[Hpn] CTO Legislation: Ontario introduces 'Brian's Law'
Tue, 25 Apr 2000 15:35:37 -0400
Attention News/Health Editors:
Ontario introduces Brian's Law for better mental health treatment and safer
TORONTO, April 25 /CNW/ - Health and Long-Term Care Minister Elizabeth
Witmer today introduced new, stronger mental health laws to make sure people
with serious mental illness who pose a danger to themselves or others get the
treatment they need.
"Brian's Law will fulfill our government's commitment to help people with
serious mental illness get appropriate care, and to ensure the safety of our
communities," Witmer said.
The bill is named after Brian Smith, an Ottawa sportscaster killed in
1995 by a man suffering from severe mental illness.
"This law will be Brian's legacy," said Alana Kainz, Brian Smith's widow,
and a strong advocate for the changes to the Mental Health Act. "Brian's Law
will save lives and prevent other tragedies."
"I commend the government for moving ahead with these important changes
to mental health legislation," said Ontario Chief Coroner Dr. Jim Young.
"These amendments appear to directly address the recommendations made by
multiple inquest juries in the past."
Brad Clark, Parliamentary Assistant to the Minister and MPP for Stoney
Creek, conducted a series of province-wide consultations on the amendments to
the Mental Health Act and the Health Care Consent Act.
"We've listened to consumers, family members and providers across Ontario
who spoke passionately about their concerns," Clark said. "We have responded
with proposed changes to the law that will improve the quality of life for
people with serious mental illness and will help families and health
professionals who are concerned about their treatment and care."
Brian's Law includes the introduction of community treatment orders,
which are legal agreements that direct appropriate treatment in the community
for those who have a serious mental illness.
In 1995, the jury for the inquest into Brian Smith's death recommended
that the Ontario mental health reform initiative should incorporate a
community-based treatment program with third-party review and appeal
mechanisms and review comprehensively the Mental Health Act and clauses in
related legislation regarding mental health.
Legislative Amendments to Support Mental Health Reform
Between March 30 - April 11, 2000, a series of province-wide
consultations were conducted by Mr. Clark in Toronto, Ottawa, Kingston,
London, Hamilton, Thunder Bay and Sudbury. Approximately 300 representatives
attended. 88 written submissions were also received. Input gathered from
consumers, family members and health providers who participated in the
consultations or sent in written comments assisted in the design of the
legislation and provided valuable advice on implementation issues.
Today, the Ontario government is introducing amendments the Mental Health
Act and the Health Care Consent Act to ensure people with serious mental
illness get the care and treatment they need in a community-based mental
The amendments include:
- Expanding the current committal criteria in the Mental Health Act;
- Community Treatment Orders (CTOs) for people with a serious mental
illness to permit appropriate treatment in the community as a less
restrictive alternative to hospitalization, as proposed by a
- community treatment for involuntary psychiatric patients who consent
to a treatment plan as a condition of their release from a psychiatric
facility to the community;
- removal of the requirement for police to "observe" disorderly conduct
before acting to take a person into custody;
- Number of other changes including removing the word "imminent";
The committal criteria are expanded 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
- cyclical illness that responded well to treatment in the past
- a risk of serious harm if not treated
Community Treatment Orders
Community Treatment Orders (CTOs) are legal agreements that outline the
conditions under which individuals with a serious mental disorder have the
opportunity to live safely in the community. CTOs are for:
- Individuals who suffer from serious mental disorders and who have a
history of repeated hospitalizations and who meet the committal
criteria in the Mental Health Act, and
- Involuntary psychiatric patients who agree to a treatment/supervision
plan as a condition of their release from a psychiatric facility to
A CTO may be issued by a physician:
- where the individual may be committed under the committal criteria.
- where it will benefit the person subject to the CTO.
- where appropriate supports exist in the community to meet the
conditions of the CTO.
- 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 with respect to
- CTOs would be initiated for a period of six months and thereafter
renewable for six month intervals.
- CTOs would include a treatment plan as well as review, appeal and
Safeguards for Patients
A number of rights would flow from the designation of a CTO, including:
- a right of review by the Consent and Capacity Board with appeal to the
courts each time a CTO 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 CTO is still necessary for the person to live in the
- a right of review of findings of incapacity to consent to treatment;
- provision for rights advice and an entitlement to counsel appointed by
Mental Health Reform in Ontario
In 1999/00, ministry spending on mental health services is expected to be
This year, ministry spending on community mental health services is
estimated at $466 million.
Since 1995, the government has invested an additional $150 million in
mental health care services:
- $19.1 million to expand community-based mental health services to a
total of 51 Assertive Community Treatment Teams (ACTTs) and to enhance
court diversion, psychogeriatric outreach; case management and crisis
- $23.5 million for Community Investment Funding (CIF) to establish and
enhance ACTTs, case management, family support and crisis response
services across the province
- $60 million for additional mental health beds and increased community-
based services, including ACTTs, case management, family support and
- $45 million to provide housing support and mental health care supports
and services for homeless individuals
- $2.5 million for hard to reach, socially isolated people with serious
mental illness in Toronto, Ottawa, Hamilton and London
The government is creating the basis for a coordinated system of mental
health services that is more accessible.
Listed below are major government initiatives in mental health policy
reform, expanded forensic mental health capacity and the steps taken to
improve integration of the mental health system since 1995:
- Then-Parliamentary Assistant Dan Newman, MPP Scarborough Centre,
conducted a review of mental health reform strategy, releasing the
results in June 1998 as 2000 and Beyond: Strengthening Ontario's
Mental Health System
- Mental Health Law Education Project was developed to inform Ontarians,
especially professionals, about their rights and responsibilities
under existing mental health legislation
- Making It Happen(1999), provincial mental health reform implementation
strategy and service guidelines, was released
- Mental Health Implementation Task Forces established in northeastern
and northwestern Ontario with a commitment to establish task forces in
other regions of the province
- A Provincial Strategy to Coordinate Human Services and Justice
Systems, a provincial forensic policy was developed
- 446 new forensic beds opened across the province with another 144 beds
to be opened as part of the expanded regional forensic programs
- Introduced court diversion process by which mentally ill people in
conflict with the law can be diverted from the criminal justice system
to the mental health system to ensure they receive treatment.
- Review of the Mental Health Act and related legislation to ensure a
mental health service delivery system is accessible, accountable,
cost-effective, and promotes public safety
- Recommendations developed for a comprehensive housing policy for
people with serious mental illness and an inter-ministerial committee
set up to deal with supportive housing issues
- 84 supportive housing programs designated for people with a serious
mental illness has been transferred to the Ministry of Health and
Long-Term Care from the Ministry of Municipal Affairs and Housing
- 25 per cent increase in per diem funding for clients in Homes for
- The Centre for Addiction and Mental Health is established with four
- Support increased for the Consent and Capacity Board and the Ontario
Review Board through increased funding and increased accountability
through new Memoranda of Understanding
Moving from institutional to community care
The need for de-institutionalization of mental health care began in the
1960s with the introduction of alternative treatment options. Since 1995, the
Ontario government has undertaken major initiatives to update Ontario's mental
health system to reflect modern practices and eliminate barriers between
hospital and community care.
In fact, the ratio of government funding towards hospital-based and
community-based has also changed. In 1994/95, the ratio was 75% hospital and
25% community funding. In 1999/00, the ratio is now 60% hospital to 40%
Community-based services include:
- 335 community-based mental health agencies
- 152 homes for special care
- 84 Supportive Housing Providers
Hospital services include:
- 4,882 mental health beds, including:
- 9 provincial psychiatric hospitals (2,256 beds)
- 4 specialty psychiatric hospitals (907 beds)
- 58 general hospitals with psychiatric units (1,719 beds)
In 1998/99, there were 60,469 total admissions.
Version franšaise disponible
For further information: Barry Wilson, (416) 327-4521, Minister's
Office; Anne Matthews, (416) 327-4382, Ministry of Health and Long-Term Care;
This news release is available on our website at: