4. Discussion

Ontarians with disabilities, especially people with mental health and addiction disabilities, continue to face disparities on several social and economic indicators compared to people without disabilities. They have a higher unemployment rate, are more likely to be in low income status, have lower educational levels and are less likely to live in adequate, affordable housing.

When controlling by disability type, the results show that people with mental health and addiction disabilities fare worse on most indicators than people with other types of disabilities. However, it is important to consider the complex relationship between these two groups. As the data show, the vast majority of people who report mental health and addiction disabilities (over 90%) also report another disability type. Having a chronic physical condition can be a risk factor for developing a mental health disability and vice versa.[38]

It may be that having a mental health disability or addiction is related to low income, high unemployment, and low education, etc., compared to people with other disabilities or no disability.[39] Alternatively, it could be that the combined effect of multiple disabilities is associated with these factors. Having multiple disabilities may contribute to greater severity of disability overall and barriers in society may be compounded, leading to increased exclusion and discrimination.[40]

However, the relationship between disability and social and economic indicators can be complex. Is it that having a disability contributes to higher unemployment, lower education levels, and low income? Or does having low income, low education levels, poor housing and poor employment opportunities contribute to greater prevalence of disability, including mental health and addiction disabilities? Research indicates that both considerations are important.[41]  

With respect to sample size, because of the relatively small data set in Ontario, the results could not be broken down by sex, age and severity of disability. Age, in particular, is a potential confounding factor. The OHRC could not examine, for example, the prevalence of mental health and addiction disabilities among Indigenous peoples, racialized people and women, distributed across age groups, in comparison with people with other disabilities and people with no disabilities. In a further example, it is not clear whether women in Ontario are more likely than men to report other disabilities because they tend to live longer. Similarly, does the reporting of mental health and addiction disabilities for racialized people differ by age?

[38] Government of Canada, The Human Face of Mental Health and Mental Illness in Canada (Ottawa: Minister of Public Works and Government Services Canada, 2006) at 16; Canadian Mental Health Association, The Relationship between Mental Health, Mental Illness and Chronic Physical Conditions (2008), http://ontario.cmha.ca/public_policy/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/#.VWNyW9LBzGc (retrieved May 25, 2015). See also Oye Gureje et al., “Persistent Pain and Well-Being: A World Health Organization Study in Primary Care” (1998) 280(2) JAMA 147.

[39] For more information on how mental health is associated with various social and economic outcomes see Canadian Institute for Health Information, Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada (Ottawa, Ont.: Canadian Institute for Health Information, 2008); Carolyn S. Dewa & David McDaid,  “Investing in the Mental Health of the Labor Force: Epidemiological and Economic Impact of Mental Health Disabilities in the Workplace,” in Izabela Z. Schultz & E. Sally Rogers, eds., Work Accommodation and Retention in Mental Health (New York: Springer, 2011); Canadian Institute for Health Information, Improving the Health of Canadians: Mental Health and Homelessness (Ottawa: CIHI, 2007); Interim Report of the Standing Senate Committee on Social Affairs, Science and Technology, Report 1: Mental Health, Mental Illness and Addiction: Overview of Policies and Programs in Canada (2004) (Chair: Michael J.L. Kirby) at 50; Government of Canada, The Human Face of Mental Health and Mental Illness in Canada (Ottawa: Minister of Public Works and Government Services Canada, 2006). 

[40] See the calculation of Statistics Canada’s global severity score, supra note 6 at 9. For a review of the impact of severe disabilities on education, employment and other variables, see Human Resources and Skills Development Canada, supra note 16 and Derek Hum &  Wayne Simpson, “Canadians with
Disabilities and the Labour Market” (1996) 22(3) Canadian Public Policy 285. See also section 9.1. of the OHRC’s Minds that Matter report, supra note 1, “Intersections with other types of disabilities” at 30.

[41] Research on the social determinants of health shows that many factors, including unemployment, discrimination, poor housing, and poverty can contribute to poor physical and mental health. See Juha Mikkonen & Dennis Raphael, Social Determinants of Health: The Canadian Facts (Toronto: York University School of Health Policy and Management, 2010) Online: www.thecanadianfacts.org/ (retrieved May 27, 2015) and Beth Wilson, Sick and Tired: The Compromised Health of Social Assistance Recipients and the Working Poor in Ontario  (Toronto: The Wellesley Institute, 2009) Online: The Wellesley Institute www.wellesleyinstitute.com/wp-content/uploads/2011/11/sickandtiredfinal.pdf (retrieved May 27, 2015).