Systemic Advocacy Issues: 2004
Following are some examples of the range and diversity of systemic issues that the PPAO was involved with during 2004.
Future Directions for Legislation regarding Long-Term Care Homes
The PPAO participated in the ministry’s consultation regarding the legislation governing Long-Term Care (LTC) Homes. This process was aimed at strengthening and consolidating the existing legislation and reforming the service delivery system. The PPAO recommended the creation of an independent seniors’ advocate to protect the legal and civil rights of those residing in Long-Term Care Homes in Ontario. An independent advocate would help residents navigate a complex health delivery system, support them in self-advocacy efforts, give a voice to the issue when unable to speak for themselves, assist with problem resolution and engage in systemic advocacy. Other recommendations focused on provincial standards for access to specialized mental health supports; fully funded and autonomous resident and family councils; the provision of rights advice on issues on matters of treatment, financial incapacity, and admission to a Long-Term Care facility; movement toward a restraint-free environment; and mandatory reporting for abuse and unlawful acts and sanctions for those who fail to fulfill this obligation.
Review of the Police Complaint System
Mental health consumers have often voiced concern to the PPAO regarding alleged police misconduct and the profound frustration that they have experienced in dealing with the current complaint process. Many have hesitated to file complaints against the police out of fear of reprisal and because they believe they will not be taken seriously due to their mental illness. Others have little confidence that their complaints will be fairly investigated. In its submission, the PPAO underscored the need for an independent, transparent and credible process in managing police complaints. Ideally, a police complaint mechanism would be both accessible and accountable to the public it serves. The PPAO called for the establishment of an independent body under civilian authority and the development of a transparent complaint process. The development of an advisory committee to assist in the design of a new complaint system and to address the special needs of vulnerable individuals coping with mental illness or disability was recommended. A role for ongoing education to police to ensure appropriate and respectful behaviour when interacting with consumers of mental health services, as well as education on the complaint process to consumers, their families and other stakeholders was also targeted. The “Report on the Police Complaints System in Ontario “ was released on August 22, 2005 and is available on the Ontario Ministry of the Attorney General website. This report echoed many of the recommendations made by the PPAO, in particular the need for an independent body to administer the complaints system, offering assistance to those filing complaints and supporting broad access to the complaints process.
Ontarians with Disabilities Act
In its submission regarding the Ontarians with Disabilities Act, 2001 (“ODA”), the PPAO encouraged the strengthening of the Act to afford the highest levels of protection and opportunity to individuals with disabilities. This act has particular relevance for individuals with disabilities arising from mental illness related problems. The PPAO called upon the Minister of Citizenship and Immigration to adopt a broad definition of disability to include self-defined disabilities and the principle of “zero tolerance” regarding the discrimination and harassment of individuals with disabilities. The formation of an independent advocacy and rights protection organization to address physical and attitudinal barriers to access, inclusion and equitable treatment for those marginalized by disability was also recommended. The PPAO called for increased funding to Legal Aid Ontario and the Human Rights Commission to improve the access to justice
Mental Disorder Provisions of the Criminal Code
The PPAO grappled with issues affecting clients served by the forensic mental health system in its submission to the House of Commons Standing Committee on Justice, Human Rights, Public Safety and Emergency Preparedness regarding changes to the Mental Disorder provisions of the Criminal Code (Bill C-10). This submission argued against the inclusion of victim impact statements during Review Board hearings, asserting that annual hearings were not the appropriate venue for their presentation and that, presented year after year, could potentially harm consumers’ progress toward recovery. The PPAO also made recommendations regarding the identification of factors determining the “least restrictive” and the “least onerous” disposition, and called for a clear definition of levels of custodial restriction. Also recommended was the inclusion of a definition for “dangerousness” in the Criminal Code, which would exclude behaviours that were undesirable but did not pose a risk. The PPAO further recommended that the treatment disposition section of the Code be removed and a model of substitute decision making be adopted similar to that of Ontario. Other recommendations included the development of a duty counsel or amicus curiae system to support unrepresented clients, clarification of what is meant by “restriction on the liberty of the accused,” and the formation of a Federal-Provincial-Territorial working group to address issues arising from stigma through education.
Personal Health Information Protection Act
The PPAO made a submission to the Standing Committee on General Government in January 2004 regarding the Personal Health Information Protection Act (PHIPA), which governs the collection, use and disclosure of personal health information. PHIPA became law on November 1, 2004 and replaced the sections of the Mental Health Act governing the access to and disclosure of confidential client records. The authority of the PPAO to access client personal health information while fulfilling its mandate to provide a broad range of advocacy services (instructed, non-instructed and systemic advocacy) requires further clarification under this new legislation. Our office is working with the Ministry of Health and Long-Term Care to develop regulations to define what is meant by s. 35 (4) (d) “ a prescribed person who is providing advocacy services to patients in the prescribed circumstances.” We anticipate that this issue will be addressed early in 2006.
Magee Inquest
The PPAO participated as a party with standing at the inquest into the death of Christopher Magee, an inpatient held in custody on the forensic unit of a tertiary care psychiatric facility in Ontario. These proceedings highlighted the critical importance of ensuring access to a full range of medical services, and in particular emergency medical services, in psychiatric hospitals. The PPAO noted that individuals experiencing physical concerns in addition to their psychiatric illnesses may be particularly vulnerable and may need added support in communicating their needs and accessing needed treatment. In its summation to the jury, the PPAO made a number of recommendations aimed at improving the quality of care and treatment received by inpatients in psychiatric hospitals. Some of the jury’s recommendations echoed those of the PPAO, calling for the availability of specialized life saving equipment to be available on “crash carts,” education of staff on emergency response protocols and complex medical needs of patients.
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