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Mental Health Reform: What It Was Meant to Be and What It Is In 1990 a legislative sub-committee toured the province to listen to people talk about the mental health system. "Hearings ... uncovered a great deal of consumer dissatisfaction with the mental health system and produced recommendations for reform" (p. 9, Final Report of the Implementation Strategy Sub-Committee for the Report of the Provincial Community Mental Health Committee). The Community Mental Health Sub-Committee Report (p. 39) states that "deficiencies in four particular areas were consistently identified during the consultations across the province:" housing, employment, income and crisis services. Yet when the document on Mental Health Reform ("Putting People First") finally came out of the Ministry, "income" was dropped as a priority concern and "case management" mysteriously appeared. Since then, government cuts to social assistance for some psychiatric survivors has clearly been contrary to what the Committee found was needed. (Aside from the human cost, this cost cutting measure actually loses government money, because as a study conducted in Brockville revealed, giving people money directly can reduce chronic hospital use, which costs hundreds of thousands of dollars more than it costs to give out the money!) In "Putting People First" "employment" apparently became "supports planned and run by consumer/survivors and families as alternatives to the formal mental health system". The great success of this policy can be seen in consumer and survivor run organizations that provide peer advocacy, peer support, and community economic development. We would like to believe that this is not just a gesture of good will, but a statement of understanding and acceptance of psychiatric survivors and our value in the community. Funding c/s initiatives supports our community in more ways that professional services ever can. Not only are we able to supply what we need through organizations that are accountable to us, but we are also living proof that we are able to help ourselves and each other. The hearings and the policy that followed also emphasized the need to move resources from psychiatric institutions to community resources. "Most people who spoke to the sub-committee members have experienced at least two levels of trauma - first, (whatever brought them into the hospital); and second, their hospitalization or "treatment" ... We also heard many frightening stories of the disabling results of psychiatric medication" (Community Mental Health Legislation Sub-Committee Report, p. 4). One attempt the Ministry has made to address this issue has been to try to make the institutional sector more accountable to the people they are supposed to serve by supporting organizations like ours. We are one of the few psychiatric c/s advocacy organizations in Ontario. But we are an organization of volunteers with one f.t.e. staff, attempting to work on behalf of thousands of people. We have been able to exert some positive influence– in matters ranging from changing the Criminal Code to building inspections to investigations of patient abuse by staff. We will be working to channel the c/s voice to the new corporation's Board– we have already organized one joint meeting of people from the different institutions. We are an example of how survivor participation is supposed to work, because we are accountable to c/s's, not to service providers. Committee recommendation #10 describes c/s's on boards and committees as "chosen by c/s's". This recommendation is routinely violated by staff in the mental health system who choose c/s participants, thus creating a serious conflict of interest in c/s representation. C/s's are left unsure of who they are accountable to, and fear contradicting the staff who gave them their position. In this way the principles of mental health reform can be distorted to suit the ends of people who have a vested interest in the system. Lately much attention has been paid in the media to a certain type of voice– that of family members and medical people calling for more psychiatric hospital beds and more forced "treatment". There is a need for more residential crisis services– but how about services that are responsive to people's self identified needs? It is absurd to discuss forced treatment when most of the people who are held up as examples of the need to force treatment were trying to get help (e.g. Cheung), and couldn't get it because of the assumption that a doctor, not the individual themselves, knows what is needed! Why not start with some compassionate (and cost effective!) alternatives to institutionalization like housing for the homeless, empathic peer support for the distressed, more real jobs. It is ridiculous to fund 50 beds for homeless people at Queen Street, at the cost of $500,000 a month, without providing homes! Especially when research shows that "psychological disturbances" are very seldom the cause of homelessness, but rather the result of it. Don't be drawn into medical solutions just because public opinion doesn't know any better. There are many people currently in Queen Street who would not be there if there was supportive housing for them in the community. That's about 70 beds, at the cost of $350.00 a day - quite a bit more that the average supportive housing. To save that money you have to follow through on your commitment to move the money saved from hospitals into the community (and be sure the resources are directed by the people who use them!) Home
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