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Appendix 1: Index of recommendations and OHRC commitments

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The following list compiles the recommendations and OHRC commitments found at the end of each section of this report.

Recommendations

General:

1.The Government of Ontario should address its obligations under the Convention on the Rights of Persons with Disabilities in full to promote human rights and fundamental freedoms for all persons with psychosocial disabilities. This includes actively promoting an environment where people with psychosocial disabilities can and are encouraged to take a full part in the conduct of public affairs (Article 29).  

2.The Government of Ontario should measure and report to the public of Ontario on the inequities that create the conditions for discrimination against people with mental health disabilities or addictions (such as unemployment and low income) and efforts to address these conditions. Such a report should be submitted to the federal government as part of its reporting requirements under Article 35 of the CRPD.

3.Organizations and individuals across Ontario should work to enhance efforts to challenge stereotypes about people with mental health issues or addictions by implementing and actively taking part in anti-stigma and education campaigns.

4.The Government of Ontario, whenever considering budget restraint measures that affect services, housing and employment for people with low income, should particularly take into account the goals identified in the Poverty Reduction Strategy and the needs  of people with psychosocial disabilities, people living in poverty, and other groups protected by the Code.

5.The Government of Ontario should enhance and improve social assistance, including reviewing and improving benefits, to make sure that people can afford the necessities of life such as food, clothing, adequate shelter and other needs.

6.The Government of Ontario and organizations providing services to people with mental health and addictions should work to identify and eliminate discrimination based on disability in their services, as well as discrimination based on age, sex, race and related grounds, gender identity, sexual orientation and other Code grounds. This may require a process of examining policies, practices and decision-making processes and removing barriers that lead to discrimination for Code-protected groups (see the OHRC’s Guidelines on developing human rights policies and procedures for more information).

7.The Accessibility Directorate should consult with people with psychosocial disabilities and disability groups to evaluate the current Accessibility for Ontarians with Disabilities Act (AODA) standards to see how well they take into account the needs of people with psychosocial disabilities. Based on the feedback from consultees, the standards should be modified to take into account any additional accessibility requirements.  

8.The Accessibility Directorate should develop and promote further education materials that show how the Accessibility for Ontarians with Disabilities Act (AODA) specifically applies to people with mental health disabilities or addictions, so organizations understand their responsibilities towards people with psychosocial disabilities.

Housing

9. The Government of Ontario should link social assistance, including shelter allowance, to the real cost of rental housing in regions across Ontario.

10. The Government of Ontario should ensure more social housing options as well as subsidy alternatives, such as a portable housing allowance, to open up opportunities for people with low incomes in the private rental housing market and to permit greater flexibility in terms of where one may live.

11. Because people with mental health issues or addictions are disproportionately likely to be in need of housing, the Government of Ontario and municipalities should consider inclusionary zoning measures: laws and bylaws that require developers and municipalities to set aside a percentage of new housing for affordable housing, or a percentage of housing to accommodate persons living with mental health issues or addictions.

The recommendations the OHRC made in Right at Home should be implemented, including:

12. That the Government of Canada adopt a national housing strategy, in consultation with provincial, territorial and municipal governments, that includes measurable targets and provision of sufficient funds to accelerate progress on ending homelessness and ensuring access of all Canadians, including those of limited income, to housing of an adequate standard.

13. That the Government of Ontario enhance its existing Affordable Housing Strategy by providing sufficient funds to accelerate progress on ending homelessness and ensuring access of all Ontarians, including those of limited income, to housing of an adequate standard without discrimination.

14. That the Government of Ontario review and improve funding rates, programs, laws and regulations in the Province of Ontario to make sure that low-income tenants are able to afford average rents, food and other basic necessities. Specific attention should be given to:

  • Ensuring that minimum wage rates are indexed to inflation and allow a full-time earner to live above the poverty line
  • Assessing impacts of rent control/vacancy decontrol
  • Address claw backs in income facilitated by the Housing Services Act and social assistance programs.

15. Supportive housing providers, working with people with mental health issues and/or addictions, should examine their application processes to ensure that the information collected is necessary and does not inadvertently create barriers for people with mental health disabilities or addictions or violate people’s rights to privacy. Before rejecting an individual, each housing provider must consider its obligations under the Code to assess a person’s individualized needs, and accommodate the person to the point of undue hardship.

16. As outlined in the OHRC’s submission to the Ministry of Municipal Affairs and Housing, the government of Ontario should amend the Provincial Policy Statement which provides direction on land use planning matters, to:

  • Confirm a commitment to human rights
  • Lay out expectations for municipalities to review and remove barriers to affordable housing development that could lead to discrimination against groups protected by the Human Rights Code
  • Lay out mechanisms of accountability for removing discriminatory barriers to affordable housing development
  • Outline clearer expectations that municipalities will increase affordable housing in their communities.

17. Municipalities across Ontario should review their zoning and rental housing licensing bylaws to eliminate barriers to housing and services used by people with mental health issues or addictions (such as group homes or addiction treatment centres). Municipalities should remove any non-legitimate or non-bona fide requirements that apply to housing or services used by people with psychosocial disabilities that do not apply to housing of a similar scale or similar types of services.

18.The Government of Ontario should support social, co-operative and private housing providers to ensure that they meet their duty to accommodate. This could include ensuring there are sufficient third-party agencies available to assist with tenants’ accommodation needs. 

19.Social, co-operative and for-profit housing providers should develop human rights expertise so they can provide housing-related human rights advice, mediate and investigate complaints, where appropriate, and do barrier reviews of their policies and procedures.

Employment

20. The Ontario Association of Chiefs of Police and other agencies should actively promote implementation of the Ontario Association of Chiefs of Police police record check guideline across police services, vulnerable sector agencies and other employers including the Government in Ontario.

21. The Mental Health Commission of Canada and the Canadian Association of Chiefs of Police should promote the principles of the Ontario Association of Chiefs of Police (OACP) police record check guideline with police and vulnerable sector agencies in other Canadian jurisdictions.

22. The Ontario Police College and the Ontario Association of Chiefs of Police should organize training and enhance their existing training on the police record check guideline. The Ontario Association of Chiefs of Police should oversee evaluation of the guideline, with community stakeholders and disability groups. After the guideline is evaluated, the government of Ontario should consider whether legislative changes are needed to make the guideline more effective. 

23. The government of Ontario, the private sector and the non-profit sector should create new opportunities for special employment, supported employment, alternative businesses, employment equity practices and other special employment programs for people with mental health issues and addictions.

24. Organizations that fund special employment or supported employment programs, and organizations that have special employment or use supported employment programs, should review their funding and employment policies and remove any inequities that expose people with psychosocial disabilities to different terms and conditions of employment from those of employees doing comparable work that do not take part in these programs.

25. The Government of Ontario, the private sector and the non-profit sector should review their hiring, promotion, retention, discipline, accommodation and termination policies to remove discriminatory impacts on people with mental health disabilities and addictions to ensure equal opportunity.

26. The Government of Ontario and the Workplace Safety and Insurance Board should change the WSIA and the policy provisions governing workplace insurance benefits to reflect recent legal decisions. They should ensure that there is equality of benefits for people who experience physical disabilities and people who experience mental health disabilities as a result of workplace incidents. 

27. All employers should develop human rights policies and procedures outlining their organization’s obligations under the Human Rights Code, including the duty to accommodate people with psychosocial disabilities to the point of undue hardship. Employers should ensure their human rights policies identify that people with mental health issues and addictions are protected under the ground of disability, and eliminate systemic barriers in the workplace (such as in their organizational culture) that may exclude or disadvantage people with mental health issues and addictions.

28. All employers should train their employees and managers on their responsibilities under the Code regarding the human rights issues that affect people with mental health disabilities and addictions. This training should address preventing and responding to discrimination and harassment, systemic issues affecting people with psychosocial disabilities and the duty to accommodate.

Services

6. The Government of Ontario and organizations providing services to people with mental health and addictions should work to identify and eliminate discrimination based on disability in their services, as well as discrimination based on age, sex, race and related grounds, gender identity, sexual orientation and other Code grounds. This may require a process of examining policies, practices and decision-making processes and removing barriers that lead to discrimination for Code-protected groups (see the OHRC’s Guidelines on developing human rights policies and procedures for more information).

29. The Government of Ontario should look for and correct inequities in health care, rehabilitative and support services for people with mental health disabilities or addictions compared to general health care. 

30. In accordance with the AODA and the Code, services should review their policies, practices, application forms and decision-making procedures, working with consumer/survivor groups and accessibility experts to identify and eliminate barriers that may result in inequitable treatment for people with psychosocial disabilities or addictions. 

31.The Commission for the Review of Social Assistance in Ontario should look at inaccessibility of the social assistance system for people with mental health issues and addictions, and make sure social assistance policies and practices do not have a negative impact on people identified by Human Rights Code grounds, including mental health and addictions.

32. The College of Physicians and Surgeons (CPSO), the Ministry of Health and Long-Term Care, should consult with the OHRC and disability groups, to increase compliance with the CPSO’s policy on accepting new patients.

33. The College of Physicians and Surgeons of Ontario should review its complaint policies and procedures and eliminate barriers that may make it difficult for people with mental health and addiction issues to complain about poor professional practices.

34. The College of Physicians and Surgeons of Ontario, the Ontario Medical Association, the Ontario Hospital Association and the Ministry of Health and Long-Term Care should train doctors and medical students about their obligations under the Code to not deny service to people based on Code grounds.

35. In light of the supports required under the Convention on the Rights of Persons with Disabilities, and the provisions of Articles 12 and 14, the Government of Ontario should review and evaluate all laws, policies and standards relating to mental health in consultation with disability groups and other stakeholders to ensure equity for people with psychiatric disabilities or addictions. This review should include Ontario’s system of guardianship and involuntary admission criteria.

36. The Government of Ontario should create provincial rules and oversight mechanisms for the consistent use of restraints on people with mental health or addiction disabilities, with the goal of using restraints only as a last resort.

37. The Office of the Chief Coroner of Ontario should conduct a mandatory inquest into the death of any psychiatric patient who dies in psychiatric facilities or hospitals while exposed to chemical or environmental restraint (seclusion).

38. All hospitals, working with disability groups and the Psychiatric Patient Advocate Office, should review and monitor the privilege system to ensure that people with mental health issues are responded to with dignity and equitably based on Code grounds and that other human rights concerns are also avoided. 

38. All hospitals, working with disability groups and the Psychiatric Patient Advocate Office, should review and monitor the privilege system to ensure that people with mental health issues are responded to with dignity and equitably based on Code grounds and that other human rights concerns are also avoided. 

39. All hospitals with psychiatric beds, in conjunction with the OHRC, the Ministry of Health and Long-Term Care, the Psychiatric Patient Advocate Office, consumer/survivor groups and other appropriate stakeholders, should identify how to collect data based on Code-grounds to measure if people from Code groups are treated differently in the use of seclusion, restraints, when deaths occur, and other relevant health care issues regarding patients with mental health issues. The OHRC’s guide, Count me in: Collecting human rights-based data, can help in this regard. Any data collection measures must ensure people’s dignity and protect people’s privacy.

40. As required by the AODA, all hospitals should develop human rights policies, accommodation policies and complaint procedures for serving and employing people with psychosocial disabilities, as well as other Code-protected groups.

41. Hospitals should regularly promote and give training on human rights policies and procedures to staff and patients so everyone knows their rights and responsibilities.

42. Hospitals should work with patients, patient groups and the Psychiatric Patient Advocate Office to identify and remove barriers to making internal complaints in a hospital setting.

43. The Government of Ontario and all hospitals with mental health beds should introduce an independent ombuds system that can take discrimination and broader human rights related complaints from people in the psychiatric system, investigate these, and make findings.

44. All hospitals should ensure that no capable person is forced to receive psychiatric treatment, as per the Health Care Consent Act and the CRPD.

45. The Ontario Police College and police services should provide training to new and seasoned police officers on human rights and the duty to accommodate people with mental health issues or addictions. All officers, including new recruits and seasoned officers, should also receive training in crisis response de-escalation techniques used by specialized crisis response teams.

46. Police services should set up community committees, which include consumer/survivors and people with addictions, to advise police about issues relating to mental health and police service delivery.

47. Police services should develop police policies and protocols that address human rights and policing issues as they relate to people with mental health disabilities and addictions. 

48. Police services should collect data to identify any inequities in the treatment of people with perceived or known mental health disabilities or addictions compared to people without mental health disabilities or addictions.

49. The Canadian Judicial Council and the National Judicial Institute should provide training to all judges on human rights and accommodating people with psychosocial disabilities during the hearing process.

50. The Ministry of the Attorney General, the Law Society of Upper Canada and the Ontario Bar Association should arrange training for lawyers and court staff on human rights issues and accommodating people with mental health issues or addictions during the hearing process.

51. The Ministry of the Attorney General and Legal Aid Ontario should examine their policies, processes and practices and remove barriers to access and improve accommodation for users with mental health issues or addictions.

52. The Society of Ontario Adjudicators and Regulators (SOAR) and SOAR Administrative and Management Network (SAMN) should continue to ensure that new and existing adjudicators and staff receive training on the Code, including how to accommodate people with mental health issues or addictions during the tribunal process.

53. Administrative tribunals and other complaint-handling and decision-making bodies should examine their policies and procedures to identify and eliminate any barriers that prevent people with mental health issues or addictions from accessing these services. As part of this process, decision-makers should use approaches that maximize participation and accommodate the needs of people who may experience difficulties with decision-making capacity.

54. The Government of Ontario and organizations addressing the needs of people with mental health issues or addictions should actively support and work with mental health advocacy services that assist people to realize their rights within housing, services and mental health hospitals. The independence of advocacy services should be considered as one factor in ensuring that people are able to assert their rights without concerns about conflict of interest. Organizations training advocates should provide training on human rights, including people’s rights under the Code.

OHRC Commitments

General

C1. The OHRC will notify the organizations about the recommendations it has made, and offer to assist in implementing these, where possible.

C2. The OHRC will work with community stakeholders to enhance public education on human rights and mental health.

C3. The OHRC will conduct training on its policy on mental health and addictions throughout the province with consumer/survivors, people with addictions, government, as well as public and private-sector organizations.

C4. In its work on its strategic priorities (e.g. policing and anti-racism, Aboriginal Peoples’ human rights, family status, disability and education), the OHRC will build in a focus on human rights, mental health and addictions.

C5. The OHRC will further examine the issue of the level of rights advice provided to older adults in long-term care who are deemed to be incapable of making treatment decisions. If this has the potential to violate the Code, the OHRC will, where appropriate, raise concerns with the responsible parties, do public interest inquiries, intervene in legal cases and/or launch Commission-initiated applications.

C6. The OHRC will develop a policy on human rights, mental health and addictions, that will build on its Policy and guidelines on disability and the duty to accommodate. In writing its policy, the OHRC will provide guidance, with examples, on how organizations can meet their duty to accommodate people with psychosocial disabilities at work, in housing and in services. This discussion will take into account the concerns raised in the consultation, the responsibilities of people and organizations during the accommodation process, and the limits of accommodation (undue hardship).

C7. The OHRC will raise awareness with the Ontario Medical Association, the College of Physicians and Surgeons and other relevant stakeholders of how the medical community can support individuals’ requests for accommodation where medical verification of a person’s limitations and needs are required to make an accommodation.

C8. The OHRC will monitor emerging issues related to mental health and addictions through requests for legal intervention from the community, examining the media, networking with community organizations and the Human Rights Legal Support Centre, and other approaches. The OHRC will consider using its mandate to address these issues by, where appropriate, doing public education, policy development, launching public interest inquiries, legal interventions and/or Commission-initiated applications at the Human Rights Tribunal of Ontario.

C9. In its policy on human rights, mental health and addictions, the OHRC will provide guidance on distinguishing the duty to accommodate from providing treatment or care to someone with a mental health issue or addiction. It will also provide guidance on when the Code may apply when organizations deny services or housing to people with psychosocial disabilities.

Housing

C10. The OHRC will continue to promote its guide, In the Zone: Housing, human rights and municipal planning and provide education to municipal councils, planners, legal clinics, developers, neighbourhood associations, tenant associations and other stakeholders on their rights and responsibilities under the Code to prevent discriminatory opposition to affordable housing.

C11. As per the commitments it made in Right at Home, the OHRC will continue to be available to consult with community organizations, municipalities/municipal associations and the Government of Ontario to help develop and implement a province-wide strategy to address and prevent discriminatory NIMBY (Not In My Backyard) opposition. 

C12. The OHRC will continue to use its mandate to actively challenge discriminatory NIMBY (Not In My Backyard) opposition through, where appropriate, working with municipal councils, conducting public interest inquiries, pursuing legal challenges, and other initiatives.

C13. The OHRC will examine the issue of mandatory treatment conditions in private, social and supportive housing in its policy on mental health and addictions and will provide further guidance to landlords and housing providers.

C14. The OHRC will continue to provide education on human rights and rental housing to tenants, landlords, housing providers and others, and will include a focus on human rights, mental health and addictions.

Employment

C15. The OHRC will raise the issue of the disclosure of mental health information that prevents people from entering the United States, with the Canadian Human Rights Commission.

C16. The OHRC and the Ministry of Labour will discuss the impact of disclosure requirements under the Ontario Health and Safety Act on people with mental health issues, and consider how this issue could be monitored and addressed.

C17. The OHRC will approach the College of Nurses of Ontario and any other relevant stakeholders to remove barriers that prevent nurses with mental health disabilities from accessing employment. The OHRC will consider using its mandate, which could include building partnerships, conducting public interest inquiries, intervening in cases, and/or pursuing Commission-initiated applications to address this issue. 

C18. The OHRC will continue to provide education on human rights and the workplace to employers, employees and unions, and will include a focus on human rights, mental health and addictions.

Services

C19. The OHRC will examine further the policies or processes of driver’s licence suspension, child protection or insurance policies and consult with the appropriate government ministries and stakeholders to consider whether these contravene the Code. Where these practices have the potential to violate the Code, the OHRC will address these concerns using the functions in its mandate.

C20. The OHRC will be available to consult with the College of Physicians and Surgeons and the Ministry of Health and Long-Term Care on increasing compliance with the CPSO’s policy on accepting new patients.

C21. The OHRC, where appropriate, will use its mandate to launch public interest inquiries, seek to intervene in cases, and/or launch Commission-initiated applications to actively challenge cases where doctors allegedly deny service delivery to people based on mental health or addiction disabilities.

C22. The OHRC will invite a provincial psychiatric institution, as well as other partners with human rights expertise in mental health, including consumer/survivor organizations, to engage in a large-scale organizational change process to address human rights concerns in service delivery to people with mental health disabilities, addictions, as well as other groups protected by the Code. Such a process may, among other things, involve a review of internal policies and practices, to identify and remove any discriminatory barriers.

C23. The OHRC will work with hospitals, the Ministry pf Health and Long-Term Care, consumer/survivor groups and other appropriate stakeholders to identify how to collect human rights-based data to measure disparities between Code groups in the use of seclusion, restraints and other relevant health care issues. Any data collection measures must ensure people’s dignity and protect people’s privacy.

C24. In its work with police services in Ontario, the OHRC will raise issues about discrimination against people with mental health or addiction disabilities in service delivery, and will work with police to build capacity to address these concerns.  

C25. The OHRC, in its human rights work with the Ministry of Community Safety and Correctional Services (MCSCS), will include as a focus concerns about the lack of accommodation of people with mental health issues and addictions, particularly as these intersect with other Code grounds including race and related grounds, other forms of disability, and sex.

C26. The OHRC will continue to work with administrative tribunals in Ontario to provide training on human rights, including the duty to accommodate, where these relate to serving people with psychiatric disabilities and addictions, as well as other Code-protected groups.

 

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