In Ontario, people with serious mental illnesses can be compelled to get treatment in a community-based system. Both the Mental Health Act and the Health Care Consent Act, allow families, police and social workers to obtain Community Treatment Orders for people who pose a risk to themselves or others, to get the care they need.

What is a Community Treatment Order (CTO)?

A Community Treatment Order, or CTO, is a doctor’s order for a person to receive treatment or care and supervision in the community, which are based on a community treatment plan. The plan outlines the medications, medical appointments and other aspects of care the doctor believes are necessary to allow the person to live in the community, rather than remain in the hospital. CTOs are developed by the doctor, the person themselves (or their substitute decision-maker, if they have one), and any other person or organization who will be assisting the person once they are back in the community. A substitution decision-maker is appointed under the law to make decisions on behalf of a person who has been found legally “incapable” of making their own health care decisions.

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What are the criteria for being placed on a CTO?

CTOs are designed for individuals who suffer from serious mental disorders, whose condition is stabilized while in a care facility, who are then released and who relapse and must be readmitted to the care facility. There are 6 criteria for obtaining a CTO:

1. Within the past 3 years the person has been a patient in a psychiatric facility two or more times (for 30 days or more), or been on a CTO previously;
2. A community treatment plan is already in place for the person;
3. Examination by a physician within 72 hours before entering into a CTO plan, who believes, among other things, that the person is able to comply with the CTO;
4. The doctor has consulted with all the people who are named in the community treatment plan;
5. Consultation of the person and his or her substitute decision-maker, if any, with a rights adviser; and
6. Consent by the person or the person’s substitute decision-maker to the CTO.

CTOs may also be used for involuntary psychiatric patients who agree to a treatment or supervision plan as a condition of their release from a psychiatric facility. CTOs are valid for six months, and may be renewed for a further six months before expiry or within one month after expiry. CTOs may be terminated at any time.

What are the rights of a person subject to a CTO?

The consent of a person subject to a CTO or his or her substitute decision-maker, if any, must be voluntary, informed and not “coerced.”

The rights of a person subject to a CTO include, the right to:

• A review by the Consent and Capacity Board with appeal to the courts each time a CTO is issued or renewed;
• A mandatory review by the Consent and Capacity Board every second time a CTO is renewed;
• Request a re-examination by the issuing physician to determine if the CTO is still necessary for the person to live in the community;
• A review of the findings of the person’s incapacity to consent to treatment; and
• Consult with a lawyer before and after a CTO is issued.

In addition to the above rights, the person (or the substitute decision-maker) has the right to withdraw his or her consent to the CTO at any time.  In such cases, the doctor must review the person’s condition with 72 hours to decide if he or she can live in the community without the CTO.  In other words, the person can’t be forced to follow a CTO, but refusing to do so can mean that they will be hospitalized again. For more information about Community Treatment Orders, contact the Psychiatric Patient Advocate Office.

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Laws relating to your health can involve many issues including privacy law, discrimination, human rights and malpractice. To get help, ask a lawyer now.

								
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