In Canada, we have a universal publicly funded, single payer healthcare system. Each of the 10 provinces and 3 territories have its own health insurance plans. In Ontario, we have the Ontario Health Insurance Plan (OHIP), for Ontario residents to use to gain access to reasonable health care services without having to pay an extra fee. A portion of our taxes are allocated to the Ministry of Health and Long-Term Care (MOHLTC). The MOHLTC determines where the money will be assigned, and to which areas of healthcare. These areas include: OHIP; Population and Public Health; Health Policy and Research; Local Health Integration Networks (LHIN); and eHealth and Information Management (Closing the Gap, 2018).

 

The Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991 dictate the way in which the nursing profession is regulated in the province of Ontario. “The RHPA applies to all of Ontario’s self-regulated health professions” while the “Nursing Act establishes the mandate of the College of Nurses of Ontario (CNO) and defines the scope of practice for the nursing profession”, which includes: authorized controlled acts; title protection; and quality assurance (CNO, 2020). The CNO is the governing body for regulated nurses in Ontario and is responsible for ensuring public safety and quality care through establishing practice standards, professional conduct, and requirements of nurses’ entry to practice (CNO, 2020).

 

As an RN working in field of Mental Health and Addictions, I need to be cognizant of the Mental Health Act, 1990 (MHA), which controls the process of an individual’s involuntary admission to hospital under a specific criteria where the “physician has reasonable cause to believe that a person is apparently suffering from a mental disorder", and this mental disorder may “result in, serious bodily harm to the person; seriously bodily harm to another person; or serious physical impairment of the person (MHA, 1990). If any single one of these 3 conditions apply, the individual will be admitted involuntarily to hospital for up to 72 hours and then reassessed by another physician to determine the next course of action. Under the MHA, there are many forms for holding an individual in hospital for a specific length of time. Each time an individual receives a form, they are contacted by the Psychiatric Patient Advocates Office (PPAO) to discuss the rights of the patient under the MHA.

 

Once admitted to hospital, the Health Care Consent Act, 1996 (HCCA) is initiated. The HCCA considers consent for the patient to receive treatment. An individual has the fundamental right to either accept or refuse treatment and what must be considered is the individual’s mental capacity to appreciate the benefits and the risks associated with the proposed treatment, which may include psychotropic medication or procedures such as electroconvulsive therapy (ECT). If the individual is deemed to be incapable to make an informed decision regarding consent for treatment, a substitute decision maker (SMD) will ultimately make the decision for whether to consent to treatment for the individual admitted, or not. The Substitute Decisions Makers Act, 1992 also applies to other aspects of an individual’s capacity to make decisions regarding their living arrangements and managing one’s own finances.

 

I am currently employed at the Centre for Addiction and Mental Health (CAMH). As a public hospital, CAMH receives funds from the MOHLTC and the Toronto Central Local Health Integration Network (TC LHIN). Additional funds are provided through donations, research grants, and fundraising.