“People with mental disabilities seek the same things as those without: a safe place to live, work, study, have a social and community life, make friends, love. As a society, however, many times we are part of the obstacles for them to achieve all this”, expresses part of the introduction of the book Trajectories of Social Inclusion of People with Mental Disabilities in Contexts of Poverty and Vulnerabilitywritten by the head of the Department of Mental Health of the Ministry of Health, Pablo Norambuena.
The book –the sixth study in the series “From the saying to the Law”–, which will be presented this morning at the La Moneda Cultural Center, points to mental disability as a factor of social exclusion in Chile. Various adverse factors are reinforced by the effect exerted by unfavorable socioeconomic contexts, marked by poverty or vulnerability. Poverty prevents people with mental disabilities from deploying their full human potential, with negative consequences for their autonomy, fulfillment of desires, self-esteem, and general well-being in the long term.
The Hogar de Cristo publication seeks to give voice and consideration to people who are normally not considered, invisible. At best, infantilized and, at worst, feared, abused, marginalized, hidden at the bottom of a patio, in deplorable conditions.
whatWhat is mental disability?
Mental disability is defined in Law 20,422 on equal opportunities for people with mental disabilities. “There is talk of those people who have a disability associated with cognitive or intellectual issues and/or psychosocial or psychiatric issues. As the definition is broad, disability as a concept is not determined by the diagnosis of people, but by the barriers they have to include themselves socially. That is why this broad concept is used in some legislations that speaks of mental health and includes all people who have a disability associated with these causes”, explains the national technical director of the Mental Disability line of Hogar de Cristo, María Isabel Robles.
-What are those indicative barriers of disability?
-For example, being in the regular education system from early childhood, having access to labor inclusion for habilitation and rehabilitation, being able to access some type of treatment for intellectual recovery. A person does not have a mental disability because they have schizophrenia, depression, TEA or down syndrome, they have a disability due to the difficulty in being part of society.
Since there is no formal indicator that measures mental disability in Chile –a situation that contributes to making their situation invisible and makes it difficult to carry out adequate diagnoses for the design of public policies relevant to their needs–, the study characterized the population from the last National Study on Disability (ENDISC II), and the 2017 version of the National Socioeconomic Characterization Survey (CASEN).
With these data, it is possible to identify 1,955,156 people with permanent or long-term mentally handicapping conditions. Of these, 390,938 are associated with some psychiatric, mental or intellectual difficulty, and 155,786 simultaneously present disability. Of the 155,786 people with mental disabilities, 43.7% are men and 56.3% women, a higher female proportion that can be explained by their concentration in the elderly (48.9% of people with mental disabilities are 59 and more years), which in turn tends to concentrate a higher proportion of women than men.
Regarding education, it was found that 35.4% of people with mental disabilities do not know how to read or write, while only 3.3% of people without mental disabilities have illiteracy. The average years of schooling for people with mental disabilities reach 5.5 years, in contrast to 11.2 years for people without disabilities. 91.6% of boys and girls (6 to 13 years old) without mental disabilities attend regular basic education, 40.4% of boys and girls with mental disabilities attend regular basic education, with 45.9% studying differential education, all data from CASEN 2017.
Other figures show that only 8.1% of people with mental disabilities have a job, earning an average of $398,878 in contrast to the average $517,649 received by people without disabilities.
People of flesh, blood and feelings
“Look, my life lacks more… more friendship. I don’t have friends, I had them… What happens is that I took medicine, it gave me another mentality. I’m not the same, the pills change one’s personality”, says a 52-year-old man.
A 30-year-old woman explains: “Since I got sick, I have excluded myself a bit from society, as they say. Before I was more friendly, I hung out with people. I got sick and people disappeared.”
Another, 35, says: “She would hit me for anything, it’s because she was ashamed to have a daughter who was transformed. She used a word that everyone always uses… crazy. Later, my parents threw me out on the street. And I spent about seven months on the street.”
Like these testimonies, the book contains 28 interviews with men and women with various types of disorders, both psychosocial and cognitive-intellectual, and different degrees of dependency, from mild to severe. “The exercise seeks to make effective the right of people to be heard, and nourishes the design of public policies by prioritizing the needs, expectations and demands of its main beneficiaries,” the text indicates. In addition, it is a qualitative element that complements the quantitative.
How to work towards inclusion?
“The first thing is the generation of public policies, if there is no definition from the State of what the inclusion of people with mental disabilities means, it is very difficult to generate processes that are effective and that improve the quality of life of these people and , especially, in those who are in a situation of poverty and exclusion. People living in poverty who have mental health problems are doubly excluded. That is why we must start by having robust, universal public policies with stable and progressive financing,” says María Isabel Robles.
But he warns that it is more important to generate a cultural change. Something that does not happen by decree. “It happens to the extent that we interact with people with disabilities on a daily basis. When we isolate people and do not generate an inclusive education from early childhood, we are not in the neighborhood, in the square, in the supermarket, at work, at school, the chances that this cultural change will not be generated is very high. And the lack of a link generates stigmatization, mistrust and that is a breeding ground for discrimination ”, he underlines.
The budget is also key. The World Health Organization (WHO) recommended for 2010 that at least 5% of the Health budget be allocated to mental health. Today, in 2023, in Chile 2.2% of the budget is for mental health. In OECD countries, investment in mental health ranges from 9 to 11% of the budget.
“We still have significant gaps, there is progress, but these advances do not manage to solve the problem. Today we are in a mental health crisis, we have increased our youth suicide rates, we also have high suicide rates in the elderly relative to other Latin American countries. There is a sustained increase in medical leave for mental health, making it the leading cause of work absenteeism. We are in a complex situation and, although we have a good mental health plan, its level of implementation is not what is required and, on the other hand, financing has remained below the WHO recommendations”, adds Robles.
In general, this study found that poverty is a determinant of mental health.
“The people and families who face the most difficulties in life: if I make ends meet, if I can lose my job, if I will be able to take care of my children, the neighborhood where I live, etc. These people tend to develop 4 times more mental health disorders than the general population. Therefore, if we take care of solving poverty problems, in some way, we will be positively impacting the life course of this population and avoiding disorders that can generate disability in the future ”, he concludes.
If you want to know more, download here the complete book.
