CITY CLERK. Provincial Announcement Regarding Ontario Works Drug Treatment Consultation Plan

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1 CITY CLERK Clause embodied in Report No. 1 of the, as adopted by the Council of the City of Toronto at its meeting held on January 30, 31 and February 1, Provincial Announcement Regarding Ontario Works Drug Treatment Consultation Plan (City Council at its meeting held on January 30, 31 and February 1, 2001, adopted this Clause, without amendment.) The recommends: (1) the adoption of the following report (December 13, 2000) from the Commissioner of Community and Neighbourhood Services; (2) that the City of Toronto support the following principles regarding the proposed Ontario Works Drug Treatment Consultation Plan, and request that the Province of Ontario ensure that: (a) (b) (c) individuals who use drugs have the same access to welfare benefits as other residents, irrespective of whether they need or receive treatment; substance abuse treatment is available to social assistance recipients and other socially disadvantaged individuals; and the need for treatment is determined through clinical assessments and a strategy for treatment agreed upon jointly by the client and case manager; (3) that the Province of Ontario be advised, in the strongest possible terms, that any proposal regarding mandatory drug treatment for social assistance recipients: - cannot be implemented at current service levels; - will not reach the majority of Ontario Works recipients experiencing substance abuse problems; - is unlikely to address the principal barriers to self-sufficiency even for the client group it is meant to reach; - singles out and stigmatizes a very vulnerable group in society and is likely to deepen the difficulties they face achieving self-sufficiency; and

2 2 - will have an adverse effect on the quality of life in the City of Toronto by increasing homelessness and deepening the desperation of some of the City's most vulnerable residents; (4) that, if the Provincial Government moves forward with any proposal that would make drug testing and treatment mandatory in order to receive social assistance, the Chair of the and any interested Councillors form a delegation, together with agencies that provide addiction services, and other service providers serving the same client base, to present Council's position as strongly as possible; (5) that the Commissioner of Community and Neighbourhood Services be requested to provide the delegation, referred to in the foregoing Recommendation No. (4), with information, if necessary, regarding: - the cost of providing the addiction services at the level that would be required to comply with the proposed change in legislation; - the availability of services for women who may need treatment, but may require child care and other supports to be able to access the service; - the availability of services in appropriate locations and/or the impact of added cost of transportation services on Ontario Works recipients; - the probable impact on children if mothers with substance abuse problems are removed from Ontario Works; - the probable impact on City services resulting from increased migration of Ontario Works recipients from communities which lack addiction services to communities such as Toronto with a relatively high number of addiction services; and - the probable impact on City services resulting from an influx of people with substance abuse problems who are removed from Ontario Works and become homeless in communities with few services for homeless people; (6) that, in light of the recent statement by the Minister of Community and Social Services that the Province is continuing to study various implementation strategies to assist social assistance recipients with overcoming drug addictions, the Commissioner of Community and Neighbourhood Services, in consultation with the Medical Officer of Health, be requested to prepare a report providing a brief analysis of: - drug awareness and prevention programs in Toronto; - an assessment of their effectiveness; and

3 3 - recommendations to be forwarded to the Province to contribute and assist in any efforts to create more effective programs to encourage social assistance and others to seek treatment and overcome drug addictions; and (7) that, if the legislation that would make drug testing and treatment mandatory in order to receive social assistance is passed by the Province of Ontario, the City Solicitor be requested to prepare a legal report on the matter to the Community Services Committee, such report to include ways and means that the City could proceed with legal and Human Rights challenges: Purpose: This report reviews the Province s recent announcement regarding the government s consultation plan for Mandatory Drug Treatment for social assistance recipients. Subsequently, a number of key issues and concerns related to the information contained in the Provincial announcements are identified and discussed. Financial Implications and Impact Statement: There are no financial implications in the year resulting from the adoption of this report. Recommendations: It is recommended that: (1) this report, and the issues identified therein, be forwarded to the Ministry of Community and Social Services for their consideration; (2) Community and Neighbourhood Services staff participate in the Ministry s consultation process related to mandatory drug treatment, and communicate key issues and concerns to Ministry staff; (3) on the release of the Province s policy on mandatory drug treatment, the Commissioner of Community and Neighbourhood Services report back to the Community Services Committee; and (4) the appropriate City officials be authorized and directed to take the necessary action to give effect hereto. Background: On November 14, 2000, Community and Social Services Minister John Baird announced the government s consultation plan for Mandatory Drug Treatment for social assistance recipients. As the Minister noted, in its election Blueprint document, the government committed to helping people with an addiction get off welfare and get back on their feet. According to the Minister, consultations are to be held with a wide range of groups prior to the end of December The Ministry of Community and Social Service s (MCSS) November 14

4 4 News Release contains further details concerning who will be consulted, as well as the issues that will be discussed (see Attachment 1). While there is no formal public consultation process, as part of the Drug Treatment Consultation Plan, Ministry staff are continuing to meet with a range of individuals and organizations. Community and Neighbourhood Services staff have attended Ministry presentations and feedback sessions held with broader umbrella organizations (e.g., the Ontario Municipal Social Services Association). The Minister has indicated that the government expects to come forward with a mandatory drug treatment policy in the new year. At this time, no details are available. For that reason, it is not possible to comment directly on the Province s specific policy proposals. However, the Department recognizes that the Provincial approach and focus raises a number of very important issues related to the delivery of Ontario Works in Toronto. Among these are the implications of the proposed approach for social assistance recipients. This report briefly highlights the Department s major issues related to the Province s November 14 announcement. It also notes the concerns that are being voiced by other organizations and groups in the City. The Department strongly believes that it is essential that the Province take these issues into consideration prior to proceeding with its drug treatment policies. Discussion: In proceeding with its mandatory drug treatment policy, the Government s aim, as the Minister has noted on many different occasions, is to remove barriers to employment and help those in trouble beat the odds. In its consultation and press materials, the Ministry has acknowledged that addiction is a complex social and medical issue, and that drug addiction is often only one of a number of significant barriers to employment that individuals receiving OW may face. Consistent with the mandatory nature of the approach being proposed, sanctions will be put in place such that individuals who refuse treatment or won t take tests on request will be ineligible for a welfare cheque. The Ministry is initially focusing exclusively on drug addiction, although there is a commitment to expand the approach to include alcohol and prescription drugs in the future. The following comments reflect a number of issues and concerns the Department has relating to the information provided by the Ministry to date. Four separate but related areas are addressed: (1) the Ministry s exclusive focus on drug addiction; (2) adequacy of treatment resources in local communities and the availability of supports required to assist clients participate in treatment programs; (3) the degree to which OW financial benefits can support clients efforts to successfully overcome severe employment barriers; and (4) the potential implications of the approach to sanctions favoured by the Ministry. Each of these issues is briefly discussed below. Finally, concerns noted by other sectors and organizations are also noted.

5 5 Provincial Focus: The Ministry s approach assumes that drug addiction poses a powerful barrier to employment for OW clients, and mandatory drug treatment is a preferred response. The Department agrees that drug addiction can be a substantial barrier to employment for some clients. However, based on its long experience delivering social assistance programs in a large city, and daily interactions with clients, the Department s perspective is that vulnerable clients are likely to face multiple medical and social issues that may involve drug or alcohol abuse, or both. In fact, in terms of constituting a barrier to employment, alcohol and prescription drugs are at least as problematic as illegal drugs, and likely for a larger group of clients. It is also evident that addiction is often intertwined with other serious issues, such as mental illness. In this context, the Ministry s exclusive focus on drug addiction seems narrow. It concentrates on a minority of vulnerable clients, and by doing so potentially isolates and negatively stereotypes this group. Consistent with the Ministry s larger aim, which is to assist clients with severe barriers to obtain work, the Department would support a broader focus that recognized the need to help clients with a range of addictions or other serious health related issues. The Department is also concerned about the dominant emphasis on treatment. For many clients with multiple barriers, treatment is only one step, albeit an important one, in the path to employability. Overemphasizing drug treatment could in fact be counterproductive if other barriers are not addressed. Therefore, recognition of the need for resources and supports to help people with other barriers must be part of a successful approach to assisting vulnerable OW clients find and keep jobs. Adequacy of Treatment Services and Client Supports: The effectiveness of any treatment program, and particularly a mandatory program, will depend on the capacity of the treatment system within local communities. The Department is aware of, and echoes, concerns voiced by those in other sectors, including the drug treatment community, about the degree to which treatment services are now adequately resourced. To achieve its ambitious aims, it is critical that the Province ensures appropriate treatment programs are available and accessible prior to the enactment of policies that would compel mandatory participation. The recent experiences with long term care reform and hospital restructuring illustrate the potential risks to communities and individuals when policy directions are not synchronized with decisions that ensure appropriate levels of resources are available, and service capacity is increased in a timely manner. Given the Department s concerns that a broader approach is required which extends beyond drug addiction, it will also be necessary to strengthen other areas, notably alcohol treatment programs and mental health services. OW clients who need treatment, or who will be mandated to seek it, must be able to access essential supports, such as affordable quality childcare, or funds for transportation or other treatment related costs. As the Department has noted in previous reports to City Council, there are insufficient childcare spaces in Toronto s subsidized system to accommodate current

6 6 demands by OW clients who are participating in employment related activities or who are working. Without additional resources, any spaces provided to clients who must seek treatment will place additional pressures on the existing system, and potentially penalize other OW clients. Overall, this speaks to the benefits of gradually phasing in any treatment related policy, and to the advantages of an implementation plan that favours pilot sites, and that makes it possible to evaluate the feasibility and efficacy of alternative approaches in different communities. OW Benefit Rates: Current OW benefit rates do not recognize any additional stresses or needs that may be faced by clients with severe barriers, including drug or alcohol addiction. Moreover, there is increasing evidence that existing benefit levels may themselves be a source of stress for clients, particularly in Toronto. This is due in large part to the widely acknowledged shortage of affordable housing, and the escalating costs of available rental units. After paying their shelter costs, many OW clients have limited resources to cover other basic needs. This vulnerable client group often faces substantial difficulties maintaining stable living arrangements, and meeting other basic needs. Yet stability is a critical element in assisting clients during treatment, and after. The Ministry acknowledges the extreme circumstances that often face clients who require treatment for addictions. The Department is concerned, therefore, that there be a recognition that additional financial supports may be required to enable clients to successfully take part in and complete treatment programs, and subsequently address other barriers as they seek employment. In addition, while there has been significant discussion of the role of sanctions, in a mandatory program it would also be appropriate to objectively assess whether certain incentives might enhance the success of Provincial policy initiatives by recognizing the unique challenges facing clients with severe employment barriers. The Role of Sanctions: As noted previously, the Ministry has indicated that individuals who refuse treatment or refuse drug testing will be made ineligible. The specific way such sanctions will work is not yet known. Neither have sanctions been discussed as part of the Ministry s consultation process. Depending on the approach that is implemented, there may be adverse effects on social assistance clients. Denying access to OW, which is the income support program of last resort in the Canadian social welfare system, has serious repercussions for people in need, particularly those who may be among the most vulnerable groups in society. Those denied assistance will have few choices, and may simply face graver personal and health risks, including homelessness, and be further marginalized. These are not desirable outcomes. In the longer term, they will only increase the level of investment required to help people get back on their feet and find employment. As noted above, the Department is also concerned that current treatment capacity in local communities may not be sufficient, and that there are insufficient supports in the OW program to facilitate clients participation under a mandatory approach to drug treatment.

7 7 For these reasons, the Department believes that a policy on sanctions should not be enacted until such time as these issues are adequately addressed. Other Perspectives: The Provincial announcement on mandatory drug treatment has elicited valuable comments and perspectives from a wide range of sectors and groups. For example, concerns have been voiced about the further stigmatization of all social assistance clients as a result of linking drug addiction and receipt of social assistance benefits. Many organizations, community groups and advocates have also identified important legal and human rights issues. Critical policy issues, such as the efficacy of mandatory approaches to addiction treatment, have also been discussed. In fact, it should be noted that a number of groups have already indicated they wish to appear before the to address these and other important issues (see Attachment No. 2). The Department will report back to Committee upon the Province s release of more detailed policy statements related to mandatory drug treatment, and will further examine the issues and concerns identified in this report as appropriate. Conclusion: This report has identified a number of key issues related to the Province s November 14 announcement on mandatory drug treatment for social assistance recipients. In light of these issues, it is essential that the Province, as part of its consultation process, carefully consider the potential impacts of policies aimed at addressing barriers to employment that involve complex medical and social issues, notably drug and alcohol addiction, and that affect vulnerable individuals. The Department would also urge the Province to proceed cautiously so as to ensure people are productively assisted rather than penalized by its specific policies. This is particularly the case given the need to make sure that communities have adequate treatment services, and sufficient capacity to provide appropriate treatment to OW clients who need it in a timely manner. Contact: Heather MacVicar General Manager, Social Services Division Tel: /Fax: hmacvic@city.toronto.on.ca Attachment No. 1: Attachment No. 2: Provincial Announcement on Mandatory Drug Treatment Requests to Depute (A copy of each of Attachments Nos. 1 and 2 referred to in the foregoing report was forwarded to all Members of Council with the agenda of the for its meeting on January 11, 2001, and a copy thereof is on file in the office of the City Clerk.)

8 8 The submits the following communication (January 10, 2001) from Councillor Brad Duguid, Chair of the Community Services Committee: Enclosed please find a Globe and Mail article indicating that the Province will be scaling back plans to test social assistance recipients for drug use. It also appears that the perceived intention of the Province to make drug treatment a condition of receiving social assistance is being reconsidered. While clarification is currently being sought from Minister Baird s office, it would appear that the Province has heeded our and others concerns. It also appears that they plan to continue working towards developing a much-needed plan of action that would enhance treatment programs for drug addiction, and encourage those on social assistance to utilize these programs. This presents an opportunity for the City of Toronto to engage in discussions with the Province on the most effective way to achieve that goal. As such, I will be moving a motion to request the Commissioner of Community and Neighbourhood Services, in consultation with the Medical Officer of Health, to prepare potential recommendations to the Province on this matter. I trust this will meet with Committee approval. The reports, for the information of Council, also having had before it during consideration of the foregoing matter a communication (January 10, 2001) from Dr. Patrick Smith, Ph.D., Vice-President, Clinical Programs, Centre for Addiction and Mental Health, attaching a copy of its position statement on mandatory drug testing and treatment of welfare recipients. The following persons appeared before the in connection with the foregoing matter: - Mr. Andy Mitchell, Community Social Planning Council of Toronto, and submitted a brief in regard thereto; - Mr. Matthew Perry, HIV/AIDS Legal Clinic, on behalf of the Toronto Community Legal Clinics/Social Assistance Action Committee, and submitted a brief in regard thereto; - Ms. Judith Keene, on behalf of the Steering Committee on Social Assistance; and - Councillor Pam McConnell, Toronto Centre-Rosedale, and submitted recommendations with respect to the issue of mandatory drug testing and treatment of social assistance recipients.