The Psychiatric Patient Advocate Office (PPAO) was the first province-wide advocacy program in Canada, established in 1983 to advance the legal and civil rights of patients in provincial psychiatric hospitals. The PPAO provides approximately 20,000 first and subsequent rights advice visits across Ontario annually and works with and on behalf of clients to address approximately 4,500 individual and systemic advocacy issues. The PPAO has traditionally provided rights advice and advocacy services in the current and divested provincial psychiatric hospitals. However, since the proclamation of Bill 68 in December 2000, the PPAO has also been designated as “rights adviser” by more than 80% of the general hospitals in Ontario that have psychiatric units. It is anticipated that some of the remaining hospitals will designate the PPAO as “rights adviser” over the coming months.
In 2003 as we celebrate our 20th anniversary, we are aware of how far we have come and how far we still have to go in promoting the civil and legal rights of individuals with a mental illness. It has been both an honour and a privilege to have served our clients for the last two decades and we appreciate that they have allowed us to be part of their journey of recovery, of hope and resilience. Sadly, we are still not an accepting and inclusive society that understands mental illness, that demystifies the stereotypes associated with it, nor is our society educated about the supports and services that people require to achieving their full potential. This has resulted in a significant loss to our communities as not all members are able to participate to the extent that they wish and are able to.
Since the time of PPAO’s inception, there have been many changes and several reports issued on mental health reform and the restructuring of the service delivery system. As time progresses, more and more patients are receiving care and treatment in the community instead of in hospitals. This shift, although positive for many, has also left some individuals behind as the individualized supports and services they require simply aren’t available. Many individuals with mental illness will continue to be vulnerable and their need for advocacy will continue to exist because at times they may need the support and assistance of an advocate in articulating and addressing their issues and concerns.
Over the past two decades the PPAO has been witness to significant changes in the mental health delivery system. Some of these changes include: the introduction of the PPAO as a rights protection organization; voting rights for individuals with a mental illness; and a focus on “rights” during the discussion of the Charter of Rights and Freedoms. These changes also include Charter challenges of mental health legislation; the rise of the consumer-survivor movements; consumers wanting a greater but equal voice in how care is provided;, and the introduction of community treatment orders. And more recently, the recognized need for advocacy services to be available to all individuals with a mental illness regardless of where or from whom they receive their care and treatment. Each of these changes has led to a discussion about creating a system of checks and balances, the need to protect the rights of persons with mental illness, and how to afford maximum rights protections to them..
The PPAO believes that advocacy is an essential and integral component of a reformed mental health system. In designing an advocacy model for the future, the PPAO and its stakeholders believe that advocacy services must be formally established, be independent from the service provider and provincially co-ordinated with both a local and regional presence so that the services are accessible to those who will utilize them. However, it is our view that these services are currently fragmented, that there is a lack of provincial co-ordination and integration and that there is a lack of a provincial framework with a corresponding accountability framework. Advocacy services in a reformed mental health system would include such components as: training and certification of advocates, development of an umbrella organization, setting of standards of practice and conduct for advocates, an accountability framework, and co-ordination of instructed, non-instructed and systemic advocacy.
Other characteristics of advocacy services in a reformed mental health system would include: advocacy is driven from the client’s perspective; services are delivered by formal and informal advocates through partnerships; and clients have a choice in who provides them with service and to the extent that they wish. Services as well would be delivered through partnerships with stakeholders, consumer-survivor organizations, families and caregivers. The benefits of such a service delivery model would allow for the pooling of talents and resources, collaboration on advocacy issues with a goal of system improvements and would complement and supplement other mechanisms, and not duplicate existing services.
As we begin our next 20 years of service we face many challenges but we will work tirelessly to overcome these as we walk with our clients in promoting their legal rights and entitlements. It is with renewed energy and commitment that we will continue articulating our vision for advocacy services in a reformed mental health system and will continue to work towards creating a system that is client-centred and respectful of patients’ rights.