You can find the full article here:

Coercion Taking Over: Community Treatment Orders Explode in Ontario Part 1 Nov 2 2022 The Lawyer’s Daily

This article was originally published by The Lawyer’s Daily, (www.thelawyersdaily.ca) a division of LexisNexis Canada.

Coercion taking over: Community treatment orders explode in Ontario

Wednesday, November 02, 2022 @ 10:39 AM | By Anita Szigeti

I did three things recently that led me to wonder just what is happening with CTOs, or community treatment orders, in Ontario.

First I spent some time talking about all the things we do to people with serious mental health issues that we don’t do to anyone else, on a podcast about Disability Rights and the Charter. Next, while attending a NARPA conference, I went to a workshop by my colleague Arthur Baer who reviewed the last 23 years of New York’s experience with its CTO equivalent. Finally, I updated my resumé. That’s when I remembered I had once spent years of my life advocating against importing this American style coercion. I also realized that, like in New York, lawyers and patient advocates here have largely lost the appetite to continue the fight. CTOs have become a fact of life for our clients living with serious mental health issues. Everybody seems resigned to the status quo now.

But just what is the state of things where these instruments of forced medication compliance under pain of threat of psychiatric detention are concerned? I determined to dig deep and made some shocking discoveries — although none we didn’t predict nearly a quarter century ago.

New York has since renamed its court-ordered involuntary outpatient commitment regime, known as Kendra’s Law, to assisted outpatient treatment. It became law in November 1999, in the wake of the death of Kendra Webdale who was pushed in front of a subway by someone in mental health crisis. In December 2000, Ontario enacted Bill 68 — Brian’s Law — and CTOs — following an inquest into the death of Brian Smith, an Ottawa newscaster also killed by someone with a psychiatric history. Such isolated but sensationalized incidents of violence by people with serious mental health issues inevitably lead to bad lawmaking, increasing restrictions on the liberty and autonomy of the affected client population. Lawyers and advocates for these clients saw the writing on the wall, but put up a long and valiant opposition to the proposed legislation.

Brian’s Law proposed what is now the CTO regime within our existing Mental Health Act. People subject to CTOs must take their psychiatric medications, attend for psychiatric follow-up and do whatever else is required of them under the order, failing which the police can pick them up and take them to a psychiatric facility for assessment, where they may be admitted. During legislative debates at the second and third reading of Bill 68, we identified a host of concerns. We worried that people with serious mental health issues would avoid treatment, for fear they’d be put on CTOs; that people who did not need them would be placed on the orders to ensure they could access services; that CTOs would be used routinely as discharge planning; and that the loss of autonomy and liberty would drive clients out of the jurisdiction to avoid or escape the orders. All of these things have since come to pass.

But mostly we worried that a lot of people would be put on these orders. Advocates sounding the alarm bell at the time were accused of “the sky will fall” fear mongering. The late Richard Patten, then MPP for Ottawa said on June 5, 2000, that we were “scaring people and leading people to believe that large numbers of persons will be forced into treatment against their will.” He and others reassured us only a very small percentage of clients would find themselves in this situation. At one point, we heard maximum numbers in the 200-250 range.

Where are we at now? By my count, although it’s almost impossible to get an even close to accurate figure, there must be at least 10,000 CTOs issued or renewed in Ontario annually. Before CTOs were enacted, we were also told people would not be on them for long. Saskatchewan’s earlier experience was touted as an example where only a handful of people had been on CTOs for a year or longer. Meanwhile, in Ontario, nearly a quarter of CTO subjects have been continuously under successive such orders for seven years or more, according to the latest available approximations as reported in the 2019 review of the regime.

This is the first half of a two-part series. 

Anita Szigeti is the principal lawyer at Anita Szigeti Advocates, a boutique Toronto law firm specializing in mental health justice litigation. She is the founder of two national volunteer lawyer associations: the Law and Mental Disorder Association and Women in Canadian Criminal Defence. Find her on LinkedIn, follow her on Twitter and on her blog.

The opinions expressed are those of the author(s) and do not necessarily reflect the views of the author’s firm, its clients, The Lawyer’s Daily, LexisNexis Canada, or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.

Photo credit / nadia_bormotova STOCKPHOTO.COM

Interested in writing for us? To learn more about how you can add your voice to The Lawyer’s Daily, contact Analysis Editor Peter Carter at peter.carter@lexisnexis.ca or call 647-776-6740.

Related Articles

• Constitutional Law – Canadian Charter of Rights and Freedoms – Reasonable limits on Charter rights – Demonstrably justified in free and democratic society – Legal rights – Life, liberty and security of person
• Addressing entrenched biases improves justice for those with mental health issues, panel says
• Mixed reaction as Alberta moves to revamp mental health laws
• Court of Appeal decision ‘monumental victory’ for psychiatric patients: Toronto lawyer
• Antipsychotic treatment of schizophrenia: Hidden sexual adverse effects