Stop the Stigma

Legislated Stigma: Mental Illness and the Law

Structural stigma: icons of where it occurs

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.

Fighting back

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.

Mental illness: Stop the stigma - graphic of face and megaphone with the words "speak up"

You can find more on mental illness stigma on the Stop the Stigma page.

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13 thoughts on “Legislated Stigma: Mental Illness and the Law”

  1. Yeah I had the same Problems With My old University, it was so bad and they had so Little expirance with Bi-polar and Depression that I quit both my jobs there and transferred out, they had no trust and no understanding of how depression worked and sent me to the E.R for absolutely no reason at one point after I had already be treated and realeased from my involuntary hospitlization.

    Like I had seriously just gotten back to my dorm room, was eating some chicken wings with my friend and watching tv when two very confused Cops came to my door to escort a ‘high risk’ student back to the E.R …I was just as Confused as they were. I ended up gettig out of the E.R cuse even the nurses were stunned as to why i was there when i was not exhibiting any of the high risk behaviors. O.O I had to get a certified medical leave from a Psyhcatric Professional since their are now laws to protect us against debt If we do need to leave in the middle of a semester, the Federal government literally told me that I had to pay my whole entire 5,000 doller balence in like a few monthes since i did not finish out the semester, it was pretty horrible and I had to jump through alot of legal loop holes to get out of their clunches. It was Horrible. People have no idea How we work, they just assumed were extremely dangerous, The fact that Bi-polar already has a huge stigma of violence and anger attached to it only made things worse, My boss Requested to also be part of my Business for the safety of the other employee’s …I was an RA assitent for the Art dorm, and it was a Huge Nightmare, everyone who ever had beef with me could basically call me crazy and no one was listening to what i had to say at all, My and my RA did not get along and she accused me of Ripping shit off the walls, Had my friend not been there as a witness to counter her claim my boss totally would of used it as an excuse to fire me, but its illegal to fire someone based on Medical leave you have to have probable cuase, in the end i quit myself cuse i knew she just wanted me gone, she didnt want to have to deal with me at all, and constantly kept pressureing for me to ‘focus on myseft, not get overwhealmed by the job, is the job to hard for me? a leave would be reasonable?’

    It was a Mess, I feel this Post on a deep level, Their are waay to many laws that basically bar you in college if you have any kind of mental health break down. I ended up returning to visit a friend almost half a year later and everyone still knew who i was, I guess i was the only openly mentally ill person in years and since it was a tiny tiny town people were still talking about me and all the drama…they had not moved on, so i never went back again despite wanting to visit friends. it was just to hard for me to walk in and know that people were staring at me and still talking behind my back. Laws Are horrible to us, and its not fair. It made me hide my disorder from everyone when i did return i never told anyone unless they were immediate family, my therapist or an extremely close friend, this year at this new school i dont give a shit but these expirances mess with us alot i agree.

    “But we gotta Fight our feelings and Not the world Cuse the world is gonna win”

  2. That’s horrible! I’m sorry you aren’t able to get the help you need when you need it because of that law. Here in the US medical privacy laws are super strict.

  3. I glad i did, otherwise i would of never gotten the meds or treatment i needed. Small towns like that have little to no mental health resources and all i had was a permit back then

  4. “for psychiatric reasons or substance abuse”…pretty much says it all…is the same principle in place for physicians?….first time i have heard the term “legislated stigma”…thanks

  5. Awful!! The government seems to always find a way to “criminalize” this illness. Having to hide your illness in order to earn a living is disgusting and dangerous. #staystrong

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