Expert Panel on Psychotropic Drugs

January 26, 2007

Hon. Mary Anne Chambers
Minister
Ministry of Children and Youth Services
56 Wellesley Street West, 14th Floor
Toronto, ON   M5S 2S3

Dear Minister Chambers:

RE: Expert Panel on Psychotropic Drugs

I was pleased to read your announcement on January 24, 2007 regarding the launch of an expert panel on psychotropic drugs to develop standards of care for the administration of such drugs for children and youth in residential settings, including group and foster care homes across the province.  I also noted that the panel will make recommendations on training frontline staff regarding informed care and monitoring the impact of the drugs.  These are important steps forward in protecting the rights of children and youth to ensure informed decisions are made about their treatment.

These standards and recommendations will likely have other beneficial effects, perhaps leading to the establishment of best practices, training standards to ensure safe administration and improved reporting and documentation guidelines.  The panel’s report will impact the care of all children and youth whether in a residential settings or living with their family in the community.  The Ministry might consider expanding the mandate of the expert panel to include a review of the reliance on psychotropic drugs and the long-term impact of the use of these drugs as our children and youth move into adulthood.  The panel might also examine strategies to reduce the reliance on psychotropic drugs.

Children and youth entrusted to these facilities and foster homes are often vulnerable because of their life circumstances or disabilities.  It is hoped that the Ministry will examine additional rights protection mechanisms to protect their rights and ensure they receive the best care and treatment possible.

Pursuant to the Health Care Consent Act (HCCA), when an individual is found to be incapable of consenting to their own treatment, a substitute decision-maker is appointed.  The substitute decision-maker (SDM) for children and youth in residential settings is often a Childrens’ Aid Society (CAS).  The HCCA outlines the principles which the SDM must follow when making a treatment decision for an individual who is found incapable of consenting to the treatment.  The CAS is an institutional SDM and derives its decision-making authority from legislation.  As such, we believe the SDM role of the CAS is akin to the SDM role of the Public Guardian and Trustee (PGT) as established under the HCCA.  The treatment consultants at the PGT receive specialized training to prepare them for the role of SDM.  We recommend that each CAS have specially trained individuals who act as SDMs for the children and youth in their care.

According to the HCCA, the health practitioner making the finding of incapacity must provide “rights information” to the individual about the consequence of the finding and the options if they disagree with the finding.  These individuals are afforded a lower standard of protection than individuals in psychiatric facilities who receive formal rights advice, when they are found to be incapable of consenting to treatment for a mental disorder.

The Psychiatric Patient Advocate Office has been providing formal rights advice, pursuant to the Mental Health Act and its regulations, in the 10 current and former provincial psychiatric facilities since 1986.  Since 2001, we have also been designated as “rights adviser” by all but five of the Schedule 1 hospitals in Ontario, in addition to providing rights advice to individuals living in the community and being considered for the issuance or renewal of a community treatment order and their substitute decision-maker, if any.  We recommend that the Ministry, as a way of fully protecting the rights of children and youth found incapable of consenting to treatment for a mental disorder, consider requiring formal rights advice before a treatment can begin.  We would be pleased to provide you with additional information about this process.

Should you have any questions or wish to arrange a meeting, please contact me at (416) 327-7004.

Sincerely,

original signed by

David Simpson
Director (A)

c.c.      Dawn Ogram
            Assistant Deputy Minister
            Corporate and Direct Services, MOHLTC

 Response from the Minister of Children and Youth Services

Letter from Mary Anne Chambers, Minister - February 21, 2007

 Promoting Patients' Rights  http://www.ppao.gov.on.ca/ser-ove.html

Rights of Children and Youth in Foster Care    

As a child or youth in foster care, I have the right:

1. To good care and treatment that meets my needs in the least restrictive setting available. This means I have the right to live in a safe, healthy, and comfortable place. And I am protected from harm, treated with respect, and have some privacy for personal needs.
2. To know
   • Why am I in foster care?
   • What will happen to me?
   • What is happening to my family (including brothers and sisters) and how CAS is planning for my future?
3. To speak and be spoken to in my own language when possible. This includes Braille if I am blind or sign language if I am deaf. If my foster parents do not know my language, CAS will give me a plan to meet my needs to communicate.
4. To be free from abuse, neglect and exploitation.
5. To fair treatment, whatever my gender, gender identity, race, ethnicity, religion, national origin, disability, medical problems, or sexual orientation.
6. To not receive any harsh, cruel, unusual, unnecessary, demeaning, or humiliating punishment. This includes not being shaken, hit, spanked, or threatened, forced to do unproductive work, be denied food, sleep, access to a bathroom, mail, or family visits as punishment. I will not receive remarks that make fun of me or my family or any threats of losing my placement or shelter.
7. To be disciplined in a manner that is appropriate to how mature I am, my developmental level, and my medical condition. I must be told why I was disciplined. Discipline does not include the use of restraint, seclusion, corporal punishment or threat of corporal punishment.
8. To attend my choice of community, school, and religious services and activities to the extent that it is right for me, as planned for and discussed by my caregiver and caseworker, and based on my caregiver’s ability.
9. To go to school and receive an education that fits my age and individual needs.
10. To be trained in personal care, hygiene, and grooming.
11. To comfortable clothing similar to clothing worn by other children in my community.
12. To clothing that does a good job of protecting me against natural elements such as rain, snow, wind, cold, sun, and insects.
13. To have personal possessions at my home and to get additional things within reasonable limits, as planned for and discussed by my caregiver and caseworker, and based on caregiver’s ability.
14. To personal space in my bedroom to store my clothes and belongings.
15. To healthy foods in healthy portions proper for my age and activity level.
16. To good quality medical, dental, and vision care, developmental and mental health services that are at least adequate enough for my needs.
17. To be free from unnecessary or too much medication.
18. TO KNOW WHY I AM ON MEDICATION AND TO BE FULLY INFORMED OF THE RISKS AND BENIFITS OF THE MEDICATION.
19. TO ASK FOR A SECOND NONE BIASED OPINION.
20. TO BE GIVEN THE OPTION OF NATURAL TREATMENT VS BIOCHEMICAL TREATMENT.
21. TO BE GIVEN THE CHOICE TO NOT TAKE MEDICATION FOR ANY NONE LIFE THREATENING ILLNESS OR DISORDERS. EXAMPLE: A.D.H.D. O.C.D. BEHAVIOURAL PROBLEMS.
22. To visit and have regular contact with my family, including my brothers and sisters (unless a court order or case plan doesn’t allow it) and to have my worker explain any restrictions to me and write them in my record.
23. To contact my caseworker, Lawyer, probation officer, Child Advocacy, Member of Parliment. I can communicate with my caseworker, child advocacy,  or my lawyer without limits.
24. To see my caseworker at least monthly and in private if necessary.
25. To actively participate in creating my plan of care and permanent living arrangement, and in meetings where my medical services are reviewed, as appropriate. To be given a copy or summary of my plan of care to review. I have the right to ask someone to act on my behalf or to support me in my participation.
26. To go to my court hearing and speak to the judge.
27. To speak to the judge at a court hearing that affects where I have been placed including status hearings, permanency hearings, or placement review hearings.
28. To expect that my records and personal information will be kept private and will be discussed only when it is about my care.
29. To have visitors, to keep a personal journal, to send and receive unopened mail, and to make and receive private phone calls unless appropriate professionals or a court says that restrictions are necessary for my best interests.
30. To get paid for any work done, except for routine chores or work assigned as fair and/or reasonable discipline.
31. To give my permission in writing before taking part in any publicity or fund raising activity for where I am placed or the agency, including the use of my photograph.
32. To not be forced to make public statements showing my gratitude to the foster home or agency.
33. To receive, refuse, or request treatment for physical, emotional, mental health, or chemical dependency needs separately from adults (other than young adults) who are receiving services.
34. To call the Child Advocate if I believe my personal rights has been violated without fear of punishment, interference, coercion, or retaliation.
35. To complain 401 Bay Street, Suite 2200 Toronto, Ontario M5H 2Y4
    Phone: (416) 325-5669 Toll-free: 1-800-263-2841
    Fax: (416) 325-5681 TTY: (416) 325-2648
    Email: advocacy@provincialadvocate.on.ca  if I feel any of my rights have been violated or ignored. To be free from threats of punishment for making complaints and have the right to make an anonymous complaint if I choose.
36. To be told in writing of the name, address, phone number and purpose of the child advocacy system.
37. To not get pressured to get an abortion, give up my child for adoption, or to parent my child, if applicable.
38. To hire independent mental health professionals, medical professionals, and lawyer at my own expense.
39. To understand and have a copy of the rights of children and youth in foster care.

(Youth 16 and older)

When I am age 16 and older in foster care, I also have the right:

1. To attend Preparation for Adult Living classes and activities as appropriate to my case plan.
2. To a comprehensive transition plan that includes planning for my career and help to enroll in an educational or vocational job training program.
3. To be told about educational opportunities when I leave care.
4. To get help in obtaining an independent residence when aging out.
5. To one or more Circle of Support Conferences or Transition Planning Meetings.
6. To take part in youth leadership development opportunities.
7. To consent to all or some of my medical care as authorized by the court and based on my maturity level. For example, if the court authorizes, I may give consent:
   • to diagnose and treat an infectious, contagious, or communicable disease
   • to examine and treat drug addiction
   • for counseling related to preventing suicide, drug addiction, or sexual, physical, or emotional abuse
   • for hospital, medical, or surgical treatment (other than abortion) related to the pregnancy if I am unmarried and pregnant If I consent to any medical care on my own, without the court or CAS involved , then I am legally responsible for paying for my own medical care.
8. To request a hearing from a court to determine if I have the capacity to consent to medical care.
9. To help with getting my driver’s license, social security number, birth certificate.
10. To seek proper employment, keep my own money, and have my own bank account in my own name, depending on my case plan and age or level of maturity.
11. To get necessary personal information when leaving care, including my birth certificate, immunization records, and information contained in my education portfolio and health passport.

For more in-depth information regarding rights of youth in care, download the brochure Know Your Rights (pdf).