UPDATE NOVEMBER 8, 2023:
Susie Dillon, MLA for District 11 Charlottetown- Belvedere contacted us November 7, 2023. MLA Susie Dillon has been assisting me to lobby for a P.E.I. Community Treatment Order. The CTO monitors and enforces medication for mentally ill patients. It is a proactive mental healthcare intervention that keeps patients well and out of expensive hospital beds.

MLA Susie Dillon invited us to attend the Legislative Assembly on November 7, 2023. The Community Treatment Order was being discussed. It was a thrilling experience to sit in the gallery and to watch the debates in Question Period.

The following information was on the front page of The Guardian, November 7, 2023. "The Dennis King Government plans to revamp the P.E.I. Mental Health Act. It will replace law that was first passed in 1994. The present Mental Health Act allows for involuntary psychiatric assessments of individuals whose mental disorder could result in a threat to that individual's safety or to the safety of others.

A guide to the present act, completed by Community Legal Information, says any Island physician could make an application for a psychiatrist assessment of a patient.

The new act will allow "substantial physical or mental deterioration" to also be considered as a criteria for involuntary treatment, along with an individual's risk of harm to themselves or others. The new act will also allow for community treatment orders (CTO) as a "valuable" treatment tool.

The purpose of a CTO is to break the cycle of admission, improvement, decompensation and readmission of certain patients.

Persons who meet the eligibility criteria for a CTO are provided with mental health support and treatments in the community. Instead of being institutionalized in a psychiatric facility the patient remains under the supervision of a psychiatrist in the community while the CTO is in effect."

The P.E.I. Green Party has some concerns about the proposed CTO and, therefore, the CTO was not passed. It will be further discussed over the next few days.

My intention is to help implement a P.E.I GOLD STANDARD COMMUNITY TREATMENT ORDER! It has to be effective and not restrictive! It makes no sense to tie the hands of the clinicians in the CTO legislation!

Andrew's mental illness has a symptom known as ANOSOGNOSIA. It means that Andrew does not realize that he is ill, and he refuses help and medications. Alzheimer patients also have this same symptom.

I have some major concerns about the proposed CTO and sent the following    e-mail this morning to Premier Dennis King, Minister of Health, Mark McLane, and several others. We have waited too long for a P.E.I. CTO, and we can not let the ball drop now at the finish line!

"Good morning everyone,
I know that the CTO is being discussed today and that the P.E.I. Green Party has some concerns. I also have some major concerns.

I sent the CTO EVOLUTION AND COMPARISONS document to several of you a few months ago. I have been working with Dr. Richard O'Reilly, renowned psychiatrist from London, Ontario. In addition, I was communicating with Dr. John Gray. They sent me a document titled CTO EVOLUTION AND COMPARISONS, which they wrote FREE OF CHARGE to help Andrew, me, and the P.E.I. Government.

Dr. Richard O'Reilly and Dr. John Gray have stated that the New Brunswick CTO, is in their opinion is the modern GOLD STANDARD! It is less restrictive and meets the needs of the patients and clinicians.

Here is the document COMMUNITY TREATMENT ORDERS: EVOLUTION AND COMPARISON:
The purpose of Community Treatment Orders (CTOs) is to assist people, who suffer from severe mental illness, to recover and live in the community. This is consistent with the principle of using the least restrictive alternative in providing care for people with severe mental illnesses. Many people who have been hospitalized involuntarily due to hallucinations and delusions, caused by severe mental illness, stop their medication on discharge because they do not recognize they have a treatable illness.

This inability to recognize the pathological nature of symptoms and impaired function is called anosognosia, and is seen in a number of neurological and psychiatric illnesses. Unfortunately, individuals who have psychotic illness and discontinue antipsychotic medications after a hospital admission usually relapse and have to be re-hospitalized. This “revolving door” pattern of admission and discharge markedly disrupts the lives of the person and their family. It predictably leads to chronicity of symptoms and a poor prognosis and sometimes results to tragic outcomes.

The first use of CTOs in Canada was designed in an attempt to prevent the revolving door syndrome and the eligibility criteria required that the person to have a long history of illness. For example, Saskatchewan, in 1995, the first province in Canada to introduce CTOs, required three admissions or 60 days of involuntary care in the previous two years.

Subsequently, the recognition of the importance of early treatment to reduce chronicity and improve prognosis led to legislative changes that enable people to be placed on a CTO earlier. For example, Saskatchewan reduced its required number of hospitalizations before being placed on a CTO from three to one, either voluntary or involuntary, with no specified length of stay.

(ii) during the preceding two-year period, the person: (A) has been admitted to a mental health centre, voluntarily or involuntarily, on at least one occasion; s.24.3
The Supervised Community Care plan in New Brunswick does not require that the person has previously been hospitalized. It can therefore be used to ensure consistency of treatment for individuals who lack the capacity to appreciate the need for ongoing treatment even after their first episode of treatment, in addition to assisting people whose illness has become chronic. In this sense, the New Brunswick act is preventative and the Alberta legislation shares similar features.

The following is a focused analysis and comparison of the PEI proposed CTO and the New Brunswick (NB) Supervised Community Care provisions. (Despite the different name the NB Supervised Community Care provisions are a type of CTO and we will use the term CTO in this document).

P.E.I. CONSULTATION DRAFT MENTAL HEALTH ACT August 30, 2022
A. ISSUANCE CRITERIA
18. Issuance of community treatment order
(1) A psychiatrist may issue a community treatment order in respect of a person, in the prescribed form, for up to six months, where the following conditions are met:
(a) within the previous two years, the person has been
(i) admitted as an involuntary patient in a psychiatric facility on two or more separate occasions, for a total of at least 30 days, or
(ii) the subject of a prior community treatment order;
(b) the psychiatrist has conducted a psychiatric assessment of the person within the previous 72 hours and is of the opinion that
(i) the person has a mental disorder,
(ii) as a result of the mental disorder, the person
(A) has caused or is likely to cause harm to oneself or others, or
(B) is likely to suffer substantial physical or mental deterioration or impairment,
(iii) the person requires community treatment, and
(iv) the person is not capable of giving or refusing consent to community treatment, but is able to comply with a community treatment order;
(c) the community treatment the person requires exists in the community and is available and will be provided to the person;
(d) the person’s substitute decision-maker has consented on behalf of the person to the community treatment plan.
NEW BRUNSWICK MENTAL HEALTH ACT
A. ISSUANCE CRITERIA
Supervised community care plan
34.01 After evaluating a person who is suffering from a serious mental illness, a psychiatrist may establish a supervised community care plan for the person, if the person meets the following conditions:
(a) the person is suffering from a serious mental illness that
(i) is continuous in nature,
(ii) severely limits the person’s functioning in the community, and
(iii) requires care and treatment; and
(b) the person is a patient or former patient who was admitted to a psychiatric facility or, in the opinion of the psychiatrist, the person has a pattern of behaviour while living in the community that demonstrates that, because of the serious mental illness, the person is likely to cause serious harm to himself or herself or to another person or to suffer substantial mental or physical deterioration.
34.02(1) Consent to a supervised community care plan is required from the person who is subject to the plan or, in the case of a person who is not mentally competent, by the substitute decision-maker under section 8.6
Comparisons
1. Previous hospitalization.
PEI: at least 2 involuntary admissions AND a total of 30 days as involuntary inpatient.
NB: 1 admission of any duration OR none if there is a “pattern of behaviour” that is likely to cause serious harm or deterioration. Alberta has a similar provision to NB.
Comment. A person who experiences a first episode of psychosis, which is severe enough to require a prolonged involuntary admission, could not be placed on a CTO in P.E.I. even if they lacked any appreciation of the need to follow-up with mental health services and continue on treatment after discharge. In contrast, such an individual would be eligible for a CTO in N.B. Even a person with 3 admissions of 9 days each, who would benefit from a CTO, would not reach the 30 total days threshold in P.E.I. Ontario counts previous hospital use over a three (as opposed to P.E.I.’s two-year period) and requires two admission OR 30 days of hospitalization – whereas P.E.I requires the two admissions FOR 30 days: a much higher bar. Even with the lower bar in Ontario, psychiatrists in that province sometimes keep patients longer than clinically necessary just so that the patient has sufficient hospital days to qualify for a CTO.
2. Harm or Deterioration
Comment. Both P.E.I. and N.B. include risk of serious mental or physical deterioration as an alternative to risk of harm in the CTO criteria. This alternative is important as psychiatrists are reluctant to discharge patients from hospital where they are documenting the patient to be at high risk to experience or cause harm.
B. RENEWALS
P.E.I. (6 months)
(1) On or before the expiry of a community treatment order, a responsible psychiatrist may renew the order for a period of up to six months…
(3) Where a community treatment order is renewed and on the occasion of every second renewal after that, the person is deemed to have applied to the Review Board for a review of the order. s. 20
N.B. (12 months)
34.03(2) A supervised community care plan remains in effect for one year following the date on which the plan comes into effect.
Comment. Issuing a CTO is an administrative burden for psychiatrists and allied clinical staff. The process of issuing a CTO also causes some patients to become agitated and undermines the therapeutic alliance. The duration of a CTO requires a balance between procedural rights for the patient - whereby the need to remain on a CTO is formally reviewed, the patient is provided with rights advice and with an opportunity to contest the CTO - and pragmatic issues concerning resource use and clinical care. Rather than using the current proposal that requires the renewal of a CTO every 6 months, an amalgam of the timelines with P.E.I might be preferable: the first certificate would last for 6 months and subsequent certificates for 12 months. Under this model each renewal of a CTO would align with the current P.E.I. proposal for mandatory review board hearings.
C. RECALL (when the person has been brought back to hospital because of non-compliance)
PEI s. 21
Actions by psychiatrist.
(5) On the completion of an involuntary psychiatric assessment of the person or the expiry of 72 hours after apprehension, whichever occurs first, the psychiatrist shall
(a) leave the community treatment order in place, make any necessary amendments to the community treatment plan in accordance with section 19, and immediately release the
person from detention;
(b) revoke the community treatment order in accordance with section 22 and immediately release the person from detention; or
(c) revoke the community treatment order in accordance with section 22 and admit the person to a psychiatric facility under section 10, where the criteria for involuntary
admission under clauses 10(1)(a) and (b) are met
N.B. 34.06(7) A psychiatrist or a physician shall examine the person who is subject to a certificate of non-compliance as soon as possible to determine whether
(a) the psychiatrist or the physician should issue an examination certificate under section 7.1, or
(b) the current supervised community care plan should be followed.
Comment: The P.E.I. proposal explicitly states that a community treatment plan can be modified when a patient is assessed because of non-compliance with the plan. This is important because the plan is not working. Sometimes, simply reminding a patient of their obligations under the CTO and the consequences of further non-compliance is sufficient to gain the patient’s cooperation. However, in other situations, it may be necessary to alter the treatment plan – for example, switching from an oral to long-acting injectable medication or instituting more frequent clinical monitoring.
The P.E.I. proposal is problematic in that it requires a CTO to be revoked if a person is involuntarily admitted to hospital after use of the recall authority of the CTO. This means that when a person is admitted and stabilized within a few days a whole new CTO must be issued, which is an unnecessary administrative burden. Ontario solved this problem by an amending its CTO legislation to allow the CTO to be continued after recall, even if the patient is admitted to hospital.
D. PROTECTIONS
There are many protections built into both P.E.I. and N.B. CTOs. These include consent to the CTO, which can be withdrawn at any time by the substitute decision-maker if they believe the CTO is not helpful, renewal examinations, voluntary and mandatory review board applications, the requirement that services must be available to fulfil the requirements of the CTO, notification to substitute decision-makers of certificate issuance and rights, patient rights notifications etc. These protections in proposed P.E.I. legislation are the same as or exceed those in most provinces.
23.8.16.
Drs. John Gray & Richard O’Reilly

I am fearful that the legislation that the Dennis King Government is proposing will tie the hands of the clinicians and not serve the needs of the patients. I caution you that anything less than the N.B. CTO SHOULD NOT BE IMPLEMENTED! IN FACT, I PROPOSE THAT YOU CUT AND PASTE THE NEW BRUNSWICK CTO!"

We have been waiting many years for CTO legislation. It was first introduced to me by Dr. Robert Jay, Andrew's psychiatrist in Charlottetown. Dr. Jay was one of the professionals that drafted the CTO information a few years ago.

I know that our son, Andrew Bryenton, and many others will need a CTO to stay on their medications. This is a proactive approach to mental healthcare. It helps the patient stay well and out of expensive hospital beds.

I am asking you to take a SECOND SOBER THOUGHT before moving forward! I have been lobbying for the CTO for many months. It needs to be effective and not a stumbling block for clinicians. Believe me, there are enough roadblocks in the mental health system now. We do not need to add the CTO to the long list!

Thanking you for any consideration that you can give.
Marlene Bryenton
MAMA BEAR"
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I received this e-mail from an Ontario resident this morning. It is amazing how God makes things happen in a timely fashion. Here are her concerns regarding the Ontario Community Treatment Order.
" I have read your latest post and don't want to respond publicly. I am writing because if you have an opportunity to have input into the legislation governing the CTO please try to make sure it doesn’t have the pitfalls we have in Ontario.
The CTO in theory sounds good and would be excellent if allowed to do its job. But the legal terms and how they are interpreted have not worked for me and many others. The term is 6 months and then it can be renewed for another 6 months and so on.. BUT at any time, once within each 6 month period the patient can contest the CTO.

By that time, the treatment is usually working and the patient has often improved sufficiently for the Consent and Capacity Board in Ontario to find the patient “capable” of making their own medication decisions (incorrectly) and dismisses the Community Treatment plan (CTP) which is the critical part of the CTO.

Without the treatment plan in place, the CTO is useless and the patient is free to refuse treatment. All the good work that has gone into getting the patient to where he/she is, is lost. It is ludicrous but it has happened to us twice, once very recently and has happened to others I know. I am currently awaiting the eventual decline after an amazing recovery. It is brutal.

I hope the legislation in P.E.I. does not follow that in Ontario or at the very least I hope that the lawyers and judges have a much better understanding of the illness & are more compassionate than they are here.

I apologize for the negativity but it is what happens and if you can contribute to making it more workable, you will perhaps save your family and many others."
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Here is another post that I received just minutes ago.
Kathleen Walker Mochnacki Note: Kathleen writes the NEWSLETTER OF SERIOUS MENTAL ILLNESSES sent to politicians. She wrote many articles about Andrew.
·
"Marlene Bryenton is fighting to have CTOs (Community Treatment Orders) implemented in P.E.I. This life saving intervention was introduced in Ontario but without initial resistance by CMHA.

Now CMHA serves people who are on CTOs in their Assertvi Community Treatment Teams.

It takes years of advocacy to create the change needed to save people's lives.
It takes parents like Marlene to lead the way."
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I am happy to announce that Minister Mark McLane met Lloyd and I prior to the Legislative Assembly opening. He gave me a hug, as he knows how hard that I have worked to get the Ministerial Order for Andrew's medical transfer home to P.E.I. I asked if he would agree to a photo. The Minister was most obliging and I have attached it.

AMAZING ANNOUNCEMENT: The PLEASE BRING ANDREW BRYENTON HOME TO P.E.I. PETITION has received 11002 signatures. This number speaks volumes about the caring and compassionate Ontario and P.E.I. residents who took the time and made the effort to sign. THANK YOU!

This song has helped me throughout the past months. It is titled GOD WILL MAKE A WAY! https://www.youtube.com/watch?v=1zo3fJYtS-o
I am hoping and praying that God makes a way for a P.E.I. GOLD STANDARD COMMUNITY TREATMENT ORDER!