Many people with mental health issues or addictions told us they were largely unaware of the right to be free from discrimination based on a psychiatric disability or addiction in housing, employment and when receiving services. At the same time, it appears that organizations also lack awareness of their responsibilities under the Code. Even where people were aware of their rights, many reported experiencing great difficulty enforcing these rights, whether pursuing complaints through the organization they were concerned about, the human rights system, or other decision-making bodies, such as administrative tribunals or the Courts.[179] We heard that ways to enforce rights were critical to correcting and preventing human rights violations that people experience. However, many people were not aware that there was a human rights system they could use to challenge discrimination.
We heard that people were often prevented from accessing complaint systems because of symptoms related to their disabilities, and they felt overwhelmed with managing their day-to-day lives, particularly due to factors related to poverty. The OASW told us that, “individuals with mental illness who have a largely transient lifestyle are likely more prone to experiences of discrimination and may have a reduced ability to seek redress through formal systems, due to lack of an address and phone number for follow-ups and continually changing life circumstances.”
We also heard how the requirements to make a complaint (such as application forms) are often complex or intimidating and are designed without considering the needs of people with psychosocial disabilities. For example, we heard that requiring extensive evidence to prepare for a hearing at an administrative tribunal may a barrier for people who have memory difficulties due to post-traumatic stress disorder.
Knowing your human rights does not mean you’re going to pursue them. The issue is not of awareness; the accessibility of voicing concerns and [raising] issues of human rights is not available. The issue is of accessibility, and reaching out of the human rights system to the people suffering discrimination. – Focus group participant
ARCH stated that administrative tribunals must have appropriate and fair processes for people who have been found to be incapable of making specific decisions. It said that when a person is believed to be incapable, tribunals may search for a “quick fix”: a substitute decision-maker, or someone who can make decisions on the complainant’s behalf. This approach may be invasive. It can extend beyond the tribunal’s process, and it may not respond appropriately to the person’s individual decision-making abilities. ARCH advises that instead, tribunals should consider using a continuum of flexible approaches that respond by first accommodating someone’s decision-making abilities. For unrepresented complainants, for example, it suggests appointing a friend of the court, or amicus curiae, to maximize respect for the person’s choices and provide the tribunal with the information it needs to evaluate the claim.[180]
Because of these concerns, a large number of consultees asked the OHRC to provide human rights education to people with psychosocial disabilities, housing providers, employers, service providers, the general public, and decision-makers such as administrative tribunals. The OASW recommended increased access to Ombudsman services to enhance individuals’ abilities to complain about services, particularly for people with transient lives.
Box: Several administrative tribunals across Ontario have conducted training on how to accommodate the needs of people with mental health disabilities and addictions during the tribunal process. Training has also been done by the OHRC. For more information, see the Society of Ontario Adjudicators and Regulators (SOAR) website at www.soar.on.ca/events/index.php. End Box.
Recommendations:
52. The Society of Ontario Adjudicators and Regulators (SOAR) and SOAR Administrative and Management Network (SAMN) should continue to ensure that new and existing adjudicators and staff receive training on the Code, including how to accommodate people with mental health issues or addictions during the tribunal process.
53. Administrative tribunals and other complaint-handling and decision-making bodies should examine their policies and procedures to identify and eliminate any barriers that prevent people with mental health issues or addictions from accessing these services. As part of this process, decision-makers should use approaches that maximize participation and accommodate the needs of people who may experience difficulties with decision-making capacity.
OHRC commitment:
C26. The OHRC will continue to work with administrative tribunals in Ontario to provide training on human rights, including the duty to accommodate, where these relate to serving people with psychiatric disabilities and addictions, as well as other Code-protected groups.
When I went to my doctor he didn’t have a clue. His first reaction was, “Well, I’m a doctor and I know what I’m doing.” Not everyone has the ability to say to the doctor, “Look it up.” You need an advocate; people with mental health problems need an advocate.
– Participant in North Bay roundtable session
A significant number of consultation participants said they had great difficulty accessing rental housing, psychiatric hospitals, ODSP, insurance benefits, administrative tribunals and other services equitably without the help of someone advocating on their behalf, particularly when they were not well. Many people also identified the need for human support, advocates and advocacy to help them navigate systems, increase their and others’ awareness of their rights, avoid discrimination and make complaints.
Advocacy can be seen as an important form of human support and a method of accommodating people’s needs. At the same time, the widespread call for advocates points to the need for organizations and services to design and deliver their services inclusively without discrimination and to remove barriers that prevent people from acting on their own behalf (see section 13.2. for more information on inclusive design of services).
I find it frustrating on behalf of the clients that they can’t get services on their own. The client is willing and they try and then get shut down; their calls will not be returned. I pick up the phone and I get someone and it is easily done. My clients are relieved but frustrated. Why does it have to take another person to get through? My client loses their independence; the client should not have to go through hoops and barriers.
– Participant in North Bay roundtable session
Advocacy roles may be played by many different individuals in different settings. For example, peer support workers were seen as one positive form of advocacy. In psychiatric hospitals, advocacy on behalf of individuals and people with psychiatric disabilities as a group is carried out by patient and family councils and the Psychiatric Patient Advocate Office (PPAO), which also has a legislated mandate to provide rights advice to patients.
Consultees pointed out how socio-economic status can affect people’s access to services. They told us that people with higher incomes are more able to access services than people with low incomes, because people with higher incomes are more likely to have someone to assist them.
Consumer/survivor groups and other organizations have emphasized the importance of independent advocacy for consumer/survivors who may find it very difficult to complain, particularly with barriers in place that may worsen real or perceived differences in power between service providers and service users. The Ontario Association of Social Workers and others told us that people face considerable risk of losing services, housing or employment as a result of making a complaint of discrimination, particularly if they depend on these systems to access basic health needs. This may make it particularly difficult to complain when different resources are directly linked to each other; for example, where a landlord also provides support services for someone with a mental health issue in a supportive housing environment.[181]
Some people took different approaches to the concepts of advocacy and self-help. For example, we heard that people’s capacity to self-advocate should be supported. As stated previously, working with people’s advocates does not remove an organization’s obligations to design inclusively, remove barriers, or measure and eliminate systemic discrimination.
Recommendation:
54. The Government of Ontario and organizations addressing the needs of people with mental health issues or addictions should actively support and work with mental health advocacy services that assist people to realize their rights within housing, services and mental health hospitals. The independence of advocacy services should be considered as one factor in ensuring that people are able to assert their rights without concerns about conflict of interest. Organizations training advocates should provide training on human rights, including people’s rights under the Code.
[179] Where justice issues relate to a mental health issue or addiction, people may be likely to use administrative tribunals such as the Social Benefits Tribunal, the Consent and Capacity Board, the Landlord and Tenant Board, the HRTO, and the OMB. These tribunals have the ability to and should apply the Code in cases that raise human rights issues; Tranchemontagne v. Director (Disability Support Program), [2006] 1 S.C.R. 513 at paras. 23 – 24; this is because the Code is fundamental, quasi-constitutional law. It must not only be given expansive meaning, but also offered accessible application.
[180] Tess Sheldon & Ivana Petricone, Access to Administrative Justice for Persons with Disabilities. Addressing the Capacity of Parties before Ontario’s Administrative Tribunals: Promoting Autonomy and Preserving Fairness (Toronto: ARCH, 2009) at ii, iii.
[181] The Code protects people from reprisal for making a human-rights related complaint (section 8).