A physician or nurse practitioner who examines someone and finds they meet British Columbia's involuntary admission criteria completes this certificate, giving reasons for each of four opinions. Completed outside a designated facility, it stays valid for up to 14 days from the assessment and authorizes apprehension and transport. Admission begins when the facility's Mental Health Act director or delegate completes Section 2, and lasts up to 48 hours.
The examining physician or nurse practitioner completes all of Section 1, including the four opinions with reasons, and signs with the date, 24-hour time, phone number and college ID. Section 2 is completed at the designated facility by the MHA director or delegate, who must be someone other than the examining professional.
Print the first and last name of the person examined, their personal health number if available, the name and address of the examination site and the examination date, then tick Designated Facility or Other Site. The form states that every Section 1 field is required. The Ministry's Guide to the Mental Health Act stresses legible printing because the certificate is a legal document, and the date matters: under section 22 of the Act the examination and the certificate must both be completed no more than 14 days before admission.
Give reasons for the opinion that the person has a disorder of the mind that requires treatment and seriously impairs their ability to react appropriately to their environment or associate with others. The Guide suggests describing the symptoms found, such as hallucinations, delusions, irrational thinking, manic excitement or depression, and showing that they are amenable to psychiatric treatment and severe enough to seriously impair functioning. Specific, plain descriptions help the reviewer more than repeating the statutory wording.
Explain why treatment is needed in or through a designated facility. The Guide says this opinion may rest on the diagnosis from the examination, current symptoms or previous treatment, and that the examiner must also be of the opinion that the treatment can only be provided in an inpatient setting, for example because the person has refused voluntary outpatient services.
State why care, supervision and control in or through a designated facility are needed to prevent substantial mental or physical deterioration, or to protect the person or others. For deterioration, the Guide looks for information that the person will likely worsen without treatment, such as a history of similar acute episodes. For protection, it notes the BC Supreme Court's ruling in McCorkell v. Riverview Hospital that protection goes beyond physical danger to social, family, vocational or financial harm.
Record why voluntary admission is not suitable. The Guide gives two common reasons: the person lacks the capacity to consent to admission or treatment, or there is a safety concern, such as a risk that the person would leave hospital and attempt suicide. All four opinions must be met and each needs its own reasons. Tick the box on the front if the summary continues on the back of the page.
Tick Physician or Nurse Practitioner, print your name, sign, and enter the date signed, the time signed in 24-hour format, a phone number and your college ID number. Tick the box confirming the patient was given a copy of the form. Then answer Yes or No to whether a police officer or constable brought the person to you under section 28 of the Act, which the Guide says covers apprehension of a person acting in a manner likely to endanger their own or others' safety.
The Mental Health Act director or delegate of the designated facility, who must be someone other than the examining professional, confirms that Section 1 sets out the information section 22(3) requires, records the involuntary admission date and time, prints their name, signs and names the facility. Involuntary admission and its 48-hour limit begin here. Section 2 is not required when the certificate relates to a person detained in a correctional centre or youth custody centre.
Use the back only when the reasons run past the front page. Repeat the person's first and last name, personal health number, name of the examination site, examination date and the examination time in 24-hour format, then continue the summary. The checkbox on the front tells the facility reviewer to look for this continuation, so tick it whenever the back is used.
Download the current version from the source each time; forms change without notice.
Form 4.1 - First Medical Certificate (Involuntary Admission)
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Sources for this guide
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Yes. Section 22 of the Mental Health Act lets a facility director admit a person for up to 48 hours on one medical certificate completed by a physician or nurse practitioner, and Form 4.1's Examining Professional box offers both. The second certificate, Form 4.2, must be completed by a physician other than the one who completed the first.
Completed outside a designated facility, Form 4.1 is valid for up to 14 days from the date of the medical assessment and authorizes apprehension, detainment and transportation. Once the MHA director or delegate completes Section 2, involuntary admission lasts up to 48 hours. If no Form 4.2 is completed in that time, a new Form 4.1 is needed to restart admission.
The examiner gives reasons for four opinions: a disorder of the mind that requires treatment and seriously impairs the ability to react appropriately to the environment or associate with others; a need for treatment in or through a designated facility; a need for care, supervision and control to prevent substantial deterioration or protect the person or others; and unsuitability for voluntary admission.
No. The Mental Health Regulation allowed a medical certificate on Form 4 only if it was completed on or before January 31, 2024, and Form 4 was repealed on February 1, 2024. New involuntary admissions use Form 4.1 for the first certificate and Form 4.2 for the second.