CHILDREN'S MENTAL HEALTH SERVICES
SERVICE MANDATE FOR DEVELOPMENTALLY HANDICAPPED
MINISTER OF COMMUNITY AND SOCIAL SERVICES
ADVISORY COUNCIL ON SPECIAL EDUCATION AND LEARNING DISABILITIES ASSOCIATION OF ONTARIO
HOME AGAIN RESIDENTIAL PROGRAMS FOR THE HANDICAPPED
CONTENTS
Monday 21 January 1991
Children's Mental Health Services
Organization
Service Mandate for Developmentally Handicapped
Minister of Community and Social Services
Peter Clutterbuck
Advisory Council on Special Education and Learning Disabilities Association of Ontario
Home Again Residential Programs for the Handicapped
Adjournment
STANDING COMMITTEE ON SOCIAL DEVELOPMENT
Chair: Caplan, Elinor (Oriole L)
Vice-Chair: Cordiano, Joseph (Lawrence L)
Beer, Charles (York North L)
Haeck, Christel (St. Catharines-Brock NDP)
Hope, Randy R. (Chatham-Kent NDP)
Malkowski, Gary (York East NDP)
Martin, Tony (Sault Ste Marie NDP)
McLeod, Lyn (Fort William L)
Owens, Stephen (Scarborough Centre NDP)
Silipo, Tony (Dovercourt NDP)
Wilson, Jim (Simcoe West PC)
Witmer, Elizabeth (Waterloo North PC)
Substitutions:
Jackson, Cameron (Burlington South PC) for Mr J. Wilson
Jackson, Cameron (Burlington South PC) for Mrs Witmer
Miclash, Frank (Kenora L) for Mrs Caplan
White, Drummond (Durham Centre NDP) for Mr Silipo
Clerk: Mellor, Lynn
Staff: Drummond, Alison, Research Officer, Legislative Research Service
The committee met at 1313 in committee room 2.
CHILDREN'S MENTAL HEALTH SERVICES
Resuming consideration of the designated matter of children's mental health services pursuant to standing order 123.
The Vice-Chair: Members of the committee, we are now going to be sitting for an hour and a half, and hopefully we can get our business done because I remind members we have witnesses appearing before us on our next item on the agenda at 3 pm. I hope we can get through this process rather quickly.
Everyone has been given, and I believe the clerk has circulated, our revised draft in two pieces, actually, recommendations and body of the report. I think it is prudent to begin by looking at the recommendations, go through those and then come back to the body of the report. Perhaps our research officer could take us through that, detail the changes that have been made and go through that process now.
Ms Drummond: Perhaps everybody could look at page 9 of the draft report which was faxed to everybody on Friday. I am missing page 9 myself. The subcommittee met this morning and the result of that meeting is what was just given to you, which is headed "Revised Recommendations." These were the recommendations where there was a certain amount of consensus reached this morning. Should I take everybody through the changes that were made this morning?
The Vice-Chair: I think so. Let's zero in on those things and then if there are any further discussions, we can deal with that after.
Ms Drummond: As you will see, there were some changes to the preamble. I was asked to redraft it to make it more positive and there were some further changes this morning. As you will see, there was a clause added to the first sentence, "...there is general agreement that many children are not receiving care in a timely and appropriate manner." The original second sentence of the preamble was dropped. The subcommittee agreed to drop it.
On the "Access to and Co-ordination of Services," the first change originated in my misunderstanding, and the subcommittee had agreed that the implementation committee should be set up and make a report by the end of September. I made the other changes on the representatives for stylistic reasons. The recommendations on the implementation committee were strengthened slightly, saying that "should address" rather than "could."
The subcommittee agreed that the first two bullet points under "Other Issues" could be folded together into one which now reads "gather systematic information on the children on the waiting list, using the report by Craig Shields commissioned by the Ministry of Community and Social Services."
The change at the bottom of that page was simply a stylistic one. "How to use" seemed a little awkward and so it is now simply "making better use of."
On page 10, the subcommittee wished to simply strengthen that first sentence, so it is now simply "We recommend." The second bullet point has been changed slightly to read "residential centres in the province should receive adequate funding to ensure the safety of children and staff."
Under the fourth bullet point, "prevention programs such as the Better Beginnings, Better Futures initiatives," simply so that is not constrained, that other prevention programs could be funded.
Finally, the point of the last statement was to encourage co-operation by different agencies. Co-ordination is also an issue of course, but "co-operation" seemed to reach that more closely.
Under "Research, Evaluation and Training," the preamble was changed slightly, as you will notice. It is the Premier's Council on Health Strategy. That is my error. Mr Beer has suggested that "request" might be a more appropriate verb to use rather than "assign" since it is an independent body.
The third bullet point under "Research, Evaluation and Training" was changed to address the issue that there are human service problems in the field throughout the province and that there are unique needs in the north. There should be a semicolon after that; I missed that. The subcommittee wished to emphasize that the Premier's Council should also be consulting a range of people in the field.
Under "Native Issues," the preamble again was changed slightly. On page ll, simply the preamble was strengthened.
Finally, on the last set of issues, the subcommittee agreed that both language and culture issues should be addressed since one of the witnesses from the Earlscourt Child and Family Centre raised the issue of services to multicultural groups.
I guess now the question is which set of recommendations the committee should be working from. I would suggest it might be a little more convenient to work from this one called "Revised Recommendations."
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The Vice-Chair: Obviously this reflects a consensus of opinion from the subcommittee members in bringing together all of the various recommendations. I think at this point, if there are any discussions or debate on the recommendations as they have been put forward, it would be appropriate to entertain discussion on these, not that there has to be discussion, but certainly there is time for any discussion that committee members deem appropriate. I open the floor to discussion of the way in which these recommendations have been put forward. Would committee members like me to move forward, if all is agreeable, in terms of the recommendations?
Mr White: There is a significant change, I think, in the preamble. Many of the recommendation points that Ms Drummond mentions are tidying-up efforts, but in the preamble the change actually, I believe, is significant and omits basic issues about family disruption and child poverty which came clear, certainly in Dr Offord's report and various other witnesses, as being significant contributors. In the revised recommendations, those references are not there. I wonder if we could have some comment as to why those changes have been made or that particular change was made.
The Vice-Chair: Would one of the members of the subcommittee like to address that and then we can discuss it along that basis?
Mr Beer: Let me try to recall our discussion on this and there may be a way of working that out so the concern you have is expressed. There was a concern that this seemed to indicate that income was the only reason or the basic reason why children had mental health problems. I guess it was that the physical needs of children were expressed there in terms of shelter, food and clothing, but that then there were also emotional needs.
It was not that one was trying to say that is not part of the problem, but trying to find some way of indicating that there are the physical needs and the emotional needs. That was why we thought then we will look at it that the emphasis is on healthy children. Perhaps that encompasses it. Now, I recognize that when you make changes that could take away, and perhaps there is a way of expressing the point you raise as long as, I think, there is a need as well to express the concern around emotional needs, because all kids of whatever income level may also have mental health problems that are not fundamentally in terms of income.
That was kind of what we were wrestling with.
Mr Owens: I agree with both Charles and with Drummond that certainly poverty is an issue that contributes to mental health problems, but we did not see ourselves wanting to make it seem like it was simply an income-driven issue. We agree that there is a problem. We agree that the problem needs to be attacked at its root and this was maybe not the best way, as we are only human, and maybe you can propose a better way of framing that kind of philosophy.
Mrs Witmer: I can understand what Mr Drummond is saying. I guess what we wanted to do was to be very positive in our approach. What we want to make sure is that with all children, not only are their physical needs going to be met but also their emotional needs. Certainly, we saw many different reasons for children suffering behavioural and mental illness problems. Some of it was because of single-parent homes, family violence, etc. Certainly that occurs in more than just homes where there is poverty. We wanted to be very positive and talk about helping families raise healthy children. That would mean we would do whatever we can, and obviously one of the things we would want to eliminate is poverty and whatever else we can.
We are focusing here very much on what we can do and I do not think we want to label and somehow point out that only children from poor homes are suffering from these problems. It is children from across all levels of society.
Mr White: If I could respond, I think again that a number of these points were mentioned. I would agree wholeheartedly with Mr Beer that implicit in a number of the recommendations are those very points, those very issues. I would think, however, that the issue of child poverty, of family violence, of sexual abuse, of family disruption are very key in terms of causing children's mental health problems.
I believe Jeanette Lewis, the executive director of Kinark, whose predecessor is here, spoke very keenly on that, that all of the children in her services were from disrupted homes and that the vast majority had been sexually abused. I think it is incumbent upon us, in terms of our preamble, to make reference to those issues. It might be in just a one- or two-sentence frame, but I think it is none the less incumbent on us.
The Vice-Chair: Would it be helpful, if I might make a suggestion, that there is reference in a more detailed fashion or at least reference to what you are alluding to with respect to this elaboration of these problems within the body of the report?
I have it on page 1. The last sentence reads, "Ninety-five per cent of residential patients served by one provider who spoke to the committee had suffered some form of abuse." There was further reference in that paragraph earlier on. So there is reference within the body of the report. In the testimony that we heard, throughout it there was this underlying common theme, that these children came from abused situations and that violence was a problem, etc. I think it is fair to say that we have alluded to that in the body of the report as being certainly a problem and in a more detailed fashion. Is that fair to say, Alison, with respect to that?
Ms Drummond: There are references to it that were raised by the witnesses, especially, and quite a bit of the original background briefing relied on Dr Offord's Ontario Child Health Study, which of course raises a lot of these issues. Yes, it is in the report. I suppose the question is whether it should be in the preamble.
Mr Hope: We are adopting this as a whole report, and as you stated the line above it says 60% of the child welfare clients seek counselling, and in the body of the report the third line up talks about preventive policies which address children's mental health. I think the encompassing of both is that we detected where a percentage of the children come from, so the preamble of the report, the recommendations, would kind of reflect one another, so when we develop policies to try to address the children's mental health problem, we can see that in the body of the report and I think they encompass one another, because it says, "The goal must be comprehensive, co-ordinated and preventive policies which address children's mental health problems." As we have seen in the body of the report, in the introduction section, the history, just a line above what you read on 95%, it talks about 60% of children of welfare clients seeking counselling or similar services. They interact with one another. I think the preamble just reflects that when we establish preventive policies and look back on the main body of this report, it will tell us that one of the key areas we have to focus on is children's welfare.
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Mr Beer: Both the Maloney report and I think Mr Hayday's presentation to us talked about the interrelatedness or the term "predeterminants." I am wondering if we could express the fact that the committee recognizes the interrelatedness, or some kind of wording like that, of both physical and emotional factors, in terms of the principle leading from our desire to raise healthy children. We could mention possibly some of those as well, family stress and a number of issues. I think the concern was simply not wanting to make it appear as though there was just one; it was the way that came forward. If we could have something that stressed the interrelatedness, that kids may face problems because of a whole series of things in different combinations. I am wondering if there is some wording that might help Drummond.
The Vice-Chair: Let me turn to Mr Jackson, and then we will try and get some sort of consensus.
Mr Jackson: Unfortunately, I was going to bring in something new. It is in this paragraph. I simply wish to suggest that I am having difficulty that we are making a statement that we have general agreement that many children are not receiving care in a timely fashion -- fine -- and appropriate manner. I am having a little difficulty implying that the current service deliverers are not providing appropriate care. That is one way of reading it. I might suggest we put, "and therefore an appropriate manner," where we link access to appropriateness. There was very limited information that there was appropriate programming, and the examples we have addressed, but for it to become a general statement almost is an indictment of the current care givers, and I have difficulty with that. I know it is not the intent, but we are not always going to be here to interpret this. This language is very important as preamble and principle.
If I can just share with you two more concerns, then will shut up. This is not a debate. I will share it and if there is no uptake, then that is fine.
The Vice-Chair: Do not make promises that you cannot keep entirely throughout the whole two-hour period, but go ahead.
Mr Jackson: The next concern I have is the reference, "The system must shift its emphasis to helping families raise healthy children." What is implicit is that there was a position which we are shifting from, and I would like to know what that was. If it was the individual child, then I would like to have that more in context. And "helping families raise healthy children" does not imply our definition of families when we know that an overwhelming number of these children are in single-parent families or have been forced to be removed from their parents and are under foster care or some other institutional care. I have trouble with this definition of "families," when we know there is a correlation to single-parent families. Maybe we can talk about fixing that.
The Vice-Chair: I think "families" means families in general, whether they be single-parent families or two-parent families. It is a generic term for families, obviously.
Mr Jackson: That is what I would hope it says. Perhaps we can strengthen that understanding with language.
My third concern is, "at the same time, the resulting reduced demand for crisis services." I understand that one of the pressures for comprehensive, co-ordinated and preventive policies was in order that the current system be able to meet the existing demand. I could not support "reduced demand for crisis services," because we are not meeting the demand and we are not saying that. Yet that was the genesis of this report: so it will help us to better meet the current demand, in my view, is what this has been all about. If it is not, I am afraid I started these hearings differently. Those are my comments. I think that is closer to what I thought our understanding was.
The Vice-Chair: Can I just point out with respect to that point -- then I will move on to other members -- that that is to be read with the previous sentence, that is, "the goal must be comprehensive, co-ordinated and preventive policies," which will then imply a reduction in demand for crisis services because of the preventive efforts. That is the intention of that sentence, but if you read it in isolation and take it out of context, then I would agree with you, but it is coming on the heels of the previous sentence.
Ms Haeck: I was going to concur with the statement you just made, because I read it that way, that because of these particular efforts we would see a reduction at the other side, the algebraic equation.
I also felt -- I do not want to say "strongly" -- I am somewhat concerned about the issue of Mr Jackson's earlier comment on "appropriate manner." I consider myself to be really a lay person in receiving the information from these very various groups. I can only say that I feel they have handled things in an appropriate manner. Unless by some chance I were an expert or we had some information by a group of experts and consultants who had done an inventory of the system and could say, "As a professional in the field, such and such a group is not handling things in an appropriate manner," I think we have to stick to the general in that area. The only one of us here that I know of -- obviously, I am not completely familiar with all the curriculum vitaes on the other side, but I know Drummond has worked in the mental health field and may be able to make some comments. I think for the most part we are very much lay individuals and we have to accept that type of terminology.
The Vice-Chair: Before moving on to Mrs Mcleod and other members, I just remind members that we are very pressed for time. I do not want to dwell too much on one point.
Mrs McLeod: I have a suggestion on how we might incorporate the concerns. I think we would agree that we want to avoid making a judgement one way or the other about appropriateness, for exactly the reasons Christel has indicated. I do not think we are in a position to make that judgement, so if we can find a wording that just takes out a judgement.
On the second part, I would suggest that we might have a sentence to indicate that many interrelated factors which increase stress on families contribute directly to children's mental health problems. Without having to list them all, it would indicate that family stress really is a significant part of the problem.
The Vice-Chair: Is there agreement on that? Let's deal with that and resolve that issue. Let's try and get a consensus on the wording.
Mrs McLeod: If I could just make my next point, which is my last one, it would try to tie in what Mr Jackson was raising as well with that previous point. It might be a way of facilitating it, if it did meet with consensus. You might look, for example, after "in a timely and appropriate manner" at a statement to the effect that: "Many interrelated factors which increase stress on families contribute directly to mental health problems in children. It is therefore essential to provide support needed to ensure that families are helped to raise healthy children." That would remove the shifting of the emphasis, which is a concern for Mr Jackson, and I think appropriately, because shifting emphasis suggests that we are somehow going to take resources away from one area, where we know there is need, and put them in another area, and I think all of us would agree it cannot be either/or.
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The Vice-Chair: I think that is a helpful suggestion.
Mrs Witmer: I can support that.
The Vice-Chair: Can you repeat that?
Mrs McLeod: Do you want me to pick it up from "in a timely and appropriate manner"? The wording will be approximate, because it has been scrawled down fairly quickly.
The Vice-Chair: Okay. Try it again.
Mrs McLeod: "The many interrelated factors which increase stress on families contribute directly to mental health problems in children." You might want to preface that by saying "witnesses in committee agree" or something to that effect. "It is essential to provide support needed to ensure that families are helped to raise healthy children."
Ms Drummond: I think that could be cut down a bit, but okay.
The Vice-Chair: Did everyone follow that?
Mr Jackson: Are we going to get rid of witnesses? "The committee agrees the system must shift its emphasis." We can stress it, but not saying we moved away from it.
The Vice-Chair: We have agreed to remove that.
Mr White: I would like to commend Mrs McLeod and Mr Beer on those points. That wording certainly encompasses my concern.
The Vice-Chair: I think that means we have consensus, so we will move forward. That is agreed to. That clears up the preamble.
Mr Jackson: Mr Chairman, the "appropriate manner" still sticks out. I recommended "and therefore an appropriate manner," so that access becomes the pivotal issue in terms of appropriateness. I still leave out there questions as to the quality of work being done in mental health facilities in its present form, and I will not accept that.
Mr Beer: I think we agreed with expressing that, that it was not meant to be judgemental.
Mr Jackson: Fine. And you accept "and therefore an appropriate manner." Thank you.
The Vice-Chair: We will move on. Next is "Access to and Co-ordination of Services." Any discussion or any relevant points to be raised on that item?
Mr Jackson: I am sorry, Mr Chair, just to finalize it: We are leaving it that the preamble and principles have nothing to do with the waiting list; it only has to do with shifting the emphasis or reducing the demand for crisis services to parental services. We are not acknowledging the notion that we will be able to serve more children, that if we reduce the demand for crisis services we can therefore assist more children in this province. I need to know the answer to that because that stems from the minister's statement that we do not know if we will need more resources. This report would indicate we may not need more resources; we are shifting the emphasis.
The Vice-Chair: I do not think that is what it says at all. I think it is a question of placing a premium on preventive measures so that we therefore would not be in a crisis situation with respect to urgent care. That is a crisis. I think it was acknowledged throughout our hearings that there was indeed a crisis. Therefore, by doing this we will not have a crisis on our hands. I think that is what the intention of that statement was.
Mr Jackson: I challenge that statement, only because we have a crisis now in terms of access. You are suggesting you will reduce the number of people who will need it, but there are still going to be many kids needing the service.
The Vice-Chair: It does not imply that services will be reduced. It will mean that the waiting list will bc reduced and as a result, there will be less of a demand for that service. That is what it implies. One does not mean the other. Do you see what I am saying?
Mr Jackson: By removing "shifting the emphasis," I might buy it. But with "shifting the emphasis" and then "reduction," it clearly implies reduced program.
Mr Beer: Your shifting is gone --
Mr Jackson: Has been removed. Yes. I can almost live with it.
Mr Beer: I want to be clear on the subject to my colleagues on the subcommittee that what we are talking about here is that we recognize that there is a problem right now, that there are children waiting for services who ought not to be waiting, and then we try to go on under the next set of recommendations to begin to spell out how we can deal with that. If we can develop "comprehensive, co-ordinated and preventive policies," we would hopefully reduce the demand for crisis services, but that would mean simply that the system was working better in dealing with kids much earlier in the system before it is a "crisis," and that we do not have the lineups for that service.
The Vice-Chair: Do we have agreement or shall we debate this point further?
Mr Jackson: I do not want to debate it further. I now understand there was a blockage in the subcommittee meeting. I did not have a chance to read all of what constitutes amendments from this morning's meeting. I presumed from day one that there would be an acknowledgement in this committee that we find the current waiting list unacceptable. I assumed that surfaced somewhere in the report. I am now told it is not. Certainly our caucus is having great difficulty that we are not making a simple statement that the current waiting list is unacceptable. Therefore, recommendations and strategies should be positive but at least acknowledge that we find the current waiting list unacceptable. That is why I am trying to imply that the preamble and principles make some reference to what our initial assignment was, which was to deal with the waiting list. There is where my difficulty is, and I am having trouble moving when we seem to not wish to talk in any way, shape or form about the waiting list and/or the impact it will have on our recommendation.
I am prepared to be flexible. I have suggested the shifting of the emphasis will help us better to address the current demand, which we consider to be far too great in this province. I could live with something as simple as that, but not to imply anywhere in this report would be, in my view, a substantive departure from where we believe we should be going as a caucus.
I just share that with you. I know Elizabeth shared that with the subcommittee in very strong words, but we also have to get it on record here as well. You know that is part of the process.
Mr Beer: I think it was our intent to recognize that there is a problem, that there are too many children waiting for service. There might be disagreement about numbers and so on, and one of the things we wanted to get to in the other recommendations is how we go about determining who is waiting and waiting for what. So we would not have any problem with trying to make it clear that we do recognize and must recognize that the current system is not meeting that need.
It is perhaps somewhat oblique, talking about not receiving care "in a timely and appropriate manner" in the context of the list. We could maybe have a look at the wording Cam has suggested in that last sentence, or some such wording. We are saying whether it is 10,000, 6,000, 3,000 or 2, we do not want to have waiting lists if we can avoid it. If there is some way of expressing that concern, then we can do that.
Mr Jackson: Before you move on, Mr Chairman, let me simply say that bullet 3 on funding will constitute a major debate. That will put in context how we intend to deal, even in the short term, with the waiting list. I am prepared to suggest we move on, as there was consensus -- except on that point -- so we can get into the meat of the recommendations and get beyond the preamble.
The Vice-Chair: I still have Ms Haeck, to address that same point.
Ms Haeck: I think it would be appropriate to move on, as I am not exactly sure what wording we are talking about. I think we are generally agreed and obviously the minister was quite clear that one child on a waiting list is too many. It is a matter of shifting -- and I will use that word -- the system so that it deals with prevention and allows a number of other things to take place at the same time.
The Vice-Chair: Mrs McLeod, do you have a suggestion for the wording of that?
Mrs McLeod: Just to try to capture the sense of the concerns that are being raised. In the last suggestion, we were looking at "families raising healthy children." We could go on to include there, "At the same time it is recognized that current waiting lists for children's mental health services are unacceptable. The goal therefore must be comprehensive, co-ordinated and preventive policies which address children's mental health problems. Comprehensive services leading to a reduced demand for crisis services will help everyone."
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Mr Hope: Shoot that over again.
Mrs McLeod: Sure. Basically it continues to recognize the family stress, the importance of helping raise healthy children, then says: "At the same time, it is recognized that current waiting lists for children's mental health services are unacceptable. The goals therefore must be," and it is the same line that is before us, stressing comprehensive, co-ordinated and preventive policies.
Mr Jackson: And "increased access for children" at the end, so "providers of those services, parents, and increased access for children."
Mr Hope: You are contradicting yourself, because if I am understanding the preamble properly, the preamble is in a three-phase operation: the current situation, what you have to address in the midterm, and then your end result will be the reduced demand on crisis services. Is that not what a preamble is all about, first of all your initial statement, what is wrong with the system, what the goals should be and what the end results should be? What you are saying is what would be the end result, because in the end result you are saying we have to have more facilities.
Mr Jackson: No. I said that reduced the total waiting list. You want to differentiate the waiting list based on what is preventive and what is acute care.
Mr Hope: No, reduce the demand.
The Vice-Chair: One at a time, because Hansard cannot follow that.
Mr Jackson: For crisis services. Sorry. I think it hits the essence of what we are about, because it deals with the notion that if we accept that the waiting lists are unacceptably high, then we have to ensure that the goal was that we increase the access for children who are currently on that waiting list. I guess the simplest way of describing it is, as it stands, the way it is presented, it says that of the 100% we are doing now, it may be 80% crisis and 20% preventive. We are now going to shift that to 40% preventive and 60% crisis. I am simply saying that we have to increase both, which does not imply institutionalization; it implies access, that is all, with more emphasis on prevention. Then everybody wins, which is what we say, "Everybody wins."
Mr White: I would agree with some of Mr Jackson's concerns. There are, I understand from the witnesses, some strong concerns about some of the core services which, regardless of the level of primary services, may still be necessary. I think that was clear from Kinark's presentation and I think as well from Earlscourt's. We do not know what the relationship is between the provision of those primary prevention services and those core services. We do know it should prevent a fair bit of family problems, a fair bit of children's mental health problems, but we do not know what impact it is going to have on those severely disturbed children.
I think it is beyond the wisdom of this committee to make any ironclad statements. I would like to suggest that the last sentence be reworded to, and I hope this would encompass Mr Jackson's concerns, "It is hoped that there will be a resulting reduced demand for crisis services, which will help everyone," as was previously noted here. That way we are not necessarily tying an increase in prevention services to a decrease in those core services for the very disturbed children. There is not necessarily a relationship between those things.
The Vice-Chair: We have a suggestion by Mr White.
Mr Jackson: I could not accept it, because I think, in all due respect, Mr White has it reversed. He has created a linkage in the language that was going forward. I am trying to create separation of that to make sure that in fact we are not looking at a status quo and just shifting the emphasis, that there is some acknowledgement that our actions -- and we should have the confidence to know that -- are going to produce greater access. That is all I am trying to imply. I feel it must be clarified and not remain silent; increased access for children.
Mr White: I do not think we have accommodation here.
The Vice-Chair: Let's hear from other members before we move on.
Mrs Witmer: I wonder if we could not simply remove this sentence altogether and simply end it with, "The goal must be comprehensive, co-ordinated and preventive policies which address children's mental health problems." That is our objective.
Mr Hope: What is the end result?
Mrs Witmer: The end result, obviously, that we are hoping for is that any demand for mental health services will be drastically reduced and we are not going to have the long waiting list. We will be able to deal with children as the needs arise. We have our preamble and then our goal.
Mr Beer: On that point, I think it is perhaps something we want to look at. If we are saying clearly in the last part of our principles that we set out our goal, "comprehensive, co-ordinated and preventive," and we then in the body of our recommendations suggest ways to go about doing that, I think the argument we are getting into around that last sentence is a valid discussion but it need not cause problems with the preamble and principles statement. Maybe it would be better, so that we can have agreement, if we just left that last line out and then looked at the other recommendations, which speak to how we seek to go about implementing our goal, because I think we all agree with that goal.
The Vice-Chair: Am I understanding this correctly? There is agreement to remove that last line?
Mr Hope: In a preamble there has to be a start, a middle section and a finish, and the finish is to take away the demand of the crisis. I believe at the same time, and I guess it is the preliminary starting of that sentence, that we need to address that if we achieve the goals, when we achieve the goals of implementing comprehensive, coordinated and preventive policies, we will then result in reduced demand for the crisis services and will help everybody provide for those services, parents and children.
Mr Jackson: We just cannot live with that. We find it discriminatory. If the goal cannot be that all children who require the service have a fair and equal shot at getting help, we cannot put our name to that report. It is that simple. It is a form of discrimination based on who gets on the list and how they get moved on the list. I know we have not spent much time on it, but I will not and we cannot endorse something that implies that we are just reducing a certain form of demand within a large problem.
Mrs McLeod: I would like to suggest that even without the last sentence, I do think the sentence about comprehensive, co-ordinated and preventive policies addressed the issue that Mr Hope was raising, because I think the preamble begins with the concern that we are not dealing adequately with children's mental health problems, goes on to recognize that in order to address children's mental health problems adequately we also have to deal with family stresses and that the comprehensive a coordinated approach is our way of dealing both with the waiting list and the family stresses that are contributing to the children's mental health problems that we identified in the first line.
I think the fact that we are emphasizing in our last statement -- it would then be the last statement -- comprehensive, co-ordinated and preventive policies takes us very directly into the body of the recommendations and that the real achievement of our committee will be to say, "This is a new direction that we all agree is essential and we recommend a task force to look at implementation."
Mrs Witmer: I know you are aware of it too, but it is the time I am concerned about. We are only dealing with the preamble. I wonder if we could have a show of hands showing some consensus, go on with the recommendations and then come back and make sure we are all comfortable once we take a look at them, or we are not going to get finished. I do not know how we will deal with it then.
Mr Hope: Why do we not deal with the recommendations we agree on?
The Vice-Chair: That is perhaps a useful suggestion, that we move on to deal with the rest of the recommendations. Then we will come back to any contentious points. The clerk reminds me we can vote on any contentious points that we have at the end. So shall we move on then to the next part of the recommendations, which is"Access to and Co-ordination of Services"? Do we have agreement on this part of the report? Any discussion? No. Let's move on to funding, on the next page. Can we move on? "Research, Evaluation and Training."
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Mrs Witmer: I had put this position forward in the subcommittee and it is number 3. I believe that if we are ever going to reduce the number of urgent cases on the waiting list, which according to the research that we have been shown is about 10,000 children, there does need to be an increased amount of funds provided to help these children who are most in need of service at the present time. So I would like to see in bullet 3 that "the upcoming provincial budget provide additional funds," meaning more than what is presently being provided, "to enable the children's service sector to address the most urgent cases on their waiting lists," because it is fine, we are going to do this study, we are going to have a task force. However, we need to deal with those children now. Those children cannot wait for a year or two years from now. Their needs need to be addressed at the present time and it is going to require more money.
Mr Hope: I think the wording put forward is adequate. What we found out in the previous administration is that we just keep dumping money into a problem without taking a proper analysis of the problem. In the long term, out of the analysis that we do in trying to come up with a resolution to the situation, we may need more funds. But whether it be more funds or equal funds or whatever, and it probably will be more funds, providing adequate funding for children's services is one of the keys.
Mr White: I certainly agree with there being urgent cases on the waiting list, but specifically targeting becomes problematical, seeing we have spent half a page on recommendations about access and co-ordination and planning. We are prejudging the outcome of that discussion among the very service providers and consumers, who are much more familiar with these issues than we are.
Mrs McLeod: I think that Mr Hope's point -- and I am sorry that Mr Jackson has left at the moment, because I think it addresses the essential conflict that was emerging in our discussion about preamble, and that is the inclination to make a judgement that there are not appropriate services being delivered by children's mental health centres.
I really cannot concur with any suggestion that there has been a problem with simply dumping money in and therefore they do not need more money. I really do not believe that was an indication, a judgement, that this committee could make based on the testimony that we heard from witnesses. If anything, the testimony would lead us to exactly the opposite conclusion, that there was a tremendous shortage of resources even to deal with crisis situations. Again, I believe it cannot be either-or. We cannot say that because we are going to recognize the importance of preventive programs and primary programs we can therefore ignore the fact that there are long waiting lists of crisis situations without resources adequate to meet those needs. I would be very concerned about a report which attempted to make this an either-or situation.
The Vice-Chair: Can I then conclude from this that there is not a consensus on that statement? Should we set it aside, Mrs Witmer? Can I just conclude that we do not have agreement on that, or would you like to hear further debate?
Mrs Witmer: Yes, I would appreciate hearing further debate. I am not quite sure why people are reluctant to provide those additional funds. We certainly heard from the witnesses the fact that such things as pay equity and the employer health tax and the additional security measures that they were taking for their own staff were forcing them to use those much-needed financial resources to pay for those type of problems, as opposed to directing the money to help with the children who were desperately in need of services. They have not been reimbursed. That money has been taken away from them and they have not received any additional funds. This is the type of additional funding that I believe should he made available to them this year. If this government is truly concerned about children and the mental health of children in this province, I think it needs to be prepared to provide that additional money that has been taken away from providing actual service to children.
Mr Owens: It is unfortunate that Mrs Witmer has framed her comments in the manner that she has, of pairing the level of care with the dollar value that this government decides to put into children's mental health services. I think that is a very unfair comment.
Second, I do not think it is within the jurisdiction of this committee to order the Treasurer to commit funds, and while we do take this as a serious issue, I think that we should leave it up to the Treasurer and the Minister of Community and Social Services to work out the when and the where and the how that funding will be granted to these services. You suggested, Mr Chairman, that this should be left aside as an issue for voting as a contentious issue.
The Vice-Chair: I am prepared to.
Mr Jackson: Would you clarify the question, just to correct his assumption that this committee cannot order up and recommend matters that impact the Treasurer. In fact, we very much can.
The Vice-Chair: It is only a recommendation.
Mr Jackson: Precisely. I just was hoping you would correct that.
The Vice-Chair: That can happen.
Mr Jackson: That is what I am saying. Mr Owens's assumption was that they could not, and I just wanted you to clarify for him that it is very much within our mandate to recommend expenditures, because it is not legislation we are dealing with, it is not private members' time. It is in fact simply an expression of our beliefs and feelings after having listened to input that is very focused on this issue, perhaps better than the minister has been able to get in the short time she has been the minister.
The Vice-Chair: That is why I suggested that we set that aside and deal with it on a vote.
Mr Jackson: I could not accept it in its present form, Mr Chairman, because it is as much as saying, "On an annual basis the Treasurer shall submit a budget." It is telling the world something we already know. Moneys are in the budget for children's mental health, there will be next year and there will be the next year. I could not support something which just simply reiterates the fact that the province continued to show somewhere in the budget moneys allocated for children's mental health. That is like stating Tuesday follows Monday. So I think it is a waste of time putting it in the report.
The Vice-Chair: Would members like further discussion on this item, or shall we move on?
Mr White: Move on.
The Vice-Chair: We will put that aside and deal with it later. Can we move on to "Research, Evaluation and Training," that subheading? Any discussion or debate, points of interest?
Mr White: Just a couple of very small points. I am wondering if it could not be added either as a bullet here or as an addendum to the last bullet on the previous area that there be encouragement through funding mechanisms to children's mental healths centres that are currently or planning to be involved in both research and program evaluation, so that we can in fact, as Dr Offord suggests, know when we are doing more good than harm.
The Vice-Chair: Just for clarification, you would like to include that in one of the bullet points here.
Mr White: That is right. It would be specifically targeted money for children's mental health centres.
Mr Beer: I am just wondering, Mr Chair, whether we might, on the last bullet, under funding, say, "funding incentives be given to encourage agencies to co-operate in the provision of local projects and to develop research and evaluation projects or programs."
Mr White: I think that is an excellent idea, especially if they are co-operating in providing that service. Then you do not have a suspicious research program where you are evaluating yourself entirely. Excellent suggestion. It certainly agrees with me.
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Ms Drummond: So is there consensus that this might be a little bit more appropriate under the last bullet, under funding, which would then read: "funding incentives be given to encourage agencies to co-operate in the provision of local projects and to develop research and evaluation"?
The Vice-Chair: Do we have agreement on that?
Mr Jackson: Only one point. It is rather incestuous that the local projects are evaluated by themselves. It is tradition in this province that they be either co-operatively evaluated -- I only introduce that because this is a complex issue, and although we support the notion of evaluation generally, the evaluation is by the government to ensure that it conforms to the provincial goals as set out by the minister and her ministry.
I think it was fine the way it was. I think it is presumed that you were to be evaluating, but no one really spoke about it; they mostly spoke about financial carrots and incentives. I think we have caught the point, but I do not wish to imply that we are checking our own evaluation systems because quite frankly, it is not done that way. It is done by external or it is done by the ministry.
Mr White: I would just like to differ with Mr Jackson on that score. My own understanding is that there is darn little outside evaluation done. Mr Goldberg from Earlscourt went into some detail about the program evaluation and his program. I believe that rather than being something which was entirely in-house, as Mr Beer suggested, if we are funding as a co-operative project among children's mental health centres, it would be to some degree removed from that particular centre. I think this, to some degree, answers Mr Jackson's concerns.
Mr Beer: Would it help, Cam, if we made it a separate point, because I was not intending --
Mr Jackson: We could put it down below.
Mr Beer: