Legislation and Professional Accountability Teaching activities and resources

Outcomes

Purpose

This section supports educators and nurses with the key concepts of mental health and addiction legislation in Canada and how they relate to professional accountability of nurses caring for persons with mental health and addiction across the continuum of care.

Outcomes

At the end of this section, the educator will:

Understand the importance of mental health and addiction legislation at the provincial/territorial, federal and international level.
Understand how legislation assists in the assessment, treatment, rehabilitation and recovery of mental illness and addiction in the jurisdiction in which they practice.
Understand that progressive legislation can be an effective tool to promote access to mental health care.
Understand the role of advocacy in the care of persons with mental health and addiction.
Have increased knowledge of the criteria for voluntary and involuntary admission as outlined in their provincial or territorial mental health act.
Understand stigmatizing and discriminating attitudes regarding mental health conditions and addiction among individuals and health-care professionals and the impact they have.
Understand the influence of socioeconomic factors (poverty, geographic) on the mental health of Canadians.

CASN/CFMHN Competencies

1.1, 1.3, 1.5, 1.6

Legislation and Professional Accountability

Mental health and illness in Canada is greatly influenced by legal factors, among other factors including cultural, environmental, historical, physiological, psychological, spiritual and socioeconomic factors (Kent-Wilkinson, 2015). The impact of the law on individuals can be complex. For example, legislation can have effects related to access to health-care services and treatment for those experiencing mental health and/or addiction issues. Therefore it is imperative that nursing students and nurses understand legislation and their professional accountability when working with clients with mental health, illness and addiction issues.

Canada, in comparison to many other countries, has comprehensive mental health policy, programs and legislation (Austin & Boyd, 2015). In regards to policy, in 2009, the Mental Health Commission of Canada developed an initial framework for a national mental health strategy, Toward Recovery and Wellbeing (MHCC, 2009). It contends that while appropriate legislation must be in place to protect anyone at risk from people living with mental health problems and illnesses, such legislation also represents power imbalances by providing the ability for care providers to impose safety measures on them, which is the “ultimate in loss of control” (MHCC, 2009, p 30). Therefore, it states a principle of recovery-oriented mental health policy and legislation must be employed.

Across Canada, each province and territory has its own Mental Health Act (see Resources) which greatly impacts the provision of care including treatment decisions and involuntary hospitalizations for individual experiencing mental illness and/or addiction (Gray & O’Reilly, 2001). Mental Health Acts rule over decisions made regarding competence—and the evaluation of competence—and what actions can be taken in cases where a person is ruled not competent. There are differing basic criteria for involuntary admission between provinces. As well, legislation impacts access to care through mechanisms such as consent from substitute decision makers, mandatory outpatient treatment (MOT), court-ordered outpatient treatment for clients who are unlikely to be compliant without a court order, and community treatment orders (CTO), an order issued by a physician and agreed to by the client that allows them to receive care and treatment in their community (Kent-Wilkinison, 2015).

Without an understanding of provincial legislation that governs treatment decisions and involuntary hospitalization, nurses will be unable to adequately care for, or advocate on behalf, of clients with mental illness and addiction. The CFMHN’s Canadian Standards for Psychiatric-Mental Health Nursing, 4th edition, (March 2014), establishes the maintenance of quality care and provides direction for safe, competent, ethical professional practice, which includes standards that nurses have knowledge about relevant legislation and strive towards client and system level advocacy, to improve quality of care and mental health services. These standards also call for the reduction of stigma, and to promote social inclusion and community integration for clients.

For more information, see Resources in this section.

Teaching and Learning Activities

The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to legislation and professional accountability.

Topics for review in curriculum:

The purpose of mental health legislation in Canada.
International Agreements and Canadian Legislation related to addiction and mental disorders.
The principles for the protection of persons with mental illness and the improvement of mental health care in accordance to legislation.
The provincial/territorial Mental Health Acts/Mental Health Service Acts in Canada.
The sections of the Criminal Code of Canada that apply for mental health assessment.
The Principles of Protections of Persons with a Mental Illness (adopted by the United Nations in 1991).
The Convention on the Rights of Persons with Disabilities (CRPD).
The criteria for involuntary care in applicable jurisdiction.

Define and distinguish between the concepts of:

Examples of stigmatizing, discrimination, and stereotyping attitudes, behaviour and actions.
Competence evaluation.
Fitness to stand trial (FST).
Not criminally responsible due to a mental disorder (NCRMD).
Mandatory Outpatient Treatment (MOT).
Community Treatment Orders (CTO).

Discussion topics:

The right to refuse treatment.
Human rights, patient/client rights, offender rights, in relation to mental disorders.
The process of commitment for voluntary and involuntary admission in respective jurisdiction.
The role of the nurse with respect to advocacy, rights and professional responsibility.
Nursing orders for the provision of care regarding Nursing Close, Nursing Constant for mental disorders (i.e., Q5, Q15 for suicide or eating disorders).

Learner Engagement Questions

The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding legislation and professional accountability. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.

How is being unable to access treatment and care an infringement of a person’s rights?
Do all Canadians have access to the same levels of health care (i.e., rural areas, northern communities, isolated communities)?
When does a person have the right to refuse treatment?
When can a person be held against his/her will?
When can the nurse legally hold a patient for mental health assessment?
How can stigma be a barrier to all aspects of life? Can you think of any stigmatizing behaviours that create barriers to care?
How would you respond to a patient with an opioid use disorder requesting pain medication post-surgery?

Evaluation and Self-reflection

The following evaluation methods can be used to evaluate students in their understanding and application of legislation and professional accountability.

Multiple choice exam questions
Clinical evaluation
Self-assessment through reflective writing
Guided discussion

SELF-REFLECTION

Self-reflection questions: What are your personal attitudes about mental illness and addiction? Have you stereotyped a person in your care? How would you know this and how could you change your behaviour in the future?

Resources

ADVOCACY GROUPS

Advocacy Groups for Mental Health in Canada—Appendix G

WEBSITES

MENTAL HEALTH ACTS

PROVINCIAL COMMUNITY TREATMENT ORDERS

CANADIAN TEXTBOOKS

Kent-Wilkinson, A. (2015). The context of mental health care: Cultural, socioeconomic, and legal. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 3, pp. 25–41). Philadelphia, PA: Wolters Kluwer.
Pollard, C. L. (2014). Ethical responsibilities and legal obligations for psychiatric mental health nursing practice. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 8, pp. 114–130). Toronto, ON: Elsevier Canada.

REFERENCE MATERIALS

Canadian Mental Health Association. (2012). Community committal. Retrieved from http://www. cmha.ca/public_policy/community-committal/
Canadian Mental Health Association. (2016). Community treatment orders (CTO’s). Retrieved from http://durham.cmha.ca/programs_services/community-treatment-orders/#.VwynTHErLcs
Kent-Wilkinson, A. (2015). The context of mental health care: Cultural, socioeconomic, and legal. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 3, pp. 25–41). Philadelphia, PA: Wolters Kluwer.
Mordoch, E. (2014). Cultural implications for psychiatric mental health nursing. With contributions from R Zoucha & K. Gregg. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 7, pp. 99–113). Toronto, ON: Elsevier Canada.
Pollard, C. L. (2014). Ethical responsibilities and legal obligations for psychiatric mental health nursing practice. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 8, pp. 114–130). Toronto, ON: Elsevier Canada.
Rynor, B. (2010). Value of community treatment orders remains at issue. Canadian Medical Association Journal, 182(8), E337–E338.
Stanyon, W. (2014). Forensic psychiatric nursing. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 34, pp. 676–685). Toronto, ON: Elsevier Canada.
Srivastava, R. (Ed.) (2007). The healthcare professional’s guide to clinical cultural competence. Toronto, ON: Mosby Elsevier.