Network, Summer/Fall 2004
What defines a disability? When we think of being disabled, we often think of people who use wheelchairs or other assistive devices for their physical needs. But mental illness can also be included within the definition of disability.
Severe mental illnesses in particular can be very disabling. Karen Liberman, executive director of the Mood Disorders Association of Ontario, says that severe forms of mental illness can prevent a person from participating fully in various activities of daily living.
Ursula Lipski, policy and research coordinator for the Schizophrenia Society of Ontario, agrees. She very much considers schizophrenia to be a disability, explaining that the illness can impair a person’s ability to complete their education, hold down a job, or manage their household. Even maintaining personal hygiene can become problematic at times. Schizophrenia affects the way people think and perceive the world around them, Lipski says, and they may be behind developmentally in the long-run. “Even when people do move on to recover, they may not recover fully to the point they were at before they became sick.”
When mental illness affects someone’s ability to work, defining the illness as a disability becomes necessary to ensure that they get the accommodations they need, says Mary Ann Baynton, director of Mental Health Works. Accommodations are necessary when the illness affects a person’s ability to complete the essential tasks of their job. For example, if a person has depression and takes medication that prevents them from being at work at 8:30 in the morning, they may need an accommodation if their job requires them to be there at that time. Mental Health Works, a project run by the Canadian Mental Health Association, Ontario, helps employees and employers to understand the issues of mental illness in the workplace, as well as their rights and responsibilities under the law.
According to both the Ontario Human Rights Code and the Ontarians with Disabilities Act, 2001 (ODA), the definition of a disability includes “a condition of mental impairment or a developmental disability, a learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language, [or] a mental disorder,” among other conditions. The Canadian Human Rights Actdefines a disability as “any previous or existing mental or physical disability, [including] disfigurement and previous or existing dependence on alcohol or a drug.”
David Schatzky, a psychotherapist who runs a private practice and a clinical member of the Ontario Society of Psychotherapists, says that it can be helpful if managers know that they are dealing with a disability. “If it’s known that [mental illness] is their disability, the workplace may be able to make some allowances for that person,” he says.
Baynton explains that people can manage their mental illnesses, but they may need some adjustments in their work routine or workplace environment. She says that employers need to be flexible and creative when negotiating accommodations for people with mental illness, and that may involve training people to communicate in a different way.
There is often a misunderstanding of mental illness in the work environment, says Schatzky. “I think there’s less tolerance and understanding of how disabling a mental illness can be.” Rather than being supported, says Liberman, some people with a mental illness have been fired when they’ve disclosed.
Mental illness is often confused with character flaws. It can be mistaken for lack of integrity or weakness of character, and people who are mentally ill are often misunderstood as having a bad attitude, being lazy or simply being a bit strange.
In the struggle to educate employers and the public, some say there is much to be learned from people with physical disabilities. The disability rights movement and disability community have been around for a while, and they have gained significant ground. People with mental illnesses need to speak up for themselves and their needs rather than having their caregivers speak for them, says Liberman.
She also believes that people in the mental illness community need to become clearer in their use of language. “In the mental illness world, we kind of blither and blather,” Liberman says, “and we say words like ‘mental health issues’ and ‘mental health and mental illness,’” The community does itself a disservice by not using clear language, she explains, because people aren’t sure whether or not they want to be taken seriously.
These two communities are perceived very differently. Liberman says that there is more inherent sympathy for people with physical disabilities, whereas mental illness has more stigma attached to it. There are many who falsely believe that people with mental illness are more likely to do harm or be violent, or that they did something to bring the illness upon themselves.
As a result, Liberman says that her clients have faced every kind of discrimination, from being rejected at jobs to being unable to qualify for income support. “As soon as they disclose that they have a mental illness, doors shut in their face,” she says. Employers and the public need more education about the physiological side of mental illness, she says.
The issue is complicated by the fact that the symptoms of some mental illnesses can be cyclical. People with a mental illness can go through a period of relative stability and then enter into a depression or mania (in the case of bipolar disorder). This makes it more difficult to access disability benefits, for example. Liberman says that if a person with a mental illness presents to a case worker in a time of stability, the worker may not think anything is wrong. “And so that worker says, ‘What’s the problem here? You’re not depressed, you’re not high, why can’t you work?’”
If people with mental illnesses were not included as people with disabilities under the law, Liberman believes they would be ignored.
James Buchanan provides a good example of how benefits for people with mental illness can be difficult to obtain. Buchanan has bipolar disorder. As a result of his illness, explains his wife Lembi, he can’t manage his own finances. On one occasion, he used their rent money to go see his favourite opera in Washington. He is also unable to handle any amount of stress. In 1990, he had a serious relapse and was hospitalized. He has never fully recovered from that episode.
From 1990 to 1995, Buchanan qualified for the federal disability tax credit, a credit to offset some of the expenses incurred as a result of disability. But Buchanan was told he did not qualify for the credit for 1997 and 1998. When Buchanan’s doctor filled out the Disability Tax Credit Certificate, Form T2201, he answered yes to the question asking if Buchanan could perceive, think and remember. He indicated that Buchanan would be permanently markedly restricted, but he also indicated that the impairment was not severe enough to restrict the activities of daily living, as defined on the form.
The disability tax credit helps with the cost of Buchanan’s medications, which can be very expensive. Lembi says they do get coverage from the Ontario Trillium Drug Plan, but their deductible is almost $2000. “We do get assistance, but we have to pay a lot of the drug costs ourselves,” she says.
She says that the wording of the question was inappropriate because even when her husband is delusional, he is still thinking. The question would have been more appropriate if it had asked if the person’s ability to perceive, think and remember was impaired.
Defining mental illness as a disability is more difficult because the condition is less visible than physical impairments. “We can’t measure mental illnesses, we can only talk about what kind of impact the mental illness has on an individual’s ability to carry on day-to-day living,” Lembi says.
The Buchanans went to the Tax Court of Canada in May 2001. Judge Diane Campbell said that Buchanan was markedly restricted within the definition used by the Income Tax Act and his impairment was severe enough to qualify for the tax credit. She also said that although Buchanan is very capable in a number of ways, he would be unable to live independently without the support of his wife. The judge ultimately ruled that Buchanan’s appeal be allowed for the 1997 and 1998 taxation years.
The Disability Tax Credit Certificate, Form T2201, was revised for the 2003 taxation year. Among other changes, the form now provides more information about determining the eligibility of people with mental illnesses and puts more emphasis on the effects of a person’s condition.
Despite the benefits of accessing financial support and getting workplace accommodations, some people with mental illness react against the idea of defining their illness as a disability. Baynton says that people may be hesitant to identify themselves as having a disability because they don’t want to be labelled. “All people resist being labelled because we don’t want to be boxed in, to be said we are something when we are someone,” Baynton says.
But Liberman sees it differently. She says that once people learn to deal with the illness, the fact that it’s a disability is a small issue. Lipski points out that the willingness of people with schizophrenia, as well as their families, to accept the illness as a disability depends on their willingness to accept the illness itself. “With both consumers and family members, some are really clear that this is very much a disability. Others have a harder time accepting that,” Lipski says.
Fear of stigma and fear of discrimination may play a big part in how people define themselves. Schatzky says that there is a difference between the two words. Discrimination occurs when someone is actively treated in a negative way because of their difference, while stigma is the feeling a person has of being seen as different or flawed. He says that it is possible for a person to feel stigmatized even though they are not being discriminated against.
There’s no doubt that having a positive self-image is important, especially for people with illnesses. But when it comes to activating and protecting legal rights, and preventing discrimination, the need to define mental illness as a disability becomes clear.
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