Community treatment orders – MHA

A community treatment order (CTO) under the Mental Health Act is a tool intended to assist you in complying with treatment while in the community. Your CTO is a treatment and care plan that outlines care specific to your needs, and may include (but is not limited to) medications you must take and appointments you must attend with care providers.

A CTO is not court ordered. Two physicians (1 of whom must be a psychiatrist) determine whether a person is suitable to be on a CTO using the criteria in the Mental Health Act. To be placed on a CTO, a person must:

  1. be suffering from a mental disorder;
  2. AND one or more of the following must apply:
    1. over the past 3-year period, on 2 or more occasions, or for a total of at least 30 days have:
      1. been a formal patient in a facility, or
      2. been in an approved hospital or been lawfully detained in a custodial institution where there is evidence that, while there, the person would have met the criteria of being a formal patient, or
      3. been both above;
    2. and/or within the past three years, have been subject to a community treatment order;
    3. and/or in the opinion of the two physicians, have, while in the community, exhibited a period of recurrent or repetitive behaviour that indicates the person is likely to cause harm to the person or others or to suffer substantial mental or physical deterioration or serious physical impairment if the person does not receive continuing treatment or care while living in the community;
  3. AND in the opinion of the two physicians, be likely to cause harm to the person or others or to suffer substantial mental or physical deterioration or serious physical impairment if the person does not receive continuing treatment or care while living in the community;
  4. AND be able to comply with the treatment or care set out in the community treatment order.

When a CTO is initiated

  • The treatment and care identified on the CTO must be available in the community,
  • AND consent must be obtained or, if certain conditions apply, the physician may issue the CTO without consent.

Definitions

  • Facility – a place or part of a place (usually a hospital) designated in the regulations as a mental health facility.
  • Formal Patient – a patient detained in a facility on the authority of 2 admission certificates or 2 renewal certificates.
  • Designated Physician – a physician designated by a board or Alberta Health Services to issue, renew, amend or cancel a community treatment order when there is no psychiatrist available.
  • Mental Disorder – a substantial disorder of thought, mood, perception, orientation or memory that grossly impairs:
    1. judgement,
    2. behaviour,
    3. capacity to recognize reality, or
    4. ability to meet the ordinary demands of life.

More information

Issuing a CTO

Two physicians, one of whom must be a psychiatrist, may issue a CTO. If there is no psychiatrist available to issue the CTO, the health authority can designate a physician to act in this capacity, only after the physician consults with a psychiatrist. It is important to note that the psychiatrist or designated physician who issues a CTO may not be the physician who supervises the care of the person under a CTO.

You are not a "formal patient” under a CTO

The CTO may have been issued when you were a formal patient under 2 admission certificates or 2 renewal certificates. Your certificates are automatically cancelled once you are on a CTO.

Consent for a CTO

As a general rule, you or your substitute decision maker must give consent for a CTO to be issued. Your consent is not required if the physicians are of the opinion that a) you have a history of not obtaining or continuing with treatment or care in the community that is necessary to prevent the likelihood of harm to others; and b) the CTO would be reasonable and less restrictive than retaining you as a formal patient.

Length of a CTO

A CTO is in effect for 6 months and may be renewed any time before its expiry. A CTO can be renewed for a period of 6 months. There is no limit to the number of times a CTO can be renewed.

Your responsibilities under a CTO and non-compliance

Being on a CTO means that you must follow the treatment and care requirements listed in the CTO. The care provider must report if you do not follow the treatment and care requirements. At that time, a psychiatrist or designated physician will make reasonable efforts to inform you (or your substitute decision-maker, if any) that you are not complying with the CTO and provide you with reasonable assistance to comply. The psychiatrist also will advise you that an apprehension order may be issued if non-compliance continues.

If you still do not follow the treatment and care requirements listed on your CTO, the psychiatrist may issue an order that authorizes a peace officer to apprehend you and convey you to a facility for an examination.

Treatment cannot be forced under a CTO

Regardless of whether the CTO is issued with or without your consent, you must agree to any treatment before it is provided.

What happens when you are non-compliant with your CTO

If you are taken to a facility due to non-compliance, an examination must be completed by 2 physicians (one of whom must be a psychiatrist or designated physician) within 72 hours. Once the examinations have been completed:

  1. the CTO may be cancelled and you may be released or offered a bed as a voluntary patient; or
  2. the CTO may be amended (changed) and you may be released to resume your treatment and care plan in the community under the amended CTO; or
  3. if you meet the criteria for certification, the CTO may be cancelled and you may be admitted to a designated facility as a formal patient.

Who to talk to about your CTO

You may speak to the psychiatrist who issued the CTO. If another physician has assumed supervision of your CTO, you may also speak with that physician or any other provider closely involved with your care.

Changing your CTO

A CTO can be changed by a psychiatrist or a designated physician. If you feel your CTO needs to be updated, you should discuss this with your case manager or someone closely involved with your care. You may also talk with the psychiatrist or physician who is supervising your CTO.

How to cancel your CTO

A psychiatrist or designated physician can cancel a CTO, as well as a review panel or the Court of Queen’s Bench.

You can speak with your psychiatrist or supervising physician. You can also ask for a review of your CTO by the review panel. To start this process, you must submit an application form to a review panel chair. You can obtain an application form for the review panel from the psychiatrist (or physician) who supervises your CTO, other care providers working with you, hospital staff, or the mental health clinic in your community. The form is called "Form 12. Application for Review Panel Hearing: Mental Health Act."

You should have received a brochure entitled “Review Panels: Community Treatment Orders” that provides more information about this process. You can also obtain this brochure by asking your care providers.

Your rights are protected under the Mental Health Act

The Mental Health Act provides persons under a CTO with many rights. For example, when a CTO is issued, a form called a “written statement” must be given to you under the CTO, as well as your substitute decision-maker (if any) and any other person that is designated to receive notices on your behalf.

How to get help

If you are receiving treatment or care under a CTO you may request assistance from your case manager or other (mental health) staff involved in your care. They will provide you with information, such as brochures regarding Review Panels, Legal Aid Alberta and the Mental Health Patient Advocate Office.

You may also contact the Mental Health Patient Advocate directly. Upon request, the Mental Health Patient Advocate provides rights information, investigates complaints, and assists persons under a CTO and those acting on their behalf.

Review Panel hearing contacts

Applications for a Review Panel hearing can be sent to the appropriate Chair for your zone at the address below. It is important to include your address on the application form so the review panel in your area will hear the application.

Edmonton and North Mental Health Review Panel
R. Allan Harris, Chair
Suite 302, Energy Square, 10109 – 106 Street N.W.
Edmonton, Alberta T5J 3L7

Calgary and South Mental Health Review Panel
Marilyn Smith, Chair
323 – 11 Avenue N.E.
Calgary, Alberta T2E 0Z2

Central Alberta Mental Health Review Panel
Richard Wyrozub, Chair
Box 4550
5016 – 51 Avenue
Ponoka, Alberta T4J 1S1

If you are not sure which health zone you live in to determine which Chair to contact, check the Alberta Health Services Zone map.