Pre-budget Consultations: Investing in People and Programs
Submission of the Psychiatric Patient Advocate Office
to the Minister of Finance, Ontario
February, 2006
Table of Contents
Covering Letter to Dwight Duncan, Finance Minister
Access to Community-based Mental Health Services
Access to Independent Community-Based Advocacy and Rights Advice Services
Adequate Income - Ontario Disability Support Program Increases
Education and Employment
Housing - Safe, Affordable and Accessible
Medication and Treatment Modalities
Services and Supports for Individuals with A Dual Diagnosis
Stigma and Discrimination
Transportation
February 16, 2006
The Honourable Dwight Duncan
Minister of Finance
C/o Budget Secretariat
Frost Building North, 3rd Floor
95 Grosvenor Street
Toronto, Ontario M7A 1Z1
Dear Mr. Duncan:
RE: Pre-budget Consultations - Investing in People and Programs
Thank you for the opportunity to participate in the pre-budget consultation process and for seeking input from a variety of stakeholders to improve the lives of all Ontarians. Over the past several years those who are vulnerable, marginalized and disenfranchised have been disadvantaged by budgets that failed to provide financing for a full range of services to meet their needs. This lack of funding has been detrimental to their health and well-being and their ability to fully participate in their community to the extent that they wish.
We would encourage you to invest in programs and support services that will lift people out of poverty, provide them with a helping hand and support them in their quest for wellness and recovery. As do all Ontarians, they deserve the right of equality of opportunity and the ability to participate in their communities to the extent that they wish.
In your upcoming budget, we would like to encourage you to invest in people and programs - a true investment in the future of Ontario that will have lasting impact for generations to come. We make several recommendations in the attached submission to improve the quality of life of many Ontarians with disabilities, including those with mental illness. The recommendations pertain to various issues, including: having an adequate income; access to safe, adequate and affordable housing; access to a full range of community mental health programs; funding for the newest and most effective medications; opportunities for employment and recreation; and investment in an independent advocacy program for all individuals with mental illness.
If our office can be of any assistance or provide additional information please contact me at (416) 327-7004.
Sincerely,
Original signed by
_______________________
David Simpson
Director (Acting)
Pre-Budget Consultation Submission
Access to Community-based Mental Health Services
Individuals with mental illness must be able to access a full spectrum of mental health services and supports in a timely manner, in their own communities and from providers that will meet their individual needs. Individuals with mental illness must be able to have a "provider of choice" and a system that is responsive to their unique and individualized needs, with a recovery and client directed philosophy. Additional investment in community-based mental health and addictions programs would be supported by the Psychiatric Patient Advocate Office (PPAO).
- The PPAO recommends that the government of Ontario provide additional funding to ensure that a full range of mental health and addiction services are available and accessible to individuals with mental illness, in their own community and in a timely manner.
Access to Independent Community-Based Advocacy and Rights Advice Services
For the past two decades, the PPAO has provided independent advocacy and rights advice services to inpatients in the ten current and divested provincial psychiatric hospitals. Since 2001 we have also been providing rights advice to all but four Schedule 1 hospitals in Ontario (community hospitals with mental health units), and to individuals being considered for placement on a Community Treatment Order, and their Substitute Decision Makers, if any. The PPAO provided approximately 21,000 first rights advice visits and worked to resolve more than 3,500 individual advocacy issues last year.
However, as mental health reform has progressed, with care and treatment migrating from hospital to community, rights protection mechanisms have not kept pace. As a result, many vulnerable individuals with mental illness no longer have access to independent advocacy and rights advice services. We recommend that you consider funding such services as part of a comprehensive mental health system in Ontario so that all individuals with mental illness, regardless of where or from whom they receive their care and treatment, would have access to an independent advocate. An independent and partisan advocate could support individuals with mental illness and give a voice to their issues when they are unable to speak for themselves, while also addressing systemic issues and providing advice to the government on mental health and addiction issues.
- The PPAO recommends that the government provide funding for an independent advocacy and rights advice program that is available to all individuals with a mental illness, regardless of where or from whom they receive their care and treatment.
Adequate Income - Ontario Disability Support Program Increases
Many individuals with disabilities, including those with serious mental illness, rely on the government of Ontario for income support. Unfortunately, their benefits were significantly reduced (26%) by the previous government and they have not been restored to previous levels. We would recommend, in consultation with the Minister of Community and Social Services, stakeholders and clients, that you review current Ontario Disability Support Program (ODSP) income levels and then provide people with an adequate income that truly meets their needs and reflects the current cost of living.
In the past, our clients, their families, service providers, health practitioners and other stakeholders have written to the Minister of Community and Social Services asking for ODSP benefit rates to be restored and for increases to be made available to people immediately. Institutionalized clients who receive only the Personal Needs Allowance have a monthly income of $116.00 or $1,392.00 annually. Although a small increase was approved, it was insufficient to lift people out of poverty, to provide them with an adequate income to purchase necessities, or to address quality of life issues. We would encourage you to increase these benefits for people with disabilities, including those with mental illness.
- The PPAO recommends that ODSP rates be increased to provide an adequate income for individuals with disabilities, including those with mental illness, to lift them out of poverty so that they can meet their needs and purchase the necessities of life while addressing quality of life issues.
Individuals with mental illness must have greater access to educational and employment opportunities if they are to be fully integrated into the community. They must have real and meaningful opportunities that will allow them to contribute to and participate in the community. Many of these individuals have skills and abilities, but lack the opportunity to utilize them for their own benefit, or the benefit of their families and their communities. Such educational and employment opportunities will require both government funding and leadership to bring them to fruition. We must rethink how we support people facing disability to fully implement and realize the fullest potential of the Ontarians with Disabilities Act. We must provide the necessary educational supports, while providing vocational rehabilitation and job opportunities, to mentor those with dreams of inclusion. Only then will we adequately serve and mentor those in need and assist them in achieving their full potential.
- The PPAO recommends that the government provide resources, funding and leadership to ensure that individuals with mental illness have access to a range of real and meaningful educational and employment opportunities.
Housing - Safe, Affordable and Accessible
The PPAO recommends that the government of Ontario provide additional funding for a range of housing options - from supported housing and staged housing to independent living. Due to the cyclical nature of mental illness, some clients may need different types of housing at different times, with varying levels of support, to continue to live independently. Over the years, we have seen the cycle of clients being housed, hospitalized, being homeless and housed again, play itself out time and time again, resulting in a "revolving door" cycle of hospital readmission and homelessness. Each time our clients lose their homes - and their possessions - they must start over again. This can only serve to isolate them from their communities and undermine their physical and mental well being. ODSP policy often perpetuates this cycle by preventing individuals from paying their rent during periods of extended hospitalization, leaving them vulnerable to eviction.
If home care were more readily available to individuals with mental illness, then many could continue to live independently in their own homes. Many clients who do have housing report that it is inadequate or substandard. Others advise us that it takes a disproportionate amount of their income to secure decent and safe housing. Individuals with disabilities should not have to choose between having a decent and safe place to live and buying groceries.
ODSP rates should reflect actual market value rents so that no individual with a disability or mental illness has to live in unsafe or substandard housing. Being concerned about having a roof over your head or living in an unsafe environment can undermine both mental health and quality of life as financial and emotional stressors rise and coping abilities are pushed to the limit. Investment by the government in a range of housing options would be both encouraged and supported by the PPAO.
- The PPAO recommends that additional investment be made in providing a range of housing options and choices for safe, affordable and accessible housing for individuals with mental illness.
- The PPAO recommends that additional investment be made in home care services for people with mental illness as a way to support independent living and allow individuals to remain in their own homes.
- The PPAO recommends that the ODSP shelter allowance reflect actual market value rent, or what clients really pay for safe and decent housing, so that no individual with a disability or mental illness has to live in unsafe or substandard housing.
Medication and Treatment Modalities
Individuals with mental illness often require numerous or costly medications. While some of these medications are covered by the Ontario Drug Benefit Card, other newer and more expensive medications are not. Individuals with mental illness should have access to a full range of medications and treatment modalities, covered by a publicly funded health care system. There should never be a question about "cost" with respect to prescribed treatments. Rather, we should ask how we can support individuals with mental illness who are in need of a particular treatment regimen but cannot afford it.
A process must be put in place that responds to this concern and grants approval for medications in a more timely and individualized manner. Some may depend on these medications to perform activities of daily living, and to function and fully participate in society. Access to the appropriate treatment regimen may be the linchpin in one's recovery and continued wellness.
- The PPAO recommends that the government ensure that the newest medications and treatments are made available to individuals with mental illness at no cost, on the recommendation of their physician, as a way to promote wellness and recovery.
Services and Supports for Individuals with A Dual Diagnosis
Individuals with a dual diagnosis (developmental disability and mental illness) often find it difficult to gain access to a full range of services and supports that meets their unique needs. Some individuals have been institutionalized or hospitalized longer than required simply because the services and supports are not available to support them living independently, thus delaying their discharge. Many require costly and labour intensive supports but this should not be a barrier to their ability to live in and participate fully in the community. A full range of housing options and services that would support independent community living must be made available. If not, one solution may be the implementation of individualized funding agreements to allow persons with a dual diagnosis to purchase the services and supports that they require from a community-based service provider of choice. If we are to be an inclusive community, then the most vulnerable must also be given the opportunity to be part of that community and to have opportunities to both live in and participate in society to the extent that they wish and are able.
- The PPAO recommends that the government provide the necessary funding to support individuals with a dual diagnosis to live in the community with access to a full range of services and supports.
Mental illness is often misunderstood by the broader community and many clients experience first hand the stigma and discrimination associated with it. Stigma and discrimination may be subtle or overt but they have a negative and insidious impact on our clients, with respect to the opportunities available to them for employment, education, housing, recreational and social activities, in addition to excluding them from the community.
- The PPAO recommends that the government provide funding for an on-going broad-based public education campaign with respect to mental health, mental illness and addictions to break down barriers and convey a zero tolerance message regarding stigma and discrimination for those with mental illness.
Some individuals with mental illness participate in a range of social, vocational, rehabilitation and recreational programs that are either hospital or community-based. These activities help to support people in their quest for wellness and recovery, engage them in meaningful activities or simply are an opportunity to interact with others on a social level. Other individuals with mental illness must attend regular appointments with many different health care providers, including psychiatrists, social workers, case managers and outreach staff, and often are not provided with sufficient financial assistance for transportation to attend these meetings.
Each of these rehabilitation, social and treatment activities may play an important role in the person's life and in keeping them connected to their community. Unfortunately, many of these programs do not provide financial assistance for transportation and ODSP does not provide full subsidy to cover the cost of monthly transportation so that clients can continue to participate in the very programs that keep them well.
- The PPAO recommends that individuals with mental illness be provided with a transportation allowance to enable them to participate in programs that support their wellness and recovery.