The Forensic Mental Health System in Ontario: An Information Guide
Absolute Discharge: A person is no longer subject to the authority of the Ontario Review Board (ORB). The person is free to live where he or
she likes within the limits of the law.
approved person: A person who has applied for and been accepted as the person who will escort you on privileges and who agrees to follow
the rules and restrictions in your disposition.
conditional discharge: Also known as "discharge subject to conditions." A person is still under the authority of the Ontario Review Board (ORB),
but is allowed to live in the community. The person must, however, follow the conditions laid out in the disposition. Examples
of conditions that are often enforced are abstaining from alcohol or drugs, submitting to random drug screens and having regular
meetings with a psychiatrist or other mental health professional.
conditions: Rules that must be followed in a disposition order.
Consent and Capacity Board: An independent panel established by the Ontario government that conducts different types of hearings, including deciding
on a person's capacity to consent to or refuse treatment.
Court Support Program: A program that exists in some courts to help people become connected with psychiatric services and community resources.
criminal justice system: The system that deals with people accused of and convicted of crimes.
criminal responsibility: A court may decide that a person did commit a crime, but find that person Not Criminally Responsible (NCR). A court finds
a person NCR when, because of a mental illness, that person could not appreciate the nature of his or her actions or did not
know that the actions were wrong. However, simply having a mental disorder does not make a person NCR.
detention order: A person on a detention order is still under the authority of the Ontario Review Board (ORB). Some people on detention orders
have the privilege of living in the community. The psychiatrist and multidisciplinary team have the right to allow or deny
any privilege listed on the disposition.
disposition: A decision the Ontario Review Board (ORB) makes after having a hearing. A disposition details where a person must go, for
example, which hospital, facility or doctor the person must remain connected to. A disposition also details what level of
security the person will be subject to (maximum, medium or minimum) and the privileges and conditions that apply for the next
disposition hearing: This is where a person who has been found Unfit to Stand Trial (Unfit) or Not Criminally Responsible (NCR) may be given:
- an absolute discharge (only available for those who are NCR)
- a conditional discharge
- a detention order.
The first disposition hearing could happen in the court or with the Ontario Review Board (ORB), if the court decides not to
conduct this hearing. All subsequent disposition hearings, if there are any, will be conducted by the ORB.
If the court chooses to hold a disposition hearing, the ORB will then be required to hold another disposition hearing within
90 days. The only exception is when a person found NCR is given an absolute discharge. In that case, there are no further
decisions to be made because the person is no longer involved with the forensic mental health system.
If the court chooses not to hold a disposition hearing, the ORB must hold a disposition hearing within 45 days of the finding
of NCR or Unfit.
After the first disposition hearing, you will typically have one ORB disposition hearing a year for as long as you remain
under the authority of the ORB.
diversion: Minor charges are dropped, or stayed, if the accused person agrees to follow an individually tailored treatment plan. The
Crown decides whether an accused person will be diverted. The defence counsel, duty counsel and court support worker can help
a person look into the possibility of diversion.
dual diagnosis : A person who has both a mental illness and an intellectual disability (also known as a "developmental delay" or "mental
Fit to Stand Trial: The ability of a person to understand what happens in court and what might result from the proceedings, and also the person's
ability to communicate with his or her lawyer. A person is declared Unfit to Stand Trial ("Unfit") if a mental illness stops
that person from understanding the nature, object or consequences of the events that happen in court, or if that illness stops
the person from being able to communicate with and instruct his or her lawyer. Simply having a mental disorder does not make
a person Unfit.
forensic: Connected to the law or the courts.
forensic assessment: The systematic evaluation of an issue, such as Fitness to Stand Trial or Criminal Responsibility. The results of the assessment
are made into a report for the court.
forensic mental health system: The system that deals with people who have a mental illness (including those with a dual diagnosis) and who have come into
contact with the law.
Form 1: "Application by Physician for Psychiatric Assessment." A legal document that comes from the Mental Health Act. If a doctor
thinks that you have a mental disorder and you are going to harm yourself or someone else, or that you can't look after yourself,
the doctor may fill out a Form 1. (Talk to a psychiatrist, lawyer or patient advocate for more information about the criteria
for a Form 1.) Once this form is signed, you can be kept in hospital for up to 72 hours, even if it is against your will.
Form 3: "Certificate of Involuntary Admission." Once you are in hospital on a Form 1, a physician must assess you again within 72
hours. If a doctor thinks you still meet the criteria for involuntary admission to hospital, the doctor may fill out a Form
3. After a Form 3 has been signed, you can be kept in hospital for up to two weeks.
Form 4: "Certificate of Renewal." If a doctor thinks you still meet the criteria for involuntary admission to hospital after a Form
3 expires, the doctor may fill out a Form 4. The doctor can use a Form 4 for as long as you meet the criteria for involuntary
admission to hospital.
hearing: A forum where legal proceedings are held. Hearings decide such things as whether a psychiatric assessment is needed, whether
a person should be granted bail or what a guilty person's sentence should be.
involuntary admission: When you are kept in hospital even if it is against your will.
mental health system: The system that assesses and cares for people with mental health problems.
multidisciplinary team: A group of people who are involved in your forensic assessment, or in your care once you are in the forensic mental health
system. This group might include people from some or all of the following professions: nursing, medicine, social work, psychology,
recreation therapy or occupational therapy.
Not Criminally Responsible (NCR): See Criminal responsibility.
Ontario Review Board (ORB): People who are found Unfit, or Not Criminally Responsible (NCR), are placed under the authority of the ORB. They will
have a hearing within 45 days or 90 days of the initial finding and then once a year after that. The ORB panel decides what
kind of privileges a person will have for the year, where that person will go and what level of security is needed.
privileges: The amount and kind of freedoms a person may have during the year when that person is under the authority of the Ontario
Review Board (ORB). Having a stable mental status, following the rules and using privileges without problems usually leads
to more privileges. The psychiatrist has the right to allow, refuse or revoke (cancel) any privilege listed on the ORB's disposition,
based on that psychiatrist's assessment of the safety of the person and the public. The goal of privileges is to help people
become re-integrated into society.
risk assessment: Ways of assessing the likelihood of future problem behaviour, usually violence.
substitute decision maker (SDM): Person who is appointed to decide on treatment for a patient who has been found incapable of consenting to or refusing
treatment. If no relative is willing or able to be the SDM, an independent organization called the Public Guardian and Trustee
will be made the SDM.
Treatment Order: A time-limited order made by the court that permits people to be treated, even against their will. The purpose of a treatment
order is to help make a person Fit to Stand Trial.
trial: A formal proceeding to decide a case by a court of law. A verdict of guilty, not guilty or Not Criminally Responsible (NCR)
will be determined at a trial.
Unfit: See Fit to Stand Trial.
The Forensic Mental Health System in Ontario: An Information Guide
- Who works in the forensic mental health system?
- What happens inside the forensic mental health system?
- The Ontario Review Board (ORB)
- Accepting or refusing treatment in the forensic mental health system
- Living in a forensic mental health setting
- Family, friends and the forensic mental health system
- Leaving the forensic mental health system
Where to go for more information