Community Treatment Order

• Individuals who are 16 years of age and older who have been diagnosed with a serious mental illness 
• Individuals who are residents of the city of Toronto 
• Individuals who are on a CTO where case management services have been identified as part of their Community Treatment Plan 

Referrals can be made by inpatient or outpatient healthcare providers (e.g. physicians, social workers or other allied healthcare providers) and/or a CAMH CTO coordinator. In order to make our services barrier free, we also accept referrals directly from clients and families as long as we have all the supporting documentation. 

The CTO Program offers weekly case management services to clients living in the community. 

A Community Treatment Order (CTO) is an order issued by a physician and agreed to by an individual (and/or their Substitute Decision Maker) under the Ontario Mental Health Act. This allows the individual to receive care and treatment in the community in lieu of detention in a psychiatric facility. CTOs are used with individuals who have had repeated psychiatric admissions and who do not voluntarily engage in outpatient treatment. A CTO allows a client to be recalled back to hospital for assessment if their mental health is deteriorating.  

CTOs are active for up to 6 months. After that, it expires unless it’s renewed. A client and/or their Substitute Decision Maker can ask the doctor to review the need for a CTO. If the doctor decides the CTO criteria no longer apply, the CTO can be ended. The psychiatrist has the right to renew at the 6 month mark by issuing a Form 49 (Notice of Intention to Issue or Renew Community Treatment Order).  

• Form 48 – Application to the Board to Review Community Treatment Order: form is completed by the client or SDM to apply to the Consent and Capacity Board for a hearing to decide if you must continue to follow the CTO
• Form 49 – Notice of Intention to Issue or Renew Community Treatment Order: initial order given to the client to let them know a physician intends to start or renew a CTO  
• Form 45 – Community Treatment Order: official form of a CTO and the details of the treatment order  
• Form 50 – Rights Advice: client and/or substitute decision maker must obtain rights advice (or best efforts to provide) 
• Community Treatment Plan (CTP): comprehensive plan of community based treatment, care and/or supervision that is less restrictive to being detained in the psychiatric hospital. All parties involved in supporting the client are noted in this document and signed by all parties.

A Substitute Decision Maker (SDM) is a person who can legally make healthcare decisions on a patient’s behalf if they are unable to understand or appreciate the information needed to make decisions about their care. Healthcare decisions can include decisions about treatment, admission and medication.

The client and/or SDM has the right to challenge the CTO by requesting the Consent and Capacity Board (CCB) to review your situation by asking your rights advisor to connect you to a lawyer, or by completing a Form 48. This can happen every 6 months by request of a client and/or SDM. The CCB will automatically review a client’s CTO every second renewal.  

A Form 47 (Order for Examination) can be issued by a physician when followup on the CTP has not taken place. This form is completed and given to the local police department in the area in which the client resides. The police will be able to get the client from their community setting to the hospital or clinic where the physician is for an examination and treatment.The client cannot refuse treatment as the CTP outlines treatment is required and the physician is legally able to enforce treatment.  

No, a CTO is a legal binding document. It is separate from any justice involvement with the courthouse and does result in a criminal record.