As a nurse in my province (British Columbia, Canada), if I am hospitalized for mental illness then the provincial Health Professions Act requires the hospital to report me to the nursing regulatory college, and the college must treat this as a complaint about my fitness to practice. This ends up with being offered the non-choice to either give up my practicing license or have the college take it away. Clearly, this is stigma in action.
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 she 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 is 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 part of the Health Professions Act. 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.
Related posts
My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
You can find it on Amazon and Google Play.
There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.
Health professionals hospitalized for mental illness are afforded a lesser degree of confidentiality compared to health professionals hospitalized for any other reasons.
This. 👏🏼👏🏼👏🏼
Ashley, I certainly hope and pray you get results from this letter, not like what happened back in 2013. Hell, I’d go as far as sending this is to your local news outlets for that matter.
Hey, the Ministry of Health wants to hear more, go through every channel necessary!
Thanks for your support!
Always!
It’s sad that the profession and patients are deprived of someone as caring and compassionate as you.
I’ve got my license now, but yeah, there have definitely been some considerable hoops to jump through.
Oh, good to hear!
Crazy stuff… same with the CPSO in ON
Oh that’s unfortunate.
❤❤❤
That’s a great e-mail. I hope they take it into account.
Thanks!
“This mandatory reporting requirement poses a significant deterrent for health professionals with mental illness to seek out mental health care services.” – This was my first thought when I read the opening of this post and your story. How many people won’t get help for fear of losing their license and their job? A very good letter – so brave of you to speak out!
Thank you! There’s already enough stigma without having moresystemic barriers in place.
Awesome!!! Good for you! Your bullet points are very clear and convincing! 🙂 I hope something changes!
Thank you!
This is awesome!! Way to go. Keep doing what you are doing. I hope they hear you out this time.
Thanks!
You’re a badass and my hero!!!!
Thank you! 😊
Way to go Ashley. You are definitely doing your part in so many ways to fight stigma. This email is fabulous. I hope they revise the very outdated rule.
Thanks!
Hell yeah, Ashley! This is fantastic – you’ve covered lots of great points and have been so damning on the aspects that are discriminatory, well done! I really do hope you get a reply to your email.. keep us updated! xx
Thanks! 💕
Well written objection to a clearly discriminatory regulation, hope it gets amended.
Thanks!
Well done. You’ve made a great point that the brain, mental health is treated so differently than any other part of the body. Good luck in these efforts, keep it up and do keep us posted.
Thanks for sharing!
Thank you!