Medicare system rife with discrimination
The biggest surprise in the Ontario Human Rights Commission’s all-encompassing report on mental health is how deeply embedded discrimination against people with mental disabilities is in the health-care system.
Doctors, nurses and paramedics — who ought to know mental illness is a disease, not a moral weakness — withhold treatment from people who need medical help, ridicule individuals in distress, prejudge and label them.
Hospitals — which ought to be a refuge from discrimination — are as unenlightened as society at large.
Listen to a few of the 1,500 participants who told their stories at the commission’s province-wide consultations, round tables and focus groups:
“After surgery, my surgeon told me, ‘had I known you were crazy, I wouldn’t have operated on you.’ ”
“I worked in emergency services. At lunch they (paramedics) would talk about having to go pick up another ‘crazy’ or ‘junkie’ — and these are the people on the front line.”
“Every attempt to question, understand or challenge a diagnosis I felt was woefully inaccurate was met by a smug smile and a dismissal. I have never felt so hopeless, helpless and suicidal.”
Some of the most disturbing examples didn’t even make it into the report. Anya Kater, a senior policy analyst, pulled this out of the files for the release of the report: “One person who experienced abdominal pain was left in the hospital for 10 hours alone before it was realized urgent surgery was needed.” The reason: the patient, a recovering addict, was on methadone treatment.
The commission heard from people with mental diseases who were denied treatment on the presumption they were angling for drugs; turned away by doctors who didn’t want time-consuming patients; and pigeonholed by psychiatrists who knew nothing about them.
Health care was not the sole focus of the report. It dealt with employment, housing, municipal bylaws, provincial laws and public attitudes. But what jumped out of the text was the lack of compassion by society’s healers. It was so counterintuitive, so hurtful.
Discrimination against persons with mental disabilities contravenes the Ontario Human Rights Code, the Canada Human Rights Act and the United Nations Convention on the Rights of Persons with Disabilities. Yet health-care workers disregard the rights of the mentally ill with apparent impunity. There is a limited amount an advisory agency can do. But human rights commissioner Barbara Hall intends to use every lever she has to root out this pernicious form of discrimination.
She is calling on the Ontario government to review its laws, policies and standards and correct those that fail to provide equity for individuals with mental disabilities.
She is urging the province’s medical schools, the College of Physicians and Surgeons of Ontario and the Ontario Medical Association to train students and practising doctors about their obligations under the Human Rights Code not to deny service to people with psychiatric problems.
She is asking Ontario’s accessibility directorate which develops and implements the standards to make the province barrier-free to Ontarians with disabilities, to evaluate its guidelines to ensure they take the needs of people with mental disabilities into account.
She is vowing to intervene in court challenges if the commission believes a doctor is denying service to would-be patients with mental disabilities; to hold public inquiries and to initiate cases before the Human Right Tribunal of Ontario.
And she is advising police to follow the guidelines on disclosure of sensitive medical information published by the human rights commission four years ago. Many forces continue to provide employers, sports organizations, child-care agencies and retirement homes with details about long-resolved mental health problems (nervous breakdowns, eating disorders, suicide attempts) that have no bearing on public safety
Worthy as these recommendations are, stronger medicine is needed. Health Minister Deb Matthews has to lay down the law: Any health-care worker found violating the rights of Ontarians with mental disabilities will be disciplined. Any institution that allows such behaviour will be penalized.
That won’t happen without public pressure. And the human rights commission’s turgid report isn’t likely to galvanize anyone.
If Hall wants change, she should start by hiring a writer who can turn her agency’s tome into a compelling document that opens people’s eyes and makes them care. Then she should follow up by telling Ontarians what they can do to foment change.
The government needs a jolt of public anger. Medicare needs better guardians. Carol Goar’s and Friday.
column appears Monday, Wednesday