntary patient.

When filling out the form:

• Check the appropriate boxes to identify which criteria the patient no longer meets.

• This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

Notes:

• In accordance with subsection 24(2) of the Act, this form must be filed with the chief executive officer or their designate.

• In accordance with subsection 24(3) of the Act, when a patient’s status is changed to that of a voluntary patient, the chief executive officer must ensure that the patient is promptly informed that they are a voluntary patient and they have the right to leave the psychiatric facility, subject to any detention that is lawfully authorized other than under the Involuntary Psychiatric Treatment Act.

________________________________________________________________

Form 6: Declaration of Change of Status

(subsection 24(2), Involuntary Psychiatric Treatment Act)

I, Dr. ___________________________________ (full name), a psychiatrist on the staff of ___________________________________ (name of psychiatric facility), am the attending psychiatrist of __________________________________ (full name of patient), an involuntary patient admitted to the facility.

I personally examined this patient on the following date and at the following time and location:

Date (dd/mm/yyyy)

Time

Location

Method

❑ a.m.

❑ p.m.

❑ in person

❑ video call

❑ telephone

If by video or telephone, state rationale:

I hereby change the status of the patient to that of a voluntary patient because (check all that apply)

❑ the patient no longer has a mental disorder

❑ the patient is no longer in need of psychiatric treatment in a psychiatric facility

❑ the patient

• is not threatening or attempting to cause serious harm to themself and has not recently done so

• has not recently caused serious harm to themself

• is not seriously harming or threatening serious harm towards another person or has recently done so

• is not likely to suffer serious physical impairment

• is not likely to suffer serious mental deterioration

❑ the patient is suitable for inpatient admission as a voluntary patient

❑ the patient has the capacity to make admission decisions

❑ the patient has the capacity to make treatment decisions

Therefore, I declare that the patient’s status is changed to that of a voluntary patient, effective on the date that this declaration is signed.

	(dd/mm/yyyy)
(date of signature)		(signature of attending psychiatrist)

		(attending psychiatrist’s name—printed)

❑I have informed the patient of their right to leave the facility per the requirements of subsection 24(3) of the Act.
❑ in writing	❑ verbally	❑ both

This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

________________________________________________________________

Instructions for Form 7: Certificate of Leave

(Section 43, Involuntary Psychiatric Treatment Act)

When to use this form:

• To allow a patient to live outside the psychiatric facility for short periods of time.

When filling out the form:

• In accordance with subsection 43(1) of the Act, a certificate of leave may be issued for up to 180 days, but, if the expiration date on Form 4 or Form 5 is a date that occurs before the end date specified on the certificate of leave and Form 5 is not renewed, the patient is no longer considered an involuntary patient and no longer obligated to comply with the conditions of the certificate of leave.

• If the conditions of the certificate of leave are to remain mandatory until the end date specified on the certificate of leave, a new Form 5 must be issued before the patient’s involuntary status expires.

• This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

Notes:

• In accordance with subsection 43(4) of the Act, a copy of this certificate must be given to all of the following people:

• the patient

• the substitute decision-maker who consented to the certificate of leave

• the chief executive officer or their designate

• any other health professional involved in the treatment plan

• It is recommended that a copy of this certificate be sent to the Review Board.

• This certificate is not effective without the consent of the substitute decision-maker.

• The patient may choose to return to the psychiatric facility earlier than the end date specified on the certificate of leave.

• In accordance with subsection 44(1) of the Act, the psychiatrist may cancel a certificate of leave without notice for any of the following reasons:

• breach of a condition

• the psychiatrist is of the opinion that the patient’s condition may present a danger to the patient or others

• the psychiatrist is of the opinion that the patient has failed to report as required by the certificate of leave

________________________________________________________________

Form 7: Certificate of Leave

(Section 43, Involuntary Psychiatric Treatment Act)

I, Dr. _____________________________ (full name), a psychiatrist on the staff of the _____________________________ (name of psychiatric facility), a psychiatric facility, am of the opinion that _____________________________ (full name of patient), an involuntary patient, should be allowed to live outside the psychiatric facility in accordance with this certificate.

This certificate allows the patient to live outside the psychiatric facility beginning on ___/___/_____ (dd/mm/yyyy) and ending on ___/___/_____ (dd/mm/yyyy—date no later than 180 days from beginning date) on the following conditions:

For this certificate of leave to remain in effect, the patient must comply with the medical treatment that is described in this certificate and must attend appointments with the psychiatrist and any health professionals referred to in this certificate.

I confirm that the patient’s substitute decision-maker ________________________________ (full name) has consented to this certificate of leave being issued to the patient.

		(dd/mm/yyyy)
(date of signature)			(signature of psychiatrist)
	a.m./p.m.
(time of signature)			(psychiatrist’s name—printed)

This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

________________________________________________________________

Instructions for Form 8: Certificate of Cancellation of Leave

(Section 44, Involuntary Psychiatric Treatment Act)

When to use this form:

• To cancel a Certificate of Leave (Form 7) and require the patient to return to the inpatient psychiatric facility identified on the Certificate of Leave.

When filling out the form:

• The patient’s certificate of leave date is the beginning date on Form 7.

• This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

Notes:

• This form authorizes a peace officer for up to 30 days after the date it is signed to take the patient into custody and to a health facility for an involuntary psychiatric assessment.

________________________________________________________________

Form 8: Certificate of Cancellation of Leave

(Section 44, Involuntary Psychiatric Treatment Act)

I, Dr. ______________________________ (full name), a psychiatrist on the staff of ___________________________________ (name of psychiatric facility), am the psychiatrist for ______________________________ (full name of patient), an involuntary patient who is currently living outside of the psychiatric facility on a certificate of leave.

I am cancelling the patient’s certificate of leave dated ___/___/_____ (dd/mm/yyyy) effective on the date of this Certificate of Cancellation of Leave because (check all that apply)

❑ the patient has breached a condition of their certificate of leave

❑ the patient’s condition may present a danger to the patient or others

❑ the patient has failed to report as required by their certificate of leave

Provide further details (if needed):

		(dd/mm/yyyy)
(date of signature)			(signature of psychiatrist)
	a.m./p.m.
(time of signature)			(psychiatrist’s name—printed)

This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

________________________________________________________________

Instructions for Form 9: Community Treatment Order

and Community Treatment Plan

(Sections 47 and 48 Involuntary Psychiatric Treatment Act)

When to use this form:

• To issue a community treatment order, where “in the community” means outside of a psychiatric facility.

When filling out the form:

• The patient must meet all 5 of the criteria under subsection 47(3) of the Act listed on the form.

• This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

Notes:

• When a community treatment order is issued, the patient and the patient’s substitute decision-maker must be promptly informed, in writing and in language the patient is likely to best understand, of the reasons for the order, the patient’s right to legal counsel, and all other rights and information listed in subsection 47(5) of the Act.

• In accordance with Section 47 of the Act, the psychiatrist who issued the order must inform the patient and the patient’s substitute decision-maker of the patient’s right to a hearing before the Review Board and must provide a copy of this order to all of the following people:

• the patient

• the patient’s substitute decision-maker

• the chief executive officer or their designate

• any other health practitioner or other person who has obligations under the community treatment plan

• A copy of this order must be sent to the Review Board.

• In accordance with subsection 49(2) of the Act, the psychiatrist who signs this order must notify all of the above-listed people of any changes to the patient’s community treatment plan.

• The community treatment order is valid for up to 180 days after the date the order is signed.

• In accordance with Section 48 of the Act, the community treatment plan must contain all of the following:

• a plan of treatment for the person subject to the community treatment order

• any conditions relating to the treatment or care and supervision of the person

• the obligations of the person subject to the community treatment order

• the obligations of the substitute decision-maker, if any

• the name of the psychiatrist, if any, who has agreed to accept responsibility for the general supervision and management of the community treatment order

• the names of all persons or organizations who have agreed to provide treatment or care and supervision under the community treatment plan and their obligations under the plan

• provision for the naming of another psychiatrist if the psychiatrist who issued the order under subsection 47(2) is unable to carry out their responsibilities under the order.

________________________________________________________________

Form 9: Community Treatment Order

(Section 47, Involuntary Psychiatric Treatment Act)

I, Dr. _____________________________ (full name), a psychiatrist on the staff of ___________________________________ (name of psychiatric facility), am the attending psychiatrist of _____________________________(full name of patient), an involuntary patient admitted to the facility.

I personally examined this patient on the following date and at the following time and location:

Date (dd/mm/yyyy)

Time

Location

Method

❑ a.m.

❑ p.m.

❑ in person

❑ video call

❑ telephone

If by video or telephone, state rationale:

I have reasonable and probable grounds to believe that the patient meets all of the following criteria:

1. The person has a mental disorder for which the person is in need of treatment or care and supervision in the community and the treatment and care can be provided in the community

2. The person, as a result of the mental disorder, (check all that apply)

❑ is threatening or attempting to cause serious harm to themself or has recently done so

❑ has recently caused serious harm to themself

❑ is seriously harming or is threatening serious harm towards another person or has recently done so

❑ will suffer serious physical impairment

❑ will suffer serious mental deterioration

3. As a result of the mental disorder, the person does not have the capacity to make treatment decisions

4. During the immediately preceding 2-year period, the person (check all that apply)

❑ has been detained in a psychiatric facility for a total of 60 days or longer

❑ has been detained in a psychiatric facility on 2 or more separate occasions

❑ has previously been the subject of a community treatment order

5. The services that the person requires in order to reside in the community exist in the community, are available to the person, and will be provided to the person.

In determining that reasonable and probable grounds exist that the person does not have the capacity to make admission and treatment decisions, I have assessed whether the person has the ability, with or without support, to understand all of the following:

• the nature of the condition for which the specific treatment or admission is proposed

• the nature and purpose of the treatment or admission

• the risks and benefits involved in undergoing the specific treatment or admission proposed

• the risks and benefits involved in not undergoing the specific treatment or admission.

The following reasons and information support my determination that reasonable and probable grounds exist that this person has a mental disorder and meets the criteria as described above:

Reasons, based on my observations and examination of the patient:

Information from other sources:

Information:

Please identify sources:

Community Treatment Plan

(Section 48, Involuntary Psychiatric Treatment Act)

The plan of treatment for the person is as follows:

Conditions relating to the treatment or care and supervision of the person are:

The obligations of the person subject to the community treatment order are:

The obligations of the substitute decision-maker, if any, are:

The following persons or organizations have agreed to provide treatment or care and supervision under the community treatment:

Person/Organization	Obligations	Contact information

If the psychiatrist who issued the community treatment order is unable to carry out their responsibilities under the order, then the following person must assume those responsibilities:

___________________________________ (full name)

For this community treatment order to remain in effect, the patient must submit to the medical treatment that is prescribed by their psychiatrist and must attend appointments with the psychiatrist or the health professionals listed above in the places scheduled, from time to time, as is consistent with good medical practice.

I confirm that the consent of the patient’s substitute decision-maker _______________________ (full name) has been requested and will be obtained before the patient is placed on a community treatment order and before the effective date of that community treatment order.

❑ By checking this box, I confirm I have informed the patient and the patient’s substitute decision-maker of the patient’s right to retain and instruct legal counsel, and the steps the patient may follow to obtain free legal counsel. I acknowledge that checking this box does not relieve me of the obligation to promptly inform the patient and the patient’s substitute decision-maker, in writing and in language that the patient is likely to best understand, of the information set out in subsection 47(5) of the Act.

This community treatment order begins on ___/___/_____ (dd/mm/yyyy) and expires on ___/___/_____ (dd/mm/yyyy—180 days after the date that the order is signed) unless it is renewed or terminated at an earlier date.


(signature of witness)		(signature of psychiatrist)

(witness’s name—printed)		(psychiatrist’s name—printed)
	(dd/mm/yyyy)		(dd/mm/yyyy)
(date of signature)		(date of signature)

This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

________________________________________________________________

Instructions for Form 10: Renewal of Community Treatment Order

(Section 52, Involuntary Psychiatric Treatment Act)

When to use this form:

• To renew a Community Treatment Order (Form 9).

When filling out the form:

• The patient must continue to meet all of the criteria under subsection 47(3) of the Act listed on Form 9.

• The date of the original community treatment order is the date Form 9 was signed.

• This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

Notes:

• When a community treatment order is renewed, the patient and the patient’s substitute decision-maker must be promptly informed, in writing and in language the patient is likely to best understand, of the reasons for the order, the patient’s right to legal counsel, and all other rights and information listed in subsection 47(5) of the Act.

• In accordance with Section 52 of the Act, a community treatment order may be renewed for 180 days at any time before it expires. There is no limit to the number of times a community treatment order may be renewed.

• It is recommended that a community treatment order be renewed at least 72 hours before its expiry date.

________________________________________________________________

Form 10: Renewal of Community Treatment Order

(Section 52, Involuntary Psychiatric Treatment Act)

I, Dr. __________________________________ (full name), a psychiatrist on the staff of ___________________________________ (name of psychiatric facility), am the attending psychiatrist of __________________________ (full name of patient), who is the subject of a community treatment order.

I personally examined this patient on the following date and at the following time and location:

Date (dd/mm/yyyy)

Time

Location

Method

❑ a.m.

❑ p.m.

❑ in person

❑ video call

❑ telephone

If by video or telephone, state rationale:

I have reasonable and probable grounds to believe that the person still fulfills the criteria for the original community treatment order dated ___/___/_____ (dd/mm/yyyy) and that the community treatment order has demonstrated efficacy.

1. The person has a mental disorder for which the patient is in need of treatment or care and supervision in the community and the treatment and care can be provided in the community

2. The person, as a result of the mental disorder, (check all that apply)

❑ is threatening or attempting to cause serious harm to themself or has recently done so

❑ has recently caused serious harm to themself

❑ is seriously harming or is threatening serious harm towards another person or has recently done so

❑ will suffer serious physical impairment

❑ will suffer serious mental deterioration

3. As a result of the mental disorder, the person does not have the capacity to make treatment decisions

4. During the immediately preceding 2-year period, the person (check all that apply):

❑ has been detained in a psychiatric facility for a total of 60 days or longer

❑ has been detained in a psychiatric facility on 2 or more separate occasions

❑ has previously been the subject of a community treatment order

5. The services that the person requires in order to reside in the community exist in the community, are available to the person, and will be provided to the person

❑ By checking this box, I confirm I have informed the patient and the patient’s substitute decision-maker of the patient’s right to retain and instruct legal counsel, and the steps the patient may follow to obtain free legal counsel. I acknowledge that checking this box does not relieve me of the obligation to promptly inform the patient and the patient’s substitute decision-maker, in writing and in language that the patient is likely to best understand, of the information set out in subsection 47(5) of the Act.

Therefore, I renew the community treatment order dated ___/___/_____ (dd/mm/yyyy), which expires on ___/___/_____ (dd/mm/yyyy).

This is the ______ (1st, 2nd, 3rd, etc.) renewal of that community treatment order and expires on ___/___/_____ (dd/mm/yyyy—180 days after date this order is signed), unless it is renewed or terminated earlier.


(signature of witness)		(signature of psychiatrist)

(witness’s name—printed)		(psychiatrist’s name—printed)
	(dd/mm/yyyy)		(dd/mm/yyyy)
(date of signature)		(date of signature)

This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

________________________________________________________________

Instructions for Form 11: Termination of Community Treatment Order

(Sections 55–57, Involuntary Psychiatric Treatment Act)

When to use this form:

• To terminate a Community Treatment Order (Form 9) or the Renewal of Community Treatment Order (Form 10).

When filling out the form:

• The date of the original community treatment order is the date Form 9 was signed.

• The date of the most recent renewal is the date Form 10 was signed.

• This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

Notes:

• When terminating a community treatment order for reason 1, 2 or 3, a psychiatrist must do all of the following:

• notify the person that they may live in the community without being subject to the community treatment order

• notify all of the following persons that the community treatment order has been terminated:

• the person’s substitute decision-maker

• the chief executive officer or their designate

• any other health practitioner or other person who has obligations under the community treatment plan.

• If the psychiatrist who issued or renewed a community treatment order has reasonable grounds to believe that the person subject to the order has failed in a substantial or deleterious manner to comply with that person’s obligations under clause 48(c) of the Act, the psychiatrist must request that a peace officer take the person into custody and promptly convey the person to the psychiatrist for a medical examination.

• The psychiatrist must not make a request to a peace officer to take the person into custody unless

• the psychiatrist has reasonable cause to believe that the person continues to meet the criteria set out in subclauses 47(3)(a)(i), (ii) and (iii) of the Act

• reasonable efforts have been made to do all of the following:

• locate the person

• inform the person’s substitute decision-maker of the failure to comply

• inform the substitute decision-maker of the possibility that the psychiatrist may make a request for the peace officer to take the person into custody and the possible consequences

• provide reasonable assistance to the person to comply with the terms of the order

• In accordance with subsection 56(3) of the Act, a request under subsection 56(1) of the Act is sufficient authority, for 30 days after it is issued, for a peace officer to take the person named in it into custody and convey the person to a psychiatrist who must examine the person to determine whether

• the person should be released without being subject to a community treatment order

• the psychiatrist should issue another community treatment order if the person’s substitute decision-maker consents to the community treatment plan

• the psychiatrist should conduct a psychiatric assessment to determine if the person should be admitted as an involuntary patient under a declaration of involuntary admission

• When terminating a community treatment order because the services required for the community treatment order are unavailable, in accordance with Section 57 of the Act, a psychiatrist must

• notify the person of the termination of the order and of the requirement for the psychiatrist to review that person’s condition and

• notify the person’s substitute decision-maker, the chief executive officer and any other health practitioner or other person who has obligations under the community treatment plan.

• Within 72 hours of issuing a notice of termination under Section 57 of the Act, the psychiatrist must review the person’s condition to determine if the person can continue to live in the community without being subject to an order.

• If the person who is subject to the community treatment order fails to permit the psychiatrist to review their condition and the psychiatrist has reasonable cause to believe that the criteria for a community treatment order continue to be met, the psychiatrist may, within the 72-hour period, request that a peace officer take the person into custody and promptly convey the person to a psychiatrist for an involuntary psychiatric assessment.

________________________________________________________________

Form 11: Termination of Community Treatment Order

(Sections 55–57, Involuntary Psychiatric Treatment Act)

I, Dr. _____________________________ (full name), am a psychiatrist on the staff of ___________________________________ (name of psychiatric facility).

_____________________________ (full name of patient) is an involuntary patient who is the subject of a community treatment order originally dated ___/___/_____ (dd/mm/yyyy), and most recently renewed on ___/___/_____ (dd/mm/yyyy) (if applicable).

I am terminating the patient’s community treatment order, effective on the date of this order, for 1 or more of the following reasons: (check all that apply)

1. ❑ the person no longer has a mental disorder for which they are in need of treatment or care and supervision in the community or the treatment and care can no longer be provided in the community

2. ❑ the person

• is not threatening or attempting to cause serious harm to themself and has not recently done so

• has not recently caused harm to themself

• is not seriously harming or threatening serious harm towards another person and has not recently done so

• is not likely to suffer serious physical impairment, and

• is not likely to suffer serious mental deterioration

3. ❑ The person has the capacity to make admission and treatment decisions

4. ❑ I am requesting a new assessment for involuntary inpatient admission because I have reasonable and probable grounds to believe that the person has substantially failed to comply with their obligations under the treatment plan, and I am requesting a new assessment for involuntary inpatient admission (Form 4).

5. ❑ I am requesting a new assessment for involuntary inpatient admission because I have reasonable and probable grounds to believe that the criteria for the community treatment order continue to be met and the following services required for the community treatment order are unavailable:


(signature of witness)		(signature of psychiatrist)

(witness’s name—printed)		(psychiatrist’s name—printed)
	(dd/mm/yyyy)		(dd/mm/yyyy)
(date of signature)		(date of signature)

This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

________________________________________________________________

Instructions for Form 12: Application for Review

(Section 68, Involuntary Psychiatric Treatment Act)

When to use this form:

• To apply to the Review Board for [to] review the patient’s file for any of the following reasons:

• to review a declaration of involuntary admission or a declaration of renewal

• to review a declaration of competency for involuntary patients under subsection 58(1) of the Hospitals Act

• under subsection 42(1) of the Act, to determine whether a capable informed consent by a substitute decision-maker has been rendered

• to review a community treatment order or a renewal of a community treatment order

• to review a certificate of leave or a certificate of cancellation of leave

• to review the status of a substitute decision-maker referred to in clauses 38(1)(c) to (g) of the Act

• the Review Board may refuse to review the file of a patient upon application of the patient at any time during the 90 days following the date the file was previously reviewed.

• This form may be filled out by

• the patient

• a substitute decision-maker

• a guardian or representative appointed by law

• a person who has been authorized to give consent under the Medical Consent Act

• a person authorized by the patient to act on their behalf (authorization is attached)

• the chief executive officer

• the chief executive officer or their designate

• the Minister of Health and Wellness or their designate

• a member of the Review Board

Notes:

• This form, once completed, must be filed with both of the following:

• the designated NSH or IWK MHA staff or administrative office responsible for managing IPTA health records

• the provincial IPTA Review Board administration at IPTAadmin@novascotia.ca.

• If an application for review is filed, the patient and the patient’s substitute decision-maker must be reminded of the patient’s right to be represented by legal counsel in accordance with Section 72 of the Act.

• In accordance with subsection 70(2) of the Act, all of the following people must be given 3 clear days’ written notice of this application:

• the applicant

• the patient

• the patient’s substitute decision-maker

• the patient advisor, if no one has been authorized to act on behalf of the patient

• the patient’s attending psychiatrist

• the chief executive officer or their designate

• every other person who is entitled to be a party

• any person who, in the opinion of the Review Board, has a substantial interest in the subject matter of the application.

• In accordance with subsection 69(2) of the Act, a hearing must begin as soon as reasonably possible after the application is received by the Review Board and no later than 21 days after the application is received.

________________________________________________________________

Form 12: Application for Review

(Section 68, Involuntary Psychiatric Treatment Act)

To: Chair of the Review Board

I, ___________________________________ (full name of applicant), of _________________ __________________________________________________________ (address of applicant), apply to the Review Board in the matter of ________________________________ (full name of patient), an involuntary patient being treated at or through ___________________________________ (name of psychiatric facility).

I ask the Review Board for a hearing to review (check one)

❑ a declaration of involuntary admission

❑ a declaration of renewal of involuntary admission

❑ a declaration of competency for an involuntary patient under subsection 58(1) of the Hospitals Act

❑ whether a capable informed consent by a substitute decision-maker has been rendered under subsection 42(1) of the Involuntary Psychiatric Treatment Act

❑ a community treatment order

❑ a renewal of a community treatment order

❑ a certificate of cancellation of leave

❑ the status of the substitute decision-maker

I am (check one)

❑ the patient

❑ a substitute decision-maker

❑ a guardian or representative appointed by law

❑ a person who has been authorized to give consent under the Medical Consent Act

❑ a person authorized by the patient to act on their behalf (authorization is attached)

❑ the chief executive officer or their designate

❑ the Minister of Health and Wellness or their designate

❑ a member of the Review Board

I understand that in a hearing before the Review Board every party, including the patient and the patient’s substitute decision-maker, is entitled to be represented by legal counsel.

	(dd/mm/yyyy)
(date of signature)		(signature of applicant)

		(applicant’s name—printed)

________________________________________________________________

Instructions for Form 13: Notice of Hearing

(Section 70, Involuntary Psychiatric Treatment Act)

When to use this form:

• For the Review Board to provide notice of a Review Board hearing.

When filling out the form:

• The Review Board must give at least 3 clear days’ written notice of each hearing to all of the following people:

• every party

• every person who is entitled to be a party

• the patient advisor if no one has been authorized to act on behalf of the involuntary patient

• any person who, in the opinion of the Review Board, has a substantial interest in the subject matter of the application.

Notes:

• In accordance with Section 72 of the Act, every party is entitled to be represented by counsel or an agent in a hearing before the Review Board.

• If a Notice of Hearing is prepared, the patient and the patient’s substitute decision-maker should be informed by the Review Board of the patient’s right to counsel and the steps the patient may take to obtain legal counsel.

• Patient Rights Advisor Services has a duty to help patients access legal counsel.

• The Review Board must send a written decision within 6 clear days of the hearing to all of the following people:

• the applicant

• the patient

• the patient’s representative

• the patient’s substitute decision-maker

• the patient’s attending psychiatrist

• the chief executive officer or their designate

• the Minister of Health and Wellness via IPTA Administration at IPTAadmin@novascotia.ca.

• In accordance with Section 79 of the Act, a party may appeal on any question of law from the findings of the Review Board to the Nova Scotia Court of Appeal within 30 days of the date the decision is received from the Review Board.

________________________________________________________________

Form 13: Notice of Hearing

(Section 70, Involuntary Psychiatric Treatment Act)

Take notice that ___________________________________________ (name of applicant) of ______________ ________________________________ (address of applicant) has applied to the Review Board to review the file of _____________________________________ (full name of patient) of ___________________________ _______________________ (address of patient), an involuntary patient being treated at or through ______________________________ (name of psychiatric facility) regarding ___________________________ (decision or order being reviewed).

The Review Board will hold a hearing for the review of this file on ___/___/_____ (dd/mm/yyyy) at _______ a.m./p.m. at ____________________________ (location of hearing).

The patient, their representative, the other parties and any individual who, in the opinion of the Review Board, has an interest in the matter may make representations at the hearing.

Every party, including the patient and the patient’s substitute decision-maker or other representative, is entitled to be represented by legal counsel or an agent at a hearing before the Review Board.

	(dd/mm/yyyy)
(date of signature)		(signature of Review Board Chair)


		(Review Board Chair’s name—printed)

The current consolidation of the Involuntary Psychiatric Treatment Regulations made under the Involuntary Psychiatric Treatment Act includes all of the following regulations:

The following regulations are not yet in force and are not included in the current consolidation:

N.S. Regulation	In force date*	How in force	Royal Gazette Part II Issue
235/2007	Jul 3, 2007	date specified	May 11, 2007
116/2024	Aug 13, 2024	date specified	Jun 28, 2024
161/2024	Aug 13, 2024	date specified	Aug 23, 2024

*See subsection 3(6) of the Regulations Act for rules about in force dates of regulations.

ad. = added am. = amended	fc. = fee change ra. = reassigned	rep. = repealed rs. = repealed and substituted
2........................................................	rs. 116/2024
2A.....................................................	ad. 116/2024
3........................................................	rs. 116/2024
5A-5D...............................................	ad. 116/2024
8........................................................	rs. 116/2024
Forms 1-6.........................................	rs. 116/2024
Form 7..............................................	rs. 116/2024; am. 161/2024
Forms 8-13.......................................	rs. 116/2024

	Note	Effective date
1	The individual health authorities (except the IWK Health Centre) listed in Section 3 were amalgamated as the Nova Scotia Health Authority under the Health Authorities Act, S.N.S. 2014, c. 3.	Apr 1, 2015
2	The reference in Form 12 to the Minister of Health should be read as a reference to the Minister of Health and Wellness in accordance with O.I.C. 2011-15 under the Public Service Act, R.S.N.S. 1989, c. 376 (corrected by N.S. Reg. 116/2024)	Jan 11, 2011

Note: Only regulations that are specifically repealed and replaced appear in this table. It may not reflect the entire history of regulations on this subject matter.

Involuntary Psychiatric Treatment Regulations	N.S. Reg. 235/2007
Involuntary Psychiatric Treatment Act
Note: The information in these tables does not form part of the regulations and is compiled by the Office of the Registrar of Regulations for reference only.