Saturday, May 19, 2007

The STIGMA in Mental Health is STILL the Same

Did you ever wonder why a student at Virginia Tech would suddenly blow a gasket, take a gun and go around shooting up his school?

How about another fellow who deliberately drank a twelve pack of beer, then walked into a Florida bar with a gun and shot up the establishment?

Of course, you are thinking ... these people have got to be mentally ill. Nobody in their "right mind" would dare to do something like shoot up a school, a bar or a former employer. That is insane!

On the more subtle side, we hear from "experts" that a disproportionate number of people that live on the streets are mentally ill. The implication of course is that such persons cannot stay in housing because they can't manage their money, they say. How about the man that was found in a Toronto apartment building surrounded by pigeons and other wild species - to a point that it got so bad, that the police shuttled him off to a mental health facility and the animal rescue people were called in to get the animals out of there.

Were these people "mentally ill" or is somebody just giving them a label because of their attitudes, behaviour and ideas? Who determined these people were "mentally ill"? Are you "mentally ill" simply because you spent a night in a mental health facility? Nobody knows "Pigeon Man's" mental health history, but they shuttled him off to a mental health facility anyways, so therefore, because he was sent to a mental health facility - everybody now believes that "Pigeon Man" was mentally ill.

How about the rest of the 99.999999% of people who apparently suffer from some type of "mental illness", whether that be anxiety, depression, schizophrenia or obsessive compulsive disorder or a whole whack of other "conditions" that continuously seem to be added year over year to the psychiatric Bible, known as the Diagnostics and Statistical Manual of Mental Disorders, the short term being the DSM-IV? Are all these people like the "Pigeon Man", living among the homeless, or are they like Cho, the infamous Virginia Tech school shooter?

Let me tell you one thing. In a recent report of the Canadian Senate, it was cited that approximately 90% of those who have been diagnosed with serious "mental illness" are unemployed. Whenever somebody with a known "mental illness" wants to move to any neighbourhood, the picket signs go up and the stigma goes full tilt. People scream about the Chos, the Pigeon Men, the bar shooters and all the other horrific characters that are simply part of the 21st Century ... to no avail. People who are open about having a "mental health" history are as good as dead even in 2007.

What is the truth? First, there is NO evidence that people who have been diagnosed with a "mental illness" are any more dangerous than you or me. Second, there is no evidence that people with "mental illness" are any more likely to do stupid, outrageous things than you or me. You point to the "Pigeon Man". I point to Criss Angel, the Mind Freak, who has his own show on A & E, where he has done a string of stupid things, ranging from from lying in the path of a mega-SUV, had himself buried alive in a coffin under a ton of dirt, as well as pretended to walk on water over a swimming pool - all on national TV! We are entertained by Criss Angel, yet nobody carts him off to a mental health facility!

You tell me that people with "mental illness" should be supervised with their money. I point out that I know many well-paid professionals that go to the casino all the time and owe hundreds of thousands of dollars, often resulting in the break-up of their marriages and the loss of their homes. I also know of many individuals who are like you and me who buy a new car every two years, put everything on credit cards, and live the life of envy of most and beyond their means, but yet never get labelled "mentally ill" or told that somebody has to manage their money for them.

What about the homeless, you say? Okay, let's make this one simple and straight forward. Can you manage to pay for a place to live, food to eat and other necessities with a sum total of $536 a month? In most places, this is even becoming difficult to do with an ODSP cheque of almost $1,000 a month. Yes, some of these people may be "mentally ill", but many of them are also physically disabled, blind, suffer from migraine headaches, or not suffer from any conditions at all. Let's be honest about this one. This is an income problem first. Once we resolve the income issue, then we can look at everything else -- too many people with a direct and financial interest in the outcomes of these issues want to put the cart before the horse and receive money for what they do, instead of allowing the people who need it the most to use it to pay for their own needs.

In my line of work, I handle appeals for various kinds of disability benefits among other things. In particular, the appeals I handle for people seeking ODSP benefits are difficult because roughly half of my appellants end up having at least one spell of homelessness while waiting for the government to get their act together. The people that end up homeless have all kinds of disabilities, e.g. very bad backs, multiple sclerosis, arthritis, Parkinson's disease, deaf or hard of hearing, spinal stenosis, cancer, etc. as well as a few that have a so-called "mental illness". In fact, most of my homeless appellants have not had a history of "mental illness". They just have a hard time convincing the peons of government bureaucracy they have a legitimate disability and they cannot compete adequately in today's labour market to sufficiently earn enough money to support themselves on a persistent basis. This has also happened to several of my worker's compensation appellants ... people who held legitimate jobs, but sustained injuries while working that disabled them. The proof is in the pudding. Welfare rates are grossly insufficient for people to live on, let alone maintain a home. Because we often have to fight uphill battles to obtain just about anything else on behalf of these folks, welfare becomes the income of first resort - not last resort - and because this income is grossly insufficient, many fall behind in rent payments and get evicted or lose their homes to forclosure. Some may be able to keep their homes, but end up in a serious debt crisis. I am working with a man who has put well over $75,000 on his credit card in order to prevent what is often inevitable if he were to turn to the welfare system.

Nevertheless, once I do get the appellants on disability and they receive their retroactive back pay, they *are* able to find and secure housing on their own. This includes those with "mental illness", if you must call it that. I don't know of any of my appellants subsequently losing their housing, except for one or two -- one I do recall had an addiction to crack and his behaviour when he was using it caused him to lose one apartment, but nevertheless, he got help (at my urging) and is now housed and has been for the past five years. Yes, these people can and do get housing - however, as I often write in these columns, eating is quite a different matter. This is why a *substantial* increase in social benefits are in immediate order. Third world style malnutrition is not difficult to find among many recipients of social benefits; it's either that or substantially increased health care costs. I know of people who have been forcibly incarcerated in nursing homes because they were unable to afford proper nutrition for themselves and their health suffered the consequences. As a society, we need to consider if we could afford to continue allowing this to happen.

One person once tried to convince me of the alleged inherent stupidity in these folks by telling me that many people on ODSP have to use the direct pay system for their landlords, so that is why they don't lose their housing. That system is actually in place *because* many landlords, upon learning that you are on social assistance, actually demand it. It has nothing to do with the recipient's own ability to manage their funds. I know this because I represented landlords before the Landlord and Tenant Board, which have made arrangements upon the recipient moving in, or as a condition of them staying, to receive direct pay. Some of my ODSP clients also offer this to prospective landlords to make themselves more desirable to rent to ... many landlords still do not like renting to people on any form of public assistance. To add a tidbit to this discussion, the vast majority of people who I helped landlords evict are tenants with jobs, some of whom were making good money. They just don't like to pay rent.

However, in spite of all this, we continue to hear the bells tolling by the so-called mental health sector that want people with "mental illness" to live in segregated housing or to work in jobs created just for them. Despite their goodwill gestures here, this actually adds stigma to the vast majority of people with mental health issues who can and will manage their lives well despite their problems. Many just can't get jobs because people believe the Hollywood images of psychos, or listen too much to the so-called "experts" who have pre-diagnosed people like Pigeon Man and thousands of others through the media before they can turn their lives around. Those people with serious mental health issues that DO get jobs LIE about their histories so they can be hired on the basis of their qualifications only, nor do they DARE ask for accommodations fearing their prospective or existing employers will treat them differently upon learning they have the red scarlet letter on their forehead of "mental illness".

There are other stigma producers, such as those who believe people with "mental illness" all want to live with others who also have"mental illness" or work with them. They create housing that is specifically made for "them", even though none of these people if asked likely will demand this kind of "support" and suffocating lifestyle these set-ups entail. Those in these types of housing are mandated to take their medications, attend counseling sessions and have "life skills" training in areas they likely already do well in. Some of these programs will actually evict someone if the resident chooses to stop taking their medications, for example. To me, this is not a "home". They may as well remain in the hospital with regards to the choices they are given under these circumstances. If one desires supports, they should NEVER be connected to the home they live in and only be delivered by whomever one chooses and in the manner and to whatever extent is desired by the person. This would be no different than somebody who - for example - requires assistance with bathing three times a week and help with light housekeeping, but can manage most other aspects of their lives. These other supports are provided to people because they request them, not because somebody else says they need them.

People with mental health conditions often get sent to work in settings that are disproportionately within the five "f's" - food, filth, filing, fetching and flowers, regardless of the person's own education, training and career aspirations. Some of these settings are non-profit groups ironically set up by other consumer/survivors, as they call themselves today, that will hire people for a few hours a week in these jobs that also smack of stigma. Only a handful of people who work in these places actually hold higher-paid, full-time management positions, while the vast majority remain on their disability pensions, which these organizations ultimately leave out of the picture when they make their calculations of costs for the purposes of marketing their programs, what their actual costs are versus what subsidies they actually get. To me, ODSP subsidizes these programs just as much as any other government funding it receives if people are not likely to get off their pensions or reduce their reliance substantially in a dignified manner. Further, if you or I have a disability and run our own businesses, why are WE not *also* entitled to the same government subsidies these people get?

The real clincher is if somebody worked for one of these places for a number of years and wants to move on, despite any valuable skills and experience they may have gained, they are forced by identifying the name of the employer to disclose to *all* prospective employers that they were diagnosed with a "mental illness". I continue to advise my clients NOT to disclose to employers their mental health history and ONLY disclose this fact AFTER they get hired and ONLY IF they feel they require certain accommodations under the Human Rights Code. In circumstances where job seekers are moving on from these "special programs", they are not given the dignity of this choice. Wearing the scarlet letter almost guarantees a lifetime of unemployment, particularly for those who were not in management or supervisory positions (who may otherwise try to hide behind that fact, because many employers don't think "mentally ill" people are capable of working in higher level jobs anyways).

The chance that a person with a known mental health condition getting hired in a supervisory or management position is slim because when people believe the stigma that people with "mental illness" are unable to manage their own money, how can they handle the money of somebody else or that of an employer? Even those who have been trained and established in a profession have difficulty finding work for employers that would hire somebody in that profession, because again - people cannot envision the possibility that somebody with a "mental illness" is capable of working in a profession, let alone holding a low level job. Remember, they are all homeless, cannot manage a budget, babble to themselves as they walk down the street and don't know any better, right? That is why I am so emphatic about HOW people - including many advocates - express themselves about the circumstances of persons with mental health issues.

As long as the media continues to publish stories about people like "Pigeon Man", the legions of homeless get diagnosed long distance via the media as being "mentally ill", and people like Cho who shoot up schools get labeled as crazy, people with "mental illness" will never be thought of in any other other way. Even those who put forth so called "positive stories", such as a non-profit cleaning company for example that hires only "mentally ill" consumer/survivors, can also plant ideas in people's minds that folks who have been through experiences that society deems to be "mental illness" can only do jobs that fall within the five f's - food, filth, filing, fetching and flowers, and forget ever hiring them to do anything in management or other positions that might actually get them OFF disability and securely housed, let alone actually *own* a home for Christ's sake. Scary.

As a result, society relies on its non-existent social safety net to support these individuals, as nobody seems to want to hire them. Those who are not lucky enough to get on ODSP must survive on a total of $536 a month ... try getting even a hole in the wall for that amount of money almost anywhere. If they get on disability, they usually spend at least 70% of their cheques on shelter, leaving very little left over for food, transportation and personal care. Then, if they have trouble keeping their housing because their income is so low, then we blame them for being poor money managers. If any "middle class" person had to survive on what they get, I am sure they'd have lots of trouble too. But instead, because we want to keep the possibility of homelessness and destitution as far away from our own lives as possible, we try to convince ourselves that the homeless are different people than what we are. So different, that we are willing to shame those who are different into believing their differences is what causes them to suffer their misfortunes - and while doing so, we are only further denying the problems that we and the governments we elect have created. Shame, shame.

Saturday, May 12, 2007

Disability Must NOT equal Poverty

People do not ask to become disabled.

They do not wake up one morning and tell themselves, "Hey, today I'm going to get hit by a bus" or "Hey, maybe I will stand in front of that burning refinery and inhale the air and hope to contract lung cancer." Seems silly, right? However, many people in our society like to believe that those of us who are disabled are actually either faking their conditions or were at least in part responsible for them. Hey, uncle Joey ate himself to balloon to four hundred pounds so it is HIS fault he had a heart attack and can no longer work. Aunt Ellie smoked two and a half packs of cigarettes a day, so is it not HER fault she got lung cancer? Maybe I have trouble with these same people suing fast food companies or tobacco industries for their supposed misdeeds of promoting and selling a legal product, but I DO have trouble when the assumption that often follows is that it is the person's own fault ... so in order to provide equitable retribution by our society, it seems that it is alright to force these same people to live in endless and perpetual poverty.

I DO think if we are going to assign blame for these people's situations, then we should ALSO assign blame to those who drive motor vehicles, as they have a far greater chance of becoming involved in an accident than those who use public transit or bike their way through town. We should also blame wealthy businessman who have two martini lunches for the eventual damage to their own livers. How about those who vacation to the sunny south a lot or use tanning beds for the eventual spread of melanoma? How about we in general blame anybody who lives in a large city because they inhale pollutants and become sick as a result? This blame game can become perpetual and can and will encompass us all. Nor is it very productive. Those among us who are unfortunate to lose their ability to create their own wealth or earn it become poor - period. This is because our country has made the conscious choice of not providing a meaningful social safety net to protect them from poverty.

You may think poverty isn't so bad. The people next door to you who are getting by on welfare have a television set, their kids have clothes and compared to those underdeveloped fat-bellied children we always see in commercials about poverty in Africa, we actually delude ourselves into believing that poverty is only a state of mind here in America. However, poverty is an insidious and hidden destroyer of community unity and various publicly-funded budgets, such as health care, education, policing, corrections and other services that we ALL pay for through our tax dollars. Think your taxes are too high now? Think again, as the costs of health care triples, the cost of policing and corrections double as we need to build more prisons and hire more police officers to protect the rest of us from desperate people who will try to make money any way they can ... and our education costs go up, because well-documented studies have shown that children from low-income families require substantially more resources just to obtain a basic education than children from middle and upper income families. Mental health and cognitive conditions such as ADHD, depression, learning disabilities and so-called "developmental delays" occur more frequently among children of low and modest means than the children of the so-called middle and upper classes. If you ask any teacher, they can accurately tell who the poor children are in their classrooms just by the prevalence of these issues. We are paying a FORTUNE to keep one in five among us in poverty! Now, we know that accepting and maintaining poverty is everybody's business, let's move on.

Poverty means a whole lot to many people. That usually means they can no longer live in the living accommodations they have, even if they stayed there for years. They will have to find cheaper accommodations if such a thing exists in their communities. A family of four that once earned a comfortable income of $45,000 to $50,000 a year, now makes less than $20,000 a year. They will have to give up the car, which for many in non-metropolitan communities, means not having a job or being stuck in the low-paid job syndrome this causes. They will have to deplete any retirement savings they have created for themselves before they became ill. If they remain on government benefits, they will likely carry nothing to their retirement age and we will be supporting more and more seniors living in poverty as the years pass. For many, poverty means they will not be eating very much and if they do, not very well. Poverty is linked to obesity and malnutrition. I know of people that have less than $50 a month for food for themselves, and while they can supplement this amount by going to a food bank here (which is only possible every two months), it is impossible for them to obtain the types of food that will keep them healthy. Most eat a disproportionate amount of starch and other unhealthy forms of carbohydrates, which for many, only lead to weight gain. I know many people in poverty that are morbidly obese. Four times as many poor people get diabetes than those of middle and upper means. Poverty is a degrading and painful process, which can and will kill, but not without years of expensive debilitation first.

For the children, they often cannot relate with the other children in their schools. Children who have lived most of their lives in poverty do not know what it is like to go on a family vacation, have a family car to take a road trip in, or to even participate in extracurricular activities, such as sports, music, theatre and dance. All this mish-mash about "over-scheduled children" means NOTHING to them. These children cannot go on field trips with their classmates and some have to resort to wearing hand-me-downs from an older sibling or a cousin. These things do not go unnoticed by other children, who often shun and ostracize them. Poverty is just another reason to bully another child. As a result of many of the effects of poverty, many of these children drop out of school or require special educational interventions which cost you and me taxpayer LOTS of money. In the meantime, their parents can't climb out of poverty. For a growing segment of the poor, class mobility is impossible.

Many people think that if people just went and got themselves a job, they would get out of poverty. According to food banks, more and more users are working full-time, all year. Minimum wages have not kept up with the cost of living. It is cited that those in receipt of ODSP, an average of 73% of their monthly income is required to maintain their housing. Many working poor are just one paycheque away from living on the streets. For people with disabilities, the climb out of poverty is much harder. Most employers and even many agencies that work with persons with disabilities assume that disabled people are only capable of performing low-level, repetitive tasks for employment and are incapable of doing work that usually gets better remuneration. There is an assumption that people with disabilities want to remain on their pensions and only to work a few hours a week to supplement what they receive. This assumption costs a LOT of money for you and me in higher taxes, because the longer a person lives with a disability in poverty, the more complex and more expensive medical care they will require. Many people who were previously capable of living independently with the right help are now stuck living in nursing homes or other over-institutionalized facilities because they can no longer remain healthy eating less than a couple of dollars a day worth of food.

Agencies often ignore the education and career aspirations of those they work with as they attempt to make more low-wage, entry-level placements to contribute to their "success" stats. Government agencies that fund them are complicit in the way that only placements, not quality of placements, count towards success. I know no less than five individuals with disabilities who have been trained and once licensed to practice law as a lawyer. All five are now on ODSP. I know several teachers, social workers, a dental surgeon, a PHd holder, two engineers, a couple of electricians and a former professional mechanical contractor, all of whom are ALSO sitting on ODSP. To me, this is disgusting! One of them was referred to a job at Wal-Mart to stock shelves at a midnight shift; another was referred to work in a scrapyard. Others were simply refused support because the funding formula for agency service providers makes it impossible to help their clients achieve success beyond the minimum call centre type job. Call centre jobs are only a valuable resource for those individuals who are able to keep their eyes on two or three different tasks at the same time, not necessarily good for somebody who is taking a lot of medications for example.

I wrote an Open Letter to Madeleine Meilleur, Minister of Community & Social Services and Minister Responsible for Persons with Disabilities, last March. Among other things, I did ask her if she would -- after she left politics -- accept a job that paid her $8 - $10 an hour, despite the fact she is trained as a labour lawyer and has substantial political and administrative experience. If she wouldn't, why should she expect that persons with disabilities that have similar training and experience accept these types of jobs? The fact of the matter is even if ALL persons with disabilities that can and want to work accepted these types of jobs, not a single one would move out of poverty. They would make the shift from the welfare poor to the working poor, which in my eyes is NOT an improvement. These people would still suffer from all the issues I described above regarding paying high housing costs, and not having money to give their kids a life beyond poverty and stress, etc. They would also not be able to save for retirement and the chances are 100:1 or even 1000:1 that the employer has no retirement pension plan of its own to offer these workers.

Maybe the trained lawyers, social workers and teachers, etc. in my life that are on ODSP or even worse, Ontario Works, may not be able to return to their former professions. However, sending them to Wal-Mart or a call centre is a very poor use of their education and transferable skills. If a person used to make $80,000 a year in their job before they became disabled and now make just over $10,000 a year, this definitely has to hurt a lot more than it does for those who have always been poor and were sort of comfortable that way. It is hard to get stats for this type of thing, but I read that 40% of those on Ontario Works in Toronto are highly educated and the employment supports offered by that program are totally inadequate for this group. Among persons with disabilities, about a third have post-secondary education ... and I am sure this is reflected in the ODSP rolls, although a good FOI request should be able to confirm this. Employment Supports under ODSP, as they are now administered, will not help this group one iota. These people are not interested in working at Wal-Mart, Tim Horton's or at some call centre that will likely fire them once they learn the person has a disability (e.g. yes, call centres are that cruel -- I am aware of numerous successful lawsuits and/or substantial settlements that arose from legal actions that have arisen from these issues). Agencies that wish to work with this group *must* develop the skills and contacts necessary to help make good things happen for this population ...

There are many reasons why people with disabilities are disproportionately poor, some of which has already been raised in this tome, but here is a summary in my view -- all a result of policy choices that were made by successive governments at a federal and provincial and to some extent, municipal levels, over the years:

1. Job discrimination/employers unwilling to accommodate various

2. Lack of a social safety net -- people coming into my office were
often forced to access Ontario Works assistance of first resort, not
last ... and as a result, by the time they get to my office, they have
lost their homes, cars, savings and in many cases, their families

3. Lack of a social safety net for people who cannot work at all or
only a little

4. A shift in the economy towards low-paying, no-benefits, unstable
jobs ... many of which will not or cannot accommodate persons
with disabilities (e.g. some have told me they don't have to adhere
to human rights laws and the employee can only fight this if they
had the resources to start legal action)

5. A mean streak in the social service system, which allows
bullies to operate unchecked (e.g. I am aware of a number of
employers that people are still being sent to that have abused
employees on OW or spouses of ODSPrecipients, only to be
told if an employee reports them or quits, the employer will
report to OW or ODSP theyhave been fired with cause to
enforce the "quit/ fire" rule that may lead to a loss of benefits
for 3 - 6 months)

6. Employers that continue to ignore the Human Rights Code
with abandon, by requiring all candidates to have a driver's
license and reliable vehicle (something most people on OW/
ODSP don't have and many people with disabilities are medically
restricted from driving)

7. The lack of a coordinated effort to assist people with
disabilities with varying levels of education and transferable
skills to get jobs that better reflect their skills and work histories

8. Professional regulatory bodies that impose huge fees for licenses
to practice, or standards of conduct that may infringe upon the
abilities of a person with a disability that is otherwise qualified,
from registering and qualifying

9. Attitudes/stereotypes exist in anybody from employers to licensing
bodies to employment agencies to even some peers with disabilities
that people with certain types of disabilities are only able to do low-
level, repetitive boring work and that people with these kinds of
disabilities are less responsible than able-bodied

10. Government policies that prevent people from having incentives
to take jobs, particularly for those thatlive in low-rental housing

There are lots of solutions attached to the above problems, but whenever these solutions are played out before the powers that be, we are told the government is doing SO much to help people with disabilities ... like a 2% increase is really going to help when inflation this year is pegged at 2.6% and we're already on average spending 73% of our incomes on housing costs.

Until my country begins to see these problems for what they are and starts to address them in an intelligent way, I will be embarrassed to carry a Canadian passport if I ever get to travel to any of the Western European countries, in particular, whose economies are worse off than ours, yet they manage to take care of their people and maintain a much lower unemployment rate.