Journal Articles
CrossCurrents
Autumn 2005 Vol 9 No. 1
David Simpson
It is encouraging to see discussion regarding advocacy in the mental health
system in Ontario and the recognition that it is an essential and integral
component of care and treatment. Unfortunately, Dr. Richard O'Reilly's column
in the summer issue of CrossCurrents failed to recognize the full range of
services provided by the Psychiatric Patient Advocate Office (PPAO), or its
contribution to the mental health system in Ontario. We provide much more
than just "right-based" advocacy. Every member of our community has been
touched by mental illness and the staff of our office are no different.
For the past two decades, Ontario has been a leader in providing independent advocacy and right advice services to inpatients in the current and divested provincial psychiatric hospitals. But Ontario needs to take the next step and extend these rights protection services to all individuals with mental illness, regardless of where or from whom they receive their care and treatment. Equitable access to services is essential if we are to support all individuals with a mental illness in their quest for wellness and recovery.
The PPAO was established in 1983 as an arms-length program of the Ministry of Health and Long-Term Care to protect the civil and legal rights of inpatients in the 10 current and divested provincial psychiatric hospitals. The PPAO also provides right advice services at more than 50 general and specialty hospitals. It provides more than 18,000 rights advice visits annually and addresses more than 3,000 instructed and non-instructed advocacy issues and more than 75 local and provincial systemic advocacy issues. The PPAO website (www.ppao.gov.on.ca) receives more than 500,000 hits annually, illustrating the thirst for information regarding patients' rights and mental health legislation in Ontario.
We agree with many of the issues O'Reilly highlighted. A lack of hospital resources (i.e., beds) often results in clients being denied admission when they clearly meet the criteria for civil commitment, or being discharged prematurely as a "cost savings" measure or to make a bed available for another patient. Others are languishing in jail awaiting a hospital bed, while countless others are dis-empowered by the devastating effects of stigma and discrimination associated with mental illness. Patients and/or families and community supports may reach out for support from the hospitals, but that support is often sadly lacking. Many individuals have reached out for help only to be turned away. Would David's story that O'Reilly recounts have ended differently if there had been sufficient resources and an available bed?
We agree with O'Reilly's assessment that "the evidence that we are failing to provide a basic level of care is all around us." But it isn't all negative. We see treatment teams and individuals doing great things and providing quality care while developing very caring and personal relationship with their clients. Resources are required to support and foster a quality and caring mental health system.
Increasingly, on their clients' instructions and behalf, PPAO patient advocates are involved in advocating admission to hospital, the prevention of premature discharges, the right to be actively involved in formulating care plans, and access to community resources and supports. Patient advocates do assist clients in ensuring their rights and entitlements are protected, but they also frequently support clients in restoring communication with treatment teams and service provides. It is not uncommon for advocates to help clients broker time with their psychiatrists, whose caseloads are stretched to the limit. Our clients want to be involved in all decisions that affect their care, life and treatment, and to be treated with dignity and respect while having choices and options and having their decisions respected. Experience has shown that independent advocacy and right advice services enhance quality of care and life of patients, which leads to improved outcomes.
The PPAO believes that the current mental health system in Ontario is in urgent need of reform and revitalization. In many cases, the mental health system is not meeting the needs of clients and families. It is not providing the individualized care and treatment that are vital to supporting individuals in their quest for wellness and recovery.
There are many success stories, but there are also many stories with unsatisfactory and sometimes tragic endings. Many of the tragedies could have different endings if we put the "care" back in mental health care and make every effort to support people when they are at the low point of their illness. We must learn from the failures and create a system in which the individual, not a lack of resources, becomes our primary focus.
Does Ontario need a treatment advocate? No. There are many treatment advocates including patients, families, physicians, other health practitioners and community agencies. What we need is a system that is co-ordinated, seamless, accessible, responsive to individual need and consumer-focused and consumer-centred. It must provide access to timely care and treatment; a re-dedication to patients' rights, options and choices; and the hospitals and community-based supports and services necessary to support recovery and re-integration into the community. We must think of a "cradle to grave" strategy that supports people in all life stages, should they require access to mental health supports, services or treatment. Currently the "system" is fragmented and disjointed.
A society is often said to be judged by how it treats its most vulnerable citizens. Will history be kind to us in assessing how we have treated individuals with mental illness, or will we be found wanting? Let's take action now by creating a mental health system that is grounded in consumer involvement, compassion, respect and acceptance, and that receives adequate resources to support every individual with mental illness in the quest for wellness and recovery.
David Simpson is acting director of the Psychiatric Patient Advocate Office
CrossCurrents: The Journal of Addiction and Mental Health - Centre for Addiction and Mental Health
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