Legislative Assembly of Ontario

AGENCY REVIEW

BROCKVILLE PSYCHIATRIC HOSPITAL COMMUNITY ADVISORY BOARD

CONTENTS

Tuesday 28 January 1992

Agency Review

Brockville Psychiatric Hospital Community Advisory Board

Chris Francis, chair

Robin Reil, vice-chairman

Jacqueline Duclos, member

STANDING COMMITTEE ON GOVERNMENT AGENCIES

Chair / Président(e): Runciman, Robert W. (Leeds-Grenville PC)

Vice-Chair / Vice-Président(e): McLean, Allan K. (Simcoe East/-Est PC)

Carter, Jenny (Peterborough ND)

Elston, Murray J. (Bruce L)

Frankford, Robert (Scarborough East/-Est ND)

Grandmaître, Bernard (Ottawa East/-Est L)

Hayes, Pat (Essex-Kent ND)

Jackson, Cameron (Burlington South/-Sud PC)

McGuinty, Dalton (Ottawa South/-Sud L)

Marchese, Rosario (Fort York ND)

Waters, Daniel (Muskoka-Georgian Bay/Muskoka-Baie-Georgienne ND)

Wiseman, Jim (Durham West/-Ouest ND)

Substitution(s)/Membre(s) remplaçant(s):

Carr, Gary (Oakville South/-Sud PC) for Mr Jackson

Ruprecht, Tony (Parkdale L) for Mr McGuinty

Sullivan, Barbara (Halton Centre L) for Mr Elston

Wessenger, Paul (Simcoe Centre ND) for Mr Marchese

White, Drummond (Durham Centre ND) for Mr Waters

Clerk / Greffier: Arnott, Douglas

Staff / Personnel: Pond, David, Research Officer, Legislative Research Service

The committee met at 1034 in committee room 2.

AGENCY REVIEW

Resuming consideration of the operations of certain agencies, boards and commissions.

BROCKVILLE PSYCHIATRIC HOSPITAL COMMUNITY ADVISORY BOARD

The Chair: Can we come to order, please. We are a little late getting under way. We are still short a couple of members and our research officer, which is quite surprising. This is a first, that he has not been here at starting time. Oh, here he comes. Welcome.

The first witnesses this morning are representatives of the Brockville Psychiatric Hospital Community Advisory Board. I would like to welcome you to the committee. I think we all appreciate that you are volunteers on this board and are taking time out of your other responsibilities to appear before us and we very much appreciate it. I wonder if you could all introduce yourselves and your role on the board for the purposes of Hansard and then we will ask you to proceed with an opening statement.

Ms Francis: Good morning. I am Chris Francis and I am the chair of the community advisory board in Brockville.

Mr Reil: I am Robin Reil. I am vice-chairman of the board, and I just want to thank you in advance for postponing this meeting until 10:30 so I could catch the red-eye out of Brockville, which lands in Toronto at 9:59.

Mr Grandmaître: Was it on time?

Mr Reil: It was two minutes early.

Ms Duclos: I am Jacqueline Duclos, and on your list there I am written down as a consumer. I would just like to state that it is consumer/survivor, and I am willing to address that at a later point if you wish.

The Chair: Please proceed.

Ms Francis: Since we have already made our introductions, I will just start in. Good morning everyone. I am really glad to be here. My understanding is that you have already received an overview of who we are and the status of operations at Brockville Psychiatric Hospital. I will therefore keep my opening remarks brief.

We are happy to be here to let you know our perceptions of our role and the challenges we are facing as an advisory board. Our mandate is to be a communication link between the hospital and the community and to advise the minister about the needs of the hospital and the community as we assess them to be.

Presently we have just completed public forums in three areas of our catchment, Ottawa, Brockville and Cornwall. The results are being compiled and our members will analyse them and make recommendations at a day-long meeting on February 29 in Brockville. We hold public meetings in one of our catchment areas at least once or twice a year. In March we are going to be meeting in Rockland, outside of Ottawa. Last year we met in Cornwall.

The reason for these meetings is to increase the awareness of the services Brockville Psychiatric Hospital offers and to get feedback from the grass roots about the perception of those services and to look for ways we can be of further service to the consumers, families and givers of service in our catchment area. For example, out of Cornwall's meeting we were able to promote partnerships of consumer-survivor groups.

A challenge we take very seriously is the complex one of reassuring the community that the hospital has in place state-of-the-art assessments to make the best possible decisions available to them regarding forensic clients. We hear and understand that the community is concerned. We know that a realistic, non-inflammatory education process is necessary. We know that the trust between the hospital and the community can be fragile. We need to build partnerships with the media to help ensure and have them take a part in that education process.

The board understands the heartache of threatened job security. We have met with the Ontario Public Service Employees Union to look for ways to keep options open. New roles may be in order for some staff. The board would like to be a catalyst for perhaps planning for skills retraining.

As I say this, I am feeling a little anxious, because at this point the writing seems to be on the wall with regard to some changes going on in Brockville, yet from the minister we are getting reassurance that the hospital will not close and layoffs are not planned, so we are caught in the middle.

The bottom line for CAB is to see its way clear through the structural, procedural trappings and help the hospital improve services to clients. We are not a management board. Our advisory capacity is like 10W-30, to grease the communication wheels. We pull ideas together, and we have to ensure that a generous squirt of that 10W-30 lands on the board itself. We have to communicate with each other.

I must commend our board for countless hours of volunteer time, accommodated between work and family responsibilities. We will try our best to answer your questions this morning so you too can fulfil your role. You will have to excuse my 10W-30 metaphor, but it was hard to resist after I read your terms of reference with that sunset metaphor in it. I hope we have a good meeting.

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Mr McLean: Has the advisory committee ever made any recommendations to the ministry over the past several years, any input it might see going on within the community which it would hope the ministry would look at?

Ms Francis: My group will have to help me with this. A lot of the contacts we have with the ministry are for clarification and reassurance. Since my being there, there have not been any specific recommendations around specific changes.

Mr McLean: You are a group that works between the community and the psychiatric facility and you say you have meetings across your area of jurisdiction? My initial question was that I was wondering if at any time you have made recommendations, having had those meetings and observing what is taking place within the community, that perhaps some changes should be made. Have you made any recommendations to the ministry?

Ms Francis: I think that is about to happen, where we have solidified all the ideas and all the data we have gathered. This community outreach is a fairly new process for community advisory boards. Although we have been in existence since 1986, traditionally that role has been passive. We have been trying to make it more active and trying to make closer connections with the community. So those recommendations are coming.

Mr McLean: Do you work with the district health council in any way?

Ms Francis: Yes.

Mr McLean: Do you have members on your board who are part of the district health council?

Ms Francis: Yes, we do. Catherine Whetter, who appeared before this committee, is part of our community advisory board.

Mr McLean: Have you any thoughts -- you may not want to express them -- with regard to the Lieutenant Governor's role, his jurisdiction or his power within the psychiatric facilities?

Ms Francis: There is a lot of controversy around that, especially in Brockville, where people are feeling unsafe. We know there is legislation in place around what the role of the review board is and what that whole process is all about. I think, as with any legislation, changes are made when the existing process is not seen as reasonable. For example, that kind of thing happened with the Young Offenders Act. At this point there is a spirit afoot to have a closer look at that process, to see if it can be changed in any way to improve the batting average, I suppose, the predictability.

Mr McLean: Are you discussing this within your own group?

Ms Francis: Yes, we are.

Mr McLean: As an advisory committee for the community, you are working on recommendations or some input where you can let the ministry or the district health council or the psychiatric facility know, but you have done nothing in that line yet of really putting something down in writing, is that right?

Mr Reil: Just to pick up -- I have been jotting down some of the questions -- with regard to being involved with the ministry and so on, I have been on the board just over a year and a half. We are now on our third Health minister. We have had a problem since I have been on the board in terms of getting a response from the minister when we simply write a letter expressing a general concern. Until Frances Lankin came in and until we had written her several letters, there had been very little response to certain basic questions, if you like, trivia and detailed kinds of things.

At the same time, since Christine has become chair our board has really become proactive in terms of holding public forums, which we did in Brockville, Ottawa and Cornwall. We are going to meet as a board for a retreat on February 29. Out of that, we are going to be making specific recommendations. There are certainly diverse needs of the three communities and we want to mesh that in and then make some specific recommendations.

We are pleased with the fact that the latest Minister of Health, although a bit late, is responding. We are hoping this dialogue is going to get better.

Mr McLean: My final question is to Jacqueline, the consumer on the board. Perhaps you can tell us when you were appointed to the board and what your role will be.

Ms Duclos: I was appointed just in the fall of this year. Again I will state that it is "consumer/survivor," and the reason I say it with the slash in it is that the idea of a consumer is a nice idea in theory, but the problem is that we are not consumers most of the time. Once brought into the system, we have no choice.

At the moment I am doing a lot of reading about the hospital, theoretically, about its programs and so on. I was a resident at the hospital for over a year, so I know that side of it and I am trying to balance it on the other side. On the board I think I have the same role anyone else does, as well as the role of representing the people who are in that facility and conditions for them. That is my basic feeling.

I would just like to make a comment on the Lieutenant Governor's warrant. The problem with it is that the legislation that was struck down is fundamentally flawed. Even with the changes they are trying to make, they are not going to eliminate the "until cured" part, so they say they will be able to do capping on it. But in reality they are leaving a loophole so they can still keep people in there for a long time. There really are problems with that piece of legislation.

Mr McLean: You will be making some recommendations to the board on that, I am sure.

Ms Duclos: I am working with some people.

Mr Frankford: Your mandate is representing the hospital in relation to the community. Does this limit you? It sounds as though in a sense you want to look at psychiatric services for the area rather than just for the hospital.

Mr Reil: I am not sure we are representing the hospital to the community. Rather, we are liaising between the two in that we answer to the Minister of Health and not to the hospital. We do share our findings with the hospital.

Mr Frankford: I am just wondering, does the fact that you are hospital-based limit you in any way? I think in your introduction you said that it is representing the hospital.

Ms Francis: We are sort of in the middle trying to juggle both roles. I feel strongly that both roles are necessary. That is, we need to help the hospital to be in touch with the community so that all the positive things that are happening can be shared with the community. But we also need to bring to the administration of the hospital what we are getting from the people in the community about those services. It is a two-way street.

Mr Frankford: These consultations you have had in the community, presumably in a sense you are doing a needs assessment.

Ms Francis: Actually, it is broader than that. Our role was to listen to people's experiences with the Brockville Psychiatric Hospital. The people we heard from were consumer/survivor groups. They were administrations from other services in the catchment area that use the services in Brockville from time to time. It was a broad base of gathering information from anyone. Families of consumers were also present. Community mental health facilities were also represented and gave their input as to how they work with the hospital, what things could be improved. This is the kind of information we are looking for.

Mr Frankford: Can you give us some idea of what the hospital does in the way of outpatient care?

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Ms Francis: What it does for an outpatient? Right now, Brockville has a new outpatient program that is in the second year of being piloted. It is run out of Ottawa. Clients are discharged from Brockville back to their home community of Ottawa. Various teams are set up as support teams to help them function effectively in the community.

Mr Frankford: There is no outpatient service or clinic actually in Brockville itself?

Ms Francis: Yes, there is. There is a schedule 1 facility, which is Elmgrove. That is part of the hospital that services Brockville and the area. Elmgrove would be similar to a psychiatric unit in a general hospital in another community, only Elmgrove in Brockville happens to be situated on the hospital grounds.

Mr Frankford: The hospital itself does not have either ambulatory care facilities for people who do not need admission or anything where discharged patients would go for follow-up or continuing medication. Is that my understanding?

Ms Francis: Yes, that would be the role of Elmgrove, unless they were from another community; in that case they would be in their home community and then followed up.

Mr Frankford: Has the board had discussions about increasing the outpatient services?

Ms Francis: Yes. As you know, the Graham report is something that seems to be a philosophy the ministry has developed around mental health. What we are looking for is to get people in their home communities and to service psychiatrically disabled clients as close to their home community as possible. The thrust is to not keep people in hospital for very long.

Mr Frankford: Do you know to what extent the staff psychiatrists in the hospital are available as consultants to physicians in the rural community?

Ms Francis: This is some of the information we have been gathering from our meetings out in the community. There are mixed perceptions. It seems the outlying communities would like to have their own service. Rather than rely on Brockville, they would like to have their own service and their own people and their financial resources to run it. They see it as unwieldy to deal with Brockville over the distance.

Mr Frankford: Does the hospital have a psychiatric director or does it just have a number of staff psychiatrists?

Ms Francis: Dr Draper is the medical director. Each service has psychiatrists who are in charge. One of the difficulties that Brockville is having is the retaining of psychiatrists. There seems to be a turnover of psychiatrists at the Brockville hospital.

Mr Frankford: Does Dr Draper sit in on your meetings?

Ms Francis: Yes, he does.

Mr Frankford: Does he give you input on his feelings about the broader psychiatric needs of the region?

Ms Francis: Usually what happens is that he has a report of the kinds of things that have been going on. He responds to our questions. One of the things we have been hearing out in the community is that when people ask to be admitted to Brockville, sometimes there is a waiting list and services are not available immediately, so the most recent discussions have been, "How can there be long waiting lists when the hospital occupancy is not 100%?" It seems there is some intricate formula that the occupancy is assessed at, so some wards are at 100% and cannot take in any new clients.

Mr Frankford: Do you have any figures or any sense of what diagnoses are on the waiting lists?

Ms Francis: The dual-diagnostic area admits clients who have a developmental handicap plus a psychiatric diagnosis. This seems to be an area where there is some difficulty. There have also been complaints from the Cornwall area for geriatric clients who also have a psychiatric illness. It seems this service is hard to come by and there are waiting lists in communities.

Mr Frankford: We have the list of hospital activities here. Registered outpatients in 1990-91 were 443. I have no idea what to expect, but that does not sound like all that many for the region you cover.

Mr Reil: The outpatient service covers just Leeds and Grenville counties, with a population of around 50,000 or thereabouts. Maybe Mr Runcicman would know better. That seems to be roughly a one-in-ten kind of situation.

Mr Frankford: You said there is a facility in Ottawa as well which is a sort of outpatient facility. Presumably the clients there have not been included.

Ms Francis: Are those included in that number? I do not know whether all --

Mr Frankford: It just says "hospital activities," so maybe it underestimates the --

Mr Reil: If I could just expand, the Ottawa outpatient is ACRP, the assertive community rehabilitation program, which deals with people who live in the Ottawa area. Rather than going through transporting them to Brockville, the basis is that it is better to be treated right at home, and if you can be an outpatient, so much the better for your mental health. The Elmgrove service, on the other hand, deals on an outpatient and sometimes on an inpatient basis with people who live within a decent distance of Brockville.

Mr Frankford: So your board does have responsibility and input into those non-Brockville services, is that right?

Mr Reil: Yes.

The Vice-Chair: Thank you. Mr Grandmaître; we are trying to limit it to 10 minutes so we can keep rotating.

Mr Grandmaître: Very good. If I may, I would like to follow up on the types of questions Mr McLean went through with you. I realize you are an advisory board and that you are volunteers and we are all proud of you, but do you feel that advisory boards, for instance your advisory board, in some instances are some kind of -- not a setup; that you look good but are not being listened to? Do you feel that way?

Ms Francis: From time to time, sure.

Mr Grandmaître: How often?

Ms Francis: My feeling, and what keeps me going, is the fact that even though the system is not perfect, it is better than having a really insular kind of situation without us. At least what is happening is that we are keeping some doors open. The potential for psychiatric hospitals to become really insular is tremendous. Historically they have been, and I think that is why community advisory boards have been developed. Even though it seems like the startup point in 1987 was quite a few years ago, there is often a feeling that we are feeling our way around. The turnaround with advisory boards is substantial. When members come on to an advisory board there is a real education process that has to take place. The system is intricate and complicated, so to get a feel for where things are at sometimes takes a little bit of time.

To answer your question, I think it is much better than not having anything. I think it is possible for us to push for some more power. Sometimes we are given mixed messages as to how much power we have when we delve into certain aspects of the running of the hospital. There is often the feeling that we are only in an advisory capacity, therefore we should not be commenting on structure.

On the other hand we get messages such as, "You have as much power as you want to take." At this point we are feeling our way around and hoping to make things better, not make things more complicated and worse simply by our existence. We want to increase communications, not make it more complicated.

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Mr Reil: Could I expand on that? Like I said, I have been on the board a year and a half, approaching two years. I have heard that when the boards were established in, I think it might have been 1984, the board members were perceived as being a kind of window dressing, political appointment process. In some ways that seemed to continue until about 1990 or 1991.

When I came on the board a year and a half ago we spent a lot of time having a nice meal at the hospital, listening to reports from the psychiatrist-in-chief and the administrator and working on mission statements. You kind of sat there, it was my perception, until you were blue in the face, sitting and listening and then going home and coming back two months later to listen again.

As Christine has mentioned, we see our role evolving because we have become much more of a proactive board. We have decided, let's get some action, let's ask some questions. For the moment we certainly remain optimistic that the communication with the Health ministry is going to improve in the sense that once there is consistency, with the same person being minister over a long stretch of time, if we can get some good communication established, which we have made some inroads into now, then things are certainly sounding on the up and up. As Christine said, I guess we can pretty much decide what our role is going to be. The more active we get, we will see what the results are and then it will come out into a kind of happy medium situation.

Mr Grandmaître: I have read some of your annual reports going back to 1986, 1987, 1988 and 1989. They seem to me very good reports. You have only been on the board for a year and a half, did you say? How many years have you been on the board?

Ms Francis: This is my fourth year.

Mr Grandmaître: What has been your experience in the last four years? When you file your report with the Ministry of Health, is it listening to you? I have seen some of those reports and now another member of the board is saying, "It is only now that we feel we are being listened to." If you had to change your mandate or advise the ministry as to how you can be more efficient as a board, what would you change in your mandate to become more efficient?

Ms Francis: Just speaking for myself, I would like to be seen as legitimate. There is often a comparison between our advisory board capacity in the psychiatric hospitals with that of boards in general hospitals. They are seen as two different mandates. The boards in general hospitals seem to have a lot more power, make decisions and can be accountable for those decisions. I do not know. There has been some discussion around divestment and whether community advisory boards should in fact be management boards like general hospital boards. Maybe that is the direction to go.

Mr Grandmaître: What are your comments on the rumours about the possible move of your hospital to the Ottawa-Carleton area? It is only a rumour, but rumours around Queen's Park seem to fertilize --

Ms Francis: Yes, many rumours. The rumours play havoc with the people who live in the community.

Mr Grandmaître: Absolutely. They must.

Ms Francis: And they are, I think, unfair. One of the things we did was to contact the minister to try and get some detailed future plans so we could begin to give some reassurance to the people who work at the Brockville Psychiatric Hospital.

On the one hand we have to look at whether we can give better service to clients in their own home communities, okay? The Graham report says yes. That being the case, what role does the Brockville Psychiatric Hospital have? I think there are other roles the hospital can play. They can be centres for other areas of expertise, and then we could perhaps meet the needs of the clients in their community, having Brockville serve as some source of expert resources. I think we have a lot of expertise around community mental health, giving service, but we have to resolve some of the logistical problems of the distance some way.

The Vice-Chair: Keeping to our 10-minute rotation, Mr Runciman is next.

Mr Runciman: Representing the Brockville area -- it is part of my riding -- I am not very heartened by that response and what you said earlier about the writing on the wall. Have you, as a board, read the Ottawa-Carleton Regional District Health Council's report and recommendations in respect to the move of long-term psychiatric beds to the Ottawa-Carleton area?

Ms Francis: We just have received those and I have not had a chance to read them.

Mr Runciman: So the board has not taken a position on that report.

Mr Reil: We have not seen the report yet.

Ms Francis: There has been some discussion. The community advisory board chairs and vice-chairs meet as a group about two or three times a year, and they as a group will be responding to that long-term care report saying that it has some deficits in the area of really addressing some needs.

Mr Runciman: I think it has a lot of deficits and I hope that rather than simply the advisory committee, perhaps you will be drawing on community input which I see as part of your role in respect to not only this question of removing long-term beds, which has been around for a long time, but also another important element: the impact on a community. Brockville Psychiatric Hospital has the largest payroll in that whole region. The significant moves recommended by the Ottawa-Carleton district health council would have a devastating impact on the economy of the region. Those are the kinds of concerns you should be taking to the table as well so that they are part of the mix.

I guess I am curious about a bunch of things. I will not get to all of them in this round.

Ms Duclos: I would like to respond to that. For one thing, the mandate put forward by the Graham report was to community-based mental health, which means services in your own catchment area, like in the city of Ottawa-Carleton. People in Ottawa-Carleton; basically want to stay in Ottawa-Carleton, they do not want to travel the distance. Also, I think the Brockville hospital is going to have to look at taking on a new kind of role into different areas than it is because it is very hard to rehabilitate somebody on a ward 135 miles away from their home. It does not teach them anything about --

Mr Runciman: Where is this happening, 135 miles away?

Ms Duclos: I do not know the direct distance from Ottawa to Carleton.

Mr Runciman: It is a little over 60 miles.

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Ms Duclos: Families do not get down there. I was there for a year; my family came down twice. I think the hospital is going to have to look for a new role if there are areas of specialization it could be moving into. I did not know the extent of the geriatric component, but it is quite large. I think they have to look at a new direction because people do not want to be locked up in a hospital for long periods of time. It does not benefit the community in the long term and it does not benefit the person. You start eating up large amounts of money supporting people in a facility of this nature when it could, I think, be directed into different areas.

Mr Runciman: I have heard all these arguments before. I was not going to interrupt you, for the benefit of the committee. The communities which will be impacted in a negative way are going to be taking a position on it and taking a look at what we fear are all the weaknesses in this report. I hope you will take a careful look at it and again, as I said, ask for input from all the communities.

I am curious about the oversight on the operations of the psychiatric hospital and how involved you are there. I know there is a budget shortfall at the hospital this year. I wonder how involved you are in terms of reviewing the budgets and going over them line by line to see where changes and adjustments can be made. Do you get involved in that sort of thing?

Ms Francis: We are involved. We sit in on the meetings. Interesting things happen with budgets. Up to a period of time we were very much in the black and things were going really well, and the planning for the future was such that if we continued along these lines we would not have a shortfall. But different messages come down through the ministry asking for adjustments, like "Do not renew contracts for people who are not on contract," that is, for the full-time staff; "Don't do that any more," or the money earmarked for a certain thing was no longer coming down the pipe any more.

These kinds of things demand that the people doing the budget -- at least it is my perception -- have to constantly adjust and head problems off at the pass. You cannot predict the future very well just because you have a budget.

Mr Runciman: I am glad you are involved in it, in any event, and taking a look at it. An area mentioned in the Ottawa-Carleton District Health Council report was the difficulty in gaining access to rehabilitation beds. I talked to the folks at the hospital in OPSEU and they say one of the reasons for that is certainly not the access problem in terms of distance but the fact that the head of the rehab unit, Dr Lafave, has made some pretty dramatic changes in admission criteria over the past few years. I wonder if you could respond to that.

Ms Francis: Dr Lafave is seen as an expert in his field. He believes in community rehabilitation. I know he has ruffled a few feathers in the community. We are in a real doublebind position here. We know community mental health is good; there is a lot of support for that. That invariably means a change of role in the Brockville Psychiatric Hospital. We have seen the changes over the years; we have seen it go from almost 3,000 patients 20 or 30 years ago to 350 patients now. Those changes come as the beliefs of the time change.

Mr Runciman: When we are talking about the DHC report I think there is confusion. They are looking for long-term psychiatric beds, psychogeriatric rehab and so on, they are not looking for community-based. A lot of their proposals are dealing with moving long-term beds to the Ottawa-Carleton area.

Ms Francis: So this means that role will not be played by Brockville.

Mr Runciman: It will be played in Ottawa-Carleton rather than Brockville. I think it is quite a significant difference in terms of community-based care.

Ms Francis: Yes, it is true. It does not matter if you are elderly; you should still have access to your own community, your own family.

Mr Runciman: You think a 45- or 50-minute drive is too far. Essentially that is what you are saying.

How much time do we have?

The Vice-Chair: You have one minute and 20 seconds.

Ms Duclos: I can say --

Mr Runciman: You are going to take up my time, but I will get you the next round.

Ms Duclos: I am sorry. At the Ottawa-Carleton Regional District Health Council, I sit on the implementation committee that is asking for and looking at proposals from the community to see what services people want in the community and how to address them. In terms of the long-term rehab beds in Ottawa-Carleton, I just attended a meeting last week with the chiefs of psychiatry where they were discussing a model, and only a model. There was a fair bit of resistance just to how they were approaching it. They were looking more at things along the lines of the assertive community rehabilitation program, which keeps people in their community again.

Mr White: First off, I want to commend all three of you for taking the time to come down here and also for demonstrating a very wide vision in terms of what mental health services should be in your community -- or, I should say, your communities.

I have some questions in regard to the role of CABs and also a couple in regard to some of the services we have just been speaking of. First off, all the appointments are made by the Ministry of Health. Who makes those recommendations?

Ms Francis: Two things happen. We advertise in the paper for people to volunteer to serve on boards, and they submit résumés to our nominating committee. A committee of the board looks over the applications and then we forward those to the minister.

There is a new process now. There is the open door, open book process, so that we are going to be getting possible appointees from our own communities and also at the ministry level, because those applications will be directly to the ministry.

Those are submitted to the minister and then they are appointed. Traditionally that time span was horrendous. Between the time we submitted the names and the time we got any indication back was sometimes nine months.

Mr White: You mentioned that Catherine Whetter is on the district health council in eastern Ontario. Ms Duclos, you mentioned that you were involved in a district health council or an organizing group in Ottawa-Carleton. Are there other members on your board who are similarly involved with other health councils?

Ms Francis: Yes. Belia Brandow would be another person who would be involved.

Mr White: Would it be a health council in Leeds-Grenville, then?

Ms Francis: Rideau Valley, I think.

Mr White: Okay. So you are able to report backwards and forward within those various groups?

Ms Francis: Yes.

Mr White: I think that is quite commendable. In terms of your mandate, you are to advise the minister in regard to the need for services in your communities. You have mentioned the community relations issue. To what degree do you advise the hospital directly -- the administrator, the hospital chief? You mentioned having meetings with OPSEU. To what degree do you advise the hospital directly, as well as partaking in or monitoring its activities?

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Ms Francis: We meet as a total group every other month, and then between times we meet in subcommittees. Dr Draper and Pat Lee attend those meetings. They share information with us and we share information with them. I am not quite sure what you are getting at. Do you want some specific things that we advise them on?

Mr White: Yes, that would be of interest -- areas where you might have given them specific advice.

Ms Francis: One of the areas is that in Cornwall, the mental health services that have been provided by Brockville have been seen as really inadequate. We brought forward to Pat Lee some of the difficulties and what we have been hearing in the community of Cornwall. What happened then was that a series of meetings was set up between Brockville, the psychiatrists at the hospital, and the administrator of the Cornwall General Hospital. They sat down face to face to try to iron out some of the difficulties with regard to the services, so it is that kind of process.

Mr White: You mentioned your other proactive moves, such as having public forums in various communities. I really want to commend you on that because I do not believe that is general with all community advisory boards, and of course it is a very important service.

When you do not have a management board capacity, as the board of a hospital would normally have, do you think a CAB would be more relevant than a group which would oversee all psychiatric services within eastern Ontario, like a district health council for psychiatric services?

Mr Reil: You cannot beat local input and involvement in terms of the facility being part of the community.

Mr White: I appreciate that, but what I am asking is, if a group like yours -- you are now facility-based. Your staffing, your resources are all at the Brockville hospital. If instead you were independent, with the same group of people or perhaps slightly different, but from the same communities, you would be independent but you would be able to monitor all psychiatric services within those communities and perhaps coordinate them better.

Ms Duclos: You would be looking at a massive coordination problem. If I can use an example from Ottawa-Carleton, trying to coordinate the hospitals with psychiatric units in that city and getting them to talk to each other was a major task. Getting them to talk to community centres, health clinics and so on, it gets very large very quickly.

I think that in terms of Brockville, just the organization and structure of that place in itself requires that someone be able to look at it. I would like to see, perhaps -- and this is only my own opinion -- the board have more real power to maybe do things. But I think that system in itself needs its own people to look at just how that place works, because it is so big on its own. Trying to coordinate the region that would be covered, you would be lost, I think, in coordinating everybody to one place. It is hard enough getting our board together at one time.

Mr White: What you are saying is that there is a need for a CAB to address the services of that psychiatric hospital --

Ms Duclos: Definitely.

Mr White: -- but also that there is no coordinating body in regard to psychiatric services in eastern Ontario.

Ms Duclos: I think you have your district health councils in each area.

Mr Francis: Well, that is their role, and that is what their role should be. I do not really like the idea of mental health services; it is health, and mental health services should be incorporated as part of district health councils.

In the Cornwall area, there was no mental health committee as part of a district health council. We are just sort of trying to start that going. Mental health services have taken low priority, in my estimation, as far as the district health councils are concerned. That has been my own experience. So the coordination is really necessary. The people who need to be talking to each other should be talking to each other face to face. There is a lot of grabbing for resources and power struggles that do occur; you are very well aware of that. A community advisory board somehow should be trying to get people face to face in a non-threatening kind of way. We have no power. We are no threat. Maybe that is a plus sometimes.

The Vice-Chair: Thank you. You have just 30 seconds.

Mr White: One brief question to Ms Duclos. You mentioned that you were at the hospital for about a year, and you and your family live in Ottawa. A year is a fairly long time in hospital, and you only had a couple of visits. Does your family have a car?

Ms Duclos: Oh, yes.

Mr White: And yet even with a car, there just was not that access.

Ms Duclos: My family now is fairly affluent, but you have not only the transportation and the time it takes to get down there, but also the reality of day-to-day life. Both my father and my stepmother worked full weeks for the federal government, and the only time they ever had was weekends. On the weekends you have to buy your groceries and all that stuff, and you also hope to try to get some break. You have the maintenance on your house. The dynamics -- it is just very difficult to coordinate time as well as that. That is a major problem. I have had people who were there in Brockville after I left, and my getting down to see them on any kind of regular basis was very difficult. You spend two hours going and two hours coming back and two hours there, and your day has gone.

Mr Reil: Can I just add one comment? There is a free bus service from Ottawa-Carleton every weekend to the hospital, so that service is provided.

Mr Ruprecht: I have a couple of questions. One of them follows within the line of Mr White's questioning, but what I wanted to ask you, really, is about the whole idea of the revolving door phenomenon. Since in my own area in Toronto we do have some experience of how this works, I wanted to find out your opinion and what recommendations you have made, generally speaking, in terms of this revolving door business.

Patients are coming into a psychiatric centre and obviously getting some treatment. After a quick treatment period, they are being sent "back into the community," meaning that there should be some help there or that someone is there to look out for them or after them, and yet we know that not too much is happening. In a very short time, it seems, the patients are back again. It is a continuous process, and not much is out there in terms of community activities.

My question to you would then be, have you made some recommendations in this kind of format, or what do you see that your psychiatric hospital could do to try to help out in terms of coming to grips with the situation?

Ms Duclos: I think there are a couple of things that first of all have to be addressed. One is that we want people to work with us, not "take care" of us or "look out" for us.

The second one is that you have to expand it beyond just the psychiatric hospital. You are looking at an issue that crosses not just the idea of a mental illness; you are looking at a whole economic and social thing too. A lot of the people you get are those who get caught in the poverty. They do not have the money to live adequately, so you really have to look at adequate housing, adequate payment for people, adequate programs in terms of rehabilitation and addressing things. There is going to be a proportion of people who will always probably do the revolving door, a percentage who get caught into that and find a security in it and so on. But in Toronto here you have burgeoning projects run by survivors trying to support them, but we get resistance.

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You can put so many millions of dollars to clear up a debt at a psychiatric hospital and then $1.3 million gets spent to fund 43 consumer groups across the province. I think one has to look at where you are directing some funds. I think the community advisory board has a role to play in that area. I do not want to see anyone lose a job because of this, but I think they have to refocus where they are and what they are delivering, because people want to live, have lives. The system that has been created is making someone into a revolving door.

Mr Ruprecht: That is my point.

Ms Duclos: But that is not the psychiatric system alone: That is the housing system; that is the social welfare system; that is the job situation; that is job retraining, school, the whole thing. You have to expand it outside of that -- very much so -- and you cannot just deal with it in isolation. It is a much larger concept.

Mr Ruprecht: Thank you very much. I am wondering whether you want to address yourself to that point as well, but while you are thinking about this, let me just make one additional point.

I think you are quite right: It cannot be done in isolation. But the question really is, is there enough help out there after patients leave the hospital? However you want to term it, whether you say, "Let's do something for them," or, "Let's work with them," is that irrelevant? Is there something there within the system that will provide enough for them to at least get some help to maintain some kind of livelihood so that it does not become systemic, so that the system does not push them back in there again? If that is the case -- and we do not want to be too harsh with you, because we appreciate your coming down here -- what do you see as the way out of all this?

Ms Francis: I agree with Jacqueline. The resources that are out there are getting better and there is some improvement. I think the assertive program Brockville has developed is a good program basically, that the support systems are in place. I do not know if it is a lot cheaper to serve these survivors out in the community, but I think you have a happier client group as a result and the recidivism rate is less. It has not been in operation long enough for us to really assess just how good it is, but there are models out of the United States. That does not mean to say that psychiatric hospitals are redundant. There still is going to be a need for them, but on a smaller scale and perhaps in a reorganized structure.

Mr Ruprecht: Do you know offhand what is the recidivism rate, roughly, of your institution?

Mr Reil: We do not have a figure offhand, but we have been told that it is better than the prison system by quite a bit.

Mr Ruprecht: Is it less than 20%, 30%, 40%, 50%, 80%?

Ms Duclos: You have to look at why people are coming back. It is not so much the numbers; it is why they are coming back, and that takes you larger again.

Ms Francis: Sometimes people come back because they have run out of money, because the support system for helping them set up their budgets and organize their lives has not been in place or has somehow fallen apart.

Ms Duclos: In Ottawa we have different programs running through the region and out of different agencies: case management, support services to people in their homes. Unfortunately, nobody wants to fund -- it is very difficult to get funding for that, and it is the preferred choice of most of the people to have that kind of service. Again, there is a role for hospitals in the spectrum, but we have to open the spectrum up from just looking at institutional situations and take it across the lines to support groups, to agencies, to whatever. We should be looking at funding a far broader range, because they will all complement themselves in the end.

Mr Ruprecht: Mr White raised a question in terms of your mandate. I am wondering, again not to be too harsh here, have you looked at this issue at all in terms of your own whatever-it-is you are discussing in your bi-weekly or monthly meetings in this kind of area? What can you actually do and what recommendations could you make, if you have not made recommendations already, that would help people in terms of your aftercare programs?

Ms Francis: One of the things we have done is that, from what we know about the assertive program out of Ottawa, we know it works. It has some tremendous pluses. It speaks to the problems of post-discharge from psychiatric hospital issues in an organized fashion with teams in place to do support, crisis intervention, that kind of stuff, to keep people out of hospital. As a board, we support that program, but we also know that by supporting that program we feel a little bit like traitors, in that we are sort of saying, "Okay, the role of Brockville will have to change," which means job losses. We have a commitment to the community to recognize that this may happen. What can we do to make it better? I mean, what kinds of other roles can Brockville play?

Mr Runciman: Mr André Bergeron is listed as a vice-chairman of the Prescott-Russell Community Mental Health Centre. Does he have anything to with Montfort hospital?

Ms Francis: Yes.

Mr Runciman: He is involved with Montfort. Again, this comes from OPSEU, which has a representative, I gather, on the advisory board now but without voting power because she is employed at the hospital.

Ms Francis: Nancy.

Mr Runciman: Yes.

Interjection: What is Montfort?

Mr Runciman: It is a French-language hospital in Ottawa. They advised me they had a concern that the president of OPSEU was not able to participate in votes, if you will, on the committee. Primarily they were concerned about this Ottawa District Health Council proposal to move long-term beds to the Ottawa area, that 10 or 14 of those beds were going to Montfort. They felt Mr Bergeron would be in a very clear conflict taking a position on that matter when in effect his employer, the hospital where he worked, would be a beneficiary in respect to that. I simply want to make sure you are aware that those concerns are there.

Mr Reil: I did have a lengthy telephone conversation with Art Lane, the OPSEU president for the area, last week about that, and yes, Mr Bergeron, as the second vice-chairman, does operate a mental health clinic situation up in Rockland which is about 30 or 40 miles east of Ottawa. In fact he deals with francophone patients. Mr Lane suggested there could be a conflict of interest there. Possibly there could, but as board members we certainly do not feel in the least bit that Mr Bergeron is in any way, shape or form in a conflict-of-interest situation. Since I have been on the board, he has worked extremely hard for the good, not of the hospital per se, but for the good of the people who are in that hospital.

Mr Runciman: I do not think anyone is suggesting -- except, on this particular matter, if the advisory board takes a position that those concerns are out there, and if he participates, they will indeed be raised, you can be assured.

Ms Francis: Brockville does not have real facilities to service francophone clients anyway.

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Mr Runciman: But there is no reason they could not; that is something that could be looked at as well. The federal legislation that was mentioned earlier, which is going to be coming into effect in February with respect to forensic patients, the criminally insane, have you taken a look at how that might impact on the hospital?

Ms Francis: We have had some discussions about that.

Mr Reil: Really, we have not. First, just in terms of our own situation, I am the principal of an elementary school in Prescott. That is a very demanding sort of job. Working on the board is a volunteer situation. The board meets every two months. The executive committee meets in alternate months, and I serve on the community relations committee that meets every two months. Very simply, there is a limit to what volunteers can do, how much time they can commit. Certainly you are raising important issues, but there are a lot of grass-roots details and concerns to be looked at.

Even though I have been on the board a year and a half, I still need a large amount of education as to what goes on at the hospital. We do spend a portion of each board meeting on updates from the chief psychiatrist on various things that are going on, or we ask him. For instance, I asked him to please at the next meeting -- this was a year ago -- talk about electroconvulsive therapy.

Mr Runciman: If I can interrupt you, because we are limited in time, I am concerned that you have not taken a look at it. I think that legislation received final reading in October and comes into force in February. Are you aware that the hospital has made a submission for additional beds at the hospital for the criminally insane?

Ms Francis: Yes.

Mr Runciman: When were you made aware of that?

Ms Francis: I met with Pat on Thursday. He said at that time he was going to be meeting with you to discuss the possibilities.

Mr Runciman: But the board itself was not asked for any of its views?

Ms Francis: No. The timing was such that it came within a couple of days of him receiving the notice. I guess there is going to be some vying for those beds for other hospitals.

Mr Runciman: So the advisory board has no view on the expansion of forensic?

Ms Francis: This was discussed with me. I support it in principle based on the fact that it would bring $1 million into the community. That seems to be one of the goals. There are two conflicting goals in Brockville. One is that we need to see a role for the hospital but we want to be selective about what those roles are. One of those roles, if it involves forensic patients, is not as palatable to the community as other roles it might play.

We are caught here and the community of Brockville has to look at what is the best decision: bringing money into the community or having fewer forensic patients there.

Mr Runciman: I agree.

You talked about community input. I gave you notice I was going to raise this issue prior to the start of the meeting. That is the letter former Brockville Mayor Clark, who approached me on the weekend and gave me a copy of the letter, sent to Mr Reil, posing a number of questions which reflected concerns in the Brockville community. That letter was sent in October, with five questions, all generally relative to the concerns about forensic patients.

He has advised me there has been no response to that letter. I am just wondering why you have not responded.

Mr Reil: As the letter was addressed to me, I suppose I should answer that. In holding our public forums, we invited members of the community, the various politicians and so on to have some input. We were asking for public input. In terms of the politicians, we received from our MP, our MPP, "Regrets, we are unable to attend" and so on. We did not receive anything from the city of Brockville until we were actually sitting in our forum and this letter arrived.

The letter has a whole series of questions. When we started our public forum, the first thing we said was, "We don't have the answers, but we are certainly looking for your concerns and your suggestions." Again, we pointed out the fact that we are unpaid volunteers. "We would like to find out what you are thinking from all aspects from the community, from various agencies, from the political point of view and so on."

I do respect Stephen Clark. Had he run for mayor again, I would have voted for him just like that. But he does indicate at the bottom that after he gets the answers to our questions, he would be more than happy to take them up with the hospital but not with us. In a sense we can say we were a little bit slighted that he said: "I know you guys are a bunch of powerless ones. Here, give us what you think and we'll take it to the big guys for you." I decided that since he had not responded to our invitation as such -- I was chair of the forums -- we just would not answer the letter.

Mr Runciman: I can perhaps appreciate your feelings, but this is the mayor of a very large community and past president of the Association of Municipalities of Ontario. I think some of these questions are certainly relatively innocuous, such as, does the community advisory board have any power to influence government policy on mental health and questions like that. When you are dealing with the mayor of a major municipality, whether you agree with his approach or not, it seems to me you are in the role of representing the community. He is an elected official who represents a community of over 21,000 people, and in my view he merits at least an acknowledgement and an explanation as to why you did not feel it was appropriate to respond in detail.

Mr Reil: Maybe we are doing a bit of tit for tat, but in trying to make contact with the mayor in the past, there was no response. Yet at various political, opportunistic times, let's say that the hospital did take some kind of bashing from the municipality and from other politicians. As unpaid volunteers, I personally do not necessarily think we have to answer letters from the mayor or the Prime Minister or whomever. If you really want some accountability from us, we should be given a specific mandate of power and maybe, like the people who serve on the pesticides board, we should get $31.20 an hour for every meeting we go to.

Mr Wessenger: I would like to go back again to this question of mandate, because I would like to be clear in my own mind what your position is with respect to your mandate. I hope you will not mind if I have some leading questions.

Mr Reil: It is Christine's turn to talk.

Mr Wessenger: I gather from your comments that you feel you can work satisfactorily within your existing mandate. Is that correct?

Ms Francis: That is a loaded question.

Mr Wessenger: Yes, it is. I thought it might provoke an answer.

Ms Francis: There have been times we felt powerless and there have been times we felt like we were scapegoats, that is, where things have happened and the question was asked, "Why didn't you do something?" when in fact we did not know it was part of our mandate to do it. I think there are certain changes that could be made that would give us more legitimacy, so to speak. It is a tough position to have all sorts of accountability and no power.

Mr Wessenger: Then you would recommend that your mandate be re-examined and further defined?

Ms Francis: Yes. These are some of the requests we have tried to make.

Mr Wessenger: That is good. How have your dealings been in the past with the hospital administration with respect to when you do make recommendations? Has the response been generally receptive?

Ms Francis: I think because we were treading lightly, a lot of our recommendations have come in the form of questions and clarifications. We as a group have decided that at some point we could, on behalf of the hospital, write to the minister to ask for certain things. Historically, the issue around physicians from the community working on a part-time basis at the hospital is one that comes to mind where we have worked with administration to make recommendations to make their life easier as far as running the hospital is concerned. There is a team kind of thing. Are you asking if there is any resistance when we make recommendations?

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Mr Wessenger: I do not expect everything is absolutely perfect, but I am just wondering if you have a good working relationship with respect to the hospital administration, generally speaking. I know these are probably putting you on the spot.

Mr Reil: It is not putting us on the spot at all. From my own perspective, we have a very good working relationship with the administration in that we certainly dialogue on all kinds of issues. We make our suggestions, the administration discusses the constraints they have and sometimes we put the administration on the spot. We do not have compunction about doing that. Maybe Mr Runciman or other people are saying, "We don't want to put you on the spot," and certainly you are not putting us on the spot at all. We are quite happy to speak our minds and tell you the way we see things, because that is what the whole process is all about.

Mr Wessenger: That is right.

Mr Reil: We are very comfortable, and challenging questions are great.

Mr Wessenger: Good. I am pleased to hear that. Just moving to some financial aspects, I notice that the budget of the board has increased over the years from a very modest beginning. Is that more a bookkeeping aspect or is it in terms of real dollars? In other words, has the budget increased because some expenditures that were formerly picked up by the hospital are now attributed to the board or have there in fact been real increases in expenditures?

Ms Francis: There have been real increases. I do not know if you know how much it costs to put an ad in the paper, but it is big bucks. The more active we got, the more money we spent. We are very aware that this is what is happening and we are trying to be really responsible about that, knowing that on the one hand the hospital's money is being limited and on the other hand we are wanting more money. Our board is unique in that we actually have a budget that is defined. We did that just to be responsible. Other CAPS do not; they are in the general hospital pot, so to speak.

Mr Wessenger: Right. This is just for my own information, because I notice one of your budget items was a CAB picnic for the community. Is that a new venture? Maybe you could just explain it to me, because I am quite interested in hearing what is the purpose of it and what is involved.

Mr Reil: This was a pet project of mine after sitting through a few board meetings and saying, "Geez, we're not doing anything." We decided that certainly public education and public information had to be one of the goals and we decided that if you could get people to walk on the grounds -- I had lived in Brockville, five minutes from the facility, for about six years and I had never seen fit to set foot on it, or you would be maybe a little uncomfortable doing that.

We decided to have an open community picnic on the first Sunday of Mental Health Week. We got a lot of volunteer groups from Richmond, outside of Ottawa, gymnastics groups and so on, to come and put on free entertainment. We provided hot dogs, pop and candy floss. Well over 1,000 people came out to the grounds. God cooperated and gave us great weather.

It was a real experience for people to walk on the grounds and to sit on the park benches there. There were patients out walking around. You could tell the patients quickly: the ones who, if they saw a smoker, would come and get a cigarette. The relationship was very good, and we looked at that as a ground-breaking process to get the local community feeling comfortable. From that point of view, it was an unqualified success.

We are having the picnic again. It is either May 3 or May 10. Mr Runciman will be sending you an official invitation. We hope you can make it this year.

Mr Wessenger: Just one last question. You may not be able to answer this, because I do not know to what extent you are involved in -- you say you do look at budgets, but I was looking at some budgets for other psychiatric hospitals and also comparing that with number of beds. Just to give you a comparison, for instance, you have 344 beds and your budget was $42 million approximately. Then you compare that with Whitby, for instance, which has the same number of beds, more employees and a budget of $38 million. Then you can also look up London Psychiatric, which has a $42-million budget, or St Thomas, a $42-million budget, with more beds. I am wondering if you are aware of the reasons it seems to be more costly on a per-bed basis for Brockville than some of the other psychiatric hospitals. If you do not know, just tell me. I was just curious if you had any idea.

Ms Francis: I have that list of comparisons as well. There are many variables that impact on that. I know the ACRP program is a costly one at this point.

Mr Wessenger: Okay. I have no further questions. I would like to thank you for coming.

The Vice-Chair: Do the Liberals have any more questions? If they do not, we will move on.

Ms Carter: I am interested in the advocacy and patients' rights side of this. As you know, the Advocacy Act, Bill 74, is in the works, along with several allied acts that impinge on health decisions and so on. First of all, I understand the one place that has had an advocacy system in place already is the psychiatric hospital. I wondered if you had any opinions as to how that is working.

Ms Duclos: The advocate's office works in the provincial psychiatric hospitals. They do not exist in any other hospital. Basically other hospitals have what they call patient representatives, who do absolutely nothing and who basically do not even know the Mental Health Act very well and have no real power to do anything.

One of the groups I work with in Ottawa has written a response to the Advocacy Act and Bills 108, 109 and 110. There are major problems with them in that usually when one puts out a piece of legislation, it has some validity to the people.

In terms of the patient advocate in Brockville, I know her. I think she is doing fairly well, with the limitations and the constraints on her, but there needs to be more.

Ms Carter: Could you enlarge on the limitations and constraints?

Ms Duclos: You are walking a fine line. You would have to go into a case kind of analysis. It gets very difficult. I work as an advocate in Ottawa. You can get stonewalled very quickly by a very powerful system.

Ms Carter: You mean the advocates themselves can become stonewalled.

Ms Duclos: Yes. They can come up against a brick wall very quickly.

Ms Carter: We have had a lot of input from two sides. The Friends of Schizophrenics in particular have strong views on this, as I am sure you know. The psychiatric survivors, on the other hand, have put the opposite view. I guess the core of the problem is, to what extent can you force people to take medications; this kind of thing. I am told that some of the treatment and the medication is destructive in the long term to an individual.

Ms Duclos: Yes. Part of what the survivor people want, and myself also, is real information about it. When you go into the hospital, you are not told about the destructive long-term effects of anti-psychotic medications. You just do not get told that. They say: "Here, take this. It'll make you feel better." We want informed choice, that we know that kind of thing. We also want the right of the individual.

Part of the problem with a large percentage of families -- you find it in Canada and I found it at a conference in Vermont and with other people I have talked to in the United States -- is that families can often work not in the interest of the person. Hopefully under the Advocacy Act we can get some protection for a vulnerable person to not have to be affected and to be able to get away from either side of it: if the system is the problem, to have some rights within it; if it is the family, to go the other way. It is very difficult.

Ms Carter: Are you familiar with the upcoming act? Do you think it is going to help with the present situation?

Ms Duclos: I have heard some interesting rumours about some changes that have been written in, or possible changes, since the draft I have. I do not know enough about it at this point, but if the rumours are true, I find it a very scary situation.

Ms Carter: Scary in what way?

Ms Duclos: We are going to lose a lot of rights.

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Ms Carter: Can you elaborate on that?

Ms Duclos: The thing is that we survivors want to act as our own advocates. We know the system; we know what is in there. The advocacy commission, yes, is great if that is the way it stays and we get survivors in there. But if it becomes a way of shifting and getting people outside of that with degrees and things like that to be our advocates, we do not want it.

Ms Carter: If you have looked at the legislation, the objective is to have as advocates people who have been themselves involved.

Ms Duclos: As I said, I have heard some rumours since I have been down here and I do not know enough about it yet.

Ms Carter: I wonder if this has any implications for the whole question you touched on of releasing forensic patients. There again we are looking at two sets of rights: the rights of the people of Brockville or wherever and also the rights of what is probably the majority of those patients to at some time achieve liberty, because most of them are not going to commit crimes again, although obviously a small number are. Do you have any opinions on how that could be resolved?

Ms Duclos: I think there is, first of all, a general impression by society that has to be dealt with, that is, basically all psychiatric patients are dangerous. We are not. Forensic patients, yes, have committed crimes. Somebody brought up the Lieutenant Governor's warrants and the changes that had to be made to them. Again, with the warrants there was a lot of power and a lot of control over the individual's rights and people spending two, three, four times longer in the psychiatric system than in the criminal system if they plead guilty. You have a problem there.

I think in the prison system there is a certain percentage they know are going to recommit crimes. Basically what people tend to be looking at from the forensic side in psychiatry is that it be 100% guaranteed people will not recommit a crime. The potential for anyone to recommit a crime is always going to be there and you cannot have a 100% guarantee. You can do your best to ensure safety, but you also have to remember that these are people and they do need a chance.

Ms Carter: The psychiatric staff obviously do not have complete insight as to who are the patients likely to be dangerous again and who are not.

Ms Francis: A little while back Brockville hired a risk management consultant team called Encon. They gave their assessment as to where things could work better but, all in all, my understanding is that Brockville was doing a good job and that there are no guarantees. The best predictor of aggressive behaviour is past aggressive behaviour.

Ms Carter: I would have thought so. Do I have any time left?

The Vice-Chair: You have another minute.

Ms Carter: I am wondering about the system as regards medication and treatment. Would you say there is any problem of overmedicating or of overtreating people? Do the patients themselves have the ability to control that situation?

Ms Duclos: In terms of the medication, yes, there is overmedication, which is another area I have looked at. You can look at why you get some of the overmedication. Some people get helped greatly and some people have horrendous side-effects from it, and then they start treating the side-effects with more medications. The idea of being able to refuse treatment, at least when I was there, and I have heard similar stories since I left, is that if you refuse the treatment, they basically find a way to certify you and then they can give you the medication anyway. There is sort of a pathologizing: "This is a brain disorder so we'll fix it with a chemical." I think the whole psychiatric system has to re-evaluate itself and connect body and mind.

Ms Carter: Does your committee have any input on this kind of problem, or could it have?

Ms Francis: Our patient advocate is invited to our meetings on a regular basis. She presents to us her perspective on what her role is and how patients' rights are protected at the hospital. I think when you look at what Brockville does and the whole history of psychiatric treatment, there are very many facets. In the past patients had no rights at all. We are increasing the rights that patients have and we are getting cries from both ends of the spectrum. Psychiatrists come to Ontario and say they cannot work in a system where they admit patients and yet they cannot treat them, so they move to other provinces where the mental health acts are a little bit different.

Mr Reil: I just want 30 seconds to respond to Ms Carter. In terms of the same situation, as the person in charge of the public forums, I have had an approach from the patient advocate at Brockville in terms of holding a forum for patients, which we are looking into right now. We have also extended the invitation to OPSEU so that we can get an employee perspective on this too, the whole idea being that there is going to be a great, mammoth working together kind of situation that we are striving for.

Mr Runciman: I just want to make a quick reference to a comment Ms Duclos made about overdrugging. You said if they cannot -- they will find a way to certify you as incompetent, I guess, is what you are suggesting. I find that a rather disturbing comment, and what you are doing is really condemning the process, if indeed that is occurring. You are saying the patient advocate is not doing, in this case, her job. Is the review board not involved in the certification of competence or incompetence?

Ms Duclos: Yes, what happens -- when I was first admitted to that hospital it was eight months before I knew there was a patient advocate. The staff did not tell me, which they were supposed to do, and the medication made it impossible for me to read, so I did not know there was a patient advocate. That is a common experience. But I think it really has to be evaluated; I mean, there are circumstances in or out of hospital.

A lot of the tranquillizers have, like, six-month maximum usage, which is passed every day. You know, people are on these medications for two, three, four, five, 10 years. The guidelines are from the Compendium of Pharmaceuticals and Specialties, the pharmaceuticals manual. Why is that happening? Also, they often surpass the maximum dosage recommended in the pharmaceuticals manual. So that is where you start getting the problem of overdrugging. It is just that people do not think about it; no one checks it.

Mr Runciman: What I am concerned about is your charge that they are finding ways to certify these people. You are sort of tarring everyone with a brush here, in my view.

Ms Duclos: No. All I am saying is that there are people within the system, good and bad, but there are people who use it as a power trip. This is unfortunate. The people I would like to hook up with are the ones who want to work for positive change. Those are the people I look for.

Mr Runciman: All right. I am still concerned about the comments you made and I wanted to make reference to them so that there was some challenge to them on the record, because I have a great deal of difficulty in accepting them. I know the court case, for example -- I think it is Day v Day -- where someone had been initially deemed competent, and at a point further in the process he was deemed incompetent. He challenged -- his relatives did, in any event, and they said that if you were competent at one point and refused treatment, even though you were at a later stage deemed incompetent, they still had no right to treat you with drugs if at the point you were competent you did not want them. In any event, I think the patient's rights are pretty significant in this province, and I have a lot of --

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Ms Duclos: They are better than in some other provinces, but people also find there are some loopholes that have to be looked at.

Mr Runciman: It is tough finding another jurisdiction with patient rights like we have in Ontario.

I think this was raised by a couple of members of the committee: the old question of an advisory board with the current makeup and the fact that you have no staff resources, you do not have a big budget, you are all volunteers and you have to rely on a lot of input from, for example, the hospital administration. I am just throwing this out for discussion's sake, I guess; whether it would not be better, perhaps -- and this may not be possible given the mandates of district health councils, but in your catchment area you have, what, three or four DHCs? Would it not be better, perhaps, to have an advisory board which, in effect, would be a subcommittee comprising representatives of all those DHCs, who would have the staff capability of executive directors and staff in each of those DHCs they could draw upon to give objective, hopefully, advice and input into the process? Right now you really do not have the resources to do the job in that sense.

Ms Francis: You are right, and part of the objectivity we hope to gain -- because we know we want to avoid this mushroom syndrome if at all possible, being kept in the dark, etc. One way to overcome that is to accept input from those people sitting around the table who are the resources the community advisory board, the CAB, has provided within the hospital, but also to let people in the community know that we are there so we get other points of view. We are happy the decision was made to include union participation on the board, because that is just another source of information. The broader our scope and our base of information, the better, more informed decisions we can make.

Mr Runciman: I have one quick question, and I talked to Ms Francis about this ahead of the meeting, and that was in respect to the murder that occurred in Brockville on the grounds of the hospital last summer. Mrs Sullivan had raised a concern about the fact that there is a lawsuit now launched by the family of the victim against, I guess, the hospital and the Ministry of Health and whether or not you might wish to respond to any of those questions in public. You said you would reply in respect to that question now.

Ms Francis: We discussed this among ourselves and we do not feel it is necessary to go in camera, because we do not know a lot of details around that. We would just like to say that it is unfortunate, because incidents like this, even though they are isolated, often have a tremendous impact on a community like Brockville and it just reaffirms the selective perception that people have about psychiatric clients or forensic clients. At this point, part of what I see as really positive is where the media take it upon themselves to help educate the public by identifying what the roles of review boards are. There were very positive pieces in the paper that helped educate the community to dispel some of the myths that forensic patients walk in and then walk out and have the community of Brockville as their playground.

Mr Runciman: One quick question, and I do not have a lot of time here. Most of these decisions, you say, are taken by the review board in terms of loosening a warrant or vacating a warrant and the community privileges a given patient receives, but where it does fall within the mandate of the Ministry of Health and within the jurisdiction of the administrator of the hospital, he has some flexibility in terms of monitoring.

The administrator has a responsibility, once that warrant is loosened, of monitoring that individual in the community. In this particular case, the administrator -- and I do not fault the administrator; I think he was placed in an awkward situation by ministry policy. When they were looking for an approved person to escort the LGW into the community, the hospital staff recommended another former LGW who himself had been responsible for a murder, and Mr Lee, the administrator, signed that approval.

I think the community and certainly yours truly were very upset about the idea of a former murderer being qualified to be an escort in the community.

Of course we did have a murder occur, and we can all be Monday morning quarterbacks, but I had certainly raised that in the House with respect to that particular element. I think that if you are going to have approved escorts, they should not be individuals like that. If you cannot find a John Q. Citizen to do it, it should be a staff person who is escorting that individual in the community. I wonder if the board took a look at that, if you have discussed it, if you have made any recommendations to the ministry with respect to that whole approach.

Ms Francis: We discuss a lot of things on an informal basis, but we have not made a particular recommendation around that.

Mr Runciman: Why not?

Ms Francis: I guess there have been a lot of other things on our plate to this point. Perhaps we should put it on a priority list for discussion.

Mr Reil: Just in terms of the issues you are bringing up and the ones various other MPPs have brought up, these are just a few more things we are certainly going to add to our annual retreat agenda. We are viewing this experience as being like holding a public forum. We went to Toronto and held a public forum. We gathered a bunch of MPPs and they expressed some concerns and asked us some interesting questions. Certainly the issues that are brought up will be well discussed when we do take our one day a year and spend all day on a Saturday and look at topics. We are certainly appreciative of these sorts of inputs.

Mr Hayes: Of course you have already been asked this question a few times. On the issue of moving some of the facilities to Ottawa, for example, I know that Mr Runciman has concern there, and probably rightfully so if there happens to be a negative effect on that particular economy and on that community. But just from someone maybe on the outside, I guess it almost looked like kind of a bit of a power struggle, but I may be wrong there.

I really have to ask a couple of questions. First of all, would there be a real improvement in the service to people, to psychiatric patients, for example? They say, "Yes, fine, you can move it there," but I always think they should look at some of those things too. Is there a possibility on top of that of duplication, for example? When we talk about trying to look at innovative ways to cut costs, would this really cut costs? The only thing I really heard was the fact of the hardship of having to travel back and forth. I would like you to address that maybe more thoroughly, please.

Ms Francis: Are you asking whether the assertive program is more expensive and whether it would be duplicating services by having that in place?

Mr Hayes: I am really asking if it is because there are a fair number of people who are from Ottawa; is that really the main reason? Are things going to improve as a result of, say, moving some of those facilities to Ottawa? I will put it that way.

Mr Runciman: I think he is talking about the ACRP component, the psychogeriatric and others.

Ms Francis: Is it going to improve? I do not know. I would need a crystal ball.

Ms Duclos: I think you can get a little philosophical. We all have the right, ultimately, to choose to live where we want to and to be able to seek services in that area. For a certain percentage of people, going to Brockville may be required because they need longer-term. But spending a year living with 24 other people on a ward with staff telling you when to get up, when to eat, all this kind of stuff, is contrary to the idea we have of freedom. If you can have something like ACRP, there is not really an equivalent that is Ottawa-based.

One of the ideas that came up in the retreat I went to was to keep that base still in Brockville, but I think the role for Brockville is going to change in the future to meet more specialized programs -- rather than this broad "somebody who needs to stay in hospital for a long time." Most of the evidence shows that on average, long-term stays are not the most effective way. I think they have to look at shifting possibly into other areas of specialty that may require shorter-term lengths of stay but are very specialized.

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They have very successful drug and alcohol programs, but they are that is lacking in Canada, in Ontario. We need more of those programs because we keep sending everyone down to the States to do a lot of the drug and alcohol programs. I would say there is going to be a change. As I said earlier, there is a spectrum. I think people are going to have to shift around and find a new role.

Ms Francis: I think there are not always guarantees that if you change something, it is going to be better. We have to be careful not to throw the baby out with the bathwater. There are some good things that go on. One of the things that sometimes concerns me is patients leaving Brockville Psychiatric Hospital and going into the community, but that community is just a mini-institution, like a boarding home, where there is no improvement, really, where the freedom we want, the closeness to the community we want, does not happen because the isolation occurs, just on a smaller level. The actual movement of people does not ensure anything. There has to be a well-organized, coordinated multi-disciplinary program in place along with that.

Mr Frankford: Just around hospital governance, the observation I think has been made that in a sense you are psychiatric regional planners, and maybe that role should be a DHC role. But then I think you would probably be left with the hospital, and historically, Ontario hospitals had boards. Would you see some way in which you could turn into something more like a conventional hospital board?

Ms Francis: There is a real move out of Toronto, I think, towards that end. Toronto psychiatric hospitals, Queen Street specifically, have been really -- this was suggested and recommended to the previous minister. I do not remember what minister it was.

The Vice-Chair: Ms Gigantes?

Ms Francis: No, way before.

Mr Runciman: They were talked about for years.

Ms Francis: They were talked about for years. At that time the minister -- I know it will come to me in a flash -- said, "It is not in the plans of the ministry at this time." This was a quote that was sent to us, and that sort of shut the whole discussion around divestment.

Mr Frankford: Could I ask for a bit of research on that topic?

The Vice-Chair: Yes, you can ask for whatever you would like them to provide.

Mr Frankford: No, from the researcher.

Ms Francis: The minister was Elinor Caplan; I just remembered.

The Vice-Chair: Do you have any comments to make?

Mr Runciman: Not at this time.

The Vice-Chair: Not at this time, fine. Thank you.

Ms Duclos: I do not know if it is appropriate to make a comment in such a setting. I just would like to say that as a consumer/survivor, being on this board gives me some sense of hope that at least we have some access to the administrator, to the information. I can get access to information about things that are happening at that hospital, how they are going, what their directions are and I find that very useful. Right now I am on a search for information. The big lack right now is information from OPSEU, what it wants, aside from what is obvious. I think that in many ways it is a good thing and hopefully the community will know we are there and it will grow. I can see a great potential for furthering the role. I just want to say that.

The Vice-Chair: I hope your input on the board will serve a very useful purpose for the advisory committee. I want to thank the community advisory committee from the Brockville psychiatric facility for appearing before the committee today. Thank you for your input. We will recess until 2 pm.

The committee recessed at 1226.