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Mental Health Act

R.S.O. 1990, CHAPTER M.7

Consolidation Period: From November 1, 2004 to the e-Laws currency date.

Last amendment: 2004, c.3, Sched.A, s.90.

SKIP TABLE OF CONTENTS

CONTENTS

Definitions

1.  (1)  In this Act,

“attending physician” means a physician to whom responsibility for the observation, care and treatment of a patient has been assigned; (“médecin traitant”)

“Board” means the Consent and Capacity Board continued under the Health Care Consent Act, 1996; (“Commission”)

“community treatment plan” means a plan described in section 33.7 that is a required part of a community treatment order; (“plan de traitement en milieu communautaire”)

“Deputy Minister” means the deputy minister of the Minister; (“sous-ministre”)

“health practitioner” has the same meaning as in the Health Care Consent Act, 1996; (“praticien de la santé”)

“informal patient” means a person who is a patient in a psychiatric facility, having been admitted with the consent of another person under section 24 of the Health Care Consent Act, 1996; (“malade en cure facultative”)

“involuntary patient” means a person who is detained in a psychiatric facility under a certificate of involuntary admission or a certificate of renewal; (“malade en cure obligatoire”)

“local board of health” has the same meaning as board of health in the Health Protection and Promotion Act; (“conseil local de santé”)

“medical officer of health” has the same meaning as in the Health Protection and Promotion Act; (“médecin-hygiéniste”)

“mental disorder” means any disease or disability of the mind; (“trouble mental”)

“Minister” means the Minister of Health and Long-Term Care or such other member of the Executive Council as the Lieutenant Governor in Council designates; (“ministre”)

“Ministry” means the Ministry of the Minister; (“ministère”)

“officer in charge” means the officer who is responsible for the administration and management of a psychiatric facility; (“dirigeant responsable”)

“out-patient” means a person who is registered in a psychiatric facility for observation or treatment or both, but who is not admitted as a patient and is not the subject of an application for assessment; (“malade externe”)

“patient” means a person who is under observation, care and treatment in a psychiatric facility; (“malade”)

“personal health information” has the same meaning as in the Personal Health Information Protection Act, 2004; (“renseignements personnels sur la santé”)

“physician” means a legally qualified medical practitioner and, when referring to a community treatment order, means a legally qualified medical practitioner who meets the qualifications prescribed in the regulations for the issuing or renewing of a community treatment order; (“médecin”)

“plan of treatment” has the same meaning as in the Health Care Consent Act, 1996; (“plan de traitement”)

“prescribed” means prescribed by the regulations; (“prescrit”)

“psychiatric facility” means a facility for the observation, care and treatment of persons suffering from mental disorder, and designated as such by the Minister; (“établissement psychiatrique”)

“psychiatrist” means a physician who holds a specialist’s certificate in psychiatry issued by The Royal College of Physicians and Surgeons of Canada or equivalent qualification acceptable to the Minister; (“psychiatre”)

“record of personal health information”, in relation to a person, means a record of personal health information that is compiled in a psychiatric facility in respect of the person; (“dossier de renseignements personnels sur la santé”)

“regulations” means the regulations made under this Act; (“règlements”)

“restrain” means place under control when necessary to prevent serious bodily harm to the patient or to another person by the minimal use of such force, mechanical means or chemicals as is reasonable having regard to the physical and mental condition of the patient; (“maîtriser”)

“rights adviser” means a person, or a member of a category of persons, qualified to perform the functions of a rights adviser under this Act and designated by a psychiatric facility, the Minister or by the regulations to perform those functions, but does not include,

(a) a person involved in the direct clinical care of the person to whom the rights advice is to be given, or

(b) a person providing treatment or care and supervision under a community treatment plan; (“conseiller en matière de droits”)

“senior physician” means the physician responsible for the clinical services in a psychiatric facility; (“médecin-chef”)

“substitute decision-maker”, in relation to a patient, means the person who would be authorized under the Health Care Consent Act, 1996 to give or refuse consent to a treatment on behalf of the patient, if the patient were incapable with respect to the treatment under that Act, unless the context requires otherwise; (“mandataire spécial”)

“treatment” has the same meaning as in the Health Care Consent Act, 1996. (“traitement”) R.S.O. 1990, c. M.7, s. 1; 1992, c. 32, s. 20 (1-4); 1996, c. 2, s. 72 (1, 2, 4, 5); 2000, c. 9, s. 1; 2004, c. 3, Sched. A, s. 90 (1-3).

Meaning of “explain”

(2)  A rights adviser or other person whom this Act requires to explain a matter satisfies that requirement by explaining the matter to the best of his or her ability and in a manner that addresses the special needs of the person receiving the explanation, whether that person understands it or not. 1992, c. 32, s. 20 (5).

2.Repealed: 1992, c. 32, s. 20 (7).

3.Repealed: 1992, c. 32, s. 20 (7).

4.Repealed: 1992, c. 32, s. 20 (7).

5.Repealed: 1992, c. 32, s. 20 (7).

Effect of Act on rights and privileges

6.Nothing in this Act shall be deemed to affect the rights or privileges of any person except as specifically set out in this Act. R.S.O. 1990, c. M.7, s. 6.

PART I
STANDARDS

Application of Act

7.This Act applies to every psychiatric facility. R.S.O. 1990, c. M.7, s. 7.

Conflict

8.Every psychiatric facility has power to carry on its undertaking as authorized by any Act, but, where the provisions of any Act conflict with the provisions of this Act or the regulations, the provisions of this Act and the regulations prevail. R.S.O. 1990, c. M.7, s. 8.

Advisory officers

9.(1)The Minister may designate officers of the Ministry or appoint persons who shall advise and assist medical officers of health, local boards of health, hospitals and other bodies and persons in all matters pertaining to mental health and who shall have such other duties as are assigned to them by this Act or the regulations.

Powers

(2)Any such officer or person may at any time, and shall be permitted so to do by the authorities thereat, visit and inspect any psychiatric facility, and in so doing may interview patients, examine books, records and other documents relating to patients, examine the condition of the psychiatric facility and its equipment, and inquire into the adequacy of its staff, the range of services provided and any other matter he or she considers relevant to the maintenance of standards of patient care. R.S.O. 1990, c. M.7, s. 9.

Provincial aid

10.The Minister may pay psychiatric facilities provincial aid in such manner, in such amounts and on such conditions as he or she considers appropriate. 1997, c. 15, s. 11 (1).

PART II
HOSPITALIZATION

Where admission may be refused

11.Despite this or any other Act, admission to a psychiatric facility may be refused where the immediate needs in the case of the proposed patient are such that hospitalization is not urgent or necessary. R.S.O. 1990, c. M.7, s. 11.

Admission of informal or voluntary patients

12.Any person who is believed to be in need of the observation, care and treatment provided in a psychiatric facility may be admitted thereto as an informal or voluntary patient upon the recommendation of a physician. R.S.O. 1990, c. M.7, s. 12.

Child as informal patient

13.(1)A child who is twelve years of age or older but less than sixteen years of age, who is an informal patient in a psychiatric facility and who has not so applied within the preceding three months may apply in the approved form to the Board to inquire into whether the child needs observation, care and treatment in the psychiatric facility. R.S.O. 1990, c. M.7, s. 13 (1); 1992, c. 32, s. 20 (6); 2000, c. 9, s. 2 (1).

Application deemed made

(2)Upon the completion of six months after the later of the child’s admission to the psychiatric facility as an informal patient or the child’s last application under subsection (1), the child shall be deemed to have applied to the Board in the approved form under subsection (1). R.S.O. 1990, c. M.7, s. 13 (2); 1992, c. 32, s. 20 (6); 2000, c. 9, s. 2 (2).

Considerations

(3)In determining whether the child needs observation, care and treatment in the psychiatric facility, the Board shall consider,

(a) whether the child needs observation, care and treatment of a kind that the psychiatric facility can provide;

(b) whether the child’s needs can be adequately met if the child is not an informal patient in the psychiatric facility;

(c) whether there is an available alternative to the psychiatric facility in which the child’s needs could be more appropriately met;

(d) the child’s views and wishes, where they can be reasonably ascertained; and

(e) any other matter that the Board considers relevant. R.S.O. 1990, c. M.7, s. 13 (3); 1992, c. 32, s. 20 (6).

Powers of Board

(4)The Board by an order in writing may,

(a) direct that the child be discharged from the psychiatric facility; or

(b) confirm that the child may be continued as an informal patient in the psychiatric facility. R.S.O. 1990, c. M.7, s. 13 (4); 1992, c. 32, s. 20 (6).

No limitation

(5)Nothing in this section prevents a physician from completing a certificate of involuntary admission in respect of the child. R.S.O. 1990, c. M.7, s. 13 (5).

Panels of three or five members

(6)Despite subsection 73 (1) of the Health Care Consent Act, 1996, the chair shall assign the members of the Board to sit in panels of three or five members to deal with applications under this section. 1996, c. 2, s. 72 (6).

Procedure

(7)Subsection 39 (6) and section 42 of this Act and clause 73 (3) (a), subsection 73 (4) and sections 74 to 80 of the Health Care Consent Act, 1996 apply to an application under this section, with necessary modifications. 1996, c. 2, s. 72 (6).

Informal or voluntary patient

14.Nothing in this Act authorizes a psychiatric facility to detain or to restrain an informal or voluntary patient. R.S.O. 1990, c. M.7, s. 14.

Application for psychiatric assessment

15.(1)Where a physician examines a person and has reasonable cause to believe that the person,

(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;

(b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or

(c) has shown or is showing a lack of competence to care for himself or herself,

and if in addition the physician is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,

(d) serious bodily harm to the person;

(e) serious bodily harm to another person; or

(f) serious physical impairment of the person,

the physician may make application in the prescribed form for a psychiatric assessment of the person. R.S.O. 1990, c. M.7, s. 15 (1); 2000, c. 9, s. 3 (1).

Same

(1.1)Where a physician examines a person and has reasonable cause to believe that the person,

(a) has previously received treatment for mental disorder of an ongoing or recurring nature that, when not treated, is of a nature or quality that likely will result in serious bodily harm to the person or to another person or substantial mental or physical deterioration of the person or serious physical impairment of the person; and

(b) has shown clinical improvement as a result of the treatment,

and if in addition the physician is of the opinion that the person,

(c) is apparently suffering from the same mental disorder as the one for which he or she previously received treatment or from a mental disorder that is similar to the previous one;

(d) given the person’s history of mental disorder and current mental or physical condition, is likely to cause serious bodily harm to himself or herself or to another person or is likely to suffer substantial mental or physical deterioration or serious physical impairment; and

(e) is incapable, within the meaning of the Health Care Consent Act, 1996, of consenting to his or her treatment in a psychiatric facility and the consent of his or her substitute decision-maker has been obtained,

the physician may make application in the prescribed form for a psychiatric assessment of the person. 2000, c. 9, s. 3 (2).

Contents of application

(2)An application under subsection (1) or (1.1) shall set out clearly that the physician who signs the application personally examined the person who is the subject of the application and made careful inquiry into all of the facts necessary for him or her to form his or her opinion as to the nature and quality of the mental disorder of the person. R.S.O. 1990, c. M.7, s. 15 (2); 2000, c. 9, s. 3 (3).

Idem

(3)A physician who signs an application under subsection (1) or (1.1),

(a) shall set out in the application the facts upon which he or she formed his or her opinion as to the nature and quality of the mental disorder;

(b) shall distinguish in the application between the facts observed by him or her and the facts communicated to him or her by others; and

(c) shall note in the application the date on which he or she examined the person who is the subject of the application. R.S.O. 1990, c. M.7, s. 15 (3); 2000, c. 9, s. 3 (4).

Signing of application

(4)An application under subsection (1) or (1.1) is not effective unless it is signed by the physician within seven days after he or she examined the person who is the subject of the examination. R.S.O. 1990, c. M.7, s. 15 (4); 2000, c. 9, s. 3 (5).

Authority of application

(5)An application under subsection (1) or (1.1) is sufficient authority for seven days from and including the day on which it is signed by the physician,

(a) to any person to take the person who is the subject of the application in custody to a psychiatric facility forthwith; and

(b) to detain the person who is the subject of the application in a psychiatric facility and to restrain, observe and examine him or her in the facility for not more than 72 hours. R.S.O. 1990, c. M.7, s. 15 (5); 2000, c. 9, s. 3 (6).

Justice of the peace’s order for psychiatric examination

16.(1)Where information upon oath is brought before a justice of the peace that a person within the limits of the jurisdiction of the justice,

(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;

(b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or

(c) has shown or is showing a lack of competence to care for himself or herself,

and in addition based upon the information before him or her the justice of the peace has reasonable cause to believe that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,

(d) serious bodily harm to the person;

(e) serious bodily harm to another person; or

(f) serious physical impairment of the person,

the justice of the peace may issue an order in the prescribed form for the examination of the person by a physician. R.S.O. 1990, c. M.7, s. 16 (1); 2000, c. 9, s. 4 (1).

Same

(1.1)Where information upon oath is brought before a justice of the peace that a person within the limits of the jurisdiction of the justice,

(a) has previously received treatment for mental disorder of an ongoing or recurring nature that, when not treated, is of a nature or quality that likely will result in serious bodily harm to the person or to another person or substantial mental or physical deterioration of the person or serious physical impairment of the person; and

(b) has shown clinical improvement as a result of the treatment,

and in addition based upon the information before him or her the justice of the peace has reasonable cause to believe that the person,

(c) is apparently suffering from the same mental disorder as the one for which he or she previously received treatment or from a mental disorder that is similar to the previous one;

(d) given the person’s history of mental disorder and current mental or physical condition, is likely to cause serious bodily harm to himself or herself or to another person or is likely to suffer substantial mental or physical deterioration or serious physical impairment; and

(e) is apparently incapable, within the meaning of the Health Care Consent Act, 1996, of consenting to his or her treatment in a psychiatric facility and the consent of his or her substitute decision-maker has been obtained,

the justice of the peace may issue an order in the prescribed form for the examination of the person by a physician. 2000, c. 9, s. 4 (2).

Idem

(2)An order under this section may be directed to all or any police officers of the locality within which the justice has jurisdiction and shall name or otherwise describe the person with respect to whom the order has been made. R.S.O. 1990, c. M.7, s. 16 (2); 2000, c. 9, s. 4 (3).

Authority of order

(3)An order under this section shall direct, and, for a period not to exceed seven days from and including the day that it is made, is sufficient authority for any police officer to whom it is addressed to take the person named or described therein in custody forthwith to an appropriate place where he or she may be detained for examination by a physician. R.S.O. 1990, c. M.7, s. 16 (3); 2000, c. 9, s. 4 (4).

Manner of bringing information before justice

(4)For the purposes of this section, information shall be brought before a justice of the peace in the prescribed manner. 2000, c. 9, s. 4 (5).

Action by police officer

17.Where a police officer has reasonable and probable grounds to believe that a person is acting or has acted in a disorderly manner and has reasonable cause to believe that the person,

(a) has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;

(b) has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her; or

(c) has shown or is showing a lack of competence to care for himself or herself,

and in addition the police officer is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,

(d) serious bodily harm to the person;

(e) serious bodily harm to another person; or

(f) serious physical impairment of the person,

and that it would be dangerous to proceed under section 16, the police officer may take the person in custody to an appropriate place for examination by a physician. 2000, c. 9, s. 5.

Place of psychiatric examination

18.An examination under section 16 or 17 shall be conducted by a physician forthwith after receipt of the person at the place of examination and where practicable the place shall be a psychiatric facility or other health facility. R.S.O. 1990, c. M.7, s. 18.

Change from informal or voluntary patient to involuntary patient

19.Subject to subsections 20 (1.1) and (5), the attending physician may change the status of an informal or voluntary patient to that of an involuntary patient by completing and filing with the officer in charge a certificate of involuntary admission. R.S.O. 1990, c. M.7, s. 19; 2000, c. 9, s. 6.

Duty of attending physician

20.(1)The attending physician, after observing and examining a person who is the subject of an application for assessment under section 15 or who is the subject of an order under section 32,

(a) shall release the person from the psychiatric facility if the attending physician is of the opinion that the person is not in need of the treatment provided in a psychiatric facility;

(b) shall admit the person as an informal or voluntary patient if the attending physician is of the opinion that the person is suffering from mental disorder of such a nature or quality that the person is in need of the treatment provided in a psychiatric facility and is suitable for admission as an informal or voluntary patient; or

(c) shall admit the person as an involuntary patient by completing and filing with the officer in charge a certificate of involuntary admission if the attending physician is of the opinion that the conditions set out in subsection (1.1) or (5) are met. R.S.O. 1990, c. M.7, s. 20 (1); 2000, c. 9, s. 7 (1).

Conditions for involuntary admission

(1.1)The attending physician shall complete a certificate of involuntary admission or a certificate of renewal if, after examining the patient, he or she is of the opinion that the patient,

(a) has previously received treatment for mental disorder of an ongoing or recurring nature that, when not treated, is of a nature or quality that likely will result in serious bodily harm to the person or to another person or substantial mental or physical deterioration of the person or serious physical impairment of the person;

(b) has shown clinical improvement as a result of the treatment;

(c) is suffering from the same mental disorder as the one for which he or she previously received treatment or from a mental disorder that is similar to the previous one;

(d) given the person’s history of mental disorder and current mental or physical condition, is likely to cause serious bodily harm to himself or herself or to another person or is likely to suffer substantial mental or physical deterioration or serious physical impairment;

(e) has been found incapable, within the meaning of the Health Care Consent Act, 1996, of consenting to his or her treatment in a psychiatric facility and the consent of his or her substitute decision-maker has been obtained; and

(f) is not suitable for admission or continuation as an informal or voluntary patient. 2000, c. 9, s. 7 (2).

Physician who completes certificate of involuntary admission

(2)The physician who completes a certificate of involuntary admission pursuant to clause (1) (c) shall not be the same physician who completed the application for psychiatric assessment under section 15. R.S.O. 1990, c. M.7, s. 20 (2).

Release of person by officer in charge

(3)The officer in charge shall release a person who is the subject of an application for assessment under section 15 or who is the subject of an order under section 32 upon the completion of 72 hours of detention in the psychiatric facility unless the attending physician has released the person, has admitted the person as an informal or voluntary patient or has admitted the person as an involuntary patient by completing and filing with the officer in charge a certificate of involuntary admission. R.S.O. 1990, c. M.7, s. 20 (3).

Authority of certificate

(4)An involuntary patient may be detained, restrained, observed and examined in a psychiatric facility,

(a) for not more than two weeks under a certificate of involuntary admission; and

(b) for not more than,

(i) one additional month under a first certificate of renewal,

(ii) two additional months under a second certificate of renewal, and

(iii) three additional months under a third or subsequent certificate of renewal,

that is completed and filed with the officer in charge by the attending physician. R.S.O. 1990, c. M.7, s. 20 (4).

Conditions for involuntary admission

(5)The attending physician shall complete a certificate of involuntary admission or a certificate of renewal if, after examining the patient, he or she is of the opinion both,

(a) that the patient is suffering from mental disorder of a nature or quality that likely will result in,

(i) serious bodily harm to the patient,

(ii) serious bodily harm to another person, or

(iii) serious physical impairment of the patient,

unless the patient remains in the custody of a psychiatric facility; and

(b) that the patient is not suitable for admission or continuation as an informal or voluntary patient. R.S.O. 1990, c. M.7, s. 20 (5); 2000, c. 9, s. 7 (3, 4).

Change of status, where period of detention has expired

(6)An involuntary patient whose authorized period of detention has expired shall be deemed to be an informal or voluntary patient. R.S.O. 1990, c. M.7, s. 20 (6).

Idem, where period of detention has not expired

(7)An involuntary patient whose authorized period of detention has not expired may be continued as an informal or voluntary patient upon completion of the approved form by the attending physician. R.S.O. 1990, c. M.7, s. 20 (7); 2000, c. 9, s. 7 (5).

Examination of certificate by officer in charge

(8)Forthwith following completion and filing of a certificate of involuntary admission or of a certificate of renewal, the officer in charge or his or her delegate shall review the certification documents to ascertain whether or not they have been completed in compliance with the criteria outlined in this Act and where, in his or her opinion, the documents are not properly completed, the officer in charge shall so inform the attending physician and, unless the person is re-examined and released or admitted in accordance with this section, the officer in charge shall release the person. R.S.O. 1990, c. M.7, s. 20 (8); 2000, c. 9, s. 7 (6).

Judge’s order for examination

21.(1)Where a judge has reason to believe that a person who appears before him or her charged with or convicted of an offence suffers from mental disorder, the judge may order the person to attend a psychiatric facility for examination.

Senior physician’s report

(2)Where an examination is made under this section, the senior physician shall report in writing to the judge as to the mental condition of the person. R.S.O. 1990, c. M.7, s. 21.

Judge’s order for admission

22.(1)Where a judge has reason to believe that a person in custody who appears before him or her charged with an offence suffers from mental disorder, the judge may, by order, remand that person for admission as a patient to a psychiatric facility for a period of not more than two months.

Senior physician’s report

(2)Before the expiration of the time mentioned in such order, the senior physician shall report in writing to the judge as to the mental condition of the person. R.S.O. 1990, c. M.7, s. 22.

Condition precedent to judge’s order

23.A judge shall not make an order under section 21 or 22 until he or she ascertains from the senior physician of a psychiatric facility that the services of the psychiatric facility are available to the person to be named in the order. R.S.O. 1990, c. M.7, s. 23.

Contents of senior physician’s report

24.Despite this or any other Act or any regulation made under any other Act, the senior physician may report all or any part of the information compiled by the psychiatric facility to any person where, in the opinion of the senior physician, it is in the best interests of the person who is the subject of an order made under section 21 or 22. R.S.O. 1990, c. M.7, s. 24.

Detention under the Criminal Code (Canada)

25.Any person who is detained in a psychiatric facility under Part XX.1 of the Criminal Code (Canada) may be restrained, observed and examined under this Act and provided with treatment under the Health Care Consent Act, 1996. 2000, c. 9, s. 8.

Communications to and from patients

26.(1)Except as provided in this section, no communication written by a patient or sent to a patient shall be opened, examined or withheld, and its delivery shall not in any way be obstructed or delayed.

Where communication may be withheld

(2)Where the officer in charge or a person acting under his or her authority has reasonable and probable cause to believe,

(a) that the contents of a communication written by a patient would,

(i) be unreasonably offensive to the addressee, or

(ii) prejudice the best interests of the patient; or

(b) that the contents of a communication sent to a patient would,

(i) interfere with the treatment of the patient, or

(ii) cause the patient unnecessary distress,

the officer in charge or a person acting under his or her authority may open and examine the contents thereof and, if any condition mentioned in clause (a) or (b), as the case may be, exists, may withhold such communication from delivery. R.S.O. 1990, c. M.7, s. 26 (1, 2).

Exceptions

(3)Subsection (2) does not apply to a communication written by a patient to, or appearing to be sent to a patient by,

(a) a barrister and solicitor;

(b) a member of the Board; or

(c) a member of the Assembly. R.S.O. 1990, c. M.7, s. 26 (3); 1992, c. 32, s. 20 (6).

Leave of absence

27.(1)The attending physician may, subject to subsection (3), place a patient on a leave of absence from the psychiatric facility for a designated period of not more than three months if the intention is that the patient shall return to the facility. 2000, c. 9, s. 9.

Same

(2)The officer in charge may, upon the advice of the attending physician, place a patient on a leave of absence from the psychiatric facility for a designated period of not more than three months. 2000, c. 9, s. 9.

Terms and conditions

(3)The attending physician and the patient shall comply with such terms and conditions for the leave of absence as the officer in charge may prescribe. 2000, c. 9, s. 9.

Exception

(4)This section does not authorize the placing of a patient on a leave of absence where he or she is subject to detention otherwise than under this Act. 2000, c. 9, s. 9.

Unauthorized absence

28.  (1)  Where a person who is subject to detention is absent without leave from a psychiatric facility, a police officer or any other person to whom the officer in charge has issued an order for return shall make reasonable attempts to return the person and may, within one month after the absence becomes known to the officer in charge, return the person to the psychiatric facility or take the person to the psychiatric facility nearest to the place where the person is apprehended. 2000, c. 9, s. 10.

Detention during return

(2)A patient who is being returned under subsection (1) may be detained in an appropriate place in the course of his or her return. R.S.O. 1990, c. M.7, s. 28 (2).

Period of detention upon return

(3)For the purposes of this Act, a patient who is returned under subsection (1) may be detained for the remainder of the period of detention to which he or she was subject when his or her absence became known to the officer in charge. R.S.O. 1990, c. M.7, s. 28 (3).

Where not returned

(4)Where a patient is not returned within one month after his or her absence became known to the officer in charge, he or she shall, unless subject to detention otherwise than under this Act, be deemed to be discharged from the psychiatric facility. R.S.O. 1990, c. M.7, s. 28 (4).

Prohibitions

(5)No person shall do or omit to do any act for the purpose of aiding, assisting, abetting or counselling a patient in a psychiatric facility to be absent without authorization. R.S.O. 1990, c. M.7, s. 28 (5).

Transfer of patients from one facility to another

29.  (1)  Upon the advice of the attending physician, the officer in charge of a psychiatric facility may, if otherwise permitted by law and subject to arrangements being made with the officer in charge of another psychiatric facility, transfer a patient to such other psychiatric facility upon completing a memorandum of transfer in the approved form. R.S.O. 1990, c. M.7, s. 29 (1); 2000, c. 9, s. 11.

Transfer of records from one facility to another

(1.1)  The officer in charge of the psychiatric facility from which the patient is transferred may transfer the patient’s record of personal health information to the officer in charge of the psychiatric facility to which the patient is transferred. 2004, c. 3, Sched. A, s. 90 (4).

Authority to detain

(2)  Where a patient is transferred under subsection (1), the authority to detain him or her continues in force in the psychiatric facility to which he or she is so transferred. R.S.O. 1990, c. M.7, s. 29 (2).

Treatment in public hospital

30.(1)Upon the advice of the attending physician that a patient requires hospital treatment that cannot be supplied in the psychiatric facility, the officer in charge may, if otherwise permitted by law, transfer the patient to a public hospital for such treatment and return him or her to the psychiatric facility upon the conclusion thereof.

Powers of superintendent

(2)Where a patient is transferred under subsection (1), the superintendent of the public hospital has, in addition to the powers conferred upon him or her by the Act under which the hospital operates, the powers under this Act of an officer in charge of a psychiatric facility in respect of the custody and control of the patient. R.S.O. 1990, c. M.7, s. 30.

Transfer of patients to institutions outside Ontario

31.Where it appears to the Minister,

(a) that a patient in a psychiatric facility has come or been brought into Ontario from elsewhere and his or her hospitalization is the responsibility of another jurisdiction; or

(b) that it would be in the best interests of a patient in a psychiatric facility to be hospitalized in another jurisdiction,

the Minister may, upon compliance in Ontario with necessary modifications with the laws respecting hospitalization in such other jurisdiction, by warrant in the approved form authorize his or her transfer thereto. R.S.O. 1990, c. M.7, s. 31; 2000, c. 9, s. 12.

Mentally disordered person coming into Ontario

32.(1) Where the Minister has reasonable cause to believe that there may come or be brought into Ontario a person suffering from mental disorder of a nature or quality that likely will result in,

(a) serious bodily harm to the person; or

(b) serious bodily harm to another person,

unless the person is placed in the custody of a psychiatric facility, the Minister by an order in the prescribed form may authorize any one to take the person in custody to a psychiatric facility and the order is authority to admit, detain, restrain, observe and examine the person in the psychiatric facility. R.S.O. 1990, c. M.7, s. 32.

Delegation of Minister’s powers

(2)The Minister may, in writing, delegate his or her powers under subsection (1) to the Deputy Minister or to any officer or officers of the Ministry subject to such limitations, conditions and requirements as the Minister may set out in the delegation. 2000, c. 9, s. 13.

Duty to remain and retain custody

33.A police officer or other person who takes a person in custody to a psychiatric facility shall remain at the facility and retain custody of the person until the facility takes custody of him or her in the prescribed manner. 2000, c. 9, s. 14.

Community treatment order

33.1(1)A physician may issue or renew a community treatment order with respect to a person for a purpose described in subsection (3) if the criteria set out in subsection (4) are met. 2000, c. 9, s. 15.

Same

(2)The community treatment order must be in the prescribed form. 2000, c. 9, s. 15.

Purposes

(3)The purpose of a community treatment order is to provide a person who suffers from a serious mental disorder with a comprehensive plan of community-based treatment or care and supervision that is less restrictive than being detained in a psychiatric facility. Without limiting the generality of the foregoing, a purpose is to provide such a plan for a person who, as a result of his or her serious mental disorder, experiences this pattern: The person is admitted to a psychiatric facility where his or her condition is usually stabilized; after being released from the facility, the person often stops the treatment or care and supervision; the person’s condition changes and, as a result, the person must be re-admitted to a psychiatric facility. 2000, c. 9, s. 15.

Criteria for order

(4)A physician may issue or renew a community treatment order under this section if,

(a) during the previous three-year period, the person,

(i) has been a patient in a psychiatric facility on two or more separate occasions or for a cumulative period of 30 days or more during that three-year period, or

(ii) has been the subject of a previous community treatment order under this section;

(b) the person or his or her substitute decision-maker, the physician who is considering issuing or renewing the community treatment order and any other health practitioner or person involved in the person’s treatment or care and supervision have developed a community treatment plan for the person;

(c) within the 72-hour period before entering into the community treatment plan, the physician has examined the person and is of the opinion, based on the examination and any other relevant facts communicated to the physician, that,

(i) the person is suffering from mental disorder such that he or she needs continuing treatment or care and continuing supervision while living in the community,

(ii) the person meets the criteria for the completion of an application for psychiatric assessment under subsection 15 (1) or (1.1) where the person is not currently a patient in a psychiatric facility,

(iii) if the person does not receive continuing treatment or care and continuing supervision while living in the community, he or she is likely, because of mental disorder, to cause serious bodily harm to himself or herself or to another person or to suffer substantial mental or physical deterioration of the person or serious physical impairment of the person,

(iv) the person is able to comply with the community treatment plan contained in the community treatment order, and

(v) the treatment or care and supervision required under the terms of the community treatment order are available in the community;

(d) the physician has consulted with the health practitioners or other persons proposed to be named in the community treatment plan;

(e) subject to subsection (5), 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 have been advised of their legal rights; and

(f) the person or his or her substitute decision-maker consents to the community treatment plan in accordance with the rules for consent under the Health Care Consent Act, 1996. 2000, c. 9, s. 15.

Exception

(5)Clause (4) (e) does not apply to the person subject to the order if the person himself or herself refuses to consult with a rights adviser and the rights adviser so informs the physician. 2000, c. 9, s. 15.

Content of order

(6)A community treatment order shall indicate,

(a) the date of the examination referred to in clause (4) (c);

(b) the facts on which the physician formed the opinion referred to in clause (4) (c);

(c) a description of the community treatment plan referred to in clause (4) (b); and

(d) an undertaking by the person to comply with his or her obligations as set out in subsection (9) or an undertaking by the person’s substitute decision-maker to use his or her best efforts to ensure that the person complies with those obligations. 2000, c. 9, s. 15.

Protection from liability, substitute decision-maker

(7)The substitute decision-maker who, in good faith, uses his or her best efforts to ensure the person’s compliance and believes, on reasonable grounds, that the person is in compliance is not liable for any default or neglect of the person in complying. 2000, c. 9, s. 15.

Legal advice

(8)The person who is being considered for a community treatment order, or who is subject to such an order, and that person’s substitute decision-maker, if any, have a right to retain and instruct counsel and to be informed of that right. 2000, c. 9, s. 15.

Obligations of person

(9)If a person or his or her substitute decision-maker consents to a community treatment plan under this section, the person shall,

(a) attend appointments with the physician who issued or renewed the community treatment order, or with any other health practitioner or other person referred to in the community treatment plan, at the times and places scheduled from time to time; and

(b) comply with the community treatment plan described in the community treatment order. 2000, c. 9, s. 15.

To whom copies of order and plan to be given

(10)The physician who issues or renews a community treatment order under this section shall ensure that a copy of the order, including the community treatment plan, is given to,

(a) the person, along with a notice that he or she has a right to a hearing before the Board under section 39.1;

(b) the person’s substitute decision-maker, where applicable;

(c) the officer in charge, where applicable; and

(d) any other health practitioner or other person named in the community treatment plan. 2000, c. 9, s. 15.

Expiry of order

(11)A community treatment order expires six months after the day it is made unless,

(a) it is renewed in accordance with subsection (12); or

(b) it is terminated earlier in accordance with section 33.2, 33.3 or 33.4. 2000, c. 9, s. 15.

Renewals

(12)A community treatment order may be renewed for a period of six months at any time before its expiry and within one month after its expiry. 2000, c. 9, s. 15.

Subsequent plans

(13)Upon the expiry or termination of a community treatment order, the parties may enter into a subsequent community treatment plan if the criteria set out in subsection (4) are met. 2000, c. 9, s. 15.

Early termination of order pursuant to request

33.2(1)At the request of a person who is subject to a community treatment order or of his or her substitute decision-maker, the physician who issued or renewed the order shall review the person’s condition to determine if the person is able to continue to live in the community without being subject to the order. 2000, c. 9, s. 15.

Same

(2)If the physician determines, upon reviewing the person’s condition, that the circumstances described in subclauses 33.1 (4) (c) (i), (ii) and (iii) no longer exist, the physician shall,

(a) terminate the community treatment order;

(b) notify the person that he or she may live in the community without being subject to the community treatment order; and

(c) notify the persons referred to in clauses 33.1 (10) (b), (c) and (d) that the community treatment order has been terminated. 2000, c. 9, s. 15.

Early termination of order for failure to comply

33.3(1)If a physician who issued or renewed a community treatment order has reasonable cause to believe that the person subject to the order has failed to comply with his or her obligations under subsection 33.1 (9), the physician may, subject to subsection (2), issue an order for examination of the person in the prescribed form. 2000, c. 9, s. 15.

Conditions for issuing order for examination

(2)The physician shall not issue an order for examination under subsection (1) unless,

(a) he or she has reasonable cause to believe that the criteria set out in subclauses 33.1 (4) (c) (i), (ii) and (iii) continue to be met; and

(b) reasonable efforts have been made to,

(i) locate the person,

(ii) inform the person of the failure to comply or, if the person is incapable within the meaning of the Health Care Consent Act, 1996, inform the person’s substitute decision-maker of the failure,

(iii) inform the person or the substitute decision-maker of the possibility that the physician may issue an order for examination and of the possible consequences, and

(iv) provide assistance to the person to comply with the terms of the order. 2000, c. 9, s. 15.

Return to physician

(3)An order for examination issued under subsection (1) is sufficient authority, for 30 days after it is issued, for a police officer to take the person named in it into custody and then promptly to the physician who issued the order. 2000, c. 9, s. 15.

Assessment on return

(4)The physician shall promptly examine the person to determine whether,

(a) the physician should make an application for a psychiatric assessment of the person under section 15;

(b) the physician should issue another community treatment order where the person, or his or her substitute decision-maker, consents to the community treatment plan; or

(c) the person should be released without being subject to a community treatment order. 2000, c. 9, s. 15.

Early termination of order on withdrawal of consent

33.4(1)A person who is subject to a community treatment order, or his or her substitute decision-maker, may withdraw his or her consent to the community treatment plan by giving the physician who issued or renewed the order a notice of intention to withdraw consent. 2000, c. 9, s. 15.

Duty of physician

(2)Within 72 hours after receipt of the notice, the physician shall review the person’s condition to determine if the person is able to continue to live in the community without being subject to the order. 2000, c. 9, s. 15.

Order for examination

(3)If the person subject to the community treatment order fails to permit the physician to review his or her condition, the physician may, within the 72-hour period, issue in the prescribed form an order for examination of the person if he or she has reasonable cause to believe that the criteria set out in subclauses 33.1 (4) (c) (i), (ii) and (iii) continue to be met. 2000, c. 9, s. 15.

Return to physician

(4)An order for examination issued under subsection (3) is sufficient authority, for 30 days after it is issued, for a police officer to take the person named in it into custody and then promptly to the physician who issued the order. 2000, c. 9, s. 15.

Assessment on return

(5)The physician shall promptly examine the person to determine whether,

(a) the physician should make an application for a psychiatric assessment of the person under section 15;

(b) the physician should issue another community treatment order where the person, or his or her substitute decision-maker, consents to the community treatment plan; or

(c) the person should be released without being subject to a community treatment order. 2000, c. 9, s. 15.

Accountability

33.5(1)A physician who issues or renews a community treatment order, or a physician who is appointed under subsection (2), is responsible for the general supervision and management of the order. 2000, c. 9, s. 15.

Appointment of other physician

(2)If the physician who issues or renews a community treatment order is absent or, for any other reason, is unable to carry out his or her responsibilities under subsection (1) or under section 33.2, 33.3 or 33.4, the physician may appoint another physician to act in his or her place, with the consent of that physician. 2000, c. 9, s. 15.

Responsibility, named providers

(3)A person who agrees to provide treatment or care and supervision under a community treatment plan shall indicate his or her agreement in the plan and is responsible for providing the treatment or care and supervision in accordance with the plan. 2000, c. 9, s. 15.

Responsibility of other persons

(4)All persons named in a community treatment plan, including the person subject to the plan and the person’s substitute decision-maker, if any, are responsible for implementing the plan to the extent indicated in it. 2000, c. 9, s. 15.

Protection from liability, issuing physician

33.6  (1)  If the physician who issues or renews a community treatment order or a physician appointed under subsection 33.5 (2) believes, on reasonable grounds and in good faith, that the persons who are responsible for providing treatment or care and supervision under a community treatment plan are doing so in accordance with the plan, the physician is not liable for any default or neglect by those persons in providing the treatment or care and supervision. 2000, c. 9, s. 15.

Same, other persons involved in treatment

(2)If a person who is responsible for providing an aspect of treatment or care and supervision under a community treatment plan believes, on reasonable grounds and in good faith, that a person who is responsible for providing another aspect of treatment or care and supervision under the plan is doing so in accordance with the plan, the person is not liable for any default or neglect by that person in providing that aspect of treatment or care and supervision. 2000, c. 9, s. 15.

Same, physician

(3)If a person who is responsible for providing an aspect of treatment or care and supervision under a community treatment plan believes, on reasonable grounds and in good faith, that the physician who issued or renewed the community treatment order or a physician appointed under subsection 33.5 (2) is providing treatment or care and supervision in accordance with the plan, the person is not liable for any default or neglect by the physician in providing the treatment or care and supervision. 2000, c. 9, s. 15.

Reports

(4)The physician who issues or renews a community treatment order or a physician appointed under subsection 33.5 (2) may require reports on the condition of the person subject to the order from the persons who are responsible for providing treatment or care and supervision under the community treatment plan. 2000, c. 9, s. 15.

Community treatment plans

33.7A community treatment plan shall contain at least the following:

1. A plan of treatment for the person subject to the community treatment order.

2. Any conditions relating to the treatment or care and supervision of the person.

3. The obligations of the person subject to the community treatment order.

4. The obligations of the substitute decision-maker, if any.

5. The name of the physician, if any, who has agreed to accept responsibility for the general supervision and management of the community treatment order under subsection 33.5 (2).

6. The names of all persons or organizations who have agreed to provide treatment or care and supervision under the community treatment plan and their obligations under the plan. 2000, c. 9, s. 15.

No limitation

33.8Nothing in sections 33.1 to 33.7 prevents a physician, a justice of the peace or a police officer from taking any of the actions that they may take under section 15, 16, 17 or 20. 2000, c. 9, s. 15.

Review

33.9(1)The Minister shall establish a process to review the following matters:

1. The reasons that community treatment orders were or were not used during the review period.

2. The effectiveness of community treatment orders during the review period.

3. Methods used to evaluate the outcome of any treatment used under community treatment orders. 2000, c. 9, s. 15.

First review

(2)The first review must be undertaken during the third year after the date on which subsection 33.1 (1) comes into force. 2000, c. 9, s. 15.

Subsequent reviews

(3)A review must be completed every five years after the first review is completed. 2000, c. 9, s. 15.

Report

(4)The Minister shall make available to the public for inspection the written report of the person conducting each review. 2000, c. 9, s. 15.

Discharge of patients

34.(1)A patient shall be discharged from a psychiatric facility when he or she is no longer in need of the observation, care and treatment provided therein.

Exception

(2)Subsection (1) does not authorize the discharge into the community of a patient who is subject to detention otherwise than under this Act. R.S.O. 1990, c. M.7, s. 34.

Conflict

34.1  Where there is a conflict between the Personal Health Information Protection Act, 2004 and section 35 or 35.1 of this Act or any provision of this Act relating to the issuance or renewal of a community treatment order or the treatment, care or supervision of a person in accordance with a community treatment plan, the provisions of this Act apply. 2004, c. 3, Sched. A, s. 90 (5).

Personal health information

35. (1)  In this section,

“patient” includes former patient, out-patient, former out-patient and anyone who is or has been detained in a psychiatric facility. 2004, c. 3, Sched. A, s. 90 (7).

Disclosure, etc., for purpose of detention or order

(2)  The officer in charge of a psychiatric facility may collect, use and disclose personal health information about a patient, with or without the patient’s consent, for the purposes of,

(a) examining, assessing, observing or detaining the patient in accordance with this Act; or

(b) complying with Part XX.1 (Mental Disorder) of the Criminal Code (Canada) or an order or disposition made pursuant to that Part. 2004, c. 3, Sched. A, s. 90 (7).

Disclosure to Board

(3)  In a proceeding before the Board under this or any other Act in respect of a patient, the officer in charge shall, at the request of any party to the proceeding, disclose to the Board the patient’s record of personal health information. 2004, c. 3, Sched. A, s. 90 (7).

Disclosure of record

(4)  The officer in charge may disclose or transmit a person’s record of personal health information to or permit the examination of the record by,

(a) a physician who is considering issuing or renewing, or who has issued or renewed, a community treatment order under section 33.1;

(b) a physician appointed under subsection 33.5 (2);

(c) another person named in the person’s community treatment plan as being involved in the person’s treatment or care and supervision upon the written request of the physician or other named person; or

(d) a prescribed person who is providing advocacy services to patients in the prescribed circumstances. 2004, c. 3, Sched. A, s. 90 (7).

Substitute Decisions Act, 1992

(4.1)  The officer in charge shall disclose or transmit a clinical record to, or permit the examination of a clinical record by, a person who is entitled to have access to the record under section 83 of the Substitute Decisions Act, 1992. 1992, c. 32, s. 20 (13); 1996, c. 2, s. 72 (12).

(4.2)  Repealed: 1996, c. 2, s. 72 (13).

Disclosure pursuant to summons

(5)  Subject to subsections (6) and (7), the officer in charge or a person designated in writing by the officer in charge shall disclose, transmit or permit the examination of a record of personal health information pursuant to a summons, order, direction, notice or similar requirement in respect of a matter in issue or that may be in issue in a court of competent jurisdiction or under any Act. R.S.O. 1990, c. M.7, s. 35 (5); 2004, c. 3, Sched. A, s. 90 (8).

Statement by attending physician

(6)  Where the disclosure, transmittal or examination of a record of personal health information is required by a summons, order, direction, notice or similar requirement in respect of a matter in issue or that may be in issue in a court of competent jurisdiction or under any Act and the attending physician states in writing that he or she is of the opinion that the disclosure, transmittal or examination of the record of personal health information or of a specified part of the record of personal health information,

(a) is likely to result in harm to the treatment or recovery of the patient; or

(b) is likely to result in,

(i) injury to the mental condition of a third person, or

(ii) bodily harm to a third person,

no person shall comply with the requirement with respect to the record of personal health information or the part of the record of personal health information specified by the attending physician except under an order made by the court or body before which the matter is or may be in issue after a hearing from which the public is excluded and that is held on notice to the attending physician. R.S.O. 1990, c. M.7, s. 35 (6); 1992, c. 32, s. 20 (14); 2004, c. 3, Sched. A, s. 90 (8).

Matters to be considered by court or body

(7)  On a hearing under subsection (6), the court or body shall consider whether or not the disclosure, transmittal or examination of the record of personal health information or the part of the record of personal health information specified by the attending physician,

(a) is likely to result in harm to the treatment or recovery of the patient; or

(b) is likely to result in,

(i) injury to the mental condition of a third person, or

(ii) bodily harm to a third person,

and for the purpose the court or body may examine the record of personal health information, and, if satisfied that such a result is likely, the court or body shall not order the disclosure, transmittal or examination unless satisfied that to do so is essential in the interests of justice. R.S.O. 1990, c. M.7, s. 35 (7); 2004, c. 3, Sched. A, s. 90 (8).

Return of clinical record to officer in charge

(8)  Where a clinical record is required pursuant to subsection (5) or (6), the clerk of the court or body in which the clinical record is admitted in evidence or, if not so admitted, the person to whom the clinical record is transmitted shall return the clinical record to the officer in charge forthwith after the determination of the matter in issue in respect of which the clinical record was required. R.S.O. 1990, c. M.7, s. 35 (8).

(8.1)  Repealed: 2004, c. 3, Sched. A, s. 90 (9).

Disclosure in proceeding

(9)  No person shall disclose in a proceeding in any court or before any body any information in respect of a patient obtained in the course of assessing or treating the patient, or in the course of assisting in his or her assessment or treatment, or in the course of employment in the psychiatric facility, except,

(a) where the patient is mentally capable within the meaning of the Personal Health Information Protection Act, 2004, with the patient’s consent;

(b) where the patient is not mentally capable, with the consent of the patient’s substitute decision-maker within the meaning of the Personal Health Information Protection Act, 2004; or

(c) where the court or, in the case of a proceeding not before a court, the Divisional Court determines, after a hearing from which the public is excluded and that is held on notice to the patient or, if the patient is not mentally capable, the patient’s substitute decision-maker referred to in clause (b), that the disclosure is essential in the interests of justice. 2004, c. 3, Sched. A, s. 90&nbs