History
Evolution of the PPAO - in chart form
History and Origin
The introduction of the PPAO as a provincial program was announced in the legislature in May 1982 by Larry Grossman, former Minister of Health. The program's first provincial coordinator (now called "director" was appointed in November 1982. The program became operational in May 1983 with the appointment of 11 patient advocates.
The mandate of the program was to advance the legal and civil rights of psychiatric patients in the province's psychiatric hospitals, and to empower patients to make informed decisions about their lives, care and treatment. The intention of all political parties at the time was that the Office would operate at an arm's length relationship with the Ontario Government in the exercise of its mandate with only administrative accountability to the Ministry of Health. The "arm's length" arrangement was made to deflect any attention from the conflict of interest inherent in an internal advocacy model.
The PPAO was introduced as an advocacy program in Ontario in response to a number of events that took place in the 1970s and 1980s, including:
- the formation of a series of patients' rights and consumer groups lobbying for improvements in the care and treatment of patients in provincial psychiatric hospitals and the advancement of patients' rights;
- the passage of the Canadian Charter of Rights and Freedoms;
- a series of patient deaths that occurred in 1980/81 at the Queen Street Mental Health Centre and that were the subject of coroner's inquests. In each case, the coroner was critical of hospital policy;
- media attention to the coroner's inquest, the poor housing of former psychiatric patients and the lack of community services;
- newspaper articles concerning mental health law that argued patients were being denied due process of law and were subjected to autocratic and arbitrary decision-making by psychiatrists and bureaucrats;
- a clear trend in the direction of restricting psychiatric authority and extending patients' rights; and
- the need to proclaim dormant sections of the Mental Health Act to bring the Act into compliance with the Canadian Charter of Rights and Freedoms. The PPAO was asked by the Minister of Health to assist in this process.
Initially the program was introduced on a project basis. In 1986 an evaluation committee was appointed by the Minister of Health to evaluate the PPAO. Its members were nominated by groups involved with advocacy and delivery of mental health services in Ontario. The evaluation committee hired external consultants to conduct an external review of the program. The committee's report to the Minister confirmed the PPAO's valuable contributions and discussed its limitations. The report made thirty nine recommendations ranging from personnel issues to reporting structure. The evaluation committee viewed the implementation of these recommendations as the means whereby the PPAO would develop from "an experimental program into...an entrenched advocacy agency".
Since 1995 the pace of mental health reform has accelerated with several key developments taking place. The Health Services Restructuring Commission released a series of reports that dealt with the provision of health care services at the local level. The recommendations would leave a profound and lasting impression on mental health service delivery in Ontario. The Commission recommended the divestment or closure of the provincial psychiatric hospitals and the repatriation of mental health services to the communities. To help implement the Commission's directives, the Ministry established nine Mental Health Implementation Task Forces to identify regional needs and to assist the Ministry with identifying and planning for the mental health services and supports required in each region.
After extensive consultations with their communities, in December 2002, the Task Forces included advocacy services in their recommendations to the Ministry. Their view was that advocacy should be considered as an essential and integral component of a comprehensive reformed mental health system.
In 2003, the Ministry will begin a process to address the question of advocacy services in Ontario's reformed mental health system.
