Pre-budget Consultations: The Road to Recovery

Submission of the Psychiatric Patient Advocate Office
to the Minister of Finance, Ontario

January, 2007

Table of Contents
Covering Letter to Pat Hoy, Chair, Committee on Finance and Economic Affairs
Introduction
An Adequate Income
A Place to Call Home
Personal Recovery Plans
Employment
Support Networks
A Community Free of Discrimination
A Respect for Rights
Conclusion

January 12, 2007

Pat Hoy, M.P.P.
Chair
Standing Committee on Finance and Economic Affairs
Room 1405, Whitney Block
Queen's Park
Toronto, Ontario M7A 1A2

Dear Mr. Hoy:

RE: Pre-budget Consultations - The Road to Recovery

Thank you for the opportunity to participate in the pre-budget consultation, in addition to developing a process that encourages and supports all Ontarians to share their ideas with you. The Psychiatric Patient Advocate Office (PPAO), on behalf of our clients, has prepared the attached submission entitled “The Road to Recovery.”

Every community in this province is touched by the problems arising from mental illness and addictions and for this reason, we ask that your government make additional investments in the mental health sector this year. As you are aware, Local Health Integration Networks (LHINs) have identified, as priority initiatives, the integration of mental health and addiction services as core components of the health service sector. We must also ensure that individuals receive assistance to become core components of their communities. At a time of transition and change, such as is the case today, we must not lose sight of the needs of individuals.

While people with mental illness can and do recover, they cannot do so without adequate  support and encouragement. The government of Ontario has both the power and authority to dedicate public funds to the development of social programs and public policy that can improve the lives of all Ontarians. The Road to Recovery provides you with a blueprint and recommendations, that if implemented, will improve the quality of life of all individuals with a mental illness and have a positive impact on every community in the province.

We are hopeful, as you begin to make difficult decisions regarding budget allocations and new investments, that you will invest in the people of Ontario and assist and support individuals in their quest for recovery. 

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
Acting Director

c.c.     Greg Sorbara
           Minister of Finance

The Road to Recovery
Pre-Budget Consultation Submission

Across Ontario, mental and behavioural disorders account for significant rates of morbidity and mortality and excessive rates of hospitalization.  Yet, this is one area where investments in community services are at least as important as investments in traditional health services.  Over the last several years a consensus has emerged that the mental health system, like the addictions system before it, must embrace a recovery philosophy that places the consumer at the centre.  Funding for integrated and accessible mental health and addiction services must be matched by investments in income supports, housing, employment, consumer and peer support initiatives, and family supports.   Only then will those struggling with mental illness and addictions be able to fully participate as equal members of their communities, to be well and to stay well.

Recovery is about hope, choice, empowerment and being able to live beyond an illness.  Individuals with mental illness are more than their diagnosis – first and foremost, they are people, who happen to have an illness.  All they want is to be loved and cared for, to contribute to the community, to be accepted, to be able to provide for their family, to be well and stay well, to have a decent income and a place to call home.  Individuals with mental illness are our family members, loved ones, friends, neighbours, and co-workers - they are us.  People with mental illness can and do recover but they often require the support of their communities and their government.  As you make decisions about what to fund in the coming fiscal year, we encourage you to invest in initiatives that fully support the recovery of individuals with mental illness.

Recovery does not readily occur in isolation.  It demands an environment of hope, resiliency, choice and a full complement of services that will espouse principles of recovery.  The following recommendations are intended to address significant barriers to wellness and recovery for individuals with mental illness.

An Adequate Income

In Ontario, individuals with disabilities, including those with mental illness, are often subjected to a life of poverty – a barrier to inclusion and full participation in society.  The Accessibility for Ontarians with Disabilities Act, 2005 defines a barrier to “mean anything that prevents a person with a disability from fully participating in all aspects of society because of his or her disability, including…a policy or practice.”  Poverty is the most formidable barrier to inclusion and full participation in society.  The government of Ontario could eradicate poverty if it had the desire to do so.

Government policy has forced people with disabilities living on limited incomes to make difficult financial choices, in supporting themselves and their families; these forced choices negatively impact their physical and emotional health, eroding self-confidence and personal effectiveness.  Many will not be able to purchase nutritious foods, such as fresh fruits and vegetables, and will have to rely on canned goods obtained from food banks.  Moreover, individuals living at or below the poverty line must often choose between paying the rent or feeding their families, or sending children on class outings or paying utility bills. 

Having an adequate income and being able to provide the necessities of life for one’s self and family is perhaps one of the first steps towards wellness and recovery.  Constantly worrying about not being able to provide their families with food, shelter and clothing takes its toll on the mental health and well-being of individuals.  For some, it will result in hospitalization, while others will simply become immobilized by stress, thus impacting their physical and mental wellbeing.   If the government is to support wellness and recovery, a significant investment will need to be made to provide people with a hand up and the resources necessary to achieve recovery.  The Accessibility for Ontarians with Disabilities Act is a legal commitment to eliminating all barriers for people with disabilities, including poverty, and it must be honoured.

Recommendation:

• The PPAO recommends that the government of Ontario immediately improve the quality of life of all individuals with a disability, including those with mental illness by:
1. Increasing Ontario Disability Support Program (ODSP) rates;
2. Ending the clawback of the Child Tax Benefit;
3. Repealing the changes made to the special diet allowance;
4. Enhancing opportunities for employment and affordable housing; and
5. Funding a broader range of community-based mental health services and supports.

A Place to Call Home

Having a place to call home is integral to all of our lives and is an essential ingredient of recovery.  Access to safe, decent and affordable housing is fundamental to personal and social stability.

As individuals progress through the different stages of recovery, they may require different types of housing, with varying levels of support and assistance, ranging from supported housing and staged housing to independent living.  Thus, it is essential that a full spectrum of affordable housing be available to meet the varying needs of each individual.  When people are ready, they should have access to the income necessary to pay market rents so that they can be fully integrated as community members.

It is also important to make “safe beds” for non-medical emergencies available in every community so that individuals could have a safe place to go without needing to be admitted to the hospital.  The development of this resource is a cost-effective and normalizing alternative to hospitalization.

Some individuals have expressed concern that they are not able to access hospital-based services and supports in a timely manner or in their own community.  At times individuals may want or need to access “bed-based” care and treatment, as part of the cycle of their illness and to support their continued wellness and recovery.  However, at times they are turned away because of a “lack of beds” or they are advised that they “don’t meet the criteria for admission.”  This inability to access services and supports can have tragic results.  Hospital services need to continue to be available to individuals with mental illness as part of a continuum of care, treatment, rehabilitation and recovery.

Recommendations:

• The PPAO recommends that the government of Ontario increase investments in housing to ensure that every Ontarian who wants a home has a place to call home.
• The PPAO recommends that individuals be provided with adequate income support so that they can access housing across a continuum from supported housing to independent living.
• The PPAO recommends that “safe beds” be funded in every community to give individuals with mental illness an alternative to hospitalization, should they require non-medical crisis intervention and support and a safe environment to meet their temporary needs.
• The PPAO recommends that individuals continue to have timely access to a full range of hospital-based services and supports, including access to “bed-based” care and treatment, if so needed and required.

Personal Recovery Plans

Developing a personal recovery plan requires a collaborative relationship between the individual and their treatment team to identify goals, the supports required to meet these goals and to negotiate how the team can best support the individual.  Recovery is a personal journey that must be defined by the individual themselves and which may require the support of staff who understands the principles of recovery and how to best operationalize them.  Wellness and recovery also requires that the individual have access to a broad range of treatment modalities, including access to the newest and most effective medications.  Unfortunately, some of these medications are costly and unavailable.  Individuals with mental illness should have access to a full range of medications and treatment modalities, covered by a publicly funded health care system.  It should never simply be about “cost” but it should be about what would work best for the individual in promoting his or her recovery and continued wellness.

Some individuals have made a choice to stop smoking only to find that smoking cessation aids are typically not covered by the Ontario Drug Benefit Card.  The cost of these aids are often prohibitive for those who live below the poverty line.  As the government of Ontario has made a commitment to a smoke-free Ontario, it is only logical that such products be covered under the Ontario Drug Benefit Program to best support and assist those individuals who wish to stop smoking.

Recommendations:

• 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.
• The PPAO recommends that the government illustrate its commitment to assisting individuals who have made a choice to stop smoking, following consultation with their physician, by providing full coverage for smoking cessation products under the Ontario Drug Benefit Program.

Employment

For most Ontarians, employment and financial security are of the utmost importance.  There is little doubt that having meaningful employment is important to all of us, but it is particularly important to those recovering from mental illness insofar as it promotes self-esteem and supports community membership and inclusion.  Accordingly, having a job is an important part of recovery and reintegration into the community.  Unfortunately, for individuals with disabilities in Ontario, including those with mental illness, there is a staggering unemployment rate but few supports for finding and maintaining employment.  For those people with jobs, the work is often of a menial nature or they are paid only a minimum wage.  Moreover, if individuals with disabilities are employed, they risk losing access to some ODSP benefits.  These disincentives must be eliminated by the government as they represent a barrier to inclusion for people with disabilities.

A labour market environment that is inclusive, responsive and welcoming of employees with disabilities must be fostered and supported by the government.  This can be achieved via vocational rehabilitation supports combined with educational opportunities, job coaching, mentoring programs, job shadowing programs and support services.  Further education of employees and employers regarding the Accessibility for Ontarians with Disabilities Act is also important. 

Recommendations:

• The PPAO recommends that the government of Ontario make an immediate investment in employment and skill training programs, employment support and mentoring services and job retention programs for individuals with disabilities.
• The PPAO recommends that the government of Ontario address the staggering unemployment rate for individuals with a disability as an urgent priority. 

Support Networks

Support networks can take many forms and many shapes.  They can include informal supports such as families and friends or formal support such as doctors, nurses, peer support workers and social workers.  Each network is instrumental to encouraging recovery by helping the person to live beyond their illness and to develop personal and helping relationships.

Over the past few years, the government of Ontario has made significant investments in community-based mental health programs and support services.  However, there are still individuals who are not able to use needed services and supports in their own communities.  Additional funding is needed to make these services more accessible.

The addition of peer support workers and peer support specialists would make a significant contribution to the current mental health system.  Peer support staff are particularly helpful in assisting individuals working towards recovery due to their commonality of experiences and ability to empower others through self-help approaches.

Recommendations:

• The PPAO recommends that the government of Ontario invest additional monies in community-based mental health programs, services and supports.
• The PPAO recommends that the government of Ontario recognize and fund peer support workers and specialists as an integral component of the mental health delivery system.  Every mental health and addiction service provider should be required to have peer support workers on staff to support individuals in their quest for recovery.

A Community Free of Discrimination

Too many individuals with a mental illness experience intolerance and discrimination, impeding their recovery and reintegration into the community.  If we are to be an inclusive, accepting and understanding community that supports individuals with mental illness and addictions, we must have zero tolerance for discrimination.  Discrimination may be subtle or overt but the impact for persons with mental illness and addictions is the same - it injures and diminishes a person’s sense of self.

Recommendation:

• The PPAO recommends that the government provide funding for an anti-discrimination campaign with respect to mental health, mental illness and addictions.

A Respect for Rights

An understanding of and respect for rights, in addition to empowerment, are integral to recovery.  However, both the community and stakeholders need to be educated about the rights of individuals with mental illness. 

All too often, we hear that mental health law is too complicated and interferes with the treatment process.  Broad-based education for clients, families, health practitioners and other stakeholders is essential if we are to uphold the rights and entitlements of some of the most vulnerable members of our communities. 

Some individuals with mental illness are vulnerable for a variety of reasons – they may not know their rights, they may not know where to turn for help or the illness itself makes them vulnerable.  In these instances, persons with mental illness may be unable to speak for themselves and assert their rights.  It is for these reasons that access to independent advocacy and rights advice services must be considered a funding priority for the government of Ontario.  Independent advocacy and rights advice services would ensure that all individuals with mental illness would not only understand their rights but would also have assistance in exercising those rights.  This would empower the individual and support his or her recovery.

Recommendations:

• The PPAO recommends government funding of a broad-based public education campaign to teach clients, families, health practitioners and other stakeholders about mental health law and the rights of individuals with mental illness.
• The PPAO recommends that the government provide funding for independent advocacy and rights advice services for all individuals with mental illness, regardless of where or from whom they receive care and treatment.

Conclusion

Recovery from mental illness can and does occur if the appropriate supports and services are in place and if communities are adequately resourced to be supportive and inclusive.  Although great strides have been made in recent years, there is still much work to be done.  The mental health system has been the subject of numerous reports and studies over the years that have each outlined a blueprint and a strategy for reforming the current system.  Regrettably, many of these reports and their resulting recommendations have not been implemented and the system has not been challenged to be more innovative.

Building communities means going beyond funding clinical services, we must invest in income supports, housing, employment, consumer and peer support initiatives, and family supports.  Mental illness and addictions can be alleviated by medical interventions, the other side of the story is that we must also give people the tools to help themselves when they are able.  As the ministry moves to adopt its stewardship role in health, it must continue to protect and assist individuals who struggle with mental illness and addictions.

This submission makes recommendations that would assist in promoting a recovery-oriented approach to the care, treatment, rehabilitation and support of individuals with mental illness in Ontario.  Such an approach would reduce the barriers experienced by Ontarians with mental illness, supporting their continued wellness and enabling their inclusion as fully empowered citizens.  We would urge you to reflect on our recommendations as you deliberate on how to spend the money entrusted to you by the people of Ontario.  We can and must do better.