People living with mental health-related disabilities who apply to the Ontario Disability Support Program (ODSP) are often turned down. This may be because the decision-maker believes that the medical treatment they are getting isn’t comprehensive enough, that there are gaps in their treatment, or there is not enough detailed and complete medical evidence to show that their impairments are “substantial”. But this approach can be contrary to the law because it does not consider the ODSP applicant’s treatment and medical evidence in their broader context as a “whole person”.
Alongside Mississauga Community Legal Services (MCLS), the Income Security Advocacy Centre represented a woman living with multiple health conditions, including anxiety, depression, and post-traumatic stress disorder. Like many people seeking ODSP benefits, her life has been shaped not only by her medical conditions, but by poverty, instability, and barriers to accessing consistent medical care. She was denied ODSP income support because the Social Benefits Tribunal found that her mental health impairments were not “substantial.”
When the Tribunal determines that impairments are not “substantial”, that can lead to a denial of ODSP. Their determinations don’t always include a “whole person” approach, however. A “whole person” approach means looking at how all of a person’s conditions, limitations, and real-world barriers interact, including gaps in care caused by poverty, wait lists or systemic barriers.
Challenging the Tribunal’s Key Findings
In their initial decision, the Tribunal reached the conclusion that the client’s impairments were not “substantial” for three main reasons:
The Tribunal’s view was that she had not undergone enough treatment, so her impairments could not be substantial. But this finding was problematic because, as the Tribunal itself acknowledged, she faced significant barriers to treatment such as medication allergies, financial limitations, anxiety, and unstable access to care.
The Tribunal placed weight on the absence of medical documentationabout her level of impairment after she began a new medication. However, the Tribunal ignored a doctor’s clinical note that showed a decline after she began the new medication. The Tribunal’s approach also ignored the reality that people may lack updated medical reports because they often experience gaps between referrals, specialists, and obtaining updated reports.
The Tribunal did not consider how her mental health impairments and daily life restrictions may overlap. However, the Tribunal was required to consider this when deciding whether her medical conditions caused substantial impairment.
“Whole person” approach
In collaboration with MCLS, ISAC filed the client’s appeal and argued that the Tribunal must assess disability using a “whole person” approach.
We argued that the Social Benefits Tribunal made a mistake when it focused on her level of treatment without considering her barriers to stable treatment, details in the medical notes and her best efforts as a whole.
We also argued that the Tribunal made an error when it ignored the ways in which her mental health disabilities affected her functioning. This is because mental health conditions are precisely the types of conditions where determining the substantiality of impairment requires consideration of how these conditions restrict the individual’s ability to function. The impairments will vary from person to person. In our client’s case, the evidence about restrictions would have assisted the decision makers in determining whether an impairment is substantial.
After starting an appeal at the Divisional Court, the clinics were successful in negotiating a settlement that granted our client ODSP eligibility. The “whole person” approach was an important and powerful way to ensure the client and her life circumstances were fully considered alongside her medical history.