PPAO Submission to the Ontario Pre-Budget Consultation, January 2008

January 31, 2008

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

Dear Mr. Hoy:

Pre-Budget Consultation

Thank you for the opportunity to participate in the pre-budget consultation and to share, on behalf of our clients, our ideas with you and the other members of the Standing Committee.  The Psychiatric Patient Advocate Office (PPAO), which is now celebrating its 25th year anniversary, has prepared the attached submission for your review and consideration.

We are hopeful, as you begin to make difficult decisions regarding budget allocations and new investments that you will choose to assist and support individuals with a mental illness.  Every community in Ontario is touched by mental illness and everyone has the responsibility to ensure we are a caring, accepting and inclusive society.  Some of the most vulnerable amongst us require empathy, compassion and a helping hand as they embark on their personal journey of recovery.  They may need our help in finding their voice, in exercising their rights or in gaining access to the supports and services they may need or want.  We can and must do better as a society.

If our office can be of any assistance or provide additional information, please contact me at (416) 327-7007 or David Simpson, Program Manager, at (416) 327-7004.

Sincerely,

original signed by

Vahe Kehyayan
Director

Background 

Recovery is about hope, choice, empowerment and being able to live beyond your illness.  Individuals with mental illness are more than their diagnosis – first and foremost, they are people, who happen to have an illness.  They want 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 health and social services and an adequate source of income 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 

It is an unfortunate and undeniable fact that many people with mental illness are exposed to poverty.  Studies indicate that 22.4% of persons with disabilities in Ontario are poor¹ while approximately 35% of ODSP recipients live below the poverty line.²

Poverty is 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.”  The government of Ontario should honour both the law and its commitment to developing a poverty reduction strategy – if it chooses to do so, the government has the ability to eradicate poverty.

Government policy has forced people with disabilities living on limited incomes to make difficult financial choices in order to support themselves and their families.  For example, a single person in receipt of Ontario Disability Support Program benefits would receive a maximum of $999.00 per month ($554.00 basic needs and $445.00 shelter allowance).  In many communities it is difficult to find safe, decent and affordable housing based on the shelter allowance received from the Ontario Disability Support Program.  In some circumstances individuals will make a decision to use a portion of their basic needs allowance to find more suitable housing but this then leaves them with very little money to pay for utilities or purchase food and the other necessities of life.

These forced choices negatively impact on physical and emotional health, eroding self-confidence and personal effectiveness.  Poverty increases people’s stress which can trigger exacerbations of illness.  In terms of diet, many people are unable to purchase nutritious foods, such as fresh fruits and vegetables, and are forced to rely on food banks.  More than half (51%) of food bank users in Toronto say they have a disability or serious illness.³  Individuals living at or below the poverty line must often choose between paying the rent, 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 health.  If the government is serious about supporting its citizens, 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, 2005 is a legal commitment to eliminating all barriers, including poverty, for people with disabilities, and it must be honoured.
The government should, at a minimum, raise Ontario Disability Support Program benefits to cover the real costs of living.

If the government fails to take action, persons with mental illness would be at a higher risk of becoming homeless.  Once homeless, even fewer supports would be available to them and there would be an increased opportunity of coming into contact with the criminal justice system.  It has been reported that homeless individuals experience a high level of victimization, but that they are often reluctant to report crimes to the police as they feel alienated from police protection.⁴  Although homeless people do not commit more crimes than people with higher incomes, they are arrested more frequently and held on remand because they can not afford to pay for bail.⁵

Recommendations:

The PPAO recommends that the Ontario government dramatically increase Ontario Disability Support Program benefits to cover the real costs of living which would allow individuals to secure safe and decent housing, as well as to be able to purchase food and other necessities of life.

Peer Support Workers 

Individuals with mental illness require greater opportunities for social inclusion so that they are able to participate in the community to the extent that they wish and are able to do so.  This requires investing in support services, including the addition of Peer Support Workers, that will assist individuals in securing and retaining employment, housing, education, social and recreational activities and volunteer opportunities.  All too frequently, individuals with a mental illness are ignored and denied opportunities due to discrimination and stigma.  As a result, they sometimes lack the confidence to assert their needs.  Peer Support Workers could be available to assist and support individuals throughout their recovery and to share their experiences as a way to empower the client in their quest for wellness and recovery.   A support system based on mentoring and peer support networks for individuals with a mental illness would be a welcome addition to the mental health sector in Ontario, a role that Peer Support Workers could easily fulfil.

Recommendation:

The PPAO recommends that the government of Ontario consider funding and requiring each mental health provider to have Peer Support Workers available to support and mentor individuals with a mental illness throughout their recovery process, should they wish to access such services.

Access to Newest Treatment Modalities 

Recovery is a personal journey that must be defined by the individual themselves and which may require the support of others who understand the principles of recovery and how to best operationalize them.  Wellness and recovery also require that individuals with mental illness  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 which are covered by a publicly funded health care system.  “Cost” should not be an issue; instead, it should be about what would work best for the individual to promote 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.

Recovery must also be supported by timely and unimpeded access to a variety of mental-health services including assessment, referral, treatment, counselling, crisis-intervention services and case-management supports to assist with re-integration into the community.

Recommendations:
The PPAO recommends that:

• the Ontario 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 Ontario government demonstrate its commitment to assisting individuals who have made a choice to stop smoking, by providing full coverage for smoking cessation products under the Ontario Drug Benefit Program;
• individuals have timely and unimpeded access to a full range of mental-health services including assessment, referral, treatment, counselling, crisis-intervention services, and case-management supports to assist with re-integration into the community and to support their wellness and recovery; and 
• all individuals with a mental illness have access to a full range of rights protection services, including, rights advice and independent advocacy as these must be included in a comprehensive mental health system to support empowerment and recovery.

Advocacy 

Ontario is a leader in independent advocacy services for persons with mental illness as evident by the creation of the PPAO twenty-five years ago.  The PPAO is the only provincially coordinated provider of independent advocacy and rights advice services with a mandate to protect the legal and civil rights of patients in the current and divested provincial psychiatric hospitals.  However, it must be acknowledged that as care and treatment has migrated from an institutional to a community-based model, Ontario has failed to modernize its advocacy mandate.  This has created an inequitable system with unequal access to advocacy and rights protection services and support.  The government needs to rectify this situation by expanding these services into the community, affording every individual with a mental illness equal access to independent advocacy and rights protection services.

The World Health Organization has recognized the beneficial impact of advocacy with regards to mental health.  It has said that “advocacy is an important means of raising awareness on mental health issues and ensuring that mental health is on the national agenda of governments.  Advocacy can lead to improvements in policy, legislation and service development.”⁶  After studying advocacy initiatives around the globe, the World Health Organization noted that despite the numerous barriers confronting people with mental illness, these initiatives have had the following effects:

• improvements in policies and practices of governments and institutions;
• changes made to laws and government regulations;
• improvements in the promotion of mental health and the prevention of mental disorders;
• the protection and promotion of the rights and interests of persons with mental disorders and their families; and
• improvements in mental health services, treatment and care.

Recommendation:

The PPAO recommends that all individuals with a mental illness have access to a full range of rights protection  services, including, rights advice and independent advocacy as these must be included in a comprehensive mental health system to support empowerment and recovery.

Discrimination 

Too many individuals with a mental illness experience intolerance and discrimination, thereby 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, 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.  An anti-discrimination campaign targeted at all sectors of society would educate people about the demoralizing impact of discrimination.  Academic institutions, including elementary schools through to colleges and universities should be mandated to have learning modules on mental health, mental illness and addictions to create awareness and foster a greater understanding of these issues and to enlighten students on the harmful effects of discrimination.  This will require a significant investment by the Government of Ontario and should be viewed through a health promotion, prevention and early intervention lens.

Recommendations:
The PPAO recommends that:

• the government provide funding for an anti-discrimination campaign with respect to mental health, mental illness and addictions; and
• academic institutions, including elementary schools through to colleges and universities be mandated to have learning modules on mental health, mental illness and addictions to create awareness and foster a greater understanding of these issues and to enlighten students on the harmful effects of discrimination. 

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 understanding and inclusive.  Although great strides have been made in recent years, there is still much work to be done.

This submission makes recommendations that, if implemented, could assist in promoting a recovery-oriented approach to the support, care, treatment and rehabilitation of individuals with mental illness in Ontario.  Such an approach would reduce the barriers experienced by Ontarians with mental illness, thereby 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.