Enhanced protection for individuals in mental crisis

Summary#

• Bill 23 reforms the P-38.001 Act, renamed the "Act on the Protection of Persons with a Mental Disorder."
• The intervention criterion changes from "serious and immediate danger" to "situation where there is a clearly defined danger" (serious harm, foreseeable risk, link to mental state, necessity of intervention).
• A physician or specialized nurse practitioner (IPS) can decide on a temporary hold (up to 48 hours) for a person at risk if a court order cannot be obtained in time.
• A police officer can take a person against their will to the hospital at the request of a crisis worker, according to specific criteria. This can also occur if the person has advance psychiatric directives (DPA) consenting to it and is temporarily unfit.
• Evaluation and appeal timelines are revised: first psychiatric examination within 48 hours; second within 72 hours; more time (up to 96 hours, with leeway on holidays) to obtain court authorization if needed.
• Creation of a "coordinated action process" among stakeholders (health, social services, police, justice, Public Curator, etc.) to coordinate actions for at-risk individuals. Information sharing is limited to what is necessary, sometimes without consent if safety is compromised.
• Establishment of a national framework agreement to set principles, roles, and governance (national and regional committees).
• Introduction of advance psychiatric directives (DPA): an adult living with a mental disorder can consent to or refuse certain treatments in advance if they become temporarily unfit, and designate a trusted third party. A provincial registry of DPAs will be created.
• Transfer to the Administrative Tribunal of Quebec (TAQ) of a new specialized section, the "person integrity section," which will exclusively hear requests for authorization of treatment and institutionalization and appeals.
• Free legal aid in the first instance for anyone subject to a request for authorization of treatment or institutionalization, without a financial test.
• New obligations for institutions: expanded protocol (care for individuals taken against their will), information on rights and remedies, planning for safe discharge, involvement of relatives, enhanced record-keeping.
• Mandatory verification of absence of impediment (background checks) for staff in regular contact with vulnerable children in youth protection and rehabilitation, and for intermediate/family-type resources housing children.
• A 3-year limitation period added for criminal proceedings regarding abuse of seniors and vulnerable adults.

What This Means for You#

• If you live with a mental disorder:

  • You will be able to draft advance psychiatric directives (DPA) with the help of a healthcare professional. They will guide your care if you become temporarily unfit. They are enforceable against professionals.
  • You can appoint a trusted third party to help activate your DPA.
  • In a crisis situation, a maximum temporary hold of 48 hours can be decided more quickly, with psychiatric evaluations within better-defined timelines.
  • You will be informed of your rights, remedies, and available resources. You can contest a hold or decision before the TAQ.

• If you are a relative:

  • Teams will need to better inform you and assess your needs for assistance when the person consents.
  • Safe discharge plans should reduce relapses and clarify follow-ups.
  • You may be consulted as part of a coordinated action process, with consent or according to the exceptions provided.

• If you are a practitioner (physician, IPS, crisis worker, police officer):

  • The intervention criteria are redefined and documented. Crisis workers will need to undergo training developed by Santé Québec.
  • New coordination mechanisms structure the coordination of actions and the strictly necessary exchange of information.
  • Institutions must update their protocols, document decisions, and support the exercise of user rights.

• If you are subject to a request for treatment or institutionalization:

  • The case goes to the TAQ (person integrity section). Hearings are generally held in camera. Decisions are executed quickly, with the right to appeal to the Quebec Court within short timelines.
  • Free legal aid is available in the first instance for these cases.

• If you work with vulnerable children (youth, rehabilitation) or in a housing resource:

  • A certificate of absence of impediment becomes mandatory and must be kept up to date. Regulations will specify the process.

Costs#

• Expected impacts for the state:

  • Implementation of the DPA registry, training for crisis workers, new coordination mechanisms.
  • Strengthening of the TAQ (specialized section), urgent hearings, technologies.
  • Likely increase in legal aid expenses.
  • Background checks for staff and resources.

• Impacts for institutions and resources:

  • Updating protocols, training, increased record-keeping, discharge planning.
  • Process for verifying absence of impediment.

• Impacts for individuals:

  • Free legal aid in the first instance for these appeals. No new fees announced for users.

• Official budget estimate:

  • No publicly available information.

Supporters' Viewpoint#

• Acting earlier prevents more serious crises and better protects the individual and others.
• DPAs enhance autonomy and dignity by respecting prior wishes.
• Intersectoral coordination reduces "blind spots" between health, social services, police, and justice.
• A specialized TAQ should provide faster, more consistent, and tailored decisions, with accessible hearings (technology, in camera).
• Free legal aid lowers barriers to contestation and remedies.
• New obligations for institutions (information, safe discharge, involvement of relatives) improve the quality and continuity of care.
• Background checks enhance the safety of vulnerable children.

Opponents' Viewpoint#

• The shift to "situation where there is a danger" could broaden the use of interventions without consent and police involvement.
• Risk of privacy infringement with information sharing without consent in certain cases, despite the provided limits.
• Adjusted timelines (e.g., up to 96 hours for certain judicial processes) could prolong deprivation of liberty.
• Increased administrative burden for the network (protocols, training, documentation), without guaranteed additional resources.
• DPAs, while binding, may conflict with an expressed refusal at the moment, creating clinical and legal dilemmas.
• Centralization at the TAQ may concern those who prefer the oversight of common law courts.
• Background check obligations may complicate recruitment in already scarce sectors if the process is cumbersome.