Local Health System Integration Act, 2006

Presentation of the Psychiatric Patient Advocate Office
to the Standing Committee on Social Policy

Wednesday 8 February 2006

Official transcript available at www.ontla.on.ca - Hansard - pages 46-48

The Chair: The next presentation is from the Psychiatric Patient Advocate Office; David Simpson and Lisa Romano. Welcome. You can start your presentation whenever you are ready.

Mr. David Simpson: Good afternoon. My name is David Simpson. I'm the acting director of the Psychiatric Patient Advocate Office. With me today is Lisa Romano, legal counsel to the Psychiatric Patient Advocate Office. We'd like to thank the committee for its invitation and the opportunity to share our recommendations. You'll see that we've made some 36 recommendations in our submission. We're hoping that these recommendations will be adopted to further strengthen Bill 36 and the health care system in Ontario.

This legislation will bring about one of the most significant transformations of our health care system in Ontario, shaping and profoundly impacting how this and future generations will access care and treatment. It is because of the significance of these changes that we are here today.

What are our concerns? We are concerned about the availability of health care services throughout communities in Ontario. We are concerned about the accessibility of a full range of mental health services and supports to Ontarians in need of these services. We are concerned about the accountability of the Ministry of Health and Long-Term Care and the local health integration networks to the public by means of effective checks and balances.

What are the questions that we have about the proposed legislation? How will the new structure improve the delivery of health services in Ontario? How will the system be accountable to the people it serves? What rights-protection mechanisms are in place to protect not only the public but vulnerable populations such as those with mental illness? Why doesn't the legislation include rights-protection mechanisms reflecting a clear commitment to patients' rights? This would include such safeguards as an independent health systems advocate, a patient bill of rights, a transparent complaints process and a sunset clause that requires mandatory review of the legislation after a period of time. How will a system that has a local perspective take into account a provincial perspective? How will the power and authority of the minister and the LHINs be tempered with checks and balances that protect the public interest?

Let me begin by saying that we are supportive of the fundamental intent and purpose of this legislation but feel it could be strengthened via specific amendments for the benefit of all parties, including those with serious mental illness and addictions who will receive direct services under the proposed new structure. The proposed amendments would provide increased public protection, transparency and accountability. This is necessary because the LHINs are not accountable to the community but to the minister, and thus the necessity to have enhanced rights protection mechanisms included in the proposed legislation. We are here today to provide recommendations and offer solutions.

For the past two decades the Psychiatric Patient Advocate Office has provided independent advocacy and rights advice services to patients in the 10 current and divested provincial psychiatric hospitals in an effort to protect and promote their legal and civil rights. With over two decades of experience, we believe we are uniquely qualified to comment on the LHINs legislation, rights protection mechanisms, transparent complaint processes, transforming the health care system to better meet the needs of patients and the potential impact that it may have on our clients.

Although our experience within the health care system is specific to mental health and addictions, we believe that many of our recommendations are equally applicable to the broader health care sector and will lead to both enhanced system accountability and adoption of a client-centred, client-first and client-directed perspective.

The PPAO is supportive of the development of the LHINs, provided that a full range of mental health and addiction services, supports and treatment modalities continue to be available and accessible to patients, including both hospital and community-based programs. This includes timely access to services available in the home community of the person, and where those services are not available, the LHINs must have a legislated responsibility to connect the person to the appropriate service they require. Moreover, clients must not be asked to pay for such services, as they should continue to be provided by a publicly funded system.

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In cases where the client is required to travel to another LHIN to access services, a system of reimbursement of expenses similar to the northern health travel grant must be put in place. Many individuals with mental illness may not have the funds necessary to travel outside their community to access services. Funding must also be made available to individuals who choose to access mental health and addiction services outside of their home community due to concerns regarding conflict with a service provider, confidentiality, privacy or the quality of care that they would receive in their home community.

Mental health has been described as an orphaned child of the health care system, and for this reason, care must be taken to ensure that mental health services are neither eroded nor inaccessible to patients. It's hoped that each LHIN will have a champion for mental health, mental illness and addictions. The provincial government must continuously monitor the LHINs to ensure that individual service delivery areas and specific services are not neglected, underfunded or simply abandoned.

We would also like to recommend that the Minister of Health and Long-Term Care form an advisory committee on mental health, mental illness and addictions to provide advice and consultation to both the minister and the 14 LHINs on issues related to this sector.
The process for engaging with clients: It would be helpful for the legislation and corresponding regulations to specifically articulate the process whereby community or citizen engagement is undertaken and how such consultations should be conducted.

The process for community engagement must be developed in consultation with a broad range of stakeholders, and the proposed legislation must specifically define what the term means. Further, the legislation must clearly define the community engagement process and include a mechanism for reporting back to the community the results of the consultation process. This will heighten accountability and further the public interest by having a real and meaningful process defined in the law.

We're also of the opinion that Bill 36 should define in law the basic basket of services required to be provided by each LHIN as well as the reasons why these services should be available in each local community. This will generate greater public discussion regarding health services and the expectations of the community to be able to receive care and treatment close to home.

Enhanced rights protection mechanisms would also be available if the legislation appointed or introduced an independent health systems advocate. That would be an important step forward in transforming health care in Ontario. An independent advocate could access not only individual complaints but systemic complaints. This environmental scanning would allow for the identification of emerging issues and trends with recommendations for the allocation of health care resources. The health systems advocate could report annually on the state of health care in Ontario and make recommendations both to the LHINs and the government on how to improve the system at large, while also reporting on the overall health of the system itself.

We also believe that Ontario should consider adopting and implementing a patient bill of rights for the health care sector. This again would heighten accountability and public awareness with respect to quality care, service delivery, outcomes and expectations, and provide guaranteed access to services.

We're also of the opinion that a complaints process should be enshrined in the legislation that specifically talks about timeliness, a fair process and a transparent process, with clear timelines and possible outcomes for resolution defined in the legislation.
In terms of commitment to consumer-survivor involvement, it's our opinion that the legislation should specifically mention the role of consumer-survivor in the mental health and addiction sector. It's also our opinion that the legislation should require that all in-patient mental health care programs have a consumer and family council that's fully funded and has autonomy. Consumers and families have a more extensive role to play and much more to offer than is currently recognized or acknowledged in Bill 36.

We would also like to see recognition and inclusion of peer support workers and peer support specialists in the legislation. This would send a clear message about their importance in a transformed health care system. It would recognize the value-added contribution the peer support workers could make to mental health and addictions programs and lead to peer support for all medical conditions being seen as important and endorsed by the community.

Again, we'd like to suggest that the minister develop a consumer-survivor advisory committee on mental health, mental illness and addiction that's parallel to the health professionals advisory committee.

The Chair: One minute left, sir.

Mr. Simpson: Last, transformation and devolution of decision-making to LHINs must also be supported by a transformation of how services are provided and how clients and patients are viewed by the system. It must have a recovery orientation and move away from a purely medical model of care provision. Once integrated, the health care system in Ontario must have a wellness and recovery focus, with a defined and shared philosophy of care. This made-in-Ontario model of care will result in an astounding transformation.

Working together, we can all contribute to a system that is responsive to individualized needs and provides the best care and treatment possible while respecting individual rights and heightening public accountability.

The Chair: Thank you very much for your presentation, sir.