Mental Health and Disability - Research Paper Example

Social work - Mental Health and Disability Introduction Mental illness is one of the most controversial fields of health. Due to its manifesting signs and symptoms, there are often issues with its acceptance and the danger that it poses to other people. Bogg (2010, p. 139) discusses that since the mid-20th century, mental illness has been acknowledged as a treatable and manageable health issue and that the duty is on society to provide treatment is based on the social values and rights-based approach. However, even with these developments, there is still a significant amount of negative attitude towards mental health in some sectors of society, and this must be acknowledged and challenged by the people and by mental health practitioners. This paper shall critically discuss the above beliefs by Bogg and it shall evaluate the role of social work in challenging this negative attitude, whilst working in relation to models and approaches to mental health care. This study aims to critically assess individual medical and social models of mental health and disability. It will also assess the concepts of disability rights, legal duties, and social agenda, including that of integration, inclusion, and modernisation. An evaluation of the role of social care in interprofessional working with disability and mental health services would also be considered in this study. Finally, a development of the strategies for anti-oppressive practice and empowering service users and carers with disabilities and mental health issues would also be established. Body The negative attitude towards mental illness has been around for as long as the mental health illnesses have been. Negative attitudes against mental illness are founded on a stigma which often causes the affected patients from denying their symptoms and delaying treatment (Centers for Disease Control and Prevention, 2010). It also leads to their exclusion in housing and employment opportunities which eventually interferes with their full recovery and their integration into the community. In an assessment of some states in the US on their attitude towards mental illnesses, a Behavioural Risk Factor Surveillance System was established. In this survey, most adults agreed that treatment can assist individuals with mental illness in eventually leading normal lives. Despite this attitude however, fewer than 57% agreed with the statement that people are generally sympathetic towards individuals with mental illness (CDC, 2010). There is therefore a decreased amount of sympathy and understanding extended towards those with mental illness and ultimately, these impacts on the recovery of mental health patients. Those with mental health issues are often subjected to prejudice in various aspects of their lives and in some instances, that stigma limit their activities more than their mental illness. Based on a report from the Institute of Psychiatry (2011), ignorance, fear, and stereotypes which are manifested in television, movies, and the media significantly add to the negative perceptions of mental illness and patients. The truth however is that most people do not have enough knowledge about these mental diseases and what knowledge they have is woefully inaccurate (Institute of Psychiatry, 2011). The health care system itself also has a stigma against mental health patients with mentally ill patients getting the worse deal in terms of NHS services as compared to any other affliction. In reviewing about 700 patients with schizophrenia in 27 countries, studies reveal that 47 percent of patient respondents express that they found it difficult to make and to keep friends because of the negative attitude of other people towards their disease (Institute of Psychiatry, 2011). About 43% of them feel discriminated from their family members, 29% can hardly land and keep jobs, and 72% of them have difficulty being involved in any relationship. These difficulties are all attributed to the negative perceptions which people have towards their disease (Institute of Psychiatry, 2011). These patients also feel that the compulsory treatment mandated for schizophrenia patients is a discriminatory provision and it limits their options in life. Moreover, the side effects of their medications exacerbate their feelings of being discriminated and being considered as plain “crazy,” or as “freaks.” Studies by the Institute of Psychiatry in associated with Rethink also reveal the attitudes of secondary school students regarding people with mental illness. Most of these words are derogatory and insulting (Institute of Psychiatry, 2011). This behaviour and attitude against the mentally ill often translates to their later adult years. In a survey by the Royal College of Psychiatrists (BBC, 1999), the group was able to establish some attitudes taken against mental illness and the people suffering this disease and in general, the RCP established that most people do not understand these mental illnesses. Even with about 18% women and 11% of men having significant mental health issues in any given week, most people still have fear and hostility towards those who are mentally ill (BBC, 1999). In a survey of about 1700 individuals on their attitudes towards six mental disorders, about 74% of the respondents consider drug addicts as dangerous while 71% consider schizophrenics and 65 consider alcoholics to be dangerous individuals (BBC, 1999). About 49% of the respondents also believe that those who are severely depressed should just pull themselves together and carry on with their lives. Moreover, 47% of them believe that drug addicts are responsible for their disease and 33% think the same thing of alcoholics, and 39% of anorexic patients are also considered responsible for their conditions (BBC, 1999). In relation to unpredictability, 81% of respondents believe that alcoholics are largely unpredictable; 78% of respondents believe the same thing for drug addicts, and 77% think also the same thing for schizophrenics (BBC, 1999). About 56% of individuals with severe depression and 50% of those with panic attacks are also considered unpredictable. Most respondents also believe that those with dementia will not improve even with adequate treatment. About 16% also believe that people with depression cannot be treated, 15% believe that of schizophrenia, 14% for panic attacks, 12% for drug addiction, 11% for alcoholism, and about 10% believe such for those with eating disorders (BBC, 1999). Due to the above negative perceptions and attitudes, most people find it hard and dangerous to communicate with people who have mental illnesses. In recent years, changes in these perceptions and attitudes have been seen, especially for diseases like alcohol addiction and drug addiction. The RCP is also quick to note how the health education of the public is an important tool in changing the attitudes of the general public about mental illnesses (BBC, 1999). Social work has a significant role in challenging this negative attitude towards mental illness. The social model of disability is focused on equality (Oliver, 2006). Struggling for such equality is sometimes also likened to the struggles for other socially discriminated groups, like, in this case, those with mental illnesses. Equal rights are meant to empower these marginalized groups and to arm them with the power to live their life well (Oliver, 2006). This model emphasizes that more positive attitudes about mental behaviour would help a person reach a more enlightened perception of other people. This model also focuses on changes in relation to the management of barriers, resources and aids. It also highlights the importance of information which uses adequate formats or coverage (Oliver, 2006). This model also points out that a prejudiced attitude towards the disabled can cause much harm on the self-esteem of the disabled person. In contrast to the medical model of disability, illness or disability is considered to be a result of a physical condition which is already a part of an individual’s own body. This model emphasizes on the need for medical remedies for any disability in order to normalize a person’s disability (Oliver, 2006). This is very much in contrast to the social model of disability which considers the treatment of a disability a discriminatory attitude towards the disease. This model therefore emphasizes the importance of society investing on resources for health care and health services in order to cure the disabilities (British Film Institute, 2010). Those who support disability rights often express their support for the social model and criticize the medical model as a source of social degradation of mentally ill people. They also point out that resources are misdirected towards medical remedies, to the exclusion of societal remedies for the disabled. The medical model is often used to justify significant monetary investments on procedures and technologies for the mentally ill (BFI, 2010). However, those who support the social model of disability point out that the medical model present disabled people as pitiable and disempowered. They further point out that the medical model does not consider disabilities to be political, social and environmental issues. Both models present valid points of discussion, the medical model of disability provides a basis for the prejudice given on these mental disorders. This model supports the negative label for disabled or for the mentally ill, presenting them as helpless individuals, needing medical help at all times and unable to function in normal society (BBC, 1999). The social model of disability seeks to dismiss disabilities as medical issues, and it emphasizes them to be societal and environmental issues which need to be addressed as such. In effect, those with disabilities must be allowed to be incorporated into society as normal individuals. These models provide extreme viewpoints on disability. In the actual setting, the medical model provides a medical basis for the disabilities, but applying this model in the treatment of patients can prove to be discriminatory to patients (Oliver and Sapey, 2006). It is possible however, to blend this model with the social model of disability which seeks to review the society and the outside world as contributory to mental illness and disability. Applying the medical model solely discriminates against the disabled, but applying the social model exclusively can also trivialize the scientific and medical aspects of the mental illness or disability (Oliver and Sapey, 2006). Both aspects cannot therefore be denied or dismissed if a comprehensive and holistic treatment for the mental illness is to be implemented. Social work can challenge the negative attitude towards mental illness by utilizing the social model of disability. The social model can be used to negate the discriminatory practices against the disables and the mentally ill (Goodley, 2001). Social workers must therefore contradict the discriminatory practices against the mentally ill by pointing out that those with mental illness are not categorically disabled by their condition and they should not therefore be excluded from the society in general and from other ‘normal’ activities. It is crucial that the health professionals and social workers do not allow those who are mentally ill or disabled to come under such one label or category of “disabled.” This would cause depersonalization where the personal and individual qualities of a person are denied and ignored (Charlton, 2000). These labels also allow the rest of society to discard and lump people together into categories like “depressed,” “anorexic,” or those with spina bifida or the quadriplegics as “disabled.” The social model of disability allows for distinctions to be made in these categories, differentiating between the disabled and those who are impaired. The social model of disability is also very much related to economics because it suggests that people can sometimes be disabled due to limitations in resources which restrict their ability to fulfil their needs (Charlton, 2000). This model also relates to issues, including under-estimation of people’s ability to contribute to the community and to contribute their productivity to the community. The UK Office for National Statistics was able to approximate that about a fifth of the working age population were actually disabled (Oliver and Sapey, 2006). Many of these disabled individuals are not given sufficient work opportunities and if they are employed, are not given enough disability benefits. As a result of these issues which restrict economic benefits for the mentally ill, various approaches have been suggested which bear consideration by social workers. In the UK, the Disability Discrimination Act specifies that disability is supported by the medical model. However, it is important to note also that the act does specify requirements for employers and other service providers to make the necessary adjustments in their policies and in the workplace in order to comply with the social model of disability. In these adjustments, the employers are limiting the barriers encountered by the disabled, in other words, the barriers to disability are removed. The Equality Act of 2010 served to combine the different UK provisions on discrimination against the disabled and the mentally ill. This provision also increases the coverage of the provisions on discrimination to cover indirect discrimination. Due to this law, it is now unlawful for employers to query employees on illnesses or disabilities during job interview. After a job offer is extended, the employers can then ask their employees about their disabilities. The role of social work is to ensure that all employers and all business establishments comply with these legal provisions, that the employees would not allow the rights of the mentally ill applicants to be ignored or discriminated against. For as long as their mental illness or disability does not interfere with their work, discrimination against employees based on their disability must not be allowed to dominate the workplace (Oliver, 2006). In effect, the employees must be judged and assessed based on their work quality and their capacity. Including reviews of their condition based on their mental capacities are subjective considerations which ultimately violate the basic rights granted to all individuals. Social inclusion is an important requirement in reducing the discriminatory practices against the mentally ill (Mental Health Coordinating Council, 2011). Social support helps to reconnect the people to society, promoting their recovery and decreasing the possibility of relapse. These social connections and inclusion activities include relations and socialization activities with friends and peers, sustaining employment and economic well-being, as well as being involved in educational activities, hobbies, physical exercise, and recreation (Mental Health Coordinating Council, 2011). Social inclusion is an important aspect of mental health care because it gives the patient purpose and a feeling of safety and security, freedom from violence and the threat of violence, as well as hope in the future. For individuals with mental illness, they are likely to find difficulties in accessing stable housing, also affordable transport, and they would likely feel the stigma and fear discrimination from other people. Even with inclusion practices for the mentally ill, these mentally ill individuals would likely still have a smaller group of friends and social networks, as compared to those in the general population and as their illness gets worse, this network will likely shrink even more (Mental Health Coordinating Council, 2011). Various studies have already pointed a strong link between social inclusion and recovery from mental illness, with those having low social support also having a decreased chance at recovery. In a New Zealand survey of individuals who were able to recover from mental illness, assistance from other people, most especially their community was a common element. Their family members and the mental health professionals were the most likely sources of assistance and more than half of the respondents also expressed receiving help from other groups, like support and therapy groups (MHCC, 2011). Friends were also considered a crucial determinant to their recovery and to the maintenance of their mental health. A significant part of the mental health recovery of patients is their ability to function as normal individuals in society. Therefore, issues with losing work, schooling, and being removed from the social scene are factors which impact on patient’s recovery (Corrigan and Watson, 2003, p. 501). The fact that their disease itself can cause difficulties in the management of daily activities is also another factor which will impact on the discrimination and on the eventual recovery of mentally ill patients. Activities of daily living include feeding, bathing, maintaining hygiene, and getting to and from the bathroom. With limitations in these activities, the higher the possibility of mental health patients isolating themselves from other people and limiting their social network (MHCC, 2011). With the presence however of support agencies, the activities of the mentally ill can be managed and proper conveniences can be ensured in order to help these patients maintain their independence, as well as preventing any harm from befalling these patients while carrying out their ADLs (MHCC, 2011). Rebuilding independent functions is as important as managing the mental illness because as the mentally ill starts to gain such independence, the better he would feel about himself and the more likely that he would be engaged in community socializations. Social exclusion and discrimination interferes with the mentally ill person’s recovery. These patients can go through a period of isolation, sometimes of their personal choice; and sometimes they may be driven into isolation my social discrimination (Goodley, 2001). A mental illness diagnosis is alienating in itself and it can sometimes make the prognosis for the patient worse, and this can cause further isolation, and so on and so forth. This is a vicious cycle which patients have to cope with; and in most cases, it can lead to compromised access to health treatment. Eventually, these are barriers to recovery which may seem insurmountable to the patients because their access to adequate health services is based on subjective qualifications which have nothing to do with the physiological manifestations of their disease. Social care for the mentally ill is also based on the premise that all patients and all people have rights and these rights transcend to equal access to mental health care services, as well as employment, political, and social opportunities. Institutions may unknowingly perpetuate discrimination attributed to mental illness. In these instances, public policies may favour good business and cost efficient economic practices which may discriminate against particular groups (MHCC, 2011). Among mental illness patients, unintended structural discrimination may be seen with decreased allocations for research on the treatment of mental illnesses. The function of social care and social work is to ensure that equal advocacy for mental health care and is established within the health care system. Interprofessional working with other mental health professionals is a function of social workers who can establish a connection with the mentally ill patient in the community setting and then coordinate with other health professionals in the assessment, diagnosis, plan, and treatment of the mental health patient (Carpenter, et.al., 2003, p. 1083). The function of the social worker would be to gather the necessary data about the patient and also to gather the health professionals as a team in planning the patient’s care. The recommendations of each mental health professional would be discussed with other professionals and an effective plan of care would be based on the expert contributions of all the members of the team (Carpenter, et.al., 2003, p. 1083). Interprofessional working would allow for a thorough and a fair assessment of a patient’s mental illness, and would ensure a plan of care which is not negatively affected by discriminatory practices or mental health stigma. Conclusion The above discussion specifies the impact of discrimination on mental health patients and such impact mostly registers in terms of their limited access to mental health care, to employment opportunities, and to other social opportunities. The social model of disability specifies important points for discussing disability and these points mostly revolve around the importance of including the mentally ill in the society. Social work can assist in ensuring that discrimination against the mentally ill is avoided and managed. They play the role of advocates in safeguarding patient rights and inclusion policies are implemented for the mentally ill. In effect, although discrimination is a significant part of our society, it is possible to prevent and manage these practices for the ultimate benefit of the mentally ill and even the disabled. 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Corrigan, P., Markvwitz, F., Watson, A. 2004, Structural Levels of Mental Illness Stigma and Discrimination, Schizophrenia Bulletin, vol. 30, no. 3, pp. 481-491 Corrigan, P. & Watson, A. 2003, What factors explain how policy makers distribute resources to mental health services? Psychiatric Services, vol. 54: pp. 501-507. Goodley, D. 2001, Learning Difficulties, the Social Model of Disability and Impairment: Challenging epistemologies, Disability & Society, vol. 16, no. 2: pp. 207–226. 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