What Form 45 is for
A community treatment order requires a person with a serious mental disorder to follow a plan of supervised treatment and care while living in the community. The ministry describes it as a less restrictive option than detention in hospital. Form 45 is the order itself, used both for the first CTO and for every renewal.
Form 45 is often confused with the forms around it. Form 49 is the notice you give before issuing, Form 46 is the notice of hearing rights you give after, and Form 47 is the order for examination you issue if the person stops complying.
Who completes it
The examining physician completes Part 1, which records the history, the criteria, rights advice and the community treatment plan, and Part 3, which sets the expiry date. The person, or their substitute decision-maker if the person is incapable, completes the undertaking in Part 2 and signs the order. Part 4 is a printed notice of the right to apply to the Consent and Capacity Board.
How to fill in Parts 1 and 3
History in the previous three years
Tick whether this is the first order or a renewal, and give the number of renewals. Then confirm the person has either been a patient in a psychiatric facility on two or more separate occasions, or for 30 days or more in total, during the previous three years, or has been on a CTO before. Give the dates of issue and expiry of the previous order when there is one.
Criteria for Community Treatment Order
All five criteria must be met for the order to be valid. The person needs continuing treatment or care and supervision in the community, is likely without it to cause serious bodily harm or suffer substantial deterioration or serious physical impairment, is able to comply with the plan, and the treatment is available in the community. If the person isn’t currently an inpatient, they must also meet the criteria for a Form 1 application. Tick every harm that applies.
The facts on which you formed the opinion
This box is the evidence for each criterion you ticked. Record what you observed at the examination and what others told you, with dates: missed depot injections, relapses after stopping medication, admissions, threats or incidents. The ministry guide says you must have examined the person in the 72 hours before entering into the plan.
Rights Advice and Community Treatment Plan
Confirm that the substitute decision-maker, if any, has had rights advice, and that the person has either had rights advice or refused it. Confirm the plan exists, that you consulted everyone named in it, and that the person or the substitute decision-maker consents. Summarize the plan on the form and attach the full plan, since the form says the order must carry it.
Part 3, Time in Force
Enter the expiry date. The order runs six months including the day it is signed, so count from the signing date, not the examination date.
Common reasons it’s challenged or invalid
- A criterion left unticked, or no harm selected under the likely-harm criterion.
- A facts box that restates the criteria with no observed or reported facts.
- Rights advice not completed, or not confirmed for the substitute decision-maker, before the order is signed.
- No community treatment plan attached, or people named in the plan who weren’t consulted.
- An expiry date counted from the wrong day, or a renewal that cites the wrong previous order.
- A missing signature from the person or their substitute decision-maker.
Submitting and who pays
Form 45 isn’t sent to a payer. Immediately after signing, give a copy of the order and the plan to the person, their substitute decision-maker, the officer in charge of the psychiatric facility if there is one, and every health practitioner or other person named in the plan. Give the person a Form 46 at the same time. Keep the original in the record. The examinations behind the order are insured services billed to OHIP in the usual way.