July 2019 By PsychDB.com

Consent and Capacity Board (CCB) Hearings

In the province of Ontario, the Consent and Capacity Board (CCB) is an independent government review panel that holds hearings to determine whether a patient meets the criteria for incapacity to treatment and/or involuntary hospitalization. The CCB is independent of the physician and the hospital, and is a quasi-judicial body. The CCB also maintains independence from the Ministry of Health and Long-Term Care.

Finding of Incapacity

If you are requesting the CCB to uphold a finding of incapacity for a patient's incapacity, you must then explain to the CCB which branch of the capacity test you believe the patient does not meet.

Example

“I am basing the finding of incapacity for the patient failing the first (understanding) AND/OR second (appreciation) branch of the capacity test.”

Involuntary Admission

If you are requesting the CCB to continue an involuntary admission, you must explain to the CCB whether you are relying on Box A and/or Box B criteria (you can use one or both). The CCB also does have a right to consider whether the patient meets either criteria as well, independent of the physician (i.e. - the CCB may ask you questions to see if the patient meets other criteria based on available evidence, even if you do not bring it up yourself).

Example

Box A

“I am basing the involuntary admission under Box A criteria, [explain which Box A criteria is met].”

Example

Box B

“I am basing the involuntary admission under Box B criteria, [explain why each of the 6 criteria under Box B have been met]. ”

What If Someone Has Improved With the Use of PRN Medications by the Time the Hearing Is Held? Are They Still Incapable or Involuntary?

While waiting for a CCB hearing, a patient who contests the finding of incapacity may not be treated involuntarily. Therefore, a patient with schizophrenia and psychosis cannot receive regular treatment prior to the CCB hearing. However, they may be given emergency PRN medications (e.g. - antipsychotics or benzodiazepines) due to imminent and emergency safety concerns (to self or others). Thus if there is consistent and ongoing PRN use, it may actually indirectly treat the underlying mental disorder by the time the hearing is held. Over time, the patient may improve the symptoms may abate. In this case, this is important to state to the CCB if it is your clinical opinion that regular PRN use has led to this improvement, and that it otherwise would not have occurred. It would be important to stress to the board that the patient's current presentation does not mean they do not have a mental disorder, but rather, that they have been treated partially with PRN medications, which led to the current improvement.

Witnesses can be called by either party, but is more relevant for the physician. Typically, family members or close friends can be called to provide testimony to the board. The physician can ask questions of the family, including:

  • What symptoms of [mental disorder] is the patient exhibiting right now?
  • How has this illness affected the patient?
  • How has this illness affected you and the patient's family?
  • Why has it gotten this bad?
  • What is [patient] like when on medications?
    • Can you be more specific?
  • What are your concerns if [patient] does not complete treatment?