As part of their work, the SAFMH National Youth Advocacy and Advisory Forum are encouraged to take up advocacy initiatives that are meaningful to them. Lesego Khumalo [Gauteng] wrote the below research paper as part of her advocacy focused on access to disability grants for persons with mental health conditions.
Lesego said: “I chose to research this subject because I think that many do not know that bipolar disorder and schizophrenia can qualify as psychosocial disabilities. I only learned of this during an exchange with a disability rights lawyer. What stood out to me during my research was the staggering estimate of disability adjusted life years (DALYs). It is a stark contrast to the level of awareness. This signals that society needs to be aware of the impact of psychosocial disabilities on those who live with them and their access to social grants.”
INTRODUCTION
This paper discusses the recognition of bipolar disorder and schizophrenia as psychosocial disabilities and the social assistance grant process for people living with bipolar disorder and schizophrenia. The focus on these two disorders is due to the fact that there are some overlapping symptoms.[1] The discussion will involve a look into the grant system and the criteria for eligibility for disability grants. The topic of mental health conditions as invisible illnesses that are not readily apparent, and how this impacts access to grants, will also be discussed.[2]
BIPOLAR DISORDER AND SCHIZOPHRENIA AS PSYCHOSOCIAL DISABILITIES
Bipolar disorder and schizophrenia are mental health conditions that are classified as severe.[3] However, it is important to note that mental health conditions have varying levels of severity.[4]
Bipolar disorder is characterised by alternating episodes of hypomania, mania, and depression, which are intense emotional states that affect a person’s mood, energy, and ability to function.[5] The periods of neutral mood are called euthymia.[6] Schizophrenia is defined as a serious mental health condition that affects how a person thinks, feels, and behaves.[7] This presents as people seeming to have lost touch with reality in a state of psychosis.[8]
As previously mentioned, schizophrenia and bipolar disorder share several symptoms.[9] Studies suggest that the reason for the similarities is due to sharing certain susceptibility genes.[10] Scholars argue that it can be difficult to distinguish between bipolar disorder and schizophrenia.[1] For example, patients with acute bipolar disorder mania present with symptoms similar to schizophrenia, and persons with schizophrenia may have symptoms of depression or mania.
As per The White paper on the rights of persons with disabilities, “Disability results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others.”.[2]Nearly 50% of persons living with schizophrenia and one out of three of those with bipolar disorder experience significant disability.[3] There has been a 113% increase in disability-adjusted life-years (DALYs) globally, within the past 30 years.[4] DALYs are a measurement unit used to quantify the burden of diseases, injuries, and risk factors on human populations.[5]
Observed patterns reflect an inverse relationship between severe mental health conditions and socio-economic statuses, which theorists explain using the social selection hypothesis.[6] This hypothesis posits that persons with mental health conditions fall into poverty as a result of the disability associated with mental health conditions. This is the argument for social assistance grants for those living with mental disabilities.
CONCLUSION
It is clear that there are several obstacles to being certified as eligible for a disability grant for a psychosocial disability in South Africa. This is mainly due to the inherent characteristics of psychosocial disabilities, such as the lack of visibility and difficulties with quantitative assessments. People living with bipolar disorder and schizophrenia are at risk of being overlooked by the system. Particularly if there are other intersecting factors, such as low socio-economic status, poor articulation due to factors such as low literacy levels, and language barriers. Measures need to be put in place in areas where the system falls short so that people do not fall through the cracks.
We ought to be cognisant of the fact that the grant is about more than just money.[1] It is a source of emotional and psychological relief as it allows beneficiaries to afford their critical medication and avoid stress due to extreme financial pressure.[2]
It is evident that barriers to access exist across the board for those with psychosocial disabilities, but the ‘periodic/episodic’ nature of bipolar disorder and schizophrenia makes it much harder to fulfil the requirement of permanence. I believe more sensitivity is required as this is a nuanced situation. Rigid approaches just won’t do. We need a grant system that adequately protects the interests of those living with bipolar disorder and schizophrenia. All those living with psychosocial disability deserve a fair chance to access potentially life-altering social assistance.
