Personal Needs Allowance
Submission to the Standing Committee on Finance and Economic Affairs
February 5, 2003
Psychiatric Patient Advocate Office
55 St. Clair Avenue West
Suite 802, Box 28
Toronto, Ontario, M4V 2Y7
Telephone: (416) 327-7000
1-800-578-2343
The Psychiatric Patient Advocate Office [PPAO] was introduced in 1982, as reported to the Committee of the Legislature on Social Development by the Ministry of Health. The intention of all parties was that the Office would operate independently, with a mandate to advance the legal and civil rights of patients in the 10 provincial psychiatric hospitals. The PPAO is an arms' length program of the Ministry of Health and Long Term Care. The PPAO is allowed to speak freely on issues involving the rights and entitlements of psychiatric patients. The program was established in recognition that at times vulnerable people need someone to help give voice to their concerns when they are unable to speak as a result of a lack of knowledge or the nature of their illness. The program became operational in 1983.
As an arms' length program, the PPAO does not speak on behalf of the Ministry of Health and Long Term Care.
The PPAO's mission is:
- To ensure the legal and civil rights of patients are promoted;
- To ensure that patients are treated with dignity and respect and that they receive high quality treatment and care;
- To contribute to the empowerment of consumers, enabling them to make informed decisions about their lives , care and treatment;
- To promote self-advocacy and self-determination
The PPAO's specific mandate is:
- To advance the legal and civil rights of psychiatric patients in all provincial psychiatric hospitals through both individual and systemic advocacy;
- To inform the patient, family, hospital staff and the community about patients' legal and civil rights;
- To assist, facilitate [self advocacy] and help resolve the complaints made by providing an avenue for resolution through negotiation according to patient's instructions;
- To investigate alleged incidents and to assess institutional and systemic responses to these incidents;
- To refer patients, when necessary, to external community advocacy resources when appropriate.
Summary Of Recommendations
The Psychiatric Patient Advocate Office (PPAO) recommends:
- That the Personal Needs Allowance [PNA] for residents in institutional settings be increased from $112.00 per month to $160.00 to reflect the increase in the cost of living over the past 10 years [since the last increase].
- That both the residential and non-residential portions of the Ontario Disability Support Plan are increased to reflect the changes in the cost of living over the past 10 years [since the last increase].
- That the Ontario Works funding formula is increased to reflect the changes in the cost of living over the past 10 years [since the last increase].
Submission
The Psychiatric Patient Advocate Office [PPAO], an arms-length program of the Ministry of Health and Long Term Care, was established in 1983 to protect the rights and entitlements of patients in provincial psychiatric facilities. Since that time the PPAO has been involved in protecting the legal and civil rights of patients by providing advocacy and rights advice services.
In making our submission to the Committee we ask that you consider an increase to all income support programs under provincial legislation. This would include the Ontario Works program, the Ontario Disability Support Plan [ODSP] and the Personal Needs Allowance [PNA] for those individuals deemed eligible under Section 4 of the regulations [ODSP].
In our work as advocates, the PPAO has contacts with individuals who are funded under each of these programs. All clients, while in a psychiatric hospital receive the Personal Needs Allowance [PNA]. A significant percentage of patients who leave hospital return to some form of social assistance, either the Ontario Disability Support Plan [ODSP] or Ontario Works. As a result of our ongoing involvement we know their struggles well.
Those individuals living in a psychiatric hospital setting receive a PNA of $112.00 per month or $3.75 per day. With these funds patients are expected to meet all their clothing needs, purchase any sundry expenses [i.e. shoes, hair cuts, hygiene products etc.], to cover other miscellaneous purchases such as cigarettes, chewing gum, and or any entertainment costs [i.e. the occasional movie or magazine]. Even a cursory look at this list clearly shows that $3.75 a day would not begin to cover the cost of meeting even the most basic needs of these individuals. In 1993 the PNA was increased to its current rate of $112.00 per month. Since that time [10 years] there has been no increase even though, according to a 2002 report by the National Council on Welfare, the cost of living has risen by 16% since 1992. As consequence patients are less able to meet their basic needs today than they were ten years ago. Given these numbers even an increase of $30.00 to $40.00 per month would only bring the rates back to 1993 levels. Most of the current research in the field [Dr. E. Lightman of the University of Toronto and Dr. R.Wilton of McMaster University] recommend a modest increase of $48.00 per month to $160.00. While we support these proposals we see this as only a first step in addressing the poverty issues for those individuals who struggle to live on the PNA.
With respect to the Ontario Works and ODSP funding formula we make no specific recommendations as to the amount that they should be increased. However, we recognize that those individuals who struggle to survive on the PNA while in hospital face many of the same realities when returning to the community namely; a staggering level of poverty fueled by rising housing costs and inadequate funds for basic needs such as food and clothing. When one adds to this poor employment opportunities and limited community supports you are left with a group of people who feel isolated and stigmatized by the communities in which they live. Most of the current and divested psychiatric hospitals are in larger urban centres where housing costs have dramatically increased over the past number of years. Often this results in discharged patients, [who tend to reside in close proximity to the hospital] seeking out substandard living situations, which only tends to exacerbate both the physical and emotional risks to their continued mental health.
Similar to the PNA, neither the ODSP funding formula nor the Ontario Works support plan has increased in the past 10 years [in fact general welfare supports were cut by 21% in 1995]. The maximum monthly income for a person living on the ODSP is $930.00, a yearly income of $11,160.00. The annual income for a single person living on Ontario Works is $6,240.00 per year. Statistics Canada has developed a standard measure of income compared to basic needs, the Low Income Cutoff [LICO]. For a single person living in an urban area the LICO is $18,371 before taxes. In a rural area the LICO before taxes is $12,696. Clearly these figures indicate that a single individual living on ODSP or Ontario Works falls well below the income level that is required to meet a persons basic needs.
As our clients tell us, and through our own observations, most live in substandard housing, have limited funds to purchase even the basic necessities such as food that would constitute a balanced diet and clothing appropriate to the season. Perhaps the greatest tragedy we see is a group of individuals who, because of limited resources are unable to participate in any meaningful way in community life. Again this adds to their feeling of being excluded and stigmatized as a result of their mental illness.
The Patient Advocates know from direct experience that a significant number of hospital readmissions are the direct result of environmental breakdowns where housing, community supports and or funding has been insufficient to meet patient needs. What our clients tell us is that they have the same hopes and dreams that we do. They want affordable and safe housing. They want a level of comfort beyond the grinding poverty of living from month to month on inadequate funds. More than anything they tell us they want to be contributing members of their community. Each of these aspirations requires financial resources. While not the only answer, an increase in the Personal Needs Allowance, and the ODSP and Ontario Works funding formula would help make this a reality.
The Psychiatric Patient Advocate Office is deeply concerned at the lack of financial and social support offered to people with disabilities in the province of Ontario. Over the past 5 years the Ministry of Health and Long Term Care set in motion a plan to reform the mental health system which includes a movement away from institutional care towards supporting clients in the community. While new community resources have been developed the funding model for OW, ODSP, and the PNA has remained unchanged for more than 10 years. This is clearly an inconsistency in the new reformed mental health framework that needs to be addressed. As a consequence, we ask you to consider an increase to the funding formula for Ontario Works, the ODSP program, and the Personal Needs Allowance, as part of your budget deliberations.
