Understanding the Consent and Capacity Board (CCB) in Ontario: An Overview

When it comes to healthcare decision-making, especially in cases involving mental health, capacity, consent, or involuntary admission, the Consent and Capacity Board (CCB) plays a crucial role in Ontario’s legal and healthcare systems. Established under the Health Care Consent Act, the CCB is a specialized tribunal that conducts hearings, reviews decisions, and resolves disputes in situations where a person’s liberty, autonomy, or legal rights are at stake.

This post explains what the CCB is, how it works, who can apply for a hearing, what to expect during the process, and how to challenge a decision.

What is the Consent and Capacity Board?

The Consent and Capacity Board is an independent administrative tribunal created by the Government of Ontario to provide timely, accessible, and specialized oversight in legal matters involving capacity, consent, and mental health. It functions similarly to a court but is designed to be more informal and accessible, while still issuing legally binding decisions.

The CCB operates under multiple pieces of legislation, including:

• Mental Health Act (MHA)

• Health Care Consent Act (HCCA)

• Substitute Decisions Act (SDA)

• Personal Health Information Protection Act (PHIPA)

• Mandatory Blood Testing Act (MBTA)

These statutes collectively give the CCB jurisdiction to address a wide range of legal and medical issues.

Matters Heard by the CCB

The CCB’s work touches on some of the most important and sensitive areas of healthcare and mental health law. It has authority to conduct hearings and make decisions in cases involving:

• Involuntary psychiatric detention (such as challenges to Form 3 or Form 4 certificates)

• Community Treatment Orders (CTOs) and related issues, including Form 47 orders

• Capacity to consent to treatment under the HCCA

• Capacity to manage property or finances under the SDA

• Capacity to consent to admission to a care facility

• Disputes between substitute decision-makers (SDMs) or between an SDM and a healthcare provider

• Directions about prior capable wishes and how they apply to current medical decisions

The CCB’s role is to ensure that individuals’ rights and freedoms are protected while also balancing public safety, clinical considerations, and legal requirements.

Who Can Apply for a CCB Hearing?

While most applications are brought by patients or individuals who are directly affected by a finding of incapacity or an involuntary admission, a wide range of parties may seek a hearing before the Board.

These include:

• Patients who have been involuntarily admitted to a psychiatric facility or found incapable of making decisions about treatment, property, or admission

• Treating physicians or hospitals seeking guidance on consent, substitute decision-making, or departing from prior capable wishes

• Family members and substitute decision-makers seeking to be appointed as a representative or asking for directions on how decisions should be made

• Attorneys for personal care or property, court-appointed guardians, or the Public Guardian and Trustee (PGT) in certain matters

Once a person is found incapable or is detained under the Mental Health Act, they are entitled to meet with a rights adviser from the Psychiatric Patient Advocate Office (PPAO). The rights adviser explains the person’s legal rights, including the right to challenge the decision before the CCB, and assists with filing the necessary paperwork.

How Quickly are CCB Hearings Scheduled?

One of the most important features of the CCB process is its strict timeline requirements. The law requires that hearings commence within seven calendar days of the application being received by the Board. This short timeframe reflects the serious rights at stake, particularly when someone is detained in hospital or has lost decision-making authority.

A case conference counts as the commencement of a hearing. Once scheduled, hearings generally take place within days, not weeks.

How Does a CCB Hearing Work?

Most CCB hearings are now held remotely via Zoom or teleconference, although in-person hearings can still occur (usually at the hospital or facility where the person is being treated). Hearings are designed to be less formal than court proceedings but still follow clear legal procedures.

Panel Composition:

A standard CCB panel includes three members:

• A lawyer (Chair)

  • Presides over the hearing and ensures procedural fairness

• A psychiatrist

  • Provides medical and clinical expertise

• A community member

  • Offers a non-legal, non-medical perspective

In some cases, a senior lawyer-member may conduct the hearing alone. Occasionally, a five-member panel is convened, often when new adjudicators are participating as part of their training.

These days, most CCB hearings are held remotely, over Zoom or by teleconference. On rare occasions, a CCB hearing may be held in person at the facility where the patient is receiving treatment.

Who Participates in a CCB Hearing?

The parties involved depend on the nature of the application but often include:

• The patient or individual directly affected

• The treating psychiatrist or healthcare provider who made the initial decision

• The patient’s legal counsel (if they have one)

• Family members or substitute decision-makers, if they are parties to the application

• Amicus curiae (a “friend of the court”) appointed by the CCB in some cases to assist with legal issues

Each party has the right to present evidence, call witnesses, cross-examine the other side’s witnesses, and make submissions.

Costs and Legal Representation

There is no cost to bring an application before the CCB.

Parties are not required to have a lawyer, but legal representation is strongly recommended due to the complexity of the issues and the potential consequences of the decision. Many individuals qualify for Legal Aid Ontario (LAO) coverage. If a patient is found incapable or detained involuntarily, Legal Aid will usually provide funding for a lawyer. Those who do not qualify can retain private counsel or choose to self-represent, sometimes with the assistance of an amicus curiae.

Decisions and Next Steps

After a hearing concludes, the CCB must issue its decision within 24 hours. The decision is legally binding.

If a party wants written reasons, they must request them within 30 days. Written reasons are often important if an appeal is being considered, as they explain how the panel reached its conclusion.

Appealing a Consent and Capacity Board Decision

The appeal can be based on a question of fact, law, or both. The court can uphold the decision, overturn it, or send it back to the CCB for reconsideration.

Steps in the Appeal Process:

1. File a Notice of Appeal: 

   This must be served on all parties and the CCB within seven days of the decision.

   
   

2. CCB Prepares the Record: 

   The Board compiles a full transcript of the hearing and sends it to the parties.

   
   

3. Hearing Before the Court: 

   Appeals are scheduled through the Superior Court. These hearings can take several months to be heard.

   
   

4. Legal Representation: 

   While parties may represent themselves, retaining counsel is strongly advised. The court may appoint an amicus curiae to assist if needed.

Enforcement of CCB Decisions

CCB decisions are legally binding. Hospitals, healthcare providers, and substitute decision-makers are obligated to comply with them. If a party fails to follow a CCB order, enforcement can be sought through the Superior Court of Justice, which has the power to compel compliance.

Recap: 7 Frequently Asked Questions About the CCB

(1) How long does the CCB process take?

• Hearings must begin within 7 calendar days of the application being received

• Decisions must be issued within 24 hours of the hearing

• Appeals to the Superior Court can take several months to be scheduled and heard

  
  

(2) Is there a cost to apply?

No. There is no fee to apply for a CCB hearing.

(3) Do I need a lawyer?

Legal representation is not required, but it is highly recommended. Many people qualify for Legal Aid Ontario, and free legal assistance is often available to patients found incapable or detained involuntarily.

(4) Can I challenge a CCB decision?

Yes. You can appeal to the Superior Court of Justice within 7 days of the decision. Appeals can address questions of law, fact, or both.

(5) What happens if the hospital does not follow the decision?

CCB decisions are binding. If a hospital or healthcare provider fails to comply, the decision can be filed with the Superior Court and enforced as a court order.

(6) Who else can apply for a hearing?

Family members, substitute decision-makers, guardians, attorneys under a power of attorney, and healthcare providers can all apply in specific circumstances.

(7) What is a rights adviser?

A rights adviser is an independent advocate from the Psychiatric Patient Advocate Office (PPAO) who meets with patients when they are found incapable or detained. They explain the patient’s legal rights, including the right to a CCB hearing, and assist with the application process.

Final Thoughts

The Consent and Capacity Board is one of Ontario’s most important legal protections for individuals facing involuntary psychiatric detention, findings of incapacity, or disputes about healthcare decision-making. It ensures that decisions affecting a person’s liberty, autonomy, and dignity are made lawfully and fairly.

Because CCB hearings often happen quickly and can have life-changing consequences, understanding the process is essential. Whether you are a patient, family member, substitute decision-maker, or healthcare professional, seeking legal advice can help you navigate the process, protect your rights, and ensure the best possible outcome.

If you or a loved one are involved in a CCB proceeding, Lukings Law can help. We represent clients before the CCB and in appeals to the Superior Court, offering strategic and compassionate advocacy at every stage of the process.