By Diana Chiu
The United Nations commemorates the annual International Day of People with Disability on the December 3, to encourage equal and full participation, as well as their inclusion in all facets of society. The present article highlights the need to address the concerns of people with mental disabilities who have been marginalized due to a lack of clarity about their plight. According to the WHO World Report on Disability, more than one billion people are living with disability, with an estimation of 450 million suffering from mental or neurological conditions and the dismal reality that about two – thirds are not accessing professional intervention due to neglect, stigma and discrimination. This may be attributed to the fact that disabilities due to mental ill- health such as neurological disorders, differences in learning, cognitive dysfunctions, fatigue, pain, emotional dysregulation are invisible. Therefore society has to remove barriers for all people living with disability, both visible and invisible while creating awareness about two Pandemics experienced globally- i.e., stigma towards mental stress and COVID-19.
There are many views about the factors that cause mental ill – health. These could be collectively described as biological, psychological and environmental factors. The Biological Factors explain thechemical imbalances of neuro-transmitters in the brain that disrupt the person’s normal cognitive functions and behavior. Heredity (Genetics) also plays a role whereby several mental illnesses run in the family, implying that people who have family members with a mental illness are more vulnerable to developing a mental illness. There are evidences which suggest that a disruption of early fetal brain development or trauma at the time of birth may explain conditions such as Autism Spectrum Disorder. Also, substance abuse may be associated with development of anxiety, depression, and paranoia. Research show that poor nutrition, infections and exposure to toxins have also been known to play a role in the development of mental illnesses.
Psychological Factor affects the persons’ well-being and mindfulness. Studies indicate that severe psychological trauma during childhood, such as physical, emotional or sexual abuse, experiences of significant early loss, neglect and abandonment may lead to low self-esteem or feelings of inadequacy or relational stress.
Social or Environmental Factors such as dysfunctional family life, socio-economic poverty, social or cultural stress, family diseases and significant life changes (for example, changing jobs or school, losing one’s job, divorce) can trigger the development of mental illness.
Detrimental effects of Mental Illness
People with disabilities can experience mental or physical impairments, and this has a long term effect on activities of daily living. Most often livelihood deficits create isolation and loneliness in their lives. Persons with disabilities are discriminated against and their dreams and ambitions are sidetracked because of society’s assumptions about their ability or inability. The cost of managing their disability can also put a huge burden on their finances, especially among the poorer sections of society. For example someone with a learning disability could experience low self-esteem because of their inability to perform as well as their classmates, often resulting in depression, anxiety, substance abuse and aggression. It is important for people to be aware that people with disabilities can also be suffering psychologically, and that they can always seek professional help.
Stigma & Discrimination in Society
Cultural superstitions due to ignorance and negative social beliefs prevent them from exploring scientific factors that cause diseases and disabilities. Many fail to understand the condition and become insensitive to all disabilities whether mental or physical. Most often it is believed to be a curse, karma that many cultures accept to be a punishment of sins committed by the parents or religious sacrilege. The society subjects the afflicted to prejudice and discrimination throughout their lives, highlight their problems, deprive them from normalizing their conditions and propagate excessive dependency for care and livelihood. Community undermines their inherent capabilities by viewing them as dangerous, incompetent and unfit. The negative impact is observed in their depression, self-pity, loneliness, low self-respect and suicidal ideations.
Therefore it is important to eradicate stigma by education, exploring treatment options, providing supportive, encouraging inclusivity, developing healthy attitudes and spreading positivity with kind words and actions to alleviate their problems.
Family and Community Environment
Family and community play an important role in providing the basic needs and care towards people with disabilities. Family care-giving usually involves tasks above and beyond assisting with activities of daily living, like bathing, dressing and eating etc.There are reports of common burden of care that leave them overwhelmed, anxious and/or intimidated by their duties. These challenges are observed in time constraints to enjoy hobbies and vacations, emotional and physical stress, financial difficulties, sleep deprivation and depression or isolation. It is known that providing support and care to people with disabilities is important. However, the family members need to seek a balance between care-giving and enjoying their own life.In order to reduce some of the burden, especially the financial constraints, we should also look at government assistance and schemes for person with disabilities. For example the Scholarship for students with disabilities provides financial assistance to access education or vocational training.
Certification for Mental Disability
The United Nations Educational, Scientific & Cultural Organization (UNESCO) and Convention on the Rights of Persons with Disabilities (CRPD) have been instrumental in ensuring equal opportunities and rights for persons with disabilities to achieve their maximum potentials in a barrier- free environment. In this context, it is observed that physical and mental illnesses tend to affect the overall capacity of the person to carry out certain social, educational and occupational functions. Therefore, the person’s ability to become independent is compromised which can increase the burden of care for family members.
This year the International Disability Day emphasizes on the need for inclusivity and development for all. Further, the Department of Social Justice and Empowerment in India has introduced various benefits through the Persons with Disabilities Act (1995). Therefore, family members of persons with mental illness can get access to the appropriate certification done by the psychiatrist, clinical psychologist or special educator. This enables the special considerations for pension, railway concession, income tax deductions, educational programs, vocational training and job placements.
Prevention of Mental Illness
There are three categories of activities for the prevention of mental ill–health. The primary prevention focuses on various determinants in the whole population or in the high risk group, the secondary prevention comprises early detection and intervention and the tertiary prevention targets the advanced recovery and reduction of relapse risk. The primary prevention of mental illness attempts to stop mental health problems before they occur and promoting good mental health for all. Often primary prevention is ‘universal’ in that it targets and benefits everyone in a community, for example anti-stigma campaigns such as Mental Health Awareness Week or Literacy programs.
Universal prevention is defined as those interventions that are targeted at the general public or entire population group that has not been identified on the basis of increased risk. Selective prevention targets individual or subgroups of the population at risk of developing mental disorders are significantly higher than average, as evidenced by biological, psychological or social risk factors. Indicated prevention targets high risk people who are identified as having minimal but detectable signs or symptoms. Secondary prevention involves decreasing the prevalence of a mental disorder by reducing the number of existing cases through early case detection, screening and effective treatment. Tertiary prevention attempts to reduce the severity of a mental disorder and its associated disability through rehabilitative activities.
(The article is prepared by a non- profit organization, RoUTES Shillong, consisting of a group of clinical psychologists and counseling psychologists providing various psychological services such as psychotherapy & counseling, disability certification & career guidance, mental health consultation and training).