If you’re new to this, this page is for you. It explains the forms, the doors in, and what actually happens at each step — including the hard parts nobody warns you about. Many of us were months into the crisis before anyone explained how any of this works. You shouldn’t have to be.
Mental Health Act (Ontario)
The Mental Health Act (the Act) is an Ontario law which regulates the administration of Mental health care. The main purpose of the law is to regulate the involuntary admission of people into a psychiatric hospital. Since the changes brought about in 2000 under Bill 68 (often referred to as Brian’s Law, named after Brian Smith who was shot dead in 1995 by a person suffering from paranoid schizophrenia), the Act allows for a community treatment order by the attending physician. This order is intended to provide comprehensive treatment outside of a psychiatric facility.
Assessment Order Forms
The following are three common ways that a person may be involuntarily admitted to a psychiatric facility (unit) in Ontario for a 72-hour observation period:
1. A doctor signs a Form 1
A family member can bring their loved one to a doctor — their family doctor, or a doctor at a hospital. If the doctor believes a psychiatric assessment is needed, the doctor signs a Form 1 (Application by Physician for Psychiatric Assessment). One thing families learn quickly: at the hospital, that doctor is usually an emergency-room doctor, not a psychiatrist. Emergency doctors aren’t mental-health specialists, and they don’t always know what to look for. Sometimes the person is sent home anyway — even after a family doctor has signed a Form 1 asking for the assessment.
2. Police bring the person to hospital
Police usually get involved in one of four ways: a family member calls them because they’re worried — their loved one is acting dangerously and they’re scared for their health and well-being; someone in the public calls because they’re worried about the person’s behaviour; a Justice of the Peace has signed a Form 2 (that’s door 3 below) and police go and bring the person in; or worse yet, the person has actually committed a crime. From there, police take the person to a hospital for assessment. A physician then assesses them — and here again, that physician is often an emergency-room doctor, not a psychiatrist. If the physician believes the person may be a danger to themselves or others, or unable to care for themselves, they can sign a Form 1 and keep them for up to 72 hours for a full assessment.
3. Go before a Justice of the Peace (Form 2)
Anyone, including a family member, can lay information before a Justice of the Peace. If the JP issues a Form 2, take it to your local police station. Police will then bring the person in for assessment, but they need to know where the person is at that time. They won’t go searching for them, so wait until you know exactly where they are before handing the form in. Go prepared. You will be swearing an oath. A Justice of the Peace can refuse the order if the case is not strong enough, so bring clear, documented examples showing the person is a danger to themselves or others, or unable to care for themselves. Expect detailed paperwork at the courthouse too — dates, examples, and what you have observed.
Involuntary admissions
Once a person has been brought to a psychiatric facility to be assessed, the physician may hold them there for up to 72 hours on an application for psychiatric assessment (Form 1). This form allows the person to be held at a psychiatric facility for assessment but does not itself permit any treatment without the person’s consent.
Consent to treatment is not covered under the Mental Health Act but rather the Health Care Consent Act. The physician must also fill out a Form 4 2to notify the person and inform them of why they’re being held.
Those 72 hours are for observation only — nobody can be forced to take medication during them. So the person sits, unmedicated, while staff watch and decide. And here’s what families know that the system doesn’t say: many of our loved ones can hold it together in front of doctors and police for a short stretch. If they seem fine, they’re let go at the end of the 72 hours, just as ill as when they came in — and most families aren’t even told. They’re just let out the door. Even when a doctor sees beyond it and keeps them on the next form, that still doesn’t mean treatment can be forced. Being held and being treated are two different things under Ontario law.
After the 72-hour assessment, a different physician decides whether the person needs to stay longer. If the person won’t consent, that physician can sign a Form 3 for involuntary admission.
In Ontario, that first Form 3 is only two weeks. In several other provinces, the first period is three or four weeks. Two weeks is often not enough time to stabilize severe psychosis, and families watch loved ones discharged still unwell. That’s why the OPA is proposing Ontario extend that first period to 30 days, and why we support it.
Families, especially substitute decision makers, need to be part of this stage. Doctors and nurses see how a person is in hospital; families know how they were before, what changed, and what isn’t normal for them. Too often that information never reaches the care team — it depends on the hospital, the doctor, and the staff. Families should be heard at every stage of care.
If the person still needs to stay, the physician can renew with a Form 4. The first renewal is up to one month, the next up to two months, and later renewals up to three months. Each time, the patient gets rights advice and can ask the Consent and Capacity Board to review.
Each time a Form 4 is filled out, another Form 30 must be filled out, notifying the patient.
Rights of the patient
A physician who places a person on a Form 3 or Form 4 is required to notify a rights adviser who is required to meet with the patient and explain to the patient what his or her rights are. If the patient requests it, a rights adviser will also help the patient apply for an appeal or acquire legal services.
If a patient is placed on a Form 3 or Form 4, they have the right to appeal the decision to a Consent and Capacity Board which will hear the patient’s and physician’s case. A patient’s involuntary status is reviewed by the Board every year whether the patient requests it or not.
The board is composed, at the minimum, of a lawyer, a psychiatrist, and a member of the community (often a family member of someone with mental illness).
If the patient or physician disagrees with the Board’s decision, they may appeal to the Ontario Superior Court of Justice.
Community treatment orders
The Act states that “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. … [and] 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.”
When a physician decides that a patient meets the criteria for a community treatment order, a treatment plan is developed with the involvement of all people involved in the plan. In addition to the physician and the patient, people involved in the plan may include other health care workers, social workers, family members, the substitute decision-maker, or others. Once the treatment plan is agreed to by all parties, the patient is required to follow the plan while living in the community. Failing to follow the plan can result in the person being readmitted to the hospital on a Form 47. One notable aspect of the community treatment orders is that it allows anyone who is named in the treatment plan to communicate with each other for the purpose of providing treatment, care, or supervision of the person. By removing barriers to communication between members of the health care team, appropriate interventions can be quickly applied when the person is at risk.
A community treatment order lasts six months and can be renewed if needed. A person on a community treatment order has the right to see a rights advisor and to appeal to the Consent and Capacity Board. The Board will review community treatment order every year whether the patient requests it or not.