Social Determinants of Health: A focus on the impact of discrimination (Mental Illness & Addiction)
- Kimberly Presta
- Oct 19, 2021
- 4 min read
Who's responsible to make it better?
Public Health Ontario (PHO) is a Crown corporation dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. According to Robinson the Diagnostic and Statistical Manual of Mental Disorders (DSM) which is the defining standard for mental health diagnoses includes substance use disorders (SUDs) as of the 1990’s (2016). With the addition of SUD these individuals will qualify for support financially through the Ontario Disability Support Program (ODSP).
My work over the past few years has led me to become more aware of the patients’ side when discrimination is impacting their health outcome. Poverty, access to health care both acute care and community care, underhoused, homelessness, food insecurity are all at risk when persons are diagnosed with mental illness. Mental illness is a certain type of disability that is not openly accepted and continues to have stigmatizing experiences. Stigma could also be considered discrimination and leads to morbidity and mortality.
Along with the stigma associated with mental illness and addictions social determinants that are akin such as poverty, homelessness and unemployment compound the persons health outcomes, “Unemployment rates are as high as 70% to 90% for people with the most severe mental illnesses” (CAMH). The disease burden of mental illness and addiction in Ontario is 1.5 times higher than all cancers put together and more than 7 times that of all infectious diseases (PHO). Furthermore, it is estimated that a persons’ life expectancy will decrease by 10 to 20 years due to a mental illness diagnosis (PHO).
Mental illness is not uncommon. In 2006, there were 77,430 people receiving income support through ODSP with a serious mental illness, representing 1 in 3 ODSP recipients (CMHA). Alternatively, ODSP rates are significantly lower than what is needed to cover the cost of necessities, such as food, clothing, and housing. Qualifying for the ODSP support requires an application and for the interim many people with mental illness access Ontario Works (OW), the publicly funded income support program for those in temporary financial need. OW recipients receive roughly half the amount provided to ODSP recipients approximately 450 per month.
Since 2017 minimum wage in Ontario was $11.60, 2018 increased to $14.00 and 2020 $14.25 and is tied to the Consumer price index and assigned a LICO Score. Comparatively, Alberta increased their minimum wage rate in 2017 from $13.60, to $15.00 in 2018.
The Ontario Disability Support Program Act, 1997, S.O. 1997, c. 25, Sched. B is a fairly new provincial Act legislated in 1997. It deemed that those with a disability have a right to have an income and to be a part of where to spend their funds. This Act is just over 20 years old with a few revisions over the years. The amount paid to the person is impacted if the person pays rent, has dependents and other personal questions. The ODSP is decreased if a person works. This is a problem as often a person with a mental illness diagnosis will work a half shift or a few weeks and then become ill again. The ODSP is immediately impacted and this causes an unnecessary further strain on a recipients desire to work, independence and self-sufficiency at times of a more well state. Leading to ongoing disparity of living within poverty.
Williams and Reuter define poverty with the intention on clarifying for policy makers that the currently used definition is inadequate. While investigating into poverty they link health outcomes and further provide guidance on what needs to happen for true change to improve health outcomes for those living in poverty. William and Reuter (1999) conclude, “evidence about the relationship between income inequality and the health of populations, along with findings about the manner in which a variety of psychosocial factors influence health, leaves little doubt that relative conceptualizations and measurements of poverty ought to guide the development of policy” (pg. 360).
Moreover although prevention is the optimum place to be there are thousands of people living in Canada with diagnosis who need help now. Living with chronic mental illness, and facing poverty, discrimination, homelessness, food insecurity, health literacy, social supports clearly compound a persons ability to have improved health outcomes. Let’s continue to advocate and be ally’s in the pursuit of health equity.
References:
Canadian Institute for Health Information, Improving the Health of Canadians:
Mental Health and Homelessness (Ottawa: CIHI, 2007).
Canadian Mental Health Association, Poverty and Mental Illness. (2007).
Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective Health Fact Sheets, Mental health care needs, 2018, Release date: October 7, 2019. https://www150.statcan.gc.ca/n1/en/pub/82-625-x/2019001/article/00011-eng.pdf?st=C45h503N
Deanna L. Williamson, Linda Reutter, Defining and measuring poverty: implications for the health of Canadians, Health Promotion International, Volume 14, Issue 4, December 1999, Pages 355–364, https://doi.org/10.1093/heapro/14.4.355
Ontario, Ministry of Children, Community and Social Services, June 18, 2021. https://www.mcss.gov.on.ca/en/mcss/programs/social/odsp/employment_support/available_supports.aspx
Open Minds, Healthy Minds Ontario’s Comprehensive Mental Health and Addictions Strategy
Robinson, S. M., & Adinoff, B. (2016). The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations. Behavioral sciences (Basel, Switzerland), 6(3), 18. https://doi.org/10.3390/bs6030018
Comments