Transcript Title of Slide Show - Disability Rights California

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.
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
- 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.
Medical Model
- A diagnosis is a fact.
- 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
People:
- Know themselves best in
terms of what they think,
feel and experience.
- Choose what’s best for
them based upon
information, guidance and
support.
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.
Recovery Model
- 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.
Medical Model
- People with mental health
disabilities can never truly
recover.
- Once someone has a
mental health disability,
they will always have it.
“…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 disability-related
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/
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.