Bill 68 (Mental Health Legislative Reform), 2000 is a law that amended the Mental Health Act and the Health Care Consent Act. It came into effect December 1, 2000.

The law was changed to support the government's ongoing mental health reform process. It will ensure that people with serious mental illness get the care they need.

It is also the government's response to recommendations of coroner's juries, members of organizations and associations, families, police and mental health care professionals that people with serious mental illness require alternatives to hospitalization.

Before December 1, 2000, the Mental Health Act did not address the issue of community-based treatment. The new law allows some people who need treatment for a mental illness to be on a community treatment order, so they can get treatment outside hospital. For example, under the old law, a person with serious mental illness might stay in the hospital, while under the new law, the person can be treated in the community.

Some of the changes to the law include :

• new committal criteria;
• community treatment orders;
• police no longer have to actually see someone acting "disorderly" before they can take the person to hospital.

The new assessment and committal criteria will allow the families of seriously mentally ill people and health professionals to act at an earlier stage of a person's mental illness.

A community treatment order (CTO) is an order that a physician signs that allows a person to have community-based treatment or care and supervision instead of being in the hospital. It is less restrictive than being in hospital.

A community treatment order can be signed or renewed by a qualified physician.

No. A CTO can only be signed or renewed for someone with serious mental illness when the conditions in the Mental Health Act are met. A CTO can only be signed if :

• in the last three years, the person has been an inpatient in a psychiatric facility two times or more or for a total of at least 30 days, or has been on a CTO;  and,
• a community treatment plan has been developed;  and,
• the physician has examined the person in the 72 hours before the plan is entered into and believes :
• because of his or her mental illness, the person needs continuing treatment or care and continuing supervision, if he or she lives in the community;  and,
• if the person isn't an inpatient in a psychiatric facility, that he or she meets the conditions for assessment;  and,
• if the person doesn't get continuing treatment or care and continuing supervision while living in the community, he or she is likely, because of mental illness, to cause serious bodily harm to himself or herself or to someone else, or suffer substantial mental or physical deterioration or serious physical impairment;  and,
• the person is able to comply with the plan;  and,
• the treatment or care and supervision are available in the community;  and,
• the physician has consulted with the health practitioners or other persons proposed to be named in the plan;  and,
• the physician is satisfied that the person subject to the order and his or her substitute decision-maker (if any) have consulted with a rights adviser and been told about their legal rights;  and,
• the person or his or her substitute consents to the plan.

A community treatment plan is made by the person who will be on the CTO, or his/her substitute decision-maker (if any), the physician signing the CTO and anyone who will be providing treatment or care and supervision of the person under the plan.

The plan must include at least the following :

• a plan of treatment for the person subject to the CTO;
• any conditions relating to the treatment or care and supervision;
• the obligations of the person subject to the CTO;
• the obligations of the substitute decision-maker, if any;
• the name of the physician who has agreed to accept responsibility for the general supervision and management of the CTO, if this is different from the physician who issued the CTO;  and,
• the names of all persons or organizations who have agreed to provide services under the plan and their obligations under the plan.

A CTO cannot be signed before the plan is made.

Yes, there are a number of protections for a person on a CTO :

• the person has to consent (or the person's substitute if the person is incapable) to the community treatment plan in the CTO;
• the person (and the person's substitute if he or she is incapable) must get rights advice and notice of the right to retain and instruct counsel;
• the person, or anyone on their behalf, can ask to have the CTO reviewed.

The person must have an opportunity to consult a rights adviser before a CTO is issued. The person may refuse to consult a rights adviser. However, if the person is incapable, his or her substitute decision-maker must consult a rights adviser who will provide information about the significance of the CTO. The person and his or her substitute must also receive notice of their right to consult a lawyer if they want legal advice about the CTO.

Yes. The person or his/her substitute decision-maker can tell the physician they no longer consent to the community treatment plan. The physician must review the person's condition within 72 hours to decide if the person can live in the community without a CTO.

A CTO lasts for up to six months. After that, it expires unless it is renewed. A CTO can be renewed at any time while it is in effect or within a month after its expiry.

A person on a CTO or his or her substitute decision-maker can ask the physician to review the person's condition to determine whether the person can live in the community without a CTO. If the physician decides the CTO criteria no longer apply, the CTO can be ended.

If a physician believes that a person is not complying with a CTO, the physician may sign an order for the examination of the person. Before signing the order for examination, the physician must have reasonable cause to believe that :

• because of mental illness, the person needs continuing treatment or care and continuing supervision while living in the community;  and
• if the person isn't an inpatient in a psychiatric facility, that he or she meets the conditions for assessment;  and
• if the person doesn't get continuing treatment or care and continuing supervision, he or she is likely, because of his or her mental illness, to cause serious bodily harm to himself or herself or someone else, or suffer substantial mental or physical deterioration or serious physical impairment;  and
• reasonable efforts have been made to :
• find the person and,
• tell the person or his or her substitute that the person hasn't complied with the CTO;  and
• tell the person or his or her substitute that the physician might issue an order for examination and what that means;  and
• help the person comply with the CTO.

An order for examination gives the police power to take the person named in the order to the physician who signed the CTO or to a physician authorized to act in place of the physician who signed the CTO.

Under the new law, police do not actually have to observe "disorderly conduct" before they can take a person for examination by a physician. Police can act where they have "reasonable and probable grounds to believe" a person is behaving or has behaved in a disorderly manner and is apparently suffering from mental illness.

Police ability to "observe" wasn't effective in many situations involving persons with serious mental illness. Police would arrive after a person acted in a disorderly manner and, because they could not "observe" this conduct, they were unable to act. Police can now act on reliable third party information if they think there are "reasonable and probable grounds" to act.

April 2001