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Stigma and associated discrimination against persons with psychosocial disabilities constitute a considerable barrier to the realisation of the highest attainable standard of health in South Africa, Africa, and further afield, constituting a significant human rights violation. This situation is evidenced and exacerbated by mental health as a whole remaining under-prioritised in law, policy and resource allocation. States parties to the Convention on the Rights of Persons with Disabilities (CRPD) have a duty to address stigma and discrimination through awareness raising and education. Some important commitments have been made in this respect, particularly at the policy level in South Africa. Nevertheless, and as demonstrated by tragic recent events, effective implementation remains lacking. This article lays out the obligations incumbent upon the South African government to address stigma and discrimination on the basis of psychosocial disability as a public health and human rights imperative by examining positive duties incorporated into international instruments and domestic law and policy. It further considers the role of political de-prioritisation of mental health and how this constitutes stigma of a systemic nature, using case law and examples of research and best practice from South Africa, Africa generally, and beyond. We conclude that South Africa is failing to meet its obligations to persons with psychosocial disabilities, and recommend that positive duties be emphasised in potential disability-specific legislation; high-level political commitment and co-ordination is secured for mental health; the CRPD's independent monitoring requirement is urgently fulfilled; and contextually-relevant interventions are crafted with the active participation of persons with psychosocial disabilities and their representative organisations. ; http://www.adry.up.ac.za ; am2018 ; Centre for Human Rights

This article conceptualizes identity-mediated psychosocial disability of socially excluded individuals and groups from a socio-behavioural perspective. It postulates collective representations, inequitable social interactions and personal characteristics that lead to perception and internalization of negative identity in members of stigmatized groups. Non-dominant identity induces self-imposed and society-ascribed psychosocial disability through stigmatization and discrimination. Psychosocial disability is a state where individual or collective sense of incapacity restricts optimal use of individual and collective human agency to influence out-groups favourably to achieve self-expansion and communal expansion. The aspects of psychosocial disability include poor self-concept, low ethnic self-esteem, negatively internalized identity, poor social integration and conflicts in social relations. It results in psychosocial disability that further increases social exclusion, reduces quality of life and well-being. This article concludes that socially excluded individuals and groups experience psychosocial disability in everyday life.

Severe mental illness, which includes disorders such as schizophrenia, bipolar disorder and major depressive disorder, is associated with significant impairment, but the severity of the impairment and the associated psychosocial disability varies significantly within each disorder. While South African legislation and policies support interventions aimed at reducing psychosocial disability and promoting recovery, implementation remains a challenge. ; http://www.journals.co.za/content/journal/healthr ; hj2021 ; Occupational Therapy

This study addressed the following question: What are the barriers and strategies to support the participation of South Africans with psychosocial disability in mental health policy development in South Africa? A systematic literature review (objective 1) addressed the question: ""What supports people with psychosocial disability to participate in national mental health policy development?"" The WHO Checklist for Mental Health Legislation, the WHO Checklist for Mental Health Policy and Plan, and domain 4 of the World Health Organisation Assessment Instrument for Mental Health Systems (WHO-AIMS) were completed, and 96 semi-structured interviews with key stakeholders were conducted, to assess current stakeholder, mental health legislation and policy support for the participation of people with psychosocial disability in South Africa (Objective 2). Nvivo-7 software was used to analysis qualitative data, using a framework analysis approach to data analysis and interpretation. These interviews were also used to ascertain the views of 56 of the 96 South African stakeholders' involved in mental health services, on environmental barriers to the participation of people with psychosocial disability in mental health policy development in South Africa (objective 3). The remaining 40 interviews with people with psychosocial disability documented their lived experience of barriers to their participation in policy development, and highlighted their priorities for policy development (Objective 4). Eleven key informants involved in leadership roles in peer led organisations for people with psychosocial disability in Africa were interviewed to inform understanding of opportunities for supporting people with psychosocial disability to participate in mental health policy development (Objective 5). The findings of objectives 1-5 were triangulated to inform the development of a conceptual framework for supporting South Africans with psychosocial disability to participate in mental health policy development (objective 6). The framework proposes the need for social transformation to overcome barriers to the inclusion of people with psychosocial disability in society, including as policy participants, support for self-directed agency, and opportunity for meaningful participation in policy development.

Background: In many parts of South Africa there is little support for people with psychosocial disability caused by schizophrenia, beyond provision of psychotropic medications. Appropriate community-based psychosocial rehabilitation interventions are a crucial element of mental health service development.Objectives: This study aimed to use an explanatory model of illness framework to document experiences of illness, disability and recovery amongst service users with schizophrenia and their caregivers in a poorly resourced area in the North West Province. Data were used to provide recommendations for a contextually appropriate non-specialist facilitated group psychosocial rehabilitation intervention.Method: Eighteen in-depth individual interviews were conducted: nine with schizophrenia service users and nine with caregivers. Interviews were conducted by two trained field researchers; both clinical psychologists fluent in the first language of participants. All interviews were recorded, translated and transcribed. Data were thematically analysed using NVivo 9.Results: Participants linked the illness to witchcraft, poverty and stress. Family conflict was recognised in the course of the illness, causing stress and challenges for emotional well-being. Knowledge of diagnosis and biomedical treatment was minimal. Key factors recognised by service users as promoting recovery were the ability to work, and the support of traditional healers and religious structures.Conclusion: Based on the findings of this study, a group psychosocial rehabilitation intervention emerged as a recommendation, with the incorporation of psycho-education, adherence support, coping skills, and opportunities for income generation and productive activity. The importance of also enlisting the support of religious leaders and traditional healers in supporting recovery is emphasised.

This article argues that civil mental health laws operate to constrict how people think, understand, and speak about psychosocial disability, madness, and mental distress. It does so with reference to views and experiences of mental health service users and psychiatric survivors (users and survivors) and their/our accounts of disability, madness, and distress, such as those articulated by the emerging field of Mad studies. The analysis considers the application of the rights to freedom of opinion and expression that are enshrined in the International Covenant on Civil and Political Rights and other international human rights instruments to the mental health context. The article explores the suppression of freedom of opinion and expression that is effected through the symbolic violence of psychiatry and the mental health paradigm. Focusing on Australian legal frameworks, the article discusses how the material violence and coercion characterising mental health laws compound this process. It is further argued that civil mental health laws, by codifying the tenets of psychiatry and the mental health paradigm so as to render them largely unassailable, validate the ontological nullification of users and survivors. The foregoing analysis exposes dangers of adopting a functional test of mental capacity as the pre-eminent legal standard for authorising involuntary mental health interventions. It is suggested that considering freedom of opinion and expression from the perspective of psychosocial disability and madness reinforces the Committee on the Rights of Persons with Disabilities' interpretation that such interventions are incompatible with international human rights standards.

About two thirds of all NDIS participants of working age have intellectual disability, autism and/or psychosocial disability. One of the aims of the NDIS is to give people with disability the same opportunities to work as other Australians including people with intellectual disability, autism and/or psychosocial disability. This research was commissioned by the NDIA to help them understand how they can best support people with intellectual disability, autism, and/or psychosocial disability to work towards their employment goals. It involved reviewing journal articles and reports to see what employment programs help people with autism, intellectual disability and/or psychosocial disability to find and keep a job, and where more research is needed. What did the research involve? The research included four parts and each report is available to download below. They include: A review of how employment programs are described. A structured review of national and international trials of employment programs to find out which programs work best. Identification of current employment programs in Australia. Interviews with academics and senior government and non-government staff working in employment for people with disability. 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The Systematic Review assessed interventions implemented as randomised controlled trials (RCTs) with a range of different comparator populations. Because people are allocated to an intervention randomly the outcome does not depend on pre-existing differences between the intervention and comparison populations, which may occur if people simply 'opt in' to an intervention. The Systematic Review provides information about the extent of the evidence base from RCTs and its quality. The Environmental Scan Part 1 provides information about the extent of research and evaluation in the field and the types and quality of the Australian evaluations using meta-evaluation tools. Typically, evaluations are considered a 'weaker' form of evidence because many do not have comparison populations and/or people self-select or opt into being part of a program or intervention. This means we cannot be sure whether differences in outcomes are due to the characteristics of people who take up a particular intervention or the intervention itself. However, when interventions are multi-faceted and individualised, they are challenging, and often unsuitable, to evaluate through an RCT. Technical reports from the Systematic Review, Environmental Scan Parts 1 and 2 (Mallett, Brown and Finnis, 2021) provide a detailed account of the methods and findings. Report details are listed above.

About two thirds of all NDIS participants of working age have intellectual disability, autism and/or psychosocial disability. One of the aims of the NDIS is to give people with disability the same opportunities to work as other Australians including people with intellectual disability, autism and/or psychosocial disability. This research was commissioned by the NDIA to help them understand how they can best support people with intellectual disability, autism, and/or psychosocial disability to work towards their employment goals. It involved reviewing journal articles and reports to see what employment programs help people with autism, intellectual disability and/or psychosocial disability to find and keep a job, and where more research is needed. What did the research involve? The research included four parts and each report is available to download below. They include: A review of how employment programs are described. A structured review of national and international trials of employment programs to find out which programs work best. Identification of current employment programs in Australia. Interviews with academics and senior government and non-government staff working in employment for people with disability. 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The Systematic Review assessed interventions implemented as randomised controlled trials (RCTs) with a range of different comparator populations. Because people are allocated to an intervention randomly the outcome does not depend on pre-existing differences between the intervention and comparison populations, which may occur if people simply 'opt in' to an intervention. The Systematic Review provides information about the extent of the evidence base from RCTs and its quality. The Environmental Scan Part 1 provides information about the extent of research and evaluation in the field and the types and quality of the Australian evaluations using meta-evaluation tools. Typically, evaluations are considered a 'weaker' form of evidence because many do not have comparison populations and/or people self-select or opt into being part of a program or intervention. This means we cannot be sure whether differences in outcomes are due to the characteristics of people who take up a particular intervention or the intervention itself. However, when interventions are multi-faceted and individualised, they are challenging, and often unsuitable, to evaluate through an RCT. Technical reports from the Systematic Review, Environmental Scan Parts 1 and 2 (Mallett, Brown and Finnis, 2021) provide a detailed account of the methods and findings. Report details are listed above.

AbstractThe National Disability Insurance Scheme (NDIS) was designed to support Australians living with disability. However, public data evidence the low number of people with psychosocial disability in the Scheme. One reason for these low numbers is that many people with psychosocial disability have still not applied to receive NDIS support. The aim of this review was to analyse and synthesise previously reported barriers preventing people with psychosocial disability applying to the Scheme. A search of seven databases identified 61 relevant documents including peer‐reviewed research, published expert opinion pieces, newspaper articles and government and independent enquiries and reports. Thematic analysis revealed five overarching barriers to applying: social inequities acting as barriers to applying; stigma, trauma and previous negative experiences; barriers to finding supports needed to apply; challenges understanding the relevance of the Scheme; and experiences and symptoms of mental illness extend and exacerbate barriers. These barriers signpost problems inherent within an application process designed without engaging or being responsive to the expertise of and insights into people living with psychosocial disability. Resolution of these substantial barriers will not be a small task. It will require commitment to redesigning the Scheme's application process through a genuinely codesigned approach.

AbstractThe aim of this paper is to inform the design of individualised funding schemes via an examination of discourses and experiences of choice related to people with psychosocial disability. Mind Australia, in partnership with Deakin University, interviewed 22 individuals with psychosocial disability who are recipients of individual funding packages in three National Disability Insurance Scheme (NDIS) trial sites across Australia. This research involved examining the policy and assumptions of choice under the NDIS, as well as the experience of undertaking choice through individualised funding arrangements which position people with psychosocial disability as consumers in a market place of service provision. The findings demonstrate that choice is an ongoing activity and that at every stage personal, programmatic and market barriers impact individuals' capacity to maximise choice. The intent of government policy to provide choice to individual funding recipients based on an optimally functioning market place with empowered self‐actualising individuals collides with a complex reality where barriers abound at every stage of the choice making process. Enhancing choice making of people with psychosocial disability within the NDIS requires governments and services to explicitly address the personal, programmatic and market‐based barriers to choice.