Hon. Deb Matthews
Minister of Health and Long-Term Care
80 Grosvenor Street
Toronto, ON M7A 2C4
January 30, 2012
Dear Minister Matthews,
In August 2011, the Registered Nurses’ Association of Ontario (RNAO) noticed and appreciated your decision to suspend the planned transfer of the Psychiatric Patient Advocate Office (PPAO) to the Canadian Mental Health Association (CMHA), Ontario. We were struck by your wisdom in recognizing that “this change requires greater conversation and consultation” and that your “priority is to make sure we get this right.” This is a perspective that is congruent with ongoing conversations that we been having with clients who access mental health services and their advocates, including mental health nurse. All share a common concern that is critical to strengthen the vital work being done by the PPAO and this continues to be true during this time of perceived instability of the PPAO structure. We are concerned at this time, however, as to our knowledge an expected consultation through the fall 2011 with patients and their advocates has not yet been started.
For more than 28 years the PPAO has functioned as an arms-length body of the Ministry of Health and Long-Term Care (MOHLTC) to meet the advocacy needs of people with mental health issues especially when their lives intersect with the mental health system. Individual advocacy services include support to negotiate with hospital staff as well as rights advice when legal status has been changed when hospitalized or on a community treatment order. The PPAO also advocates around systemic issues by addressing discrimination, power imbalances and societal injustice that further disadvantages people living with mental health issues.
A 2008 Coroner’s Jury investigating the death of Jeffrey James in a psychiatric facility in Toronto included recommendations to the MOHLTC about ways that would strengthen access to 24/7 PPAO rights advice and advocacy in all psychiatric facilities, including schedule 1 facilities in community and general hospitals where psychiatric care is provided. The Coroner’s Jury also identified eight recommendations directed to PPAO that would strengthen this body, including meeting with the MOHLTC to discuss models of governance. The Coalition for an Independent PPAO has noted that community stakeholders would like to see the PPAO strengthen its level of independence to one similar to the Office of the Provincial Advocate for Children and Youth. Another crucial recommendation from the Jeffery James’ inquest was that a Board of Directors be created to include a majority voice from the client/survivor community and advocacy groups such as the Empowerment Council as well as institutions and organizations with expertise acting in the public domain.
RNAO heard quite clearly from clients/survivors and mental health nurses that the province needs to take measures that will strengthen the PPAO in order to protect the human rights of people living with mental health challenges. Branches of CMHA in Ontario provide front-line community mental health services such as case management. Although there is a separation between the regional organization and the branches, there is a perception amongst some community members that there could be potential conflicts of interest that could erode trust in being able to access effective advocacy. Should the PPAO lose its arms-length government status, it will no longer be within the jurisdiction of the Ombudsman of Ontario and thus be in danger of losing consistency in oversight and accountability.
As this file moves forward at the same time as the Ontario Human Rights Commission’s consultation on human rights and mental health, we urge implementation of the Jeffrey James’ inquest recommendations as well as careful consultation with various stakeholders, especially the clients/survivors and their advocates.
With thanks and warmest regards,
Doris Grinspun, RN, MSN, PhD, LLD(hon), O.ONT.
Registered Nurses’ Association of Ontario
Coalition for an Independent PPAO
Mental Health Nursing Interest Group
Ontario Human Rights Commission
Voices from the Street