Form 5 (British Columbia - Consent for Treatment [Involuntary Patient])

• If a patient has an involuntary admission (i.e. - a Form 4 or Form 6), completion of the Form 5 is not optional and is a legal requirement under the BC Mental Health Act!
• Before any psychiatric medication can be administered against an individual's will or without their consent (unless it is an emergency situation), a Form 5 must be completed.
• While Form 5 does not expire, a new Form 5 must be completed every time there is a significant change in treatment, such as starting electroconvulsive therapy, clozapine initiation, initiation of restraints, or transfers to a new designated facility.

The Form 5 serves several important functions:

1. If a patient accepts and consents to treatment, the Form 5 provides the space to document the course of treatment a patient has consented, and the time and date that consent was provided. Documenting a patient’s consent to treatment is particularly important in the context of an involuntary admission, because legally, the patient has actually been deprived of their right to refuse it.
2. Alternatively, If a patient refuses to consent or is unable to consent, the Form 5 requires the prescribing physician to obtain the hospital director’s authorization to proceed with the proposed treatment. Under the BC Mental Health Act, the director is ultimately responsible for ensuring the patient receives treatment appropriate to their condition. Proper documentation on the Form 5 is particularly important for patients who initially on admission may have been incapable of appreciating illness or treatment but later regain some capacity.
3. Finally, the Form 5 is an essential part of the medical-legal record for patients exercise their right to seek a second medical opinion on the appropriateness of the treatment prescribed by the patient's physician and authorized by the director.

• Under the MHA, a person maintains the right to refuse medical (i.e. - non-psychiatric interventions/treatment).
  • Consent to non-psychiatric treatment is not covered by the MHA and should not be dealt with in a Form 5.
• Staff may provide medical treatment on a voluntary basis, but must otherwise rely on the Health Care (Consent) and Care Facility (Admission) Act (HCCCFA) if they determine the patient is not capable of consenting to medical treatment.

• A Form 5 should clearly document the authorized treatment such that the patient can make an informed decision as to whether to request a second opinion (Form 11). If a patient decides to exercise this right, the Form 5 shows the second opinion physician what treatment the director has authorized.
• A Form 5 can be completed and signed by a Director or designate.
  • Who this individual is depends on the each hospital (i.e. - sometimes can be a physician, lead nurse, or other hospital administrator)
• If there is a significant change in a treatment (i.e. - using a different class of medications), a new Form 5 must be completed.

• The description of the treatment proposed by the physician should be of sufficient detail, and specifically that the physician has set out the nature of the patient’s mental health diagnosis, nature of the condition, options for treatment, the reasons for and the likely benefits and risks of the proposed treatment for the patient.
• It should also be sufficiently descriptive (for example, it should include details of the medication class and psychotherapy type, but it is not necessary to list individual medications).^[1]

• There is a Part A and Part B to the Form 5, and only one part (either A or B) should be filled out.
  • Part A is filled out if the patient is involuntarily admitted, but capable to consent to treatment.
    • Part A may not be as commonly filled out, as an involuntarily admitted patient may not be capable to consent.
  • Part B is filled out if the patient is involuntarily admitted, but also incapable to consent to treatment.
    • In this situation, a Director/delegate will sign on the patient's behalf.

• Who exactly is the “Director,” and what is a “director’s authorization”?
  • In practice, the person signing the form is often the nurse-in-charge at the facility, but could also be a specialized psychiatric nurse clinician, patient care (or services) manager, or a care management leader.
  • Regular standing psychiatric treatment is not legally binding until the Form 5 has been co-signed by a Director/Delegate
• In the cases of emergencies related to agitation or risk of harm to self or to others, and a Form 5 is not able to completed in a timely matter, emergency psychiatric treatment (e.g. - intramuscular treatment or restraints) could temporarily be given under the Health Care (Consent) and Care Facility (Admission) Act. However, this is the exception and not the rule.