Psychotropic Medication Use — Children and Youth
January 26, 2007
Hon. Mary Anne Chambers
Minister
Ministry of Children and Youth Services
56 Wellesley Street West, 14th Floor
Toronto, ON M5S 2S3
Dear Minister Chambers:
RE: Expert Panel on Psychotropic Drugs
I was pleased to read your announcement on January 24, 2007 regarding the launch of an expert panel on psychotropic drugs to develop standards of care for the administration of such drugs for children and youth in residential settings, including group and foster care homes across the province. I also noted that the panel will make recommendations on training frontline staff regarding informed care and monitoring the impact of the drugs. These are important steps forward in protecting the rights of children and youth to ensure informed decisions are made about their treatment.
These standards and recommendations will likely have other beneficial effects, perhaps leading to the establishment of best practices, training standards to ensure safe administration and improved reporting and documentation guidelines. The panel’s report will impact the care of all children and youth whether in a residential settings or living with their family in the community. The Ministry might consider expanding the mandate of the expert panel to include a review of the reliance on psychotropic drugs and the long-term impact of the use of these drugs as our children and youth move into adulthood. The panel might also examine strategies to reduce the reliance on psychotropic drugs.
Children and youth entrusted to these facilities and foster homes are often vulnerable because of their life circumstances or disabilities. It is hoped that the Ministry will examine additional rights protection mechanisms to protect their rights and ensure they receive the best care and treatment possible.
Pursuant to the Health Care Consent Act (HCCA), when an individual is found to be incapable of consenting to their own treatment, a substitute decision-maker is appointed. The substitute decision-maker (SDM) for children and youth in residential settings is often a Childrens’ Aid Society (CAS). The HCCA outlines the principles which the SDM must follow when making a treatment decision for an individual who is found incapable of consenting to the treatment. The CAS is an institutional SDM and derives its decision-making authority from legislation. As such, we believe the SDM role of the CAS is akin to the SDM role of the Public Guardian and Trustee (PGT) as established under the HCCA. The treatment consultants at the PGT receive specialized training to prepare them for the role of SDM. We recommend that each CAS have specially trained individuals who act as SDMs for the children and youth in their care.
According to the HCCA, the health practitioner making the finding of incapacity must provide “rights information” to the individual about the consequence of the finding and the options if they disagree with the finding. These individuals are afforded a lower standard of protection than individuals in psychiatric facilities who receive formal rights advice, when they are found to be incapable of consenting to treatment for a mental disorder.
The Psychiatric Patient Advocate Office has been providing formal rights advice, pursuant to the Mental Health Act and its regulations, in the 10 current and former provincial psychiatric facilities since 1986. Since 2001, we have also been designated as “rights adviser” by all but five of the Schedule 1 hospitals in Ontario, in addition to providing rights advice to individuals living in the community and being considered for the issuance or renewal of a community treatment order and their substitute decision-maker, if any. We recommend that the Ministry, as a way of fully protecting the rights of children and youth found incapable of consenting to treatment for a mental disorder, consider requiring formal rights advice before a treatment can begin. We would be pleased to provide you with additional information about this process.
Should you have any questions or wish to arrange a meeting, please contact me at (416) 327-7004.
Sincerely,
original signed by
David Simpson
Director (A)
c.c. Dawn Ogram
Assistant Deputy Minister
Corporate and Direct Services, MOHLTC
Response from the Minister of Children and Youth Services
Letter from Mary Anne Chambers, Minister - February 21, 2007
