Melanie Mills wore a face shield when she went to the Ottawa Hospital for a routine epidural to treat chronic pain in her lower back and legs.

Despite a posted policy specifically asking visitors to wear face masks during the , Mills had no problem getting into the hospital or making her way up to the neurology department for her appointment last August. But when the 58-year-old met her doctor, she says, he denied her the epidural unless she swapped her face shield for a mask. She struggled to explain why she couldn’t wear one, she says, but the doctor insisted and kept saying, “I don’t know what to tell you.”

The conversation frazzled Mills so much she couldn’t stop herself from telling the doctor exactly why she couldn’t wear a mask: that decades ago she was raped, her face pushed to the bed, and the feeling that she would suffocate remains so severe that her post-traumatic stress dampens every day of her life.

“I couldn’t think about this, talk about this, without crying,” says Mills of her interaction with the doctor, which she’s anxiously been replaying in the lead-up to her next scheduled appointment.

Face masks are one of the most visible symbols of the pandemic, proven to be one of the in curbing transmission rates even as they’ve become a individual freedoms. Debates still rage over whether businesses have the to unmasked customers. But even in places like Toronto that have adopted mandatory mask policies, those policies for people with medical conditions.

And yet, when it comes to underlying conditions, asthma is more likely to come to mind. Rape is not.

But sexual violence is common and women like Mills should not be put in a position where they have to defend their need for an accommodation, says Megan Walker, executive director of the London Abused Women’s Centre, in London, Ont. “The automatic response should be, ‘OK, how can we help you?’”

Michaela Schreiter, a spokesperson for the Ottawa Hospital, said she couldn’t comment on specific cases, but noted that when people are unable to wear a mask “staff will work with the patient to evaluate all options and find a manageable alternative solution.” Variations of that policy are in place at major hospitals across the province, including the University Health Network in Toronto and Hamilton General Hospital.

Walker notes that with help, sexual assault survivors might be able to cope, but for Mills “to have to defend to a complete stranger why she’s not able to wear a mask because of that… [it] can do great damage to that woman’s psychological and emotional health.”

Given that there’s no indication people are faking accommodation needs to avoid a mask, Walker says health-care providers should be taking women like Mills at face value when they say they need it and make a new plan. In the U.K., a sexual assault survivor whose PTSD is similarly triggered by having her mouth and nose covered, is advocating for clearly labelled that people could wear in public to avoid having to repeatedly justify why they aren’t wearing a mask.

Mills knows masks work and she knows face shields don’t provide equal protection. Indeed, numerous studies so far indicate face shields are not as effective as masks in preventing droplet transmission, although as a stopgap measure in cases where a person’s underlying medical condition makes mask-wearing impossible.

After being turned away at the hospital in August, Mills, who lives in Lanark County outside of Ottawa, received an alternative pain treatment from a local doctor, but says it’s “maybe 40 per cent as effective” to treat the spinal stenosis she’s had for 22 years.

Mills doesn’t work because of her disability, which requires her to use a cane, and a pain flare-up sometimes confines her to a wheelchair. The epidural offered at the Ottawa Hospital, which , typically provides pain relief within a few days that can last for months at a time.

When she is feeling well, Mills spends as much time as she can helping with community projects, everything from disability advocacy to food security and women’s issues, especially sexual violence. She says she was raped by someone she had previously been in a relationship with and that her rapist never faced any repercussions.

Mills is supposed to go back to the Ottawa Hospital for the specialized treatment in December, but first wants assurances they’ll accommodate her.

After her August appointment, Mills sent an email to patient relations: “I cannot negotiate a mask,” she wrote. “If there is no other way, I will forego treatment.”

In response, a triage co-ordinator wrote back to apologize “for the added stress the situation caused [her]” and said the office would set up a meeting to speak further.

Mills says her three children are some of her fiercest advocates. Her daughter, Meghan Valvasori, responded on her behalf, saying that while she understood the safety considerations, she urged patient relations to advocate for those with mental health disabilities who need medical care.

“[My mother’s] trauma is rooted in feelings of helplessness and entrapment,” Valvasori wrote. “This trauma is triggered, as she also details below, in response to activities that restrict her breathing, involve her mouth or face, or — and with respect, I gently point this out to you — when a detailed description of her disability is described as ‘concerns’ and her response as ‘added stress.’”

That was more than two months ago and Mills says a meeting has yet to happen.

Jennifer Hollinshead, a clinical counsellor who works with victims of sexual assault at the practice she founded, , says health-care providers sometimes need a reminder that mental health is not a sidenote to physical health and putting people into positions where they feel they need to justify their trauma response can have ripple effects.

“It can worsen physical health outcomes because the person might not want to engage with the medical system,” says Hollinshead, who is based in Vancouver.

It’s a human rights issue full-stop, says Walker.

Broadly requiring people to wear masks for legitimate health reasons is not a human rights violation, according to Rosemary Parker, a spokesperson for the Ontario Human Rights Commission. However, she says that “unless it would amount to undue hardship based on cost or health and safety,” organizations have a duty to accommodate individuals who cannot wear masks because of a disability, be it physical, developmental or mental.

“An inability to use a mask or other equipment must not lead to automatic negative consequences such as complete denial of service,” Parker says.

Mills says her pain cuts into her sleep and limits how much she can do. She’s hoping she’ll be able to go back for an epidural next month, but she meant what she said in her email to the hospital: if they can’t accommodate her, she’ll stomach the pain.

“As a woman who has experienced a lifetime of trauma and a lifetime of being dismissed as not important… I had to fight really, really hard to make myself believe that I’m not worthless,” she says.

“[That doctor] immediately dismissed me and it put me right back down to that place.”