Mental Health : The Next Steps : Strengthening Ontario's Mental Health System

Consultation on proposed legislative changes to the Mental Health Act and the Health Care Consent Act

Ministry of Health and Long-Term Care

March 22, 2000

Table of Contents


Government is moving forward with its Blueprint election commitment to propose legislative changes that will ensure people with serious mental illness get the care and treatment they need in a community-based mental health system.

The key values, principles and objectives of mental health reform include :

  • providing the best care possible to those with mental illness;
  • ensuring public safety by providing care and treatment to those who pose a danger to themselves or others;
  • creating an integrated plan of services and legislation that supports mental health reform;
  • ensuring access to care and treatment for those with serious mental illness;
  • addressing the needs of families who require support from the mental health system;
  • building on a foundation of mental health reform initiatives that facilitate the smooth transition from institutional care to community living;  and
  • developing a mental health system that protects the public and provides for an improved quality of life for the seriously mentally ill.

Since 1995, the Ontario government has re-invested $150 million in mental health care programs, infrastructure and community-based services to support the integration and implementation of its mental health reform strategy. This $150 million re-investment has meant the establishment and enhancement of :

  • crisis response programs;
  • 51 Assertive Community Treatment Teams;
  • added case management resources;
  • increased forensic beds and support services;
  • increased acute in-patient beds for adults and children;
  • housing and support services for the homeless and patients discharged from a psychiatric hospital bed to a community residential setting;  and
  • an aggressive education and public awareness campaign aimed at clarifying the intent and application of the Mental Health Act and related legislation.

In June 1998, the government announced a review of the Mental Health Act and related legislation in response to the recommendations of MPP Dan Newman's report, entitled 2000 and Beyond: Strengthening Ontario's Mental Health System. In his report Mr. Newman stated " ...that it is critical for our government to ensure that all components of the mental health system, including legislation, operate in an integrated and coordinated fashion to deliver the best services to Ontarians who need them. ...As our government moves forward to reform the mental health system we must ensure that our statutes reflect the new system that we create".

Following Mr. Newman's report, an internal working group at the Ministry of Health and Long-Term Care began an extensive review of all aspects of mental health legislation. The review included :

  1. An analysis of current legislation, its current use and perceived deficiencies;
  2. The need for legislation to address all aspects of mental health treatment and services, including community care and treatment;
  3. A review of mental health legislation in other jurisdictions.

Consultation Process

The government will begin consultations on March 30, 2000. Invited participants will provide input on how proposed amendments to legislation should be implemented.

Mr. Brad Clark, MPP Stoney Creek, and Parliamentary Assistant to the Minister of Health and Long Term Care will lead the consultations to be carried out over the next month in London, Hamilton, Toronto, Ottawa, Kingston, Thunder Bay, and Sudbury.

Input gathered from the consultations will assist us to design effective legislation.

Legislative Amendments to Support Mental Health Reform

The results of the review to date suggest that amendments to legislation should be made. The government is undertaking consultations on how to amend the Mental Health Act and the Health Care Consent Act to better facilitate access to care and treatment.

The amendments proposed for consultation include :

  • redefining the current committal criteria in the Mental Health Act, including removing the word "imminent";
  • Community Treatment Orders (CTOs) for people with a serious mental illness to permit appropriate treatment in the community , as proposed by a psychiatrist/physician;
  • community treatment for involuntary psychiatric patients who consent to a treatment/supervision plan as a condition of their release from a psychiatric facility to the community;
  • regulatory authority in respect of Community Treatment Orders (CTOs), and the facilities or agencies responsible for CTOs, and other mental health services and service requirements;
  • amendments to the committal criteria, the Consent and Capacity Boards and Courts' jurisdictions and the application of the Health Care Consent Act provisions to CTOs hearings and appeals;
  • removal of the requirement for police to "observe" disorderly conduct before acting to take a person into custody where police have reason to believe that the behaviour meets committal criteria;
  • bringing definitions into compliance with current health care practice; changing the definition of "attending physician" to indicate that it includes any duly qualified medical doctor who is responsible for a patient's observation, care or treatment in a psychiatric facility;  and
  • other technical changes that have been raised over the past 20 years and to be raised again during the consultation process.

Legislative Amendments to Support Community Treatment

Community Treatment Orders (CTOs) are legal tools that outline the conditions under which individuals with a serious mental disorder have the opportunity to live safely in the community.

Proposed Target Population

  • Individuals who suffer from serious mental disorders and who have a history of repeated hospitalizations and who currently meet the committal criteria in the Mental Health Act.
  • Involuntary psychiatric patients who agree to a treatment/supervision plan as a condition of their release from a psychiatric facility to the community.

Proposed Committal criteria

Expanded committal criteria to reflect :

  • a need for treatment;
  • a serious mental disorder;
  • a lack of mental capacity to make treatment decisions;
  • the availability of a substitute decision maker willing to consent to;
  • treatment;
  • cyclical illness that responded well to treatment in the past;
  • a risk of serious harm if not treated.

Proposed Conditions for Applying Community Treatment Orders

A Community Treatment Order (CTOs) may be issued by a physician :

  • where the individual may be committed under either the current committal criteria or the revised criteria as outlined above;
  • where it will benefit the person subject to the CTOs;
  • where appropriate supports exist in the community to meet the conditions of the CTOs;
  • where it is less restrictive and less intrusive to provide treatment/supervision for the individual in the community rather than in a psychiatric facility;
  • where consent has been obtained from the individual or substitute decision maker, if the individual is found incapable.

Proposed Safeguards for Patients

A number of rights would flow from the designation of a Community Treatment Order (CTOs), including :

  • a right of review by the Consent and Capacity Board with possible appeal to the courts each time a CTOs is issued;
  • a right to request additional reviews by the Consent and Capacity Board in the event of a material change;
  • a right to request a re-examination by the issuing physician to determine if the CTOs is still necessary for the person to live in the community;
  • a right of review of findings of incapacity to consent to treatment;  and
  • provision for rights advice and an entitlement to counsel appointed by the Board.

Proposed Rights and Responsibilities

  • CTOs to be initiated for a period of six months and thereafter renewable for three month intervals.
  • Terms and conditions for signing and complying with CTOs to be set out with the consent of the patient or the substitute decision-maker.
  • CTOs to include a treatment and service plan as well as review, appeal and cancellation mechanisms.
  • Legislation to identify those who will be responsible/accountable for the implementation and care provisions of the CTOs.
  • Legislation to include an escalating series of consequences for non-compliance before imposing an assessment for admission to hospital.
  • Legislation to provide for information sharing needed for effective service coordination and monitoring of high-risk individuals while protecting the confidentiality of sensitive personal mental health and psychiatric records.
  • Legislation to ensure that providers adhere to the terms of CTOs Agreements.
  • Legislation to ensure compliance with reporting and record-keeping requirements.

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