Public Policy

Recommendations for including persons with mental illness in public policy discussions – ADA Accommodations

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Supporters of the MHAP spoke with City of Portland staff at various levels in 2014 anticipating the eventual exclusion and discrimination against persons participating in public policy discussions. Following those discussions we wrote the recommendation below. Some of our recommendation was acted upon, such as the hiring of a “mental health coordinator” to staff meetings and provide accommodation on request.

Persons with mental illness are the most discriminated against persons in this or any other nation, now or at any time in history. They are routinely and legally discriminated against in housing, in law, in education, in the workplace, in churches and synagogues, in hospitals and clinics, and most everywhere else. Their NAACP hasn’t been formed. Their Martin Luther King hasn’t been born.

The perspective of persons with mental illness goes missing from public policy discussions because their discrimination is routinely ignored by civil servants, politicians, judges, and other facilitators of public discourse.

This discrimination can end – but not without protected inclusion, which, as defined by the Americans with Disabilities Act, means providing an accommodation.

Different disabilities require different accommodations. Few are cheap or easy. Accommodating people with a hearing disability may require ASL interpreters or captioning at public events. Accommodating people with ambulatory disabilities commonly requires elevators, ramps and wider hallways. Not cheap or easy – but often, legally required.

In Oregon about 160,899 persons have a hearing disability. About 256,000 have trouble getting around and/or up and down stairs. Mental illness, as measured by the federal government and not including addictions, overwhelms all other disabilities combined; in Oregon the number is 780,000.

Lack of inclusion of persons with mental illness in public policy discussions and decisions is a key reason public mental health systems have routinely poor outcomes.

Your organization or governmental agency should have a policy which clearly describes and defines what a disability accommodation for mental illness looks like, and how to respond when someone requests an accommodation for mental illness. If your organization or agency doesn’t have such a policy, ask your executive to create one. If they need guidance, contact the Mental Health Association of Portland for a list of consultants who can help formulate this policy for the organization.

What makes an effective accommodation for a person with mental illness, allowing them to participate in a public policy committee, an agency board of directors, or an oversight committee?

Mental illness is not a single condition or constant state. There are many different diagnosis, and many levels of disability due to each diagnosis. Thus, there is no one recommended accommodation suitable for all persons with mental illness.

Instead, an effective accommodation for a person with mental illness is discovered – and often deployed – through routine communication with an experienced, trained, integrated and committed support staff member.

A public policy accommodation for a person with mental illness is access to staff with the following qualities.

Routine Communication should be defined by the participant, but available in any form and at any time. Communication must be respectful – both ways.
Experienced Support staff members must have had personal experience as a recipient of a mental health services as defined by Medicaid within the past ten years.
Trained Support staff members must be certified Peer Support Specialists, or equivalent.
Integrated Understanding the issues is key. Support staff must be integrated in committee work. They must know committee members and be able to contact them on behalf of the participant. They must understand the committee governance, policies and processes. They must read, understand and be able to explain all subjects discussed and all documents distributed.
Commitment Staff should plan to spend approximately an hour one-on-one with each participant for each hour in a public or private meeting, and an additional hour for each document distributed to committee members. Staff should not spend more time than this.

DON’T assume a person with a disability needs or wants an accommodation. A person may have a disability and not wish to have an accommodation, or they may not need one. It is the disabled person’s responsibility to ask for an accommodation.

DON’T be unprepared. Government agencies are required by federal law to provide an accommodation upon request – not a month or a week or a day later. Upon request means now.

Disability statistics from

Suggested reading: Mental Health in the Workplace: Situation Analyses, United States, Part 2: The Role of Government and Social Partners (Cornell University ILR School), pp. 26-40:

For a list of consultants who can advise your organization about formulating a policy for inclusion of persons with mental illness in public policy discussions, send a request to