The Registered Nurses’ Association of Ontario (RNAO) is the professional association for registered nurses who practise in all roles and sectors across Ontario. We work to improve health and strengthen our health-care system. Nurses believe that health is a resource for everyday living and that access to the conditions that permit health, including access to health care, are universal human rights. RNAO welcomes the opportunity to respond to the Ontario Human Rights Commission’s consultation paper on Human Rights and Mental Health Research and Policy.
Canada and Ontario are not Fulfilling Their International Human Rights Obligations
“Poverty steals from your soul, leaving you with little or no hope. It robs you of all that can be good in life. It leaves you isolated, lonely and hungry and that is just the start of it. Every day is a struggle….
Many people are losing faith in human rights…it is the beginning sign of a society that will fall apart. It truly concerns me when people who are living on the edge are no longer concerned about their rights and (about) fighting for them. Parliamentarians should find that equally scary.” Michael Creek, Voices From the Street, 2008
(Michael Creek) was shocked this week when Prime Minister Stephen Harper had more to say about head injuries to millionaire hockey players than the estimated 3.1 million Canadians living in poverty. “Hockey may be our national sport,” Creek said. “But poverty is our national shame.” Michael Creek, Voices From the Street, 2011
The failure of Canada’s federal and provincial governments to meet their human rights responsibilities to ensure that everyone has an adequate standard of living for health and well-being, despite the means to do so, has been thoroughly documented by the Committee on Economic, Social and Cultural Rights and the United Nations’ Human Rights Council’s Special Rapporteur, Miloon Kothari.
There is overwhelming evidence from the World Health Organization’s Commission on the Social Determinants of Health, academic research, government of Canada reports, non-governmental studies, and testimony from the lives of those most impacted by poverty on how social inequities are causing illness, suffering, and early death. Those who are particularly at risk for persistent low-income and the negative health impacts that arise from deprivation include single parents (most frequently mothers); recent immigrants; persons with work-limiting disability; Aboriginal people; women; individuals who do not complete high school; and racialized group members. The need for swift and effective action on poverty, affordable housing, food insecurity, and other social determinants of health by all levels of government has never been so obvious.
Structural changes in human rights protection legislation and public policies that must be made to improve the health of individuals, families, and communities include:
The federal government fulfilling its obligations (including enshrining the human right to adequate housing) under international conventions and treaties by implementing the recommendations of the Committee on Economic, Social and Cultural Rights and other international bodies;
Amending provincial human rights legislation to fully include economic, social, and cultural rights (including the human right to adequate housing);
Providing adequate funding for the Ontario Human Rights Tribunal to enhance enforcement of equality rights through the Ontario Human Rights Code;
All levels of government must work together to ensure capital subsidies to build new affordable housing stock or renovate existing housing stock that is substandard; rent supplements to ensure affordable housing for low and moderate income households; and supportive community-based housing and services for those with physical, cognitive and/or mental health needs.
Increase the minimum wage until it becomes an actual living wage and enforce the Employment Standards Act to improve protection of vulnerable workers.
Transform Ontario’s social assistance system from a punitive, incoherent tangle of contradictory rules and regulations to a person and family-centred system that treats clients and staff with dignity. Social assistance rates must be raised significantly to reflect the actual cost of living. Introduce a $100 per month Healthy Food Supplement as a down-payment to addressing the serious gap between dangerously low social assistance rates and nutritional requirements.
Canada and Ontario Need an Evidence-Informed, Comprehensive Public Health Rather than Criminal Justice Approach to Mental Health and Addictions
The ritual is never-ending. Offenders who are often disorientated and babbling are disgorged at prison gates, leaving harried staff to gauge how dangerous they are and place them where they are least likely to run afoul of tougher inmates or try to take their own lives….Behind bars, effective treatment is rarely more than a promise while reality is a severe shortage of psychiatric professionals…After clogging cell blocks for months or years, untreated prisoners often are released only to get into trouble all over again….
…. “The developmentally delayed are the forgotten population,” Ms. Gauthier says.’…It is like putting four-year-olds in custody. They cry all day for their mommies. Social workers give them colouring books and crayons.
She recalls an inmate who arrived clinging desperately to a Beanie Baby, which prison rules didn’t allow in his cell. “He had never been separated from it. He finally let us take a picture of it so he could hold that.”
How did Canada’s prison system turn into a holding tank for mentally deranged individuals? Kirk Makin, Globe and Mail, January 21, 2011
Despite report after report documenting the need for mental health system reform in Canada and Ontario, “entirely preventable deaths” continue to occur such as that of 19 year-old, Ashley Smith, who died in custody. Howard Sapers, the Correctional Investigator for Canada’s federal prisons who chronicled how the system failed Smith, said “simply and sadly put, if not for the glaring void of mental health services for children, youth and offenders in Canada, Ashley would likely have never been sent to a federal prison where she ended her life.”
In the Canadian context where crime rates (including violent crime) have been declining for the last thirty years, it is irresponsible to promote an expensive “tough-on-crime” federal political agenda that has proven to be counterproductive. On the provincial level, RNAO has expressed disappointment in a plan to replace four old jails with a capacity for 400 inmates with two mega-jails that will accommodate 2,000 inmates built through an expensive public-private partnership. Instead of building mega-jails that will inappropriately hold and not treat a disproportionate amount of people with mental health, addictions, and developmental challenges, our governments must invest in actual affordable housing and other social determinants of health as well as transform the ad-hoc collection of services that currently comprise our “mental health and addiction system.”
RNAO urges the provincial government to develop a systematic and seamless mental health care system for all Ontarians, with sensitivity to cultural norms, delivered at the individual’s preferred location, with special consideration for disadvantaged individuals such as those living in Aboriginal communities, older adults and elders tackling new and ongoing mental health and addiction challenges, people from racialized communities, people with disabilities, and children and youth. A robust continuum of mental health and addiction services would be facilitated by strengthening access to high-quality and universally-available primary care services. In a context where Canada’s only supervised injection site, Insite in Vancouver, is defending its existence at the Supreme Court of Canada, it is critical that evidence-based models of outreach such as harm reduction be contingent on public health science rather than political agendas.
Given the importance of the nexus between mental health and homelessness and the federal government’s refusal to implement any of the Standing Senate Committee on Social Affairs, Science and Technology’s 74 recommendations on poverty, housing, and homelessness, there is an urgent need for the province and municipalities to address points of disconnection in public policies related to housing, income support, and mental health. It is clearly unacceptable, for example, that in London, Ontario in 2002 there were at least 194 instances when people were discharged from psychiatric facilities to the street or shelters. There is an urgent need to support innovative programs that prevent prolonged homelessness and re-hospitalization by preventing people from being discharged to the street from psychiatric facilities. Cheryl Forchuk and her colleagues in London studied individuals who had no prior history of homelessness who were being discharged. The intervention group received immediate assistance in accessing housing and in paying first and last month’s rent while the control group received the usual care. All seven people who received the intervention maintained their housing after 6 months but six out of the seven people who received the usual care were still homeless after 6 months. The seventh person avoided homelessness by joining the sex trade.
What is the Tornado?
Is the tornado the experience of mental illness or the experience of society’s response to mental illness? The participants’ descriptions would suggest the latter. The loss and destruction experienced were not linked to the experience of symptoms, such as depression or hallucinations. Rather, the loss and destruction were related to the loss of home, possessions, relationships, and human dignity. Forchuk, Ward-Griffin, Csiernik, & Turner, Surviving the Tornado of Mental Illness: Psychiatric Survivors’ Experiences of Getting, Losing, and Keeping Housing.
While the tornado that whisked Dorothy and Toto to Oz can be traced to unstable weather and the active imagination of L. Frank Baum, the tornadoes experienced by people living with mental health challenges are often set in motion by stigma and discrimination endemic to our society. Our failure to safeguard the basic human rights of all people, especially those with multiple kinds of vulnerabilities, is perhaps the most fundamental challenge that we must address together.
In addition to working collaboratively on the systemic challenges previously identified, we would be delighted to work with the Ontario Human Rights Commission in educating the public for transformational change. One specific example of a disturbing problem is the cultural assumption that it is somehow acceptable to use stereotypes and derogatory images of people living with mental health challenges for entertainment purposes. Voices From the Street, the Mental Health Nursing Interest Group, and the Registered Nurses’ Association of Ontario joined together in the fall of 2010 to register our concerns about the Power House of Terror Charity Haunt held at a municipal Toronto recreational centre. Held at the site of the former Lakeshore Psychiatric Facility, enormous harm was done by portraying people living with mental illness as violent, fearsome, and loathsome. The outcome of our advocacy to date has not been an unqualified success and so we would welcome an opportunity to discuss strategies on how to prevent this form of “entertainment” that is being periodically organized by both for-profit and charitable enterprises.
RNAO’s comprehensive set of policy recommendations on improving access to mental health and addiction services, enhancing medicare, improving access to nursing services, and improving health equity by addressing the social and environmental determinants of health are available in Creating Vibrant Communities: RNAO’s Challenge to Ontario’s Political Parties 2011 Provincial Election.
Fact sheets for the public as well as clinical and organizational resources pertinent to mental health and wellness are available to be downloaded without charge from the RNAO website (www.rnao.ca ) including:
Best Practice Guideline Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour
Best Practice Guideline Caregiving Strategies for Older Adults with Delirium, Dementia and Depression
Best Practice Guideline Client Centred Care
Best Practice Guideline Crisis Intervention
Best Practice Guideline Embracing Cultural Diversity in Health Care: Developing Cultural Competency
Best Practice Guideline Enhancing Healthy Adolescent Development
Best Practice Guideline Integrating Smoking Cessation into Daily Nursing Practice
Best Practice Guideline Establishing Therapeutic Relationships
Best Practice Guideline Interventions for Postpartum Depression
Best Practice Guideline Preventing and Managing Violence in the Workplace
Best Practice Guideline Screening for Delirium, Dementia and Depression in Older Adults
Best Practice Guideline Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients
Best Practice Guideline Supporting and Strengthening Families Through Expected and Unexpected Life Events
Best Practice Guideline Supporting Clients on Methadone Maintenance Treatment
Best Practice Guideline Woman Abuse: Screening, Identification and Initial Response
Position Statement: Respecting Sexual Orientation and Gender Identity
Thank you for the outstanding leadership demonstrated by the Ontario Human Rights Commission in generating opportunities for Ontarians to think about and talk together about human rights and mental health so that we can work together to build a more inclusive and healthier province.