Stigma can be found in many places, even places where we might like to think it shouldn’t be. One such place where I have found it is in government legislation, hence the title of this post, legislated stigma.
Mandatory reporting of hospitalized nurses
As a registered nurse, my professional license is through the College of Registered Nurses of my Canadian province, which is covered by the provincial Health Professions Act. This legislation applies to many different health professions, and addresses multiple aspects of professional practice, including health professionals whose ability to practice is impaired. Health professionals are required to report to the appropriate regulatory college if they have reason to believe another health professional poses a risk to the public related to impairment due to any sort of health condition. A provision along these lines is typical for health professions legislation in many jurisdictions.
My province decides to take things a step further with its legislation by including a provision that doesn’t exist in any form in any other province in Canada. If a health professional is admitted to hospital for psychiatric reasons or substance abuse, the hospital is required by law to inform the patient’s regulatory college, and the regulatory college is to treat this as a complaint about the individual’s fitness to practice. Full stop. No assessment of risk, just mandatory reporting based on diagnosis.
Reported without warning
I initially found out about this during my first hospitalization in 2007. My mom was regularly checking my mail, and brought me in an envelope that had come from the College of Nurses. The enclosed letter stated they had “received a complaint about [my] fitness to practice”, and I was given the non-choice of voluntarily giving up my professional license or having it taken away. I was gobsmacked.
Who had complained and how could I possibly be a risk to anyone but myself? It’s not like I could have wandered away from my involuntary hospitalization and somehow found some patients to start providing care to. Oh yeah, these aren’t hospital PJ’s, they’re nurse’s scrubs, and the hospital socks are just because they’re comfortable!?!? I was frantically asking different hospital staff, trying to find out who had been low enough to do this behind my back. Eventually, I found out it was the nurse manager of the unit, and her explanation for why I hadn’t been informed was that it had happened shortly before I was being transferred to the psych ICU. Great. Thanks a lot.
This was the beginning of my journey with legislated stigma.
Conditions on my nursing license
When I (and my community psychiatrist) eventually managed to convince the College of Nurses that I was no longer crazy, they slapped a bunch of conditions on my license. One of these was that I share those same conditions with my employer. Even though the conditions didn’t spell out details of my mental illness, the condition that I had to see a mental health team and get regular reports submitted by my psychiatrist blew any chance of privacy I might have hoped for straight out of the water.
And those quarterly reports the College required my psychiatrist to submit? That meant that I ended up lying through my teeth to him. When I decided to go off meds, I didn’t say a word about it and kept picking them up from the pharmacy at regular intervals to back up my lie, because I didn’t want the College of Nurses or my employer to know what I was doing in terms of my own health. I’m not sure how that situation helps anyone…
My next two hospitalizations were at a different hospital, where either they didn’t know about, or chose to overlook, the mandatory reporting requirement. During my fourth hospitalization, I was again reported to the College and given the non-choice of giving up my license or having taken it away. The doctor who initially reported me didn’t have the cojones or consideration to actually tell me; I had to find out about it later from someone else.
What happened to privacy?
So, privacy is all fine and dandy right up until the government decides it isn’t. It’s worth mentioning that at no point did anyone treating me ever express concerns that I was posing a risk to anyone besides myself. If I was hospitalized for a neurological condition like brain cancer or epilepsy, there would be no requirement to report me, but because my brain condition happens to be psychiatric, all of a sudden I am deemed to present a risk to the public, full stop. No professional judgment allowed on the part of treatment providers; legislated stigma means that if I am hospitalized for depression then that is more than enough to determine that I am dangerous and people need to know about it.
Add this to the rest of the negative experiences I’ve had in hospital and I’ve come to a few conclusions. One, I will never voluntarily admit myself to hospital. And two, I will never knowingly say anything to a doctor that is likely to get me committed to hospital. That means I never disclose to doctors when I’m having thoughts of suicide. Again, not sure how that situation helps anyone.
When I was a little younger and a little less jaded, I tried to campaign to challenge this legislated stigma. I was in grad school at the time and one of my courses touched on policy briefs, so I wrote a policy brief citing legislation from other jurisdictions and relevant case law. I sent it to anyone that I thought might be willing to read it. My provincial nurses union and professional advocacy association didn’t even have the courtesy to respond with an acknowledgement. A couple of organizations expressed an interest and did take the issue to the government, but didn’t get anywhere. I don’t know what else is in my power to do.
The fact remains, though, that this is discrimination specifically against people with mental illness that is enshrined in provincial legislation; this is legislated stigma. And no one seems to care. For all the talk by government-mandated organizations like the Mental Health Commission of Canada about addressing stigma, I’m living in a province where, because I struggle with depression, I am considered a second-class nurse who doesn’t deserve the right to have my private medical information stay private. There is something really fundamentally wrong with that, and it means that indirectly the government is putting my health at risk. And that should never be ok.
You might also be interested in a more recent post The Health Professions Act and the Fight Against Stigma.
You can find more about stigma on the Stop Stigma page.