She struggled to control herself during a March Zoom meeting convened by a provincial panel that hears appeals from people who have been deemed unable to make key medical decisions for themselves. She watched her psychiatrist describe her as having severe mental illness.

“They paint you in the worst light possible,” she said in an interview later. “You don’t feel as human anymore.”

Lafleur has been subject since August to what’s known as a Community Treatment Order. That followed a three-month hospitalization after her parents told doctors she was acting bizarrely and aggressively. The doctor ordered her to undergo monthly outpatient injections of antipsychotics, and renewed the order in January.

The 32-year-old says the drugs make her feel numb and cloud her thinking. “The ability to brainstorm, to pull something insightful — I can’t do that,” she told the Investigative Journalism Bureau.

Lafleur has struggled with substance use for years. She was diagnosed with schizoaffective disorder, a diagnosis she disputes, arguing she has post-traumatic stress disorder from 16 years of periodic forced psychiatric treatment. She has past criminal convictions, including two assaults and a count of forcible confinement. She says she knows she faces hurdles but argues antipsychotics aren’t the answer.

So she challenged her Community Treatment Order before the independent body that adjudicates such challenges in Ontario: the Consent and Capacity Board.

She lost.

That isn’t unusual. In the last 10 years, almost 85 per cent of Community Treatment Order decisions by the board have sided with doctors, an IJB analysis found. So did 90 per cent of forced treatment decisions (which can apply inside or outside a hospital) and 82 per cent of forced hospitalization decisions, which usually entail being held in a psychiatric ward.

Most provinces have a framework for what happens when people are deemed unable to make decisions about their own health. Some provinces are expanding these, and Ontario’s leaders have mused about doing so.

But some people subjected to forced care, and their advocates, argue Ontario’s system is tilted unfairly toward doctors.

The IJB obtained a decade of applications and outcomes before the Consent and Capacity Board, spanning more than 100,000 applications. They show how often the board sides with doctors making medical decisions for patients who may not believe they are ill, may disagree about the best course of action, or may find side-effects of the medications they are forced to take intolerable.

Some lawyers who represent patients before the board say the board’s decisions often deprive their clients of autonomy and potentially put their jobs, homes or even child custody at risk.

“I think there is deference to the physician because we want to think they’re not arbitrarily keeping someone in hospital,” said lawyer Melissa Lukings, who has represented many people before the board.

Consent and Capacity Board vice-chair Lora Patton said in an email that the panel does not “side” with any party. “We make a decision in accordance with the legislated criteria and the evidence presented by the parties.”

Most panels are comprised of three members appointed by the Ontario government. The burden of proof is on the doctor to show that a patient poses a danger to themselves or (far more rarely) to someone else, or lacks the mental capacity to make a medical decision. The patient has a right to a lawyer and can testify but does not have to.

In an earlier interview, Patton said the board’s frequent agreement with doctors shows the system works.

Presenting evidence to the board is “an awful lot of work,” she said. She thinks doctors only appear before it when they think their case is strong. Otherwise, they would simply reverse any treatment order a patient is appealing.

“We’re just a check and balance in the system … to see if there is something inappropriate going on. And I’m glad to know that, for the most part, there isn’t.”

But such fundamental rights as freedom and bodily autonomy are at stake in these cases, said lawyer D’Arcy Hiltz, who has also chaired the board. He thinks assumptions are sometimes made that the doctor is right.

He recounts how once, appealing a finding of incapacity to Superior Court, a judge asked him, “What are we doing here? … The physician’s already said your client’s not capable.”

Patients may be subject to involuntary hospitalization, among strangers and with no fresh air for days, potentially, or in rarer cases locked in a room and obliged to catch a nurse’s attention even to use the bathroom.

“Let me lock you up for an hour,” Hiltz said.

‘Psychiatrists are being judicious’

The Consent and Capacity Board’s caseload has grown. About 5,000 applications contested involuntary hospitalization in 2025, up from 3,142 in 2015.

The number of applications contesting a finding that a person lacked mental capacity to consent or withhold consent to treatment has more than doubled in a decade.

The outcomes show “psychiatrists are being judicious,” said St. Michael’s Hospital psychiatrist-in-chief Karen Shin.

Caseloads are up because people are sicker, Shin said. They aren’t getting care early, so they’re coming to hospital late, when they are less manageable in the community. Substance use is playing a bigger role – especially cannabis, which can worsen psychosis, she says.

In a December 2023 decision, the board upheld a woman’s involuntary hospitalization in part because she risked becoming homeless on discharge and “would experience hypothermia or some other significant adverse event resulting in her serious physical impairment.”

“We are storing people in the hospital instead of addressing the housing problem,” Lukings said.

The system needs to get better at caring for people before they come to hospital, Shin said, and afterward – providing ongoing community treatment that can prevent readmission.

A burden of proof, frequently met

On an April day in an Ontario psych ward, a young woman sat by a window in her room as a doctor told a panel via Zoom she was malnourished, looked dishevelled and smelled bad. The doctor said she had been tied down and injected with medication during her involuntary hospital stay.

It was one of five Consent and Capacity Board hearings the IJB observed to see firsthand the challenges faced by individuals contesting forced treatment as well as by the doctors seeking to help them.

In this hearing the doctor said the patient showed signs of psychosis and needed to be hospitalized and treated against her will. He also articulated the conundrum of such coercive care: How do you earn the trust you need to treat a sick brain when you are doing things to that brain’s owner against their will?

“It’s difficult to kind of draw therapeutic benefit when the administration is such a traumatic administration,” the doctor testified.

An IJB review of more than 50 Consent and Capacity Board written reasons for judgment, which are published online when one of the parties requests it, shows a person’s disagreement that they had a mental disorder was repeatedly cited as evidence they lacked capacity to make their own medical decision.

Even when patients agreed they had some symptoms or, in one case, a “mild” version of the illness, the board frequently decided they could not appreciate the benefits of the treatment and were therefore incapable of deciding whether to partake in it.

In one case, the board decided that a patient who denied having a serious mental disorder did not have a right to a comprehensive explanation of her symptoms and the risks and benefits of treatment. The board rejected her challenge.

Published decisions rarely discuss individuals’ personal experiences in hospital or with medication, even though some lawyers told the IJB that unbearable side-effects such as brain fog, weight gain, sedation and movement disorders played a significant role in their clients’ willingness to be treated.

In a small minority of cases in which the board sided with a patient, slightly more than half were because of a procedural issue, such as a form that went unsigned or a notice not given in a timely manner.

‘The most severe penalty that we inflict’

Jennifer Chambers, a patient advocate and executive director of the Empowerment Council at the Centre for Addiction and Mental Health, bemoans what she calls “the Catch-22 of the system.”

“If I say I’m mentally ill and need treatment, then it makes no sense for me to refuse treatment,” she said. “If I say I’m not mentally ill and I don’t need this treatment, then you say that’s proof I’m mentally ill and therefore have to be treated.”

Chambers says patients “are seriously disadvantaged in this process” and it is easy to forget how much power the medical system wields.

“For someone who’s never really thought about the system or had anything to do with it before, suddenly they’re experiencing the most severe penalty that we inflict in Canada on someone, which is being detained in a small corridor with other people who also don’t want to be there, against your will. And unlike the judicial system, there’s no clear means of exit or understanding of why you’re there a lot of the time. ”

The Consent and Capacity Board could “rebalance” a system tilted against patients, Chambers argued, by having board members scrutinize doctors more and give more weight to the testimony of people fighting coercive treatment, even if they may have severe mental illness.

Lafleur is weighing whether to fight her Community Treatment Order at Ontario Superior Court, which her lawyer says could take years. The order expires this month but could be renewed as it has been in the past.

Lafleur says she’s amenable to psychological treatment such as psychotherapy but does not trust psychiatry, “a negative institution.”

“I think it’s always better to challenge,” she said, adding that she wants, “an equal chance to defend yourself. That would be an improvement.”