The Psychiatric Patient Advocate Office (PPAO) was established in 1983 as an arm’s length program of the Ministry of Health and Long-Term Care to provide service to patients in the provincial psychiatric hospitals. Throughout its two decades of service delivery, the PPAO has become known as a partisan advocate for their clients, for its expertise in mental health legislation and patients’ rights and for the provision of independent advocacy and rights advice services.
Many of the clients who approach the PPAO for assistance are vulnerable, perhaps because of their illness, not knowing where to turn for help, perhaps they aren’t aware of their rights or how to exercise them, may be socially marginalized or disenfranchised, they may be isolated or simply don’t have supports and services available to them. PPAO staff is often called upon to give a voice to the client issue, to assist them in self-advocacy efforts and to help them overcome the barriers they face in their journey to wellness and recovery. If we are to overcome the stigma and discrimination faced by those with mental illness we must work towards the creation of an understanding, inclusive and accepting society, to address inequities, dispel the myths of mental illness and advance the rights of all individuals. Advocacy helps to reduce the vulnerability of individuals with mental illness by protecting and advancing their rights and addressing power imbalances, improving their quality of life.
The PPAO provides instructed and non-instructed advocacy services in accordance with four guiding principles: advocacy is independent, is accessible, uses avenues of least contest and is client directed. Throughout the advocacy process, the Advocate ensures that the client’s legal and human rights are respected, that their self-determination, independence and autonomy are maintained and that they are able to make informed decisions in keeping with their values, wishes and beliefs.
Patient Advocates routinely address issues related to care and treatment, access to mental health services, admission and discharge and abridgement of legal and civil rights. Individual instructed advocacy issues could include: inappropriate use of seclusion and restraint; withholding property without legal authority; informed consent; allegation of abuse or assault; failure to involve the client in discharge planning; concerns about medication or treatment modality; access to clinical record; changing patient’s legal status; and denial of privileges or visits.
At times, PPAO Advocates provide non-instructed advocacy. This usually occurs with the most vulnerable clients who may lack the ability to instruct an Advocate. Such patients may include those with advance stages of Alzheimer’s or those with the most severe developmental or neurological impairments. When conducting non-instructed advocacy, the Advocate’s actions are limited to redressing an abridgment of a legal right or therapeutic or social entitlement that imperils the incapable client’s health, estate, personal security or human dignity.
Systemic advocacy addresses issues that affect a group of patients in a facility or across facilities. It also addresses mental health system issues related to law, policy, services and funding. As a catalyst for change, the Advocate works collaboratively with stakeholders, including hospital staff, to find resolutions to the issues and bring about change at both the micro and macro levels. For example, the PPAO has been advocating for mandatory inquests under the Coroner’s Act when an involuntary patient dies while in a mental health facility. It is discriminatory that a mandatory inquest is held when an inmate dies in a correctional facility yet when a patient dies in a mental health unit the decision to hold an inquest is at the discretion of the Coroner.
In addition to providing rights advice in the ten current and divested hospitals, since 2001 the PPAO has been providing rights advice to patients in Schedule 1 Facilities and those in the community who are placed on a Community Treatment Order. The PPAO has been designated as “rights adviser” by 54 of 59 Schedule 1 Facilities. In 2003 the PPAO provided rights advice on 18,378 forms and assisted clients in making 3,147 applications to the Consent and Capacity Board.
In-patients in mental health units have benefited over the past two decades from having a rights protection system in place, fortified by the law which requires prompt rights advice in nine mandatory situations and supported by an infrastructure that confirms that rights advice has been provided. This system has worked well in protecting the rights of inpatients, however, such protections have not been extended to those receiving care and treatment in the community as there is no legal requirement for them to receive formal rights advice.
Although Ontario has been a leader in the promotion and protection of patients’ rights, there is still much to be done if we are to ensure that every individual with mental illness is aware of their rights and how to exercise these rights. There is an identified need for independent community-based advocacy and rights advice services as an integral and essential component of mental health reform.
To learn more about the work of the PPAO visit their website at www.ppao.gov.on.ca.