1. LEGAL AID ONTARIO MENTAL HEALTH & ADDICTIONS STRATEGY Ryan Fritsch, Lead, Mental Health Strategy Policy, Research & External Relations January 2015

2. Starting Points  Providing high quality services to clients with mental health issues is a priority for LAO  LAO has a specific statutory directive to provide mental health law services: s.13(2) of the Legal Aid Services Act, 1998 provides that LAO “shall provide legal aid services in the areas of criminal law, family law, clinic law and mental health law” 2

3. Current MH Services  LAO has traditionally delivered its mental health mandate through two programs:  Consent and Capacity Board (CCB) certificates to clients in the civil mental health system, exercising rights under Ontario’s Mental Health Act and Health Care Consent Act before the CCB  Ontario Review Board (ORB) certificates to clients in the forensic mental health system, including “mentally disordered accused” under the jurisdiction of the Criminal Code of Canada and the ORB 3

4. Current MH Services  Specialized Duty Counsel – LAO trains duty counsel who specialize in mental health cases, attending criminal courts around the GTA  Enhanced tariff payments for vulnerable clients – criminal certificates may qualify for an enhanced block fee tariff when the client has a history of mental illness  Appointment of counsel – LAO arranges for the appointment of counsel pursuant to orders made under LASA s. 85(2); Health Care Consent Act s. 81 (for unrepresented clients appearing before the CCB); and Criminal Code 672.24 (for unrepresented clients found unfit to stand trial) 4

5. LAO Mental Health Strategy 5  April 2012: LAO’s Board of Directors initiated development of a Mental Health Strategy (MHS) with a five-year mandate  October 2012: Work on the MHS began  The objectives of the Strategy:  ScopeReview all LAO services and mandate through a mental health lens  StudyHow does MH&A intersect with LAO?  SequenceConsultations on client and service provider needs  StakeholdersInvolve stakeholders in the initial and ongoing development of the strategy, and in new partnership initiatives

6. MHS: Scope 6  The MHS is adopting a broad definition of mental health and addiction, including: serious and persistent mental illness, addictions, intellectual disabilities, trauma, and dual/concurrent diagnoses and disorders  The MHS is taking a corporate-wide scope, asking how mental health and addictions impacts across:  LAO’s mandate: family, refugee, criminal, clinic, aboriginal, etc.  LAO’s services: duty counsel, clinics, staff lawyers, private bar certificates, etc.  Critical questions  Are LAO services accessible to clients with mental illness?  What are the specific and unmet legal and service needs of clients with mental illness?  How are intersecting and concurrent legal issues addressed? Scope

7. MHS: Study 7  How does MH&A intersect with LAO?  The majority of LAO clients are between the ages of 18 and 35, the age when most mental illness emerges  1 in 3 LAO certificates may go to a client with mental illness. 73% of LAO’s certificate clients are on ODSP, OW, or have no income (incarcerated / homeless)  Clients have high and recurring legal needs. Just 10% of all clients with a previous ORB/CCB certificate are issued 50% of crim certs and 30% of family & CFSA certs (within that cohort)  Litigation impacts health and wellness. 37% of clients with legal problems report adverse effects on mental health  Demand for core service is increasing. Since 2005/06, CCB certificates are up 25% and ORB certificates by 40% Study

8. Mental Heal Strategy Consult Themes 8 April 2014

9. MHS: Sequence 9 Sequence  Consultations: What are the Client and Service Provider Needs ?  LAO launched a discussion paper and 4-month public consultation process in November 2013  2500+ unique visits to the MHS website and 650+ unique downloads of the consultation paper  24+ in-person consultation sessions in Kenora, Thunder Bay, Sudbury, Toronto, Peterborough, and Hamilton  Written feedback from over 65 individuals and organizations

10. MHS: Consultation Feedback 10 Consultation  Rights: LAO has a special responsibility to ensure a rights-based approach to mental health services and supports  Access to justice: legal services should be provided along the service pathways clients take through health and social supports  Service models: proactive and accommodating programs and services may reduce the number of self- and unrepresented litigants; legal and financial eligibility should be expanded; retainers should be more flexible  Competence: Advocates need training in communication skills, trauma-informed approaches, health and service options, cultural and religious competence, etc.; training should be locally driven  Unmet needs: expand legal eligibility to cover legal issues of particular concern to clients with mental illness

11. MHS: Stakeholders 11  LAO is exploring potential initiatives with stakeholders, including:  Pilot projects for new and expanded services in the community, courthouses and health facilities  Training for all staff and empanelled lawyers, including the participation of persons with lived experience  Development of intake & triage tools  Relaxed eligibility and expanded legal coverage policies for clients with mental illness  Inter-professional service models  Innovation frameworks to support local solutions  New certificate services for mental health appeals Stakeholders

12. MHS: Next Steps 12  LAO is actively developing the Mental Health Strategy for release early in 2015  Several core commitments are already under development, including training programs, updated panel standards, new / expanded programming, and intake interview & needs assessment tools

13. Contact Me!  Ryan Fritsch, Policy Counsel Mental Health Strategy  fritschr@lao.on.ca fritschr@lao.on.ca  LAO_RFritsch (Twitter) LAO_RFritsch 13