It is well established that some groups (or populations) in society experience social and economic disadvantage – inequities – due to the unequal distribution of power, wealth and resources. The social determinants of health both determine and deepen inequities.
Inequities contribute to poor physical and mental health, making it difficult to access the resources needed to be, get and stay healthy (Braveman and Gruskin, 2003).
CMHA Ontario and partners identified social inclusion, freedom from discrimination and access to economic resources as the three most significant determinants of mental health in Ontario in Mental Health Promotion in Ontario: A Call To Action. All three determinants are key components of equity.
Equity issues impact mental health in three important ways:
1. People with lived experience of mental health issues experience a range of inequities including stigma, discrimination and social exclusion.
2. All marginalized groups in society are at greater risk for poor mental health and, in some cases, mental health conditions, due to the social determinants of mental health, especially discrimination, violence, social exclusion and poverty (Keleher and Armstrong, 2006).
3. People with lived experience of mental health issues facing added layers of marginalization experience stigma, discrimination and exclusion on the basis of mental health, but also face added challenges due to other layers of disadvantage (CMHA Ontario, forthcoming)
Health inequities may be experienced by:
- Aboriginal, e.g. First Nations, Métis, Inuit peoples
- Age-related groups, e.g. children, youth, seniors
- Disability, e.g. physical, Deaf/deafened or hard of hearing, visual, intellectual/developmental, learning, mental health, addictions/substance use
- Ethno-racial, e.g. racial/racialized or cultural minorities, some immigrants and refugees
- Francophone populations, including new immigrant francophones, deaf communities using French or Quebec sign language (LSF or LSQ) etc.
- Homeless, marginally or under-housed people
- Linguistic communities, e.g. people not comfortable receiving services in English or French or whose literacy affects communication
- Low-income, underemployed or unemployed people
- People in contact with the law
- Religious/faith communities
- Rural/remote, inner-urban populations, e.g. geographic isolation, social isolation, under-serviced areas
- Sex/gender e.g. women, trans, transsexual, transgendered, two-spirit
- Sexual orientation, e.g. lesbian, gay, bisexual
- Other populations, depending on context and issue
Adapted from the Ministry of Health and Long-Term Care, 2012.
How CMHA Ontario is addressing this issue
Advancing Equity in Mental Health is one of CMHA Ontario’s 2010-2013 strategic directions.
Equity and Mental Health Framework
Although there is evidence that equity issues significantly impact mental health, with growing momentum to take action, there is currently no framework to address equity issues in the mental health context. CMHA Ontario is developing a framework to conceptualize equity issues in the mental health context and mental health issues in the equity context by defining key concepts, identifying priority populations, and offering high-level options for action.
In May 2014, CMHA Ontario launched Advancing Equity in Mental Health in Ontario: Understanding Key Concepts. This discussion paper seeks to increase understanding and dialogue within Ontario’s health system by creating a common language for talking about equity issues in mental health.
Following the launch of the discussion paper, CMHA Ontario will convene key stakeholders from the mental health, health and community sectors to plan action in five strategic areas: Embedding equity in provincial mental health policy and planning; expanding the evidence-base for equity issues in mental health; fostering collaboration with people with lived experience of mental health issues and other marginalized populations; building healthy communities by taking action to address the social determinants of health; and challenging discrimination, stigma and social exclusion.
Community of Interest for Racialized Populations and Mental Health and Addictions
CMHA Ontario plays a lead role in the Community of Interest for Racialized Populations and Mental Health and Addictions, a provincial forum for knowledge exchange and collaborative knowledge creation about racialized populations and mental health and addictions. The COI’s goals are to strategically leverage existing or emerging evidence to improve provincial, LHIN and provider policy, planning and practice related to racialized populations and mental health and addictions; share innovative knowledge and practices; and convene a critical mass of stakeholders to identify and respond to crucial issues impacting racialized populations.
The COI’s initial focus is on increasing knowledge about mental health and addictions-related use of emergency departments (EDs) by racialized populations in Ontario. On March 26, 2013, the CoI held a Think Tank on Mental Health & Addictions-Related Emergency Department Use by Racialized Populations in Ontario. The purpose was to promote knowledge sharing and stakeholder dialogue. Over 100 participants from across the province attended in-person and virtually. The recordings of the webinar, which was broadcast live, and materials from the day are available online.
The COI is a collaboration between the following organizations:
- Across Boundaries: An Ethnoracial Mental Health Centre
- Addictions and Mental Health Ontario
- Canadian Mental Health Association, Ontario
- Canadian Mental Health Association, Toronto
- The Centre for Addiction and Mental Health (CAMH)
- Community Resource Connections of Toronto
- Ontario Peer Development Initiative
- Ryerson University
- Wellesley Institute;
- Women’s Health in Women’s Hands Community Health Centre
- Working for Change
Health Equity Racism Ontario (HERO)
CMHA Ontario is a Steering Committee member of HERO, a coalition of organizations across Ontario working collaboratively to promote the health and well-being of communities facing systemic racism by addressing barriers to achieving optimal health.
In November 2012, HERO partnered with CMHA Ontario’s Minding Our Bodies initiative to hold a forum about equity, mental health, physical activity and healthy eating in Ottawa. Visit the Minding Our Bodies website to access the presentations and resources from the forum.
Building Capacity for Equity in Health Promotion
CMHA Ontario was a Steering Committee member of this partnership initiative which was funded through the Healthy Communities Fund of the Ontario Ministry of Health Promotion and Sport. The project tackled inequities in health experienced by racialized communities, especially low income communities.
The specific areas of focus were healthy eating/food security, physical activity and mental health promotion. Key project activities included convening five conferences across the province and producing a literature review, titled Health Equity and Racialized Groups, and a resource guide, titled Addressing Health Inequities for Racialized Communities.
Supporting Health Equity Impact Assessment
CMHA Ontario is supporting the Ministry of Health and Long-Term Care’s to promote use of a Health Equity Impact Assessment tool in Ontario’s health system, with a focus on enhancing applicability and promoting use of the tool in the community mental health context. In early 2017, CMHA Ontario developed the HEIA Mental Health and Addictions Tip Sheet to help consider and integrate mental health and addictions issues when completing the HEIA tool.
On July 17, 2014, CMHA Ontario partnered with the Ministry of Health and Long-Term Care (MOHLTC), Health Nexus and CMHA Toronto to offer a training webinar about Using the Health Equity Impact Assessment (HEIA) Tool in Community Mental Health. The webinar was recorded and can be viewed for free at any time. Read more about the webinar in the Knowledge Exchange section of our website.
Advancing equity for persons with lived experience of mental health issues (PWLE)
CMHA Ontario continues to provide policy advice and research on equity issues impacting persons with lived experience of mental health issues through submissions, backgrounders, and policy papers. Areas of work include access to services, human rights, disability accommodation, the justice system, housing, income and employment.
Mental Health Works is a nationally available program of CMHA that builds capacity in workplaces to provide disability accommodation for PWLE and address mental health issues in the workplace.
In 2017, CMHA Ontario developed the HEIA Mental Health and Addictions Tip Sheet to help consider and integrate mental health and addictions issues when completing the Health Equity Impact Assessment tool.
In 2014, CMHA Ontario launched Advancing Equity in Mental Health in Ontario: Understanding Key Concepts. This discussion paper seeks to increase understanding and dialogue within Ontario’s health system by creating a common language for talking about equity issues in mental health.
CMHA Ontario collaborated with Rainbow Health Ontario to develop a fact sheet on LGBT mental health.
CMHA Toronto’s Opening Doors Project provides free workshops to newcomer communities, mental health survivors, mental health service providers, agencies and organizations about mental health, equity and diversity. Visit their website for more information and a video about migration and mental health.
In 2012, the Ontario Human Rights Commission released a report, Minds That Matter: Report on the Consultation on Human Rights, Mental Health and Addictions, on its consultations across Ontario to better understand human rights issues impacting PWLE. This report provides an overview of human rights issues facing PWLE in Ontario.
In 2009, the Mental Health Commission of Canada released a report entitled Improving Mental Health Services for Immigrant, Refugee, Ethno-cultural and racialized groups that identifies key issues and options to improve service delivery for these populations.