Official Report of

DEBATES OF THE LEGISLATIVE ASSEMBLY

(Hansard)

WEDNESDAY, MAY 21, 1997

Afternoon

Volume 5, Number 4

[ Page 3501 ]

The House met at 2:06 p.m.

Prayers.

L. Reid: I had the very great pleasure last week, when the royal commission hearings on the workers compensation system came to Victoria, to meet Mr. Ken Worrall and his wife Sue Worrall. I would ask the House to please make them welcome. I would also ask the House to recognize Pat Kean, Nancy Der Hogg and Annalise Roosten, who are joining them today.

Hon. U. Dosanjh: I take great pleasure in introducing to the House 25 students from Tecumseh Elementary School in my constituency of Vancouver-Kensington, with their teacher Ms. Duncan. Would the House please make them welcome.

Hon. M. Farnworth: In the gallery today are 35 grade 11 students from Riverside Secondary School in my riding, who are here as a reward for writing the Sir Matthew Baillie Begbie exam. There's $4,000 worth of scholarships given to students throughout the province, and these were top students, so I would ask the House to please make them welcome.

Hon. D. Miller: We have a special guest in not the members' gallery but the general gallery. Jay Bruns is the consul general of the United States of America at Vancouver. Mr. Bruns is obviously very busy working, amongst other things, on the upcoming APEC round, which culminates in the leaders' meeting in November. I would ask the House to please make him welcome.

G. Campbell: I'd like to introduce to the House Rita Morin, a longtime friend of mine and someone who has been very active in the community in Vancouver and in British Columbia. She is a volunteer par excellence, and I'd like the House to make her welcome.

B. Penner: It's my pleasure to introduce to the Legislature Mr. Shane Willoughby. Mr. Willoughby is a law student from the University of Victoria, and he recently returned from Bangkok, Thailand, after completing a co-op work term at the same Bangkok law firm that I worked at in 1991. I had the pleasure of meeting Mr. Willoughby this past January when I travelled to Thailand for the Team Canada trade mission. Mr. Willoughby was generous enough to help me reduce my travel costs by allowing me to share his room at the Bangkok YMCA for a couple of nights. I can highly recommend that accommodation to anyone here. Would the House please make Mr. Willoughby welcome.

The Speaker: I'd just remind members that these are introductions rather than autobiographies, but thank you. [Laughter.]

Hon. L. Boone: In the gallery today is a former constituent of mine, Mr. Roger Powell, who unfortunately has left there -- I don't know why he's left Prince George but he has -- and moved to Victoria. But I do hope he has a good life down here. We will miss you. Please make him welcome.

Introduction of Bills

HEALTH AUTHORITIES

AMENDMENT ACT, 1997

Hon. J. MacPhail presented a message from His Honour the Administrator: a bill intituled Health Authorities Amendment Act, 1997.

Hon. J. MacPhail: I move that the Health Authorities Amendment Act be introduced and read a first time.

This bill represents a further step in our government's Better Teamwork, Better Care approach to health care regionalization. In November of 1996, our government moved forward with a simpler, more streamlined approach to health care governance and management, designed to reduce bureaucracy and waste, and to ensure that more of our tax dollars are invested in direct patient services that B.C. families depend on.

These amendments represent the input and counsel of hundreds of health care stakeholders who contributed to an assessment of the regionalization process last summer. The legislation brings clarity to the appointments, direction and accountability of our new governing bodies and will allow necessary change in the structure of our health care system to proceed in an expedited fashion, with the appropriate checks and balances to ensure that the interests of patients and taxpayers are both protected.

A new

part 3 has been added to the act to deal with labour relations in the health sector. The new statutory provisions build on the former health sector labour relations regulation, including the simplicity of the five bargaining tables recommended by the Dorsey commission. The statute will uphold the certification rights of unions that have represented health workers.

These amendments are important and will significantly contribute to achieving our government's goal of delivering better care and better services to all British Columbians. I move that the Health Authorities Amendment Act be placed on the orders of the day for second reading at the next sitting of the House following today.

Bill 28 introduced, read a first time and ordered to be placed on orders of the day for second reading at the next sitting of the House after today.

Oral Questions

PLACEMENT OF NATIVE FOSTER CHILD

(MURPHY CASE)

G. Campbell: Last week the Minister for Children and Families informed the House that her ministry "have placed all the information we have before the Child and Family Review Board" with regard to the Murphy case. My question to the Minister for Children and Families is simply this: will the minister confirm with the House today her statement that all the information with regard to the Murphy case was placed before the Child and Family Review Board as of last Thursday?

Hon. P. Priddy: My understanding is that all of the information that we had from our home studies, the confirmation of a clear criminal records check, etc., was placed before the Child and Family Review Board.

G. Campbell: I have in my hand a letter sent to the ministry last Thursday from Bruce Hardy, who is from the Child and Family Review Board, to Ross Dawson, who's the director of child protection for the Ministry for Children and Families. The letter says:

[ Page 3502 ]

"A letter dated July 12, 1996, from Nelson Horney of Touchwood Child and Family Services to Diana Flaherty of the Ministry for Children and Families states that criminal record checks had been completed . . . . These were to be forwarded to the ministry in British Columbia. The board is not in receipt of this documentation."

Can the minister explain why these documents were not forwarded to the Child and Family Review Board up to and including the very day that a decision was to be made?

Hon. P. Priddy: As I understand this, the actual documentation of the criminal records check was not attached, but the letter that said the criminal records check had been done and was clear was part of what was submitted. The attachment was not; it clearly should have been. That was an oversight that should not have happened. But there was indication to the Child and Family Review Board that the criminal records check had been done and was clear. Nor did we hear back from the Child and Family Review Board of any question about it.

[2:15]

G. Campbell: Well, we do have a letter from last Thursday, which asks the ministry specifically to make sure that all information is available. Clearly Mr. Hardy, who is the Child and Family Review Board member who we're asking to determine the fate of this young child, was of the impression that he was not in receipt of all the information that was available -- the information with regard to charges that had been laid, the information which there may have been with regard to children who had previously been in the same family and who had been injured. The question that Mr. Hardy is concerned about . . . .

I have concerns that this information was not made available to Mr. Hardy. I'd like to be certain with this minister today that all of that information was available to Mr. Hardy, so he could make an informed decision which was in the best interests of this child.

Hon. P. Priddy: As I said previously, my understanding is that the actual record check was not attached. Was this an oversight? That is correct, it was, although clearly the Child and Family Review Board did not either note it or question it. My understanding was, though, that they had been told that it was a clear criminal records check.

In terms of the additional information around charges being laid, that is not information that the ministry had. The first time I heard that was when it was raised in the House. Our ministry obviously, then, having heard that, went back and did some further checks as well. I think it may be problematic. But there is no way that a criminal records check shows anything about charges being laid. We did not have that information and did not present it to the board. We didn't have it available to us.

M. Coell: A criminal records check is the single most important piece of information the ministry needs in placing a child in a foster home -- or any home, for that matter. Apparently the Child and Family Review Board was considering the Murphy case without all the relevant information. Can the minister tell us why, when the future of a six-year-old girl was in question, the minister did not provide the Child and Family Review Board with all the facts necessary to make a decision?

Hon. P. Priddy: I'm not sure that I have not answered this question, but let me try again. The criminal records check, I agree, is an important -- although certainly not a totally defining -- piece, because, as I've indicated, it indicates convictions -- but not anything beyond that. That information should have been at the Child and Family Review Board; there's no question about that. On the other hand, the Child and Family Review Board -- which, as the member noted, was making their decision last Thursday -- also did not call and ask.

Therefore I think they must have had the information that said it was clear; but they did not have the attachment, which I've acknowledged they should have had.

M. Coell: Being that the Child and Family Review Board is not totally independent, I fail to see why it would need to phone and ask for more information. It is relying on the government to give all of the information that it has to the review board for its decision. Can the minister tell us whether they followed up the review of the Saskatchewan services company and the criminal records check to see if there was any further information that the review board would have needed?

Hon. P. Priddy: We followed up immediately on Thursday when the ministry staff realized that the attachment around the criminal records check had not been attached to the covering letter -- followed up immediately with that and spoke with the staff at the Child and Family Review Board. In terms of the information that was raised in the House -- I assume that's what the member is referring to -- we followed up on that information as well and provided it to the Child and Family Review Board.

G. Farrell-Collins: A further question to the same minister. Can the minister tell us whether or not either of the two home studies, the one done in Saskatchewan or the one done here in British Columbia, included information with regard to charges of child abuse that had been laid against one of the individuals with which this child was to be put into custody, and whether or not that information was forwarded to the Child and Family Review Board for its decision?

Hon. P. Priddy: I want to make sure I understand the question correctly. The member is asking if the home study included information about charges being laid. Is that . . . ? I'm not sure I understand the question correctly, although I don't think my answer would be different. I have not seen the home studies -- nor, quite frankly, should I have seen the home studies. The minister does not make decisions about the individual future of individual children. So I have not seen the home studies; I can't tell you what is in those. But my understanding was and is that the information around charges being laid was new information when I heard it in the House on Thursday.

G. Farrell-Collins: A question again to the same minister. I have a copy of a letter that was sent to Janet Donald of the Child and Family Review Board on May 2 from Jane Tyson, who works in the minister's ministry. It says:

"Please find enclosed the ministry's submission to the Child and Family Review Board. The attachments to the submission include the following documents:

1. Consent to the release of the home studies . . . .

2. Copy of the home study prepared by Dr. McCreight . . . . "

That's the one done from British Columbia. There is no record here of the Saskatchewan home study being forwarded to the Child and Family Review Board.

Can the minister confirm whether it was the ministry that sent the Saskatchewan home study or whether it was the Murphys' lawyer who sent it?

[ Page 3503 ]

Hon. P. Priddy: I'm going to say this and then would want to be able to confirm that I am correct, and I would need to check. My understanding is that both home studies were submitted to the review board. The second home study was done at our request and, as a point of fact, was done because we hired someone to do an additional, secondary home study.

G. Farrell-Collins: My concern is that there was a home study done in Saskatchewan. For some reason there was an additional home study done by the province of British Columbia. For some reason the ministry, in advising the Child and Family Review Board, failed to include the initial home study. That raises serious questions in my mind. Subsequently they did in fact get that home study.

What I'd like to know from the minister is why all the relevant information was not given to the Child and Family Review Board and why a second home study was required.

Hon. P. Priddy: I cannot comment at this stage on why a second home study was done. I think the Child and Family Review Board has not reported out, and I feel somewhat uncomfortable commenting. But obviously, if we were going to do a second home study, then we would have had some reasons or issues that had been raised with us and that we wanted to be comfortable enough with to be able to proceed with the placement of the child. Beyond that, I'm not prepared to comment on the specific reasons for the secondary home study, but it's obviously because there were issues raised and we wanted to be sure.

In terms of why . . . . I don't know when that was submitted. My understanding is that we submitted both of those home studies to the Child and Family Review Board. I'm not sure of the date the second home study was done and whether it was done by May 2 or not, but I will certainly check and let the member know.

M. de Jong: As we understand it, the Saskatchewan home study was done in July 1996. Last Thursday we were told that a decision that would profoundly impact the life of this little girl was hours away from being made.

The question, quite simply, is this: why wasn't all of the information -- some of it upwards of a year old -- provided by the ministry to the people who would be reviewing what would happen to that girl for the rest of her life?

Hon. P. Priddy: Since we're now talking about when particular reports were done and when they were submitted, I clearly have to check with staff to know the dates for that. But my understanding was that all of the information other than the piece I referred to, which was the criminal records check, which was not attached . . . . By the way, although the CFRB may not be independent, surely that would be a consideration in their decision-making, and had they noted it was not there they would have called. My understanding is that all that information was handed over. In terms of whether it went on two different dates, I really will have to check with staff and let the member know.

M. de Jong: The issue, again, is this: the body that is charged with the responsibility for deciding this little girl's future simply isn't receiving all of the information it requires to make that decision. The minister is suggesting that it would be expected to go looking to different agencies -- to make inquiries. Surely the fundamental issue is this. Will the minister address it head-on, upfront and explain why the review agency, in this case, has to go the added step -- to ask, to inquire -- and why it wouldn't have been provided this information in a timely way at the first instance?

Hon. P. Priddy: The only information that I am aware at this time did not go to the review board was the attachment of the criminal records check, which I have already said should indeed have been attached to the covering letter. I acknowledge that. Nobody for one minute would suggest that the Child and Family Review Board should have to go looking for information. We have a responsibility to provide all the information we have to them. I don't think anyone expects them to go looking for it. I have acknowledged that it should have been attached and was not. We remedied that as soon as it became apparent to us.

G. Plant: Well, the issue of what was and was not sent to the review board is an issue of considerable importance. Last Thursday we had the minister's statement that in the home studies were included the criminal records checks. I understand that we now have the statement of the minister that it was, in effect, in error; the checks themselves were not attached to the documents. But the real issue is whether there was disclosure about criminal records at all. I want to return again to the letter of May 15 which Mr. Hardy wrote to Ross Dawson. After saying that the board had not received the criminal records check documentation, Mr. Hardy goes on to say this:

"If this information" -- not documentation -- "does exist about a party seeking custody, that is in your possession, I expect to be advised of it by tomorrow afternoon. Pending receipt of notice as to whether such information does exist and my consideration of the same, my decision will be delayed."

So my question for the minister is: is she able to confirm that in fact there was any disclosure of criminal records information in the material provided to the review board by her ministry?

Hon. P. Priddy: When I made the statement in the House last week that the criminal records checks had been included, that was the understanding I had been given by staff. When the issue arose in question period, people from the review board -- I think someone was watching -- double-checked the file, alerted us to the fact that it had not been attached, and we provided it to them immediately. The criminal records checks had been done. As I say, they were not attached. It was an oversight that was our fault, but they had been done. We provided them as soon as we realized that they had not been included.

G. Plant: I understand the minister's answer in that respect.

Now it's important that we turn to the other issue, which is the issue of criminal charges. I understand that the minister has made some statements about the existence and delivery of home studies, but the fact that's missing here is that the home study done in July 1996 was made available to the ministry at that time.

The question that I think arises there is: did the home studies include work done to determine the appropriateness and the background of these two individuals, including the question of whether or not there were or had been in the past outstanding criminal charges against these individuals that might make them unsuitable as parents for this child? If that information was not there, why not?

[ Page 3504 ]

Hon. P. Priddy: If the member is referring to the Saskatchewan home study, I cannot comment on what was in it, because I have not read it. I will now try and find out what was in that.

But let me tell you, hon. Speaker, that I don't think any elected person -- unless there are circumstances that say differently -- should be reviewing the personal, confidential information of every child and decision in this ministry. The director of child protection has that responsibility. He has reviewed the home studies. He has made sure they were provided to the Child and Family Review Board. He made sure that the records check was provided as soon as we knew that it was absent. We will continue to provide all of the information we have.

The Speaker: The bell ends question period.

Tabling Documents

Hon. U. Dosanjh: I have the honour to present the twenty-fifth annual report of the Criminal Injury Compensation Act of B.C. for the year 1996.

Orders of the Day

Hon. J. MacPhail: In Committee A, I call Committee of Supply. For the information of the members, we'll be debating the estimates of the Ministry of Aboriginal Affairs and the Ministry of Municipal Affairs and Housing. In this House, I call Committee of Supply. For the information of the members, we'll be debating the estimates of the Ministry of Health.

The House in Committee of Supply B; G. Brewin in the chair.

ESTIMATES: MINISTRY OF HEALTH AND

MINISTRY RESPONSIBLE FOR SENIORS

(continued)

On vote 40: minister's office, $462,000 (continued).

[2:30]

R. Coleman: I'd like to ask the minister, if I could, a few questions about the Riverview lands, the 244 acres of land in Coquitlam. Is my understanding correct that the minister put the planning process on the Riverview lands on hold about ten days ago in a meeting with BCBC or other authorities?

Hon. J. MacPhail: A meeting took place amongst BCBC, the local MLA in whose riding Riverview resides, some of my staff and me. The local MLA was asking what the future of Riverview Hospital is, and he was searching that out in order to determine what his recommendation to the community should be on how to proceed in the consultation.

At that time, I informed him that the future of Riverview is not resolved yet, that it will be part of the mental health plan currently under review and that the issue will be decided in the fall. It would be my advice that consultation should take place with renewed vigour after the future of Riverview Hospital as a health care institution is finally determined.

R. Coleman: My understanding was that there was a plan being worked on with BCBC for the Riverview lands and that it was put on hold until 1998. Is that correct?

Hon. J. MacPhail: Let me just tell you what my understanding is of the consultations. There's a consultation process in place that had been . . . . A certain part of that consultation had been finished amongst the community. Further financial work had to be done in terms of assessing the various options for the future use of Riverview lands, and that work continues. There is no plan . . . . If there is a plan, I certainly am unaware of it, because there's no agreement on the future of Riverview lands. Certainly there's no conclusion yet about the future of Riverview Hospital, so I'm unaware of what the member is talking about.

R. Coleman: My understanding of the process -- and this is through a review of the lands last year during estimates and also a review during the past year -- was that the plan was to be prepared through consultation with various agencies, including Health, to be taken for consultation and input from the community. The consultation and input from the community, as I understood it, was to be on the concept of a 350-bed hospital and the balance of the property going to 500 units of housing.

The housing was supposed to offset the cost of the hospital by paying for it, and the concept was that it would then go to a plan. The plan would be written in draft form and presented to the community for consultation and input. At that point in time, with the community consultation and input, a decision would be made and finances considered, or whatever the case may be, and it would go forward to the ministry. My understanding is that that process has been put on hold until 1998. That's what I'm wondering.

Hon. J. MacPhail: Certainly, if that was the plan, that would meet with a lot of difficulty in the community. That's my understanding. The concept outlined by the hon. member may be one of several views being put forward. It's interesting, because I happen to know, just from personal consultation with other interested groups, that that plan would not be acceptable.

Again, I can't comment on the specifics of that. I can only say that the local MLA and I agree that until we know the future of Riverview Hospital and what, if any, portion of the site will be dedicated to a renewed Riverview Hospital or, indeed, parts of the old Riverview Hospital -- until that decision is made -- further community consultation should wait. But that will be by the fall.

R. Coleman: I guess the information that I'm receiving from various Crown corporations is incorrect. I will confirm that this afternoon to see if it is incorrect -- get copies of planning reports to see if I am incorrect. I believe that I am correct in the process that I outlined, from my discussions with the various agencies I've been dealing with for some time over this particular piece of property.

I think we should understand, though, that it is a valuable asset. The asset is a great opportunity to prove that real private-public partnerships do work, that they can be done and that this land could actually pay for a facility if it was handled properly, with long-term payback to the community through some form of share equity for seniors or other forms of housing that can be created by utilizing land to a purpose, similar to an annuity, for the future of the community.

That has been done in other communities, and the opportunity here is extreme. Considering the great objection that was made by this government, when they were in opposition, over the Expo lands and other lands that have been sold rather than used for future development and payback to the community, I think it's very important that the ministry take

[ Page 3505 ]

into account that 244 acres of land could have a tremendous community payback. I'm wondering if the philosophy of the ministry is at least to take a look at it from that standpoint to ensure that maximum payback comes back to the community and that we can hold the land base on a residual value either through some sort of share equity and long-term lease arrangement into housing for seniors, or whatever other uses are possible.

Hon. J. MacPhail: I thank the member for putting that on record. I expect that that aspect of a proposal will be considered amongst the community. As you know, our government generally has announced that we're very interested in private-public partnerships. But I do say that the future of the lands is going to be considered in a community consultation, and I expect that the future use as described by this particular member will be part of the number of options being considered by the community.

Hon. Chair, I would ask leave to make an introduction.

Leave granted.

Hon. J. MacPhail: It gives me great pleasure to introduce the parents of my deputy minister, David Kelly. Lil and Stan Kelly are here visiting their son. It's unfortunate that they have to be locked up here, watching us in this chamber, but I'm sure it's an opportunity for them to see the great performance of their son, and I welcome them to visit with us.

B. Penner: I rise -- I suppose this is my second time during Health estimates -- on a slightly different topic this time. I'm rising to address an issue which I know was spoken about here yesterday, and it has to do with the number of drugs used in the treatment of mental illness, particularly schizophrenia. I wish to take this opportunity just to put my concerns on the record for the benefit of my constituents.

I too have been contacted by a number of people in the riding of Chilliwack who are concerned about the ministry's policy towards -- I'm going to try to pronounce these terms appropriately -- risperidone and olanzapine. Those are two drugs that I know the Minister of Health is now aware of after the estimates debate here in the last little while. But I do feel that those types of drugs need to be examined by the ministry.

Certainly the letters I've received at my office indicate, on the part of the writers, that those drugs were beneficial to them. They feel that the ministry's policy at present is detrimental to the mental well-being of people throughout British Columbia, and they're asking for support wherever they can get it. I suppose that a number of MLAs have been getting similar letters, but the ones that I've received are specific to Chilliwack and are very thoughtfully written.

I'll turn now to the matter of mental health generally. I would like to share with the hon. minister the text of part of a letter that I received in early January, because I think it is very moving. Essentially, the author of the letter is calling for greater awareness, generally, in terms of the problems of mental illness and for changing society's outlook or perspective in terms of how we deal with mental illness and those people who are afflicted by it. I'll read extracts of this letter with your permission, hon. Chair.

[2:45]

"In about 1989, our beautiful 29-year-old daughter became acutely ill. She had two small and wonderful children, whom she loved dearly. Her voices told her that she must take her life. She tried several times. She finally succeeded by hanging herself in our small barn, on our anniversary, on August 25, 1993.

"Our lives have not been easy since that time, since mental illness invaded -- completely and unexpectedly -- our lives. My husband and I have tried to do all we can possibly do to work with the system, and to forgive inadequacies and to bravely face life's challenges."

The letter goes on to talk about some of the encounters that they've had with various people in different government ministries.

I won't mention here the names that are contained in the letter, for the sake of confidentiality -- not only of the people in the system but also of the people who have written to me. But suffice to say that the letter goes on to express concerns about some of the treatment they have received, both before and after their daughter's death, from people in the mental health care system in British Columbia.

Obviously, I suppose, in any organization or any system, you have some good apples and you have some bad apples. I'm wondering if the minister could, for the sake of the people who have written to me expressing their concern about mental health, outline some of the steps that her ministry is taking with respect to mental health issues and how she sees her approach differing from ministers in the past.

I do believe that in society, generally, there is a greater acceptance that mental health is a serious issue and not one to be laughed at or taken lightly. I'd invite the minister just to give us a few of her comments.

Hon. J. MacPhail: I thank the member for bringing to light in such a moving way such an important issue. It has been very interesting and sometimes very troubling as I moved from being the Minister of Social Services, and being in many ways responsible on another front for the well-being of people with mental illnesses, to being the Minister of Health and understanding how, in some ways, there is a ranking of health priorities -- unadmitted, of course -- in the health care system, and that mental health really has to fight for its proper ranking in the care and attention of our health care system.

We have many dedicated health care professionals, but certainly -- and I say this with the greatest of respect -- heart surgery and cancer treatment take a great priority across the whole population, and then we look at mental health. It's our goal to ensure that mental health has its rightful place in the planning as we regionalize health care. We have done that by properly enveloping the funds for mental health and by ensuring that they cannot be used for anything other than mental health and that there are expected improvements to be made in the mental health system.

I also discussed very briefly yesterday that we are reviewing our whole mental health plan. The last plan was done in 1987, and much in society has changed since then, including a different approach, sometimes, to the health and well-being of people suffering from mental illness. That review will be completed by September and will be unveiled publicly, and then we will be doing a report on the implementation of the mental health plan as well.

I have often had it described to me by the advocates and the families from the community of mental health that the biggest solution in dealing with patients with mental illness is housing, and that proper housing -- supported housing -- allows people to ensure that their medication is taken and that they can live in a world where they can be employed and succeed on a family basis. So we are concentrating much of our energy in the area of providing more supported housing, and will continue to do so.

[ Page 3506 ]

I also thank the member for bringing his own concerns around the issue of atypical anti-psychotic drugs. I'm sure he heard the debate yesterday -- where that matter is under review.

B. Penner: I did hear about that. I didn't hear it directly, but I heard it through our mental health critic, the member for Okanagan-Vernon. It will be an issue that I'll try to keep on top of as well. I hope the issue is addressed in such a way as to give people who do need those drugs the kind of help that they're desperately looking for. I should mention that their families are also looking for that kind of help.

Just to go back for a moment to the letter which I was referring to a few minutes ago, the mother of this young woman who took her life says that in the year since that tragic incident, she has got involved and tried to volunteer her services in many ways. She says that she has spent hours in local, regional, lower Fraser Valley, provincial and Riverview meetings and at conferences. She has tried to bring a lot of enthusiasm to this process, it appears, but she has come up against what she cites are a number of shortcomings. I'll just review what I'm told are the shortcomings in the system, because I have not had that much personal involvement.

She cites a lack of outreach for the mentally ill, presumably by government agencies; a lack of adequate housing for those that are mentally ill; a lack of sufficient beds and hospital stays long enough to stabilize a patient; and a lack of follow-up by local psychiatrists. According to her, rivalry and turfism is apparent amongst the different agencies responsible for dealing with those who do have some mental illness.

I bring those shortcomings to the attention of the minister in this form, because I think it is a good opportunity to get the message delivered directly.

I note that throughout, she tries to keep getting back to a positive tone, but she does make a criticism. She cites -- again, I won't use the person's name -- a particular individual, an employee of the mental health system, who has been removed from the local area. I presume it was perhaps due to some kind of reorganization within the health care system. She's concerned about the removal of a particular individual from the Chilliwack area, as she felt that this person was particularly helpful to her family and to others. This brings her to conclude by asking: "Closer to home? No way. Closer to Victoria and with less funding and support."

Although she doesn't come right out and say it, I suppose the real purpose of her letter is to try and find out why this health care professional was being removed from Chilliwack and why that support was taken away from the people that really need that kind of help. I'm not sure if the minister is able, through my cryptic remarks, to determine which person I'm talking about. Their position is not identified in the letter, so I don't know what that individual's actual job was.

Interjection.

B. Penner: Yes, it was a male individual. Apparently he was involved in the mental health care system.

Hon. J. MacPhail: The member has given enough information for me to reassure him that the vacancy either has been filled or is about to be filled. There was a vacancy and the position is fully funded -- it wasn't a matter of cutbacks at all -- and if it's not filled now, it will be filled.

I couldn't agree with the member more about the priority we need to give in terms of integrating our services for people with mental illnesses. My vision for mental health is that people with mental illness should be able to access the services they need in the same way as people with physical health care needs. That can only be realized through the integration of community or hospital services. Patients and families of patients with mental illness should be able to access those services in just the same way as if they were accessing treatment for heart ailments.

We have some way to go, but I truly do believe that the regionalization of health care will go a long way towards addressing these concerns. Communities develop different ways of delivering services, depending on their needs. For instance, in the member's community, which is a combination of both urban and rural services, there are different demands than in my community, where it's strictly inner-city urban services that are needed.

So I look forward to us working very closely with the regional health boards to ensure an increase in health care delivery to people with mental illness.

B. Penner: I'm coming close to concluding my participation on this aspect of the debate, but I would like to just share these thoughts. It's been my observation, and I'm sure that of many others, that increasingly we see people on our streets today -- often they're homeless people or they're marginally housed, if I could use that expression -- who perhaps in years gone by would have been in full-time care in our mental health care system.

But due to restructuring and cutbacks and a change in approach -- I think that was in the mid-1980s -- these people were essentially turned out of the institutions and set amongst the rest of society. Just through casual conversation with people I meet, the view is expressed that these changes were made without adequate support for the individuals once they reached the community, or perhaps even that some of these people simply are not fit to be out looking after themselves in the community.

As the minister knows, I practised law for a number of years prior to being elected. In the last year before the election, I was doing primarily legal aid work. Many of my clients, I felt, would have been better served by not being brought through the criminal justice system, because that was merely addressing the symptom rather than the cause of whatever conduct had got them into trouble with the law. I don't stand here today and pretend to have an easy answer to that problem.

Obviously, as much as possible we would like to integrate people in our society, providing that we can give them the necessary support. But it appears to me, and I want to make it clear that this is just my own personal view, that perhaps we've gone too far in the other direction. There are clearly some individuals who are not able to look after themselves on a day-to-day basis, and they put not only themselves in jeopardy in terms of their physical and ongoing mental health, but they also put society's safety in jeopardy.

It's not simply the annoyance of having a person stealing another loaf of bread because the person's head is filled with strange voices. Oftentimes these people will commit other offences, or when caught or being apprehended, they will lash out and cause bigger problems for themselves and for others around them.

So my concern is that shift we've seen in British Columbia from having too many people institutionalized to perhaps not having enough long-term facilities for people who really do need that help. I'll sit down now and turn the debate over to other people, but I look forward to hearing the minister's comments.

[ Page 3507 ]

Hon. J. MacPhail: That is exactly why we need to review the mental health plan: to keep up with the changes in society since 1987. Also, what we've learned in the course of those last ten years from that was, as I remember it, broad community-based support for deinstitutionalization. But the member's quite right: how successful has that proved to be, and where have the failings been in terms of community readiness for people being deinstitutionalized? Our mental health plan has to address all of these concerns, as the member raised.

And I know from personal conversations with the Attorney General that he is well aware of the incidence of incarceration of people who have mental illness and the inappropriateness of that, and he is taking action on that front, as well.

D. Symons: I do have some questions for the minister. Actually, one is a question I ask yearly, and I guess I'm hoping that there will be some movement on it. It's a problem that occurred to me in my very first year of being elected. I asked the question then and I will ask it again. It deals basically with the involuntary admission and treatment of people. The issue that came to me back then was from a parent whose son was schizophrenic. Because of his condition, her son was not capable of making decisions on his own appropriate care.

He was off his medication -- in fact, he was on illicit drugs -- living on the streets, and his parents were basically watching him go down the tube. They came to me out of frustration, because they had nowhere to turn to get help for their son when they saw him basically killing himself.

[3:00]

Just recently I read a letter to the editor in the Vancouver Sun that talks about mental illness limiting a son's choices. The writer said:

"My son became obviously mentally ill when he was 19, technically an adult. He 'chose' to live in forests and streets rather than get treated. I was advised he had the right to that 'choice.' In the past four years, I have gone the missing persons route, spent my savings on a detective to find him and tailed psychotic tramps through Stanley Park trying to talk to them.

"Then I started to educate myself about the terrible disease, schizophrenia, from which a high percentage of the homeless suffer. Schizophrenia is a brain disease; it affects a person's ability to think. Delusions can be just as real as the cars on the street. How can a person in this condition be said to 'choose'?

"Schizophrenia is a treatable disease. Should we, as the

article suggests, just write off those who are too sick to know that they need help?"

That's the concern that I raise again this year and that I've raised in past years. It was brought up in 1992, I believe, when there was a review done of the Health Act. I gather from the discussions in the public forums they had on that and the recommendations that came forward that they basically hit a roadblock on that particular issue. There's the civil rights issue on the one hand, and the issue of what's best for the person on the other hand.

Can the minister tell me if there has been any movement on solving that dilemma between civil rights and what's in the best interests of the person involved?

Hon. J. MacPhail: I hope I can give you some hope this year, actually. The debate continues. I have met from people who advocate on both sides of the issue, but I do believe that we are coming much closer to resolving the issue with the proper balance between the two, so that both communities are pleased with the balance achieved. I know that at least one part of the group advocating on this issue would suggest that we change the Mental Health Act, but in recent months they have withdrawn that request as long as we make the rights that exist on both sides of this issue very clear.

We listened to them very carefully, and therefore we have just published -- in fact, it's at the printer right now -- a guide to the Mental Health Act, which is really a users' guide. It's not a physicians' guide. It's a parents', advocates' and patients' guide to the Mental Health Act. It doesn't have someone else with a particular point of view determine the issues for the parents or the children, but they can use this guide themselves.

It includes, for instance, all aspects of what the provisions are for compulsory treatment in the community. Some people could withhold that information about compulsory treatment, so that's now included in the guide. It also clearly outlines patients' rights, so there's the other side of the fulcrum. It's in plain language, and it also includes all the recently revised statutes. We have received excellent feedback on this guide from community groups and advocacy groups -- including groups such as the Schizophrenia Society -- so I'm hopeful that this will go a long way to resolving the issues.

[J. Doyle in the chair.]

D. Symons: I thank the minister for that answer. That's the most encouraging answer I've got over the years, so that's great. I do note that the Canadian Mental Health Association, at least the B.C. branch -- this was back a few years -- had indicated that there may be times when there will be a need to be involuntarily hospitalized. So that seems to be one group, but I also have received letters from both sides on this issue, as the minister and the ministry no doubt have received submissions from both sides on it, as well. It's good to hear that there may be some movement in that direction so that people who are incapable of making informed decisions on their health can do it.

In looking into this problem, I found it interesting that when people get older or because of illness or something else, the family can get power of attorney over the affairs of that particular person, but it seems we don't have that power of attorney to the same extent in dealing with the mentally ill. It's good to see that we're moving in that direction.

There's just one other thing I might ask relating to this. It primarily relates to schizophrenia as well, and that is the problem of accommodation in Richmond. When Riverview closes a bed, we find that that bed might service six people in a year. Therefore when you're closing that bed, you're making one place available in community care.

If you take one out of Riverview and put one in the community, it's not really a one-for-one. It really means the Riverview one can handle maybe six people over a year, but the person in the community might occupy that bed all year long. We're not really getting that one-for-one; it's really a six-for-one, in a sense. If we take schizophrenia as a problem, there are approximately 30,000 people with schizophrenia in British Columbia, and 25,000 of those people receive some handicap assistance, mentally or physically. I'm wondering what we can do about accommodation for the number of people who need it.

Also, at our particular location in Richmond, we have a house that accommodates people, but the house basically takes most of their disability cheques. They get a small comfort allowance, which has been increased by 7 percent in five years. It's now $82 per month. Social Credit apparently raised it by 50 percent quite a while ago, but it hasn't been raised recently at all. I'm wondering if there is any move to increase the disability allowance that people have so that when they are in homes of this sort, they can have something to this effect, or what is referred to as a comfort allowance.

[ Page 3508 ]

Hon. J. MacPhail: Let me answer a couple of these issues. I appreciate your point that the one-for-one bed into the community is not the same as what a Riverview bed would be used for in terms of treatment of patients. I can only reassure the member that that has been taken into account as we move beds from Riverview into the community, in terms of the stabilizing factors that exist when people are returned to the community with proper support, and our ability, then, to use funds to reinvest elsewhere in the mental health system.

As we talked about earlier today, the issue of housing is key to proper treatment of people with mental illness. This year, for instance, during 1997-98, we are spending $2.2 million in new funding for housing of people with mental illness.

Just let me tell you how that will be spent: $1.5 million will be used to fund 200 supported-housing units, and basically, that will be in the lower mainland; another $0.3 million will be provided for additional support for people, because there is an increased level of disability in the community; and $0.4 million will be used for housing support, which is us working with the B.C. Housing Management Commission and the Ministry of Municipal Affairs. We are reaching agreement with them on priority being given to people with mental illness in terms of access to B.C. Housing.

We anticipate that this year, with the spending of the $2.2 million, and with our planned capital expenditure over the course of the next few years, there will be another 1,000 units of housing available before the turn of the century.

Sorry. And the third question was . . . ?

D. Symons: I have some concerns about the arrangements, you might say, that are going to B.C. Housing for priority. I know that within Richmond there are long waiting lists for people for B.C. Housing accommodation. If you give priority to one group, it means that waiting lists for the others are going to get considerably longer, unless, as the minister said, more housing is made available for the mentally ill through things that are specifically for them.

There is some housing in Richmond for the mentally ill, both the apartment type of arrangement and also housing for people who are going to be in those facilities long-term, and they're good. They're very good. They have very good staff there, and I commend the ministry for those. The problem is that the need is much greater than the facilities that are available. I guess that's the concern you are addressing and that we all struggle with.

On a slightly different topic . . . . I'm not quite sure how we deal with this one. It's an isolated incident, I hope, and maybe I can give you a heads-up so it doesn't happen elsewhere. A short while ago a young lady who was in Richmond General Hospital because of a mental illness was put in a ward with a pile of other people with mental illnesses. She was 16; the man that molested her during the night was 44. They were on the same floor, in the same ward, and there was no sort of supervision to the extent that prevented this girl from being molested by somebody while she was under care.

So I'm wondering how we can address those issues of segregation, in a sense that people . . . . Basically, her illness put her in a place of jeopardy to her well-being.

Hon. J. MacPhail: None of us are aware of the incident, so thank you for bringing it to our attention. But if your constituent seeks advice . . . . First, it sounds like it's a criminal matter; second, the hospital should be investigating that as well. That is inappropriate care.

D. Symons: The hospital is looking into it and investigating it. It came to me from a parent who was irate, to put it mildly, and had, I guess, been mollified somewhat by the fact that the hospital was investigating.

There is the problem of dealing with a situation like that -- when the person that's perpetrating the incident is also mentally ill. It creates a problem: are they capable of making an informed decision to commit this act? Anyway, it is being looked into, but I think it's something that any of the hospitals that might have a ward where this could be repeated should maybe be given a heads-up on.

One last little thing: a suggestion that maybe what the province needs is something like we have now where we have a child advocate. We may possibly need a provincial mental health advocate. I wonder if the minister might comment on the possibility of that happening.

Hon. J. MacPhail: We had a good discussion about this yesterday, but just quickly, I said that when we conclude our review of the mental health plan and update it, I fully anticipate appointing a mental health advocate at that time. The only reason we wait for that period is that it will be important that we select the right person to advocate on behalf of the new plan for the mental health system.

L. Reid: Many times in this Legislature I've talked about the necessity for appropriate services for elementary-age children under the delivery system we call mental health. I would submit today -- I trust that the minister will probably agree -- that the services are insufficient, certainly if we take it all the way down the line to counselling services that are available to children in elementary schools. I can certainly commit to the record today that when I worked as a school administrator, we often had access to one half-a-day counsellor a week. I had a school of 500 students; that amounted to two hours of counselling intervention.

It seems to me that if we are indeed moving to an evolution of service delivery, we simply decide whether or not the service is necessary, and that if we agree it is, we don't continue to have the Minister of Health say, "It's an Education response," and the Minister of Education say: "No, no, it's a Health response." If we agree that it's a vital service to be delivered . . . . I think there's enough research on the books today that says if you're going to make a significant difference with young children with mental illness, the start time of that service delivery is paramount.

If you wait until they're 15, 16, 17 years of age, you've missed probably ten decent years of intervention where you might have made some positive changes.

So I commend the government on the Ministry for Children and Families, because I think that is about an integrated service delivery model. I want to know today whether or not that extends to providing counselling services to children who are of an elementary school age, because every year I've asked this question, and every year I've been told that the other minister has the responsibility. I want to know if we're indeed going to go down the road of integrating that service, so that if a child is six years old in British Columbia, there will be services available.

[3:15]

Hon. J. MacPhail: I don't know whether the member will take comfort in this or not, but that was exactly why we created the new Ministry for Children and Families -- to integrate all of these services and make sure that there's not

[ Page 3509 ]

wasted duplication in administration, but that services are going right into the front line to ensure the well-being of our children and youth. Child and youth mental health has been transferred to the Ministry for Children and Families, and I will certainly make the minister aware to expect your question.

But I also know that the protocols of transfer were set up in such a way that there will no longer be any excuse about who's responsible for what. There's a very clear delineation of responsibility for the delivery of services, and the Ministry for Children and Families insisted on that. I'm hopeful that the change will maybe address the concern that the member raises.

L. Reid: The minister's comment warms my heart. I would be delighted if in the next school year we could actually have that service delivered on a regular basis, because if service is not offered when they're of an elementary age, when the need is demonstrated, we don't fix the problem; we simply postpone it. Then we all have to deal with it as they reach high school, on into post-secondary and then on into the community.

In terms of community questions I wish to raise . . . . I did scan the Blues after yesterday's debate, and I want to reference the working group to identify the regional resources necessary to resume the downsizing of Riverview Hospital -- the June 1996 report. Just a couple of questions -- and I do appreciate that this was discussed in some detail.

My concern and my dilemma with this report is that it speaks, I think, with more regard for the people who are categorized as being formally part of the downsizing procedure. For those who, for whatever reason, are not part of that formal group, the level of funding is dramatically different. To quote it, it's $191 a day for people who are officially part of the program and somewhere between $20 and $30 a day for clients who are not.

I've certainly read many of these reports, and I'm not clear how the categorization works -- whether it's based on a particular set of demonstrable skill sets or behaviours or whether it's a random sample. I have families who phone me regularly to find out why their family member did not end up in the well-funded pilot phase, if you will. That's a question I've put before this Legislature numerous times in the past, and it's a question that I don't believe has been answered to date.

The level of care you can provide for $191 per day per client is dramatically different from the level of care you can provide for $20 or $30 per day per client. One is tokenism, and one is heading down the right road.

Thirty dollars a day won't buy you a great deal of service in Richmond; it won't buy you a great deal of service in the lower mainland. Whether or not you can purchase reasonable service outside the lower mainland, I still don't think that's the case. I would ask the minister to indicate how these individuals were assigned to particular groups, because that's the question that my constituents are posing to me: "Why is it that my family member is not part of the well-funded downsizing mechanism?"

Hon. J. MacPhail: I'll try to give a general answer on this, not one specific just to Richmond. The member is quite right; when a person left Riverview, $191 a day accompanied her to the community. But I think it's safe to say that generally -- although I can't talk specifically about Richmond -- that $191 a day went to the community and not necessarily just to serve the patient who has moved into the community. So it may meet the needs of one, two or three people in the community.

But let me just say that the funding and support in the community for people with mental illness is under review. That is part of the mental health plan review that we're doing right now. This issue will be considered -- how funding flows, what happens to the issue of aging parents who may have been responsible for their child with a mental illness and are no longer capable of meeting those needs . . . . They actually contributed to the government on a voluntary basis. All of these issues will be addressed in our mental health plan review.

L. Reid: The question specifically, minister, was: how do those individuals arrive in the well-funded group? What's the criteria for selection? If you're the parent of a child who needs that service, and your child is receiving $191 a day to go into the community -- and as an example, my child is receiving $30 a day -- what mechanism was in place to allow your child to be placed in the well-funded category and others not? That's the question.

Hon. J. MacPhail: Sorry, I didn't make myself clear. The patient doesn't arrive in the community with $191 per day. What is transferred is that when the patient leaves Riverview, $191 a day is contributed to community services as a slot, for lack of a better term -- that's not a very nice . . . . I don't mean that in any pejorative way. The community gets $191 per day with the transfer of that bed, for lack of a better term, into the community. But the level of services provided to an individual is based on need and not on whether that patient came to the community with a slot of $191 a day.

So they're not classified . . . . The community support may be based on different funding mechanisms, but it's not on a per-patient basis that the funding is allocated.

L. Reid: I would disagree with this minister, because when we talk about $191, it's purchasing power. Can the community provide X service for $191 that they cannot provide for $30? Yes. So I don't think we're differing on that. Do I believe that the patient carries the $191 in their pocket? No. But does the patient have purchasing power? Does the community have the ability to provide a different level of service based on the funding? Yes. I mean, I think that's fairly clear.

So the question specifically . . . . And if the minister will not confirm that patients in communities across this province today have a different level of purchasing power . . . . I, in fact, know that to be true; that is the case. We do have mental health agencies that have, by list, patients who are valued, for lack of a better term . . . patients whose purchasing power is, say, $30 per day and patients whose purchasing power is $191 a day. That's true. The question parents raise -- and they may or may not be aware of all the details of how this funding mechanism works or doesn't . . . .

The point they raise -- and to be really clear, to cite directly from the report -- is that the people with reasonable purchasing power account for less than 10 percent of the Riverview population that actually is returned to the community.

So we have 90 percent of that population -- and that's the crux of the issue for me -- who arrive in communities where the communities simply cannot absorb that level of client base at $30 a day. The pilot study at $191 a day is a very different purchasing-power discussion.

What I'm asking of the minister is, first off, to acknowledge that there's a difference, because it's a fact, then to indicate whether or not this issue has been looked at in any kind of reasonable way. I mean, this is not a new problem; this

[ Page 3510 ]

has been going on since 1992. It's now 1997, so for five years the response has been: "Well, we're going to review it." I appreciate that and if indeed the answer is going to be with us in the next six months, I will accept that. But I can tell you that the families who have been living with this scenario for the past five years find it completely unacceptable.

Hon. J. MacPhail: Okay, let me try to advise you of how it's done now. But also, I too understand that this has to be reviewed as part of the mental health plan review. As an example, the $191 a day is for a long-term patient at Riverview who's moving into the community, and the funding for that bed is being transferred to the community. Currently, on average, that $191 a day buys housing for about $70 a day, rehabilitation programming for about $30 a day and clinical support for $45 a day. That totals $145 on average for a patient -- and this is a patient who has been chronically ill and institutionalized.

So there is another $46 left over that's available for support for other clients in the community.

On top of that, we've increased community mental health funding by 100 percent; it's a $100 million increase. All mental health-related services -- whether they be in the hospital, forensic, Pharmacare or continuing care -- have increased by half a billion dollars over the course of the last ten years.

So there are substantial increases in funding, but how the funding gets allocated is decided at a community level, based on the needs of the patient. If what we're discussing here is that more needs to be funded then that's a fiscal issue, and I'm more than willing to discuss that. But in the community, the allocation on a per-patient basis is to be done on the need of that patient, and there are some that are chronically ill and there are some that have episodic illnesses and need different supports in the community.

L. Reid: In terms of perhaps clarifying this discussion, I will cite directly from the report, page 1. It talks about:

"Informed stakeholders agree that the planned transfer of suitable patients from Riverview Hospital to community care arrangements as part of the downsizing process has in fact succeeded very well in placing and maintaining individuals in the new surroundings" -- this is where the report breaks down for me -- "with funding of $191 per day per patient transferred from Riverview for this purpose. Between 1992-93 and 1994-95, 162 patients were placed in this way. However, downsizing patients account for less that 10 percent of the people being discharged from Riverview Hospital."

So where it breaks down for the average constituent is: why the difference? I appreciate the minister's comment that it's done on the basis of need. The families who try and discover what criteria are in place to establish that level of need are having extreme difficulty.

I can't imagine that all of those questions are going to be answered by the review, because they're questions that have been on the books for five years. So it seems to me that there's still some difficulty around clarifying how those budgets are arrived at.

I will await the minister's report. Perhaps it may shed some light on this. I'm finding some difficulty with it. I know my constituents are, and I know I've certainly had calls from different parts of the province where when individuals phone Riverview directly they are told: "That person has X level of funding; do your best." It's, frankly, not good enough.

The minister makes reference to the fact that the budget has increased. Anecdotally, I will share with the minister that I taught special ed in this province for many years. The budget was always increased, but it was always tossed out if somebody decided to buy basketballs. So I'm not convinced we're at any kind of adequate level of funding for mental health in this province, or that we are at a place where we recognize how important it is to adequately deal with mental health issues.

There are always the issues that fall off the table when it comes to setting priorities in health care. That's certainly been my experience in this Legislature over the last five years. I will do all I can to work with this minister to ensure that it works its way to the top of the list, because it has been underfunded, undervalued and under-recognized as being a significant community issue forever. I'm not clear that this province has ever handled mental health issues with any amount of determination to better the situation.

I appreciate what the minister said in terms of $2.2 million going into housing. I would simply ask for some clarification in terms of . . . . When she talks about how $1.5 million will create 200 supported-housing units, are we talking single family or single-person apartment living? Are we talking group homes? What's the breakdown?

Hon. J. MacPhail: Single-person subsidy in a supported-living arrangement.

[3:30]

L. Reid: That brings me to my next concern. It's around family members who have spouses and who have children, but do have significant mental illnesses. Is there any way for the ministry to, first, recognize that oftentimes keeping the family intact is perhaps a useful direction? There may be cases where that's not reasonable. A lot of individuals come to acquire some type of mental illness in their thirties and forties. Oftentimes their lifestyle is fairly established. They have dependents, and there is very little if any opportunity for them to receive assisted living, if you will.

Basically, there's no chance for their family to maintain any kind of contact if indeed they're not allowed to be together. Does the minister have any comment?

Hon. J. MacPhail: It's an interesting question, because, of course, the member may remember that we face this in social services as well: parents who are aging and who have kept at home their children with a mental handicap or physical handicap -- the same issue. What we have tried to do as a government is to support the individual. I assume that the member is talking about adult children here, because children of learning age are supported in the community.

Interjection.

Hon. J. MacPhail: Adult children and adult parents, yes. What we've tried to do -- in fact, I think it's worked fairly successfully, but we can certainly anticipate this question when the estimates come up for the Minister of Human Resources -- is that we have funded the adult child for the very first time under the handicapped benefit.

People with mental illness now are eligible for the handicapped benefit. They never were previously, because their illness was defined as an episodic illness, and therefore they were not permanently disabled. The definition of handicap has changed; we did that last year. Now people with episodic illnesses, mainly mental illness, are eligible. I understand that they're applying and being determined eligible in tens of hundreds, actually, which is good news. That's an extra $271 per month -- I know it sounds minimal -- to support the family.

[ Page 3511 ]

L. Reid: I thank the minister for that response. My colleague earlier talked about the necessity for protective settings. Certainly I support that; there will be people who will always require some type of protective setting.

Where the system breaks down is when individuals are hospitalized and the doctor's order says round-the-clock care. What that looks like is different from hospital to hospital, for sometimes that's one person checking them every four hours. There's been a number of cases in the press lately where people have actually committed suicide while they were under round-the-clock care. But when you go back and read the chart, that meant that somebody checked on them once every four hours.

We as a Legislature have to come to grips with what the definition of round-the-clock care is. Indeed, if we agree that a protective setting is necessary and someone is put into care, and the family breathes a huge sigh of relief and goes home for the night, and then someone else doesn't check that person for four or five hours . . . . The communication is a huge hardship there. But certainly, often tragedy strikes. And no one is taking responsibility, because from hospital to hospital it isn't defined what round-the-clock care is. Could the minister comment?

Hon. J. MacPhail: We work continuously on standards with acute care hospitals that provide services to mentally ill patients. We articulate those standards regularly, and we expect the hospitals to meet those standards. But it requires constant vigilance. I don't want to in any way besmirch the reputation of hospitals. But there is no question that clear standards have to be set and met.

L. Reid: I certainly agree with the minister. If I today were looking for a definition of round-the-clock care, would I find it in that set of standards the minister has just referenced?

Hon. J. MacPhail: The standard, I am advised, is called constant attention. It's the standard of care, depending on the acuity of the patient. But the standards are articulated in correspondence between hospitals and the ministry.

L. Reid: I thank the minister for the answer, because I'm certainly in need of that definition. I will be passing it on to the folks who have raised the issue with me.

Perhaps my last question on this topic is in terms of the working group -- the report of June 1996. It basically makes the case that it's a two-part system, that it is about replacing Riverview Hospital and reforming the mental health care system. Most of our discussion has been on the Riverview Hospital component. The reforming of the mental health care system, I think, is equally valid, equally important.

My particular issue is around alcohol and drug programs. For lots of individuals with mental illness, that's an overlay they simply can't afford. What we have today in Richmond is a superior service. Their concern is that this service is going to be fragmented, disjointed beyond all recognition, and that it doesn't make good sense to ramp that service together. In terms of the Vancouver-Richmond health board, in terms of a much larger system, the people who do best in drug and alcohol programming are those who have some kind of relationship and rapport with the staff, with the people who actually make the program work.

It's a concern for Richmond because the program is first-class. It's a superior program; it's certainly been modelled in many different jurisdictions. So it seems to me that perhaps the minister can scrutinize in more detail the effectiveness and the validity of current alcohol and drug programs. The ones that are really doing an exceptional job, frankly, should be allowed to continue. Could the minister comment?

Hon. J. MacPhail: Yes. We're aware of the excellent quality of services provided. What we're attempting to do now -- and I think we will meet with success -- is maintain those services intact from a patient point of view. We may have to change the administrative or payment relationship between the Ministry for Children and Families that's taking it over and the Vancouver-Richmond health board. But our goal is to not change in any way the relationship between the patient and the service delivered. How we administer that under the new context is to be determined, but we're working on it right now.

B. Barisoff: I beg the minister's indulgence to repeat some of the questions that have already been asked, but it's just some issues that have been brought up in my riding, too. I think, coming from a rural riding, it's only right that the minister hears from all parts of the province.

The first one, of course, is the restrictions on risperidone and olanzapine. Those are in letters that I've received; I didn't bring copies of the letters to read into the record. But I think those are areas of concern that I've got letters on from the rural part of B.C. Just another quick comment by the minister . . . .

Hon. J. MacPhail: Yes, we're well aware of the concerns. We're also pleased that risperidone and olanzapine are covered under our Pharmacare program as a special authority. We want to provide the best possible care through our Pharmacare program. That's why we are covering olanzapine and risperidone. But also, whether this be a first-line or second-line prescription drug is currently under review with the appropriate experts in the field. I expect to have a report back on that -- which is the issue of concern to your constituents -- in a few weeks.

B. Barisoff: Another concern, of course, that came and that I know the minister has addressed earlier was the downsizing of the Riverview facility. Would the minister indicate maybe to the people of the rural areas, if the downsizing takes place in Riverview . . . ? Would smaller hospitals in the interior be equipped to handle some of the patients that would come from there?

Hon. J. MacPhail: As we downsize Riverview, we do so only in the context of providing the community with the corollary support services. In fact, the downsizing of Riverview for patients in the lower mainland has been put on hold. The only patients that will be moved from Riverview into the community are those from outside the lower mainland.

We will be providing the corollary community supports as well; they'll take place. There are crisis stabilization beds and housing that will be put into the community, and of course, the Riverview replacement facilities as well, one of which is slated for Kamloops, I think, which would be most appropriate for this member's consideration -- oh, and extra emergency room support as well.

B. Barisoff: You mentioned Kamloops, which is quite a distance away. With regionalization, I was wondering whether there would be anything closer in the Okanagan that would service some of the patients who might be coming from there, from the lower mainland. Kamloops is probably

[ Page 3512 ]

about three and a half hours away from Okanagan-Boundary constituents, so I was wondering if there was anything in the Okanagan that would be closer.

Hon. J. MacPhail: Yes. There will be 16 replacement beds in the Kelowna-Penticton area, and 85 replacement beds in the Kamloops area.

B. Barisoff: It's great to see that there are some in the Okanagan.

Another question is: with the aging population that is retiring in the Okanagan, the concern that I have, particularly in small hospitals, would be psychogeriatrics -- whether there's any thought of what they're going to do in that area.

Hon. J. MacPhail: Yes, and we have had a good discussion on this over the course of the last day or so. You can certainly refer to that discussion, but in addition to that, just let me say again, very briefly, that provision of services for geriatric patients suffering from mental illness is part of the review of the mental health plan that is currently underway.

B. Barisoff: Continuing along those same lines, I think probably my biggest concern -- I am in a riding with two relatively small hospitals -- is whether some of these facilities would be put in the smaller hospitals. The two are South Okanagan General and Boundary Hospital in Grand Forks. The closest, biggest hospital, I guess, would be in Penticton or Kelowna. Whether some of these facilities would be put into some of the smaller areas, and in the case of Grand Forks, where they're quite a way from any major hospital . . . .

Hon. J. MacPhail: Thank you for that advice. We certainly will take it into consideration as we move forward.

B. Barisoff: Again, I'm just wondering whether there would be another riding such as mine, where we have a lot of different ethnic backgrounds, and whether any ethnic group counselling would be offered as a service to areas such as the South Okanagan.

Hon. J. MacPhail: I heard the member say ethnic group counselling?

B. Barisoff: Yes.

Hon. J. MacPhail: Okay. Services such as that will be decided upon by your regional health board -- which is good news, because if that's what your community needs and asks for, then the regional health boards should respond on that basis.

B. Barisoff: I have a list of them: respite care, short stay and anger management. I would venture to say, then, that what the minister is indicating is that most of these things would be covered by the new regional board that would dictate the area that they might go in. Would the minister be giving any kind of indication, or a kind of a push, that in some cases they wouldn't always be forced to the bigger centres, that some would be forced to the smaller areas such as South Okanagan and Grand Forks?

Hon. J. MacPhail: The regional health board will decide the allocation of the resources within the region's geographic boundaries, and they will be required to deliver services within their boundaries. The allocation of those resources within the region will be a matter for the regional health board. I hope the hon. member will work with them to make the best case for the best services within the region.

[3:45]

B. Barisoff: Probably my biggest concern, now that we've regionalized the boards, is to make sure that somehow through your ministry, with the weighting of votes in the way they might be, a lot of the acute care and the things that had been taking place in the smaller regional hospitals aren't lost in the shuffle of dollars and cents -- and things that are actually needed in smaller communities not only throughout my riding but throughout the entire province . . . .

My concern is still that when the dollars come into areas, they don't get shuffled into the bigger centres, and that the minister looks at the overall program to make sure that somehow there's an equity in funding and that smaller hospitals are dealt with in a manner that they can provide service for patients throughout the entire region of British Columbia, whether it's big or small.

Hon. J. MacPhail: I appreciate the concerns, and we discussed those at length when we discussed the regionalization of health care.

J. van Dongen: I just have a few questions for the minister on the provincial eating disorders program. I'd like to start out by thanking the minister and her staff for the assistance given to the Werry family from Sardis. Brandon Werry is a 13-year-old boy, one of the more serious anorexia cases in British Columbia. So I just thank the minister for that.

In working with that case for over a year now, I certainly have an interest in the provincial program, generally. I wonder if the minister could give us an overview of the program and what's involved in terms of staffing, budget and that kind of thing.

Hon. J. MacPhail: For clarification from the hon. member -- the provincial program for eating disorders, generally? Okay.

Just for information, I would ask the member if he could read Hansard of yesterday, and if he has any questions following that, we could talk about them. I went through the provincial eating disorders program yesterday. Maybe after you read Hansard , if there are any more questions arising out of that . . . .

J. van Dongen: I wouldn't mind doing that. I don't know what was addressed in that discussion, but I would like to have the minister's understanding that if I go back to Hansard , I can bring it up later in estimates. I certainly don't want to duplicate all the discussion.

I will simply say at this point that I certainly have concerns about the program, particularly about the interaction between the Ministry of Health and the Ministry for Children and Families. I will just put one or two questions to the minister now, and then go back and look.

I'm particularly interested in the issue of care teams involving both ministries -- how they're organized and who the minister feels should be in charge of those care teams. I don't know if that was addressed yesterday. Maybe the minister could just comment on that.

Hon. J. MacPhail: It will be easier to deal with concerns as they arise. I know the member may be expressing fears that

[ Page 3513 ]

are not yet realized, because certainly in terms of the delivery of the service from a patient point of view or a family point of view, nothing has changed. The mental health workers are in the community doing as they did before, and the care team is assembled in the same fashion.

If the caution to us is not to disturb that effective care team because one portion of mental health services is transferred to the Ministry for Children and Families, I absolutely agree with the member; that is exactly what should happen. There should be nothing but improvement in the delivery of service from a patient-parent-family point of view.

That's exactly how we're working on the transfer of authority. It should be seamless from a care point of view, but there will be benefits from a planning point of view and from a policy-setting point of view in that the care team now has to make sure they're integrated with all of the other services provided to children by the Ministry for Children and Families. So the difference will take place literally behind the scenes, away from the patient, in terms of policy and planning, but patient care should be unaffected.

J. van Dongen: I guess I raised some issues that I wasn't even looking to raise with the issue of the transfer of some responsibilities to Children and Families. Maybe I could ask the minister: will the delivery of the anorexia-bulimia program, then, be wholly through the Ministry for Children and Families, or will it be partially through Children and Families and partially through the Ministry of Health?

Hon. J. MacPhail: The eating disorders program is a provincial program delivered through St. Paul's and Children's Hospital, but access to the service is through the provincial program, and support for the person in the community is delivered in coordination with mental health services in that community.

J. van Dongen: I simply say to the minister that my concern, from my observations, is that there have been lots of problems with the way the system has been working. I'm not saying that to be critical; I'm saying I think there's lots of room for improvement, and that's what I'm hoping to address.

What I propose is that I dig through Hansard and look for the discussion of the other day, and then maybe I'll come back and ask some questions. One of the other members will have some questions in between.

R. Coleman: I want to go back briefly to the Riverview issue that I canvassed earlier. I was basically going a bit more from memory when I was filling in. I want to clarify some points with the minister. I have gone back and pulled my Hansard s and my information from last year.

In the last session I was advised that a 340-bed hospital with more on-site residential facilities was going to be developed on the Riverview lands, and that was in June or July of last year. The background on Riverview land use planning clearly states:

"A new 340-bed tertiary psychiatric hospital designed to service the lower mainland is being planned on the current site as a replacement for the entire Riverview Hospital complex. An additional 250 beds are to be located outside the lower mainland."

It also goes on to say:

"There are 61 existing buildings on the Riverview site, comprising 1,534,452 square feet of rentable space. These buildings were originally designed for the particular use of the hospital, which at one time had some 5,000 patients and may not be appropriate for any other use due to age, design and construction."

When I brought this up earlier, there seemed to be some misunderstanding that there was any indication that a 340-bed hospital was to go on this site. Going back into the last three business plans and annual reports of the B.C. Buildings Corporation, I find references to the planning process on these particular lands in each one of their reports. I note that the commencement of the Riverview Hospital replacement program was announced by the Ministry of Health in May of 1995. I'm just wondering if the minister could . . . . I might as well do this all in a couple of questions.

The next part of the information I have is the planning process itself, which was:

" . . . established to take full advantage of the unique features of the lands, recognizing their heritage, esthetic, psychological and locational qualities, as well as the enduring legacy of mental health on the site, while ensuring balance, economic and social returns to the people of British Columbia."

Then it goes on and outlines five phases of planning for the Riverview site. The phases of process for Riverview are: phase 1, data collection and analysis; phase 2, identifying community objectives and priorities; phase 3, developing planning principles; phase 4, preparing land use concept plans; and phase 5, selection and approval of the land use plan.

It also states that phases 1 and 2 are already complete, which means we've already identified the community objectives and policies, and we've already collected our data and our analysis.

We also have on record here that the data collection analysis was recorded in two reports, which I would ask the minister to please make available to me. One is referred to as a project context report, and the second is a resource assessment report, issued on April 18, 1996.

My questions, therefore, would be . . . . First of all, planning is very, very important. Whenever you do a project of this size . . . . There are five phases planned. I want to know if we're now developing the planning principles or if we have those on hold, whether or not they were put on hold by the ministry, and if they are put on hold, when do we plan to go ahead with them? Secondly, are we or are we not planning a 340-bed tertiary psychiatric hospital on this site? If not, maybe you could advise me why other Crown corporations and agencies are referring to it in their reports.

Hon. J. MacPhail: There is nothing inconsistent with what you're saying and what I'm saying. There will be a . . . . Well, the tertiary care hospital may be a little bit bigger on site, because we're working with new information on demographics, and we're also, as we said earlier, reviewing our whole mental health plan. That may or may not, depending on input from the stakeholders, shift the balance between community care and institutional care once again. At a minimum we're now planning for -- and the planning is proceeding -- a 367-bed hospital. Those figures have been updated from yours because of the increased demographics of people suffering from mental illness.

What is at issue and what we're awaiting is where the actual tertiary care hospital will be on the site and what the rest of the land will be used for, if anything different. That's what the community planning process is.

In terms of the community, the local MLA and I have agreed that it makes sense for us to finish our mental health plan and determine whether there will be any change to the tertiary care hospital -- not in any way that would make it fewer beds, but maybe a few more beds that would therefore require a greater site acquisition. So that's why we're pausing. In terms of planning for the institution, that continues.

[ Page 3514 ]

R. Coleman: I guess my second question would be . . . . I know I included it in my first question, but could I please have a copy of the project context report and the resource assessment report that were issued on this site?

[T. Stevenson in the chair.]

Hon. J. MacPhail: I'll certainly pass your request on to the minister responsible for BCBC.

[4:00]

R. Coleman: The number change, I guess, is just a change of 17 beds. This one

summary I've got is from March 31, 1997, which is pretty recent.

Would the minister tell me . . . ? I'm really kind of curious, when we go from 357 beds and 250 beds elsewhere in the province -- and knowing, as the Housing critic, how many times the minister earlier addressed the priority being given in B.C. Housing sites to people with handicaps -- who would have been dealt with at Riverview in social housing. But given the fact that we're actually building about 25 percent of the number of units that are required just for families in the province at this particular point in time, if we had 5,000 patients in this hospital and we're now going to be at 300 and some, where do they go and where are they now?

Hon. J. MacPhail: I certainly don't believe the member gets this from personal experience, because the 5,000 population of Riverview occurred in the 1920s. I'm sure he wasn't even alive during that time. In fact, I know he wasn't -- just by looking at him.

We now have, though, in the province -- and yesterday I stated that there were about 700 . . . . There are 808 beds in Riverview that are funded, and there are about 5,800 beds, living places, for people in the community now. The 808 that I mentioned at Riverview . . . . There are regional beds, acute psychiatric, crisis residential, residential, supported housing, family care and emergency shelters. So that's where people are now.

R. Coleman: I knew that maybe I should have just gone a step further when I was referring to the 5,000 beds, but I would be a great commercial for plastic surgery if I'd been around in the 1920s -- and that would probably be a reason you might want to include it in the health care system. If I look this good today . . . . Mind you, some people think I don't look that good at all, but that's beside the point.

Just one other question with regard . . . . We have to canvass some issues as we go through group homes, and what have you, and as we go through the Ministry of Housing. All housing seems to bounce around six or seven ministries in this province, with Health supporting some forms of housing and B.C. Housing having management and design on one side -- it's all over the place.

My question is: how many of the -- I know you said supportive housing, and I'm assuming that supportive housing is when you subsidize somebody in place in a housing project -- units that are in social and seniors housing in the province, in standardized projects, are presently being funded to this type of client versus the type of client that would be the norm of the system?

Hon. J. MacPhail: The number of clients who have a mental illness who are funded through our ministry for supported housing is 2,157. But I would also expect that there are clients in social housing beyond that who have mental illnesses who are not funnelled through our ministry. We are actually trying to determine that with B.C. Housing. Of course, in many cases that means self-identification of your illness, and that isn't always forthcoming.

R. Coleman: Would the 2,100 you're referring to, then, be housing in a group home type of environment versus the social housing type of environment?

Hon. J. MacPhail: No, they're not. Residential care is group home care, and there are 1,758 in residential care.

R. Coleman: So the 2,100 are . . . . I just want to get that clear again. You brought another 1,700 clients into there, which you just referred to as residential care. My question is: where are the 2,100 housed?

Hon. J. MacPhail: In subsidized housing in the market.

R. Coleman: Just a couple more questions. The 1,700, then, I would guess, would be more in the group home as far as dealing with subsidized care. Would that be correct?

Hon. J. MacPhail: Yes.

R. Coleman: And is the B.C. Housing Management Commission handling your proposal calls and allocations in that regard? Are they covered under their budget, or covered under the Ministry of Health's budget -- for the physical housing portion itself, not the subsidy?

Hon. J. MacPhail: The capital allocation is included in my ministry, but the development and delivery of the housing is through B.C. Housing.

R. Coleman: Now, when we deal with this particular form of housing, and we have the capital . . . . The capital is funded by the Ministry of Health. I would assume the subsidy for the residence is through the Ministry of Health, and B.C. Housing is taking care of design criteria and allocations and public proposal calls.

If that is the case, are these particular forms of housing being operated basically by both the ministry and non-profit housing societies? Or are they strictly being operated by the ministry?

Hon. J. MacPhail: There's no one model. The Crown owns the asset. If there needs to be staff assigned, then the region can now either decide to contract that staffing or they can directly employ the staff. And there are also housing society models.

R. Coleman: I'll move away, then, for a second from the ministry directly handled ones and go to the society handled ones. I would ask if the ministry has a long-term lease arrangement with the society -- i.e., 35 years -- with the asset being held by the Provincial Rental Housing Corporation or whether the asset's actually held by the ministry of . . . . I'm talking about the land and the physical base of the property, and whether there's an operating agreement in place and the length of the leases that are in place with regards to the non-profit societies.

Hon. J. MacPhail: Some non-profits that are fairly old own their own assets and provide a service, and we contract

[ Page 3515 ]

for the service. But the newer ones are developed by the B.C. Housing Management Commission, and all of the rules . . . . The Crown owns the asset, and all of the rules and leases that apply to that are determined by the B.C. Housing Management Commission. I'll certainly advise the minister responsible to be prepared to discuss those matters.

R. Coleman: Then I just want a clarification on the assets. I'm sure your staff would be able to answer this.

The asset value, then . . . . And I'll explain where I'm coming from so you understand the question. All assets in social housing, which is delivered through the B.C. Housing Management Commission . . . . All the land ownership is with the Provincial Rental Housing Corporation, and then there's subsequently a lease arrangement back to a society that operates that particular agency. Now, the leases do change, as I understand it, from social housing to Ministry of Health-type housing.

So, first of all, I'd like to request that the minister give me a copy of the standard form of lease that's being used -- back on Health-related housing -- in this particular field. I'd like to know whether the asset on land base is being held at the Provincial Rental Housing Corporation or somewhere else.

Hon. J. MacPhail: The asset is held by the B.C. Housing Management Commission. I can certainly tell the Minister of Housing to be ready to report on that issue. We'll find out where it's booked, but the Crown asset is held through their books.

R. Coleman: Just for the information of the ministry, if it's with the B.C. Housing Management Commission, it will be booked with the Provincial Rental Housing Corporation and listed in their assets. I've already asked for a list of all their assets, so we'll be able to determine from that which ones are group homes and what have you in our discussions in Housing.

The second part of my question is: could I could have a copy of the standard form of lease which is being used by your ministry with the society for those group homes?

Hon. J. MacPhail: Yes, you can.

R. Coleman: Just one other thing. There are always standards and practices that are established whenever housing is dealt with in other jurisdictions of government, and I'm just wondering if it's the same here -- that is, if there's a non-profit operating agreement put in place. That operating agreement outlines the responsibilities of the operating group, whether it be a ministry agency or a non-profit society, and it has certain criteria of audit, certain criteria of performance and certain criteria of qualifications. I'd like to know if similar types of operating agreements are in place here.

Hon. J. MacPhail: Yes, there's a standard purchase-of-service agreement with the society and all of those provisions are contained in it.

R. Coleman: I'd just ask the minister if I could also have a copy of that.

Hon. J. MacPhail: Yes.

J. van Dongen: I just want to continue on with some questions to the minister about the provincial eating disorders program. I've had a quick look at Hansard for yesterday, and I understand that the program is a $6.5 million program, and I assume that it is within the Ministry of Health. I wonder if the minister could just describe in some detail what is included in that part of the program that's in the Ministry of Health. I'm interested in the responsibility of the Ministry of Health and the responsibility of Children and Families in this situation.

Hon. J. MacPhail: The provincial program is delivered through St. Paul's Hospital and Children's Hospital. That's where the $6.5 million is delivered. Of that, there's also $2.7 million being delivered through acute care and mental health services. I outlined that yesterday.

I'm curious. I'm not quite understanding your concern. I need more detail on your concern about how that relates to the Ministry for Children and Families. The $6.5 million is a Ministry of Health program, and it's when one delivers the services in the community, through the mental health services, that there is the interaction with the Ministry for Children and Families.

[4:15]

J. van Dongen: Well, maybe we could go at it this way. Is the biggest part of that $6.5 million in actual treatment which takes place at St. Paul's Hospital and Children's, or is it in structuring a program which is delivered, say, in local hospitals or other facilities? Is the biggest part of the $6.5 million in actual treatment? I guess that's my question.

Hon. J. MacPhail: There are residential programs that are delivered. There's the Vista program, a ten-bed program which is at West 2nd and is operated by St. Paul's Hospital. There is an adult tertiary program for in-patient beds at St. Paul's Hospital. There is the B.C.'s Children's Hospital ambulatory eating disorders program. Then there is the acute care admissions program that exists through hospitals throughout the community. But we can get you a breakdown of the actual dollar allocation amongst the various programs.

J. van Dongen: So on the $2.7 million part of that budget, for example, those are dollars that actually go to the acute care system out of this budget for people who have eating disorders and for treatments for that?

Hon. J. MacPhail: Yes.

J. van Dongen: Does the provincial program prescribe protocols and approaches for the handling of cases, say, for the people in the Ministry for Children and Families who deliver it at the front end?

Hon. J. MacPhail: The provincial steering committee, which I described at length yesterday, is responsible for setting the standards of care and the protocols for delivery of care within the community. So each patient is referred to the provincial program, and the provincial program is run on the standards set by the provincial steering committee for eating disorders. The provincial program determines the best model of care on a patient-by-patient basis and where and how that care should be delivered in the community. But all of it harkens back to the standards set by the provincial steering committee on eating disorders.

J. van Dongen: Is there then a document that sets out those protocols and, as the minister says, standards from the provincial eating disorders committee?

[ Page 3516 ]

Hon. J. MacPhail: Yes, there is a document available that the steering committee has prepared. I know the hon. member has a great deal of interest in this area. I would be more than happy to provide him with a briefing on it and a visit or whatever he wishes. Not to preclude any questions now, but it's actually a well-recognized program, and I would be more than happy to make all of the information available, either through a personal briefing or through documents.

J. van Dongen: I hope the minister appreciates that I'm not trying to put her on the spot. I'm asking the questions for two reasons. One is my personal experience sitting in on two care team meetings, and, particularly in the Werry case, my own personal observations. The other is comments made by Dr. Lask from London, England, about our program, which were not particularly complimentary. The minister is probably aware of those comments. They were reported in the Vancouver Province , I think, last December. So that's really where I'm coming from.

I will accept the minister's invitation for a briefing, but I would still just like to ask a few questions right now. One of them is the issue of who is in charge of the care teams. It seems to me that it's a fairly fundamental question as to what type of person should be responsible and ultimately in charge of the care teams. I'm wondering if the minister is aware of what the provincial program calls for on that issue.

Hon. J. MacPhail: It would be helpful if the member could be a little more specific in his concern, but let me try to see if there is a concern at all.

The way that a patient receives a service from the care team remains unchanged by regionalization of health care -- I've already answered that portion of it. If the member is now raising concern because children's mental health is with the Ministry for Children and Families and adult mental health is with the region, then . . . . I expect he is anticipating a concern, but that is an issue that we're managing. There is coordination taking place; we're certainly working in a cooperative model, both with the Ministry for Children and Families and with the transfer to the regions.

We have not experienced problems yet. Naturally, in any change there is confusion, and that confusion has been straightened out. It's not confusion in the delivery of service to the patient but, as I said, in terms of administration and direction behind the scenes.

J. van Dongen: I want the minister to know that my particular concern does not come from the changeover to Children and Families. I don't think that's particularly the issue here because I think's it's probably all of the same people involved -- formerly in the Ministry of Social Services and now in the Ministry for Children and Families.

I guess I'm concerned about the apparent lack of structure and precedent in the way the care teams operate. I think that you could have a situation where you might have a general practitioner who appears to be chairing the care team; you may have a psychologist; you may have one of the people within the Ministry for Children and Families. They're issues of accountability, issues of performance. That's where I'm coming from. I think this is probably a fairly technical discussion and I will pursue it further in the briefing.

But just a few more questions. The provincial eating disorders committee -- is part of that committee's mandate to in some manner measure the performance of the provincial program? Is that part of their mandate?

Hon. J. MacPhail: Yes.

R. Thorpe: I ask leave to make an introduction.

Leave granted.

R. Thorpe: Visiting us today are Claire Ingles, a teacher from Parkway Elementary School in Penticton, 37 students and also some parent chaperons. Of course, they are from Penticton. It's a great pleasure to have them here. I'd ask all the members in the House right now to make them feel very welcome in Victoria.

J. van Dongen: Following up on the issue of the measurement of performance, is there an annual report done by the provincial eating disorders committee on the performance of the program that will be available to the minister and to ourselves?

Hon. J. MacPhail: No. But it can be part of the briefing that you get the evaluation of it.

J. van Dongen: I just want to ask the minister a few questions about anger management courses and training. I was made aware that there were some anger management courses being delivered through the mental health division of the ministry. I don't know if that's happening in Abbotsford, but it's an area that I'm particularly concerned about. I think that in terms of dealing with the issues of domestic violence, we need to be more focused on preventative programs and on dealing with the root causes of the issue within the perpetrators of domestic violence.

I understand that in some constituencies the anger management courses have been dropped as a cost-saving measure by some of the agencies in local communities. I'm wondering: is this a prescribed area of responsibility within mental health? That's the first question. And secondly, if those courses are being dropped, is the minister going to do something about that? It seems to me that's a fairly critical area.

Hon. J. MacPhail: There have been no cuts in the area of mental health, so any area that's decided . . . . Certainly the ministry hasn't taken any decisions to eliminate anger management programs, so I'm unaware of what the member is talking about. There are standard programs delivered in our mental health service delivery model, and now it will be up to the region to decide the priority of those programs within the system.

J. van Dongen: Just to clarify then, there will be nothing prescribed by Victoria with respect to anger management courses in the regions.

Hon. J. MacPhail: Anger management is a therapy that's offered. It's part of a range of therapies that are offered, and it's up to the health care professionals to determine the need for that therapy and then to provide it.

V. Anderson: I rise to ask follow-ups of the discussion yesterday on Riverview -- I was listening and present -- and also to follow up on my yearly discussion with the minister on Riverview. They were talking yesterday about extra beds in Riverview being open and available. Up until now, closing down and downsizing Riverview was at least the theory. In adding beds, are we indicating -- and I would agree if this is the case -- that the theory has changed and that Riverview will not necessarily be downsized but will be increased and made more permanent?

[4:30]

Hon. J. MacPhail: No, there's been no shift in philosophy, and there won't be until we've completed our review of

[ Page 3517 ]

the ten-year-old mental health plan. But what we did say to Riverview is: "Open up 50 beds that you've been funded for and have not been using." It really was a matter of withdrawal of services that wasn't appropriate, and we've said: "Restore that service."

V. Anderson: I appreciate that, because as the minister knows, there's certainly a great need in the community for those services to be available. What integration process is there in place to relate the needs of the community to the needs that Riverview can respond to? At this point, for the communities across the province, what is the process for making sure those beds are used if they're now available? How are people referred, and what is happening as a result of that?

Hon. J. MacPhail: There is a provincial mental health advisory committee council. It has a family advisory council portion to it and a consumer advisory council portion to it. I would be pleased to make available the outline of the council. That feeds into the provincial mental health advisory council, which makes recommendations and advises me on the relationship between provincial tertiary care and community care.

V. Anderson: When we were discussing the issues a year ago -- last August, in fact -- the minister indicated that she would be visiting Riverview soon to meet with them. Did she have an opportunity to meet with members of the patients' empowerment committee and discuss some of the issues that we raised at that time?

Hon. J. MacPhail: No, I actually haven't met with that committee since I've become Minister of Health. I think my last meeting with them was just prior to finishing my responsibilities as Minister of Social Services.

V. Anderson: I think the minister and I had the previous discussion under Social Services, and she referred me at that time to Health. Last year we discovered it was Health and therefore under her mandate. Might I ask if anything has been done about the clothing subsidy that we've discussed for the last two or three years? Have changes been made or has there been any improvement for the clothing of the people while they are at Riverview?

Hon. J. MacPhail: I reported in my last estimates on a resolution to the provision of clothing for patients of Riverview. Since then, there's been no change. I understand that the resolution is meeting the needs of the patients.

V. Anderson: If the minister reported that, it wasn't at the time that I was having discussions with her. I have the Hansard before me, and I see no resolution of that. The minister indicated at that time that she would be referring back and looking at that. So if there was a resolution, I'd appreciate it very much if she's able to let me know about that at some time.

Also, the other issue she was going to be discussing with them further was the issue of bus passes. There was a temporary resolution at that time, so that people in Riverview would be able to get out and do some visiting and one thing and another. I'm wondering what has happened in that regard.

Hon. J. MacPhail: I think the resolution that started out as temporary proved to be satisfactory and is now the permanent resolution for the provision of bus passes. But I can either confirm that directly or else . . . . The Ministry of Finance is responsible for the bus passes, but I believe we were looking at the solution as temporary only until it was reviewed to see whether it met the needs of the patients. My understanding is that it did and therefore became the permanent solution.

V. Anderson: I'd appreciate receiving information on that too, if the minister's able to do that.

Another concern we had was that when persons were leaving Riverview after they had been there for some time, there was not a good process in place for helping them to move back out into the community. They didn't necessarily have the documentation they needed -- their birth certificates and the other identification items. I know the minister was going to look into that service to see if something more effective could be done to help them with their identification papers and the other items that they would need as they move back into the community. Has that been rectified?

Hon. J. MacPhail: The issue of proper discharge planning is one that is affected by the review board process -- if there's an early and unexpected discharge of patients from Riverview because the review board has discharged them. There is certainly a proper discharge planning procedure in place for people who are scheduled to be discharged. But you're right: the issue is still of concern to people who are quickly and unexpectedly discharged as a result of the review board. Frankly, we continue to work on that problem.

V. Anderson: I will take the minister's word that it was only the unexpected ones that this wasn't arranged for. But the information we were receiving was that it went far beyond that and that it should be in place for persons on a more regular basis. When people are discharged into the community at this point, we hear a great deal of concern about people who seem to get lost in the downtown area or other places where they move to. What follow-up is done with those persons in the first month or two or whatever to make sure that they're out and established in the community?

Hon. J. MacPhail: The patients are followed through a care plan that's part of their discharge plan. Most often that care plan assigns them to a mental health team for care and follow-up.

V. Anderson: When they're assigned to a mental health team for care and follow-up, is there a report back to Riverview, to the hospital itself, as to what's happened to them? Is there a follow-through and a kind of carryover? Some of those would also come back in. What is the relationship?

Hon. J. MacPhail: The discharge plan and the care plan are part of the patient's record -- file, for lack of a better term. So there's no reporting back to Riverview Hospital, but there is reporting on the file and recordkeeping of the patient's development. If indeed the patient has to return to Riverview, that file goes with her.

V. Anderson: I'm following up in part from a letter of June 8, 1995, that I received from the minister when she was the Minister of Social Services. I had been asking about the integrated care team between the Ministries of Health and Social Services. It had to do particularly with the discharge of patients. If I can quote for a moment: "Whereas I understand that the committee has not yet dealt with the specific issue of integrating patients' services upon departure from Riverview

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Hospital, I have instructed the committee chair to place this item on the agenda for the next meeting." It was a follow-up of what happened as a result of that meeting between Social Services and Health on an integrated plan for discharge that I was asking about, in part, at this point. Could the minister explain what happened as a result of the joint integrated committee working on this plan?

Hon. J. MacPhail: The discharge project at Riverview Hospital, which was an integrated team, was put in place. That project focused mainly on people being discharged within the lower mainland, particularly in the downtown east side, where the most vulnerable seemed to end up. That project resulted in a great measure of success so that there is now in place a permanent bridging team -- it's called the bridging team -- which bridges the life of a person going from Riverview into the community. That's a permanent service now.

V. Anderson: In 1984 we had the review of Riverview Hospital, and I know that over a period of time these recommendations, which were part of that plan, were being fulfilled. I don't intend to go over them one by one, but at this point is there a report available as to what has been accomplished as a result of those recommendations? If so, would that be available so that we could get a copy of it?

Hon. J. MacPhail: The member refers to the 1994 report? Yes.

The remaining outstanding issue of recommendations that have not been met yet is the appointment of a provincial mental health advocate. I'm on record -- yesterday and today -- saying that as we review and, I expect, update our provincial mental health plan from 1987 . . . . As we move forward and our health plan is clear, I will be appointing a mental health advocate at the conclusion of that -- I expect by this autumn.

No, there is no written response to the report on a collected basis, but there are individual responses as we move forward. As I say, the outstanding issue is the appointment of a provincial mental health advocate.

V. Anderson: There are some 100 recommendations of one kind or another in that report. Without having to go over them one by one, it would be interesting to know how many of these have been implemented and which ones were not implemented, for whatever reason. As time has gone on and as they looked at this, I would assume that there may have been reasons why certain ones should not be implemented, and perhaps they were substituted by something else. So that's why I'm trying to get a follow-up.

A lot of time and effort went into the report and doing the recommendations, and it would seem logical to me that there should be a follow-up, even in point form, as to what happened -- which were implemented, which weren't, which were changed, what was substituted for them and which may still be outstanding.

Hon. J. MacPhail: Yes, I can make that information available to you.

V. Anderson: Thank you very much.

[4:45]

S. Hawkins: I recall a member -- I believe it was the member for Chilliwack -- addressing some of the needs of the homeless. Does the ministry track how many homeless people there are? Do they have any idea how many people there are? The member was saying that he noticed over the last few years, there have been more and more. I recall taking a flight last summer, and there was a visitor from Australia sitting beside me. She was quite shocked, and she was wondering if we actually had programs for these people in our province.

She had visited a couple of years ago, and she found even in the scope of a couple of years that they had increased, especially in Vancouver. I wonder if the ministry tracks how many and what kinds of health programs they have in place for these people.

Hon. J. MacPhail: I appreciate the question. To track a homeless person is a very difficult thing to do. We actually attempted to do it in preparation for the last provincial election by permitting people to have a very temporary address in order to register to vote for the very first time. The ones who registered with temporary addresses are statistically available through Elections B.C. But there is no other way of tracking homeless people, by virtue of the fact that they have no permanent record.

We do offer a range of services to the homeless: social services, mental health services and health services, including mobile clinics, shelters, temporary residential care and mental health teams. In my own community there are health care workers that work on the street 24 hours, around the clock.

S. Hawkins: The number that was given to me was 20,000 homeless in B.C., and I don't know if the ministry has any indication of how many. If you have mental health teams and other programs that work with them, is there a certain amount budgeted in the ministry targeted for this group?

Hon. J. MacPhail: Not specifically at homeless, but at people who you have to access through the street, is a way of describing it. Frankly,