Physicians’ perspectives on processes for emergency mental health transfers from university health clinics to hospitals in Ontario, Canada: a qualitative analysis

Abstract

Postsecondary students confront many stressors that may contribute to the emergence of mental illness. 1 Longitudinal data suggest that rates of mental illnesses are increasing among Canadian postsecondary students, with more students reporting self-harm, suicidal ideation and suicide attempts over time. 1 When a student presenting at a university-affiliated health clinic is assessed to be at imminent risk of harm, legislative tools may be used to mandate emergent psychiatric assessment. In Ontario, Canada, under the province's Mental Health Act, 2 a "Form 1 Application by Physician for Psychiatric Assessment" can be completed to initiate this process. When a Form 1 is issued, students must be transferred to a designated hospital facility for evaluation.Although robust data are lacking, the annual number of student mental health transfers on some Ontario university campuses has increased substantially since 2014. 3 However, the processes for such transfers are an underresearched topic, part of a larger gap in research surrounding the conveyance of people experiencing a mental health crisis to hospital from communitybased points of care. [4][5][6][7][8] There is substantial heterogeneity in transfer processes when a Form 1 is completed for students pre-senting at university health clinics in Ontario. In particular, the involvement of police and use of physical restraints for transfers vary between institutions 8,9 and have been the subject of media scrutiny. 3,[10][11][12] These issues are important questions confronting health care professionals. 9 Some have argued for police involvement and use of restraints on the basis that they provide a type of safety to patients themselves, to health care professionals and to those transporting patients to hospital. 13 Opponents of routine police involvement and restraint use contend that such practices are traumatizing and stigmatizing, and perpetuate the criminalization of people with mental illness. [7][8][9][14][15][16][17] Given

Seclusion within the first 24 h following admission into inpatient mental health services and associations with referral pathways, recent service contact and HoNOS ratings

“…Some referral pathways may involve higher levels of distress, urgency and coercion that could contribute to the subsequent risk of being secluded, such as referrals from police and emergency departments (EDs). Police involvement in mental health admissions can be stigmatising and criminalising and can further exacerbate people's distress (Brophy et al., 2016; Chittle et al., 2022; Maharaj et al., 2012; Sambrano & Cox, 2013). Moreover, there are concerns around the use of restraints in police and ED settings, primarily handcuffs (Brophy et al., 2016; Holman et al., 2018).…”