9.5. Intersections with race and related grounds

Dealing with racism in my workplace contributed significantly to me having mental health problems in the first place. 
– Survey respondent

Doctors assume that since I am female and an immigrant that I must be okay with being subjugated or treated as less than an autonomous adult. 
– Survey respondent

We heard about the different types of intersecting discrimination occurring because of race, citizenship, ethnic origin, place of origin, ancestry, colour or creed, in addition to mental health disabilities and/or addictions. We were told how perceptions about people’s disabilities can contribute to negative perceptions based on race in different ways. For example, one person told us she was labelled as the “angry Black woman” at work because of her symptoms of depression.

The Metro Toronto Chinese and Southeast Asian Legal Clinic (MTCSALC) and the New Mennonite Centre said discrimination and barriers to integration can affect the mental health of immigrants to Canada. Some people said they had difficulty disclosing their mental health issues within their community.

MTCSALC said the social stigma experienced by people with mental health and addiction issues may be more severely felt by immigrants and people from racialized[65] communities because the stigma adds to the multiple challenges they already face, not because issues are more prevalent in these communities. In a focus group organized by the Ethno-Racial Disability Coalition of Ontario (ERDCO), one participant said that having to ask for accommodation or speaking up to assert one’s rights were made much more difficult when dealing with issues of racial discrimination because of power imbalances.

We were told that people from racialized communities and in particular, African Canadian men, experience harsher treatment than non-racialized people in the mental health and forensic mental health systems (where people are also involved in the judicial system).  People were concerned that there is a high representation of racialized people with mental health issues in the criminal justice system, and that African Canadian men with mental health issues are more likely to enter the criminal justice system than the community mental health system.[66] One person from an agency serving racialized communities said misdiagnosis may be common because of stereotypes and cultural and language barriers.

A growing body of international research supports many of these findings.[67] Some studies suggest there are higher rates of restraint and confinement for people of African or Caribbean descent compared to people of other ethnic backgrounds, although the reasons for this may be complex.[68]

a) Language

Language is not a prohibited ground under the Code, but it can be related to ethnic origin or place of origin. [69] The Provincial Human Services and Justice Coordinating Committee (PHSJCC) and many others said that the lack of accommodation of language needs for people with mental health issues or addictions is a major issue.

We heard the lack of interpretation and translation can lead to not being able to access services, or being treated differently within services. Advocates said there is a systemic issue of racialized people being treated as “non-compliant” in the hospital setting when their cultural or language needs are not accommodated, and people have been treated poorly as a result (for example, they have been improperly assessed, or have had hospital privileges taken away). The PHSJCC recommends that the Ontario government develop targets to improve access to mental health and addiction services for ethno-racial communities, including improving access to language interpretation.

The French Language Health Services Network of Eastern Ontario (RSSFEO) told us that there is a documented lack of mental health-related services for Francophone people in Ontario.[70] It recommends recognizing language as an element of discrimination for anyone with a mental health disability or addiction.

b) Creed

We heard how people’s creed beliefs were not accommodated in different types of services used by people with mental health issues and addictions. Some women were prohibited from wearing their hijabs in hospital due to “health and safety concerns,” or had to remove their clothing in the presence of men. We also heard about some services that did not observe creed-based dietary needs. Some non-religious people said that it was hard to find addiction services that were not religion-based; one person said that, within these services, non-religious views were seen as a barrier to recovery.

[65] Race is a social construct. The Report of the Commission on Systemic Racism in the Ontario Criminal Justice System defined racialization “as the process by which societies construct races as real, different and unequal in ways that matter to economic, political and social life.” Ontario Human Rights Commission, Policy and Guidelines on Race and Racial Discrimination (Toronto: Queen’s Printer for Ontario, 2005) at 11.

[66] A study conducted in Montreal also found that African-Canadians were overrepresented in police referrals to emergency psychiatric services. G. Eric Jarvis, et al. “The Role of Afro-Canadian Status in Police or Ambulance Referral to Emergency Psychiatric Services” (2005) 56:6 Psychiatric Services 705.

[67] Research from the US and the UK, and some from Canada, has supported that people of African or Caribbean descent, particularly men and people who are immigrants, are disproportionately likely to be represented in the mental health and forensic mental health system and diagnosed with psychosis or schizophrenia, although multiple contributing factors need to be considered. One report states, “there are no statistics available, but psychiatric forensic units in Southwestern Ontario (including CAMH), based on anecdotal information, seem to have a disproportionately high number of men of colour, including African-Canadian men.” Pascale C. Annoual, Gilles Bibeau, Clem Marshall & Carlo Sterlin, Enslavement, Colonialism, Racism, Identity and Mental Health: Developing a new service model for Canadians of African DescentPhase I report (Toronto: CAMH, 2007) online: Centre for Addiction and Mental Health www.camh.net/publications/resources_for_professionals/EACRIMH/eacrimh_report1107.pdf at 13; G. Eric Jarvis, et al. “High rates of psychosis for black inpatients in Padua and Montreal: Different Contexts, Similar Findings” (2011) 46 Soc. Psychiatri. Epidemiol. 247; Kwame McKenzie & K. Bhui, “Institutional Racism in Mental Health Care” (Mar 2007) 334 B.M.J.649.   

[68] G. E. Jarvis, Emergency Psychiatric Treatment of Immigrants with Psychosis, (Master of Science in Psychiatry, Department of Psychiatry, McGill University, Faculty of Medicine, 2002) [unpublished] at 91;  Amos Bennewith, et al. “Ethnicity and Coercion among Involuntarily Detained Psychiatric In-patients” (2010) 196 British J. of Psychiatry 75; Rachel Spector, “Is There Racial Bias in Clinicians’ Perceptions of the Dangerousness of Psychiatric Patients? A Review of the Literature” (2001) 10:1 J. of Mental Health 5.   

[69] See Ontario Human Rights Commission, Policy on Discrimination and Language (Toronto: Queen’s Printer for Ontario, 1996), online: OHRC www.ohrc.on.ca/en/resources/Policies/lang/view.

[70] Seventy-seven percent of Francophone people in Ontario have no or rare access to alcohol treatment centres in French; 66% have no or rare access to drug addiction centres in French and 53% have no or rare access to mental health services (excluding psychiatric hospitals) in French. Office of the French Language Services Commissioner, Special Report on French Language Health Services Planning in Ontario (Queen’s Printer for Ontario, 2009) at 8, as cited by the submission by the French Language Health Services Network of Eastern Ontario.


Code Grounds: