PPAO in the Media
The Journal: Centre for Addiction and Mental Health
Autumn, 2003
PPAO celebrates two decades of advice and advocacy
"Our clients want the same things in life as we do: friends, a home,
money, to be loved and cared for, to contribute to the community and
to be affirmed as people. Just because you have a mental illness doesn't
mean that you can't achieve great things as defined by you."
So says David Simpson, program manager at the Psychiatric Patient Advocate Office (PPAO), an advocacy and rights advice service for inpatients of Ontario's psychiatric institutions. The PPAO was created 20 years ago, in response to the need for a province- wide service for people residing in psychiatric facilities.
The PPAO is a program of the Ministry of Health and Long-Term Care, and is administratively accountable to the province. But it operates at an arms length from government. This independence has been crucial to the PPAO's role in advocating for its clients, sometimes urging legislation through and sometimes acting in direct opposition to government policy.
One of the PPAO's earliest tasks was to assess sections 66 and 67 of the 1978 Mental Health Act. These upgrades to the act were intended to add teeth to the review process for involuntary hospitalization. They required psychiatric facilities to notify the Legal Aid area director whenever a client was detained against his or her will, and gave the client the right to apply to what is now the Consent and Capacity Board for a review of the decision. These sections were deemed a crucial human rights issue, and the PPAO lobbied for their proclamation, with the sections being passed by the provincial legislature in 1984.
In 2000, the PPAO successfully lobbied for changes to Bill 68, an amendment to the Mental Health Act. This bill brought about community treatment orders, which provide a plan of community-based treatment for those in need of treatment as an alternative to detention in a psychiatric facility. The plan requires the consent of the capable individual or the substitute decision-maker, and may involve other individuals who provide support. Initially, the PPAO's position was that the legislation was intrusive. It successfully advocated for changes to include mandatory rights advice for every client receiving a community treatment order.
Currently, the PPAO has initiated a social action process to raise the Personal Needs Allowance (PNA), a sum made available monthly to inpatients to pay for the necessities of life such as toiletries. The current allowance of $112 per month has not changed in almost a decade despite inflation. The PPAO is pushing for the allowance to be raised to $160 per month.
In addition to advocacy work, the PPAO plays a crucial role in advising clients of their legal rights. Colleen Woodruff, a rights adviser at the PPAO's Kingston office, advises clients whose legal status has changed, for example, if they are ordered to comply with treatment. If the client decides to challenge the new status, the case is heard at a Consent and Capacity Board, and Woodruff attends to make sure the correct procedures are followed.
Three years ago, Maria (not her real name), an involuntary patient at a Toronto psychiatric facility, was attacked by another patient. After a hospital stay to attend to her injuries, she returned to the same psychiatric ward. Frightened of a repeat attack, she pulled the fire alarm and was placed in seclusion. Maria contacted the PPAO, which put her in touch with an advocate who ensured she had access to a telephone and a lawyer and who helped negotiate Maria's request for protection from the patient who had attacked her. "The advocate told me how I could enforce my rights," recalls Maria. "What the PPAO does very well is listen and consider your opinion valid and important." The PPAO also acts as an advocate for clients who have issues with staff.
Public education is another key role for the PPAO. "An informed population is essential if mental illness is to be de-mystified, so that stigma, discrimination and stereotypes are dispelled," says Simpson. To this end, the PPAO sends guest speakers to talk about mental illness and human rights to students and professional bodies. The organization also has a web site, which offers detailed guides for clients and caregivers facing specific legal situations.
Anniversaries provide a useful opportunity to examine the past and plan for the future. With its 20th anniversary, the PPAO is doing both. The biggest challenge facing the organization is that of representing all people with mental health issues, not merely those residing in institutions. Debbie MacLean, a patient advocate in St. Thomas, Ontario, says: "As psychiatric services are being divested from the hospitals into communities, I would like to see our program's mandate expanded to enable us to provide service to clients living in the community."
Abigail Pugh
