People are very judgmental and refer to you as “lazy” and “crazy.''' People think we “lack motivation," "if only we'd try harder" or "snap out of" our depression. - People Advocating for Change through Empowerment (PACE)
Stereotypes are assumptions about individuals based on the presumed qualities of the group they belong to. Stereotypes can lead to inaccurate assessments of people’s personal characteristics. Throughout the consultation, participants told how they were exposed to negative stereotypes based on disability, and subject to the “stigma” of mental health issues and addictions.[32] Stereotyping may be the basis for discriminatory acts by individuals. But it can also lead institutions to develop policies, procedures, and decision-making processes that exclude or marginalize people with psychosocial disabilities. This is a type of “systemic discrimination.”
Stereotypes about people with disabilities arise from a wide-spread belief system called “ableism.” Ableism refers to attitudes in society that devalue and limit the potential of persons with disabilities. People with disabilities are assumed to be less worthy of respect and consideration, less able to contribute and take part, and of less value than others. Ableism can be conscious or unconscious and is embedded in institutions, systems or the broader culture of a society.[33] Although ableism can affect all people with disabilities, people with psychosocial disabilities experience unique forms of stereotyping.[34]
There are a number of widely-held stereotypes about people with psychosocial disabilities; for example, characterizing all people with mental illness as violent or unpredictable when most are not. In reviewing the literature, CMHA Ontario points out the complexities of estimating the rates of violence by people with mental illness due to the different types of research methods used and indicates that a definitive causal relationship between mental illness and violence has not been established.[35]
Every time there is an incident and it comes out in the media and they say, ”manic depressive” or “bipolar disorder” … It just means now I can’t tell more people. – Toronto roundtable participant
CMHA Sudbury-Manitoulin and others said that the media play an important role in perpetuating stereotypes and shaping public opinion. CMHA Ontario recommends that the media develop a balanced approach to reporting on mental health, making sure to include the perspectives of consumer/survivors, family members and care providers.[36]
Some submissions told of being considered a security risk based on assumptions about their disability. Where there is no real evidence of risk, this type of behaviour may be a form of “profiling” based on mental health. For example, one service provider was concerned about hospitals that routinely called security personnel to be present if patients’ files revealed a mental health diagnosis.
Other stereotypes about people with mental health disabilities or addictions are that they lack credibility, are not able to accurately assess situations, and cannot make decisions about their own lives. Some said these assumptions related to their concerns about the medical approach to disability. Some people criticized the medical model, saying that it pathologizes people with disabilities and assumes that they are not experts of their own experiences. This perpetuates the notion that people with mental health issues or addictions are less worthy than other people.
People said that pervasive paternalistic attitudes devalue their experiences, thoughts and choices, and lead to society having low expectations of people with mental health issues or addictions. It is hard to complain or assert yourself or your rights because your experiences are minimized and attributed to your disabilities, we were told.
Every attempt to question, understand or challenge the diagnosis that I felt was woefully inaccurate was met by a smug smile, "expertise," and a dismissal. I have never felt so disempowered, hopeless, helpless and suicidal as I did then. Every single feeling, experience, or thought I have that my psychiatrist does not like, no matter how valid, healthy or normal it is, is rendered completely and utterly irrelevant. I do not matter.
– Survey respondent
If [you] are not doing well, and if you feel you have been discriminated against, these responses are invalidated. For example, I’ve heard from clinical staff that instead of someone with a mental health issue having a valid complaint, the person is being “triggered” [where something causes the onset of disability-related symptoms]. That is very frustrating, because it’s hard to prove your feelings are valid.
– Consumer/survivor advocate
Other prejudices about people with mental health disabilities and addictions include that people have brought disabilities upon themselves because they are of weak moral character,[37] are not as intelligent, or are “less human” than other people. In addition, physical illnesses may be seen as “more legitimate” than psychiatric disabilities or addictions.[38] All of these misperceptions can lead to discriminatory attitudes and inequitable treatment.
Certain types of disabilities are more stigmatizing than others due to the stereotypes associated with them. We were told that people with addictions are generally seen in a more negative light than people with mental health disabilities because of assumptions about how much they are personally responsible for their disability, and assumptions about their involvement with crime.[39]
People with schizophrenia or drug addictions may experience particularly negative attitudes from others based on beliefs about dangerousness, anti-social behaviour or risk.
Because of stereotyping, many people we heard from reported a fear of disclosing their disability to others. Many reported being labelled, experiencing negative attitudes from others, losing their jobs or housing, or experiencing unequal treatment in services after disclosing a mental health issue or addiction. Fear of discrimination can also result in people not seeking support for a mental health issue or addiction.[40]
7.1. Challenging stereotypes
Many people strongly recommended that the OHRC and other institutions educate the public to dispel stereotypes and teach people about human rights and mental health and addiction issues. One effective way to change negative attitudes about mental health is to have person-to-person contact with consumer/survivors or people with addictions. A report on anti-stigma recommends targeting carefully defined groups, such as health care providers, establishing organizational leadership and involving consumer/survivors in developing and leading any initiative.[41]
However, other people emphasized that rights must be enforced. Training on its own is not likely to effect change on a systemic level. Research has shown that education on mental health alone is not likely to be effective in changing people’s behaviour over the long term, and should be complemented with other approaches.[42]
Recommendation:
3. Organizations and individuals across Ontario should work to enhance efforts to challenge stereotypes about people with mental health issues or addictions by implementing and actively taking part in anti-stigma and education campaigns.
OHRC commitments:
C2. The OHRC will work with community stakeholders to enhance public education on human rights and mental health.
C3. The OHRC will conduct training on its policy on mental health and addictions throughout the province with consumer/survivors, people with addictions, government, as well as public and private-sector organizations.
[32] “Stigma” is a term used to capture a number of different concepts relating to mental health and addictions. Link and Phelan define stigma in terms of, “the convergence of interrelated components.” Stigma exists when elements of labelling, stereotyping, separation, status loss and discrimination occur together in a power situation that allows them. Bruce G. Link and Jo C. Phelan, “Conceptualizing Stigma” (2001) 27 Annul. Rev. Sociol 377.
[33] Law Commission of Ontario, Advancing Equality for Persons with Disabilities Through Law, Policy and Practice: A Draft Framework (March 2012) at 3.
[34] For example, the term “sanism” has been used to describe how the community and the legal system in particular have an “irrational prejudice” towards people based on mental disability. Michael Perlin, “International Human Rights and Comparative Mental Disability Law: the Use of Institutional Psychiatry as a Means of Suppressing Political Dissent” (2006) 39 Isr. L.R. 69 72.
[35] The risk of violence has been documented to be higher when people with serious mental illnesses also use substances; however, CMHA Ontario reports that rates of violence among individuals with mental illness without concurrent substance use tend to be similar to the rates of violence in the general public. People with serious mental health issues are more likely to be victims of violence than the general population. Canadian Mental Health Association, Ontario, Violence and Mental Health: Unpacking a Complex Issue. A discussion paper (September 2011), online: Canadian Mental Health Association, Ontario www.ontario.cmha.ca/backgrounders.asp?cID=1081747.
[36] CMHA Ontario recommends that the media refer to the guidelines on responsible media coverage developed by organizations like the Canadian Psychiatric Association and the Centre for Addiction and Mental Health, ibid., at 10.
[37] According to a 2008 Ipsos Reid poll of over 1000 Canadians, almost half (46%) of respondents felt that the term "mental illness" is used as an excuse for bad behaviour (Canadian Medical Association, 8th Annual National Report Card on Health Care (2008) online: Canadian Medical Association www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Annual_Meeting/2008… at 4.
[38] Gerald B. Robertson, “Mental Disability and Canadian Law” (1993) 2:1 Health L. Rev. 23; Standing Senate Committee on Social Affairs, Science and Technology, supra note 6 at 40.
[39] For example, a psychiatric model of addiction which was popular between the 1940s and 1970s attributed the individual’s addiction to personality “flaws.” Caroline J. Acker, “Stigma or legitimation? A Historical Examination of the 27 Social Potentials of Addiction Disease Models” (1993) 25:3 J. of Psychoactive Drugs 202, as cited by Centre for Addiction and Mental Health, The Stigma of Substance Abuse: A Review of the Literature (18 August 1999) at 7.
[40] Neasa Martin & Valerie Johnston, A Time for Action: Tackling Stigma and Discrimination: Report to the Mental Health Commission of Canada (2007) at 11.
[41] Ibid., at 17. In addition, in recent years, there has also been a commitment by public and private organizations to engage in broad anti-stigma campaigns to educate the public about mental health issues, including Bell Canada and the Mental Health Commission of Canada. The Globe and Mail also created a series about mental health.
[42] Ibid., at 17.