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Overcoming Barriers to Physical Health Care Access for People with Mental Health
Disabilities
Learning Objectives
1. Explore impact of stigma & discrimination on people with mental health disabilities.
2. Discuss legal issues regarding access to physical health care for people with mental health disabilities.
3. Develop strategies for reducing stigma and overcoming health care access barriers for people with mental health disabilities.
Overview of Training Agenda
1. Introduction
2. Stigma & Discrimination
3. Effects of Stigma
4. Models of Treatment: Recovery v. Medical
5. Actions that Discriminate
6. Strategies for Reducing Stigma and Discrimination
7. Legal Issues
Feel free to ask questions at any time!
DRC SDR Project Goals
Reduce stigma & discrimination by
- Increasing awareness of laws, policies & practices that address discrimination & support mental health services in non-traditional settings through provision of culturally-relevant and age appropriate training & materials for people with disabilities, their families, providers, and the general population.
DRC SDR Project Goals
Identifying laws that contribute to stigma and discrimination & writing policy papers that recommend needed policy changes to reduce or eliminate stigma & discrimination.
Stigma & Discrimination
Different Cultural beliefs about people with mental health
disabilities:- Inspired………………Possessed
- Respected……………Rejected
- Different………………Abnormal
What is Stigma?
Attitudes and beliefs, based on stereotypes, that lead people to reject, avoid, or fear those they perceive as being different
What is Discrimination?
- Discrimination occurs when people act on stigma in ways that deprive others of their rights and life opportunities.
- Discrimination and stigma are based on the stereotypes that drive a wedge between “us” and “them.”
Types of Stigma
1. Public Stigma
2. Institutional Stigma
3. Self Stigma
Self Stigma
- Self stigma is when a person with a disability accepts the attitudes of society or of the medical community.
- Self stigma is rarely discussed, and can lead to hopelessness and helplessness.
Stigmatizing Language
- Crazy
- Insane
- Disturbed
- Abnormal
- Delusional
- Incompetent
- Out of control
- Dependent
Effects of Stigma
- Low Self-Esteem- Isolation- Feeling Devalued - Social Rejection- Shame
Effects of Stigma
- Over-interpretation of Behavior - Opinions are Ignored - Not given Responsibility - Not Trusted - Victims of Violence- Barrier to Seeking Treatment
Many people say that the stigma associated with their own (or their family member’s) diagnosis was more difficult to
bear than the actual illness.
What is “Stigma”?
Stigma refers to attitudes and beliefs that lead
people to reject, avoid, or fear those they perceive
as being different
Types of stigma:
1. Public Stigma
2. Institutional Stigma
3. Self Stigma
All types of stigma are based on stereotypes
about people with mental health disabilities.
Studies have shown that stigma is even prevalent among the mental health
provider community.
Knowledge about mental health disabilities does not preclude
stereotyping.
“One study of mental health consumers and family members
cited that stigma related to mental health care…accounted for nearly one quarter of their reported stigma experiences.”
- The California Strategic Plan on Reducing Mental Health Stigma and Discrimination
Yet people go to mental health professionals for help when they need treatment, understanding
and support.
People who encounter stigmatizing attitudes from
health professionals may avoid seeking or continuing treatment.
Mental Health Treatment Models
Medical Model vs.
Recovery Model
Medical Model
Mental health assessments and diagnoses too often focus on
weaknesses and problems rather than addressing a person’s
strengths, interests and goals.
Recovery Model
HopePersonal EmpowermentRespectSocial ConnectionsSelf-Responsibility
Recovery Model- A diagnosis is a “guide”
for treatment rather than a “name” for a person.
- Mental health disabilities may shape or affect who a person is, but we are not defined by our disability.
Medical Model- A diagnosis is a fact.
- Mental health providers may refer to people by their diagnosis.
- People are their disability.
Recovery Model Medical Model
People:
- Have different realities – there is not “one” reality.
- Have insight into their own reality – it just may not be other people’s reality.
- Have the ability to take care of themselves, with support as needed
People with Mental Health
Disabilities:
- Lack insight into their own disability
- Are unrealistic and unreasonable
- Need to be taken care of
Recovery Model
- People with mental health disabilities can and do get better.
- Recovery is unique to each individual.
- A person’s recovery can not be defined or determined by others.
Medical Model
- People with mental health disabilities can never truly recover.
- Once someone has a mental health disability, they will always have it.
“…hope is one of the most valued ingredients in the
professional/client relationship and the strongest predictor of
positive outcomes.”
- Mood Disorders Society of Canada
Actions that Stigmatize
- Disrespecting, patronizing ortalking down to people
- Ignoring what people want
- Making decisions for peoplerather than helping them
make their own
How to Reduce
Stigma and Discrimination
- Use Plain Language
- Use People First Language: Acknowledge and respect clients as people rather than disabilities.
- Treat the illness with the seriousness it deserves, but treat people with dignity and respect.
- Listen to what clients have to say
- Empathize with them, but don’t tell them what they feel or think.
- Identify, acknowledge and explore a client’s self-stigma
Health professionals are consultants whom clients rely on
for information, guidance and support.
Be conscious of the powerof diagnosis and the labeling
process – this might alsocontribute to a wiser
use of diagnoses
- Focus on a person’s strengths and what he or she can do.
- Teach Self-Advocacy: Help people help themselves
Contact a Peer Support Organization, Group or Peer Advocate for Guidance:
- Peer/Self-Advocacy Program (PSA) of Disability Rights California www.disabilityrightsca.org
- National Empowerment Centerwww.power2u.org
- National Self-Help Clearinghousewww.mhselfhelp.org
Legal Issues
Understanding and respecting individuals’ legal rights can promote
a sense of autonomy, counteract stigma and promote effective
treatment.
Access to Health Care
Access to health care includesthe rights to access facilities,
services, and information offered by doctors’ offices, other health care providers and insurance plans.
Disability Discrimination Laws
Americans With Disabilities Act
T.II: Public Facilities & Services
T.III: Private Facilities & Services
(“Public Accommodations”)
Rehabilitation Act, Section 504
Facilities & Services Receiving Federal Funds
Similar State Laws
California Unruh Act
Legal Protections for People with Disabilities
1. Full and equal access to health care services and facilities.
2. Reasonable modifications to policies, practices, and procedures that are necessary to make health care services available to people with disabilities.
3. Effective communication, including auxiliary aids and services, such as the provision of sign language interpreters or written materials in alternative formats.
Examples of Potentially Discriminatory Conduct
Requiring a companion to attend a medical appointment
Refusing to provide services because of a mental health disability
Making disrespectful or harassing comments about a mental health disability
Reasonable Accommodations
RA = reasonable modifications in policies, practices and procedures, when necessary to avoid discrimination on the basis of disability.
RA ≠ undue financial or administrative burden, or fundamental alteration of the nature of the service.
Examples of Reasonable Accommodations
Allowing a support person in a medical examination or consultation
Scheduling an appointment at a specific time
Taking extra time for a consultation
Psychiatric Service Animal and Emotional Support Animals
ADA allows service animals – but not emotional support animals – to accompany people with disabilities to medical appointments in public or private facilities.
Definition of Service Animal
- Only dog or miniature horse.
- Individually trained to do work or perform specific tasks for the benefit of a person with a disability.
- Example: Dog that is trained to recognize and respond to signs of panic attack.
- License not required & not determinative.
Definition of Emotional Support Animal
- Provides comfort to a person with a mental health disability.
- Not individually trained to do disability-related tasks.
Qualifications on Right to Service Animal
- Animal must be well cared-for.
- Animal cannot pose a threat to people or property.
- Health care providers may make limited inquiries about necessity of service animal, but may not ask questions about an individual’s disability.
Other Rights Protecting Access to Health Care
- Right to be participate in treatment and discharge planning
- Right to challenge decisions of conservator
- Right to access to medical records- Right to confidentiality of medical records
Culturally and Linguistically Appropriate Services
Recipients of federal funds must take reasonable steps to ensure that people with limited English proficiency have meaningful access to programs and services, including health care services.
Title VI, Civil Rights Act of 1964
Executive Order 13166, Improving Access to Services for Persons with LEP
Culturally and Linguistically Appropriate Services
Health care providers should “provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.”
National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care
www.thinkculturalhealth.hhs.gov
How to Address Discrimination By Health Care Providers
1. Talk to the provider directly or through Ombudsman.
2. File complaint with provider’s ADA/504 Compliance Officer.
3. File administrative complaint.
Administrative Complaints - OCR
U.S. Department of Health and Human Services
Office of Civil Rights (OCR)
90 - 7th Street, Suite 4-100
San Francisco, CA 94103
Telephone: (415) 437-8310
TDD: (415) 437-8311
Fax: (415) 437-8329
www.hhs.gov/ocr/civilrights/complaints
Administrative Complaints - DOJ
United States Department of Justice (DOJ)
950 Pennsylvania Avenue, NW
Washington, DC 20530
Disability Rights Section: (202) 514-4713
E-mail:[email protected]
Administrative Complaints - CDSS
California Department of Social Services (CDSS)
Civil Rights Bureau (CRB)
744 P Street, M.S. 15-70
Sacramento, CA. 95814
Or call collect at (916) 654-2107
E-mail: [email protected]
www.dss.cahwnet.gov/cdssweb/PG49.htm
Deadline for Filing Administrative Complaints
180 days from date of discrimination
California Department of Managed Care
For care or services provided by managed care plans: - File Complaint- Ask for Independent Medical Review (IMR)- File for Medi-Cal Fair Hearing
http://www.dmhc.ca.gov/
Disability Rights California isfunded by a variety of sources, for a
complete list of funders, go to http://www.disabilityrightsca.org/
Documents/ListofGrantsAndContracts.html.
CalMHSA
The California Mental Health Services Authority
(CalMHSA) is an organization of county governments
working to improve mental health outcomes for
individuals, families and communities. Prevention and
Early Intervention programs implemented by CalMHSA
are funded by counties through the voter-approved
Mental Health Services Act (Prop 63). Prop. 63 provides
the funding and framework needed to expand mental
health services to previously underserved populations
and all of California’s diverse communities.
