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Stop tying applications for disability income assistance to doctors
Removing mandatory doctor or nurse practitioner reports in applications for disability payments would be a simple and ethical policy change that would undo some of the centralized power physicians have over their patients and could be implemented immediately. (File photo: Henry & Co./Unsplash)
Applying for disability income assistance in British Columbia is cumbersome, time-consuming and unfairly assesses people based on their perceived weaknesses. It requires a medical signature from a doctor or nurse practitioner. It also requires that another health professional fill out an “assessor” report.
The Ministry of Social Development and Poverty Reduction makes the final decision on whether applicants meet the eligibility criteria for income assistance as persons with disability (PWD), who can then receive the financial and other health supports to which they are entitled.
The application for PWD status, which includes criteria for being deemed unable to maintain traditional employment, is 28 pages long. A physician or nurse practitioner must have a clinical history with the applicant and complete a medical section. A second report needs to be filled out by a health professional from a prescribed list, including social workers, psychologists and physiotherapists.
Undue delays and health-care strains
It can be difficult finding a family health practitioner in the province. A professor who tracks wait lists across Canada has said it could possibly take years, despite B.C. Health Minister Adrian Dix recently announcing the startup of an online database to connect patients to primary caregivers. This database shows 270,000 B.C. residents are on the wait-list and 900,000 people are without a family doctor.
Additionally, the ministry can take over two months to decide on an application, due in part to its length and the requirement for separate medical and social assessments.
Needing to go through this two-pronged application process unduly delays access to health support, income and, consequently, housing, food, water and other necessities, thereby infringing on human rights. And limiting a section of the application to only permit a physician or nurse practitioner’s signature unnecessarily strains a fragile, overloaded health-care system.
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Removing the mandatory doctor’s signature would help increase and speed up access to financial and other health supports for people entitled to them. One signature from assessors such as social workers, nurses, physical or occupational therapists, counsellors, midwives, support workers, elders or other disability experts should be made to suffice. Physicians and nurse practitioners could remain as options.
Narrow eligibility criteria are another hurdle in obtaining disability income assistance and tend to further exclude youth and families.
A 2023 provincial government analysis showed 382,000 people in B.C. were living in poverty, that is, below a threshold based on the cost of specific goods and services needed for a basic standard of living. But that measurement has been analyzed as understating the level of poverty for disabled people.
Non-disability income assistance is typically $560 for an individual, with a possible $500 subsidy for shelter. Rental ads in 2023 indicated that the average one-bedroom apartment in B.C. had surpassed $2,100 a month – more than double the assistance and shelter payments combined.
The PWD income assistance rate does not provide enough to live on, either – $983.50 is provided for an individual (with the same $500 housing subsidy).
Discrimination against PWD
People with disabilities – whether mental-health issues, physical or mobility barriers, brain injuries and/or intellectual or developmental impairments – routinely face discrimination in health care and social services settings.
But their right to an adequate standard of living is protected by the International Covenant on Economic, Social and Cultural Rights and the United Nations Convention on the Rights of Persons with Disabilities – both ratified by Canada. They declare that governments must not discriminate against people with disabilities and must take steps to safeguard and ensure adequate provision of health, food, water, housing and financial assistance.
The Canadian Charter of Rights and Freedoms protects life, liberty and security of the person. The PWD application in B.C. arguably violates these fundamental rights in that disabled people are ineligible or face indefinite delay in receiving government financial or health assistance simply by not being able to find a family physician or nurse practitioner. Lack of financial support can lead to abject poverty, which can result in premature death through deprivation of nourishing food, clean water, shelter and health care.
Defining disability
As scholar A.J. Withers writes, the medical model “views disability as an individual tragedy and as based within the body.” In the 1970s, as Withers details, disabled people advocated for a shift in the dominant social understanding of disability to “the oppression imposed on disabled people as a result of impairments.” Withers likewise argues for recognition that people are disabled “because we are identified as such by existing power structures,” and that “all disabled people, including physically disabled people, can be, and are, disabled and able-bodied simultaneously.”
By now, the Accessible Canada Act and the UN recognize these truths to a limited degree. However, B.C.’s persons with disabilities application remains a medical fossil that focuses almost entirely on the deficits of the individual as defined by a physician or nurse practitioner.
The reality of welfare
In April 2023, Care Not Cops 604, with endorsement from eight B.C.-based community groups — including Pivot Legal Society, Disability Alliance BC, South Asian Mental Health Alliance and the Coalition of Peers Dismantling the Drug War – produced a policy roadmap to shift income security services away from being primarily punitive and workfare-oriented.
To date, B.C.’s NDP government has only tinkered around the edges, ignoring most of the 20-plus recommendations, rather than ensuring adequate access to supports that would permit people to live with dignity. Increasing the rates and decreasing punitive barriers are both essential transformations at this time.
There are alternatives
Removing mandatory doctor or nurse practitioner reports in applications for disability payments would be a simple and ethical policy change that would undo some of the centralized power physicians have over their patients and could be implemented immediately. Having to provide two assessments, only to be judged by a panel of bureaucrats, is an unnecessary and costly burden to both the applicant and the province.
It is far past time to raise payments, shift income security from punitive to supportive, use resources to keep people safer inside and out, and do away with the mandatory involvement of doctors in applications by expanding who is eligible to complete assessments.
This article first appeared on Policy Options and is republished here under a Creative Commons license.
