Why Keep Mental Disability A Secret? Like...A Lot of Reasons.

Written by Danielle Pierre and Jasmine Irwin

A recent editorial in the Toronto Star criticized York University’s recent policy change; the university no longer requires students with mental health disabilities to disclose their diagnoses in order to receive academic accommodation. While the columnist was insistent that her objections came from a place of concern, whether well-intentioned or not, several of her points suggest that she has misunderstood certain key aspects of the issues at the heart of this policy change. This piece, beginning with a call to talk about mental illness openly, ironically upholds stereotypes of students, millennials, and the mentally-ill: only serving to re-stigmatize these individuals rather than provide insightful commentary.

Although broad consensus has not been reached, others in the sector seem to be moving in the same direction as York. A 2013 study by Queen’s University and St. Lawrence College arose from a recognition of the barriers students with mental health issues experience in seeking accommodation. Namely, the recognition that documentation requirements are not standardized across the province and mental health disorders are inherently episodic in nature; changes in symptoms and medications may also result in changes to functional impairments or limitations. This study recommends that institutions use functional limitations as the basis for providing accommodation, instead of diagnoses. This is in line with the Ontario Human Rights Commission’s Policy on Preventing Discrimination Based on Mental Health Disabilities and Addictions, established in accordance with the Human Rights Code.

So put simply: York’s policy change simply reflects the law.

An important note-- in order to access accommodation, a student’s functional limitation must still be corroborated by a recognized health care provider. This caveat often seems to get lost in the shuffle of conversations surrounding this issue. The slippery slope detractors tend to imagine a future where students are given free license to independently self-diagnose random medical conditions, real or imagined (case in point, from the editorial: “Perhaps exams could be written outdoors in the quad. No, grass allergies. Really? Prove it. Don’t have to.”). If we are concerned about the ability of doctors to responsibly and accurately diagnose or identify limitations, that is a different conversation that needs to be had.

The distinction between “I can share my diagnosis,” and “I must share my diagnosis ” is one of basic autonomy. All students should be given the choice as to whether or not, and to whom, they disclose private medical information. Many students may still believe sharing their diagnosis is right for them: they may think that it will help service providers assist them better, they might still feel the urge to “legitimize” their limitation, or, as the author encourages, they might wish to dispel stigma through talking about their experiences.

On that latter point, though: of course, when people speak openly and publicly about their experiences it can help erode stigma. However, it is not the responsibility of those with disabilities to be educators, examples, or banner-wavers. Aside from the fact that naming a student’s diagnosis to an institution is a dubious method to “bust stigma” (it’s not as though that information is publically circulated, thankfully), the premise that forcing people to the front lines of fighting misinformation, discrimination, and assumptions is one that should be unsettling. Coming down hard on one side or the other (must disclose/must not disclose) takes away the individual’s agency to make their own decisions.

A diagnosis is not required to determine appropriate accommodation, and in some cases, its disclosure could do more harm than good. Disabilities are socially constructed: university administrators’, disability advisors’, or instructors’ perceptions of limitations they associate with a specific medical diagnosis may contribute to a student’s disability regardless of whether or not the perceived limitation actually exists. In these instances, the disability does not reside in the individual with the limitation, but rather in their environment and social interactions. According to the OHRC, longstanding and pervasive stereotypes can similarly influence actions against people with mental health issues.

So while Alex’s depression may cause her to fixate on the scratching of pens and creaking of chairs in the exam hall, Morgan’s depression might freeze his mind and actions entirely. The same diagnosis needs two different solutions: one where Alex can write the exam alone in the accessibility services exam centre, and another where Morgan can be given a different evaluation entirely. However, if both of these hypothetical students are provided accommodations based on their diagnoses, assumptions may mean that they do not receive the accommodation that alleviates each of their unique limitations. Worse still, functional limitations may manifest long before a diagnosis can be provided. The student advocate from York, Navi Dhanota, experienced limitations but had to get diagnosed with a whopping six conditions before she was assisted at the University of Toronto.

Such significance is placed on nomenclature, even when it is not necessary. While labels may be convenient, they are often a messy way to refer to broad and varying sets of symptoms. One person’s debilitating exam anxiety may be another’s source of motivation. While one medication may make an individual drowsy in the morning, another medication may energize them. By recognizing and respecting these differences, and accommodating limitations rather than diagnoses, we are treating students as individuals, for the betterment of the system.

Adhering to labels often privileges the comfort of the accommodation provider over that of the individual seeking accommodation. There is much room for misinterpretation and miscommunication when we are discussing mental health, so while it would be nice to believe students can discuss their conditions openly, stigma and preconceptions still exist. By working closely with a healthcare professional and safeguarding their medical information, students can save themselves unnecessary pain and disability placed upon them by others.

How is this a triumph? This policy change signals York University’s commitment to students as well as its commitment to respect and follow policy set by the Ontario Human Rights Commission. The OHRC’s policy interpreting the Code has been developed in extensive consultation with individuals who experience disabilities as a result of mental illness or addiction. Following these guidelines gives voice to these individuals and gives their dignity back to them.

So do we actually care about giving students basic agency to make health decisions that are best for them, instead of insinuating that they are at best, misguided, and at worst, “faking it”? Really? Prove it. Don’t have to: Ontario’s legislation means that disclosure decisions are in very able hands-- those of the students themselves.

Danielle Pierre
OUSA Research Analyst

Jasmine Irwin
OUSA Director of Communications