9. Mental health, addictions and intersecting Code grounds

A significant theme in the consultation was how a person’s identity, based on mental health or addictions, intersects with other Code-related aspects of identity (such as race, sex or age), which can be the basis for unique or distinct forms of discrimination. People told us it was much harder to get a job, housing, or services because of discrimination based on two or more Code grounds. For example, we heard that young African Canadian men with a psychiatric disability find it harder to get housing due to stereotypes related to race, age, gender and disability.

Many people spoke of the effects of discrimination, harassment or negative stereotypes on a person’s mental health. They pointed to the profound systemic – including physical and mental health - impacts of longstanding discrimination and social exclusion on marginalized communities. The World Health Organization says:

…Vulnerability can lead to poor mental health. Stigma and marginalization generate poor self-esteem, low self-confidence, reduced motivation and less hope for the future.  In addition, stigma and marginalization can result in isolation, which is an important risk factor for future mental health conditions. Exposure to violence and abuse can cause serious mental health problems, including depression, anxiety, psychosomatic complaints, and substance abuse disorders. Similarly, mental health is impacted detrimentally when civil, cultural, economic, political and social rights are infringed, or when people are excluded from income-generating opportunities or education.[52]

The Empowerment Council – clients and ex-clients of the Centre for Addiction and Mental Health – pointed to the importance of considering the social determinants of health to advance a human rights approach. The social determinants of health help to explain how inequities in social factors affect mental health. These determinants include housing, health care services, food security, gender, country of origin, exposure to discrimination and racism, and education.[53]

We were told it is very hard to get appropriate health care and support services that provide “culturally competent” services - that is, that respect and meet the specific needs of different communities being served. [54] Services are often designed based on mainstream models that do not consider people from marginalized communities, or cultural differences in perspectives, frameworks and definitions of mental health.[55] This can lead organizations to unintentionally discriminate against people from racialized and immigrant communities, Aboriginal Peoples, people who are gay, lesbian, bisexual, transgender people and other people based on Code grounds. Services may have exclusionary policies, procedures, decision-making practices and an organizational culture that is not inclusive.

The Ontario Federation of Indian Friendship Centres (OFIFC) said a lack of culturally appropriate services may result in poorer care, and indirectly contribute to people’s deteriorating mental health. Racial stereotyping or a lack of understanding of specific cultures and communities during intake and assessment can lead to misdiagnosis, poor diagnosis or poor treatment of people from racialized communities.[56]

We heard about several instances of differential treatment because of a lack of cultural competency. We heard that people who are gay, lesbian and bisexual may find it difficult to disclose their sexual orientation within psychiatric hospitals and programs because of a non-inclusive environment. This can discourage people from using these services. One Aboriginal woman said that medical doctors did not consider her preference for Aboriginal-specific and alternative medicines. She did not return, and was left with little choice for alternative care.

A representative from a Francophone agency in Ottawa said some English-speaking service providers, instead of providing the services in French or providing a language interpreter, may see Francophone clients as having diminished power to communicate their wishes, and they look for someone to act or speak for them, for example, as their power-of-attorney.

Except in [a community mental health agency], which is not covered by OHIP, [mental health counsellors] I have met so far have very little knowledge or readiness to deal with sexuality issues (gay), and when the issues of race intersect, their knowledge was surprisingly low and I am still left without a health professional who could understand or who is really willing to understand the intersections of issues (race, gender, newcomer related) in counselling! – Survey respondent

We also heard that people were subjected to harassing or discriminatory comments within services based on Code grounds.

[52] World Health Organization, Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group (2010) online:  World Health Organization www.who.int/mental_health/policy/mhtargeting/en/index.html at xxv- xxvi.

[53] World Health Organization, WHO Resource Book on Mental Health, Human Rights and Legislation (Geneva: World Health Organization, 2005) as cited by Ontario Federation of Mental Health and Addiction Programs, Embracing Cultural Competence in the Mental Health and Addiction System (June 2009) online: OFMHAP www.ofcmhap.on.ca/sites/ofcmhap.on.ca/files/CulturalCompetwC%20(4).pdf at 24; Juha Mikkonen & Dennis Raphael, Social Determinants of Health: The Canadian Facts (Toronto: York University School of Health Policy and Management, 2010) online: The Canadian Facts www.thecanadianfacts.org/The_Canadian_Facts.pdf at 9; Mental Health Commission of Canada Diversity Task Group, Improving Mental Health Services for Immigrant, Refugee, Ethno-cultural and Racialized Groups – Issues and Options for Service Improvement (12 November 2009) online: Mental Health Commission of Canada www.mentalhealthcommission.ca/SiteCollectionDocuments/Key_Documents/en/2010/Issues_Options_FINAL_English%2012Nov09.pdf at 15. 

[54] Although definitions vary, cultural competence refers in part to “the level of knowledge based skills required to provide meaningful, supportive and respectful service delivery to clients from various marginalized groups in society …” Key principles of cultural competence include inclusiveness, holistic health, anti-oppression and valuing diversity. Zine, in progress, as cited by Ontario Federation of Mental Health and Addiction Programs, Embracing Cultural Competence in the Mental Health and Addiction System (June 2009) online: Ontario Federation of Mental Health and Addiction Programs www.ofcmhap.on.ca/sites/ofcmhap.on.ca/files/CulturalCompetwC%20(4).pdf at 22.

[55] Kwasi Kafele, Racial Discrimination and Mental Health: Racialized and Aboriginal Communities (December 2004), Submitted to the OHRC Race Policy Dialogue, online: OHRC www.ohrc.on.ca/en/issues/racism/racepolicydialogue/kk/view at 13. 

[56] Kwasi Kafele, Racism and Mental Health: A compendium of Issues, Impact and Possibilities (2006). Resource provided to the OHRC.


Code Grounds: 

9.1. Intersections with other types of disabilities

Every diagnosis that you have creates another level of discrimination or barrier. – Toronto roundtable participant 

People may be discriminated against based on a combination of mental health and other types of disabilities. We heard that people with both mental health issues and addictions are often looked down upon. Some said that because of a mental health issue, their physical disability will not be taken as seriously.[57]

Often mental health services are not designed to serve people with more than one disability, leaving people with multiple disabilities, such as mental health and addiction issues, developmental disabilities or learning disabilities, from receiving timely or adequate services (Learning Disabilities Association of Ontario). This issue is explored in section 8 (Services). We also heard that certain medications for psychiatric disabilities, such as schizophrenia, have side-effects that can lead people to develop physical disabilities like diabetes. People could then need accommodation for both disabilities.

We heard that some people were assumed to have addictions when they exhibited certain behaviours related to a disability. Because of this, they were treated as a security risk. A few people said that security personnel and police assumed that they were using drugs or alcohol when they had symptoms of a physical disability or a mental health issue.

Some people could not get services or supportive housing – including mental health services and supports – in an equal way because their physical disabilities, such as mobility disabilities or hearing disabilities, were not accommodated.

A client of mine was assaulted. She is Deaf and has a mental health disability. The police didn’t provide an ASL interpreter, and instead of trying to listen to her about being assaulted, they took her to [a psychiatric hospital] where they assumed she was making it all up because they didn’t provide her with an interpreter. So they Formed her [detained her in hospital involuntarily]. – Community legal clinic representative

[57] People with a psychiatric disability as well as a physical disability tend to report more perceived stigma and discrimination overall, and in the areas of lack of housing, poverty and neighbourhood of residence. Allison Bahm & Cheryl Forchuk, “Interlocking oppressions: The Effect of a Co-morbid Physical Disability on Perceived Stigma and Discrimination among Mental Health Consumers in Canada” (2008) 17:1 Health and Social Care in the Community 63.

Code Grounds: 

9.2. Intersections with sexual orientation

We heard how people face a “double burden” of coming out as gay, lesbian or bisexual and also disclosing a mental health issue. Some said the stress they experienced because of discrimination based on their sexual orientation contributed to mental health issues and addictions. Lesbian, gay and bisexual (LGB) people are at greater risk for certain mental health issues, including depression, anxiety and substance abuse disorders. [58] These often relate to experiences of discrimination.[59] LGB youth are more likely to have experienced suicidal thoughts or attempted suicide than heterosexual youth. [60]

We heard concerns about stereotypes that gay, lesbian and bisexual people are assumed to be “mentally ill,” even though being gay is no longer identified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Some people told us of homophobic remarks from mental health service providers, or that their service providers lacked understanding about their experiences relating to sexual orientation.

I was sent to a psychiatrist at [a hospital]. When I mentioned to him that I am gay and wanted to talk about it, he wasn't ready to listen, because he was "not an expert in that area"! I had to wait another five months before I met a gay-friendly counsellor at [a community mental health agency]. – Survey respondent

We heard about homophobic comments from other clients within a service environment, which may be dealt with inappropriately by service providers. Within mental health services, same-sex partners may not be treated as legitimate family members, preventing them from getting information about someone receiving treatment or support. 

[58] Allen M. Omoto & Howard S. Kurtzman, eds., Sexual Orientation and Mental Health: Examining Identity and Development in Lesbian, Gay and Bisexual people (Washington, DC: APA Books, 2006); S.D.Cochran, J.G. Sullivan, & V.M. Mays, “Prevalence of Mental Disorders, Psychological Distress, and Mental Health Services Use among Lesbian, Gay, and Bisexual Adults in the United States,” (2003) 71 J. of Consulting and Clinical Psychology 53; I.Meyer, “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence” (2003) 129 Psychological Bulletin 674; as cited by W.B. Bostwick, Mental Health Issues among Gay, Lesbian Bisexual and Transgender (GLBT) People, (National Alliance on Mental Illness: 2007) online: NAMI www.nami.org/TextTemplate.cfm?Section=Fact_Sheets1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=54036, retrieved 5 August 2009.

[59] For a review of the literature, see Dean L, et al., “Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns” (2000) 4:3 J. of the Gay and Lesbian Medical Association 101.

[60] Elizabeth Saewyc et al., Not Yet Equal: The Health of Lesbian, Gay, & Bisexual Youth in BC (Vancouver, BC: The McCreary Centre Society, 2007) at 31.


Code Grounds: 

9.3. Intersections with sex

There is a close connection between mental health disabilities, addictions and gendered violence. Women who are survivors of violence, trauma and abuse often face substance use and mental health issues.[61] Several women reported gender-based violence related to having a mental health history. Some said they were sexually harassed or assaulted by patients or staff while hospitalized for a psychiatric disability.

At [a hospital], I was subjected to harassment from a fellow … patient. He would appear every morning at my bed, wake me up, and point to his erection, and show me his colourful collection of condoms. Later it was discovered another woman complained of an assault. I was terrified in my bed, afraid of taking medication since I thought I’d be raped since I was sedated … It was reported, nothing was done, [the other female patient] was discharged and he continued to harass me. – Written submission

Women with mental heath issues and addictions can be even more vulnerable to harassment or violence when they also experience poverty, age-related and other disabilities. In late 2011, the Ministry of Health and Long-Term Care set up a task force to address the many complaints of abuse against older adults in nursing homes, including sexual assault of female residents with dementia. [62]

Some women said their mental health concerns were minimized compared to men’s mental health issues, and that mental health issues and “women’s issues” are seen as the same thing. Historically, women in the West were diagnosed with “hysteria” – a so-called nervous disorder – based on their female reproductive anatomy. This provided a rationale for denying them civil and political rights. [63]

One addictions worker described negative stereotypes about women with addictions – they are assumed to be sex workers or to put themselves in situations where they contract illnesses. Women with psychiatric disabilities or addictions may face discrimination based on cultural ideals of femininity because they gain or lose weight due to their disability or the side-effects of medication.

Women’s experiences with discrimination based on mental health and addictions must be understood in the context of other Code-related identities, including sexual orientation, race, ancestry, age, family status and having other disabilities. For example, we heard that mothers may experience multiple stereotypes or challenges based on sex, family status and disability. We were told women with addictions may be assumed to be poor parents or may be afraid to use mental health or addiction services because of concerns that child protection workers will become involved and their children will be taken from them.

[61] Ad hoc working group on women, mental health, mental illness and addictions, Women, Mental health, Mental Illness and Addictions in Canada: An Overview (2006) online: Canadian Women’s Health Network www.cwhn.ca at 25.

[62] Moira Welsh & Jesse McLean, “Nursing home residents abused” Toronto Star, (17 November 2011), online: The Toronto Star www.thestar.com; Moira Welsh, “Task force gets cracking on troubled nursing home system” Toronto Star (1 February 2012) online: The Toronto Star www.thestar.com. 

[63] Barbara Ehrenreich & Deirdre English, For Her Own Good: 150 Years of Experts’ Advice to Women, (Garden City, NY: Anchor Books, 1978), as cited by the Ad hoc working group on women, mental health, mental illness and addictions, supra note 61 at 1.


Code Grounds: 

9.4. Intersections with gender identity

[At] my last job, I told my boss I was trans, and she told me flat out not to tell anyone [or] I would be fired. I can’t make enough money to support myself right now, and the stress of that has a huge impact on my mental health … The discouragement of looking for work that you are qualified for, and that you know you can do, and being turned down again and again and again, is really damaging.  – Focus group participant

Transgender people told us about the major impacts on their mental health from daily discrimination, lack of societal acceptance, poverty, unaffordable housing and alienation from family, based on gender identity. A focus group co-facilitated by Rainbow Health Ontario, identified poverty as a consequence of discrimination, but also a contributing factor to poor mental health. In a study of 433 trans Ontarians, half “seriously considered” suicide because they were trans. Trans youth (up to age 24) were more than twice as likely to seriously consider suicide than trans people over age 25.[64]

People expressed their concerns with “gender identity disorder” being included in the Diagnostic and Statistical Manual of Mental Disorders because it treats trans people as having a mental illness. We heard that trans people are automatically believed to have mental health issues. However, there are tensions around the inclusion of “gender identity disorder” in the DSM-IV-TR. Without being diagnosed as having a disability, trans people do not have access to the Ontario Disability Support Program, funded hormones or sex-reassignment surgery. Some people said the need to transition should be considered a physical health issue, not a mental health issue. 

Some trans people talked about having difficulty getting medical supports to undergo transition, such as hormones, because of mental health issues. They told us how their transition or hormones were seen as the cause of the mental health issue, when the mental health issue may have been linked to broader experiences of discrimination. Some indicated they were not treated with dignity while hospitalized or receiving treatment for a mental health condition; they were not allowed to transition genders, they were sexually harassed, or segregated from other patients. They emphasized the importance of amending the Code to include “gender identity” as an explicit ground to ensure trans people’s rights to equal treatment and full participation in society are recognized. In June 2012, “gender identity” and “gender expression” were added as grounds of discrimination in the Code.

[64] Kyle Scanlon, et al,, “Ontario’s Trans Communities and Suicide: Transphobia is Bad for Our Health,” Trans PULSE E-Bulletin 1:2 (12 November 2010), online: Transpulse project transpulseproject.ca/documents/E2English.pdf.

Code Grounds: 

9.5. Intersections with race and related grounds

Dealing with racism in my workplace contributed significantly to me having mental health problems in the first place. 
– Survey respondent

Doctors assume that since I am female and an immigrant that I must be okay with being subjugated or treated as less than an autonomous adult. 
– Survey respondent

We heard about the different types of intersecting discrimination occurring because of race, citizenship, ethnic origin, place of origin, ancestry, colour or creed, in addition to mental health disabilities and/or addictions. We were told how perceptions about people’s disabilities can contribute to negative perceptions based on race in different ways. For example, one person told us she was labelled as the “angry Black woman” at work because of her symptoms of depression.

The Metro Toronto Chinese and Southeast Asian Legal Clinic (MTCSALC) and the New Mennonite Centre said discrimination and barriers to integration can affect the mental health of immigrants to Canada. Some people said they had difficulty disclosing their mental health issues within their community.

MTCSALC said the social stigma experienced by people with mental health and addiction issues may be more severely felt by immigrants and people from racialized[65] communities because the stigma adds to the multiple challenges they already face, not because issues are more prevalent in these communities. In a focus group organized by the Ethno-Racial Disability Coalition of Ontario (ERDCO), one participant said that having to ask for accommodation or speaking up to assert one’s rights were made much more difficult when dealing with issues of racial discrimination because of power imbalances.

We were told that people from racialized communities and in particular, African Canadian men, experience harsher treatment than non-racialized people in the mental health and forensic mental health systems (where people are also involved in the judicial system).  People were concerned that there is a high representation of racialized people with mental health issues in the criminal justice system, and that African Canadian men with mental health issues are more likely to enter the criminal justice system than the community mental health system.[66] One person from an agency serving racialized communities said misdiagnosis may be common because of stereotypes and cultural and language barriers.

A growing body of international research supports many of these findings.[67] Some studies suggest there are higher rates of restraint and confinement for people of African or Caribbean descent compared to people of other ethnic backgrounds, although the reasons for this may be complex.[68]

a) Language

Language is not a prohibited ground under the Code, but it can be related to ethnic origin or place of origin. [69] The Provincial Human Services and Justice Coordinating Committee (PHSJCC) and many others said that the lack of accommodation of language needs for people with mental health issues or addictions is a major issue.

We heard the lack of interpretation and translation can lead to not being able to access services, or being treated differently within services. Advocates said there is a systemic issue of racialized people being treated as “non-compliant” in the hospital setting when their cultural or language needs are not accommodated, and people have been treated poorly as a result (for example, they have been improperly assessed, or have had hospital privileges taken away). The PHSJCC recommends that the Ontario government develop targets to improve access to mental health and addiction services for ethno-racial communities, including improving access to language interpretation.

The French Language Health Services Network of Eastern Ontario (RSSFEO) told us that there is a documented lack of mental health-related services for Francophone people in Ontario.[70] It recommends recognizing language as an element of discrimination for anyone with a mental health disability or addiction.

b) Creed

We heard how people’s creed beliefs were not accommodated in different types of services used by people with mental health issues and addictions. Some women were prohibited from wearing their hijabs in hospital due to “health and safety concerns,” or had to remove their clothing in the presence of men. We also heard about some services that did not observe creed-based dietary needs. Some non-religious people said that it was hard to find addiction services that were not religion-based; one person said that, within these services, non-religious views were seen as a barrier to recovery.

[65] Race is a social construct. The Report of the Commission on Systemic Racism in the Ontario Criminal Justice System defined racialization “as the process by which societies construct races as real, different and unequal in ways that matter to economic, political and social life.” Ontario Human Rights Commission, Policy and Guidelines on Race and Racial Discrimination (Toronto: Queen’s Printer for Ontario, 2005) at 11.

[66] A study conducted in Montreal also found that African-Canadians were overrepresented in police referrals to emergency psychiatric services. G. Eric Jarvis, et al. “The Role of Afro-Canadian Status in Police or Ambulance Referral to Emergency Psychiatric Services” (2005) 56:6 Psychiatric Services 705.

[67] Research from the US and the UK, and some from Canada, has supported that people of African or Caribbean descent, particularly men and people who are immigrants, are disproportionately likely to be represented in the mental health and forensic mental health system and diagnosed with psychosis or schizophrenia, although multiple contributing factors need to be considered. One report states, “there are no statistics available, but psychiatric forensic units in Southwestern Ontario (including CAMH), based on anecdotal information, seem to have a disproportionately high number of men of colour, including African-Canadian men.” Pascale C. Annoual, Gilles Bibeau, Clem Marshall & Carlo Sterlin, Enslavement, Colonialism, Racism, Identity and Mental Health: Developing a new service model for Canadians of African DescentPhase I report (Toronto: CAMH, 2007) online: Centre for Addiction and Mental Health www.camh.net/publications/resources_for_professionals/EACRIMH/eacrimh_report1107.pdf at 13; G. Eric Jarvis, et al. “High rates of psychosis for black inpatients in Padua and Montreal: Different Contexts, Similar Findings” (2011) 46 Soc. Psychiatri. Epidemiol. 247; Kwame McKenzie & K. Bhui, “Institutional Racism in Mental Health Care” (Mar 2007) 334 B.M.J.649.   

[68] G. E. Jarvis, Emergency Psychiatric Treatment of Immigrants with Psychosis, (Master of Science in Psychiatry, Department of Psychiatry, McGill University, Faculty of Medicine, 2002) [unpublished] at 91;  Amos Bennewith, et al. “Ethnicity and Coercion among Involuntarily Detained Psychiatric In-patients” (2010) 196 British J. of Psychiatry 75; Rachel Spector, “Is There Racial Bias in Clinicians’ Perceptions of the Dangerousness of Psychiatric Patients? A Review of the Literature” (2001) 10:1 J. of Mental Health 5.   

[69] See Ontario Human Rights Commission, Policy on Discrimination and Language (Toronto: Queen’s Printer for Ontario, 1996), online: OHRC www.ohrc.on.ca/en/resources/Policies/lang/view.

[70] Seventy-seven percent of Francophone people in Ontario have no or rare access to alcohol treatment centres in French; 66% have no or rare access to drug addiction centres in French and 53% have no or rare access to mental health services (excluding psychiatric hospitals) in French. Office of the French Language Services Commissioner, Special Report on French Language Health Services Planning in Ontario (Queen’s Printer for Ontario, 2009) at 8, as cited by the submission by the French Language Health Services Network of Eastern Ontario.


Code Grounds: 

9.6. Aboriginal Peoples

I would like to see Aboriginal health advocates accompany people to places in the city because we do not always receive a good reception where we have to go. I think people are cruel towards us and the youth have no supports to help them get around and to get help.  – Survey respondent

People do not care to understand me or my situation as related to my disability. The other parts of who I am as 2-spirit, masculine identified [and] Aboriginal play into how people treat me, even before I want to discuss my ways of coping and living with mental health diagnosis and illness. – Survey respondent

Many organizations and individuals spoke of how Aboriginal Peoples in Canada have been affected by a long history of colonization, institutionalized racism and discrimination, such as the residential school policies. The Ontario Federation of Indian Friendship Centres (OFIFC) said that for the urban Aboriginal population, this has led to intergenerational trauma, family violence, poverty, homelessness, lack of education and incarceration. All of these have serious negative impacts on people’s mental health.

Mental health issues such as suicide, depression and substance abuse are higher in many Aboriginal communities than in the overall population. The OFIFC stated that the Aboriginal suicide rate is 2.1 times the Canadian rate; Aboriginal women are three times more likely to commit suicide than their non-Aboriginal counterparts.[71] The suicide rate for Aboriginal youth aged 15 – 24 is five to six times that of the non-Aboriginal population.[72]

Stereotypes about drug and alcohol use were raised in the consultation. Many people described how they were treated unequally in services, exposed to harassing comments, or profiled as a security risk based on stereotypes about their Aboriginal identity and misperceptions about alcohol and drug use. The OFIFC said that the provincial mental health reform in the 1990s that led to hospital closures meant that many Aboriginal people with mental health issues and addictions were released into urban areas and not back to their communities of origin.

Many said lack of affordable housing was a major issue of concern and that it is much harder to get housing because of intersecting identities of having a mental health issue or addiction, and being of Aboriginal ancestry. 

[71] National Council of Welfare, First Nations, Métis and Inuit Children and Youth: Time to Act 127 (Ottawa: Her Majesty the Queen in Right of Canada, 2007) at 64.

[72] Jeff Latimer & Laura Casey-Foss, A One-Day Snapshot of Aboriginal Youth in Custody across Canada: Phase II, (Ottawa: Department of Justice Canada, Youth Justice Research, February 2004) at iii.


Code Grounds: 

9.7. Intersections with age

a) Younger people

The Ontario Secondary School Teacher’s Federation (OSSTF/FEESO) expressed concern that mental health services for children and youth are not mandated in Ontario, which leads to inconsistent and fragmented approaches. Younger people (under 25 years of age) who took part in the consultation said that they could not get mental health or addiction services because they were too young for adult services, too old for paediatric services, or did not meet the program criteria because they had multiple disabilities. One youth worker described how a youth addiction treatment program denies service to youth who have been involved in child protective care.

The Children’s Hospital of Eastern Ontario (CHEO) said that by ratifying the International Convention on the Rights of the Child, Canada is obliged to ensure that children realize their rights to the highest attainable standard of health. CHEO said that Canada must strive to make sure no child is deprived of his or her access to such health care services (Article 24.1). CHEO said that it is a serious of breach of children’s rights to have no legislation on children’s mental health. In its Mental Health and Addictions strategy, the Ontario Ministry of Health and Long-Term Care (MOHLTC) has targeted increased service delivery for children and youth, with a focus on early detection and intervention.

b) Older adults

The Advocacy Centre for the Elderly (ACE) spoke of significant issues of discrimination facing older adults with mental health issues and addictions. Estimates are that one in five persons over age 65 has a mental health disorder.[73]

ACE is frequently contacted by older adults and substitute decision-makers because older adults in long-term care have been given medication, particularly anti-psychotic medication, without informed consent. ACE voiced concern about the high rate of anti-psychotic drug use in long-term care homes for residents with dementia compared to use among older adults with dementia living in the community. [74] ACE raised concerns about the side-effects and long-term effects of this type of medication. ACE also said that, in contrast to people covered by the Mental Health Act, people in long-term care do not have the same access to legal rights advisors if they are found incapable to consent to treatment. Other issues regarding long-term care are described in the section on Housing (Section 11.1).

Others told us how discrimination based on age combines with discrimination based on disability, particularly in the area of employment. They said it is much harder to find and keep employment when dealing with the experiences of aging and disability.

Although I have over 30 years of experience in administrative/secretarial/clerical along with about 25 years of organization/event planning/public relations/promotions/media ... I cannot find appropriate work due to the fact [that] I am presently only able to work 25 – 30 hours per week and I'm [around] eight years out of the workforce. Add that to the fact I'm only seven years away from the usual retirement age of 65, and many people just don't want to hire me. 

– Survey respondent


6. The government of Ontario and organizations providing services to people with mental health and addictions should work to identify and eliminate discrimination based on disability in their services, as well as discrimination based on age, sex, race and related grounds, gender identity, sexual orientation and other Code grounds. This may require a process of examining policies, practices and decision-making processes and removing barriers that lead to discrimination for Code-protected groups (see the OHRC’s Guidelines on developing human rights policies and procedures for more information).

OHRC commitments:

C4. In its work on its strategic priorities (e.g. policing and anti-racism, Aboriginal Peoples’ human rights, family status, disability and education), the OHRC will build in a focus on human rights, mental health and addictions.

C5. The OHRC will further examine the issue of the level of rights advice provided to older adults in long-term care who are deemed to be incapable of making treatment decisions. If this has the potential to violate the Code, the OHRC will, where appropriate, raise concerns with the responsible parties, do public interest inquiries, intervene in legal cases and/or launch Commission-initiated applications.

[73] D. Jeste, et al, “Consensus statement on the upcoming crisis in geriatric mental health: Research agenda for the next two decades” (1999) 56 Archives of General Psychiatry 848, as cited by the submission from ACE.

[74] ACE said that according to the Canadian Institute for Health Information, in 2006-2007, 37.7% of residents in long-term care homes on public drug programs were prescribed antipsychotic medication versus only 2.6% of older adults living in the community who could claim anti-dementia drugs. The study stated, “The higher rate of antipsychotic use among seniors using anti-dementia drugs in nursing homes may suggest that there are factors in addition to differences in the prevalence of dementia that contribute to variation in the rates of antipsychotic use.” Canadian Institute for Health Information, Antipsychotic Use in Seniors: An Analysis Focusing on Drug Claims, 2001 to 2007 (2009), online: Canadian Institute for Health Information http://secure.cihi.ca/cihiweb/products/antipsychotics_aib_en.pdf at 15.


Code Grounds: