DISABILITY

Disability
• Disability: is present when a person has a
health condition (in this case, mental illness)
which impairs their day-to-day functioning in
some way.
• The level of disability experienced depends
partly on the seriousness of the impairment,
and partly on the social exclusion that further
disables people with mental health problem.
Disability includes difficulty in one or more of the following
areas:
 Understanding and communicating
 Getting around
 Self-care
 Getting along with people
 Working (including housework)
 Participating in society, e.g. attending a funeral or coffee
ceremon
Major causes of impairment
• Disease
• Poverty
• Wars
• Drought
• Famine
• Harmful traditional practices
• Household, work place and traffic accidents
• Figure 1.23: Physical disability& physical aids

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Mobilizing community taking care of disabilities
• Disability, in contrast, is not something
individuals ‘have’, but has a wider social
meaning. It is the exclusion of people with
impairments due to attitudinal and environmental
barriers that limits their full and equal
participation in the life of the community and
society at large.
• It is now accepted that the disabling
environmental and social barriers are major
causes of the disability experienced by
individuals with impairments.
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• It is important to ensure the inclusion of disabled
people in society.
• Inclusion refers to the need to make sure that
people with disabilities have access to all
necessary services and that the barriers and
limitations they experience in society are reduced.
• Impairment refers to the physical, intellectual,
mental and/or sensory characteristics or
conditions that limit a person’s individual or
social functioning, in comparison with someone
without these impairments

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Models of disability
• The charity model of disability is a
traditional way of viewing persons with
disabilities as being dependent and helpless.
• In this model, people with disabilities are seen
as:
• Objects of charity Having nothing to give, only
to receive Being inherently poor, needy and
fully dependent on charity or welfare for their
survival

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• The charity model is often related to
traditional cultural and religious beliefs and
practices.
• The problem with such practices is that they
reinforce the idea that people with disabilities
are helpless recipients of ‘charity’ from a
‘caring’ society, rather than subjects with
rights.

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 The medical model
• The medical model of disability focuses
primarily on the medical problems of persons
with disabilities and emphasises medical
solutions. It assumes that:
• The problem of disability is due entirely to the
individual’s condition or impairment.
• People with disabilities are — first and
foremost — ‘patients’.
• The problem of disability requires a purely
medical solution
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• The social model
• The social model of disability views people with
disabilities as being disabled less by their impairment
than by society’s inadequate response to their specific
needs.
 The social model emphasises that:
• Disability is best thought of as a social problem.
• The problem is not the person with disabilities or their
impairment, but the unequal and discriminatory way
they are treated by society.
• The solution lies in removing the barriers that restrict
the inclusion and participation of people with
disabilities in the social life of the community
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 The human rights model
• The human rights model of disability can be seen
as the most recent development of the social
model. It states that:
• All human beings are equal and have rights that
should be respected without distinction of any
kind.
• People with disabilities are citizens and, as such,
have the same rights as those without
impairments.
• All actions to support people with disabilities
should be ‘rights based’; for example, the demand
for equal access to services and opportunities as a
human right.
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 Types of impairments
• There are many types of impairments; the most
common types will be briefly discussed in this
section.
Mobility and physical impairments
• There are a variety of physical impairments
that impact on functioning and mobility.
• These include limitations in the use of the
limbs, limited manual dexterity, and limited
coordination of limbs, cerebral palsy, spinal
bifida and sclerosis
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• Physical impairment can be congenital
(something one is born with), or it can be the
result of disease, accident, violence or old age.

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 Sensory impairments
 Visual impairments: Virtually everyone will
experience a visual impairment at some point in their
lives.
 Usually these are minor or treatable, e.g. temporary
visual impairments caused by bright lights or
headaches, or age-related visual impairment that can
be ‘self-treated’ with reading spectacles. But they
can also be serious, e.g. permanent visual
impairment or more severe conditions requiring
medical treatment.
 Visual impairment can be congenital (present at
birth), due to genetic conditions, or the result of
accidents, violence, or diseases such as trachoma,
glaucoma and cataracts
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 Hearing impairments: There is a wide variety in
the form and severity of hearing impairments,
ranging from partial to complete deafness.
 People who are partially deaf can often use hearing
aids to assist their hearing.
 Deafness can be genetic, be evident at birth, or
occur later in life as a result of disease or due to
old age. Both deaf and partially deaf people use
sign language as a means of communication.
 The lack of knowledge of sign language amongst
the general population can create communication
difficulties for deaf and partially deaf people and
can also be thought of as a disabling barrier.
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 Intellectual impairments: are characterized by
significant limitations in intellectual functioning,
which also impact on many everyday social and
practical skills.
 The medical term for these impairments is
‘intellectual disability
 Multiple impairments: Some people have to cope
with several impairments, either permanently or for
periods of time (e.g. during an illness).
 Examples of permanent multiple impairments
include people who are both deaf and blind, and
people with both a physical and intellectual
impairment.
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 Mental health problem

• Mental health can be defined as ‘a state of well-being in which the

individual realizes his or her own abilities, can cope with the normal

stresses of life, can work productively and fruitfully, and is able to make

a contribution to his or her community’(WHO).

• Mental illnesses occur in the absence of mental health, and are generally

characterized by some combination of abnormal thoughts, emotions, and

behavior and relationships with others

 CONT.
Cultural explanations for mental illness
• Spirit possession (likift, zar, wuqabi)
• Punishment for sins
• Evil eye
• Bewitched/cursed
• Thinking too much
• Exposure to cold air (berrd)
• Exposure to sun rays (mitch)
What causes mental illness?
 The biopsychosocial model
• Biological causes: genetic (inherited) causes, a chemical
imbalance in the brain, head injury, alcohol or khat use,
under nutrition
• Psychological causes: not loved in childhood, too many
worries, the stress of somebody dying, disappointment,
frustration, severe shock
• Social causes: poverty, not living in a good house, not
having somebody who they can talk to about their
problems, discrimination, migration
Cont.
 Sign and symptoms
• Sleep or appetite changes — Dramatic sleep and appetite
changes or decline in personal care.
• Mood changes — Rapid or dramatic shifts in emotions or
depressed feelings, greater irritability.
• Withdrawal — Recent social withdrawal and loss of interest
in activities previously enjoyed.
• Drop in functioning — An unusual drop in functioning, at
school, work or social activities, such as quitting sports,
failing in school or difficulty performing familiar tasks.
• Problems thinking — Problems with concentration,
memory or logical thought and speech that are hard to
explain.
 Cont.
• Increased sensitivity — Heightened sensitivity to sights,
sounds, smells or touch; avoidance of over-stimulating
situations.
• Apathy — Loss of initiative or desire to participate in any
activity.
• Feeling disconnected — A vague feeling of being
disconnected from oneself or one’s surroundings; a sense of
unreality.
• Illogical thinking — Unusual or exaggerated beliefs about
personal powers to understand meanings or influence events;
illogical or “magical” thinking typical of childhood in an adult.
• Nervousness — Fear or suspiciousness of others or a strong
nervous feeling.
 cont
• Delusions: believing things that are untrue, for
example that people are in love with them, or
that people are trying to poison them
• Hallucinations: hearing or seeing things that
no one else can hear or see
Suicide risk indicators in people
with mental illness
• Suicidal thoughts: if a person tells you they
are thinking about suicide
• Substance misuse: the risk increases when the
person also misuses substances like alcohol
and khat.
• Social isolation and lack of support
• History of suicide attempts or self-harm
 Risk indicators for life-threatening self-
harm
• Preparation for self-harm: someone who has taken time
to plan, considered the consequences of their actions,
said goodbye to people or taken precautions to avoid
being discovered by others represents a much higher risk
than a person who self harms without much thinking
about it .
• Seriousness of the method used to self-harm: violent
methods such as hanging, stabbing or throwing oneself
into deep water are considered serious and indicate
higher risk.
 Cont.
• Current mental illness: at least 60% of people who
self-harm have some form of mental illness.
• Factors that reduce self-control: the use of alcohol or
other drugs, or having an impulsive personality,
reduce self-control and increase the risk of serious
self-harm.
• Presence of ongoing ‘real life’ difficulties: marital
problems, financial problems, difficulties at work, or
other problems in daily life increase the risk of self-
harm.
 Priority mental health disorders
(WHO)
• Psychosis: this is the collective name for a
group of serious disorders characterized by
changes in behavior (for example poor self-
care, restlessness), strange thoughts or beliefs
(for example believing that others wish to do
the individual harm) and related dispositions.
 Cont.
• Mania: a form of severe mental illness in
which a person is excessively happy or
irritable (experiences extreme mood swings),
appears over-active and sleeps poorly. People
with mania have poor reasoning skills (they
have difficulty understanding what is good
and what is bad), and display excessive self-
confidence
 Cont.
• Depression: this is the most common priority
disorder and is characterized by excessive
sadness, loss of interest, lack of energy and
related symptoms.
• Suicide: this will be discussed in more detail in
this session and refers to the intentional ending
of one’s own life.
• Abuse of alcohol and other substances
• Childhood mental disorders
 Cont.
• Dementia: this condition is more common in
older people and is characterized by memory
problems and broader problems with thinking
and understanding.
Questions to help assess the risk of suicide in
someone with a mental illness
• How do you see the future?
• Do you think things will get better for you?
• Are there times when you feel you have had
enough of life itself?
• Are there times when you wish you were
dead,
 The roles of Health professional
Practitioners in mental healthcare
• Improving detection of mental illness by identifying
people who are affected in your community
• Referring people with possible mental illness to the
nearest health facility for further assessment and
treatment
• Supporting people with mental illness and their
families in the community
 CONT.
• Encouraging people to attend follow-up
appointments and to keep taking their
medication
• Educating patients, their families and the
wider community
• Reducing stigma, discrimination and abuse
against people with mental illness