From the people and organizations it has met with thus far, the OHRC has heard that numerous issues intersect with one another, posing considerable human rights concerns for people with mental health disabilities and addictions. Participants described a “domino effect”, whereby barriers in one area (such as education or employment), lead to barriers in other areas (such as housing). All of these barriers contribute to experiences of poverty. These issues are compounded for individuals who may already experience discrimination because of their race, sex, sexual orientation, citizenship, disability status, gender identity, age, ethnic origin, or because they are receiving social assistance.
Areas of concern identified by participants included the following:
- Lack of awareness about rights
The OHRC heard that many people are unaware of their right to be free from discrimination in housing, employment, and services based on a mental health disability or addiction. Participants also noted that there is a generalized lack of understanding on the part of employers, service providers, housing providers and the public regarding the duty to accommodate. Many people are also unaware of their rights to consent or refuse treatment when they are institutionalized in a mental health facility.
- Stigma and discrimination
Participants shared that people are afraid of identifying as having a mental health disability because of the stigma associated with it. Participants identified that the OHRC should focus not only on negative attitudes resulting from stigma, but also on discriminatory acts. Stigma and discrimination were seen as creating profound barriers in many social areas, such as housing, employment and education. The OHRC also heard that anti-stigma campaigns should be done in partnership with or by people with mental health disabilities.
- Lack of access to appropriate health care
The OHRC heard that the lack of adequate mental health care services across Ontario is a major concern. Participants also noted that people with mental health disabilities are refused service by GPs and psychiatrists at a high rate. In addition to lack of health care services generally, participants talked about homophobia and racism that exist in general health care and mental health institutions and the lack of “culturally competent” care. The OHRC also heard that children and youth are not being diagnosed or treated early enough and lack timely access to appropriate services.
- Income support
As noted above, many participants spoke of the intersection between poverty, mental illness and addictions. Many identified income support (the Ontario Disability Support Program or ODSP) as creating a major barrier for people with mental health disabilities. They identified that ODSP levels are set below the poverty level, and that people with addictions still face restrictions when applying for ODSP. The OHRC also heard that the application process for ODSP is onerous for people with mental health disabilities. ODSP was also criticized for keeping people in non-employment situations by clawing back extra earned income. Some participants noted that ODSP does not provide people with enough transportation money for people to get to their medical appointments.
Participants noted that barriers to employment include employers that rely on stereotypes when hiring and firing, and lack awareness of the duty to accommodate people with mental health disabilities and addictions. In addition, the OHRC heard that individuals with mental health disabilities do not have proper educational opportunities to obtain employment without subsidies or job training, which is also limited. Return-to-work processes were also described by some participants as onerous and restrictive.
Participants echoed what the OHRC heard in its housing consultation: people with mental health disabilities often lack access to adequate, affordable supportive housing and people tend to face discrimination in rental housing at very high rates. Municipal practices and zoning by-laws were also seen as a problem in that they can prevent the development of affordable housing for people with mental health disabilities.
- Consent and Capacity Issues
Some participants raised concerns about people’s ability to know their rights to consent and refuse treatment and assert these rights in mental health institutions or before the Consent and Capacity Board. Some participants identified practices undertaken by the Consent and Capacity Board, and under the Mental Health Act and Personal Health Information Protection Act, as potentially raising human rights concerns. Concerns were also raised about older people’s access to consent and capacity rights in the long-term care system. Others identified concerns with respect to substitute decision-makers or legal guardians assisting people in presenting their cases before the Human Rights Tribunal of Ontario and other administrative tribunals. Participants were divided about whether or not the OHRC should become involved in this overall area.
- Criminal justice system
Many interviewees noted the link between the lack of mental health services and involvement in the criminal justice system. They noted concerns about arrests and detention for behaviour associated with disability that resulted from involvement in less serious crimes. In addition, participants were concerned about the use of tasers on people with mental health issues, and their lack of access to appropriate medical treatment in prisons. People with mental health disabilities are more likely to be in conflict with the criminal justice system and receive criminal records. This can have a major impact on their ability to access housing, employment and volunteer opportunities.
Among the issues that were raised with the OHRC regarding education was the concern that elementary and secondary schools did not have the resources to deal with students with mental health disabilities, resulting in young people falling through the cracks. Some participants identified the prevalence of discriminatory attitudes in classrooms. Others indicated that post-secondary institutions and business schools are not sufficiently accommodating students with mental health disabilities.
- Additional issues
The OHRC also heard about barriers to transportation, such that people are sometimes barred from using transit because of perceived mental health disabilities. Strong concerns were raised about Aboriginal children and youth, who are frequently at high risk for suicide. A very specific concern raised was that people with mental health disabilities are often deemed ineligible for mortgages or insurance because they are perceived to be at high risk for default.