Social exclusion worsens the mental health of the disabled
Lebogang Mosikare | Monday October 23, 2023 06:00
FRANCISTOWN: Masego Lecha, a certified addiction professional at Sbrana Psychiatric Hospital, recently revealed that the country’s main facility for mental health rehabilitation does not have sign language interpreters.
This, she said, makes it cumbersome for the Hospital to adequately address the medical needs of People Living with Disabilities (PLWDs).
“Persons with disabilities experience significant barriers to accessing health care,” Lecha said at the Fourth National Mental Health and Psychosocial Support Services (MHPSS) Forum held a fortnight ago.
The challenges with sign language interpretation at Sbrana underline the severe challenges PLWDs face in bridging the gap to the services such as education and health, that the able-bodied enjoy. And the challenge is a vicious cycle where those suffering various disabilities, face such social exclusion that triggers mental health challenges over and above the difficulties that come with the disability itself.
For instance, while being hearing impaired or deaf is a challenge within itself, if those difficulties worsen someone’s mental health, they will receive a compromised level of care at the country’s main mental health hospital, Sbrana.
PLWDs face these challenges and more.
“Barriers which can be particularly severe for those residing in rural areas can include physically inaccessible medical clinics and hospitals as well as lack of appropriate transport to enable them to seek medical care or rehabilitation services,” Lecha said.
“(The challenges can also include) lack of communications and accommodation in health care settings, untrained personnel and inadequate staffing, negative attitudes of health care providers and harmful practices, particularly in relation to persons with psycho-social disabilities.”
She continued: “Those with mental health challenges often experience denial of treatment on grounds of mental disability while privacy and confidentiality may be compromised for persons with mental disabilities seeking medical treatment or counselling.”
Lecha, who is also a Principal Social Worker, told the recent forum that social inclusion is a human right for all people, including people with mental illness and it is also an important part of recovery from mental illness.
She added that social exclusion of people with mental illness remains an unresolved global public health and human rights challenge.
The US Centers for Disease Control and Prevention (CDC) says that often there are multiple barriers that can make it extremely difficult or even impossible for PLWDs to function. The seven most common barriers are: attitudinal, communication, physical, policy, programmatic, social and transportation. Often, more than one barrier occurs at a time, the CDC says.
In Botswana, the link between social exclusion of PLWDs and their worsening mental health, is glaringly evident in access to education. Within education, PLWDs face many of the CDCs seven barriers, at the same time.
Sean Sebolao, the Deputy Chairperson of the National Children’s Consultative Forum, told the recent Forum that despite education being a basic and Constitutional right and indispensable for the exercise of other human rights, PLWDs are not enjoying the benefits other members of society are. He said currently, public schools catering for PLWDs were mostly concentrated in the Kgatleng District. “This does not bode well for PLWDs because they are forced to relocate to Kgatleng to further their education,” he said. “The relocation has serious mental health implications for PLWDs because circumstances beyond their control are forcing them to leave their families to live with caregivers they don’t know who may not give them the love and assistance that their parents or guardians are giving them at home.”
According to Sebolao, the relocation of learners with disabilities to faraway places is also causing mental stress to parents of these learners because some of them may not have the economic means to visit their children at these schools.
Once the children are at school, they face a range of physical challenges that only highlight how different they are from other learners and that worsen their mental health. Sebolao said learners with physical impairments have difficulties accessing school buildings or facilities because most of these do not have ramps. The situation forces the affected learners to depend on their able-bodied peers, even when accessing the toilet, something that compromises their privacy.
“Because of immaturity on the part of learners, lack of privacy may lead some peers of learners with disabilities to taunt them which may distress them further,” Sebolao said.
The plight of learners with disabilities flies in the face of the Revised National Policy on Education (RNPE) of 1994, which lists specific provisions for the education and training of all children and young people, including those with disabilities.
In the RNPE, the goals of special education include to ensure that all citizens of Botswana including those with special needs have equality of educational opportunities. The RNPE also aims to prepare children with special educational needs for social integration by integrating them as much as possible with their peers in ordinary schools, amongst others.
The social exclusion facing learners with disabilities is also at variance with the Vision 2036 pillar of human social development, which states that by 2036, Botswana will be a moral, tolerant and inclusive society that provides opportunities for all in the sectors of spiritual wellbeing, culture, strong family institutions, health and wellness, social inclusion and equality, education and skills development, gender equality, the youth and children’s wellbeing.
Sebolao pleaded with the Ministry of Education and Skills Development to make education in all public schools in Botswana inclusive to all children including learners with disabilities. During a panel discussion held during the Forum, it also became apparent that the insufficient provision of mental health and psychosocial support services to PLWDs is not confined to the public service, but is actually rife in the social context.
For example, the panellists and the audience were in agreement that there exists stigma, prejudice and discrimination where some people in society see disability as a tragedy and something that needs to be cured or prevented.
Some see it as a punishment for wrongdoing or an indication of the lack of ability to behave as expected in society. These are some of the attitudinal barriers that compound the mental health challenges of PLWDs.
Delegates at the Forum resolved that there is an urgent need for the government to train many people in sign language and then deploy them across the public service to cater for the needs of PLWDs.
The forum also resolved to make public spaces and facilities physically accessible for PLWDs, which will also provide access to people who may not have disabilities such as families with baby strollers and others.
The symposium also resolved that the government should build institutions of learning in all districts in Botswana to cater for PLWDs in all districts and also integrate health services across the country. It was also resolved that bringing together a team of doctors, nurses, social workers, and therapists together, integrated care can normalise and de-stigmatise mental health treatment and ensure that all of a patient’s health needs are met holistically.
The forum also addressed the burning issue of employment opportunities for PLWDs, resolving that since it is illegal to discriminate against hiring anyone on the basis of a disability unless that disability interferes with the basic job function, where the job functions of PLWDs are not in question, they should be considered in the same light as all other applicants if they are the most qualified candidates.