overcoming barriers to physical health care access for people with mental health disabilities
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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

Overcoming Barriers to Physical Health Care Access for People with Mental Health Disabilities

learning objectives
Learning Objectives
  • Explore impact of stigma & discrimination on people with mental health disabilities.
  • Discuss legal issues regarding access to physical health care for people with mental health disabilities.
  • Develop strategies for reducing stigma and overcoming health care access barriers for people with mental health disabilities.
overview of training agenda
Overview of Training Agenda
  • Introduction
  • Stigma & Discrimination
  • Effects of Stigma
  • Models of Treatment: Recovery v. Medical
  • Actions that Discriminate
  • Strategies for Reducing Stigma and Discrimination
  • Legal Issues

Feel free to ask questions at any time!

drc sdr project goals
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 goals1
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.


Different Cultural beliefs about people with mental health disabilities:

  • Inspired………………Possessed
  • Respected……………Rejected

- Different………………Abnormal

what is stigma
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
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
Types of Stigma

1. Public Stigma

2. Institutional Stigma

3. Self Stigma

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
Stigmatizing Language

- Crazy

- Insane

- Disturbed

- Abnormal

- Delusional

- Incompetent

- Out of control

- Dependent

effects of stigma
Effects of Stigma

- Low Self-Esteem- Isolation- Feeling Devalued - Social Rejection- Shame

effects of stigma1
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.


“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.

Medical ModelMental health assessments and diagnoses too often focus on weaknesses and problems rather than addressing a person’s strengths, interests and goals.

Recovery Model

Medical Model

- A diagnosis is a fact.

- Mental health providers may refer to people by their diagnosis.

- People are their disability.

  • 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.

recovery model medical model
Recovery ModelMedical Model


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

Recovery Model

Medical Model

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.

Recovery Model

Medical Model

- 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 or talking down to people- Ignoring what people want- Making decisions for people rather 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

health professionals are consultants whom clients rely on for information guidance and support
Health professionals areconsultants whom clients rely on for information, guidance and support.
Be conscious of the power of diagnosis and the labeling process – this might also contribute 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 promotea sense of autonomy, counteract stigma and promote effective treatment.
access to health care
Access to Health Care

Access to health care includesthe rights to access facilities, services, and information offered by doctors’ offices, other health care providersand insurance plans.

disability discrimination laws
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
Legal Protections for People with Disabilities

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.

examples of potentially discriminatory conduct
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
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
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
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
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
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
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
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
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 services1
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


how to address discrimination by health care providers
How to Address Discrimination By Health Care Providers
  • Talk to the provider directly or through Ombudsman.
  • File complaint with provider’s ADA/504 Compliance Officer.
  • File administrative complaint.
administrative complaints ocr
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


administrative complaints doj
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
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]


deadline for filing administrative complaints
Deadline for Filing Administrative Complaints

180 days from date of discrimination

california department of managed care
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




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.