Overcoming Barriers to Physical Health Care Access for People with Mental Health Disabilities. Learning Objectives. Explore impact of stigma & discrimination on people with mental health disabilities.
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Overcoming Barriers to Physical Health Care Access for People with Mental Health Disabilities
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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.
-Identifying laws that contribute to stigma and discrimination & writing policy papers that recommend needed policy changes to reduce or eliminate stigma & discrimination.
Different Cultural beliefs about people with mental health disabilities:
Attitudes and beliefs, based on stereotypes, that lead people to reject, avoid, or fear those they perceive as being different
1. Public Stigma
2. Institutional Stigma
3. 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.
- Out of control
- Low Self-Esteem- Isolation- Feeling Devalued - Social Rejection- Shame
- 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.
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
Medical ModelMental health assessments and diagnoses too often focus on weaknesses and problems rather than addressing a person’s strengths, interests and goals.
-A diagnosis is a fact.
-Mental health providers may refer to people by their diagnosis.
-People are their disability.
-Mental health disabilities may shape or affect who a person is, but we are not defined by our disability.
People with Mental Health Disabilities:
-Lack insight into their own disability
-Are unrealistic and unreasonable
-Need to be taken care of
-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:
-Don’t know themselves as well as mental health providers know them.
Don’t know what’s “best” for them.
-Know themselves best in terms of what they think, feel and experience.
-Choose what’s best for them based upon information, guidance and support.
-People with mental health disabilities can never truly recover.
-Once someone has a mental health disability, they will always have it.
-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.
“…hope is one of the most valued ingredients in theprofessional/client relationship and the strongest predictor of positiveoutcomes.”- Mood Disorders Society of Canada
-Disrespecting, patronizing ortalking down to people-Ignoring what people want-Making decisions for peoplerather than helping them make their own
-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
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
Access to health care includesthe rights to access facilities, services, and information offered by doctors’ offices, other health care providersand insurance plans.
Americans With Disabilities Act
T.II: Public Facilities & Services
T.III: Private Facilities & Services
Rehabilitation Act, Section 504
Facilities & Services Receiving Federal Funds
Similar State Laws
California Unruh Act
1. Full and equal accessto 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.
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.
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.
Allowing a support person in a medical examination or consultation;
Scheduling an appointment at a specific time;
Taking extra time for a consultation.
ADA allows service animals – but not emotional support animals - to accompany people with disabilities to medical appointments in public or private facilities.
-Provides comfort to a person with a mental health disability.
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
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
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
United States Department of Justice (DOJ)
950 Pennsylvania Avenue, NW
Washington, DC 20530
Disability Rights Section: (202) 514-4713
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
180 days from date of discrimination
For care or services provided by managed care plans:
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.