Stop the Stigma

The Health Professions Act and the Fight Against Stigma

Structural stigma: icons of where it occurs

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 offering 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 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 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.

Then I saw a news story that said the government was calling for public submissions, as they’re reviewing the Health Professions Act after the damning results of a commissioned review looking into one of the regulatory colleges. The story said they haven’t gotten many submissions yet, and the deadline is the end of this week.  So hey, might as well give it another try.  Here’s the email I wrote to them.


Letter to the Minister of Health, June 2019

To the Minister of Health:

I am writing regarding a particular section of the Health Professions Act that I believe should be changed as part of the current review of the Act, regardless of whether it is revised or rewritten.

Under section 32(3) of the Act, there is a requirement to notify the appropriate professional college any time that a regulated health professional is hospitalized for mental illness or a substance use disorder. The college must then treat this is a “complaint” about an individual’s fitness to practice.

In the attached document I have outlined a number of concerns at greater length, but I’ll briefly present them here:

  • To treat mental and physical illnesses differently as a matter of course, and to make judgments about an individual based on whether their illness is mental or physical, is blatantly discriminatory.
  • Section 33(4) of the Act already addresses the handling of concerns about a registrant’s fitness to practice regardless of the reason for the impairment.
  • No other province in Canada has mandated reporting based solely on hospitalization.  Most provinces make no specific mention of mental disorders in terms of fitness to practice concerns.
  • The provision in section 32(3) promotes and perpetuates stigma against mental illness.
  • Health professionals hospitalized for mental illness are afforded a lesser degree of confidentiality compared to health professionals hospitalized for any other reasons.
  • This mandatory reporting requirement poses a significant deterrent for health professionals with mental illness to seek out mental health care services.  In turn, this poses significant risk of harm to health professionals with untreated or under-treated illness.  In the end, this poses a far greater risk of harm to the public.

I hope the Ministry of Health will take advantage of the current review of the Health Professions Act to remove this regressive, discriminatory section. Health professionals like myself living with mental illness, along with all British Columbians, deserve better.

Regards,

Ashley Peterson


Letter to the Minister of Mental Health & Addictions, Aug. 2020

An open letter to the Hon. Judy Darcy, British Columbia Minister of Mental Health and Addictions re. B.C.’s Health Professions Act

I’m writing to express my dismay that it appears that the Government of British Columbia does not intend to take advantage of the modernization of the Health Professions Act to remove section 32(3), which stigmatizes health professionals with a mental illness.

Section 32(3) reads:

Duty to report respecting hospitalized registrant

32.3   (1) If an other person is a registrant in a college prescribed by the minister for the purposes of this section and because of admission to a hospital or a private hospital as defined in the Hospital Act, for psychiatric care or treatment, or for treatment for addiction to alcohol or drugs the other person is unable to practise, the chief administrative officer of the hospital, or someone acting in that capacity, and the medical practitioner who has the care of the other person must promptly report the admission in writing to the registrar of the other person’s college.

(2)The medical practitioner who has care of the other person must, no later than the date of that other person’s discharge from the hospital, provide the registrar of the other person’s college with a written report of the diagnosis, particulars of treatment, prognosis and an opinion as to whether the other person is fit to continue to practise the other person’s health profession.

Making this kind of sweeping generalization, based not even on diagnosis but on an arbitrary distinction between mental and physical illness is archaic, absurd, and stigmatizing. I would hope that it would be obvious to anyone with even passing knowledge of mental illness how wildly inappropriate it is to suggest that all health professionals hospitalized for psychiatric reasons pose a risk to the public across the board and no health professionals hospitalized for physical illnesses pose a risk to the public.

That kind of arbitrary distinction truly is the essence of stigma. There are other provisions in the Act that cover reporting of health professionals who are impaired and do pose a risk. There is absolutely no need to have section 32(3) tacked on to formally legislate stigma.

I’ve been a mental health nurse for 15 years. I also have major depressive disorder. On two of the occasions when I’ve been hospitalized, the hospital reported me to what was then the CRNBC. I can speak from personal experience that section 32(3) acts as a significant deterrent to seeking treatment. If I’m extremely depressed and suicidal and everything feels like a burden, why would I agree to hospitalization when that would create the massive burden of dealing with the College and facing the non-choice of giving up my practicing license or having it taken away, and all the hoop-jumping that goes along with that.

Section 32(3) also establishes a different standard of privacy protection for health professionals with mental illness. If I was admitted to hospital for a brain tumour, the hospital would not be mandated to report my personal medical information because I was admitted for a physical illness. If I’m admitted for depression, I’m afforded no such right to privacy, and my College is informed of my diagnosis, particulars of treatment, and prognosis, regardless of whether or not I pose any actual risk to anybody but myself.

When the Government places barriers in place to seeking out mental health treatment for the sole purpose of enshrining stigma in law (since, as already mentioned, there are other provisions that protect the public from registrants who are impaired), it is putting the lives of health professionals in jeopardy. I have been trying for years to get somebody, anybody, to listen in regards to this issue.  No one appears to care, because hey, who cares about crazy people, right?

Are you prepared to accept that provincial legislation perpetuates stigma? And, more importantly, if a health professional dies by suicide because section 32(3) is just one more barrier to accessing care, are you prepared to have that blood on your hands?

Regards, Ashley Peterson RN BSN MPN


Moving forward – or not

This isn’t a new issue. I’ve been trying to raise a stink about the legislated stigma in the Health Professions Act for the last eight years or so. It seems like such a clearcut issue, yet no one’s interested in listening.

Currently, the provincial government is doing a massive overhaul of the Health Professions Act. I emailed the Minister of Health in 2019 when they were doing public consultation. I also emailed the provincial nursing advocacy organization. In summer 2020, recommendations were released from the consultation process, but this issue was a non-starter. I was not impressed, although I also wasn’t surprised.

I think there are a couple of reasons that no one cares. One is that nobody cares about crazy people. Another is that most health professionals who are also crazy people want to sweep that business under the rug. No one wants to lead the anti-stigma crazy person charge. So there’s me. I never particularly cared what people would think of me being crazy and loud, and at this point, it seems pretty certain that I’ll never be returning to work.

Instead, I’ll wave the crazy person anti-stigma banner, and that means going down the road of righteous anger rather than self-stigma, which is also a good thing.

Book cover: A Brief History of Stigma by Ashley L. Peterson

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.

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.

31 thoughts on “The Health Professions Act and the Fight Against Stigma”

  1. Health professionals hospitalized for mental illness are afforded a lesser degree of confidentiality compared to health professionals hospitalized for any other reasons.

    This. πŸ‘πŸΌπŸ‘πŸΌπŸ‘πŸΌ

  2. 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!

  3. “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!

  4. 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.

  5. 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

  6. 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!

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