Is Disability a Medical or Social Concern - Essay Example

 Is Disability a Medical or Social Concern? Introduction While the process by which a person gets to a point where s/he may be considered medically disabled is certainly a medical concern, what happens to the disabled individual and the stigma they have to live with is certainly a social concern. This is particularly true when it comes to individuals who have mental disabilities since they are physically fit but the reaction given to them by society and the way they have to live their life in a world of ‘normal’ people makes it a very important social concern (Fernando, 1995). Undeniably, changing laws and improvements with regard to our understanding of disabilities have improved the medical and legal situation as discussed by Oliver (1983) but the social situation still leaves a lot of room for improvement. With the evidence gathered from researchers and analysts of the situation, it can be shown that disability in general and mental disability in particular is a social concern as much if not more than a medical concern for the disabled as well as the people around them. Disability has to be seen by a social perspective first since mentally disabled individuals have as much a right to be a part of society as any of their fellow humans. Putting Disability in Perspective Mental health problems have been around us as long as there has been a acceptance of mental health discrepancies. In the modern world, many of the stigmas and social problems connected with mental health concerns have been overcome by the people but still a lot remains to be done before we can arrive at a position where there is no social stigma associated with mental disabilities (Fernando, 1995). In fact, whilst it would be logical to assume that stigmatisation and the social issues are limited to the general population, in reality the stigmatisation can also be observed amongst doctors, nurses and social workers who are not supposed to be have such issues. Such as case was noted by Happell (2005) where one of the mentally disabled individuals she was working with received a negative remark from an official. She says that, “The remark, which was made in an official capacity, questioned, perhaps even refuted, one of the most basic human rights for people diagnosed with a mental illness (Happell, 2005, Pg. 1)”. The remark came from someone in an official capacity which goes to show that negative stereotypes and stigmatization of those with mental disabilities continues despite laws made to protect them. The reasons why disabilities issues are a social concern are quit complex since there a number of influences which make them so. It is certainly a matter of concern that despite of the progress we have made, there are still problems that remain when it comes to dealing with cases where individuals have disability problems. Harris (2004) suggests that the representation of individuals with mental health related disabilities in the media is partly to blame for this. Additionally, the news reports where individuals suffering from mental health issues killed their children or other situations where people suffering from mental health showed aggressive behaviour do nothing to help the social issues of those who experience disability. The social problem concerning how disability is seen or understood is doubled when it comes to the minority groups or the recent immigrant to the country who may not have the cultural awareness and sensitivity towards disability (Gary, 2005). Additionally, disability issues connected with children or with senior citizens also lead to social issues which are difficult to tackle (Turner, 2005). On a global level, second or third world countries tend to have considerably lower standards of treatment for the mentally or physically disabled which means the problem is not limited to our country alone (Crabtree, 2003). Discrimination and exclusion become a part of life for those who have disability issues despite laws to the contrary. Even those who are seeking a resolution to their mental health services or their physical disability may be unaware of the issues and problems associated with it. In such a situation, it becomes the responsibility of social workers to understand disability issues with regard to both physically disabled individuals and mentally disabled persons. A part of the problem also comes from the manner in which a type of disability is viewed. Physical disability is easier for most people to comprehend. As discussed by Oliver (1983), the physical disability may often be quite obvious and this makes the disability more acceptable in social terms than a mental disability which may not be obvious. Ostman (2004) shows how even twenty years later, mental disability remains a greater issue than physical disability since it is still not understood completely by the public at large. The social importance of physical disability over mental disability has been discussed by Happell (2005) who reports that the primary focus of most social caregivers is towards physically ill patients and they may choose to ignore, or provide a lower level of care, to those who are seen to be mentally disabled. In fact, there is an assumption that mentally disabled individuals may take needed services away from those who are physically disabled since they may be seen as being more in need. Such assumptions are certainly ill-founded since they can only lead to social discrimination against the mentally disabled. For all social organisation and workers who deal with such patients, the importance of seeing disability as a social concern is quite high since it helps them understand that disabled individuals need help in cases where others could get by on their own. The social stigmatisation of mental health patients is a subject of concern which requires careful attention. An understanding of the issues involved would give social workers the means by they can prevent discrimination against mentally disabled individuals. The breakthroughs in technology and medicine which came after the World War Two have led us to understand many of the links between the brain, emotions and the body. In terms of actual medical treatment, mentally disabled patients can be treated with the same kindness and insight which given to the physically disabled. We have made great strides in understanding brain chemistry and are able to treat mental health problems through medicinal means. The idea of dealing with cases where mental disability is involved has become a part of the mainstream in terms of social work and it is now possible to treat all cases on the basis of equality. However, the stigma associated with any sort of disability remains present in society primarily due to the lack of education and understanding which prevails in the public. Since that general population sector also includes case workers, medical staff and social officers of the state, in spite of their education, they can also stigmatise those who suffer from any disability (Happell, 2005). Simply put, people may see a person who is known to have a mental disability as being scary, fearsome may avoid being in their company. Turner (2005) discusses these problems at length, and shows that some nursing students had experienced negativity when their peers reacted negatively their mental disability. He describes a nursing student who confessed to his fellows about being mentally disabled and said that, “I saw that his eyes were full of tears. He had heard negative attitudes expressed by fellow students, which made him feel be had to hide his experience (Turner, 2005, Pg. 33)”. In essence, acceptance of those who have some mental issues still needs to be developed further in society. Social Issues The root of the social issue is that people with mental disabilities are being seen as the outsider and abnormal which generates fear (Turner, 2005). While such behaviour certainly hurts the person who is disabled, the pain becomes worse when the discrimination and fear comes from loved ones who might find it difficult to understand the individual’s needs for repeat visits to a mental health clinic (Ostman, 2004). Further, even the relatives might be burdened with concern initially but after a few such visits, the process become routine and may even be seen as an annoyance by them. The role of the social worker here becomes quite important and it is entirely justified to place that role in the context of this discussion because the social worker is often the first line of defence for the mentally or physically disabled (Oliver, 1983). Social workers have played a very historical role along with doctors and mental health experts in the past for improving the conditions as well as the level of social acceptance for mentally disabled individuals. In fact, it is largely due to them that any level of acceptance has been created since the approach taken to mental health issues in medieval times and even till the 18th century was little more than a story of horror (Shorter, 1997). However, despite the advancements made by science, even medical professionals today may have issues dealing with those who have a mental disability of one sort or the other. Crabtree (2003) discusses the case of an institute where young doctors displayed considerable anxiety while working with the mentally disabled. The reason they presented for the anxiety had a lot to do with the non-professional attitude of their peers who thought working with individual who have mental disability issues to be very dangerous. One doctor reported: “When you tell people, other doctors, you work at Hospital X, they say, ‘oh, that place!’ It’s not easy to be here. Some people, even you know, doctors, seem to think that if you work here long enough you might become insane as well – it’s contagious, sort of thing (Crabtree, 2003, Pg. 717).” This goes to show that negative stereotypes and images based on false information can really affect society and how people react. Disillusionment can slowly creep in and lead to social workers losing patience with other caregivers, the relatives of the patients or even the disabled individual him/herself. Even if a social worker is not totally disillusioned by the situation, they can certainly become pessimistic which hurts their professionalism and takes away from their capacity to work with disabled individuals. This is certainly a situation which must be avoided since social workers should not be bigoted themselves while they are fighting against discrimination towards the disabled. Discrimination and Social Exclusion Undeniably, discrimination and exclusion are still present in our communities to some extent and they reduce the quality of life for a disabled individual who is already placed in a negative situation. Social exclusion and discrimination continue to be cited as one of the reasons why those with disabilities continue to have a lowered quality of life (Lehman and Steinwachs, 1998). Chan and Yu (2003) discuss individuals with mental disabilities and say that: “People with mental health problems had significantly less satisfaction with their quality of life than a sample from the general population. They had many difficulties, such as financial problems, unemployment and lack of opportunities to participate in social activities that resulted from stigma and discrimination (Chan &Yu, 2003, Pg. 72)”. The situation is no better in America Lehman et. al. (1982) shows us that more than two decades ago, the quality of life for mental health patients in the US was much lower than those who were physically ill. The same was seen to be true in for mental health patients in the United Kingdom as well as Hong Kong (Chan &Yu, 2003). One would expect that the stigma associated with mental health issues would be removed once the disability has been removed but Atkinson et. al. (1997) show that the problems and the discrimination continue even after the patient recovered completely. In our social setup, a person who suffers prolonged bouts of mental disability comes to a position where their persistent mental health issues lead them to believe that they can never be cured at all (WHO, 2001). Along with the manner in which society deals with them, they may get to a point where they have lower their expectations for everything. This creates a problem of mental depression and an absence of interest in getting back on their feet. Once they get to this point, the person with the mental disability may lose the will to bring any change in their life (Chan &Yu, 2003). Even hospitals have staff that discriminate against those who have mental disabilities as discussed by Crabtree (2003), mental health hospitals might be seen as nothing more than asylums by some social and health professionals. Goffman (1991) states that the use of the name asylum and even the image of the asylum are negative since it suggests that the individuals within are similar to criminal prisoners or similar to those who have no chance for getting a cure. To overcome this social problem, Crabtree (2003) recommends reclassifying mental health institutes as therapeutic havens rather than insane assylums. This would certainly be a positive change from the negative image of the mental asylum as they had been operated in the 19th and 20th centuries and could help diffuse the situation when it comes to the local populations (Shorter, 1997). However, with regard to the immigrant population, the stigma of being mentally disabled seems to be greater. Gary (2005) examined this social issue and conducted a study about mentally disabled individuals coming from different ethnic minorities and he says that there are serious social concerns about prejudice and discrimination for such individuals. Gary reports that: “Ethnic minority groups, who already confront prejudice and discrimination because of their group affiliation, suffer double stigma when faced with the burdens of mental illness. The potency of the stigma of mental illness is one reason why some ethnic minority group members who would benefit from mental health services elect not to seek or adequately participate in treatment (Gary, 2005, Pg. 979).” To be a member of an ethnic minority creates many of the same problems as those which are seen for elder patients that need care because of mental disabilities. Older individual may have problems with loneliness and discrimination but when a mental disability is added to their set of issues, they become further stigmatised. These cases need case workers who are fully prepared to handle the challenges in caring for such individuals and social workers need to move beyond the stereotypes of senility. Perhaps the best analysis concerning the social problems for people who have mental disabilities comes from Chan and Yu (2003) who report that: “Stigmatization of and discrimination against people with mental health problems are a major hindrance to employment and social integration. Clients may have more life satisfaction if they have gainful employment, are able to integrate into the community and live a reasonably ‘normal’ life (Chan &Yu, 2003, Pg. 81)”. Government bodies, social networks and official regulations may say that discrimination and exclusion for those who have mental health issues has to be eradicated, the process of getting that stage is still underway. It is clear that the social situation can only be helped when education, compassion and awareness is created for the people as well as those who are the caregivers of the people suffering from a disability. Social organisations can certainly help and reduce the stigma associated for those who have mental disabilities as well as the discrimination and negative social experience they go through with the use of social alliances. The concept of this sort of alliance between a caregiver and the patient is greatly appreciated by Safran & Segal (1990) who recommend the development of a support system between the patient and the social workers involved with the patient. The basic concern in any such alliance between the social worker and individual is the need for ethical conduct which means that the person suffering from a disability must be able to agree with the goals and methods for becoming more socially integrated. This does not apply to social workers alone since medical professionals can also engage in the provision of hands on care for the disabled individual (Cole, 2006). The role of a social worker in removing the stigmatisation and exclusion of the patient cannot be taken as a static function since it is dynamic and based on the particular situation the social worker is in. For instance, a social worker may have to explain to the children of the mentally disabled individual why their parent is behaving in a strange way. Such situations certainly need a lot of emotional stability and maturity which comes with time and experience. It may not be possible for social workers to be present and support the individual at all times therefore the relationship between the caregiver and the patient may fall with prolonged disconnects (Gelso & Carter, 1994). Therefore, a social worker might have a limited amount of time in which to make the connection and get a rapport established with the individual who needs care. The time spent with the individual should be gainfully utilised to learn from the mentally disabled individual and to see how the patient deals with their own situation and what the social workers can do to help with the recovery process (Dewing, 2005). Such positive alliances can have a long lasting effect on the recovery of the patient and they can be formed with any care giver for the patient at all possible levels. Social Mainstreaming While the argument for creating separate hospitals for mentally disabled individuals or for those who have psychological or mental issues is losing its force, mainstreaming is still not the system under which all social care givers can operate. Happell (2005) makes the recommendation that the same standards of treatment should be kept for those who seek mental care as the standards for those people who are physically disabled. In this manner, the ability to access welfare services for mentally disabled individuals can be increased and this would lead to a more useful consumption of welfare funds (Jordan, 1987). In fact, social workers should understand that the level of care given to a person should not depend on their disability or their social status since the job of a social worker is to give to society as much as s/he is able to give (Happell, 2005). While it is easy to change the policies governing the NHS, it is more difficult to change the attitudes of people about individuals who need have mental health disabilities (Ostman, 2004). The descriptions of mental health patients as they are presented in the general media show that these attitudes might be harder to change than it was previously thought (Cole, 2006). To overcome the fear, loathing and discrimination against people with mental disabilities the only tool we have is education. Towards this objective, social workers must play their role positively when it comes to educating relatives, other staff members and even the population at large about the problems and issues faced by those suffering from a mental disability (Dewing, 2005). As a matter of fact, these people are no different from those who have a physical disability or a medical condition such as diabetes. However, while there are support groups and special interest sections looking out for the interests of those may be physically ill, few patients who have a mental disability can find support. Social workers also have the responsibility to educate themselves as much as they can with about the care and treatment given to those who have a disability (Dewing, 2005). Working directly with such individuals is a positive learning experience that can lead to the personal development and professional improvement of the social worker. The work creates emotional maturity and builds an understanding nature which is very applicable in all other tasks a social worker may have to perform. Social workers who work with disabled individuals not only support the profession but also fight against the negative imagery and the stereotypes that are prevalent in the world today (Fernando, 1995). While we may know that working with people who have mental disabilities is not contagious, there are still countries in the world where such ideas are seen as the truth. A social worker in the UK may know that certain stereotypes are wrong as well as negative for the person with a disability and s/he must convey the same to others. If the social worker manages to help only one individual it makes a difference. It would be very easy to be frustrated and disillusioned as a social worker who is working with mental health patients while the public as well as others in the profession display no signs of changing and a lack of respect for those who have a disability. In such cases, it becomes the duty of the social worker to keep hope alive by helping people understand the situation and be an advocate for the rights of people who are disabled (Happell, 2005). The problem is certainly not unbeatable because many social and healthcare professionals have shown compassion for mental health issues and have been positively rewarded for their charity and persistence. Conclusion Disability in all its forms remains a social concern more than a medical concern since there is a stigma associated with being disabled due to the lack of understanding and education which is prevalent in the general public. Social workers should continually challenge their own discriminatory attitudes as well as the attitude of other professionals with regard to the social issues created by disability. By influencing the world around us in a positive manner, social workers bear the responsibility to bring improvements for all of us. This is certainly not an easy task and it may take years before it is completed. However, the rewards are such as that not working towards such as objective would undermine the very reason social workers become social workers. Word Count: 4,069 Works Cited Atkinson, M. et. al. 1997, ‘Characterising quality of life among patients with chronic mental illness’, The American Journal of Psychiatry, vol. 154, no. 1, pp. 99–105. Chan, S. & Yu, I. 2003, ‘Quality of life of clients with schizophrenia’, Journal of Advanced Nursing, vol. 45, no. 1, pp. 72–83. Chan, S. and Cheng, B. 2001, ‘Creating positive attitudes, the effects of knowledge and clinical experience of psychiatry in student nurse education’, Nurse Education Today, vol. 21, no. 1, pp. 434–443. Cole, M. 2006, Power over therapy? Mental Health Practice, vol. 9, no. 9, pp. 28-32. Crabtree, S. 2003, ‘Asylum blues: staff attitudes towards psychiatric nursing in Sarawak, East Malaysia’, Journal of Psychiatric and Mental Health Nursing, vol 10, no. 1, pp. 713-721. Dewing, J. 2005, ‘Double skills, double knowledge’, Mental Health Practice, vol. 8, no. 5, pp. 46-47. Fernando, S. 1995, Mental Health in a Multi Ethnic Society, Routledge, London. Gary, F. 2005, ‘Stigma: barrier to mental health care among ethnic minorities’, Issues In Mental Health Nursing, vol. 26, no. 10, pp. 979-99. Gelso, C. and Carter, J. 1994, ‘Components of the psychotherapy relationship: their interaction and unfolding during treatment’, Journal of Counselling Psychology, vol. 41, no. 2, pp. 296-396. Goffman, E. 1991, Asylums: essays on the social situation of mental patients and other inmates, Penguin Books, London. Happell, B. 2005, ‘Mental health nursing: challenging stigma and discrimination towards people experiencing a mental illness’, International Journal of Mental Health Nursing, vol. 14, no. 1, pp. 1-2. Harris, R. 2004, ‘Media representation of people with mental health problems’, Nursing Times, vol. 100, no. 34, pp. 33-5. Jordan, B. 1987, Rethinking Welfare, Blackwell. Lehman, A. & Steinwachs, D. 1998, ‘At issue: translating research into practice. The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations’. Schizophrenia Bulletin, vol. 24, no.1 pp. 1–10. Lehman, A. et. al. 1982, ‘Chronic mental patients: the quality of life issue’, American Journal of Psychiatry, vol. 139, no. 1, pp. 1271–1276. Oliver, M. 1983, Social Work with Disabled People, Macmillan. Ostman. 2004, ‘Family burden and participation in care: differences between relatives of patients admitted to psychiatric care for the first time and relatives of re-admitted patients’, Journal of Psychiatric and Mental Health, vol. 11, no. 1, pp. 608–613. Safran, J. and Segal, Z. 1990, Interpersonal Process in Cognitive Therapy. Basic Books, New York. Shorter, E. 1997, A History of Psychiatry. John Wiley & Sons, New York. Turner, T. 2005, ‘Hurt by stigma’, Nursing Standard, vol. 20, no. 1, pp. 32-3. World Health Organization. 2001. The World Health Report 2001, Mental Health: New Understanding, New Hope. WHO, Geneva. Read More