A significant theme in the consultation was how a person’s identity, based on mental health or addictions, intersects with other Code-related aspects of identity (such as race, sex or age), which can be the basis for unique or distinct forms of discrimination. People told us it was much harder to get a job, housing, or services because of discrimination based on two or more Code grounds. For example, we heard that young African Canadian men with a psychiatric disability find it harder to get housing due to stereotypes related to race, age, gender and disability.
Many people spoke of the effects of discrimination, harassment or negative stereotypes on a person’s mental health. They pointed to the profound systemic – including physical and mental health - impacts of longstanding discrimination and social exclusion on marginalized communities. The World Health Organization says:
…Vulnerability can lead to poor mental health. Stigma and marginalization generate poor self-esteem, low self-confidence, reduced motivation and less hope for the future. In addition, stigma and marginalization can result in isolation, which is an important risk factor for future mental health conditions. Exposure to violence and abuse can cause serious mental health problems, including depression, anxiety, psychosomatic complaints, and substance abuse disorders. Similarly, mental health is impacted detrimentally when civil, cultural, economic, political and social rights are infringed, or when people are excluded from income-generating opportunities or education.
The Empowerment Council – clients and ex-clients of the Centre for Addiction and Mental Health – pointed to the importance of considering the social determinants of health to advance a human rights approach. The social determinants of health help to explain how inequities in social factors affect mental health. These determinants include housing, health care services, food security, gender, country of origin, exposure to discrimination and racism, and education.
We were told it is very hard to get appropriate health care and support services that provide “culturally competent” services - that is, that respect and meet the specific needs of different communities being served.  Services are often designed based on mainstream models that do not consider people from marginalized communities, or cultural differences in perspectives, frameworks and definitions of mental health. This can lead organizations to unintentionally discriminate against people from racialized and immigrant communities, Aboriginal Peoples, people who are gay, lesbian, bisexual, transgender people and other people based on Code grounds. Services may have exclusionary policies, procedures, decision-making practices and an organizational culture that is not inclusive.
The Ontario Federation of Indian Friendship Centres (OFIFC) said a lack of culturally appropriate services may result in poorer care, and indirectly contribute to people’s deteriorating mental health. Racial stereotyping or a lack of understanding of specific cultures and communities during intake and assessment can lead to misdiagnosis, poor diagnosis or poor treatment of people from racialized communities.
We heard about several instances of differential treatment because of a lack of cultural competency. We heard that people who are gay, lesbian and bisexual may find it difficult to disclose their sexual orientation within psychiatric hospitals and programs because of a non-inclusive environment. This can discourage people from using these services. One Aboriginal woman said that medical doctors did not consider her preference for Aboriginal-specific and alternative medicines. She did not return, and was left with little choice for alternative care.
A representative from a Francophone agency in Ottawa said some English-speaking service providers, instead of providing the services in French or providing a language interpreter, may see Francophone clients as having diminished power to communicate their wishes, and they look for someone to act or speak for them, for example, as their power-of-attorney.
Except in [a community mental health agency], which is not covered by OHIP, [mental health counsellors] I have met so far have very little knowledge or readiness to deal with sexuality issues (gay), and when the issues of race intersect, their knowledge was surprisingly low and I am still left without a health professional who could understand or who is really willing to understand the intersections of issues (race, gender, newcomer related) in counselling! – Survey respondent
We also heard that people were subjected to harassing or discriminatory comments within services based on Code grounds.
 World Health Organization, Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group (2010) online: World Health Organization www.who.int/mental_health/policy/mhtargeting/en/index.html at xxv- xxvi.
 World Health Organization, WHO Resource Book on Mental Health, Human Rights and Legislation (Geneva: World Health Organization, 2005) as cited by Ontario Federation of Mental Health and Addiction Programs, Embracing Cultural Competence in the Mental Health and Addiction System (June 2009) online: OFMHAP www.ofcmhap.on.ca/sites/ofcmhap.on.ca/files/CulturalCompetwC%20(4).pdf at 24; Juha Mikkonen & Dennis Raphael, Social Determinants of Health: The Canadian Facts (Toronto: York University School of Health Policy and Management, 2010) online: The Canadian Facts www.thecanadianfacts.org/The_Canadian_Facts.pdf at 9; Mental Health Commission of Canada Diversity Task Group, Improving Mental Health Services for Immigrant, Refugee, Ethno-cultural and Racialized Groups – Issues and Options for Service Improvement (12 November 2009) online: Mental Health Commission of Canada www.mentalhealthcommission.ca/SiteCollectionDocuments/Key_Documents/en/2010/Issues_Options_FINAL_English%2012Nov09.pdf at 15.
 Although definitions vary, cultural competence refers in part to “the level of knowledge based skills required to provide meaningful, supportive and respectful service delivery to clients from various marginalized groups in society …” Key principles of cultural competence include inclusiveness, holistic health, anti-oppression and valuing diversity. Zine, in progress, as cited by Ontario Federation of Mental Health and Addiction Programs, Embracing Cultural Competence in the Mental Health and Addiction System (June 2009) online: Ontario Federation of Mental Health and Addiction Programs www.ofcmhap.on.ca/sites/ofcmhap.on.ca/files/CulturalCompetwC%20(4).pdf at 22.
 Kwasi Kafele, Racial Discrimination and Mental Health: Racialized and Aboriginal Communities (December 2004), Submitted to the OHRC Race Policy Dialogue, online: OHRC www.ohrc.on.ca/en/issues/racism/racepolicydialogue/kk/view at 13.
 Kwasi Kafele, Racism and Mental Health: A compendium of Issues, Impact and Possibilities (2006). Resource provided to the OHRC.