Creating a Cultural Analysis Tool for the Implementation of Ontario's Civil Mental Health Laws

The purpose of the study was to develop a Cultural Analysis Tool (CAT). The CAT consists of specific thematic questions that can serve as a cultural and equity analysis instrument for practitioners to use in the implementation of Ontario’s civil mental health laws. The rationale behind creating the CAT is based on research suggesting that ethno-racial people with mental health disabilities experience inequities and differential outcomes while interacting with Ontario’s civil mental health laws. Given the increasing multi-racial population in Ontario, there is a need to develop mechanisms to address these intersecting issues. Other countries that have created evaluative tools for mental health legislation include the United Kingdom and Australia. Such a tool does not exist in Canada, let alone in Ontario specifically. This study contributes to a better understanding of how equitable outcomes for ethno-racial people with mental health disabilities interacting with Ontario’s civil mental health laws can be achieved. I developed the CAT through an iterative process involving a comprehensive review of the literature and qualitative data drawn from thirty-five semi-structured interviews with seven members of each of the following groups: (1) ethno-racial people with mental health disabilities including in-patients and ex-patients, (2) lawyers who practice in the area of mental health law, (3) health care professionals including psychiatrists, nurses and social workers, (4) service providers such as front-line case workers at mental health agencies and (5) adjudicators, government advisors and academics. I analyzed the data using the grounded theory approach, symbolic interactionism, tenets of the theoretical framework and an analysis of the jurisprudence, legislation, international laws and literature on the existing tools used for mental health legislation. After developing a draft version of the CAT, I refined the CAT’s questions through an expert review (involving the qualitative technique of member-checking) using three focus groups of 1) ethno-racial people with mental health disabilities, 2) mental health lawyers and service providers and 3) health care professionals. Lastly, in order to develop the final version of the CAT, I analyzed and contextualized the results that emerged from the interviews through primary and secondary sources and the focus group data.