Brian's Law (Mental
Health Legislative Reform), 2000, Bill 68, Mrs
Witmer /Loi Brian de 2000 sur la réforme
législative concernant la santé mentale,
projet de loi 68, Mme Witmer
Psychiatric Survivors
of Ottawa
Ms Sonja Cronkhite
Dr Julio
Arboleda-Flórez
Eastern Regional
Network
Ms Lisa Leveque
Mr Gary Holmes
Royal Ottawa Health
Care Group
Mr George Langill
Dr Marv Lange
Ms Sheila
Deighton
Schizophrenia Society
of Ontario, Ottawa-Carleton chapter
Mr Leonard Wall
Mr Ian Chovil
Michael and Maureen
Cassidy
Canadian Mental
Health Association, Ottawa-Carleton branch
Mr Dwane Unruh
Ms Marnie Smith
Ottawa-Eastern
Ontario Residential Care Association
Mr Jean-Guy Nadeau
Ms Christine
Renaud
Miss Karen
Wilson
Canadian Advocates
for Psychiatrized People
Ms Sue Clark
Ms Alana
Kainz
STANDING COMMITTEE ON
GENERAL GOVERNMENT
Chair /
Président
Mr Steve Gilchrist (Scarborough East / -Est PC)
Vice-Chair / Vice-Présidente
Mrs Julia Munro (York North / -Nord PC)
Mr Toby Barrett (Norfolk PC)
Mrs Marie Bountrogianni (Hamilton Mountain L)
Mr Ted Chudleigh (Halton PC)
Mr Garfield Dunlop (Simcoe North / -Nord PC)
Mr Steve Gilchrist (Scarborough East / -Est PC)
Mr Dave Levac (Brant L)
Mr Rosario Marchese (Trinity-Spadina ND)
Mrs Julia Munro (York North / -Nord PC)
Substitutions / Membres remplaçants
Mr Brad Clark (Stoney Creek PC)
Mrs Lyn McLeod (Thunder Bay-Atikokan L)
Mr Richard Patten (Ottawa Centre / -Centre L)
Also taking part / Autres participants et
participantes
Mrs Claudette Boyer (Ottawa-Vanier L)
Clerk pro tem / Greffier par intérim
Mr Tom Prins
Staff /Personnel
Ms Lorraine Luski, research officer,
Research and Information Services
The committee met at 1100 in the Delta Hotel,
Ottawa.
BRIAN'S LAW (MENTAL HEALTH LEGISLATIVE REFORM), 2000
/ LOI BRIAN DE 2000 SUR LA RÉFORME LÉGISLATIVE
CONCERNANT LA SANTÉ MENTALE
Consideration of Bill 68, An
Act, in memory of Brian Smith, to amend the Mental Health Act and
the Health Care Consent Act, 1996 / Projet de loi 68, Loi à
la mémoire de Brian Smith modifiant la Loi sur la santé
mentale et la Loi de 1996 sur le consentement aux soins de
santé.
The Chair (Mr Steve
Gilchrist): Good morning. I'd like to call the hearings
to order this morning. We are here, of course, to hold our sixth
session on the hearings into Bill 68, An Act, in memory of Brian
Smith, to amend the Mental Health Act and the Health Care Consent
Act, 1996.
PSYCHIATRIC SURVIVORS OF OTTAWA
The Chair:
We have deputations this morning and this afternoon. Our first
group is the Psychiatric Survivors of Ottawa. I wonder if the
representatives could come forward to the witness table. Good
morning. Welcome to the committee. We have 20 minutes for your
presentation, and it's up to you to divide that between either a
presentation or a question-and-answer period for the members of
the committee.
Ms Sonja
Cronkhite: Good morning. My name is Sonja Cronkhite. I
am the community and advocacy coordinator for the Psychiatric
Survivors of Ottawa. We are a group consisting of people who have
had significant personal experience of the mental health system.
Many of our members are very concerned by this bill, as it
affects them very directly. I've been given direction to voice
their concerns.
There's often a misconception
about Psychiatric Survivors of Ottawa, that we're some monolith
of malcontents. I would like to say that we have a membership of
around 200 people, and they are varied in their thoughts on the
mental health system. We have everyone from people who are
anti-psychiatry to people who have been referred to us by their
psychiatrists and were very happy with their relationships. I
just want to say they come from a wide range of people.
This bill is touted as being
about providing treatment to the seriously mentally ill. I
question this. There is no improved access to services mentioned
in this bill. There are no increases to community supports
mentioned. Where is this treatment that people are expected to
receive? We see involuntary hospitalization as an option in this
bill, but not a very pretty one, and not a very realistic one, as
anyone who has actually tried to seek institutional care can tell
you. The beds and staff do not exist, and they may not always be
the most appropriate course.
Also within this bill, I see
that people under CTOs are expected to "receive continuing
treatment or care and continuing supervision while in the
community" and there seems to be an assumption that this capacity
exists in Ontario. I can tell you this: There's a very long wait
for community supports. People would love to have access to
community supports, and it wouldn't take a community treatment
order to get them there. People want and need to be supported,
but I don't see support anywhere in this document.
In fact, it seems likely that
people will feel the loss of some of their current supports.
Community treatment orders will undo a lot of trust that has been
built up over the years between patients and their caregivers, be
they ACT team members, case managers, social workers. Trust is a
very large issue for people who feel vulnerable. If people are
convinced to try something by someone they trust and do it
because they want to feel better, then they are far more likely
to stick with it. You can't trust and confide in people who are
obliged to turn you in, or medicate you, or send you to the
hospital. Community support workers will no longer be supportive.
Their role will become to be informers and enforcers. In effect,
they will become parole officers. Hence, people engaged in these
relationships will no longer be receiving any support in the true
sense of the word.
Another pitfall I'm hearing
about is that people who need help are going to avoid seeking
care altogether. I've heard this again and again from our
members. When faced with a system in which they may have no say
over their own care, they choose to take their chances on their
own. This situation would be unspeakably sad, not to mention
unnecessary.
Perhaps the greatest concern
and most fundamental flaw in this is that it is not about support
or care at all; it is about
treatment-forced treatment. Knowing the traditional mental health
system as well as I do, I can imagine that treatment translates
directly to medication.
It is not true that if people
just took their medications, all would be well. Pills will not
cure poverty, dysfunctional families, homelessness or loneliness.
At best, they should only be one part of a treatment plan; at
worst, they can be devastating. People are not merely being
non-compliant. There are some very rational reasons for not
taking medication. These are: They can have extreme and often
permanent side effects; they are very expensive; they can affect
your ability to work; the side effects can make you appear
strange or frightening to others; they can affect your personal
relationships; and they simply may not work, they may not make
you feel any better at all.
The individual needs to
decide what is a reasonable trade-off. To take medications or not
is a very personal decision.
I understand that people are
concerned about the perceived potential for violence, but you're
looking at the wrong people. As I'm sure you've heard before,
study after study has proven that people diagnosed with a mental
illness are no more likely to commit violent crime than anyone
else. In fact, I have footnotes on some of these studies in the
brief I've submitted.
Much ado has been made about
the fact that this bill is mainly aimed at those individuals with
a diagnosis of schizophrenia. Yet, according to the MacArthur
study: "people labeled schizophrenic are no more violent than
others. Rates of violence do not change according to
diagnosis."
Yes, there are times when a
person suffering from a mental illness is a genuine risk, but
current mental health legislation allows action to be taken when
he or she clearly demonstrates behaviour which endangers life and
limb.
Vulnerable, law-abiding
individuals need not be penalized along with the very few but
well-publicized offenders. It makes no sense to threaten an
entire group of people-one in five Canadians, according to the
Clarke Institute of Psychiatry-with losing their liberty and
freedom of choice when they have not committed a crime and are
not at a higher risk for committing one.
To sum up, we feel this bill
is unnecessary for a number of reasons: First, the present
problems could be addressed by easier access to community
supports; for example, safe houses, crisis response, supportive
housing, case workers and assertive community treatment
teams.
Also, the current Mental
Health Act, Substitute Decisions Act and Health Care Consent Act
adequately cover the concerns. In fact, there is a provision in
the Mental Health Act that provides for a kind of community
treatment order. At the moment they are not working, because
physicians do not know how to correctly use them and there are
not enough resources in place for the community even if they
did.
Furthermore, Psychiatric
Survivors of Ottawa objects to the confinement or forced
treatment of citizens who have committed no crime and pose no
identified risk to themselves or others. It is not a crime to
refuse treatment, to be poor, to be homeless, to be different, to
act strangely, to be sick. What we are asking is to keep our
civil rights intact.
With that in mind, we have
made three recommendations: Do not enact Bill 68; develop
accessible, appropriate and timely community supports for persons
in the mental health system and their families; we need education
for physicians on the correct usage of the current Mental Health
Act, Substitute Decisions Act and Health Care Consent Act.
Thank you very much for your
time.
1110
The Chair:
Thank you. That leaves us about three minutes per caucus for
questioning. We'll start the rotation with the Liberals.
Mrs Lyn McLeod
(Thunder Bay-Atikokan): One of the very clearly stated
criteria for a community treatment order is that the physician
issuing the order has to be satisfied that community supports or
treatment are available. Given the fact that I agree with your
concern about the lack of community supports and full
comprehensive treatment options being in the community right
now-I think that's a major concern we would all have-if the
community treatment orders could only be issued if there's
satisfaction that the community supports are there, do you think
this bill could actually be a way of identifying the gaps that
are in the system in the sense of, if a review is built in and
the community treatment orders aren't being issued, and the
reason they aren't being issued is because the community supports
and treatments are not available, it's a way of identifying the
fact that we have not really made very much progress in the
community in that regard?
Ms
Cronkhite: I don't think we actually need a community
treatment order to recognize the fact they're not there. I think
you've probably heard that at every stop you've made. I don't
think we need to pump a lot of money into a bill to find that out
yet again. That's known. That's not a secret. There are gaps, and
every service provider can tell you that.
Mrs McLeod:
You mentioned threatening an entire group of people. One of the
things we've heard at committee regularly is that community
treatment orders would only benefit a very small, very narrowly
defined group of people. Do you believe there is a small group of
people who could benefit from this and that one of the problems
is that this group is not narrowly enough defined in this
bill?
Ms
Cronkhite: Again, I don't see this bill as being
necessary to define that small group of people. There are already
provisions-I think the leave of absence agreement in the Mental
Health Act. Michael Bay has gone around the province-
Interjection.
Ms
Cronkhite: According to Michael Bay, you can. He has
been sent around by the province of Ontario talking about
this.
Mr Richard Patten (Ottawa Centre):
His board overturned it when they tried to use it for that.
Anyway, sorry.
Ms
Cronkhite: Anyway, he has gone on record as stating that
if properly used, it can work, it can do this job. This system is
not going to work for these people. Just having them in the
community, having them perhaps receiving medication, some people,
if they are violent, medication will not make them less violent.
I think we have to look at that. This may not be strong enough
for some people, and it's too strong for the majority. Some
people, even with community treatment orders, will still be
dangerous. We need something to deal with those people, and this
isn't it.
Mr Rosario Marchese
(Trinity-Spadina): Thank you, Sonja. As I understand it,
no community treatment order can be issued unless the person
agrees or the substitute decision-maker agrees. Doesn't that
cover, to some extent, the concern?
Ms
Cronkhite: No.
Mr Marchese:
All right, explain.
Ms
Cronkhite: When your choices are involuntary
hospitalization or signing a community treatment order, you're
really choosing the lesser of two evils. Most people would not
consider that voluntary. If they said, "We can kill your wife or
your child," that's not voluntary. You're choosing the lesser of
two options. I know that's far more extreme, but it's not really
voluntary when the power imbalance is so great and you're talking
about your liberty.
Mr Marchese:
You're opposed to community treatment orders altogether?
Ms
Cronkhite: Yes.
Mr Marchese:
You're saying what we need are supports?
Ms
Cronkhite: Yes.
Mr Marchese:
What some people are saying is, if you're going to pass this bill
that has this as one of its features, then you've got to have the
supports in place. If this were to go through-I know you're
saying you disagree with it, but what you're saying is, the
supports are not there. They are not there at the moment, and you
probably have no faith that they will be there in the future. Is
that-
Ms
Cronkhite: This is true. I've been part of the district
health council in the past in Ottawa-Carleton. I've also been
part of the regional coordinating committee for mental health for
the eastern region. We've seen promise after promise that as they
cut beds, we would have services back in the communities. Well,
the beds are cut and we haven't seen the services through
reallocation. No, I think anyone who has spent much time working
with mental health has no faith that we really will get our
community supports.
Mr Marchese:
I was reading an opinion by Dr Turner, who says the way that this
is being redefined will capture so many more people who would
require hospitalization. We already have a problem in terms of
being able to put people into hospitals. There are just no beds.
Is that part of the concern you were raising earlier on as
well?
Ms
Cronkhite: We have members who try to get into hospital
who are feeling intense emotional pain; they're afraid. Maybe
they're hearing voices; they don't like what they are saying.
They go to the hospital and there's no place for them. Perhaps
the hospital isn't the best place for them. Maybe they don't need
medical supports, but there is no place for them. They can't go
to the hospital. They don't have any place else to go. That's a
great problem.
Mr Marchese:
But you're saying some people do need help or treatment.
Ms
Cronkhite: Some people will say that. They will come to
you and say, "We need help, but we can't find it."
Mr Marchese:
OK. You're saying some of the help may not be in a hospital
necessarily. It could be in the community, but the services are
not there.
Ms
Cronkhite: They're not there to meet the need, no.
Mr Brad Clark (Stoney
Creek): You're opposed to community treatment
orders?
Ms
Cronkhite: Yes.
Mr Clark:
You support the Mental Health Act as it is currently written?
Ms
Cronkhite: Yes.
Mr Clark:
Can I ask you a question, then? The leave of absence in the
current Mental Health Act states:
"(1) The officer in charge
may, upon the advice of the attending physician, place a patient
on leave of absence from the psychiatric facility for a
designated period of not more than three months, if the intention
is the patient shall return thereto.
"(2) The leave of absence may
be permitted upon such terms and conditions as the officer in
charge may prescribe."
The leave of absence has been
described to us by many people as the precursor to community
treatment orders, that it is in fact a community treatment order
and that it is a step down from a psychiatric facility to the
community. You're opposed to community treatment orders, but you
support the current Mental Health Act, which in fact has
community treatment orders in it, assigned as leaves of absence.
How can that be?
Ms
Cronkhite: That can be because in this law how someone
gets in the hospital is much wider. The latitude is much wider
for people ending up in that position in the first place. There
are some people for whom, if there were those benefits and the
doctor saw that these people, after being in the hospital,
perhaps could step into the community if there were the
supports-for a very few people perhaps, but this has such
latitude in how people-
Mr Clark:
Are you opposed to the criteria or are you opposed to community
treatment orders? You just talked about criteria.
Ms
Cronkhite: I am opposed to the criteria, and I'm also
opposed to the number of people who could be put into community treatment orders. I
also don't think it's the best way to go.
Mr Clark:
But you understand that the community treatment order is in
essence a leave of absence agreement, which is currently in the
act.
Ms
Cronkhite: But much wider, with much larger
implications.
Mr Clark:
You can address the criteria, but do you support the community
treatment order? You support the act with the leave of absence
agreement. Do you support community treatment orders with narrow
criteria?
Ms
Cronkhite: With narrow criteria. I do not support the
act as it stands, the Brian's Law act as it stands.
Mr Clark: If
the criteria were narrowed, would you be supporting community
treatment orders?
Ms
Cronkhite: If very, very narrow, but I-
Mr Clark: So
a narrow group of people?
Ms
Cronkhite: You're talking about two different laws. We
would have to change so much in this law that it would not be the
law that it is now. I'm speaking for myself now. There are also
other opinions from my group.
Mr Clark:
You can understand the confusion it causes for me when I look at
a leave of absence agreement, which in essence is a precursor. It
was a catalyst. It's something that spawned community treatment
orders.
Ms
Cronkhite: Yes. You will find other people in my
organization who would not agree with them under any
circumstances. I'm not happy about the leave of absence
personally. I understand it is something that is in there that
can be used in a similar way. What I'm saying is, we don't need
this law because that is there.
The Chair:
Thank you, Ms Cronkhite. We appreciate your coming before the
committee this morning and bringing your perspective. We
appreciate that very much.
1120
JULIO ARBOLEDA-FLÓREZ
The Chair:
Our next presenter, Dr Julio Arboleda-Flórez, if you could
join us at the table here, please. Good morning. Welcome to the
committee. We have 30 minutes for your presentation. Again, you
can divide that between an actual presentation or a
question-and-answer period as you see fit.
Dr Julio
Arboleda-Flórez: Thank you for the opportunity to
present my opinions regarding this issue to you. I plan to use
about 15 minutes presenting these matters, and then I'll have the
rest of the time for questions from the group.
You have in front of you, I
believe, a document called Community Treatment Orders that I have
just passed around.
The Chair:
It's coming.
Dr
Arboleda-Flórez: Now you owe me one minute.
The Chair:
We sound like parliamentarians.
Dr
Arboleda-Flórez: I tried to figure out what are the
issues in regard to community treatment orders. Several arguments
have been advanced against them. Some of the arguments come from
philosophical attitudes against a particular piece of legislation
or way of providing services; others are advanced about the lack
of services or lack of treatment otherwise; and others are
advanced simply on some kind of rhetoric against any kind of
medical interventions, whether they are medications or whether
they are talking therapies or whatever. As long as it is provided
by a medical doctor or nurse or somebody related to a hospital
situation, then that is considered bad in itself.
The question is, what is
the rhetoric and what are the issues?
Community treatment orders,
we try to say, are for only those who are severely and
persistently mentally ill. Those are the ones who really are the
concern of the mental health system, because those are the ones
who most often end up non-compliant to treatment; who usually end
up having problems with substance abuse; who, when they become
acutely psychotic, seriously mentally disturbed, have difficulty
recognizing their own symptoms; and who also have difficulties
establishing alliances with hospital staff and their relatives,
who sometimes, completely fed up with the situation, also become
uncooperative in helping them and in helping the staff.
What are the effects of
non-compliance? The effects include poor community adjustments;
these individuals simply do not fit well in the community. They
are the ones who usually end up in problems with homelessness,
and homelessness carries a tremendous import on the issue of
victimization. About 20% of individuals who are homeless and
severely mentally ill get exposed to major attacks, about eight
times higher than other persons who are not sociatively
disturbed. There is an increase in rehospitalization. There is an
increase-in one article a 100% increase-in standardized mortality
rates for suicide. There is an increase in criminalization and
recriminalization, and there is an increase in violence.
The point has been made:
Who are they who are so violent? We consider that, of those
persons who are violent, only about 6% are the ones who cause
most of the trouble. About 6% of those individuals who cause
violence in mental institutions belong to this particular group
and are responsible for 50% of all the attacks and 50% of all the
serious attacks. The point has been made that mental illness does
not cause violence. If you push the line as to what is the cause,
then that statement is semi-correct. The fact is that there is
not enough scientific evidence yet to prove that one causes the
other. That does not mean that one is not associated with the
other.
We know an association says
25% of these types of patients present fear-inducing behaviour
during the previous two weeks before admission in the community.
Some 32% of these patients present such behaviour at emergency,
and 13% of them attack personnel at emergency. About 20% of
admissions to acute psychiatric units have committed violent
assaults in the previous two weeks before admission; 60% attack
relatives.
We know very well, and
stories are clear on this, that threat/control override
symptoms-those are delusions, hallucinations-dementia cases and problems with
acute manic behaviour are the most common symptoms at attack
time. We also know that current and former patients more likely
engage in hitting, fighting and the use of arms in the community
than normal controls. These are the studies done out there on the
street.
There is an association, or
co-morbidity, with substance abuse. Obviously, individuals who
have used substances and are not mentally ill are more violent
than those who are normal and are not using substances. But those
who are normal and use substances have less violence than those
who are mentally ill, especially those suffering major illnesses,
and who abuse substances as well. We already know that lack of
compliance increases that they will substance-abuse.
Previous criminality and
previous violence are predictive factors for future criminality
and violence.
There are plenty of
histories to indicate that prisoners are at a higher risk of
suffering from mental illness, even prisoners immediately taken
or examined 24 hours from being taken from the street or being
detained. The stories are there. In the stories by Bland, 92%
have a life prevalence of a mental condition; in the stories by
Arboleda-Flórez, about 50% of women and 56% of men had a
previous month prevalence of mental problems.
About 31% of evaluees in
forensic care and forensic situations have reoffended violently,
especially if they have a combination of anti-social personality
disorder and abuse of substances. Among serving prisoners, we
also know that 17% of criminals with a history of mental illness
commit violent acts, compared to 13% of the others. We also know
that 5% of those prisoners who have a problem with mental illness
commit unmotivated violent acts, compared to only 1.2% of those
who do not have that history.
Some 23% of federal
prisoners have had a diagnosis of mental illness. Among
ex-prisoners, those with a history of criminality and mental
illness have a higher history of re-offending.
In the community, over 50%
of people diagnosed as having had a mental illness had been
violent, compared to only 19% of those without such a history;
54.5% versus 15.4% in another study of a similar type.
On a birth cohort, in
Sweden, among those with mental conditions, men were at risk
4.16%, and women 27.45%, of having been in prison because of
violent behaviour.
There are conclusions in
that regard with that kind of literature: The prevalence of
mental illness, particularly problems with substance abuse
disorders, among incarcerated populations is extremely high;
ex-mental patients are at a high risk of arrest and violence when
released into the community, particularly if they have a history
of prior arrests or violence or if they are untreated and
experiencing psychotic symptoms; hospitalized mental patients are
at a high risk of committing violence, including in the
psychiatric institutions; and family members, not the general
public, are the ones who are exposed to the violence.
There are problems with the
controls on the CTOs, community treatment orders. First, there is
the issue of the threat to civil liberties versus the little
positive treatment to be done for casualties of
deinstitutionalization. Those individuals we are talking about
fall off the deinstitutionalization possibilities, not because
there are not enough services in the community, but many times
because their condition does not allow them to access the
services, even when they exist. The services are there; the
person who is acutely mentally ill, seriously disturbed, doesn't
go for the services.
So there are concerns, of
course: on civil liberties, on the liabilities on the clinicians,
on the fiscal burden on the state, on the lack of information
that the state provides citizens, and on the failure to enforce
the consequences of non-compliance. Those are the concerns.
For that purpose, there are
guarantees. We have eligibility restrictions. It's a small group;
there are restrictions; we know exactly who they could be. There
are limitations on the therapeutic interventions. We are not
saying in the treatment orders that everybody gets whatever is
there; there are limitations on the physicians and on the
treatment teams. Those limitations do not indicate only
medications; it's a whole range of approaches. Of course, there
are procedural considerations and guarantees to protect the
rights of the patients.
What is the case against
community treatment orders? Some people say it's another failed
attempt at benevolent coercion, because we have experience in our
society of previous attempts at benevolent coercion that have
failed in the past. Some say there is too much state intrusion.
Some say this is a rebirth of a need-for-treatment standard. But
this is American literature. In Canadian legislation we do have
need-for-treatment standards and they work well. There are
problems with quality control, of course. There is the issue of
no right to refuse treatment and there are other problems of
undermining the therapeutic relationship. Those are the problems
that those organizing and those applying community treatment
orders will have to be concerned about.
1130
What is the case for? What
is liberty if it is a negative liberty? Is liberty to be there on
the street being victimized, being raped, being mugged,
suffering, being recriminalized? That is not liberty. It is a
negative way of liberty. We think liberty should be a positive
way of having your mind clear to make decisions.
There is the case for more
broadly based treatment. The community treatment order opens the
door to better treatments, more appropriate treatments and
imposes an obligation on the state. It also helps in overcoming
the rehabilitative inertia, because there are no mechanisms.
Clinicians simply do not act.
It would prevent the
re-emergence of asylums. We already hear many individuals asking
for reinstitutionalization, and it is a middle ground between
community reinsertion philosophy and reinstitutionalization.
Now, what are the results?
There was a major study or a major paper in which Maloy compiled
11 studies of histories
up to 1992. A review of 11 histories to 1990 provides almost no
valid empirical evidence in support of the effectiveness of
IOC-that's involuntary outpatient commitment, the terminology in
the USA-vis-à-vis treatment compliance, success in the
community for people with severe and persistent mental illness or
amelioration of the problems associated with revolving-door
patients.
There is another study that
ended up saying it doesn't work, and I don't quote it here
because it came to me too late. In contrast, we have other
studies which I'll mention in a second. The study by Bursten
found no differences in readmission rates between patients
ordered to mandatory treatment after involuntary hospitalization
and patients in a control group. He concluded that mandatory
outpatient treatment had no effect on recidivism. But this
conclusion may be qualified by the strong evidence indicated in
his own group, that the outpatient commitment laws were not
enforced in the cases that he had in his group.
So those are the two major
studies. One was not a study; it was a recapitulation of the
literature up to 1990, and this person says "almost" because some
of the studies he reviewed were positive. And there is a study
that says it didn't work, the study of Bursten.
Then there is the positive
side. Hiday and Scheid-Cook, in 1989: Patients who were committed
to outpatient treatment were significantly more likely than
patients with two other dispositions, other types of systems, to
utilize after-care services and to continue in treatment even
after the order had elapsed.
Fernandez and Nygard, in
1990: State hospital admissions and days in hospital during a
three-year period experienced statistically significant
decreases. The biggest per cent reduction occurred in admission
rates.
Geller, in 1992: Two
periods of coerced community treatment, of eight months in the
first period and all together two to four years duration,
produced positive results quite distinct from the periods of
uncoerced community treatment.
Swartz, in 1995:
Involuntary outpatient commitment appears to provide limited but
improved outcomes in rates of rehospitalization and lengths of
hospital stays.
Borum, in 1997: More than
80% of respondents-those are people who have been the subject of
a community treatment order-perceived that the court order for
outpatient commitment required them to keep their appointments
and to take medication as prescribed and helped in keeping them
out of hospital. There was a satisfaction rate of almost 80%.
The last study that just
appeared in December 1999 by Swartz and collaborators: Outpatient
commitment can work to reduce hospital readmissions, 57% lower,
and total hospital days, 10 days fewer per person when orders are
sustained and combined with intensive treatment, particularly for
individuals with psychotic disorders, the ones who would benefit
most from this. There were were 72% fewer readmissions and 28%
fewer days of hospitalization.
In my opinion, there are
enough studies to say this works and it works well.
The Chair:
Thank you, Doctor. Just before I go to questions-I don't normally
do this, but five lines up on the last page of your presentation,
it reads 20 but you read into the record 10 fewer days. Was that
an intentional change?
Dr
Arboleda-Flórez: Which page was that?
The Chair:
The very last page.
Dr
Arboleda-Flórez: It says "work to reduce hospital
readmissions and total hospital days, 20"-it's 20 fewer.
The Chair:
OK, so it should be 20. You read into the record 10.
Dr
Arboleda-Flórez: Oh, I'm sorry.
The Chair:
That's fine, I just wanted to make sure we had an accurate
picture.
Dr
Arboleda-Flórez: It's 20 days fewer, and for those
acutely psychotic it's 28.
The Chair:
Thank you very much. You've left us 15 minutes, so five minutes
per caucus. This time the rotation will start with Mr
Marchese.
Mr
Marchese: Thank you, Dr Flórez. We appreciate the
analysis, pros and cons. You mention that it's not a problem of
accessing services; the services are there. You don't see a
deficiency then?
Dr
Arboleda-Flórez: The services are there-
Mr
Marchese: Sorry. The point you made was that it's their
own condition that prevents them from seeking the service rather
than the problem being that the service is not there.
Dr
Arboleda-Flórez: I say that even in those districts
where the services are available, if a person is seriously
mentally ill, the mental illness by itself prevents them from
accessing the services, even when they are available.
Mr
Marchese: "The services are there," is what you
basically said, whereas the previous speaker said that the
services are not there in terms of the supports the people
need.
Dr
Arboleda-Flórez: I speak from my area. I don't
think that we are so severely underserviced in southeastern
Ontario, the Kingston area. I don't say that everything is
perfect, but the services are there. The problem is access when
the person is so seriously mentally ill.
Mr
Marchese: Under "Community Treatment Orders," where you
make a case for, under 2 you say that with this act there will be
more broadly based treatment. What is that again?
Dr
Arboleda-Flórez: It means that the treatment order
obliges the physician to enter into negotiations with the
treatment team, not to simply say, "Here is the prescription for
the medication," but to have a complete treatment team that
covers many other alternatives to treatment than just simply
medications.
Mr
Marchese: Which is not the case at the moment.
Dr
Arboleda-Flórez: Which is not the case. Many times
the physician or the psychiatrist simply goes ahead and
prescribes.
Mr
Marchese: In terms of the community treatment orders,
there was a point in Saskatchewan, according to the Centre for
Addiction and Mental Health's document Community Treatment Orders: Overview and
Recommendations-this is what they say about that:
"Much can be learned from
the Saskatchewan approach to introducing CTOs and their framing
of their legislation. The province saw the need for a broad-based
consultation process and took two years to complete.... It also
assumed that the infrastructure of a comprehensive mental health
system needed to be in place before any changes to the Mental
Health Act were made. Thirdly, the legislation included strict
criteria for issuing a CTO so as to limit the application to the
very small number of people for whom it might be beneficial."
That's a concern they
raised. Does that apply to this bill?
Dr
Arboleda-Flórez: It applies to this bill. First of
all, we have to make sure that the services are available, that
the community alternatives are there. Second, we have to make
sure that the protections of the rights of the person are there.
In this particular piece of legislation it is on their own
consent, or if the person cannot give consent there are other
safeguards. The person also has the ability to call on a lawyer,
has the ability to access counsel. All of those protections are
there, so in my opinion, the concerns that were raised in
Saskatchewan are being taken care of under this legislation here
in Ontario.
Mr
Marchese: So it's quite possible that the services may
be available in some communities but not in all communities.
Dr
Arboleda-Flórez: It is a possibility.
Mr
Marchese: It would be the duty of the government to make
sure those services are there but, God bless, who knows?
Dr
Arboleda-Flórez: It is a possibility, but I believe
that the legislation imposes an obligation on government to
provide the services.
Mr
Marchese: It usually does, doesn't it? There's a concern
here. The health professional issuing a CTO does not have to be a
psychiatrist in this bill. Does that concern you?
Dr
Arboleda-Flórez: No, that doesn't necessarily
concern me because it may be-that is the question-that the broad
type of therapeutic interventions may not require medication.
Usually, it is the psychiatrist or the family physician who is in
charge of that or giving the medication. It may be that there are
other ways of dealing with the case without necessarily being
medications.
1140
Mr
Marchese: I understand, but in some places in Ontario
you may not have psychiatrists. So usually, yes, they issue the
order, let's say, but in some places where there is no
psychiatrist, somebody else has to deal with that, and you're
saying that might be all right.
Dr
Arboleda-Flórez: Medical practitioners, general
doctors and general practitioners are usually trained on
psychiatric issues and there are plenty of ways of training them
or helping them whenever there are difficulties. Most psychiatric
systems have access to consultations in cases of difficulty with
a general practitioner.
The Chair:
Mr Marchese, we're actually beyond our five minutes.
Mrs Julia Munro
(York North): I certainly appreciate the kind of balance
you've provided for us in your assessment. I want to come back to
a couple of issues that have been raised by you, certainly in
conversation with Mr Marchese. You talked about the fact that by
legislation there is an imposition, if you like, on the part of
the government to provide these services. I would just call your
attention to the fact that in the legislation it specifically
says that the treatment or care and supervision required under
the terms of a community treatment order are available in the
community. I just want to reinforce your comment that this is in
the legislation itself. Although some made the comment that their
concern about community treatment orders might imply that the
services weren't there, I think you've pointed out for us quite
successfully that the opposite is true.
I was going to ask you
about the role of physicians, but I also want to come back to
something that is a recurring theme by many presenters: that this
piece of legislation spreads too wide a net and that there's a
concern in that regard. I just wonder if you would care to
elaborate a little further in your sense of just how small a
group this is directed towards.
Dr
Arboleda-Flórez: I think the legislation is
restricted enough for individuals who are, as we say, seriously,
persistently, chronically mentally ill, and especially who keep
having recurrences and relapses. The legislation clearly says it
has to be after several admissions in a particular period of time
for X number of days etc. That's restricted enough. A person
without that kind of problem, without that problem of
non-compliance, would not be relapsing so regularly, so it is
restricted enough.
It says during the
three-year period prior to the order, where a patient was "in a
psychiatric facility on two or more separate occasions or for a
cumulative period of 30 days." Those are the restrictions on
eligibility, which I think are extremely restrictive, even more
restrictive than what we have in legislation in other
jurisdictions in the USA.
Mrs Munro:
I think that's really an important issue for many people.
I want to ask you to
elaborate a little bit more on-I'm not sure of the page
number-where you were talking about community treatment orders
and the issue you've described as overcoming rehabilitative
inertia. I think that's something we as a committee need to hear
a little bit more about.
Dr
Arboleda-Flórez: That simply means that what is
happening many times is that everybody shrugs their shoulders.
"There is nothing to be done. There is no way to continue dealing
with this person. Wait until he commits a crime. We'll get him in
jail." That's why the jails are filled with them. In my own
stories, as I said, about 50% of females and around 55% of males
have a one-month prevalence of a mental condition. This is not
only a problem of personality disorder; these mental conditions
include the very serious ones, such as major depressions,
schizophrenia etc.
The stories of Bland in Edmonton say exactly the
same. He measured lifetime prevalence, and about or over 90% of
persons in prison, arrested in remand centres, had those
problems. If we then look at the number of mental patients in
prisons serving time, not just remanded, the pathology is exactly
the same. It's extremely high. If we go further, past to
penitentiaries, it is extremely high. So what we are doing is
therapeutic inertia; nothing to be done; shrug the shoulders. He
commits a crime. So what? The justice system deals with him.
Mr Patten:
Doctor, you're affiliated with which hospital?
Dr
Arboleda-Flórez: I am the professional head of
psychiatry at Queen's University and I'm the
psychiatrist-in-chief of the psychiatric services.
Mr Patten:
I have two quick questions and then my colleague Mrs McLeod would
like to ask a question.
We've heard generally that
the population of the mentally ill are no more violent than the
general population. I concede that point as a generalization.
However, you've provided some data that suggest that within
subgroups some people who are suffering from psychosis, in other
words untreated-in certain circumstances you're talking about a
factor that may be eight times as great as another person. There
were two studies I read a year or two ago from England and
Scotland that suggested about a 10-times factor. Essentially
paranoid schizophrenic males who are untreated, suffering from
psychosis, have about a 10-times factor. Does that concur with
your research?
Dr
Arboleda-Flórez: It does concur. The statement,
"They are no more violent than"-well, of course they're not,
because about 25% of the population, at one time or another in
the year, have some kind of mental problem. All of us have mental
problems of some type or another. Of those 25%, about 6% require
treatment and 2% require admission. So we are really slowing
down. If we take all of the mental patients in the community, of
course the thing dilutes itself, especially in countries where
they don't have so much violence or acute violence as we have in
Canada, thank God. In other countries it will be higher, because
in the United States, for example, the levels of violence are
higher.
The question here is that
specific groups of mental patients do have a higher rate of
violence, and there are stories after stories, not only on
patients just released-they're comparing them to normal
controls-come way high up when they are so psychotic.
Mrs
McLeod: There are so many questions I'd like to ask you
to take advantage of your expertise. I'm going to cheat a little
bit and I'm going to place four questions on the record. My hope,
since I know you won't have time to answer them all, is that we
might be able to prevail upon you to respond maybe to a phone
call from research afterwards. But I don't want to miss taking
advantage of your expertise.
My first question would be
to recognize the statement you've made both to Mr Marchese and
Mrs Munro about the obligation placed on government under this
legislation to ensure that treatment is available, but to tie my
concern back to Mr Marchese's question about the ability of
non-psychiatrists to prescribe community treatment orders, which
you said didn't concern you. I guess my concern would be, in the
absence of a full range of community treatment options and
supports, would there be a danger that the only treatment that
might be prescribed and considered adequate to fulfill the
community treatment orders would be medication and that we would
in fact still be leaving people with mental illness without a
full range of community supports?
If you don't mind, I'm just
going to table my questions. This is very unfair, but otherwise
I'm not going to be able to raise all my issues.
The second question I'd
like to be able to ask you is, in defining the very narrow group
that might benefit according to the studies, are we clinically
talking exclusively about people with acute psychotic states of
schizophrenia? Would any kind of enforced compliance be
inappropriate, for example, for manic-depressives, or can we not
define the target group clinically in such a narrow way?
My last questions were
around your intriguing statement under guarantees about
limitations on therapeutic intervention. I'm wondering what you
would consider to be appropriate limitations. Would you, for
example, have a prohibition on any use of force in order to
ensure compliance? For example, would you be as specific as
limiting something like enforced ACT?
I'm sorry to do that, Mr
Chair. I didn't know how else to take advantage of this man's
expertise.
Dr
Arboleda-Flórez: The first one is in regard to the
issue of who will be there to provide the treatment. I repeat:
General practitioners are very well taught on psychiatric issues,
or if not, there are plenty of training opportunities and plenty
of opportunities for them to access consultations-telepsychiatry,
for example. We do telepsychiatry with Timmins. We do
telepsychiatry around Kingston. There are plenty of
telepsychiatric systems in London, Ontario, and at McMaster
University, and general practitioners access consultations, not
just psychiatrists. Any one of them could be accessed at any
time.
1150
I don't have any concerns
in that regard as long as there is a willingness-and this is also
something that I didn't say-to help the practitioner, the
clinicians, to also be more effective and to limit their sense of
frustration that there is nothing to be done. In fact, there are
dozens of frustrations which, as I have said, have increased the
number of mental patients in prisons. There is also that sense of
frustration which is the result of an increase in the access to
forensic services under "not guilty by reason of insanity" or
"not criminally responsible" regulations in the Criminal Code.
There has been an increase of almost 100% of these cases in
Ontario in the past 10 years or so, since the new laws came into
effect in 1992. Why? Because clinicians just simply don't act any
more. They are hamstrung to act.
The second issue was the
matter of which diagnosis. I think rather than going to a
diagnosis we should concentrate on symptoms-the stories demonstrate that
it is the symptoms, regardless of the diagnosis. A person
suffering from acute manic excitement may also be experiencing a
tremendous number of delusions or hallucinations. Delusions and
hallucinations are not the defining factors or diagnostic factors
for schizophrenia. It is the symptoms that we are worried about
as opposed to a diagnosis or a label.
The last question was?
Mrs
McLeod: Limitation on therapeutic interventions.
Dr
Arboleda-Flórez: Limitation on therapeutic
interventions is the limitation on clinicians as to the range
where they could intervene. I say there is an obligation for them
to come up with an adequate, appropriate treatment plan for the
particular person. The legislation has protections included which
also limit the therapeutic interventions. I don't think that
under this legislation a clinician could order a lobotomy. I
don't even think that a clinician could order electroshock
therapy under this legislation, mostly because this is not given
on an outpatient basis.
There are limitations on
the therapeutic interventions, and no, they do not have to be the
acute, heavily dosed anti-psychotics. There are other
possibilities. Those are the limitations that I believe are
included in the legislation.
The Chair:
Thank you very much, doctor, for coming before us and sharing
your expertise with us here. We appreciate your taking the drive
up from Kingston.
EASTERN REGIONAL NETWORK
The Chair:
Could our next group, Eastern Regional Network come forward,
please. Welcome to the committee. Good morning. We have 20
minutes for your presentation. It's up to you to decide between
an actual presentation or question-and-answer period as you see
fit.
Ms Lisa
Leveque: My name is Lisa Leveque. I just drove from
Lanark county. Hi, Brad; I recognize you. To tell you the truth,
it isn't one of my strengths to be speaking to a group of
strangers even though I've done it before. I'm not defending a
thesis. I haven't put a whole lot of time into everything we
would want to say. Of course, we have to limit ourselves in time.
I'd much rather be bowling with the consumers at our project
simply because it's easier than this, but I am going to get
through this.
I'm the coordinator of the
Mental Health Support Project of Lanark, Leeds and Grenville, a
project for consumers of mental health services. This project was
conceived of and developed by consumers and is managed by a board
of directors and three staff members, including myself. All of us
are consumers. We provide a support network for people with
mental illness. Some of the services we offer include weekly
support group meetings; individual outreach; social, recreational
and educational activities; and consumer advocacy. We find
ourselves in a position of support in terms of just helping these
individuals navigate their way through some of the difficulties
in life.
We're one of approximately
58 consumer initiatives which are funded by the Ontario Ministry
of Health. Our funds are managed and dispensed by a flow-through
sponsor agency. We are very fortunate to have the North Lanark
Community Health Centre as our sponsor, and when our project can
fully demonstrate that we can provide sound governance of all
features of our program, we will be going toward the path of
independence.
My colleague Gary Holmes
and I are here today as representatives of the Eastern Regional
Network, so of the 59 projects we represent 10 in the eastern
region of Ontario. This is the second round of consultations I've
participated in regarding changes to the Mental Health Act and
the implementation of CTOs and other matters. I can only imagine
that this increases the likelihood that my feedback truly matters
to all of you. I'm going to take five minutes and pass the next
five over to Gary.
Our concerns, points to
consider and recommendations: Health and long-term care minister
Elizabeth Witmer has stated we are now following through on the
Blueprint election commitment to make sure that people with
serious mental illness who pose a danger to themselves or others
are getting the treatment they need. In fact, I think most of us
believe it would take a madman to allow dangerous people to be
running in the streets, so we are certainly not advocating
that.
Community treatment orders,
however, as one of the tools being considered in Ontario, have
been implemented in three other Canadian provinces and have been
applied to a very small number of mentally ill individuals. We'd
like to point out that in 1998, New Brunswick considered
implementing such laws as CTOs, but after a provincial
consultation like the one we're at here, they decided to put
greater emphasis on community programs. So we have three
provinces that have gone ahead with CTOs. New Brunswick gave it
second thought after the consultation and have changed their
minds, so it is possible that not all of this will go
through.
We suggest that while CTOs
are intended for a small number of individuals who are too sick
to realize the implications of not being treated, the vast
majority of consumers are still underserviced in regard to other
community supports. In particular in the rural area, of which I'm
a part, local psychiatric care is not available to us as of yet.
I believe that the government is working to improve those
services.
Consumer programs such as
ours and others in this province which have been proven to help
people gain and maintain mental stability are allotted less than
1% of all Ontario mental health dollars. I think that's a really
important figure that we'd like to put on the table here: less
than 1%. This is inadequate when compared to the assumed cost of
developing, implementing and monitoring CTOs. In the government's
attempts to monitor our mental health system, we believe this is
an insufficient use of funds.
Other questions and
concerns regarding CTOs: Many mental health providers and
consumers, including ourselves, believe that the current Mental Health
Act is more than sufficient to deal with the more seriously ill
members of our society. The problem that has arisen is that with
the increasing closures of psychiatric beds, psychiatrists have
increasingly been prematurely releasing their patients before the
case goes to the Consent and Capacity Board. So, in fact, there
is already a mechanism in place to keep patients for extended
periods, but it has been compromised by bed closures. In this
context, CTOs appear to be an ill-conceived and expensive
band-aid solution.
How will we measure if CTOs
will actually accomplish any of their therapeutic goals? I don't
think I've heard that at any of the discussions. What if we
discover that in fact they have the reverse effect of driving
mentally ill people underground, where their illness will remain
untreated and in isolation? I think we'll be in deep trouble
there.
Finally, it is our belief
that one cannot enforce therapeutic treatment, and I think that
is the gem in this part. It's antithetical to the features of
healing, which are acceptance of one's illness and willingness to
get well. Studies have repeatedly shown forced treatment to be
ineffective.
I'll move away from CTOs
now and go quickly into problems with the proposed amendments as
we see them. The proposed removal of the term "imminent" from the
Mental Health Act, combined with removing the requirement for
police to observe disorderly conduct-as you all know, before
acting to take a person into custody-we believe is fraught with
social, moral and legal implications that I don't think we can
imagine at this time. Countless studies have shown that it is
extremely difficult to predict the inevitability of dangerous or
violent behaviour. In the current Mental Health Act, the word
"imminent" at least helps to facilitate this prediction. For
example, if someone is brandishing a knife, that is a pretty good
indication there could be harm.
The fact that studies have
repeatedly found that mentally ill people are most likely to be
victims rather than perpetrators of violence is of no
consequence. These studies are apparent. I think the social myth
gets perpetuated, and certainly government policy helps to
perpetuate that. This pervasive stigmatizing of the mentally ill
is dangerous and one of the major reasons people don't seek
treatment. Who wants to be considered crazy, let alone crazy and
dangerous?
In 1998, Dr Bruce Link
commented in the Archives of General Psychiatry-this is a very
important quote that I'd like you to hear-"To date, nearly every
modern study indicates that public fears are way out of
proportion to the empirical reality. The magnitude of the
violence risk associated with mental illness is comparable to
that associated with age, educational attainment and gender."
This would be somebody in the field of psychiatry saying
this.
1200
The removal of the word
"imminent"-this is another concern-would nullify or at least
impair any appeal process because even minimal proof from
officials will no longer be required. The arbitrary loss of
freedom initiated by a police officer or other person will need
no presentation of evidence in a court of law, unless you can
tell us differently. Under the new legislation, a person could be
taken into custody and detained purely on a subjective basis in
the absence of any overtly harmful or disorderly behaviour.
Unlike a criminal or a provincial offence, the authorities will
not be called upon to defend their actions by way of proof and
evidence because they don't need the evidence. This should never
be allowed to happen in a democratic society.
We believe that the
expanded committal criteria are also potentially problematic. Two
of the new criteria include the need for treatments and that the
person would benefit from treatments. We find that to be
alarmingly vague. It actually widens the catch net that may
ensnare those who are in a situational crisis and may not need to
take up the precious services that are left.
These proposed changes are
all the more insidious by being unveiled in the patients' new
bill of rights. I think this breeds a bit of cynicism among the
consumer population and those of us who work in the field. We
don't seem to conceive of these changes having the potential of
violating the rights of individuals. Moreover, any medical
re-examination requested by the patient can only be done by the
original attending physician. The patient will now have the right
to not choose the examining physician nor seek a second opinion.
You have the right to be told you're crazy twice over by the same
physician. How emancipating. I don't mean to be snarky, but I
think I was getting a bit upset at this point.
My part of the conclusion:
We believe there needs to be a continuous focus and dialogue
about improving community mental health services during the times
between tragedies as opposed to only afterwards. We believe we
can truly honour Brian Smith in other ways that address the root
causes of mental illness and social suffering. For example, what
about a sports scholarship for individuals with mental illness?
What a way to honour Brian Smith.
We need consumer legal
advocacy in our communities to ensure that these new changes do
not infringe on the rights of consumers who are already the most
vulnerable of our society. We request that more mental health
dollars go into consumer initiatives and less into a parole-type
system of monitoring the mentally ill. We hope that after the
bricks and mortar are taken care of a little more money might
flow, and we encourage this government to follow the common sense
of New Brunswick's display of courage in putting greater emphasis
on community programs and not caving in to the reactionary and
hasty decision-making that appeases some and benefits even
fewer.
Gary Holmes is my
colleague.
Mr Gary
Holmes: A lot of ground to cover in the 10 minutes
remaining. Basically I'm going to go through a few things and
it's rather a bit of a checklist of what I see as some of the
problematic highlights.
Overall, I'd say first off, at the outset, Eastern
Regional Network is against community treatment orders, as is
Ontario CMHA. I've read the Ontario CMHA recommendations and they
seem to make a lot of sense in terms of their highlights as well
as the legislative changes that would be necessary if you're
still going ahead with it. But I see it as a very flawed document
and I think it should be stopped. As CMHA Ontario said in the
beginning, if CTOs were to come into Ontario, at least adopt the
Saskatchewan model. They were designed for people who have had
involuntary times, as well as the revolving door concept, in and
out of hospital.
I myself have been in that
category. There have been abuses of the Mental Health Act that we
presently have. I went to a review board once myself, represented
myself and was certified involuntary. The next day I found a job
and was working. There's something wrong with a system that can
be as imbalanced as that. Abuses occur. A lot of these changes
will allow and broaden the potential for further abuses.
Every time I did get out of
hospital-and it's been 13 times-the supports haven't existed in
the community. It's much like an empty glass. The legislation
isn't going to provide more housing. It's not really addressing
the severe poverty that people are under. There hasn't been an
increase in financial assistance since 1992 and there are
cost-of-living problems.
We have a very restrictive
drug plan in Ontario. I've been on the task force for Ontario
CMHA on that. That report will be out shortly.
The "imminent" clause is a
problem. CMHA Ontario recommends three months. I still see that
as a long time frame. Will that be at the expense of hospital
beds that are already inaccessible to people who are voluntarily
trying to get into hospital? Here we have a situation of, how can
we get more community mental health services in place? CTOs have
the potential to perhaps create a further log-jam or a more
hospital-based system, and then mental health reform won't
proceed.
Some $351 million was the
target set in 1995 for transitional funding for mental health
reform. That money is still needed, as well as about $226 million
for housing and supports for housing. Consumer-survivors want and
need availability of services and timely access to services. That
really doesn't happen.
In terms of leaves of
absence under the Mental Health Act, there's a problem. It really
hasn't even been that well known. Second, it hasn't been used
because of issues of potential liability. The hospitals don't
really want that. There's no renewal beyond three months. It
could be a well-versed amendment to the existing Mental Health
Act to change it so there can be renewal beyond three months so
that people can have a trial period in the community.
The Health Care Consent Act
and some of the legislation in the CTOs right now is contrary in
the way it's defined. For example, community treatment orders and
physician orders are not necessarily the same thing although
they're spelled out currently in our existing acts. I don't see
how physicians will be able to provide ancillary services such as
housing, case management and things like that. Here in Ottawa
we've been asking for that kind of thing. We've had additional
funding but not always to the level requested and not always to
the type of community mental health services that we've wanted.
ACT teams, which seem to have been more funded and more
resourced, rather than let's say the strengths model of case
management, aren't necessarily the preferred method. I know
people working on ACT teams and they don't even see why CTOs
would be necessary for their clients because they are monitored
so much. They do receive medications.
Another aspect in terms of
medications is, what happens if someone is forced on medications
but they're allergic to those medications? Medications themselves
aren't a panacea for everyone. They don't always work. I've had
to be on a number of different medications. Diagnostic categories
change often and medications don't always work. There are often
terrible side effects. And there's a lack of access to
alternatives to medications, other holistic alternatives that
might work, not just for consumer-survivors but even other ethnic
groups who find that hard.
1210
Bumping of services is a
potential as well. Will people voluntarily seeking services right
now be bumped in favour of people who are mandated to be on a
community treatment order? This is a real reality that can happen
unless additional dollars flow to the community level where most
of us live. "Apparently incapable," that means to be stricken
from the record-apparently has to be incapable or capable.
I have a concern about
monitoring costs. If it's set up, you have an ACT team, you have
a physician, you have a hospital and several social agencies. The
tracking of that is going to cost quite a lot of money and will
also result in perhaps less money going to the needed supports,
the real supports for most of the consumer-survivors who don't
even need CTOs, and those supports don't exist like affordable
housing, subsidized housing and proper income or employment
supports.
I also recommend that there
be a freeze on CTOs. If they do go ahead as the election promised
one year before, they should not go into effect until existing
services are put in place in the community, properly developed
and evaluated, coordinated and integrated.
It's been seen that
diagnosis and disorder studies by Penetanguishene hospital don't
predict dangerousness. It's a predictor of dangerousness. The
Marshall study in fact shows, as you're probably aware, that
we're no more dangerous than the rest of society, yet we're
basically discriminated against at the outset as Ontario
citizens. I myself find that a real travesty. Having volunteered
for years with mental health reform on numerous committees, at
the Canadian Mental Health Association and consumer-survivor
initiatives, and even receiving the community action award from
the Ontario government with Premier Harris's signature on it, I
think it's a real slap
in the face for most of us who do a lot of good volunteer work
and are contributing members of society.
Furthermore, forced
medication, as was previously mentioned by Lisa, really doesn't
work. The situation of a community treatment order is going to
erode the trust that is necessary, that needs to be developed. It
usually takes at least a year for a mental health worker to
establish a good rapport and trust. Without that trust, people
aren't going to come forth and reveal the real symptoms or
perhaps even the level of dangerousness they might be
contemplating, either suicidal to themselves, or to others in
terms of dangerousness. It's a real erosion in terms of finding
out about dangerousness, as well as even in terms of recovery for
people.
I'm going to sum up and
leave it open for a few questions here.
Lastly, I think there need
to be independent rights advisers and advocates. A two-year
review will have to take place if CTOs are implemented, and
definitely, as all the consultations previously stated here and
across Ontario, a lot more money is needed in the community with
community-based mental health supports and services and proper
housing, addressing the real problems of people living in the
community with adequate housing and income and employment
supports.
I'll leave it open to your
questions, and thanks for listening.
The Chair:
Thank you both very much. Actually we've gone over the 20
minutes.
Ms
Leveque: You have 30 seconds for questions.
The Chair:
I don't think any of my colleagues could state their riding name
in 30 seconds, never mind pose a question and get an answer, but
we do appreciate your taking the full time to share your views
and make the suggestions you have. We very much appreciate
it.
Committee members, just
before we break for lunch, you may recall one of the groups that
had presented to us earlier, the Ontario Council on Alternative
Businesses, had mentioned this video. Rather than try and put
together a screening for the whole committee, if you like, we
could just put it in rotation and if each-
Mrs
McLeod: Am I to be given the responsibility for that
video?
The Chair:
Ms McLeod now has custody of it.
Mr Holmes:
That video is also available at the National Film Board, and most
CMHAs have it.
The Chair:
Thank you. That's now available for everyone. With that, we're
going to break for lunch. The committee will adjourn until
1:30.
The committee recessed
from 1216 to 1333.
ROYAL OTTAWA HEALTH CARE GROUP
The Chair:
Good afternoon and welcome to the committee as we continue our
hearings on Bill 68, An Act, in memory of Brian Smith, to amend
the Mental Health Act and the Health Care Consent Act, 1996. Our
first presentation this afternoon will be from the Royal Ottawa
Health Care Group. We invite them to come forward to the witness
table. Ah, just one today.
Mr George
Langill: Actually, Mr Chairman, there are two. The other
half of this presentation is out in the hallway with the media
right now.
The Chair:
Very good. We have 20 minutes for your presentation, and it's up
to you to divide between either a presentation or a
question-and-answer period as you see fit.
Mr
Langill: We would like to make a presentation. We have
submitted a written brief to members of the committee and
sufficient copies to pass around. That certainly is the heart of
our presentation.
Perhaps I could start by
introducing myself. I'm George Langill, CEO of the Royal Ottawa
Health Care Group. To my right is Dr Marv Lange, the clinical
director at the Royal Ottawa Hospital. We had hoped to have Dr
John Bradford, who is the clinical director of forensic
psychiatry, also available today, but unfortunately he's been
detained at a trial in Toronto and couldn't be here.
Let me start by saying that
we certainly appreciate this opportunity, which as you know has
particular relevance to all of us from this region because of
this bill's association with Brian Smith and following similar
events over the last few years in our community. We believe very
strongly that the reasonable availability of mental health
assessments and treatments, like all other medical and clinical
services, is a societal expectation and a standard worth
achieving in our society.
I'd also like to take this
opportunity, if I may, to recognize the initiative of this
government in the area of mental health reform. They have shown
that they are prepared to make the necessary decisions to move
reform's implementation in this province through action like this
legislative review and update to reflect what we believe is a
very sound policy platform in making it happen, and also through
decisions that we feel have certainly taken the courage of your
convictions around that policy through decisions such as the
creation of these mental health implementation task forces and
through the divestment of the provincial psychiatric hospitals
and their further rationalization within a reformed system. We
feel that has to be recognized for its initiative, for its very
forward thinking as we move to reform mental health care.
We'd also like to commend
and recognize the outstanding advocacy of Richard Patten in his
long-standing pursuit of a reformed mental health system and a
more responsive mental health legislative framework.
Before asking Dr Lange to
comment on the bill from a broad clinical perspective, may I
point out one thing that I think has to ride very high over the
implementation not only of this legislative framework but of
reform to our mental health system; that is, that at the core of
the reformed system is an accepting community, a community that
understands, a community that has empathy, a community that is
moving with the times and with reform. This emphasizes the very
strong need up front and continuously to have a strong investment
in public education. We
ask you to consider that not so much as a legislative issue but
as an implementation issue as the government moves forward in
this regard with reform.
The same thing will be
necessary with the various professionals who are expected to
operationalize this legislation. Academic health science centres
in this province-and there are five of them-should be mandated
and appropriately funded to implement, evaluate and maintain
effective ongoing systems of education and knowledge support for
the professionals working with such legislation in the respective
regions. We feel that's absolutely mandatory here and we've
learned that through the experiences of prior changes to mental
health legislation over the years, that that education, that
available support within regions to professions, becomes
absolutely very critical.
I would add to that a
consideration that these academic health science centres, because
of their academic and research mission, should also be mandated
to develop on a province-wide basis, but to be implemented
regionally, some form of system of evaluation and research of
these changes and their impact on the effectiveness of mental
health service delivery.
I'll certainly leave you
with those thoughts that obviously are more post-legislative in
terms of implementation but that will be very critical to
ensuring that the reform program and the legislative
implementation goes smoothly and is maintained as a rigorous
regional effort. What I'd now like to do is call on Dr Lange to
make comments to you from his clinical perspective as a clinician
who deals with issues day to day in our organization.
Dr Marv
Lange: Thank you very much for giving us the opportunity
to speak to you. We certainly support the amendments to the act,
which we think have to strike a balance between the rights of the
individual and the rights of families and society at large. We
believe that the individual must have the right to mental health,
the right to treatment when mentally ill, and the right to
safety.
Too often persons become
mentally ill with an illness which impairs their judgment,
leaving them either not to seek treatment or to reject treatment
when it is offered. The tragedy is that often these same persons
deteriorate, as a result of their illness, to the point where
they become a threat to themselves or to others as a result of
their illness.
The course of their illness
may seriously affect their physical and social well-being. Their
social deterioration often leads them into dangerous situations,
with victimization by criminal acts, substance abuse and exposure
to climatic extremes. Too often, seriously mentally ill persons
suffer deterioration of their health, severe injury or even
death. This is because of their inability to care for
themselves.
1340
People with serious mental
illnesses are suffering even when they do not pose a risk to
themselves or to society. The lack of insight caused by the
illness results in a loss of judgment that effective treatment
can alleviate their suffering. Ignoring such people until they
pose a danger means that we have deprived them of their right to
mental health.
At hospitals we frequently
speak with families who tell us about family members who are
clearly ill and who are deteriorating but who refuse treatment.
Too often these are patients who have discontinued treatments
which were effective and who lacked the judgment, as a result of
their illness, that continued treatment is necessary for their
recovery.
It seems a tragedy that we
have to wait until these people pose a risk to someone before we
can intervene. We believe that the right of the family members to
have access to treatment for their loved ones cannot be
ignored.
With the steady movement to
treatment in the community, we see community treatment orders as
being one more modality in the continuum of care for persons with
serious mental illnesses. We now must keep some patients in the
hospital for longer periods of time because of the recurring
problem with non-compliance with treatment. In selected cases, we
believe that community treatment orders will offer a less
restrictive setting for treatment of some people who could
function outside of the hospital if they felt some compelling
reason to continue a proven treatment plan. We believe that with
proper monitoring and close follow-up, in selected cases we could
treat some recurringly ill patients in a community setting which
more closely reflects the ultimate goal of treatment, which is to
live in the community with as much independence as their illness
will allow.
Thank you very much.
The Chair:
Thank you. That's left us about six minutes for questioning,
about two minutes per caucus. In the rotation, the first speaker
last time was NDP, so Mr Clark or Ms Munro, if you have any
questions.
Mrs Munro:
Thank you very much for coming here today and giving us some
insight into this. I wonder if you could expand a little on the
issue you raised initially, that of education, because clearly,
when one embarks on what is essentially a new direction in terms
of the way in which this bill is structured, that becomes a
particularly important issue. You mentioned the need for both
public education and education for health care professionals. I
wondered if you could give us some indication, in either of those
cases, of the kinds of things you think would be most
effective.
Mr
Langill: Perhaps I can start, but I'm sure Marv has
comments too.
In mental health, the
legislative procedures and practices we work with are like a
surgeon or another physician having to work with certain
procedures. If you're changing that technology or those
procedures, there has to be a proper orientation, there has to be
proper education, there has to be proper evaluation of how these
are implemented.
The academic health centres
in our various regions have that mandate, not only for medicine
but for the other clinical professions, whether it's in the
formal sense of students
who are going into these professions or continuing education. We
see a necessity here of ensuring that built into the
implementation plan are those educational programs that will
target the health professions, the police, and others who will be
integral to ensuring that the proper procedures and the proper
manner of interpreting these procedures are put into effect and
that there is some form of evaluation. We're simply saying that
this should be somehow layered into the mandate and mission of
these academic health science centres.
Dr Lange:
I would agree with that. To add to that, the people who use our
service also need to know what the amendments to the law are.
After all, it does affect them very definitely.
Mr Patten:
Thank you for coming today. You talk in your paper about the
fears of some members of the community, particularly the
consumer-survivor community-and, by the way, some representatives
of general hospitals-saying that with the expanded criteria in
this proposed bill, we'll increase the pressure, they say, on
general hospitals and they think on all services. Unless there's
a greatly increased programmatic increase in volume at almost
every level, this cannot be done with the resource level at the
moment. What would be your response to that? In other words, even
at the ROH, do you have excess capacity? I would think not.
Dr Lange:
No. That's pretty straightforward. There's no question. Any of
the papers and submissions we've read on this whole issue
indicate a concern that a proper resource base has to be in
place, a set of community supports, including the backup of the
hospital, to make this work; otherwise, it becomes an academic
exercise.
The issue of the impact of
this legislation-we have not a whole lot of experience to go by.
Certainly the Saskatchewan experience, which you're very familiar
with, indicates that if the criteria are properly adhered to, the
volumes are not that high. If anything, it can act to facilitate
the re-entry of the individual into the community, the
maintenance of the individual in the community and the avoidance
of the revolving-door syndrome, which could in fact take pressure
off the hospital system, but inevitably it will put certain
pressures on the community-based system to provide those
supports.
Again I would reiterate the
importance (1) of education, making sure everyone has the right
information and knowledge base they're working from, and (2) a
system of rigorous evaluation that gives us the answers to some
of these things, Rick, in time and due course so that government
and others can evaluate the implications and make adjustments at
that time. We're not as concerned about that particular agenda
being the most likely to occur if those things are put in
place.
Mr Patten:
Some people are suggesting-I don't share the view, but I'm
hearing it-that the leave provision in the existing Mental Health
Act is a form of a community treatment order and can and should
be used but it seems not to be. What's your response to that? In
other words, if we just employed that option, it would be there;
we wouldn't need the community treatment order program we're
proposing.
Dr Lange:
I don't agree with that, because the leave provision is something
quite different than what we're talking about. Generally, what
we're talking about here is people who are recurringly ill or
people who, on discharge from hospital, discontinue their
treatment. I don't think the leave issue from hospital really
addresses that issue.
But to go back to your
first question, I don't think this bill is going to increase the
incidence of severe mental illness in Ontario, so I don't see
that that should have a huge impact on resourcing. What may
happen is that we may have to assess more people. I see that as a
positive thing rather than a negative thing, that when families
are very concerned about someone, they have some way of getting
that person to at least have an assessment. The assessment may
come to the conclusion that this person does not need to be in
hospital, but at least there is some reassurance for the family
to know that their family member has been assessed.
Mr
Marchese: Thank you for the presentation, Mr Langill and
Dr Lange. Just to agree with you quickly about a few points you
made before I get to two quick questions, first of all on the
balancing of rights: It's a concern of mine all the time, because
we tend somehow, when we do reform of one kind or another, to go
to one extreme and then we go to the other extreme. Part of our
attempt, it seems, in terms of your comments at least, is that
we're trying to find that balance, and that's always the
challenge. To agree with you on education, we always talk about
that. Almost with every bill invariably someone says we should
put into what we are doing some resources for educating the
people who are affected or the people who are going to provide
the treatment and so on. We say it and we never do it, we never
really do it. It's a failing, I believe, on our part. It should
literally be built into everything we do, that there's an
education component and resources allotted to it. I wanted to
agree with you and tell you that it's usually a failing of ours,
even though we agree.
On the point of evaluation,
sometimes it happens, sometimes it doesn't. It usually happens
later, when we're looking for reform, and then we do the
evaluation-but much later.
In terms of questions, a Dr
Ty Turner, chief of psychiatry for St Joseph's Health Centre,
makes this comment: "Why would police apprehension be facilitated
and why would the committal criteria be loosened up unless there
was an objective to increase the flow of the mentally ill people
back into hospital? The clock has been turned back and people
will be taken out of the community and detained against their
will. Flowing people back into hospital makes no sense when, at
the same time, beds that were once available are being taken out
of the system. Many beds have already been taken out and many
more will follow." That's the comment he makes. What is your
response to that?
1350
Dr Lange:
I think that's a two-part thing. It addresses resourcing on the
one hand. I agree with George that resourcing is always an issue
for us. But the first part of the question is about police. Some people have
the perception that the police have nothing to do in our society
but take people they don't like or who annoy them to the
hospital. My experience has been that actually they're quite busy
and their numbers are reduced, as always, and when they bring
someone to the hospital they usually bring them because they have
significant concerns. I can understand that loosening the rules
might lead to more people being assessed, but my experience has
been that we also need to educate the police so they have an
understanding of who they need to bring.
Mr
Marchese: The previous language was that the police
personally observe disorderly conduct and now it's "reasonable
and probable grounds." It's on the basis of this definition that
there might be some greater probability that people will be put
away. I know the cops don't like to do those things, but if you
change the definition, doesn't it make it more probable that more
people will be detained?
Dr Lange:
People may be brought for assessment. Being put away is another
issue.
Mr
Marchese: Of course. A quick question: The health
professional issuing a CTO does not have to be a psychiatrist,
according to this bill. Do you think that's a good thing or bad
thing?
Dr Lange:
In most cases, it should be a psychiatrist. Certainly the
Saskatchewan experience has been that CTOs are not used very
frequently, because there needs to be a treatment plan made, and
in most situations, a treatment plan for somebody with a serious
mental illness should be done by a psychiatrist.
Mr
Marchese: So it would be a problem if a CTO is done
without-
Dr Lange:
It's a potential difficulty, yes.
The Chair:
Thank you, gentlemen, for coming before us here today. We very
much appreciate the perspective you've brought to the hearings
here.
SHEILA DEIGHTON
The Chair:
Our next presentation will be from Ms Sheila Deighton. Welcome to
the committee. We have 10 minutes for your presentation, to be
divided as you see fit.
Ms Sheila
Deighton: Thank you for having me here today and for
listening to our story. I am a family member. My husband has
schizophrenia. On the surface we seemed like any other family
living in the 1990s, two working parents with three teenage sons
who were very active in sports. Our plate was full. We had more
than our fair share of problems, but we learned to cope on our
own with each crisis as it arose, with little outside direction
or support, because mental health professionals failed to
appreciate the serious consequences of living with untreated
mental illness. It would not be until a life was taken away from
us that I would realize how bizarre our life had become. Our
family was different. Both my husband and son suffered from
untreated mental illness.
My late son Al desperately
needed psychiatric care in the last years of his life. He was a
very troubled boy who threatened and attempted suicide many times
and very nearly succeeded on one occasion. His response to life's
adversities was often aggression towards himself and others. Al
made his second, near-fatal, suicide attempt in August 1993 by
jumping 30 feet from a concrete dam. He sustained
life-threatening injuries and was rushed into surgery. Five hours
later, we were told he had survived. We were so grateful: Our son
was alive and now he would get the psychiatric help he so
desperately needed. We had hope, a starting point, or so we
thought.
But Al denied being
suicidal throughout his entire hospital stay and he was not
considered to be a danger to himself. In view of his suicide
attempt, admission to the psychiatry ward was offered and
recommended by the psychiatrist treating him, but Al refused to
go. As none of the required criteria were met, Al was not deemed
to be certifiable under the Ontario Mental Health Act and thus
there were no legal grounds to keep him in hospital. Al was 16
years of age and as such could legally decide for himself whether
he stayed in hospital or left. The fact that Al's grandmother
suffered from schizophrenia and that his father was under the
care of a psychiatrist carried very little weight. Eight days
later he was discharged.
One year later, in July
1994, I would return to the emergency department with Al, this
time following an assault on his father, suicide threats and
property damage to our home. The OPP were called by my husband
and the property damage and physical assault were documented.
Reluctantly, Al agreed to go to emergency, where he again
expressed suicidal thoughts of shooting himself with a gun. As
the day wore on, Al began to display some insight into his
present situation and agreed to be admitted to hospital. But his
request was denied. The attending psychiatrist felt that he was
no longer suicidal and he failed to meet the dangerousness
criteria for admission.
My husband, Alistair
Deighton, I would discover much later, had a long history of
serious untreated mental illness, as do many members of his
family. His childhood was a nightmare which left him profoundly
traumatized as an adult. But with the support of his family, he
coped responsibly and successfully with his condition for most of
his life. But even though he was continuously in the care of a
psychiatrist, his deteriorating condition was not properly
recognized or treated, putting many lives at risk. We were a
family in crisis. What was it going to take to get the treatment
our family needed?
On January 30, 1995,
tragedy struck our family. My husband, untreated and struggling
to deal with our son's behaviour, lapsed into a psychotic state.
He shot and killed our son Al, who was 18 years old at the time.
Arrested and charged with murder, Alistair Deighton was held in
jail for two months until a bed in the forensic system became
available. Six weeks later, he was diagnosed with schizophrenia
and major affective disorder.
Justice was served, and
effective, responsible medical treatment, through the forensic
system, was provided our family by our legal system, which on March 8,
1996, found Alistair to be not criminally responsible due to a
mental disorder in the tragic shooting death of our son. It took
a criminal offence to finally get the treatment our family
needed. Unfortunately, our case is not the exception. It has
become the norm. For it still seems the hardest thing to do in
our society is to have mental disorders recognized and treated,
even after they have ended in tragedy.
I applaud the government's
efforts to amend the Ontario Mental Health Act and the Health
Care Consent Act and support Bill 68, Brian Smith's law. Would
Bill 68 have made a difference in our particular situation?
We will never know, but what we do know is that the current
legislation failed to protect our family, the people it was
designed to protect.
I would recommend that a
system be put in place to monitor and evaluate the effectiveness
of the proposed amendments; that we ensure adequate supports are
in place for implementation of the community treatment orders;
that we launch a public awareness and education program on the
amended legislation; that we change the name of "community
treatment orders" to "community treatment agreements"; and that
involvement of family members is essential.
I would also recommend that
this government needs to look at developing a children's mental
health act, an act which recognizes the need for early
intervention. In youth, symptoms of mental illness often emerge
as behavioural problems, which are too often ignored, it seems.
Many distraught parents are not aware of the symptoms of mental
illness in adolescents and children. Legislation must be
established that sets standards of care for the people it is
designed to protect, children and their families.
The Chair:
Thank you, Ms Deighton. That leaves us with two and a half
minutes. Recognizing the realities of question-and-answer, I'll
allocate that time to the Liberal Party.
Mrs
McLeod: Thank you very much for being with us today and
for telling us your story, which I'm sure must be very difficult
to retell. As I hear your comments and read your submission, my
sense is that in saying how this law could help other families
that might face a situation similar to the one your family was
in, it would be through ensuring greater access to community
treatment, the kind of treatment your husband should have been
able to access. Is that a fair read of what you believe this will
do?
1400
MsDeighton: There are a number of things. Changing
the criteria from dangerousness to need for treatment is
extremely important. The psychiatrist treating my son recognized
that he could benefit from treatment admission to the psychiatric
ward. He spent four days in intensive care and four days
recovering from surgical injuries, because he had a massive
incision. He had hemorrhaged. They recognized that this was a boy
who had a genetic history of schizophrenia but were restricted by
the current Mental Health Act, because he at that time was not
considered dangerous.
Mrs
McLeod: Even though he was agreeing to be admitted to
hospital?
MsDeighton: The second time we were told: "He is
not suicidal right now. He's not a danger. Take him home." There
was no support for our family.
One of the things that
happened once we went into the forensic system-which is very
similar to CTOs: my husband has an order, he came home in
February 1997 and he's living at home-is that there's support for
our family. My husband has not been re-hospitalized. He sees a
psychiatrist according to his order. He's taking his medication.
There's therapy for him and there has been therapy and support
for us. There's not a lot of community services available, but
those essential supports that were necessary for us as a family
to survive this kicked in after we endured this tragedy.
Mrs
McLeod: What I think I hear you saying is that without
that element of dangerousness, which your husband hadn't
demonstrated up until the actual incident, it would have been
possible to have him in treatment, that a community treatment
order might have been accessible as a way of getting your husband
into treatment, even though he wasn't recognizing the need?
Ms
Deighton: I asked for an investigation into the standard
of care, and the college found that the level of care provided by
the psychiatrist failed, didn't meet their standard. The
psychiatrist said he could not have committed my husband prior to
this offence, because even though he was very ill, he was not
considered to be dangerous. He had given no evidence.
The Chair:
Thank you, Mrs McLeod. Thank you very much, Ms Deighton. We very
much appreciate the personal perspective you brought to us here
today.
SCHIZOPHRENIA SOCIETY OF ONTARIO,
OTTAWA-CARLETON CHAPTER
The Chair:
Our next presentation will be from the Schizophrenia Society of
Ontario, Ottawa chapter. Welcome to the committee. We have 20
minutes for your presentation today, and, as you've heard me say
before, to be divided as you see fit between a presentation or
questions.
Mr Leonard
Wall: Thanks very much, Mr Chairman, and good afternoon,
ladies and gentlemen. My name is Leonard Wall. I'm the president
of the Schizophrenia Society of Ottawa-Carleton, and I'm here to
support Bill 68 today. My cohort is Ian Chovil, who is a
consumer-survivor and will speak for a few minutes on his
thoughts.
Today I'd like to speak not
only as the president of the Schizophrenia Society of
Ottawa-Carleton but as a father of a son who has schizophrenia,
and also as a spokesperson for the hundreds of families who have
called our organization in the last year or so, crying out: "Help
me. How can I get my loved one into care? I can't get them into
the hospital. They can't get treatment. They're ill, they're suffering, they're
deteriorating and they're going to die." The doctors recognize
that these people are very sick and need treatment, but because
they are not a danger to themselves or to others, they cannot be
admitted to hospital. And if they choose not to take their
medication, that's OK, that's their right.
Families take their loved
ones home, watch them deteriorate, get sicker and sicker, episode
after episode, until they deteriorate to the point where they
become a danger to themselves or to the community, putting
themselves at increased risk of homelessness, suicide, substance
abuse and criminalization. How do you tell these parents,
husbands, siblings, people like the people sitting back there-and
I know every one of these family members. They have a story they
could tell as well. How do you tell them the doctors, the
hospitals, the community workers are restricted by law from doing
the right thing?
Too often families have to
resort to charging their ill relative with a criminal offence.
Only under the forensic system will they receive responsible,
monitored care. Imagine having to criminalize your loved one in
order to access responsible medical care, a solution which often
tears families apart, alienates the family from the sick
relative, sometimes permanently.
Over the last two years I
have talked to a number of people who suffer from schizophrenia
and today are stabilized on medication. When asked, "If you were
to suffer a relapse, stop taking your medication and become very
psychotic, would you like to be involuntarily treated?" 100% say
yes.
The schizophrenia society
recognizes that in a civilized, caring, responsible, and
compassionate society, mental illness is a community
responsibility and is viewed as an illness which requires medical
treatment. Legislation must be amended to reflect the role of the
community when treatment is provided in a community setting. Bill
68 recognizes that medical treatment in the community will fail
without compliance on the part of the individual and as a
consequence of not receiving continuing treatment or care and
supervision while living in the community.
In addition, over the last
decade coroners' juries have made recommendations which urge
amendments to Ontario's current legislation to include community
treatment orders, which permit treatment of persons suffering
from severe mental illness while living in the community. The
schizophrenia society supports community treatment orders, which
are designed to treat people who are at risk in a community
setting.
Individuals who qualify for
these agreements are the sickest of the sick. They have a history
of being in and out of hospital, stabilized on medication,
released into the community without proper support and follow-up,
failing to take their meds and beginning a downward spiral into
hell. Eventually they end up on the streets, in our shelters, in
our jails or back in the hospital.
They make up 35% of our
homeless population. We pass them daily. We've allowed ourselves
to become complacent, to ease our conscience by saying, "We have
laws that protect the rights of individuals to choice." But what
we cannot allow ourselves to forget is that they are someone's
son or daughter or mother and that no family is immune to this
illness. This is a major medical illness, with major,
far-reaching impacts. This province has in excess of 200,000
people with severe mental illness. Of this total, it is
anticipated that some 400 to 500, or 1/4 of 1% of this
population, will be eligible for a community treatment order.
The schizophrenia society
appreciates the concerns expressed by the anti-treatment
advocates regarding the implementation of community treatment
orders in Ontario. The rights of the patients are paramount. But
what about the individual's right to treatment? What about their
families? Families are often the silent and forgotten victims of
untreated mental illness. Families impeded by the current Ontario
Mental Health Act are forced to watch their loved one deteriorate
to the point where a shelter for the homeless becomes their only
source of community support and involuntary treatment is provided
only when they have met the criteria for treatment: evidence of
dangerousness.
I have an addendum to my
package, which is a statement from a young woman from Deep River,
by the name of Barbara Shreeve, whose brother killed his parents
recently. She couldn't make it today and I wasn't sure if I'd
have enough time, because I wanted to have Ian have a few words,
but I would like you to read that, if you would, if you haven't
already. It's really heart-rending. This man suffered from
schizophrenia for 20 years and lived at home with his family. I
don't know how many of you realize that families are the
institutions for approximately 65% of the people with severe
mental illness, especially schizophrenia.
I'm going to ask the kind
folks on this panel to deliberate very wisely, to listen to the
words of all the presenters, but most of all to think of the
impact on the lives of the people affected by Bill 68. See the
pain, the suffering, the fear and the devastation of your
constituents and be courageous. Have the understanding and the
compassion to make sure that all persons suffering from severe
mental illness have an act that recognizes the individual's right
to treatment, the right to be well, and the public's right to
feel safe.
Two recommendations, and
I'm sure you've heard them before:
Ensure that adequate and
appropriate community supports are in place. Treatment agreements
will not work without them.
Change the name from
"community treatment orders" to "community treatment agreements."
Most of the consumers I've talked to don't like the word "order"
but they agree that "agreement" is a more appropriate name. I
would also like, as a concern, to suggest that early diagnosis,
as well as education programs to promote prevention, are very
important. That ties in with the fact that children with mental
illness and their families are vulnerable and need protection and
help.
We receive 500 phone calls a month in our
office, which is a volunteer-run office for families in this
city. They're asking for help. They're asking for information.
And they're not all from families: they're from police forces,
from social workers, from literally everybody saying, "Where can
I get help for this person?" They're from business, they're from
industry. This has never happened, except in the last couple of
years, this volume. I will thank you very much for the time and
turn it over to Ian.
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Mr Ian
Chovil: Thank you for allowing me to speak here today.
I've had schizophrenia for 25 years now and I'm going to restrict
my comments to schizophrenia. It's the one I know inside-out, so
to speak. I've been taking medication for the last 10 years, and
each year on medication has been better than the previous year.
Prior to medication, I was psychotic for about 10 years. Over
that time period, I was homeless, I attempted suicide, I was in
jail for a couple of nights. I remember planning to murder the
man who was torturing me telepathically. You can't go to the
police when someone is torturing you telepathically, because you
don't have any evidence. I know that people in a psychotic
episode are much more likely to be violent. I was and my friends
were. I don't know if that holds true for people with mental
illness generally, but people in a psychotic episode are having a
lot of trouble maintaining contact with reality, and sometimes
that reality makes demands on them.
Without medication, and I'm
really echoing what Len was saying, people with schizophrenia
will become homeless or they'll end up in jail if they are not
re-hospitalized. It's as simple as that. I would have no
objection to a CTO if I became psychotic again. I wonder why I
had to lose 10 years of my life to an untreated psychotic episode
in the first place. I had no idea I was ill during that time. For
me, a CTO law is like a law requiring you to wear a seat belt.
It's for your own protection, whether you agree to it or not. A
CTO is even better than a law for seat belts, because it's a law
for people who consistently get into accidents without their
medication. It's as simple as that.
The people who object to
this legislation, I have found, generally have very little
awareness of what schizophrenia really is. They have no medical
training, and I strongly object to their speaking on my behalf.
They don't know what it's like to be psychotic. They don't know
that psychotic episodes are bad for your health, that they
essentially cause irreparable brain damage. With each episode and
with each delay in treatment, the response to medication
decreases and the individual becomes increasingly disabled for
the rest of their life.
I'm really impressed with
the research that has gone into Brian's Law, what I understand of
it anyway. Someone really took the time to learn a lot about the
dynamics of schizophrenia. It will be a great improvement on what
currently exists and will help a lot of people with schizophrenia
keep a better quality of life. That is something that opponents
of this bill don't really realize. Thank you very much.
The Chair:
Thank you very much, both gentlemen. That leaves us some time for
questioning here, about seven minutes, so if we can try to keep
our questions and comments to about two and a half minutes
each.
Mr
Marchese: Thank you for the presentation. I'd just tell
you, as a way of sympathizing with the problem, that my father
died of Alzheimer's disease. You don't understand the disease, of
course, until it happens to you, and then you realize the extent
of the pain it causes family members, because we're all involved
then in taking care of father. It was a tremendous sacrifice made
by all, but especially my mother, who wanted him at home.
So the sacrifices are many
for those who are affected by a particular problem, in this case
schizophrenia. Although I've never had any member of my family
affected by it, I understand what it means, based on the stories
I hear.
I agree with your
recommendation and the previous speaker's about changing the
terminology from "community treatment order" to "community
treatment agreement." Even the language itself sends a powerful
message. An order is something you almost want to resist; there's
something bad about the whole thing. I think "agreement"
communicates a different sense of what I think many of you are
trying to get at. I appreciate the language you are suggesting
and I personally agree with it, even through I'm not the critic
in this area.
Is there anything in this
bill that you think may bring problems to other people, not
perhaps to your concern in terms of those affected by
schizophrenia, but others who may suffer from other kinds of
mental illness?
Mr Wall: I
don't think so, for the simple reason that people who are
mentally ill come in sort of two classes: One class has a broken
brain; the other one has a brain that doesn't work on a temporary
basis. The ones where they have a broken brain can't speak for
themselves. That's why you have so few people with schizophrenia
talking to you or listening or being the advocates in all these
consumer-survivor organizations. But the fact that we're going to
allow people to get treatment quicker is important. That's what
this law is all about for me, and for the consumers. I speak for
the ones who called me a Nazi at the Brian Smith inquest who now
support this bill.
Mr Clark:
Thank you for coming. I really appreciate it. As you know, in the
last round of consultations I really endeavoured to bring
everyone to the table to talk about the ways and means to improve
the actual discussion document of the next steps. Out of the
consultation, one of the things that came up was the need for a
balance in terms of rights advice. That came up at all the
consultations. Through that, in the legislation we're proposing
now, we have incorporated rights advice, we have incorporated a
review process, an appeal process, as well as legal counsel. Do
you feel we have done a sufficient job in developing the balance,
so we not only give the patient the right to treatment but
respect their individual rights?
Mr Wall: I want to make sure
that patients have their rights. The rights are a two-sided coin,
as we all know. It's the right to say no, but it's also the right
to be able to have somebody say yes for them. I think it does.
Again, I was on a radio program this morning run by consumers.
When I first went in there they were quite worried about it. When
the program was over, they said: "Oh, we understand. You're not
my enemy." So yes, I think there are rights.
I'll say this much: This is
a different society than it was 20 and 30 years ago, and family
members won't take anything anymore. We are educated, we have the
Internet, we have the ability to communicate, and we are not
going to allow anyone to hurt our kids any longer. It's that
simple. Regardless of what the law is, we'll fight.
Mrs
McLeod: Thank you both for the presentation. Ian, you
can help me understand the way the community treatment order
would work if you would be able to say to me why that would have
made a difference to you. You're obviously aware of the need for
treatment, you're aware of the need for compliance, so how would
this change have made a difference earlier in your experience
with the illness?
Mr Chovil:
Assuming that when I walked into the emergency shelter I was
diverted to assessment for psychiatric illness and possibly
hospitalized-I mean, even after I started on medication, it took
three years for me to realize I had schizophrenia. I took the
medication unwillingly, only at my psychiatrist's insistence.
Assuming I was in hospital and being treated through a substitute
decision-maker, because I was not capable of making an informed
decision, I would be fine while I was in hospital, but as soon as
I was discharged, there was no way that anyone could keep me on
medication, through a substitute decision-maker or any other way.
With a community treatment order, someone can be discharged and
kept compliant with medication until such time as they're capable
of an informed decision on whether to take medication or not.
In that sense, the
legislation as it is now could have gotten me assessed earlier,
in the first year rather than 10 years later, when I got in
trouble with the law. It would have kept me on medication. I
understand that the community treatment order is more of a last
resort sort of thing, but it could have allowed them to discharge
me and I would still have been compliant until such time as I was
able to realize that I was very ill.
Mrs
McLeod: Would you have had to be forced to take the
medication? One of the things we hear is a concern about
people-you know, the image of people being held up against a wall
and forced to take medication. Others have said, no, it's the
fact of having made an agreement that would bring greater
compliance.
1420
Mr Chovil:
It really raises the profile of the medication in the treatment.
Essentially, it makes a world of difference whether you take the
medication or not. It's very difficult for someone to realize
that the medication will help them that much, because unlike any
other drug, it's not an immediate effect. It takes two or three
years before you really see the benefit of the medication, I mean
in the long run. Six weeks, I think, is an average response time
for an anti-psychotic when someone's psychotic.
It raises the importance of
the medication in the treatment and-I've forgotten your question,
because my short-term memory doesn't work very well.
Mrs
McLeod: It's whether or not people would have to be
forced to take the medication.
Mr Chovil:
As I understand it, there will be a series of levels of force, as
you say. There will be an agreement, a gentleman's agreement that
they will take it every night to comply with the treatment order.
If they relapse and have to be reassessed or maybe when they
don't show up for an appointment, they'll be given a phone call
and if they don't answer that then someone will come around to
the house to see where they are. As I understand it, it will be
an increasing escalation of force per se, the ultimate level
being an injection every two or three weeks that will guarantee
compliance with medication. But that's a lesser-quality
medication than the atypicals available now. I understand they
want to use the atypicals first, even in a community treatment
order. I could be wrong.
The Chair:
Thank you both for coming before us. Before you depart, I just
want to tell you, Mr Wall, and the members of your association
who've come before us here-it's important to put on the record in
case not everyone is aware-that these are somewhat unique
hearings. We're holding them after first reading debate of the
bill. Normally, you hold hearings after second reading and
everyone's sort of adopted their formal position, and it's not as
prone to lead to the sort of all-party support for amendments
that we think we see developing right now. So it is very
appropriate that you came forward with your specific proposals,
and the others we've heard so far and will continue to hear. I
want to tell you that already in the discussions behind the
scenes, when we break for lunch and after the meetings, that we
really are seeing from all three parties a recognition of the
importance of moving forward. We do want to hear about specific
suggestions for improvements. We do appreciate the time you and
the members of your group have taken to come and visit with us
here today.
Mr
Marchese: If only we could do that with other bills.
The Chair:
We're setting a trend here, Mr Marchese.
Mr Wall: I
want to say thank you. You all recognize that this is a health
issue, not a political issue. Thank you very much.
The Chair:
Absolutely. Thank you, Mr Wall.
MICHAEL AND MAUREEN CASSIDY
The Chair:
Our next presentation will be from Mr Michael Cassidy. Mr
Cassidy, good afternoon. We appreciate your joining us here
today.
Mr Michael
Cassidy: I'm joined by my wife, Maureen Cassidy, who was
booked for a doctor but it turns out that she is free.
The Chair: Excellent. We have
10 minutes for your presentation. Please proceed.
Mr
Cassidy: Thank you. My wife, Maureen, and I come before
you today to support Bill 68 and to express the hope that it will
be adopted by the Legislature without any significant changes. We
make this submission based on the experience we have had with
Ontario's current Mental Health Act over the past 15 years.
Our youngest son became
seriously ill with schizophrenia in 1985. Over the next 12 years
he was admitted to hospital a dozen times and spent a third of
his time as a psychiatric patient, either in Ottawa hospitals or
at Brockville. We faced countless obstacles, many of them
stemming from the Ontario mental health law, in securing
appropriate care for our son. We are fortunate that today he has
his own apartment, has daily assistance with medication, and with
this support has succeeded in keeping out of hospital for the
past three years. Nonetheless, we cannot help feeling that the 12
years our son spent going in and out of hospital, the revolving
door, could have been drastically reduced or even eliminated if
legislation like Bill 68 had been in force.
As you no doubt know by
now, schizophrenia is the most serious of all the major mental
illnesses. It affects about 1% of the population over their
lifetime in Ontario and world-wide. In many cases, the illness
lasts for decades. Schizophrenia is a disease of the brain, the
serious symptoms of which are its effect on people's ability to
think clearly, to look after themselves and to make sensible
decisions about their lives. It scrambles the brain and often is
accompanied by such symptoms as paranoia, psychosis and
unreasonable fears and delusions. There is no known cure for
schizophrenia, but its damaging effects can be sharply reduced
through the regular use of anti-psychotic medication.
Our story is typical of
many families where someone in the family begins to show the
symptoms of schizophrenia. At first, we thought our son was just
suffering from adolescent growing pains. A psychiatrist who saw
him regularly for over a year failed to identify his illness. It
took three years before we finally had a diagnosis.
Then what? Under the Mental
Health Act, our son was considered well enough to leave hospital,
though his illness was not yet under control. There followed a
series of makeshift living arrangements in student lodgings, in
rooming houses, a disastrous move to Toronto in which he wound up
in hospital, and an attempt to move to Pennsylvania, which was
thwarted by an alert border officer at the United States border.
I should say that because of our son's condition, we could not,
while we were both working, leave him in the house on his own
alone. The security risks were just too great.
Our son would typically
spend three or four months in hospital, where his condition would
improve thanks to regular medication and an absence of stress.
He'd be fine for a few months once he was back in the community.
Then he would stop taking his medication, with the inevitable
result that his condition would deteriorate. All we could do was
watch helplessly. We had learned that there was no point calling
for help to have our son readmitted to hospital because he would
not go willingly, and the conditions for involuntary admission
under the Mental Health Act of Ontario were too strict for him to
qualify until he became desperately ill again.
We found ourselves blocked,
not just by the law, but by the way it was interpreted. The law
allowed for involuntary admission to hospital only if a doctor
was convinced that the patient's mental disorder was likely to
result in imminent and serious physical impairment. As we have
heard too often from other anguished family members, the term
"imminent" has often been interpreted to mean "almost
immediately," with the result that family members who have been
ill for months are often turned away from hospital when the
family appealed for them to receive care, on the grounds that the
sick relative was no longer in imminent danger.
My wife and I welcome the
proposed removal of the word "imminent" in the bill's criteria
for involuntary admission. We also welcome the new provisions in
the bill that broaden the criteria for readmission to hospital of
a patient who has suffered already from serious mental
illness.
After our son was diagnosed
with schizophrenia, we had many episodes where his condition
deteriorated to the point he needed to return to hospital. Even
though schizophrenia is known to endure for many years, we had to
meet the same conditions each time we were seeking to have him
readmitted as an involuntary patient, as though he had never been
ill before. The proposed changes to sections 15, 16 and 20 of the
act mean this will no longer be the case.
Finally, my wife and I
would like to welcome the introduction of community treatment
orders to Ontario under Bill 68. In other jurisdictions, CTOs
have proved successful, both as a tool and as a means of
persuading patients to agree to take their medication
voluntarily. Here again, we cannot help reflecting how the course
of our son's illness might have changed if he had been required
to continue taking medication whenever he was discharged from
hospital. It has taken him 12 years to accept that regular
medication is essential if he is to remain living in the
community, and even now, this is only with the assistance of an
assertive community treatment team.
How much further might our
son have progressed today if he had only had one or two years of
serious illness, followed by regular treatment that enabled him
to control his symptoms and remain living in the community, to
finish high school, to develop his artistic talent and maybe to
go to college, to find a girlfriend or get a job?
We know that Bill 68 is
only part of the answer to the problems of treating mental
illness in Ontario. We are particularly concerned that
psychiatric beds will not be available when they are needed
because of recent cutbacks. The bill will still help, however,
because it is likely to result in quicker admissions when care is
needed, followed by shorter stays in hospital and much less
frequent need for return visits.
When you review Bill 68 and make your
recommendations to the Legislature, we ask you to think of young
people just beginning to suffer from serious mental illness, like
our son was 15 years ago. Must these young people stay in the
revolving door syndrome for 12 years because Ontario puts so much
emphasis on their civil rights that it effectively denies them
needed treatment? Or will you proceed with Bill 68 and offer the
hope that in future, people in our son's situation will have the
chance of early, effective and continuing treatment, and not
suffer the waste of years and of talent that we have seen with
our son?
Thank you very much on both
of our behalf.
The Chair:
Thank you. The committee has about three minutes for questions,
so this time in the rotation we're up to the Conservatives.
1430
Mrs Munro:
Thank you very much for coming and giving us insight into it from
your perspective as parents. We've heard from a number of groups
their concern about this being too broad, the potential for too
many people to be involved, that they would like the definition
to be narrowed. I wonder if you could offer us any comments or
any suggestions in dealing with that concern we have heard.
Mr
Cassidy: Len Wall just told you that 35% of the homeless
are people suffering from schizophrenia. That's what results when
the criteria are too narrow. We've been there and done that. I'm
confident that if you give more leeway so that people can make
appropriate decisions-psychiatrists are not beasts slavering to
put people into hospital. Also, hospital beds are going to
continue to be a scarce resource. That's not really going to
change. There will continue to be problems, but at the same time
I believe that the protections that are there, the fact that it's
72 hours, and then seven days, and there are numerous reviews-the
days when somebody got thrown into a psychiatric hospital and
left there for years on end left us a long time ago. That's not
going to recur.
Mrs Munro:
One quick question: Would you have any suggestions for
recommendations, any changes you would suggest?
Mr
Cassidy: I didn't want to make too many suggestions. I
did think that the conditions related to CTOs were probably a
little too strict. Somebody who came in with a full psychosis,
clearly in need but who recovered very quickly with medication in
hospital after only one episode, but who said, "Look, when I go
out I'm not going to continue taking the medication"-that is a
case for CTO without the rather more arduous conditions in the
proposed bill.
Ms Maureen
Cassidy: I'd like to see them called community treatment
agreements, because that implies a two-way street.
Mrs Munro:
We certainly heard that. As the Chair mentioned a moment ago,
because of the fact that we're doing this legislation at this
point in the process, we are very interested in that kind of
comment.
Mr
Cassidy: We had a friend whose son committed some crime
and was put under a forensic order to take medication for a year.
He'd had a lot of problems, but for that full year, while he was
under that court order, he kept his medication, he improved, and
on the day the court order expired, he was back to where he was
before. I think the CTAs or CTOs will be an effective negotiating
tool. Many people will not even sign them, but they will agree. I
think as well that they will provide enough of a pretext that
people will say, "OK, I've agreed to this, or this is the order,
and I'm going to stick to it." I don't think most people are
physically resistant to taking the medication.
The Chair:
Thank you very much, Mr and Mrs Cassidy. I'm sure, Michael, it
must be somewhat ironic after the debates you probably sat
through in 1978 to update the Mental Health Act. It's an object
lesson to all of us that issues such as mental health and the
Mental Health Act are something that have the potential to touch
any life. I very much appreciate the courage you folks have shown
by coming here.
Mr
Cassidy: I have to say that I speak like perhaps many
people, which is that 95% of us in this society don't directly
experience mental illness through a family member. In 1978, those
amendments went through and it was Greek to me. I just wasn't
there in terms of understanding what was happening and why it
should occur.
The Chair:
The good news is that from all caucuses we have people who have
had a family perspective, family issues relating to mental
health. That's allowed them to be strong advocates for the
changes we're talking about making right now.
Mr
Cassidy: Ottawa Centre is always a leader in progressive
thought. I thank Richard Patten, who now has the seat I held, for
having introduced private members' bills that preceded this
bill.
CANADIAN MENTAL HEALTH ASSOCIATION,
OTTAWA-CARLETON BRANCH
The Chair:
Our next presentation will be from the Canadian Mental Health
Association, Ottawa-Carleton branch. Welcome to the
committee.
Mr Dwane
Unruh: We're going to try to be brief. We would like to
say, to start with, that we agree very much with the submission
you had from the families of people with schizophrenia just now.
I'm actually a family member myself, three times over. I'm also a
program coordinator at the Canadian Mental Health Association in
Ottawa-Carleton. Marnie Smith is a program coordinator as
well.
I'm going to try to get
through this. My voice is flagging, I'm afraid, but I'm going to
try to get through this as quickly as possible so we can answer
some questions. Our perspective is a little bit different from
the previous submissions, but I think you'll find that what we
want is ultimately the same thing for people.
The Canadian Mental Health Association,
Ottawa-Carleton branch, is a non-profit organization involved in
the planning for and delivery of services for people who have a
serious mental illness. Directed by a community board, CMHA works
with a strong network of mental health, social service and
supportive housing agencies, consumer-survivors, hospitals,
planners, family members and funders. We also provide direct
service to consumer-survivors through outreach and case
management services. Our direct services focus exclusively on the
homeless. In the year 1999-2000, the agency provided quality
community-based direct services to a total of 521 homeless
individuals with serious mental illness. Through the mental
health community support services coordinated through our agency,
a total of 739 individuals received long-term case management or
outreach services.
In this submission, CMHA
outlines its response to Bill 68, An Act, in memory of Brian
Smith, to amend the Mental Health Act and the Health Care Consent
Act, 1996. We wish to focus particularly on how the bill might be
amended to address issues related to the community mental health
care system and then to provide some ideas concerning the
community treatment order provisions. I was quite encouraged by
what you had said earlier about this still being an open
process-that's what I think I understood-just after first
reading.
We are aware that the
committee has heard a submission from CMHA Ontario division that
proposed extensive amendments to the bill. We will not try to be
as extensive in our submission, but we do direct your attention
to their submission. Our focus is less on the detail of the bill,
except in relation to certain difficulties we anticipate in
implementing parts of the proposed legislation.
I wanted to focus first on
legislative provisions not present in the bill in hope that you
could reconsider the context in which the bill is situated. We
have grave concerns that Bill 68 focuses narrowly on changes to
the Mental Health Act that will bring in community treatment
orders while ignoring changes that could help to ensure proper
delivery of community-based service to people with severe and
persistent mental illness. The following are submissions
concerning the proposed legislation that we believe would help to
lay the groundwork for a better, more integrated and
comprehensive mental health system.
CMHA has consistently
maintained the need for a comprehensive community mental health
system. Regrettably, the new legislation does nothing to clarify
the various linkages between components of the mental health
system, nor does it establish minimum standards for service
provision. We recommend that the bill be amended to clarify these
linkages and establish minimum standards for service
provision.
The existing mental health
legislation emphasizes hospital mental health services. We
recommend that the bill be amended to include clear delineation
of hospital and community mental health service delivery.
Along these lines, the
legislation should include a statement of rights, similar to the
bill of rights included in the Long-Term Care Act, 1996, that
will apply to all people who use mental health services and
supports governed or funded under this legislation. Included in
such a statement of rights could be the right to dignity and
respect, to least-restrictive environment, to services in the
person's home community and to access to services appropriate to
the person's needs, including special needs, the right to refuse
service, choice of service, a review process and access to
information.
In addition, it is
essential that there be a clearly defined, accessible, effective
and user-friendly enforcement mechanism in place to ensure that
these rights are respected. Possible enforcement mechanisms
include contractual arrangements and/or a readily accessible
complaint mechanism, both internal and external to the service
provider. A patient advocate is an example of what this mechanism
could be-an ombudsman etc.
These legislative steps
would be insufficient, however, if not accompanied by swift
implementation of strong community-based services through greater
funding to community mental health. Currently in Ottawa-Carleton,
80% of all funding apportioned for mental health goes to the
institutional sector. Individuals with severe and persistent
mental illness can wait at least two years for case management
services. Added to this, there is a lack of affordable and safe
housing in Ottawa-Carleton, which has the lowest vacancy rate
among major Canadian cities, at 0.7%.
1440
I refer here to the
prevalence rates of mental illness in Ottawa-Carleton-I have
given you a one-sheet summary-just to give you a sense of the
numbers we could ultimately be dealing with if we had adequate
resources in a community. The estimates here range between 4,458
and 11,887 people who could legitimately benefit from services
that certainly are not adequate to serve that number of people in
a quality way.
Clearly, if sufficient
supports are to be put in place in this region, the underfunded
community mental health sector will need to be supported
adequately and adequate housing resources will need to be
developed. The transition from a fragmented system, biased
heavily towards institutional care, to an integrated system where
60% of funding is allocated to the community sector requires not
only a major reallocation of funding over several years, but also
the infusion of significant funding to create, staff and develop
community based services as the number of hospital beds is
reduced. A multi-year funding commitment is essential. We
estimate that a further $320 million in transition funding is
needed to ensure success. Moreover, the provision of appropriate
housing for persons no longer "housed" in hospitals will require
large additional sums for the acquisition, operation and
maintenance of such housing. Some estimates in this area suggest
a need for a further $250 million in ongoing funding.
At this point I'd just like
to point out the book we've given you, this handout, which is a
consumer preference survey our agency had sponsored through an
independent body to assess the preferences in all areas, whether
it's housing, what kind of supports, how they want the mental
health system to work with them. If you were to peruse it, this
may give you some idea of what the consumer-survivors are saying
and what they feel is needed, based on their own experience in
our community in Ottawa.
With regard to parts of the
legislation that refer to community treatment orders, we wish to
make the following observations. We are as hopeful as anyone that
the concerns of the previous speakers could be addressed
adequately; we're just not sure that they can be addressed
through community treatment orders, so we want to raise some of
the potential problems.
We have serious concerns
about the implementation of community treatment orders. We have
taken the position in the past that our community does not need
community treatment orders; it needs adequately funded community
mental health services such as case management and outreach
services. Evidence provided to the committee by CMHA Ontario
division has suggested that community treatment orders have not
been proven to be successful; what has been proven to be
successful, however, are community mental health services that
are flexible, voluntary, mobile and
psychosocial-rehabilitation-based, like case management and
outreach services. Very often, when studies have been done of
community treatment orders and when they have shown some measure
of success, they can only attribute that success to the services
that have been attached to the community treatment order.
Some confusion exists as to
when community treatment orders might be used. If a person is
"formable" under the Mental Health Act, ie, they meet the
criteria for involuntary admission to a psychiatric facility,
they pose a current threat to themselves or others. If one is to
consider the safety of the community and of the person, a release
into the community could only be contemplated, it would seem,
once a person no longer meets the criteria for involuntary
admission under the Mental Health Act. Otherwise, the release
into the community represents a significant increase in liability
to the practitioner who signs the order and possibly to any
community-based agency that agrees to participate in the order.
I'm not sure that people have considered the safety issues that
might be involved in actually letting someone who otherwise would
be "formed" and put in the hospital out at that moment.
On the other hand, if a
person no longer meets the criteria of involuntary admission
under the Mental Health Act, what incentive would there be for
the person to sign a community treatment order, since it will not
shorten the person's stay in hospital? If we can no longer hold
them in hospital, we have nothing with which to coerce them into
signing a treatment order. Despite great hype in the media, it is
hard to see how major inroads in the provision of services to
individuals with serious mental illness will be made through the
provision of community treatment orders-and I might say through
community treatment orders alone, but maybe just in general.
Moreover, we are
uncomfortable with the role of enforcer that community agencies
may be forced to adopt in relation to community treatment orders.
The development of trusting relationships with clients is the
cornerstone of our direct services. Although we have in the past
been and will continue to be involved on occasion in forming
someone under the Mental Health Act, this process is clear in its
relation to safety issues as they relate to the current situation
of the client. A client of the agency may agree to terms in a
community treatment order that they later regret, and although
fully competent to make this decision, cannot easily revoke. An
agency's role in enforcing such an order may well be problematic,
and that's just one example of where it may be problematic.
Despite these comments, we
do not wish to focus at great length on the community treatment
orders, as we wish to ensure that the issue not be allowed to
obscure the larger issue facing the mental health system at the
moment, that being that at the present time, Ottawa-Carleton does
not have sufficient community mental health services to meet the
demands of our population. There is skepticism in our community
that new mental health legislation will remedy the gaps in the
present system and provide an integrated service delivery for our
citizens who have a serious and persistent mental illness. Unless
the new Mental Health Act legislation enshrines in it the
specifics of a comprehensive mental health system, there is a
concern that the legislation will not provide a sufficient
platform for reform of our system.
We exhort the members of
the committee to bring this perspective to the Mental Health Act
amendments and to recommend sweeping changes to ensure that the
Mental Health Act becomes the first player in a series of changes
to the mental health system that will finally bring about the
integrated, comprehensive system long awaited by this and other
Ontario communities.
I'd like to thank you for
the time we've had, and we'll be willing to answer any questions,
specifically Marnie, because my throat is about finished, I
think.
The Chair:
Thank you. That leaves us with about five minutes for questions,
so I'll divide it this time between the Liberals and the NDP.
Mr Patten:
Thank you for your presentation. I certainly concur that unless
you have a comprehensive system, as you call it, this is not
going to work. There are opportunities for amendments, and I
think you will see some of those go forward.
The one thing, though, that
I would like to say is that you refer to no evidence of anything
positive from community treatment orders. I must tell you, I
don't like the term "community treatment order," because it
historically came out of our court system. I believe the intent
of this is to arrive at maximizing a consensual agreement with
the patient or their substitute decision-maker. There is evidence
that being part of this, with the seriousness of the arrangement,
the agreement, it does have some impact, number one. Second, there are three
studies in particular, some a little more recent, that show some
rather significant reduction in hospitalization of those who are
on a CTO. It seems to me that that opportunity, while it is an
alternative to a hospitalized situation-there are some
encouraging signs when you look through the literature, as I
think many of us have, though that literature is not massively
extensive, of course. It's a matter of how you want to interpret
it.
1450
Ms Marnie
Smith: There's no doubt, Mr Patten, that it's very
important to try to figure out ways to get treatment for our
client sector and for people who have mental illnesses, because
we understand, from our working perspective with our clients,
that it is often difficult to access services. We've been fairly
successful in doing so when we have had workers who have been
able to monitor clients and then get them into services. I think
there's a lot in the legislation now that will help, in some of
the wording changes, where "imminent" will come out, and also if
there's education and training done across the hospital sector on
how broadly the terminology can be interpreted. I know Michael
Bay had done a wonderful education and training exercise
previously, and hopefully something like that can also occur in
the future so that when the legislation is passed, it will also
be used in the way it should be used. I think that was what Dwane
was really tapping into, that we did have a lot of difficulty
when we brought our clients in, trying perhaps to get an
assessment in emergencies, or an admission. Sometimes it wasn't
being interpreted that it was time they could be admitted to the
hospital. There's no doubt it's a problem. But I think there is a
difficulty in believing that community treatment orders or
agreements, however we'll word it, will be the answer to what's
occurred without getting treatment for clients. I think it'll be
one of the mechanisms of doing so, which will be great.
The importance that I think
the ministry has to add into this, though, is looking at, what
does the system of community mental health services look like in
our area? We're very underserviced in this area, and I'm not
really sure, with the discussions we've had to date, whether
that's going to be very quickly remedied. For example, in the
program I co-ordinate, we applied for 30-some case managers. We
just got funding for 10. The ministry is not really funding what
they said should be in place in communities. It is difficult for
us as community agencies, when we definitely want better service
for our clients, to try and sort through and figure out how you
will do that with the resources we have.
The Chair:
Unfortunately, Mr Marchese, a long question and a long answer
have taken up the time, so we'll start with you in the next
rotation.
Mr
Marchese: Was that five minutes?
Ms Smith:
I didn't think that was five minutes.
The Chair:
It was indeed. Time flies. Thank you very much for coming before
us today. I appreciate your taking the time to bring your views
forward.
OTTAWA-EASTERN ONTARIO RESIDENTIAL CARE
ASSOCIATION
The Chair:
Our next presentation will be from the Ottawa-Eastern Ontario
Residential Care Association. Good afternoon, and welcome to the
committee. We have 20 minutes for your presentation, sir. If you
care to leave any time for questions, I'm sure Mr Marchese in
particular would be most grateful.
Mr Jean-Guy
Nadeau: Good afternoon, Mr Chair, ladies and gentlemen
of the committee. I'm Jean-Guy Nadeau, the president of the
Ottawa-Eastern Ontario Residential Care Association. We represent
domiciliary hostels in Ottawa-Carleton, also known as residential
care facilities. We are providing care to the mentally challenged
population, and because we work on a continuous basis very
closely with individuals who stand to be affected by Brian's Law,
we would like to comment on the proposed Bill 68.
To begin, we would like to
stress that we do not want to infringe on individuals' right to
freedom of choice when it comes to medical treatment. Our
facilities have always worked in conjunction with community
agencies to ensure that the rights of this population were
respected. Nevertheless, we have to be realistic and say that at
times, when they are ill, mentally challenged individuals fail to
realize the seriousness of their condition and do not recognize
that they need professional help. Even when the family is
involved, it may be very difficult for them to make the right
decision because of their emotional involvement. As a result,
they do not insist that proper medical action be taken, and then
the individual remains untreated.
The end result is that
sometimes mentally challenged individuals have episodes during
which they are a danger to themselves or others. There is no
doubt in our minds that the incident that ended with the tragic
death of Mr Brian Smith here in Ottawa occurred during one such
episode. To prevent similar events from happening again, as a
community we have to accept that there needs to be a balance
between the individual's right to accept treatment and the right
for the rest of the population for a safe and secure
environment.
Based on our experience in
caring for the mentally challenged population, we feel that this
bill is a positive step towards solving several social
problems.
It is also a fact that a
large percentage of the homeless population consists of mentally
challenged individuals who have refused medical treatment. This
bill represents another tool that can be used by care providers
to assist these individuals and give them a chance to improve
their lives.
In our view, this bill will
also contribute to reducing the homelessness situation by
providing this population with the stability they need to
function in a group setting. It is often the only requirement
missing for our facilities to be able to provide them with a
place to live and services to enhance their future. We are
experienced, well equipped and trained to house this vulnerable
population and are
positive that we can make a positive change, given the
opportunity. This bill will give us such an opportunity.
The Chair:
With that, you've left lots of time for questioning. Mr Marchese,
you'll start the round, and we'll be going for about three and a
half minutes per caucus.
Mr
Marchese: Mr Nadeau, there was one individual who spoke
earlier about the fact that we really don't have a community
service problem but, rather, the problem lies with the individual
and the problem he or she has in terms of being able to access
the service. Previous speakers talked about how lacking we are in
so many areas of community services. What is your experience in
terms of whether or not we have what is needed in the community,
that there is really a different kind of problem?
Mr Nadeau:
As we mentioned, we are working closely with community agencies
to take care of those people. As residential care facilities, 99%
of our residents are mentally challenged people. Those who have
come to our residences have benefit of the medical treatment. The
degree of care that we could provide in our homes could be
extended to more people could they be convinced originally for
the medical treatment. They will be more receptive to go to one
of our homes, because they don't really like to go to a home
where they have to live with certain rules, where they have to go
for a meal at a certain time and have to go to recreation at a
specific time. We find that's where the difficulty is. If they
had been able to have access to the medical treatment, it would
be easier to convince them that, yes, they do need some help and
they could go to some of those homes where they could be
assisted.
Mr Clark:
Thank you for coming out today and making your presentation. For
clarification's sake, in your presentation you referred to your
patients or the residents who are living in your facilities as
mentally challenged, a slightly different nomenclature than
"seriously mentally ill." Are the patients living in your
residential care programs people in terms of community living, as
what we would know in the political world as mentally challenged,
or are they suffering from mental illness?
Mr Nadeau:
The majority of the illness is schizophrenia. I would say in our
homes about 75% of them have schizophrenia. Some of them do not
accept to be so and do not want to be treated, but when they have
been diagnosed and they have accepted it, they can have medical
assistance which has turned around their lives completely. We
also have some who have double personalities, some who are
manic-depressive, but the majority have schizophrenia.
1500
Mr Clark:
Do you see in your mind, then, that the supportive housing in
terms of residential care that you're talking about could
actually form a component of a community treatment order, that a
physician or a psychiatrist would state, "Here's a number of
terms and conditions, one of which is that you will be living in
this particular facility and working with these particular
people"?
Mr Nadeau:
We have been providing that service for several years. The
majority of our residents, at the outset, when they have recently
been diagnosed and have accepted the diagnosis and have come to
our homes, are followed by a psychiatrist. We make sure that
their meetings are met and that they do go to any medical
appointments.
Mme
Claudette Boyer (Ottawa-Vanier) : Bonjour, Monsieur
Nadeau. C'est un plaisir de vous revoir. Ces deux résidences
sont justement dans le comté d'Ottawa-Vanier, alors je suis
un peu familière avec ce qui se passe. Ce sont des gens qui
sont schizophrènes, et je vous remercie de tout le travail
que vous faites, vous et monsieur Howcroft, avec
« hostel care » et tout ça. Est-ce que
vous pourriez faire un plus grand travail ? Est-ce qu'il
vous manque des fonds ? Est-ce que ce projet de loi devrait
proposer d'avoir plus de financement ? Ce que j'ai pu voir,
ayant visité, et même M. Baird, avec Edgewood, ce
que je me suis fait dire à ce moment-là, c'était
que si vous ne recevez pas le financement adéquat pour ces
programmes-là, vous devrez laisser ces gens-là aller
et, comme M. Clark a dit, if these people don't get the full
funding, they will be on the street and they will be homeless
people. J'aimerais que vous nous dites quel est le financement
que vous devriez avoir pour pouvoir continuer le bon travail de
« hostel care ».
M.
Nadeau : Exactement. En juin l'année
dernière, lorsque nous avons commencé à travailler
pour sensibiliser le gouvernement au programme qui est en
vigueur, on n'avait pas eu d'augmentation depuis 1993. Après
avoir fait une étude de nos services, afin de pouvoir
continuer le même service, que nous n'avons pas
négligé même si nous n'avons pas reçu de
fonds depuis 1993-nous étions rémunéré à
un taux de 34,50 $ par jour-nous avons démontré
que cela nous prenait une augmentation de 10 $ par jour des
34,50 $ par jour juste pour « break
even ». Présentement, on continue à donner le
service dans nos maisons mais au détriment de nos fonds
personnels que nous devons ajouter dans la compagnie à la
fin de chaque année pour être capables de continuer
d'offrir ces services.
Là, l'année
passée on était vraiment sérieux que quelque chose
devait être fait parce que nos fonds personnels
commençaient d'être pas mal éliminés à
un niveau qui n'était pas raisonnable. Si rien ne se
produit, nos maisons commencent à tomber-l'une est
présentement tombée en
« receivership », Rothwell Heights, qui est
sur le chemin Montréal. M. Howcroft, qui a Edgewood,
une grande maison, a des déficits extraordinaires. À
moins que le gouvernement ne reconnaisse notre programme, lui
proposait de changer sa façon d'opérer. On est
sensibles aux gens s'ils sont dans la rue. Il y a 150 personnes,
ce qui veut dire que 150 autres personnes tomberaient dans la
rue.
Heureusement, la
région a réalisé que c'est un problème
sérieux. Notre programme, dont vous êtes au courant,
est financé à 80 % par le gouvernement
provincial et à
20 % par la région. La région a dit :
« On va procéder en avant et nous allons donner
notre 20 % immédiatement. » Donc, "effectif"
le 1er janvier, nous avons eu 2 $ des 10 $
que nous cherchions. On est présentement
rémunéré à 36,50 $ par jour, et on est
touché par ça.
M. Baird, du gouvernement,
a reconnu l'urgence ici à Ottawa-Carleton et il a donné
un « one-time-only grant » de 550 $
mille, ce qui représente à peu près 2 $ par
jour. Mais ceci va se terminer le 31 décembre de l'an
2000. Qu'est-ce qui va arriver le 1er janvier de
l'année prochaine ?
Nous voulons continuer
à donner les services, mais nous allons quand même
sensibiliser le gouvernement à Toronto maintenant que nous
avons beaucoup de difficultés à avoir une réponse
positive là-dessus.
Mme
Boyer : Merci beaucoup.
The Chair:
Any further questions? Thank you very much, Mr Nadeau, for coming
before us today. It's a different perspective you brought, and we
appreciate your taking the time.
CHRISTINE RENAUD
The Chair:
Our next presenter will be Ms Christine Renaud. Good afternoon,
and welcome to the committee.
Ms Christine
Renaud: My interest in being here is very personal. I
have a sibling who suffers from schizophrenia. It was about seven
years ago that he probably hit the heights of the illness. Like
many other families, we spent years of cycling in and out of
hospitals. He's destroyed furniture, run up debts, walked out of
restaurants etc etc. On one of our last visits to the hospital,
he went in there voluntarily, asked us to bring him in, and he
brought with him pages of ramblings-I can't think of a better
description for it-that clearly indicated he was ill and needed
help. He was asking for help. He was contemplating suicide. Even
with all of that and presenting all of that, the attending
physician refused to sign him into the hospital, saying he didn't
meet the criteria.
They wanted to release to
us, to which one of my older sisters said: "That's fine. You do
that. But when he kills himself tonight, we will be back." Only
after we made that threat did they sign him in. Needless to say,
before the night was out and before we had made it back home,
he'd signed himself back out and was back out on the streets.
It was then that I decided
that I was attacking this from the wrong way, that it was the act
itself that prevented me from getting him the help he needed,
that he couldn't help himself until I had rules and something in
place that would allow me to do that. I'm digressing from my
presentation, but this is essentially what it gets down to. As I
say, my quest began there. It was aimed at changing an
ineffective act that put the onus for receiving equitable and
compassionate medical treatment on the mentally ill person-the
very same person who suffers from an illness that, by its very
nature, makes it impossible for that person to know they need
help, let alone to be of the capacity to ask for that help.
It was an act that
prevented family involvement. The physicians couldn't speak to
us, even though we knew long before them when he was ill and when
he needed help. The only way we could do that or could get
interference was with a court order, and then we just ran into
more difficulties there.
Because of all the
roadblocks built into this Mental Health Act, members of our
society are left to suffer, left to die, left to serve time for
crime, or just to serve time because there's a lack of any other
facility for them to be treated at. Then they're on the streets
and you see people pointing at them and laughing at them, and all
I think is that they're somebody's brother, husband, wife or
sister and it's because of the system and years of histories that
they are now here. I always remember that there is probably a
thin thread between them and me.
I cannot find a cure for
mental illness, so therefore, as I say, I've taken up this quest.
Anything I can do to assist him or any others suffering from
mental illness to get the assistance, I want to be there.
It appears that the
community treatment order certainly is the right step towards
that. It seemed to me when I read through this and when you
listen to the concerns, over and over the questions are: Is there
a problem? If there's a problem, what is it? Are there other
options? And of course, with those options, are we then
infringing on their human rights? I've always been of the
personal opinion that as long as I allow my brother and others to
sit on a street slowly dying, then I have infringed on their
right to medical treatment.
I've reviewed the current
proposal and I'm going to try to aim at that and some of the
problems I see or some of the loopholes. It might be that it's
still at its early stages and is very much a discussion paper.
One of the changes that I think needs to be made or one of the
recommendations is the inclusion of family and friends as the
caregivers, and I don't mean the aunt who comes to visit once
every six years, but somebody like me, who has lived it and
breathed it for seven years with my brother. We are well aware,
so when we call we should be taken seriously, that when we ask
for assistance we get that. I think we can provide that valuable
input to both sides.
1510
I also think it's crucial
that there is action on any warrants or any community treatment
orders issued. I know that when we went to the police, twice,
having involuntary orders-and it's in here-the first reaction
was: "Well, it's you guys who have the problem. He doesn't. He's
just fine." The second time, Mark explained to them that we were
out to get him, so they released him outside of the hospital
doors as we stood there in the emergency room watching him run,
to which the doctors and the police said to us, "Boy, that bugger
can run." We're thinking: "I'm glad you think it's funny. Now we
have to go find him again" sort of thing.
There's a section in the
bill that deals with police enforcement, entitled "Unauthorized
absence," and I notice
two words or statements in there that concern me. One of them
begins with the statement, "Where a person who is subject to
detention is absent without leave..." and goes on to say that if
an order has been issued, the police "may, within one month after
the absence becomes known to the officer in charge, return the
person to..." As I said, "may" is not going to work. It must be
"must" action it, because when we've had legal orders, we've not
had them actioned, or the action we've gotten has not been
sufficient, in my personal opinion. I think that has to be made a
little stronger, that you have to say "you must" order. Trust me,
when I've gone in and I've gotten an order essentially to arrest
my family member, I've not done that lightly. It's because I know
they're in the throes of life or death, truly. To allow up to a
month, it's too late, way too late, at that point; there's no
sense in my getting the order, there's no sense in doing this, I
guess. I think those things have to be considered.
We've all said and we'll
say over and over again, and I've often said, that it's a tragedy
that Brian Smith had to die and die the way he did, but at the
same time he has given us not-so-famous people a voice here. He
probably was pivotal in the amount of attention that was given to
the whole cause. I'm not saying it was always ignored, but it
certainly increased the attention here. I will always be mindful
that he didn't die in vain, and I guess that's all I can offer up
to his family, that he didn't if this act definitely does come
forward.
I guess that would be all I
have to say, unless you have some questions, aside from thanking
Richard very much for listening and giving me this opportunity,
as well as committee members. It's the first time I've ever truly
felt I'm doing something for my brother, and I thank you for
that.
The Chair:
There are three minutes for questioning, and I'll give it in the
rotation this time to the Conservatives.
Mrs Munro:
First of all, let me thank you personally for coming forward
today. I can appreciate, as with those other members of the
community who have come forward, how difficult it is for you to
do this. Your comments here are very valuable to us. The
information you can provide from that personal position is
extremely important. I think you were here earlier when it was
explained that this is in an early stage of the process and that
we're particularly interested in getting advice from individuals
such as you.
One question: A number of
people have expressed concerns about the fear that this kind of
legislation might make it too broad in its interpretation.
There's a fear that more than those who need this kind of
response would in fact find themselves in that position. I just
wondered whether you had any comments to make on addressing those
fears.
Ms Renaud:
I don't think so. I think this act is very specific, because it's
essentially dealing with where the problems were with such
quotations as "imminent" danger to themselves and so on and so
forth, and that doesn't take in the whole broad spectrum. It
generally is probably for those bipolar diseases such as
manic-depressive in the worst of the manic stage, and
particularly for paranoid schizophrenics or schizophrenics. I
don't know that it would necessarily apply to somebody who was
having a nervous breakdown and so on and so forth. It's sort of
half a dozen of this, a dozen of that. You make it so strict
again that I'm standing there-
Mrs Munro:
Powerless.
Ms Renaud:
Yes. So I don't believe it would. I certainly think it's
fine-tuning we will be doing. It will probably be a working
document for some time.
The Chair:
Thank you, Ms Renaud. You made comment towards the tail end about
"if this act comes forward." I can assure you the bill will be
going forward expeditiously. It's whether there are some changes
and improvements we can make to the draft you see before you now
that is the only matter up for discussion. I'm confident that all
three parties share a zeal to get this through the House
quickly.
Ms Renaud:
Well, if I can do anything more.
The Chair:
Thank you.
KAREN WILSON
The Chair:
Our next presentation will be from Miss Karen Wilson. Good
afternoon, and welcome to the committee. Thank you for joining us
here today. We have 10 minutes for your presentation.
Miss Karen
Wilson: I don't think I'll need that much time. Having
listened to everyone else, I feel kind of unprepared to deal with
the specifics of the bill, but I'm a consumer-I suffer from
schizophrenia-and I'd like to just give you a bit of a personal
story. I can testify to the fact that at the time I most needed
medication, I wasn't able to make that decision for myself, and
to the difference that medication has made in my life.
My earliest recollection of
something going awry in my mind occurs in 1989-90, during a year
I spent in Europe. As I look back on that time, there were a
couple of instances where I believed people were able to read my
mind. These instances were isolated, and for the most part of
that year I was functioning in the real world. However, when I
returned to Canada the following year, things began to go very
wrong with the inner workings of my mind. At first I suspected my
friends were plotting different things behind my back, and
eventually that paranoid belief progressed to believing that my
apartment was bugged by police and that my friends and family
were constantly putting me under hypnosis, among other things. I
heard other people thinking my thoughts, I found special meanings
in slogans I would see, believed that public speakers and TV
personalities were having conversations with me, and I eventually
manifested a complete incapacity for dealing with reality. I
continued working until approximately 1993, when I accused the
pastor I worked for of being a cop and his whole church of being
a sting operation.
I was first presented with
the diagnosis of schizophrenia, as near as I can remember, in
1992. Upon hearing the
diagnosis, I immediately rejected it, as the voices that took
over my mind constantly told me that I did not have
schizophrenia. I did, however, briefly try medication. I hated
the side effects: stiffening muscles, blurred vision, and even an
inability to make myself walk. Not believing I had schizophrenia,
I quickly went off medication.
I spent several years in a
psychotic world. The best way I can describe living in that world
is to say it was a tortured existence. I believed I had
absolutely no privacy. Voices in my head told me my deceased
parents had been evil. I consequently destroyed all the
sentimental things of value I possessed, including their wedding
bands. This was a completely false belief, as I was brought up in
a very loving family. Uniformed police officers once showed up at
my apartment because I had been screaming at the night, at the
perceived police I believed had bugged my apartment. Suicidal
thoughts and urges plagued me.
My psychiatrist, while I
continued regular appointments with her, could not reason with
me, as I believed she was working for the police. I had alienated
myself from family and friends and burned bridges in my career.
My sister and brother were beside themselves trying to get me
help. They felt they possessed no legal avenues for getting me on
medication or having me hospitalized. I was now living on
welfare, which eventually led to me receiving a disability
pension.
Eventually, out of fear
that I would be evicted from my apartment, I shared some of my
fears with my psychiatrist, who, as usual, offered that I take
medication. She agreed to try a different medication, in the hope
it would have fewer side effects. I told her once again that I
didn't need medication because I did not have schizophrenia. She
countered with the notion that the medication would help me with
some of the frustrations I was feeling. Believing the medication
would somehow act as a tranquilizer and help me to feel calm in
the face of constant police surveillance, I decided to take
it.
Two weeks after I had been
on medication, I awoke out of the psychotic world I had been
living in for years. I began to cry and realized that I had
schizophrenia. I immediately called my psychiatrist and told her
I needed help in dealing with the fact I had the illness. She
reminded me that I had been on medication for approximately two
weeks and it had begun to do its work. I began calling my friends
to tell them I had schizophrenia, and interestingly enough, two
of my closest friends used the same words with me: "Welcome back,
Karen." The friend who had been lost to them for years had now
returned via medication. I consider medication to be my miracle.
I have been functioning in the real world now for about four
years, and I have recently returned to work part-time.
As I mentioned before,
living in a psychotic world is to live somewhat of a tortured
existence. I cannot help but feel that my family, rather than me,
could have made the decision for me to go on medication when I
was in a frame of mind that rendered me incapable of making a
rational decision. I'm sure if they had, I wouldn't have lost so
many years of my life. Also, my decision to go on medication was
a fairly precarious one. I made it tentatively. If I had
experienced significant side effects I'm certain I would have
ceased to take it. My mental health wasn't secure in my own
hands.
1520
As far as schizophrenia and
other mental illness is concerned, there will be no real cause
for celebration until a cure is found, but I believe this bill
will help to make the best of a very bad situation, enabling
people who can help themselves, indeed people who may be of
danger to themselves or the minority-and I stress the
minority-who may be dangerous to others, to receive the help they
need.
The Chair:
Thank you very much. We have about five minutes left for
questioning so we'll try again this time to split it between the
Liberals and the NDP.
Mrs
McLeod: I'm not sure I have a question. You've told your
story so well. I just want to thank you. I'm sure it's not easy
to tell a personal story in such a very public setting. I think
one of the questions we've all been asking is, how does a
community treatment order help? But I think you've said very
clearly that if your family could have been in a position,
authorized to prescribe medication for you, that would have
allowed you to return to the real world much sooner.
I guess my only question,
and I've been asking it repeatedly, is whether or not you think
at any point it would have been necessary to actually forcibly
have you take medication, and are there ways of avoiding that?
There are images of people being forced to take the medication,
and whether or not there are ways to avoid that.
Miss
Wilson: I think good psychiatric care is one way. Even
though I believed my psychiatrist was acting with the police, she
constantly offered me medication on a regular basis and she
didn't deny me treatment when I wouldn't take medication. So
maybe that's one way. I don't know, sometimes I think force is
just necessary, because like I said, you're acting so
irrationally you're not able to make that decision for
yourself.
Mr
Marchese: I'm just curious. Once you took the drug that
the doctor prescribed and it worked, it was then that you
realized you had a problem. If it hadn't worked you would have
continued to deny you had a problem. Is that it?
Miss
Wilson: I'm sure I would have if it hadn't worked.
Mr
Marchese: And because it worked, you said, "I have
it."
Miss
Wilson: Yes, and because the side effects of this
particular medication weren't so bad I decided to stick it out,
but it took two full weeks for it to kick in. The first day I
took it, I didn't realize I had schizophrenia. It was when I
phoned my psychiatrist and she reminded me that it had been two
weeks since I started taking the medication that I realized it
worked.
Mr
Marchese: Thank you for your presentation.
The Chair: Thank you on behalf
of the entire committee, Miss Wilson, for a very articulate
presentation. I thank you very much for taking the time to come
before us.
CANADIAN ADVOCATES FOR PSYCHIATRIZED PEOPLE
The Chair:
The clerk has not seen the 3:30 presenter yet, so if Ms Clark is
around? Hello, Ms Clark. In light of a vacancy, if you'd care to
move up your slot, we'd be happy to hear from you now. You have
20 minutes for your presentation.
Ms Sue
Clark: Please bear with me, because I stutter. I am Sue
Clark, director of the Canadian Advocates for Psychiatrized
People, CAPP. We are former psychiatric patients who lobby all
levels of government on the issues of housing rights, welfare
rights, mental health reforms and social justice issues etc. We
have supporters and advisers from several community groups. My
asthma is acting up too.
Our group is opposed to
Bill 68. The story I will tell you is why we think Bill 68 will
not assist people in our community.
On November 3, 1997, a
woman from Ottawa was with her brother and they decided to go to
the Chapters bookstore on Rideau Street in Ottawa. The woman had
a Web site she wanted to show her brother on the Internet at the
store. The computers were being used so the two decided to have a
coffee and wait. A security guard came up to the woman and her
brother and told the woman to leave the store. When the woman
asked why, she was told: "Last night we think you tried to steal
a book but we saw you put it on the coffee table, so we want you
to leave the store for good. I followed you out of the store and
told you to stop and you didn't."
The woman looked puzzled.
Her brother was shocked that his sister was being treated so
rudely. This woman had a high profile in the community and was an
honest person. She had bought five books the previous day and
told one of the managers she was treated rudely by a salesclerk
and showed the manager the receipt for the books. When this was
told to the security guard, he stated, "They all say that."
The woman refused to leave
the store and asked that the police be called to assist the
woman, as she thought her rights were being violated. The
security guard mocked the woman as he called the police. Two
police officers were called.
The woman suffers from
post-traumatic stress disorder. The woman became very vocal and
loud as a crowd was gathering to see what the altercation was all
about. The man and woman police officers said that a quiet area
would be appropriate to ask for more information. The Chapters
staff brought the group to a room at the back of the store on
Rideau Street on the ground floor which had two swinging doors
and two small windows. The male police officer, Steven Bell, told
the group to stay back from the windows and he led the woman
alone into the back room. He grabbed her left arm roughly and
said, "This is what we do to people who steal." The woman
protested she had done nothing wrong and reiterated her story.
She had to sit down as her legs had arthritis, and Bell, the
officer, shoved the woman down on the chair with his hands.
The brother was frantic and
yelled, "What is going on in there?" Bell motioned to the group
to come in. The woman officer questioned the lady. The lady told
her the male cop was rough with her. The male cop said: "This
woman should be on medication. I had to manhandle her because she
wouldn't comply with me." This was untrue; the lady did comply. A
notice of trespass was given to the woman in a form, and a notice
of civil litigation for having stolen books by Iron Horse
Investigation Co was issued to the lady in question.
The lady went home and was
upset and called her friends. She saw bruises on her left arm and
had the police take pictures of her arm later that evening. The
next morning she had a bruise the size of a grapefruit on her
chest. She called the Chapters headquarters in Toronto and told
them the story. Nothing was done. Two days later she had a daily
protest outside the Chapters store on Rideau Street. A rally of
supporters came one day and she had a radio interview on CHUO.
Thirteen days of protesting later, the vice-president of
operations for Chapters in Toronto, Daniel Soper, spoke to the
lady. A letter was sent to the woman apologizing to her and
rescinding the trespass notice and civil litigation form, signed
by Daniel Soper, VP, Chapters, Toronto, Canada.
She was allowed to go back
to Chapters as a "valued customer." The security firm was kicked
out of Chapters and a new firm put in. A police complaint was
filed and nothing happened. A year later, the woman protested
outside the Ottawa-Carleton police station on Elgin Street and
asked for a formal apology from Brian Ford, the police chief. The
police chief never apologized, even though they had the letter
from Chapters rescinding everything. A lawsuit is still pending
against Chapters and the police.
1530
The woman in this story is
me. Again, the woman in the story is me, Sue Clark-and my
brother, Chris Legare. How many similar stories of civil
injustice like this will happen, suggesting someone needs
psychiatric drugs, if Bill 68 becomes legislation in Ontario?
That is the question.
Thank you for allowing me
to speak to you today. My advocate, Jane Scharf, can be reached
to verify all of the above at 1-613-258-6176.
I'm not finished yet. There
is something that was written by Pastor Martin Niemoller. Some of
you may know this. It goes like this. Bear with me for my
stuttering; it's one of my disabilities, along with
post-trauma.
"In Germany they came first
for the Communists, and I didn't speak up because I wasn't a
Communist. Then they came for the Jews, and I didn't speak up
because I wasn't a Jew. Then they came for the trade unionists,
and I didn't speak up
because I wasn't a trade unionist. Then they came for the
Catholics, and I didn't speak up because I was a Protestant." I'm
actually Irish, by the way. "Then they came for me, and by that
time no one was left to speak up."
I speak for my peers in
Canada today. We are opposed to Bill 68.
Any questions, please?
The Chair:
Thank you. That leaves us about three and a half minutes per
caucus, up to three and a half minutes each.
Mr
Marchese: Sue, I just wondered, have you had an
opportunity, you or other people who are part of the Advocates
for Psychiatrized People, to review the bill?
Ms Clark:
We've taken a look at the bill.
Mr
Marchese: So specifically as to what is contained in the
bill, you are opposed to-
Ms Clark:
All of it. All of the bill. That's my answer: all of it. We don't
like anything that forces someone to have forced medication. In
the first place, dangerous people should be locked up and not on
the streets at all, and that is a point we're trying to make.
They shouldn't be on the streets in the first place. Dangerous
people should be locked up for life and not let out on probation
a few years later to walk the streets. They should be locked up
for life. That's what we think.
Mr
Marchese: If I can, so part of the story you were
telling us is to show how a person could be discriminated against
on the basis of one's behaviour, possibly, in terms of-
Ms Clark:
Yes.
Mr
Marchese: You said you were looking at the book and
you'd left it somewhere else-
Ms Clark:
I had put it down, yes.
Mr
Marchese: -and as a result of that, that person followed
you and the story ensued. Your point is that discrimination
exists on the basis of how one appears or how one-
Ms Clark:
Well, what happened, sir, is that as soon as the security guard
said, "We know you didn't take the book, but leave the store," I
felt my rights were violated, because my brother was also at one
time a security guard, and he went up to the man and said: "Hey,
I was a security guard. I can vouch for the credibility of my
sister. She's an honest person." Another point we're trying to
make here: If Bill 68 was in action at that time, Officer Bell
could have had me incarcerated immediately down to the ROH
factory and I could have been incarcerated against my will. I
would have, of course, called Chapters, but I could have been
incarcerated against my will, and I had done zero, nothing
wrong.
I'm also concerned about
the pending lawsuits you are going to have when people have done
nothing wrong. What happened at Chapters is that I became very
upset and agitated. I yelled out loud and said, "Hey, my rights
are being violated." I asked them to call the police because,
hey, why should I leave the store? I was just having a coffee and
minding my own business waiting for the computer. So I became
agitated, which is part of post-trauma. I can get excitable. That
is not a mental illness; that is part of the post-trauma, like a
war vet. I got very hyper with being accused for something I
didn't do. So I'd be very clear on that.
This bill is a very scary
piece of legislation. I myself have post-trauma and suffered a
very abusive childhood and two bad marriages. If I saw someone
who looked like my ex-husband, I could yell at the man on the
street, not thinking, "Oh my goodness, it might be him." Someone,
hearing me yell on the street, could say: "Hey, that lady looks
crazy. Call the PD." But that's not the case. Some people like me
have dissociative disorders caused by very severe abuse.
If you don't look into
those issues, you're heading into a treadmill of a lot of
lawsuits should the people have money-and I'm sure a lot of these
people aren't going to have money. This law is going to be for
very vulnerable people and poor people who use the mental health
system because they have nothing else.
I can't go for a vacation
to Florida when I'm stressed out. I am out of the psychiatric
system now for 10 years, and I've been off the meds for 10 years.
But I'll tell you something: I get stressed out, and I have no
money to go anywhere. So people use the Royal Ottawa for their
so-called medication and their vacationland. That is true. I did
that for many years, for 18 years.
Mr Clark:
I don't have any questions, but I do want to thank Ms Clark for
coming out today and participating in this consultation. It's
important that people like yourself who have these stories share
them with us as legislators. We need to hear from people like
yourself who've had these incredible difficulties. It took a lot
of courage for you to come out today, and I want to share with
you our gratitude for you coming out today and sharing your story
with us. So thank you very much.
Ms Clark:
All I can say is, when Bill 68 passes, it'll be a very sad day in
Ontario. The rights of the mentally handicapped will be violated,
in my opinion.
The Chair:
Thank you on behalf of the committee, Ms Clark. We do appreciate
you coming forward today.
ALANA KAINZ
The Chair:
Our next presentation will be from Ms Alana Kainz. Good
afternoon, and welcome to the committee. We have 20 minutes for
your presentation. If you'd care to leave time for questions and
answers, we'd be happy to afford that opportunity to members of
the committee.
Ms Alana
Kainz: First of all, I would like to thank you for
allowing me to appear before this legislative committee today. I
am the widow of Brian Smith. The legislation we are here to
discuss today was named after this wonderful man.
Brian Smith lived and
worked in Ottawa all his life, except when he left to play
professional hockey. He lived his life feeling like he was in a
safe place. Ironically, whenever we visited Florida, we would
have to remind ourselves that this was not as safe as at home.
What we didn't know
was that the mental health legislation we had in Ontario in those
days put the mentally ill, their families and innocent bystanders
like Brian at the same risk as a walk through downtown Miami-in
fact, at greater risk. About 2% of the population suffers from
schizophrenia. Ten per cent of them will kill, not others, but
themselves. That's over 40,000 people a year in Canada-the
equivalent of 50 major plane crashes. All it takes is one death,
though, to have a tragedy.
On August 1, 1995, Brian
finished his sportscast, took off his jacket, flung it over his
shoulder-I'm sorry; I thought I was OK.
Interjection.
The Chair:
We'd be happy to do that.
Ms Kainz:
No, that's good. Thank you.
Brian's Law is as close to
achieving a promise I made to Brian as we can get. As Brian lay
dying in the hospital, I made him a promise that I would do
whatever we can to prevent this from happening again.
I believe Brian's Law is
Brian's greatest legacy and will save lives. The bill nicely
balances the right for individuals to make their own informed
choices with the right of all people to be mentally well, and
with the right of those in the community to be safe.
1540
An inquest was held into
the circumstances surrounding Brian's death. I believe the
inquest proves that if we had Brian's Law in place, Brian would
be alive today.
At the inquest we
discovered that in the five years leading up to Brian's death,
Jeffrey Arenburg had sent alarm signals to doctors, the police,
social workers, judges and friends, and though some tried, most
felt powerless to help.
Looking back, Jeffrey
Arenburg was a prime candidate for a community treatment order,
section 14 of the new bill. He didn't like hospitals, he didn't
trust them. His revolving-hospital-door background meant that he
would have met the criteria for a CTO. I believe that had a
doctor had that option, Jeffrey could very well have agreed to an
order so he could go on with his life in the community.
Brian's inquest also heard
from a probation officer who knew Jeffrey Arenburg appeared
mentally ill, but he did not have the authority to get him to a
doctor. He also did not have the information that Jeffrey had
been diagnosed with schizophrenia. Section 16 of the bill says
those who provide treatment to a person under a community
treatment plan are permitted to share with each other information
relating to the person for the purpose of providing
treatment.
The inquest also heard from
a union mission worker who tried to take Jeffrey to the Royal
Ottawa Hospital after he damaged a van and made serious threats
at CHEZ 106 radio station. The social worker testified that he
was shocked when he left on the Friday afternoon and returned on
the Monday to not only see Jeffrey back at the homeless shelter
but telling the social worker that his voice was now on the radio
waves he was hearing. Frustrated, and actually afraid for his
life, the social worker quit his job shortly after that. A nurse
who worked with him quit too, the inquest heard. The new criteria
for committal to hospital, section 15, would have made it easier
for Jeffrey to be kept and treated at the hospital.
Brian's was not the first
inquest into a senseless death, nor, unfortunately, was it the
last. At least 10 other juries have recommended the changes that
have finally appeared in Brian's Law.
The inquest juries are
randomly selected juries, like Brian was randomly selected as a
victim. These are serious jurors who spend weeks listening to
testimony and come up with recommendations. Can a dozen inquests
be wrong?
This could easily be called
Jeffrey Arenburg's law. Jeffrey was a victim of a mental health
law that failed him too, when he shot Brian. There has been a
small amount of opposition to naming this legislation after
Brian. A handful are afraid that it sends a message that all
people who are mentally ill are murderers. First of all, Brian
was not murdered. I have come to terms with that. There were two
victims here. Naming the law after one of the many victims puts a
human face on the legislation and reminds us of its purpose.
This is not about reacting
to a serious event. It's about preventing one. This is not about
the many people with borderline, very manageable illnesses. This
is about the most seriously ill and the severe consequences of
them being left untreated for a period of time.
The Canadian Mental Health
Association has come out against this legislation. I would like
to take some time to address the CMHA. The CMHA had a chance to
request standing at Brian's inquest and at others and declined.
To me that means they did not want to be an active part of the
process that landed us here today with Brian's Law. Had they sat
through witness after witness at Brian's inquest, they would
likely have come to an understanding that the current legislation
does not work.
The CMHA is funded mostly
through tax dollars and United Way campaign contributions from
people like you and me. The Ottawa-Carleton branch of the CMHA
got $320,000 from the United Way in 1999 and $2.3 million from
the province. The CMHA certainly doesn't speak for me when it
comes to this legislation, or the people in my community. I don't
think they should be receiving money to oppose legislation that
is so widely supported.
This week I plan to send
letters to the heads of all the United Way campaigns across
Ontario asking that they not give any money to the CMHA that will
be used to fight this legislation.
Don't get me wrong. The
CMHA plays an important role in delivering mental health
services, and it should focus on that. Any money they spend on
opposing this legislation is money taken away from group homes,
outreach programs and social workers. The CMHA should not be
taking sides in this debate. They should leave that to advocacy
groups.
The Ottawa chapter of the
Schizophrenia Society, which fully supports this legislation, has
received only $4,300
in public money this year from the region-hardly enough to go up
against the giant that is the CMHA.
The CMHA wants the
government to wait two years before implementing the legislation.
I believe there would be blood on the hands of anyone who follows
that advice.
The CMHA worries the most
that if you open the door even slightly, all those who suffer
from any form of mental illness are at risk of having their
rights violated. That is completely wrong. There is still a fair
appeals process in place. All those who are hospitalized will
have access to lawyers. They have easier access to lawyers than
doctors, nurses and the families of victims. If you keep the door
closed, many more will die.
The CMHA says the chances
of being a victim at random are high. Well, tell that to the
family of the woman thrown in front of the subway train, the
woman in Ottawa stabbed waiting for a bus and the woman stabbed
at the Rideau centre buying coffee. It goes on and on. One life
in this province is worth saving.
The CMHA believes this
legislation goes against the Charter of Rights and Freedoms.
Sure, the charter protects individual rights, but it also
protects our right to security of the person. These need not be
competing rights.
Since I was first thrust
into this debate five years ago, I have been baffled by the
tension between some of the players. There seems to be a real
hospital-versus-community tension out there. It doesn't make
sense to me if we all share the same goal of helping people be at
their best. I just don't get it. I feel it is important for all
groups, including the Canadian Mental Health Association, to come
together on this. What we don't need is any mass hysteria over a
piece of legislation which has only good intentions.
Community treatment orders
and easier committal procedures are here-finally-as they are in
many jurisdictions around the world. People have both a right to
be well and a right to be safe, and this legislation deals with
that.
I believe we can use this
law to start fresh, salve old wounds and start working
together.
In conclusion, I
recommend:
Brian's Law should remain
virtually intact, with a few slight amendments.
Brian's Law is
appropriately titled as legislation because being named after a
victim puts a human face on it.
The Canadian Mental Health
Association should be asked not to spend taxpayers' and charity
dollars on charter challenges, which can be hundreds of thousands
of dollars that land in the pockets of lawyers in Toronto.
Instead, money should be given directly to advocacy groups such
as the Schizophrenia Society of Ottawa-Carleton, the Depression
and Manic Depression Mutual Support Group and other patient
rights groups.
All interested groups
should be brought together after the legislation is enacted to
discuss how to best implement it while achieving everyone's goal
of better care for all people suffering from mental illness.
I congratulate the
government for introducing such progressive legislation. I
especially applaud opposition MPP Richard Patten for spearheading
the change.
I feel that Brian's death
and the death of so many others after him have saved countless
lives. It's so seldom in our life, and in our death, that we can
make a real difference.
I remember many of us in
the mental health debate feeling frustrated and helpless at one
time or another. In September 1997, shortly after Brian's
inquest, the Ottawa Sun editor wrote, "Any attempt to change the
Mental Health Act is wishing upon the fallen star of Brian
Smith." Any attempt at change was in vain, he wrote.
Well, Health Minister
Elizabeth Witmer, Richard Patten and so many others have proven
him wrong. I hope this committee recommends just minor changes to
this law, this wonderful tribute to a fallen star-Brian
Smith.
The Chair:
Thank you, Ms Kainz. We certainly have time for questions. In the
rotation, we'll start with Mr Marchese this time.
1550
Mr
Marchese: Thank you very much for the presentation.
Obviously, it's always a very difficult thing to talk about the
issue once again. I think your contribution was very important,
and the only comment I would make is that I don't think we should
necessarily take money away from the Canadian Mental Health
Association, because I think you need these organizations.
Sometimes many of us don't have the expertise to be able to speak
on issues, and yes, we disagree from time to time. As you
indicated, there is tension between some of the players, hospital
versus community-that is out there, it's been out there for
years, and it will continue-in terms of where you put resources.
I think you're also right in your observation that it would be
nice if they could work together. That would be ideal, but I'm
not sure it might happen overnight, other than your desire to see
that kind of co-operation. But to take money away isn't something
that I would necessarily recommend, although I understand the
frustration you are feeling.
Ms Kainz:
Actually, I don't recommend you take money away from the CMHA. I
think the services they provide are excellent. What I am saying
is to control the spending and make sure that every dollar they
spend is on services. There are many patient rights groups out
there, and I believe they should have a voice.
Mr
Marchese: I agree with that.
Ms Kainz:
But if they had more money and more resources, they could have a
stronger voice and they could focus on what they do best, which
is determining what's best for them, and leave the CMHA to
deliver services under legislation that directs what we all do in
the system. In fact, I'd like to see them get more money, more
money for homes and more money for social worker outreach
programs and the other programs.
Mr Clark: Thank you for coming
out today. My predecessor, Dan Newman, did a consultation
creating a document, For 2000 and Beyond. Then we had the
document Making it Happen. Then we created the Next Steps
document, the discussion paper we did the consultation on that
you participated in. I'm wondering if I could get comments from
you in terms of-some people make allegations that the
consultation was not appropriate, that it didn't reach out to the
stakeholders, that it just wasn't a fair consultation. You
participated in the consultation. What do you think of the
process in terms of how we've come to where we are today?
Ms Kainz:
When Brian was first shot, I wanted legislation changed
overnight. I just wanted it to happen right away. Now I
understand that good legislation takes time. This has taken four
years, and it will be five years when it's all said and done. The
consultation really started for me five years ago, and there have
been at least 10 inquests-some say 13 inquests-since 1990 that
have dealt with the law. So we had that opportunity through
inquests. Then we had mental health reform; that process
occurred. Then the pending legislation came out, and you led the
consultation around the province on that. And now we're here
today. I believe that every voice has been heard and I think
we're ready now to get to work. What's trickled down through all
of this is some very good legislation.
Ontario is behind other
jurisdictions. We've learned from other jurisdictions too. I
think this legislation will be a model for other communities now,
other provinces or states or countries, other places.
Mr Patten:
Thank you for coming out today, as is appropriate. As you say in
your paper, can all these inquiries be wrong? Yet, as I'm sure
you know, there are numerous groups, mainly consumer-survivors,
as they call themselves, who categorically, vehemently, are
opposed to this legislation in the name of human rights. Their
fear is that they will be swept up, grabbed off the streets and
literally thrown into hospitals, that they will lose their
personal human rights. In some cases I ask if they have read the
legislation. Some say they have; some have not. But there's this
atmosphere in community groups in this particular field that is
to me quite worrisome, quite disturbing. I have two reactions:
One is that I want to be as responsive as possible to allay the
fears, and the other is that I think there's a propagation of a
total misread of what this legislation intends to do, which is
geared to a very small group, as you said in your paper, of
people within the mental health population, maybe as small as
1%.
I know you've studied a
lot, have read a lot, and I know you continue to do so. In your
findings, how would you explain this with people you've met? Do
you have an explanation for this?
Ms Kainz:
First of all, we've lived with a Charter of Rights and Freedoms
for over 10 years, and I think as a society we've learned that
individual rights are important and should be protected,
regardless of what legislation we have in place. I do see that
there could be some problems with hysteria, and had this been
knee-jerk legislation enacted three years ago we would have had
much more opposition than we have today. I think there's been a
history of tension that I would like to see dissipate over the
next five to 10 years. That started decades ago, where there were
abuses, where there was neglect and where people were
incarcerated wrongly. As a society, we listened to the problems
that we had for many years and we came up with legislation that
swung the pendulum way too far in one direction. My belief is
that this legislation swings it back and it lands in the middle,
at the end of the day.
What we have to do now is
educate patient rights groups and other groups that are out there
that this will not mean that the police will go around sweeping
up the streets and that this is a way for Mike Harris to clean up
the streets of Ontario. That's not what's happening here. This is
a way to treat people, and people have that right. I think a year
from now we're going to look back and say, why were we so worried
about individual rights? Sure, we've had some people appeal and
they've won appeals and they've lost appeals, and there will be
the odd case where people will still have fallen through the
cracks and died, but I think we'll see that there'll be fewer
cases and fewer inquests. In fact, I say no more inquests.
The Chair:
Ms Kainz, thank you very much. You've added immeasurably to these
hearings. Let me just say it's certainly our goal to find that
balance. It's my understanding that it's only the second time
ever that the name of a person has been applied to a piece of
legislation in the province of Ontario. I think it is very
fitting.
Ms Kainz:
Thank you for doing that. That's why I get so emotional. You
didn't make me cry.
The Chair:
Congratulations to you and best of luck on the institute. Thank
you.
With that, colleagues, we
conclude our day's hearing here in Ottawa. The committee stands
adjourned until next Monday at 3:30 back in Toronto.
