Psychiatric Patient Advocate Office Mental Health Trends and Issues - CMHA Sarnia Ryan Fritsch, Legal Counsel March 3, 2011
OVERVIEW OF THE MENTAL HEALTH SYSTEM SPEAKING FOR AN-OTHER • This presentation is an overview of the mental health system as seen through the work of the PPAO • There are a vast array of perspectives on concepts like recovery, empowerment, rights and treatment • There are many different consumer/survivor/ex-user groups, other advocacy organizations, professional bodies, independently managed hospitals, researchers, and governmental actors with different perspectives • Our perspective is as rights advisers and patient advocates having a province-wide mandate • We do not speak for the Ministry of Health; PPAO has arms- length independence, independently retained legal counsel
OVERVIEW OF THE MENTAL HEALTH SYSTEM OUTLINE • Map of the Ontario Mental Health System • Mandate and Activities of the PPAO • Emerging Issues and Trends • Discussion
MAP OF THE ONTARIO MENTAL HEALTH SYSTEM PPAO The Client? DEB MATTHEWS Minister of Health
MANDATE AND ACTIVITIES OF THE PPAO • Established in 1983 as the first province-wide patient advocacy program in Canada • Cluster of patient deaths at CAMH – inquests and reports – cited advocacy as addressing power and communication imbalances and providing a perspective external to the care team • Charter of Rights and Freedoms 1982: s. 7, 9, 10 and 15 - advocacy and rights advice as a check and balance to bring the Mental Health Act into compliance • Independent from the MoHLTC under a MoU (1993) • Province-wide Rights/Advocacy Mandate: • Rights Advice (71/74 Sch 1 hospitals) • Patient Advocacy (10 major MH facilities) • Systemic and Law Reform and Public Education
MANDATE AND ACTIVITIES OF THE PPAO RIGHTS ADVICE • Ensures that patients involuntarily detained under the Mental Health Act, or found incapable of consenting to treatment under the Heath Care Consent Act, understand what has happened to them and what legal options are available • The provision of Rights Advice essentially follows the Charter of Rights and Freedoms 1982 s. 7, 9 and 10: liberty rights accorded the principles of fundamental justice, freedom from arbitrary detention, right to be informed of reasons for detention, given the opportunity to retain and instruct counsel, provided with adequate due process protections • Rights advisers must meet face-to-face with the patient and work only on an instructed basis
MANDATE AND ACTIVITIES OF THE PPAO RIGHTS ADVICE • PPAO provides rights advice over 25,000 times a year • PPAO is rights adviser at 61 of 64 hospitals with a MH ward and the 10 major MH hospitals in Ontario • Rights advisers meet with a patient within 24 hours of receiving notice (“promptly”) • Rights advice was provided in over 44 languages in 2009 • All rights advisers in the province must complete the four day PPAO certification course, recently updated
MANDATE AND ACTIVITIES OF THE PPAO RIGHTS ADVICE Nine rights advice situations arise under the MHA: • involuntary status (Form 3) • involuntary status renewal (Form 4) • involuntary status renewal transfer (4th Form 4) • incapacity to consent to treatment under the Health Care Consent Act (Form 33) • incapacity to manage property (Form 21) • continuing incapacity to manage property (Form 24) • incapacity to consent to the collection, use and disclosure of personal health information under Personal Health Information Protection Act (Form 33) • admission as an informal patient between the ages of 12 and 15 (Form 27) • community treatment orders (Form 49) – patient and SDM
MANDATE AND ACTIVITIES OF THE PPAO RIGHTS ADVICE Rights Advice in Primary Hospitals 2008 • 70% related to involuntary detention • 14% related to treatment incapacity • 10% related to property incapacity
MANDATE AND ACTIVITIES OF THE PPAO RIGHTS ADVICE Community-based rights advice in 2008 • 73% related to involuntary detention • 11% related to treatment incapacity • 9% related to community treatment orders • Fraction of persons between age of 12 and 15 (Form 27)
MANDATE AND ACTIVITIES OF THE PPAO CIVIL MENTAL HEALTH SYSTEM CCB Applications filed by the PPAO (on behalf of client) in 2008
MANDATE AND ACTIVITIES OF THE PPAO PATIENT ADVOCACY • Assists in-patient clients with issues related to quality of life, quality of care, access to justice, treatment, social services and entitlements, hospital policy development, hospital staff education, and the development of systemic issues • 12 full-time Patient Advocates across the province: • 1 at each of Kingston, Brockville, St. Thomas, London, Hamilton, North Bay, Thunder Bay, Whitby • 2 at each of CAMH and Penetanguishene • Assist clients in both the civil and forensic mental health system • Penetanguishene is the only maximum-level secure facility in Ontario • Advocacy services limited to in-patients
MANDATE AND ACTIVITIES OF THE PPAO PATIENT ADVOCACY: PRINCIPLES & BENEFITS • Instruction-based => client control, participation, responsibility, empowerment • Bridge between treatment team and patient • Agent of trust – seen as neutral / safe party • Help overcome communication barriers • Early warning system / patient feedback mechanism (service innovation and risk management) • Reduce pressure on health care team to “do it all” • Activation and actualization of legal rights • Patient Advocacy For Health Care Quality: Strategies For Achieving Patient-Centered Care by Jo Anne L. Earp, Elizabeth A. French and Melissa B. Gilkey (2007)
MANDATE AND ACTIVITIES OF THE PPAO ADVOCACY Advocacy in Primary Hospitals 2008 • 3400 advocacy issues addressed • 50% of issues related to legal and access to justice matters • 50% of clients in the forensic mental health system; 27% involuntarily detained in the civil system; 14% voluntary patients
MANDATE AND ACTIVITIES OF THE PPAO PATIENT ADVOCACY CASE EXAMPLES • Rental housing issues once in care • Behavioural triggers and restraint • Language / Ethnic Origin Discrimination in Care • Personal Health Information Rights under PHIPA • CTO / ACTT terms • NCR / Disposition appeals
MANDATE AND ACTIVITIES OF THE PPAO SYSTEMIC LAW REFORM AND EDUCATION • PPAO engages in a wide variety of law and systemic reform activities informed by the experience of our client and inquiries from the public • PPAO present on many advisory boards: Legal Aid Ontario, Human Services and Justice Coordinating Committee Toronto, CAMH Restraint Committee, Toronto Police Board, CCB Board and Bar Committee • Litigation (coroner’s inquests, human rights tribunal cases, intervener in civil and criminal cases) • Stakeholder engagement: consumer/survivor groups, housing, hospitals, policing, legal services, government • Reports, journal articles, media
MANDATE AND ACTIVITIES OF THE PPAO SYSTEMIC LAW REFORM AND EDUCATION Recent PPAO Achievements: • Inquest into the death of Jeffrey James (2008) and development of model restraint policy at CAMH • Inquest into the death of Ryan Coulter (2009) • Police Record Check Coalition – development of province- wide guideline for disclosure of mental health information in police background checks with Ontario Assoc. of Chiefs of Police (2011) • Cross-border disclosure of mental health information to US Immigration / Dept. of Homeland Security (2011) • “Best Efforts” policy for CTO Rights Advice (Bill 16 MHA amendments) (2010)
MANDATE AND ACTIVITIES OF THE PPAO SYSTEMIC / LAW REFORM WORK AND EDUCATION Other PPAO Systemic Activities 2010/2011: • OHRC Consultation on Mental Health Strategy • Law Commission of Canada Consultation on Disability and the Law • MH Commission of Canada human rights consultation • Hospital Satisfaction Survey and need for province-wide MH Advocacy program • Updating the Rights Adviser Training Course • Upcoming report on experience of clients in the forensic system • Developing human rights test cases • Submissions to the Legislature: • Bill 16 amending the MHA (CTO order for examination, transfer rights, best efforts and PGT rights advice) • Bill 21 introducing the Retirement Homes Act (restraint, rights advice) • Regulations under the LTCHA • Select Committee Report on Mental Health & Addictions • www.ppao.gov.on.ca - viewed 3 million times a year; 45 InfoGuides
OVERVIEW OF THE MENTAL HEALTH SYSTEM CURRENT TRENDS AND EMERGING ISSUES “Where are we headed?”
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