Rights of the mentally ill

Miscellaneous and Personal Stuff I Must Share
1

I’m starting this here, I don’t know if it belongs in IMHO or elsewhere… but here’s my question/beef:

Personally, I’ve been diagnosed with Borderline Personality Disorder and chronic depression. I’m on a pretty standard dose of antidepressants, with antipsychotics on an as-needed basis. I live a more-or-less regular life, but there are drawbacks (such as not being able to sleep/sleeping too much, having the occasional day when leaving my apartment is a terrifying prospect… there are certainly some aspects which can’t be controlled without nasty side-effects from overmedication). My question, however, isn’t just about me.

Do you think that mentally ill deserve to be considered as handicapped/disabled people? Currently in Canada, there are no laws in place to protect someone who mentions that they’re on medication or under treatment fro discrimination, and discrimination abounds. I’ve been passed over for jobs because of it. Here’s another little catch-22 from the job front for you: if I miss a day because of my disorder, I’m expected to provide a medical note. However, generally medicare only provides a psychologist or psychiatric nurse to help me along, if that. Neither type of professional is able to write a “doctor’s note” as is required by most employers. If I go higher than my counselor, generally I’m told that since they psychiatrist in charge has not been treating me directly, he/she can’t write a note for me.

What do you guys think? Should there be laws on discrimination against the mentally ill? Should it be awarded the status of a handicap? Should there possibly just be more public awareness about mental illness? If yes to the last, how might one go about it apart from notifying the enlightened teeming millions?

2

I agree - there should be legislation in place to protect the mentally ill, with some provisions. If a person is refusing treatment for their illness and subsequently misses a lot of time, that should not be protected. If someone stops taking their medication and subsequently is unfit to work, that should not be protected. If something goes WRONG with their medication and they are subsequently unfit to work, that should be protected. And also, as with normal physical ailments, if even with optimal treatment the person misses more than the allowed number of paid and unpaid sick leave days allowed by the company, that person will have to find another job. I do not think it should be considered comparable to a(some) physical handicap(s) - many mentally ill are very high functioning when they are properly medicated, however there is no pill that will allow a paraplegic to regain use of their legs.

I think that the fact that this could end up being -very- complicated to write up has prevented it from being done up till now. In your particular case, I think you should sit down with your boss and get some guidelines written up for yourself. And signed. Perhaps if you can provide the name and contact information for your counselor they will consider any note from him/her to be an acceptable excuse. If they aren’t willing to compromise on this issue, I would say they aren’t interested enough in their employees to warrant a long-term job (but that’s just MHO).

3

OK, what’s happening is that you’re being shafted by not having direct treatment from the psychiatrist (who’s obviously just being used to prescribe your meds on suggestions from the psychologist and the psych nurse).

This is unacceptable, but this kind of bullshit happens a lot in the Quebec health care system.

I know this is a dumb question, but have you insisted that you be under a psychiatrist’s direct care? It’s irresponsible IMO for the shrink to prescribe meds for a patient he or she isn’t actually seeing for therapy sessions.

The pressing issue here is that you need someone with an M.D. who can write letters to excuse you from work. (The letter doesn’t have to say what’s going on with you - only that loupdebois was unable to work on such-and-such a date, signed so-and-so, M.D..) Do you have a general practitioner that can do that for you? (I know, finding a GP who is willing to follow you and take an interest in your life and health is a pain in the ass - if not imossible - in Quebec. I’m lucky to have found mine when I did.) You can explain that look, the dude who’s prescribing me meds is unwilling to write me notes for missed work.

(Take a step back and look at it: he’ll write a script for Zyprexa or Risperdal or whatever for some patient he’s not seeing, but he can’t be bothered - on the same prescription pad - to write a brief note excusing you from work. THAT IS NOT ACCEPTABLE and UNETHICAL.)

Look up AMI Québec and call/email them. I’m sure they hear this kind of shit all the time and can point you in the right direction.

Some personal advice on navigating through the decrepit Quebec health care system and “winning,” as it were: it all starts with a good foundation, and that is finding a general practitioner who, as I said above, is willing to follow you (the kind of doctor where you can call and say, hey, can you fit me in sometime this week? I’ve got this weird lump in my armpit that hurts! Thanks!), and take an interest in your life and your health - not just someone who rattles off prescriptions and kicks you out of the office so he or she can get to the next patient. This is by far the hardest part.

But once you have a good GP with whom you’ve established a good relationship, you can be sure that he or she will refer you to specialists for problems out of his or her spectrum. I’ve already been referred to two specialists by my GP, both of whom have taken me right away. It’s all in their own professional networking. You call up the specialist and say, “My general practitioner is Dr. So-and-So, and he’s referred me to Dr. Specialist, and would like me to see Dr. Specialist as soon as possible about [the problem].” And you get in faster than you would otherwise.

Anyway, call AMI Québec, find a good GP, and let us know how it goes. I can always give you my GP’s name and number - I don’t know if he’s taking new patients, but he’s very, very patient-oriented (as opposed to being obsessed with appeasing the Régie d’assurance-maladie). If he can’t take you, he’ll know someone who will. My email’s in my profile.

Courage, mon ami.

4

Venoma: WhileI agree that the degree of a mentally ill person’s disability is not on a par with a paraplegic, consider a less extreme example. A friend of mine in my first call-centre job was a midget. In the work environment, she had difficulty reaching the controls of her phone and needed a small step-stool. She also needed to take slightly longer breaks because it took her much longer to get downstairs for a cig. That’s about the length and breadth of her limitations job-wise. The government and my employer considered her handicapped for all intensive purposes, which means her employment was subsidised.

BTW, I’m sticking to the call-centre environment for examples because I’m intimately familiar with it.

To summarise my particular case in the same way: once in a blue moon I need a day off (because I’m so depressed I can barely move) or a break taken outside of the schedule (because I can’t stop crying). I generally make up the hours, often when they’re most needed. During a particularly bad period, I may ask for my schedule to be reduced by five hours per week. Very occasionally, such as when I’ve just changed dosage in my meds, I need to leave early as the side-effects make me ill. That’s a very important point about meds: yes, with the ideal combination of meds, a person can be very high-functioning. There are dozens of meds out there, and a particular case may need a combination of up to six of them, each at the right dosage. Each erroneous combination will cause side-effects, which can be mild (disturbed sleep, bowel problems, etc) or severe (nausea, cramps, fainting, total insomnia - I once couldn’t sleep for two weeks because of a med I was taking on a trial basis - “spock syndrome” - not the official term, more of a slang for the complete inability to express emotions which are nevertheless fully felt - even short term memory loss). Since each attempt must go on for at least a month to ascertain the potential benefit, it can take years to find the precise mix necessary. And no, not even the best psychiatrist can do more than make an educated guess as to what will work.

Let’s look at your paraplegic example. What does he need? Obviously the building needs to be wheelchair accessible: wheelchair ramp, large-stall bathroom. The desk needs to be wide enough to accomodate his chair, and he may have to adjust the level of the keyboard… all but the shoddiest call centres can accomodate this. He also needs adapted transport to and from work, which can be a real bitch (trust me, I know). This is where the trouble to the employer comes in. He will be late approximately once a week (I know from my midget friend). He will be unable to do overtime, as the transport has to be scheduled two days in advance.

So yes, to be fair, a paraplegic’s plight is more serious because there isn’t much to be done for recovery. However, mental illness can be just as disabling, there are people who will never be entirely better despite a cocktail of drugs and years of therapy, and they are accorded less respect than flu victims. A doctor will more readily write a note for someone who pukes on his shoes than someone who has been medicated for years on something that works “more or less” and had a few days where he was so depressed he couldn’t leave his bed.

All done ranting, respond as you see fit.

5

Dude, I said up there and in my email reply, call AMI Québec!

I know how it feels to want to have the leeway to “call in depressed,” as it were. (Although now I’ve finally, with my doctor’s help, found a drug cocktail that works incredibly well, and I feel better than I have in five years…) But even though people are more accepting that depression, bipolar disorder, anxiety disorder, etc. are legitimate medical conditions that can often be as debilitating as, say, shingles… and even though they understand that we can’t just “snap out of it” - they still think that we should (in spite of what they know about mental illness) buck up, and come into work, and try to perform.

I’ve been having frequent appointments with my doctor over the past couple of months - every two weeks, almost. This is because we’ve been adjusting my meds, adding new ones, upping dosages, and what not, and my doctor is very meticulous about following up every time we add or change a med. (A bit anal retentive, but better than doctors who scribble off a script for Paxil or Xanax or something, and send you on your way, buh-bye, hope it works, have a nice life.) My manager at work is aware of the situation, and I’ve mentioned that my doctor insists on following up. So I have to leave an hour early every couple of weeks… big deal. First of all, I make sure (as you do) to make up my 37.5 hours, which means staying late a couple of days. Second, my manager - who has seen me at my absolute worst - knows very well that if I don’t manage my depression, anxiety (and I think she’s catching on that my sobriety is the foundation of my well-being, and must be managed as well), then I’m of little to no use to her as an employee. She’s seen how well I’ve been performing since I got sober and adjusted my meds - she’s told me so. I’m even outperforming my job requirements. So she knows that these appointments every so often are necessary.

Not all employers do, though. That’s where an advocacy group like AMI Québec can help with strategies. (I’ve never been in contact with them, so this is only based on what I’ve heard.)

Anyway, call those places I gave you in my email, and let me know how it goes.

6

This statement of the law isn’t correct - there are laws at both the federal and provincial level that prohibit discrimination on the basis of disability, regardless whether it’s a physical or mental disability.

For example, here’s the relevant provision from the Quebec Charter of Human Rights and Freedoms:

The equivalent federal statute is the Canadian Human Rights Act, which contains the following:

And, the Supreme Court of Canada has said that mental disabilities are protected under human rights laws in the same way as physicial disabilities. See: Battlefords and District Co-operative Ltd. v. Gibbs, [1996] 3 S.C.R. 566.

The above comments are not intended as legal advice about your personal situation, but simply to comment on a matter of public interest and discussion. If you believe you have been subjected to discrimination based on handicap, you might want to contact the Commission des droits de la personne et des droits de la jeunesse, which is the Quebec agency that investigates complaints under the Quebec Charter.