Mental health consequence of disability

The leprosy mission Nigeria conducted a disability survey in Kogi and Niger states in 2005, investigating the demographic characteristics of people with disabilities, using gender, age, religion, mental, educational, occupational, employment and economic status, understanding of disability and health-seeking behaviour.

From the 1,093 respondents studied, the most common disabilities involved vision (37 per cent), mobility (32 per cent) and hearing (15 per cent). A third of these were less than 21 years of age who had no occupation, over half of them had no education, while only 20 per cent had primary education. They were mostly beggars.

These findings are comparable to what obtains in other parts of the country, as disability affects the ability to participate in education, work and family life, which invariably culminates in poverty.

It is roughly estimated that about 20 per cent of Nigerians are living with one form of disability or the other, excluding those with intellectual and sensory impairments.

This community of persons is growing at a geometric rate since factors of predisposition   such as terrorism, road and domestic accidents, medical misdiagnosis, non-compliance to immunisation of children, collapsed buildings, surge in non-communicable diseases, poor obstetric care and many others are prevalent.

There is a historical background to the definition of disability, which also determines the quality of attention it elicits from society and government. The moral model is the oldest and regards disability as a consequence of sin; while the medical model views it as sickness that requires medical intervention.

The rehabilitation model regards disability as a deficiency that must be fixed by various rehabilitation professionals, while the disability model takes on a strong social paradigm by defining the problem in the context of the attitude of professionals and other members of the society, apart from the socio-economic burden.

The United Nations has adopted the disability model and categorised disability as impairment which involves any loss of function, whether psychological or anatomical; and disability as any restriction to perform an activity within the range considered normal for a human being; and handicap as a disadvantage occasioned by an impairment that interferes with the fulfillment of a social role.

The social model, therefore, regards disability as a normal aspect of life, not as a deviance; and rejects the notion that persons with disability are, in some inherent ways, defective.

The issue of mental health consequences of disability brings to light the socio-environmental undertones in disability. People who experience disability have to deal with the expectations of the family, cross-cultural issues and consequences of negative attitudes towards people with disabilities.

Everyone is vulnerable, as I imagine a surgeon or an engineer coming down with stroke at midlife. The psychological experience of a new disability is similar to enduring the loss of a loved one, which include shock, denial, anger /depression, adjustment/acceptance. A difficulty sets in when resolution gets stuck at a stage that impairs smooth transition to acceptance. This may, invariably, lead to the development of mental health problems.

People with disabilities are at a greater risk of mental health problem than the general population; and therefore make a disproportionate contribution to mental health morbidity internationally.

Incidentally, the personal and social costs of mental disorders are considerable throughout the world, which may serve as a major mitigating factor to contend against the strong points of the social model approach that seeks a wholesome consideration of disability.

There is ongoing accumulation of evidence on the relationship between disability and mental disorders, possibly manifesting through three different pathways. First, the experience of living with disability or having a health challenge or an impairment associated with disability could lead to mental health disorders; secondly, people with mental health problems are   more likely to subsequently become disabled, especially if intervention is not prompt and optimum; and thirdly, other factors such as the socio-economic consequences and social discrimination may independently increase the risk of disability, causing mental illness.

The intervention cannot only be undertaken by a single professional, but requires a multi-disciplinarian approach.

For many years now in Nigeria, persons with disabilities, through the Joint National Association of Persons with Disability, have been demanding the passage of the National Disability Bill. Twice, this bill has been passed into law by the National Assembly, but I am not certain if it has enjoyed presidential assent.

This will definitely serve as template to tackle a lot of the social issues that may complicate disability with mental health consequences, whether in the community, workplace or in various social situations.

They also require a lot of psychological intervention in terms of assessment and medication; as well as psychotherapeutic interventions that ensure a robust mental health, which is crucial for wholesome social integration, as advocated by the social model.

PUNCH.