I live in Canada so I'm not really familiar with the ADA and this may not apply...

I work with people living with chronic mental illness (schizophrenia, manic-depression, depression, etc.). Awareness (or acceptance) of illness is sometimes an issue. (Irrelevant for me as a nurse as my focus is health and lifestyle choices - but there are areas of overlap and the system IS based on medical models of diagnosis, etc.) If a client doesn't see themselves as medically ill or as having a disability, that is their perspective and that should be respected as much as possible ie the right to refuse medical treatment / medication. 

If that person's choices result in potentially dangerous behaviours (either to themselves or others) then there are legal means to step in for protective interventions (for the individual or for society). Examples would include suicidal behaviour, self-neglect (not eating, skin breakdown from poor hygeine, wearing clothing inappropriate for the weather, etc.), or violence. In these instances the family, the police or the medical system can act to have the patient assessed and possibly treated against their will in certain circumstances.

The only other instances where one could act contrary to the person's expressed wishes would be if that person is deemed to be incompetent. This is a medical/psychiatric evaluation. If declared incompetent then a substitute decision maker is appointed (usually a family member but sometimes a court-appointed guardian).

As far as I know these are pretty standard guidelines in psychiatry in North America, though every jurisdiction would have some variations. 

Unfortunately that means that many people are at risk of falling between the cracks. If they don't see themselves as either ill or disabled they are unlikely to seek out assistance or accomodations offered by ADA. If they have cognitive impairment they may not be able to navigate the system to access services. If their behaviour does not fall into one of the categories mentioned above then no one may even become aware of their situation to offer assistance or education re their rights. My understanding is that a large percentage of the homeless population in North America consists of people who have some form of chronic mental illness (including addiction issues) that is untreated. This makes them highly vulnerable - to malnutrition, exposure, crime, neglect... 

The hardest part of my job sometimes is to have to respect a person's right to walk away from the help I can offer. But people have to have the right to make their own choices for themselves and live their lives as they wish. 

Just my thoughts.

Yvonne

>>> [log in to unmask] 11/15/00 10:40PM >>>
I need to know if there's any ADA or other federal case law regarding
reasonable accommodations which addresses the needs of cognitively or
psychiatrically impaired individuals who may be impaired from requesting a
reasonable accommodation due to the nature of their disability? In other
words, if the requirement for reasonable accommodation is that the PWD must
initiate the request, what happens when the disability prevents the PWD from
being able to do so?

What happens when they don't see themselves as disabled, even when by any
objective standard, they clearly are?

Don't the above situations leave these individuals unnecessarily vulnerable
under the law if no other provisions are in place.

I know some state statutes address these issues, but what about Federal?
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