Most prevalent form of discrimination is due to mental illness and homelessness

Vulnerable populations in ethnically diverse Toronto reported more discrimination by health care workers based on their housing status, mental health or substance abuse issues than race, a new study has found.

Forty-two per cent of people surveyed reported at least one form of perceived discrimination by health care workers, lead author Dr. Vicky Stergiopoulos wrote in a paper published today in the journal BMC Health Services Research.

The most prevalent form of perceived discrimination was due to mental illness or substance abuse (33 per cent) and homelessness or poverty (30 per cent), said Dr. Stergiopoulos, psychiatrist-in-chief at St. Michael's Hospital.

Only 20 per cent of non-Caucasian and 15 per cent of overall participants reported discrimination due to race, ethnicity or skin colour, said Dr. Stergiopoulos, who is also a scientist in the hospital's Center for Research on Inner City Health.

Data for this research came from the Toronto site of the At Home/Chez Soi randomized controlled trial of providing safe, quality housing to homeless adults with mental illness to help them better focus on recovery.

All types of discrimination in health care settings were associated with more frequent use of Emergency Departments, a greater severity of lifetime substance abuse and mental health problems, Dr. Stergiopoulos said.

Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination: those who reported discrimination due to homelessness or poverty were 32 times more likely to report discrimination due to mental illness or substance abuse. Those who experienced discrimination due to mental illness or substance abuse were almost nine times more likely to report discrimination due to race, ethnicity or skin colour.

"The findings suggest that among ethnically diverse homeless adults with mental illness in a large urban centre in Canada, perceived discrimination in health care settings in common," Dr. Stergiopoulos said.

She said the most common complaint was a lack of respectful treatment by various practitioners.

"Discrimination can have a significant impact on the lives of those affected," Dr. Stergiopoulos said. "The stress of perceived discrimination negatively affects mental and physical health, poverty and social marginalization, and may increase the likelihood of risky behavior. Discrimination by health care providers can be a key barrier to obtaining needed services, resulting in avoidance or delays in seeking treatment, underdiagnosis and mistreatment, nonadherence with or discontinuation of treatment and poor treatment outcomes."

Dr. Stergiopoulos said understanding discrimination in health care is the first step toward designing policies and interventions to address health disparities among disadvantaged populations.

She noted that homeless people with mental illness are already among the most marginalized patient groups, reporting high levels of unmet health needs.