Mental Health Law

Steady Legal Support for High-Stakes Care Decisions

Focused support for capacity, admission, and Review Board matters.

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Decisions about capacity, treatment, and admission move fast. We represent hospitals, clinicians, patients, before the Consent and Capacity Board and the Ontario Review Board. Let’s review options and set a plan.

Hospital and Community Resources

Clinicians need tools they can use today. Access capacity interview checklists, least-restrictive plan guides, and hearing prep steps. Book a short in-service for your team.

Consent & Capacity

Findings of incapacity, treatment decisions, and hearings at the Consent and Capacity Board happen quickly. This page explains how and when capacity is assessed, what the law requires, how substitute decision-makers should decide, and how a review before the Consent and Capacity Board unfolds. The aim is steady preparation, reliable records, and a workable plan.

When capacity is assessed

A capacity assessment happens when a person is asked to consent to treatment and there is concern they may not understand the information or may not appreciate the risk and the benefits of the proposed treatment or how it applies to their situation.

A finding that a person is not capable of making their own decisions with respect to a proposed treatment will lead to the health care practitioner seeking consent from a substitute decision maker. Patients who are found incapable have the right to request an independent review before the Consent and Capacity Board. Court appeals can be available within set time limits.

The legal test in plain language

Two questions guide every decision. First, does the person understand the information about the proposed treatment. Second, do they have the ability to appreciate the reasonably foreseeable consequences of accepting or refusing the proposed treatment. Clinical notes and records that clearly document the nature of the discussion between the health care practitioner and the patient will be given more weight by the Consent and Capacity Board.

Notes should show how understanding and appreciation were explored, not only that illness was denied. Record alternatives considered, side effect discussions, and the reasoning for the proposed plan. If a substitute decision-maker is involved, document rights advice and who was contacted. When a review is requested, organize the chart and confirm who will speak to the assessment in clear, factual terms.

Hearings and next steps

Reviews are scheduled within 7 days of receiving an application. The Board hears from the health care practitioner/assessor, the person or their representative, and any other relevant witnesses. Questions focus on the applicable legal test and compliance with the legislation and regulations of the Mental Health Act and Health Care Consent Act. Written reasons will be produced if they are requested. Upon receiving the outcome of the hearing, a meeting will be arranged to discuss next steps and a plan of action.

Community Treatment Orders

A community treatment order allows a person to live in the community under a defined plan when hospital care is not required but support and structure are. This page explains when orders are considered, what a workable plan contains, how issuance, renewal, or termination is reviewed, and what to expect if the matter goes before the Consent and Capacity Board. The emphasis is practical supports, clear records, and steady follow-through.

When a community treatment order is used

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.

What is required to issue a Community Treatment Order?

A physician may issue or renew a community treatment order under this section if, during the previous three-year period, the person:

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

The patient has been the subject of a previous community treatment order.

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.

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:

a. 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.
b. 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.
c. 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.
d. The person is able to comply with the community treatment plan contained in the community treatment order.
e. The treatment or care and supervision required under the terms of the community treatment order are available in the community.

The physician has consulted with the health practitioners or other persons proposed to be named in the community treatment plan.

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.

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.

Reviews and next steps

Reviews are scheduled promptly. The Board looks for evidence that the order is lawful and that the plan is appropriate and workable. Testimony focuses on the person’s needs, the available services, and how the plan manages risk while supporting independence. Written reasons follow with clear directions. If the order is confirmed, the team implements it and monitors compliance. If it is varied or terminated, follow-up steps are set so support continues without interruption.

Ontario Review Board Reviews

Some people under the criminal law system are supervised by the Ontario Review Board after a finding that they were not criminally responsible. This page explains what the Board reviews each year, how conditions can change, what is involved in reintegrating patient’s into the community , and what to expect at a review hearing. The aim is careful preparation, clear records, and steady follow-through. This practice covers annual and restriction-of-liberty reviews.

When Ontario Review Board supervision applies

Board Supervision applies when a court has made a finding of not criminally responsible. The Board reviews the case at set intervals and can change conditions based on current risk and available supports. The disposition can include detention in hospital, a conditional discharge, or when the person is no longer a significant threat to the safety of the public, an absolute discharge. The decision turns on present risk and the least restrictive option that still addresses safety. The safety of the public is the primary consideration of the review board.

What the Board looks for

The Board considers structured information about risk, treatment, and supports. Records should show the current clinical picture, progress since the last review, any incidents and how they were handled, and what services are in place now. Clear evidence about housing, supervision, medication, appointments, and day-to-day routines helps the Board assess whether community living is workable and safe. Often before the Board is willing to grant community living as a clause in a disposition, the Board will want to see a successful trial of living in the community.

Building a workable community plan

Plans carry weight when they are specific, supported by named services, and can start immediately. Consideration should be given to whether supervised living is appropriate or whether independent living is feasible.

Describe the supervision level being proposed, the role of each professional, how medication will be managed, and how missed appointments or early warning signs will be addressed. Include housing details, curfews or passes, and how communication with police or other agencies will occur if needed. Note progress since the last review and explain why the plan is the least restrictive option that still addresses risk.

Set out where the person will live, who will help with daily routines, how work or school will be supported, and who to call when problems arise. Identify a plan for transportation to appointments and for managing triggers that have caused trouble in the past. Be realistic and specific.

Preparing for the review

Preparation begins with a short, organized record in the form of a report to the Review Board: disposition history, any medication or diagnostic changes, any incidents with responses, current treatment, and available community supports. Witnesses are chosen for their knowledge of daily function and risk management, not only diagnosis. Where a change in liberty is requested, preparation focuses on why the proposed step is safe now and how supervision will work in practice.

The hearing and next steps

At the hearing, the Board hears from the hospital team, the person or their representative, and other helpful witnesses. Questions focus on present risk, stability, and whether the proposed disposition is the least restrictive option that still addresses safety. Written reasons follow with directions. If conditions change, the team implements the order and confirms follow-up. If conditions remain as they are, the plan may be adjusted, and preparation begins for the next review.

For Hospitals & Clinicians

Units need clear process, reliable documentation, and steady representation when capacity, treatment, or admission decisions are reviewed. This page sets out how we support psychiatric units, emergency leadership, patient relations, and community teams with preparation, hearings, and brief policy improvements. The aim is fewer surprises, cleaner records, and practical plans that decision-makers can trust.

How we help your unit today

Support begins with fast triage and a short review of the record. We confirm timelines, identify who should speak at any hearing, and align the plan with what was documented. For some files, that means focused preparation for a Consent and Capacity Board review. For others, it means refining the discharge or community plan so it addresses the risks identified by the team. When helpful, we join case conferences to keep the legal test and the operational plan in sync.

Documentation that helps decision-makers

Decision-makers rely on concrete, case-specific notes. Records should show how the assessment explored understanding and appreciation, why a particular plan is proposed, and whether a less restrictive option was considered and rejected for clear reasons. The goal is not volume, it is clarity.

Describe the discussion in practical terms. Record how understanding was checked, how appreciation was explored using real-life consequences, and any concerns raised about side effects or access. Note rights advice and who was notified. Keep examples short and specific.

Explain why hospital care is required now, what alternatives were discussed, and why those options were not adequate at the time. If a supervised discharge was considered, record the gaps that prevented it and what would close those gaps.

Set out where the person will live, how medication will be taken, who attends appointments, transportation, and early follow-up. Identify a contact for problems and how setbacks will be handled. Tie each element to a documented risk or need.

Training and brief policy support

Short, focused in-services help teams apply the legal tests and document decisions with confidence. Popular sessions include capacity interviews in practice, least restrictive planning that decision-makers accept, and preparing witnesses for hearings. We also offer concise policy tune-ups, template language for common notes, and quick briefings for new staff. Sessions are designed to fit into busy schedules and can be delivered on site or virtually.

Working together on urgent matters

When a review is requested or a deemed review is pending, timelines are tight. We organize the chart, confirm witnesses, and set a brief preparation call. Testimony is calm and factual. After reasons are released, we assist with implementation and confirm next steps so plans begin without delay. If the decision stands and adjustments are needed, we help the team revise the plan and communicate changes to the patient and family.

Continuous improvement after hearings

Each review offers lessons that reduce future friction. We debrief with the team, note what supported the outcome, and update documentation practices where needed. Small changes in how notes are written or how options are recorded can improve consistency across shifts and reduce repeat issues over time.

For Patients & Families

When a person is kept in hospital or found not capable to consent to treatment, it can feel overwhelming. This page explains what those decisions mean in plain language, when a review can be requested, how to prepare, and what to expect at a hearing before the Consent and Capacity Board. The goal is clarity and a practical plan that supports safe care and steady progress.

Understanding the decisions you have been told about

A capacity decision asks whether a person understands information about a proposed treatment and appreciates how that information applies to their life. If the person is found not capable, a substitute decision-maker may be asked to decide. Involuntary admission is used when hospital care is required for safety or health and a voluntary plan will not work at that time. These decisions can be reviewed on short timelines. Knowing which decision you are dealing with helps you choose the next step.

Should you ask for a review

A review is a short, focused hearing before an independent tribunal. People request a review when they believe the capacity finding does not reflect what the person can do, or when they believe a safe, less restrictive plan exists outside the hospital. A review is most useful when you can show concrete information that answers the concerns recorded by the team. If you are unsure, a short call can help you decide whether a review makes sense.

Preparing for a hearing

Preparation is about facts and plans, not arguments. Start with a brief history of what has helped in the past. Add current supports and any barriers that must be solved.

Bring the capacity interview notes if you have them, the proposed treatment plan, a short list of medications that have worked or caused problems, and any letters that show work or school arrangements. If a substitute decision-maker is involved, gather any known prior wishes and a simple statement of the person’s values. Keep documents short and clear.

Explain where the person will stay, how medication will be taken, who will go to appointments, and how transportation will work. Add a plan for daily check-ins during the first week and name a contact for problems. If money or access to devices was a trigger, describe a temporary safeguard. Realistic steps carry weight.

What happens at the hearing and after

Hearings are scheduled quickly. The panel hears from the clinician who made the decision, the person or their representative, and anyone else who can help. Questions focus on the legal test and on whether the plan is workable. Written reasons follow. If the outcome changes, discharge or treatment steps are set and follow-up is confirmed. If the decision stands, the plan may be adjusted and appeal timelines are reviewed where appropriate. Calm, specific communication with the team helps the plan succeed.

Urgent help and privacy

If a hearing notice has arrived or the hospital has told you a review is coming, contact us promptly so timelines are met. Health information is private. Only records needed to understand the decision and prepare for the hearing are requested, and consent is confirmed before speaking with others. Families are guided on what to share and how to keep sensitive details secure.

Meet Our People

Al Pace

Founder & Chairman

Anu Malhotra

Senior Lawyer

Tanner Blomme

Lawyer

Protecting Patient Rights and Supporting Care Teams

Capacity, and involuntary admission cases require steady advocacy and precise documentation. We work with psychiatric units, emergency leadership, and community teams to prepare evidence, ensure compliance with relevant legislation/regulations, and move cases through hearings with discipline. For patients and families, we explain the process in plain language and focus on practical next steps.

Our Approach to Mental Health Law Matters

We begin with fast triage, confirm timelines, and collect all clinical notes and records to get a complete picture of the case. The strategy focuses on legal tests and the real-world plan that decision-makers will trust. For hospitals and clinicians, this means better documentation to support your findings, clearer evidence, and smoother hearings. For patients and families, it means a clear path through intake, preparation, hearing, and follow-up. The tone is calm. The steps are firm. The goal is a safe and workable outcome.

Get in Touch

Call us now or fill out the form to discuss your case with an experienced legal professional.

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Our Locations

Office Location

191 The West Mall, Suite 1100
Toronto, ON M9C 5K8
Phone: 1-877-236-3060
Fax: 416-236-1809

Office Location

191 The West Mall, Suite 1100
Toronto, ON M9C 5K8
Phone: 1-877-236-3060
Fax: 416-236-1809