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The PPAO must NOT become part of the CMHA

July 4, 2011

Ontario’s Psychiatric Patient Advocate Office (PPAO) is set to come under the umbrella of the Canadian Mental Health Association (CMHA).  This is as big a conflict of interest as you are likely to encounter in Canadian health care.

When you are admitted to a psychiatric facility in Ontario — especially under a Form 1 (“Application by Physician for Psychiatric Assessment”; viz., involuntary admission) — you are pretty much at the mercy of staff save for the efforts of the PPAO.  What does it do?

  1. It provides information to the patient on their rights concerning admissions under the Mental Health Act, the Criminal Code, and into long-term care facilities.
  2. It offers in-hospital patient advocacy on the above issues as well as in matters of complaint procedures, uses of personal health information, and treatment modalities.
  3. Outside the clinical sphere, it engages in systemic advocacy in a full range of vital areas, including appropriate use of force, the employment of restraints, police deployment of tasers, accessibility to elections, and consent and capacity issues.

In the larger sense, the PPAO is about guaranteeing human rights and civil liberties to inpatients.  In the immediate sense, it is about preventing abject abuses to their persons and psyches.

Why must the PPAO not come under CMHA authority?

The CMHA is not an institution, but it is de facto the main provider for outpatient mental health services and allied psychiatric supports in many communities, often in conjunction with hospitals.  In Grey and Bruce Counties (whose hub is Owen Sound), there are three(!) distinct mental health-related organizations, all designed to operate interdependently.  In essence, Grey Bruce Health Services-Owen Sound (our Schedule 1 hospital — that is, hospital with psychiatric inpatient services), our branch of CMHA, and the Grey Bruce Community Health Corporation all function en bloc.

CMHA, then, is a significant part of the system no matter where you live, and has its own interests and aims.  However, allow me to quote from PPAO’s official history:

“The intention of all political parties [in 1982, when the PPAO was founded] was that the Office would operate at an arm’s length relationship with the Ontario Government in the exercise of its mandate with only administrative accountability to the Ministry of Health.”

It doesn’t matter that the CMHA is a non-profit charity, answerable to a board of directors and not directly to the Ministry of Health and Long-Term Care.  The same principle should hold.  It is not reasonable to presume that a body whose mandate is to remain independent can function under the aegis of an organization which is an adjunct to inpatient facilities. 

So, what can you do?

  1. Read up on the topic.  Look at what we post in the Facebook group “Psychiatric Patient Advocacy Must Be Independent“.  Consult the PPAO’s website, as well as the CMHA’s.
  2. Lobby lobbyists, like the Ontario Mental Health and Addictions Alliance, of which CMHA is a part.  Their aim is to keep mental health issues on the front burner moving into the 2011 Provincial election.  But because they speak principally from the point of view of service providers and not patients (though the Ontario Association of Patient Councils and the OPDI are represented), they must be made to know that this is unacceptable.
  3. Apply pressure through conventional and alternate media —, etc.  Connect with socially conscious journalists.  Write letters.
  4. Make use of Deb Matthews (the Minister of Health and Log-Term Care) and your MPP’s — write them!

This is not a mere administrative issue.  Independent bodies are independent for a reason.  They need the leeway to speak and act on behalf of vulnerable individuals.  They must be free to hold institutions to account lest these summarily decide to curtail a person’s rights. 

We Survivors have fought long and hard to define what constitutes institutional abuse.  We can’t lose what we have gained.

5 Comments leave one →
  1. Marie Taylor permalink
    July 4, 2011 6:34 pm

    This would ba e a huge conflict of interest as CMHA is in the business of providing direct clinical servuices to PPAO’s clients including development of CTO’s (CTO cordinators) membership on ACTT teams, Mental Health Court workers, and CMHA housing staff. The PPAO would no longer be the indipendent advocate. Ergo the PPAO would no longer be able to honestly address complaints from clients regarding CMHA staff.

  2. Lucy Costa permalink
    July 5, 2011 1:36 am

    Thanks so much for writing this Richard !

  3. July 5, 2011 3:01 pm

    I am very concerned upon hearing that the PPAO is going to become part of CMHA. The ministry states:

    “Integrating the PPAO’s rights advice and advocacy services with the CMHA’s own and other related community-based mental health services will result in a more coordinated, patient-centred continuum of care. The transfer would include the funding, governance, operational management and accountability of the PPAO’s current services and functions.”

    I was the Team Leader for Community Development of the Ontario Advocacy Commission in the early 90’s supervising Regional Facilitators in seven regions across the province. In that role I met with people all over Ontario – – consumers, advocates, service providers — about rights advice and advocacy rights for vulnerable people in the Province of Ontario. I would dare to say that none of those parties would think it would be acceptable to take this kind of action in the interest of “increasing efficiencies”. It was always intended that:

    “The intention of all political parties [in 1982, when the PPAO was founded] was that the Office would operate at an arm’s length relationship with the Ontario Government in the exercise of its mandate with only administrative accountability to the Ministry of Health.”

    This proposed action cannot be framed as a a mere administrative issue to increase “efficiencies”. The PPAO was created to be independent of CMHA and the institutions that are connected to it for a reason. They need to be in order to speak and act on behalf of vulnerable individuals and to free to hold institutions to account in cases where a person’s rights might be curtailed because of individual or institutional actions – whether intentional or unintentional. It is hard to believe after all the years of trying to win rights for vulnerable people in Ontario – – for people who are much more likely to be marginalized or find themselves in vulnerable situations at the mercy of system in which they have no power or agency — that this is even under consideration. The PPAO cannot be seen to be a part of the institution it is supposed to be protecting people from, in part.

    We know from many other instutitions that internal investigations or abuse, boundary violations or simply questionable behaviour and practices is not the way to go. From the police, teachers, doctors, etc. we know that we do in fact need arm’s length bodies to do that advocacy and investigative work.

    Joanne Bacon

    • Heather McKee permalink
      July 6, 2011 11:39 am

      This is great background, thank you. A lot of work has been done to fight for independent advocacy (and more needs to be done so that folks in the community also have protection). We can’t go backwards – Heather

  4. July 5, 2011 3:33 pm

    Thank you all for your replies! I appreciate the feedback, clarifications, support and additional info. Let’s take this into the election, big time.

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