Transcript Overcoming Barriers to Physical Health Care Access for

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
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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
Reduce stigma & discrimination by
- Increasing awareness of laws, policies &
practices that address discrimination &
support mental health services in nontraditional 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
- Delusional
- Insane
- Incompetent
- Disturbed
- Out of control
- Abnormal
- 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
Hope
Personal Empowerment
Respect
Social Connections
Self-Responsibility
Recovery Model
Medical Model
- A diagnosis is a “guide”
for treatment rather than
a “name” for a person.
- A diagnosis is a fact.
- Mental health disabilities
may shape or affect who
a person is, but we are
not defined by our
disability.
- Mental health providers
may refer to people by
their diagnosis.
- People are their disability.
Recovery 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
Medical Model
People with Mental Health
Disabilities:
- Lack insight into their own
disability
- Are unrealistic and
unreasonable
- Need to be taken care of
Recovery Model
Medical Model
- People with mental health
disabilities can and do get
better.
- People with mental health
disabilities can never truly
recover.
- Recovery is unique to
each individual.
- Once someone has a
mental health disability,
they will always have it.
- A person’s recovery can
not be defined or
determined by others.
“…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 or
talking down to people
- Ignoring what people want
- Making decisions for people
rather 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 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 Center
www.power2u.org
- National Self-Help Clearinghouse
www.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 includes
the 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 disabilityrelated 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 is
funded 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.