Cap 136A SCHEDULE (MENTAL HEALTH REGULATIONS; MENTAL HEALTH ORDINANCE)

Contents of Section

Chapter:	136A	Title:	MENTAL HEALTH REGULATIONS	Gazette Number:	L.N. 130 of 2007
Schedule:		Heading:	SCHEDULE	Version Date:	01/07/2007

Remarks:

For the saving and transitional provisions relating to the amendments made by the Resolution of the Legislative Council (L.N. 130 of 2007), see paragraph (12) of that Resolution.

[regulation 2]

FORM 1

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 35A(1))

APPLICATION UNDER SECTION 31 (1) FOR REMOVAL OF A PATIENT TO A MENTAL HOSPITAL FOR THE PURPOSE OF DETENTION AND OBSERVATION

I, [name and address of applicant] .............................................................................
..................., have reason to believe that [name of patient, and, if known, identity card number and address] ........................................................................................................
...................................................................................................................................... -

(a) in suffering from mental disorder of a nature or degree which warrants *his/her detention in a mental hospital for *observation/observation followed by medical treatment for at least a limited period;

AND

(b) ought to be so detained (See Note 1)-

(i) in the interests of *his/her own health or safety; and

(ii) with a view to the protection of other persons.

The reasons for my belief are-

I am *the [state relationship] ................................................................................. of the patient/a registered medical practitioner/a public officer in the Social Welfare Department.
I have informed a relative of the patient, namely *his/her [state relationship and name and address of relative] ....................................................................................................
........................................................................................................................................
........................................................................................ of this application (See Note 2).

I have been unable to locate any relative of the patient in Hong Kong and it is impracticable to delay the making of an order until a relative can be found (See Note 2).
I apply for an order in accordance with the provisions of section 31 (1B) of the Mental Health Ordinance authorizing the removal of the patient to a mental hospital for the purpose of detention and observation.
This application is founded on the attached written opinion of a registered medical practitioner in the prescribed form.
I last saw the patient on [date] .................................................................................. (See Note 3).

Signed ............................................

Date ..............................................

*Delete as appropriate.
Notes: 1. Delete (i) or (ii) unless both apply.

2. Delete this paragraph if applicant is a relative.

3. The applicant must have seen the patient within the previous 14 days.

FORM 2

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 31(1A))

CERTIFICATE OF A MENTAL PRACTITIONER IN SUPPORT OF APPLICATION FOR REMOVAL OF A PATIENT TO A MENTAL HOSPITAL FOR THE PURPOSE OF DETENTION AND OBSERVATION

I, [name and address of medical practitioner] .............................................................
................................................, a registered medical practitioner, am of the opinion that [name of patient, and, if known, identity card number and address] ......................................
.............................................................................................................................. should be removed to ..................................................................................................... Hospital for the purpose of detention and observation in pursuance of an order made under section 31(1B) of the Mental Health Ordinance. I last examined this patient on [date] ..................... (See Note 1).
I am of the opinion that this patient-

(a) is suffering from mental disorder of a nature or degree which warrants *his/her detention in a mental hospital for *observation/observation followed by treatment for at least a limited period;

AND

(b) ought to be so detained (See Note 2)-

(i) in the interests of *his/her own health or safety; and

(ii) with a view to the protection of other persons.

The grounds for the opinion I express in paragraph (a) above are as follows-

The reasons for the opinion I express in paragraph (b) above are as follows-

The patient *has/has not requested to see the District Judge or Magistrate.

Signed ...................................................

Registered Medical Practitioner

Date ......................................................

* Delete as appropriate.

Notes: 1. The medical practitioner who gives this certificate must have examined the patient within the previous 7 days.

2. Delete (i) or (ii) unless both apply.

FORM 3

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 31(1B))

ORDER BY A DISTRICT JUDGE OR MAGISTRATE AUTHORIZING THE REMOVAL OF A PATIENT TO A MENTAL HOSPITAL FOR THE PURPOSE OF DETENTION AND OBSERVATION

I, [name and address]................................................................................................
...................................................................................................................................., a *District Judge/magistrate having received an application made under section 31(1) of the Mental Health Ordinance from [name and address of applicant] .........................................
............................................................................................................................... dated ................................. and a medical certificate in support from [name and address of registered medical practitioner] .........................................................................................
........................................................................................................................................
........................................................................................................................................
............................................................................................................................... dated .......................................................................... in pursuance of section 31(1B) of the Mental Health Ordinance hereby authorize the removal of [name of patient, and, if known, identity card number and address] .....................................................................................
........................................................................................................................................
........................................................................................................................................
to ........................................................... Hospital for the purpose of detention and observation for a period of not exceeding 7 days from and including the date of this order.

Signed ...............................................

*District Judge/Magistrate

Date ..................................................

* Delete as appropriate.

FORM 4

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 32(1))

CERTIFICATE OF MEDICAL PRACTITIONERS FOR EXTENSION
OF PERIOD OF DETENTION FOR OBSERVATION

To: The Medical Superintendent,
............................ Hospital.

We, [names and addresses of 2 medical practitioners] ................................................
........................................................................................................................................
...................................................................................................................................... ,
registered medical practitioners, *one/both of whom *has/have been approved for the purpose of section 2(2) of the Mental Health Ordinance by the Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap 113) (See Note 1), hereby certify that-

(a) we have examined *separately/together [name of patient, and, if known, identity card number and address] ..................................................................................

.........................................................................................................................

who is detained in .............................................. Hospital by virtue of an order made on ......................... 19 ....... in accordance with the provisions of section 31(1B) of the Mental Health Ordinance;

(b) we are of the opinion that it is necessary that this patient be detained for a further period of ........................................ days for the purpose of observation, investigation and treatment (See Note 2).

The reasons for my opinion are-

Signed .....................................................

Registered Medical Practitioner

Date ........................................................

The reasons for my opinion are-

Signed .....................................................

Registered Medical Practitioner

Date ........................................................

Countersigned in accordance with the provisions of section 32(2) of the Mental Health Ordinance.

Signed ...........................................

District Judge

Date ...............................................

* Delete as appropriate.

Notes: 1. At least one of the registered medical practitioners who signs this certificate must be approved for the purpose of section 2(2) of the Ordinance by the Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap 113).

2. Only one extension of not more than 21 days from the expiry of the order under section 31(1B) of the Mental Health Ordinance is permitted.

(68 of 1990 s. 24)

FORM 5

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 35A(1))

APPLICATION FOR ADMISSION INTO GUARDIANSHIP
UNDER SECTION 33(1)

To: The Director of Social Welfare.

PART I

I, [name and address of applicant] ...........................................................................
..................................................................................................., have reason to believe that-

(a) [name of patient, and, if known, identity card number and address]

.......................

.........................................................................................................................

is suffering from mental disorder of a nature or degree which warrants *his/her reception into guardianship under section 33(1) of the Mental Health Ordinance;

AND
(b) it is necessary that the patient should be so received (See Note 1)-

(i) in the interests of the welfare of the patient; and

(ii) for the protection of other persons.

The reasons for my belief are-

*The patient is aged .....................

[if the patient's age is not known] *I believe that the patient has attained the age of 18 years.
I am *the [state relationship] ...................... of the patient/a registered medical practitioner/a public officer in the Social Welfare Department.
I have consulted a relative of the patient, namely *his/her [state relationship and name and address of relative] ....................................................................................................
........................................................................................................................................
........................................................................................................................................
about this application (See Note 2).

I have been unable to locate any relative of the patient in Hong Kong (See Note 2).
I apply for the patient to be received into the guardianship of [proposed guardian's name] ..............................................................................................................................
...................................................... in accordance with the provisions of section 33 of the Mental Health Ordinance (See Notes 3 & 4).
This application is founded on the attached written opinions in the prescribed form of 2 registered medical practitioners.
I last saw the patient on [date] .................................................................................. (See Note 5).

Signed .............................................

Date ...............................................

PART II (See Note 6)

I, [proposed guardian's name, address and identity card number] ................................
........................................................................................................................................
............................................................. , am willing to act as the guardian of [name of patient] ...................................................................................................... in accordance with section 33 of the Mental Health Ordinance.

Signed ......................................

Date .........................................

* Delete as appropriate.

Notes: 1. Delete (i) or (ii) unless both apply.

2. Delete this paragraph if applicant is a relative.

3. A gurdianship application should be forwarded to the Director of Social Welfare within 14 days of the patient's last examination by a registered medical practitioner for the purposes of the application.

4. The person named as guardian in a guardianship application may be the Director of Social Welfare or any other person (including the applicant).

5. The applicant must have seen the patient within the previous 14 days.

6. Part II to be completed only if proposed guardian is not the Director of Social Welfare.

(L.N. 184 of 1992)

FORM 6

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 33(3))

CERTIFICATE OF MEDICAL PRACTITIONERS IN SUPPORT
OF APPLICATION FOR GUARDIANSHIP

We, [names and addresses of two medical practitioners] ............................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
registered medical practitioners, *one/both of whom *has/have been approved for the purpose of section 2(2) of the Mental Health Ordinance by the Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap 113) (See Note 1), are of the opinion that [name of patient, and, if known, identity card number and address] .....................................
.......................................................................................................................................
........................................................................................................................................
................................................................ should be received into guardianship in pursuance of an application made under section 33(1) of the Mental Health Ordinance.

I, [name of first practitioner]......................................................................................
................................................................................................................... last examined the patient on ...................................................................
In my opinion this patient is suffering from mental disorder of a nature or degree which warrants reception into guardianship under the Mental Health Ordinance. This opinion is founded on the following-

[Give clinical description of the patient's mental condition]

I am of the opinion that it is necessary (See Note 2)-
(a) in the interests of the welfare of the patient; and
(b) for the protection of other persons,
that the patient should be so received for the following reasons-

[Reasons should state why the patient cannot appropriately be cared for without powers of guardianship]

Signed ....................................................

Registered Medical Practitioner

Date ........................................................

I, [name of second practitioner] ...............................................................................
......................................................................................................., last examined the patient on ......................................................................
In my opinion this patient is suffering from mental disorder of a nature or degree which warrants reception into guardianship under the Mental Health Ordinance. This opinion is founded on the following-

[Give clinical description of the patient's mental condition]

I am of the opinion that it is necessary (See Note 2)-
(a) in the interests of the welfare of the patient; and
(b) for the protection of other persons,
that the patient should be so received for the following reasons-

[Reasons should state why the patient cannot appropriately be cared for without powers of guardianship]

Signed .....................................................

Registered Medical Practitioner

Date ........................................................

* Delete as appropriate.

Notes: 1. At least one of the registered medical practitioners who signs this certificate must be approved for the purpose of section 2(2) of the Mental Health Ordinance by the Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap 113).

2. Delete (a) or (b) unless both apply.

(68 of 1990 s. 24)

FORM 7

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 36)

CERTIFICATE OF MEDICAL PRACTITIONERS AS TO MENTAL DISORDER

To: *The Medical Superintendent,
................................ Hospital. (See Note 1)
*The Commissioner of Correctional Services (See Note 1)

We, [names and addresses of two medical practitioners] ............................................
........................................................................................................................................
........................................................................................................................................
..................................................................................., registered medical practitioners, *one/both of whom *has/have been approved for the purpose of section 2(2) of the Mental Health Ordinance by the Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap 113) (See Note 2), have *separately/together examined [name of patient, and, if known, identity card number] ..................................................... who is-

*(a) a patient liable to be detained in a mental hospital or in the Correctional Services Department Psychiatric Centre; or

*(b) a voluntary patient in a mental hospital who on [date on which notice was given under section 30(2)(a) of the Mental Health Ordinance] .................................... gave due notice of his intention to leave the hospital.

In pursuance of section 36(1) of the Mental Health Ordinance we hereby certify as follows-

I, [name of first practitioner] ..................................................................................., last examined the patient on ...............................................

In my opinion this patient is suffering from mental disorder of a nature or degree which makes it appropriate for *him/her to receive medical treatment in hospital.

This opinion is founded on the following-

[Give clinical description of the patient's mental condition]

*I am of the opinion that (See Note 3)-
(a) the patient is abnormally aggressive; and
(b) the patient's conduct is seriously irresponsible (See Note 4).

*I am of the opinion that it is necessary (See Note 3)-
(a) for the health or safety of the patient; and
(b) for the protection of other persons,
that the patient should receive such treatment and it cannot be provided unless *he/she is detained under section 36 of the Mental Health Ordinance for the following reasons-

[Reasons should state why patient cannot appropriately be treated without being detained in hospital]

Signed .....................................................

Registered Medical Practitioner

Date ........................................................

I, [name of second practitioner] ............................................................................... last examined the patient on .......................................................................

In my opinion this patient is suffering from mental disorder of a nature or degree which makes it appropriate for *him/her to receive medical treatment in hospital.

This opinion is founded on the following-

[Give clinical description of the patient's mental condition]

*I am of the opinion that (See Note 3)-
(a) the patient is abnormally aggressive; and
(b) the patient's conduct is seriously irresponsible (See Note 4).

I am of the opinion that it is necessary (See Note 3)-
(a) for the health or safety of the patient; and
(b) for the protection of other persons,

that the patient should receive such treatment and it cannot be provided unless he is detained under section 36 of the Mental Health Ordinance for the following reasons-

[Reasons should state why patient cannot appropriately be treated without being detained in hospital]

Signed .....................................................

Registered Medical Practitioner

Date ........................................................

Countersigned in accordance with the provisions of section 36(2) of the Mental Health Ordinance.

Signed .....................................................

District Judge

Date .......................................................

* Delete as appropriate.

Notes: 1. Where the patient is detained under a hospital order or sentence of imprisonment, the procedures under section 36(1) and (2) of the Mental Health Ordinance shall not be commenced more than 30 days before the date he or she would, in the absence of such procedures, be released from detention.

2. At least one of the registered medical practitioners who signs this certificate must be approved for the purpose of section 2(2) of the Mental Health Ordinance by the Hospital Authority within the meaning of the Hospital Authority Ordinance (Cap 113).

3. Delete (a) or (b) unless both apply.

4. A patient who is neither suffering from mental illness nor psychopathic disorder may not be certified under section 36 of the Mental Health Ordinance unless he or she is abnormally aggressive or his or her conduct is seriously irresponsible.

(L.N. 76 of 1989; 68 of 1990 s. 24; L.N. 184 of 1992)

FORM 8

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 39(3))

NOTICE OF REVOCATION OF PERMISSION TO BE ABSENT ON TRIAL

To: [name of patient, and, if known, identity card number and address] ..............................
................................................................................................................................

In pursuance of section 39(3) of the Mental Health Ordinance I, ............................... , Medical Superintendent of ............................................................................................... Hospital, give you notice that permission for you to be absent on trial from [date] ................. is hereby revoked and you are required to return to ................................. Hospital forthwith (See Note 1).

I am of the opinion that your recall is necessary (See Note 2)-
(a) in the interests of your own health or safety; and
(b) for the protection of other persons.

Please note that if you do not return to .......................................... Hospital forthwith, then (See Note 3) [for a period of 28 days from the date of the service of this notice] you may be taken into custody and return to ................................... Hospital by any officer or servant of the Hospital or any person authorized by me.

Signed .................................................

Medical Superintendent

Date .....................................................

Notes: 1. A patient may not be recalled in pursuance of section 39(3) of the Mental Health Ordinance after he or she has ceased to be liable to be detained under the Ordinance.

2. Delete (a) or (b) unless both apply.

3. Delete words in square brackets if the patient is liable to detention under a hospital order other than one endorsed under section 45(1A) of the Mental Health Ordinance.

FORM 9

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 39(4))

CERTIFICATE THAT A PATIENT WHO IS ABSENT
ON TRIAL NEED NOT BE FURTHER DETAINED

I, .............................................................................................................. , Medical Superintendent of the .......................................................................................... Hospital, certify in accordance with the provisions of section 39(4) of the Mental Health Ordinance that it is not necessary that [name of patient, and, if known, identity card number] ................
........................................................................................................................................
........................................................................................................................................
who was detained in that hospital as a *certified patient/patient under observation and who is now absent on trial from that hospital, be detained under the Mental Health Ordinance.

Signed .............................................

Medical Superintendent

Date ...............................................

* Delete as appropriate.

FORM 10

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 42)

APPLICATION FOR DISCHARGE OF A PATIENT BEFORE RECOVERY

To: The Medical Superintendent, .....................................................................................
........................................................................................... Hospital.
I, [name and address of *relative/friend] ....................................................................
........................................................................................................................................
........................................................................................................................................
make application in accordance with the provisions of section 42(1) of the Mental Health Ordinance for the discharge of [name of patient, and, if known, identity card number] ................................................................. from the above-named Mental Hospital.

My relationship or connection with the said patient is that of a ...................................

I request that the said patient may be delivered over to me.

I undertake that the said patient will receive proper care and will be prevented from doing injury to *himself/herself or to others.

*I am the person upon whose application the said patient was admitted to a mental hospital.

*I have given notice of this application to .................................................................. the person upon whose application the said patient was admitted to a mental hospital.

Signed .........................................

Date ............................................

* Delete as appropriate.

Note: The patient must be discharged within 48 hours unless the Medical Superintendent completes Form 11.

FORM 11

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 42)

CERTIFICATE OF REFUSAL TO DISCHARGE A PATIENT

I, .........................................................................................., Medical Superintendent of ............................................................................................................. Hospital, in pursuance of section 42(1) of the Mental Health Ordinance certify that I refuse to discharge [name of patient, and, if known, identity card number] ......................................
........................................................................................................................................ a *voluntary patient/certified patient/patient under observation on the grounds that-

*I am satisfied that the said patient is dangerous or otherwise unfit to be at large.

*I am not satisfied that the said patient will receive proper care.

Signed ....................................................

Medical Superintendent

Date ......................................................

* Delete as appropriate.

FORM 12

MENTAL HEALTH ORDINANCE

(Chapter 136)

(Section 42B(3))

NOTICE OF RECALL OF A CONDITIONALLY DISCHARGED PATIENT

To: [name of patient, and, if known, identity card number and address]
......................................................................................................
In pursuance of section 42B(3) of the Mental Health Ordinance I, ..............................
......................................, *Medical Superintendent of ...................................................... Hospital/medical officer authorized by the Secretary for Food and Health, *recall/call you to ............................................................................................................. Hospital *forthwith/within ...................... days of the date of service of this notice (See Note 1).

(a) It appears to me that you have failed to comply with the following conditions to which your discharge on [date] ...................... was subject-

[list breaches of condition]

AND

(b) I am of the opinion that your *recall/call to a mental hospital is necessary (See Note 2)-

(i) in the interests of your own health or safety; and

(ii) for the protection of other persons.

Please note that if you do not attend at ......................................................................
.......................................................................................... Hospital as required by this notice, then (See Note 3) [for a period of 28 days from the date of service of this notice] you may be detained and taken into custody and removed to ..................................................... .......................................... Hospital by any officer or servant of the Hospital or any person authorized by me.

Signed ...............................................................
Medical Superintendent/Medical Officer

Date .................................................................

* Delete as appropriate.

Notes: 1. A patient recalled/called to a mental hospital in pursuance of section 42B(3) of the Mental Health Ordinance shall upon admission to a mental hospital be deemed to have been detained under section 31 of the Mental Health Ordinance.

2. Delete (i) or (ii) unless both apply.

3. Delete words in square brackets if the patient prior to conditional discharge was detained under a hospital order other than one endorsed under section 45(1A) of the Mental Health Ordinance.

(L.N. 416 of 1989; 68 of 1990 s. 24; L.N. 106 of 2002; L.N. 130 of 2007)