Psychosocial Disabilities Research Articles

Challenging Involuntary Treatment and Confinement in Canada Through the United Nations Convention on the Rights of Persons with Disabilities (CRPD)

The Convention on the Rights of Persons with Disabilities (CRPD) came into force in 2008. People with disabilities, including people with psychosocial disabilities, were instrumental to its development. Article 12 and Article 14 of the CRPD, which respectively affirm the universal legal capacity and right to liberty of persons with disabilities, were viewed as key victories by disability rights movements. These provisions are particularly important for people with psychosocial disabilities who are routinely subjected to human rights violations through psychiatric detainment and involuntary treatment authorized under domestic mental health legislation in many states. We aim to advance discourse surrounding the CRPD and its development by centring mad peoples’ voices and individuals with lived experience through a literature review and interviews with key disability rights advocates. Using Canada as a case study, we critically examine the implementation of the CRPD and the need to align mental health acts with our international human rights obligations. We argue that forced psychiatric interventions violate the rights of persons with psychosocial disabilities and cause inherent harm. There is an urgent need to move towards new paradigms of care that promote the dignity and autonomy of people with psychosocial disabilities.

7080 Copy Number Variation (CNV) in Self-Limited Delayed Puberty (SLDP)

Abstract Disclosure: Y. Al-Sayed: None. M. Ishida: None. C.L. Hall: None. S. Howard: None. SLDP is where the onset of puberty is more than 2-2.5 standard deviations later than the population mean age and is often familial with strong genetic determinants. The reproductive axis is regulated by gonadotropin-releasing hormone (GnRH), which plays a crucial role in initiating puberty and maintaining fertility through its pulsatile secretion. Disruption in GnRH neuron development or hypothalamic function can lead to DP. UK Biobank data has identified negative health outcomes associated with SLDP including early menopause/andropause and cognitive and psychosocial disabilities. Consequently, there has been extensive research to investigate genes affecting the hypothalamic-pituitary-gonadal (HPG) axis that might be implicated in the pathogenesis of DP by our group and others which has identified sequence variation contributing to the aetiology of SLDP. However, factors beyond nucleotide variations, such as epigenetic changes and CNVs can also lead to pubertal timing disorders. Moreover, CNVs are seen in multiple individuals (n=92) from the Deciphering Developmental Disorders study (https://www.deciphergenomics.org) with a phenotype including DP (HP:0000823). We performed whole genome sequencing on 49 probands with SLDP and subsequently, analysed the data for CNV. The data was initially called, annotated, filtered then partitioned for classification of CNVs using a command-line tool that implements the ACMG guidelines to evaluate the pathogenicity of germline duplications and deletions. Using an unbiased candidate gene approach, we identified several deletions that affected 60 known/predicted dosage sensitive genes and combines with functional enrichment analysis; This approach revealed potential molecular pathways and biological processes involved in the pathogenesis of SLDP, including histone acetylation, and neural plate development. To refine our findings, we applied additional filters, including known HPG axis genes, GWAS loci associated with pubertal timing, decipher CNV tracks, and DP gene panels, to narrow down large number of rare predicted damaging CNVs and prioritize those with potential relevance to DP. Our study highlights the potential role of CNVs in DP and expands our understanding of the molecular pathways and biological processes involved in this condition, shedding light on the complex mechanisms underlying DP. Presentation: 6/2/2024

9205 Copy Number Variation (CNV) in Self-Limited Delayed Puberty (SLDP)

Abstract Disclosure: Y. Al-Sayed: None. M. Ishida: None. C.L. Hall: None. S.R. Howard: None. SLDP is where the onset of puberty is more than 2-2.5 standard deviations later than the population mean age and is often familial with strong genetic determinants. The reproductive axis is regulated by gonadotropin-releasing hormone (GnRH), which plays a crucial role in initiating puberty and maintaining fertility through its pulsatile secretion. Disruption in GnRH neuron development or hypothalamic function can lead to DP. UK Biobank data has identified negative health outcomes associated with SLDP including early menopause/andropause and cognitive and psychosocial disabilities. Consequently, there has been extensive research to investigate genes affecting the hypothalamic-pituitary-gonadal (HPG) axis that might be implicated in the pathogenesis of DP by our group and others which has identified sequence variation contributing to the aetiology of SLDP. However, factors beyond nucleotide variations, such as epigenetic changes and CNVs can also lead to pubertal timing disorders. Moreover, CNVs are seen in multiple individuals (n=92) from the Deciphering Developmental Disorders study (https://www.deciphergenomics.org) with a phenotype including DP (HP:0000823). We performed whole genome sequencing on 49 probands with SLDP and subsequently, analysed the data for CNV. The data was initially called, annotated, filtered then partitioned for classification of CNVs using a command-line tool that implements the ACMG guidelines to evaluate the pathogenicity of germline duplications and deletions. Using an unbiased candidate gene approach, we identified several deletions that affected 60 known/predicted dosage sensitive genes and combines with functional enrichment analysis; This approach revealed potential molecular pathways and biological processes involved in the pathogenesis of SLDP, including histone acetylation, and neural plate development. To refine our findings, we applied additional filters, including known HPG axis genes, GWAS loci associated with pubertal timing, decipher CNV tracks, and DP gene panels, to narrow down large number of rare predicted damaging CNVs and prioritize those with potential relevance to DP. Our study highlights the potential role of CNVs in DP and expands our understanding of the molecular pathways and biological processes involved in this condition, shedding light on the complex mechanisms underlying DP. Presentation: 6/2/2024

Breaking Barriers and Building Opportunities: Employer Perspectives on Working with People with Psychosocial Disabilities in a Rural Setting in Kenya

Breaking Barriers and Building Opportunities: Employer Perspectives on Working with People with Psychosocial Disabilities in a Rural Setting in Kenya

The Indian Perspective on Existing Human Rights Violations Against People with Cognitive Psychosocial Disability

Regardless of economic status, violations of human rights are committed worldwide against those suffering from mental and psychological disorders. Rather than coming from scientific research, the evidence from low- and middle-income nations comes from reports from non-governmental organizations (NGOs), UN documents, official publications, and the media. Additionally, a wide consultation with individuals from low and middle income nations who have people with mental and psychosocial disabilities has been conducted. The WHO Quality Rights Assessment Tool, which evaluates the mental health institutions in compliance with the CRPD and their suitability for human rights, served as the basis for this qualitative consultation.

Promoting the social in psychosocial recovery: Interviews with Australian National Disability Insurance Scheme participants

AbstractSocial connection is a central element in mental health recovery and has been found to have a significant impact on the health and well‐being of individuals. This study examines the experiences of social connectedness for people accessing NDIS support for psychosocial disability. Interviews were conducted with eight NDIS participants. The study's findings suggest that people with psychosocial disabilities experience limited social connections and small social worlds. While NDIS support relationships were seen as important facilitators in increasing social engagement, these relationships may also limit opportunities for participants to extend their social connections beyond these professional support contacts. The impacts of participants' illnesses were identified as major barriers to establishing social connections and further research is needed to identify effective interventions that reduce social isolation in this population. This study highlights the role the NDIS can play in supporting social connection and inclusion for participants. Further consideration regarding the role of NDIS support relationships and NDIS‐funded interventions in supporting the social connectedness of participants is needed.

Development of Mental Health and Social Rehabilitation Service Models for Psychosocial Disabilities

This study aims to determine the extent to which policies related to persons with disabilities and mental health can accommodate the rights of people with psychosocial disabilities, then the extent to which the model of mental health services and social rehabilitation for psychosocial disabilities contributes to mental health treatment in DIY. YAKKUM Rehabilitation Center through capital development of mental health services and post-recovery social rehabilitation that is accessible and community-resourced. This model is oriented towards improving the quality of life of people with psychosocial disabilities and the existence of communities that contribute proactively to community-based mental health efforts in DIY. The data mining method in this study uses a mixed method, namely discriptive studies, descriptive qualitative, participant as observer and participant non observer. Subjects in this study included people with psychosocial disabilities, caregivers, mental health cadres, village governments, puskesmas and related local organizations. The results of this study show that the service model developed by the YAKKUM rehabilitation center is able to encourage social recovery in people with psychosocial disabilities, strengthen their role in the community in community-based mental health, local mental health policies that accommodate the rights of people with psychosocial disabilities, the existence of a mental health service system that focuses on fulfilling the rights of psychosocial disabilities and social rehabilitation.

Family strengthening, for all?

By means of the epistemology of intersectionality, three categories are brought together and questioned in the implementation of public policies for family strengthening in the child protection system: childhood, gender and disability. Women with disabilities, considered strangers to traditional hegemonic and patriarchal mandates, challenge the exercise of motherhood under criteria that are overvalued and demanded compared to women with psychosocial or intellectual disabilities. They challenge the prevailing mandate of hegemonic motherhood, which does not conceive of other designs for the exercise of the constitutional and conventional right to family life. States have the obligation to design support systems (arts. 12 and 19 CRPD) so that women with disabilities are not separated from their children because of their disability. Children and adolescents have the right not to be discriminated against because of the condition/situation of their parents (art. 2 CRC) and to be raised by them (art. 9). Support systems should be effective public policies for strengthening families so that children can remain in the care of their mothers in accordance with their best interests and so that mothers can exercise their maternity on an equal footing with other persons, as mandated by the Constitution.

Implementation of the World Health Organization's QualityRights initiative in Ghana: an overview.

Globally, human rights violations experienced by persons with psychosocial, intellectual or cognitive disabilities continue to be a concern. The World Health Organization's (WHO) QualityRights initiative presents practical remedies to address these abuses. This paper presents an overview of the implementation of the initiative in Ghana. The main objective of the QualityRights initiative in Ghana was to train and change attitudes among a wide range of stakeholders to promote recovery and respect for human rights for people with psychosocial, intellectual and cognitive disabilities. Reports of in-person and online training, minutes of meetings and correspondence among stakeholders of the QualityRights initiative in Ghana, including activities of international collaborators, were analysed to shed light on the implementation of the project in Ghana. In-person and online e-training on mental health were conducted. At the time of writing, 40 443 people had registered for the training, 25 416 had started the training and 20 865 people had completed the training and obtained a certificate. The team conducted 27 in-person training sessions with 910 people. The successful implementation of the project is underpinned by a committed partnership among stakeholders, strong leadership from the coordinating agency, the acceptance of the initiative and the outcome. A few challenges, both in implementation and acceptance, are discussed. The exposure of the WHO QualityRights initiative to a substantial number of key stakeholders involved in mental healthcare in Ghana is critical to reducing human rights abuses for people with psychosocial, intellectual and cognitive disabilities.

Reflections on the status of protection of the rights of persons with intellectual and psychosocial disabilities in Kenya

Commissioner Prof Marion Mutugi, Kenya National Commissionon Human Rights (KNCHR), Prof Ronald Chepkilot, Deputy ViceChancellor (Administration and Finance), Kabarak University, DrHarun Hassan, Executive Director, National Council for Persons withDisabilities, Dr Bernard Mogesa, Secretary, KNCHR, Dr Julius Ogato,the Chief Executive Officer, Mathari National Teaching and ReferralHospital, Mr William Aseka, Programme Manager - Africa, ValidityFoundation, Representative of the Kenya Prisons Service, Nakuru, MrHenry Opondo, Chairperson of the Law Society of Kenya, NakuruChapter, Representatives of civil society organisations working in thearea of mental health rights, faculty and students of Kabarak University,esteemed guests, ladies and gentlemen, good afternoon.

Anxiety and Depressive Symptoms in Moroccan Patients Following Major Lower Limb Amputation: A Three-Month Follow-Up.

Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression symptoms changed during the three months following the amputation. A prospective longitudinal observational study was conducted between October 1, 2019, and January 1, 2021, in the Department of Vascular Surgery and the Department of Orthopedic Traumatology of the Ibn Sina Hospital Center in Rabat, Morocco. The study assessessymptoms of anxiety and depression in patients who have undergone a major lower limb amputation over a three-month interval. In patients who had undergone a major lower limb amputation, the prevalence of anxiety and depression symptoms was very high immediately postoperatively (47.4% and 79.2%, respectively), with a significant decrease in these symptoms. Three months later, anxiety was reported in 24.4% of cases, and depressive symptoms in 65.1% of cases. Age, amputation level, stump pain, phantom limb pain, re-amputation, and emergency amputation were all associated with an increased risk of anxiety and depression. The patient's psychological preparation prior to the amputation, the anesthetic technique used during the procedure, the patient's mobility, and the patient's post-amputation professional status were all protective factors. Our research findings bolster the necessity of promptly evaluating and managing anxiety and depression in the initial three months following major lower limb amputation. Thus, we believe that amputee patients ought to receive a formal psychological evaluation, which could be helpful, particularly for those whose anxiety or depression symptoms did not improve after three months.

The CRPD and mental health law reform in Scotland

Scotland's mental health and capacity legislation and its implementation is underpinned by European Convention on Human Rights (ECHR) informed principles, and such legislation and its implementation has remained largely ECHR compliant. It is designed to protect individuals' autonomy from inappropriate and disproportionate nonconsensual intrusions but its scope is largely limited to this. However, since the legislation was enacted at the start of the twenty first century the UK subsequently ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) which requires the law and related practice to focus on giving effect to all the rights of persons with mental disabilities (people living with psychosocial, cognitive and intellectual disabilities) on an equal basis with others and to actively support such equality in rights enjoyment.The Terms of Reference of the independent Scottish Mental Health Law Review (2019–2022) included considering and making recommendations to align Scotland's mental health and capacity legislation with the CRPD. After engaging widely with stakeholders its recommendations sought to strengthen the voice of persons who use services and of those who care for them, reduce the need for non-consensual measures and secure rights to the help and support necessary to live a good life. In order to achieve this, it recommended, amongst other things, a refocusing on mental health and capacity law together with a Human Rights Enablement, Supported Decision Making and Autonomous Decision Making framework.

An analysis of Nepal's Draft Mental Health Acts 2006-2017: competing values and power.

This qualitative study maps the process of drafting and consulting on Nepal's mental health legislation from 2006 to 2017. A total of 14 people were interviewed and interviews were analysed thematically. These themes were subsequently interpreted in light of Shiffman and Smith's policy analysis framework, as the process was found to be at the agenda-setting stage. Two groups of actors were identified with different views on appropriate policy content and how the policy process should be conducted. The first group included psychiatrists who initiated and controlled the drafting process and who did not consider people with psychosocial disabilities to be equal partners. The psychiatrists viewed forced detention and treatment as upholding people's right to health and lobbied the Ministry of Health and Population (MoHP) to pass the draft acts to parliament. The second included the rights-based civil society actors and lawyers who saw the right to equality before the law as of utmost priority, opposed forced detention and treatment, and actively blocked the draft acts at the MoHP. There is no clear legal definition of mental health and illness in Nepal, legal and mental capacity are not differentiated, and people with mental and behavioural conditions are assumed to lack capacity. The analysis indicates that there were few favourable conditions to support the progression of this policy into law. It is unclear whether the drafters or blockers will prevail in the future, but we predict that professionals will continue to have more input into content than service users due to national policy dynamics.

Combating domestic violence in West Bengal, India: Gendered norms and legal regulations

Domestic violence has long been a major concern for women's organisations globally. Despite decades of progressive legislation in India since the 1980s, this paper underscores the persistent and structural nature of domestic violence, which afflicts lives across gender identities. The study draws on findings from a survey of 2193 aggrieved women and select case studies across 13 districts of West Bengal who have accessed the Protection of Women from Domestic Violence Act (PWDVA), a civil law enacted in 2005 to give protection to victim-survivors from domestic violence (as opposed to punishing the perpetrators). The paper argues that even ‘radical’ legislation such as the PWDVA helps survivors manage and endure violence rather than eliminate it from their lives. In doing so, the legislation offers a coping strategy to the aggrieved rather than a means through which deep-seated social structures of patriarchy that perpetuate domestic violence can be challenged to ensure gender justice. Our study indicates that there is a greater degree of precarity among women survivors with psycho-social disabilities and members of gender-sexual minorities. The majority of actors in the socio-legal ecosystem who should be upholding survivors’ right to live a life free from violence instead place them primarily in the heterosexual patriarchal family. The feminist vision behind the enactment of PWDVA, which valued the assertion of a survivor's rights as a citizen of a democratic country to lead a life free from violence, is eschewed in favour of preserving the institution of family and marriage over gender justice.

Enhancing Community Resilience: An Integrated Home-based Psychological Intervention for Individuals Living with Physical Disabilities

Individuals living with physical disabilities more likely develop psychological problems and less able to seek appropriate care for their issues as compared with the individuals living without disability. This study aimed to assess the effectiveness of an integrated home-based psychological intervention in managing psychological problems among individuals living with disabilities. For the purpose, a total of 60 participants were enrolled from the Community-Based Rehabilitation (CBR) program at Aid to Leprosy Patients (ALP) in Rawalpindi Pakistan between November 2021 and July 2022. These participants received comprehensive rehabilitation services alongside a structured psychological intervention. The duration of the study was 5 months including the follow up sessions. Significant improvements observed from pre-treatment to post-treatment. The main effect for psychosocial disabilities was (F = 116.93, p<.001), emotional problems (F = 116.93, p<.001), Depression (F = 117.30, p<.001), Anxiety (F = 150.02, p<.001) and Stress (F = 93.36, p<.001). The integrated home-based psychological intervention served as an effective rehabilitation approach for individuals with physical disabilities, particularly those previously unable to reintegrate into community life.

Problems, Issues and Concerns in Mental Health

Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development. Mental health is more than the absence of mental disorders. It exists on a complex continuum, which is experienced differently from one person to the next, with varying degrees of difficulty and distress and potentially very different social and clinical outcomes. Mental health conditions include mental disorders and psychosocial disabilities as well as other mental states associated with significant distress, impairment in functioning, or risk of self-harm. People with mental health conditions are more likely to experience lower levels of mental well-being, but this is not always or necessarily the case. This research paper will focus on those challenges and problems which are more serious rendering them into genuine mental health concerns. An attempt will also be made at discussing and explaining how these mental health problems can be dealt with and managed, while acquainting you with the existing forms of psycho therapy and intervention which are used.

STIGMATIZATION OF PSYCHOSOCIAL MENTAL DISABILITIES THROUGH THE MENTION OF PEOPLE WITH MENTAL DISORDERS

Stigma against persons with psychosocial disabilities in the mass media causes people to be afraid to seek help and open up in public spaces. Stigmanisai in the mass media occurs through the designation ODGJ or People with Mental Disorders which should since the Law on Persons with Disabilities be referred to as persons with psychosocial mental disabilities. The study used the CADS method or Corpus Assisted Discourse Studies with the keywords mention of OGDJ and the relationship between word frequencies that appeared in the mass media whose results showed that the word ODGJ was dominated by news related to law enforcement through the institution of police power at various levels as bourgeois actions in the public sphere. The news also shows more about actions that in theory stigma as behavior that is strongly disapproved of by the social normal that is full of normal. This is a form of mass media framing of psychosocial mental people by serving the value of society as an interesting news article for readers and viewers to enjoy rather than advocating for people and disability issues as social justice issues that require broad access to appropriate treatment.

DEBULKING SURGERY: MANAGEMENT OF PENOSCROTAL LYMPHOEDEMA IN A NEGLECTED TROPICAL DISEASE AFFLICTING YOUNG MALE PATIENTS

Lymphatic filariasis, caused by parasites such as Wuchereria bancrofti, Brugia malayi, and B. timori, remains a significant global health concern, leading to severe physical and psychosocial disabilities. This study provides an overview of lymphatic filariasis, commonly known as elephantiasis, with a focus on its symptoms, detection methods, epidemiology, and risk factors. Despite efforts to eliminate the disease, LF remains prevalent in some regions, including India, presenting challenges exacerbated by factors such as climate change. This paper presents a case study of a young male patient suffering from massive penoscrotal lymphoedema due to microfilaria, highlighting the clinical presentation, diagnostic approach, surgical intervention, and postoperative management.

Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health?

PurposeCommunity-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India.MethodsWe interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically.ResultsCHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD.ConclusionCommunity health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.

‘Doctors advised to take medicines to remove these thoughts’: the violence and violations in sexual mental health care in community mental health programmes in Kerala

Abstract Community mental health programmes (CMHPs) have proliferated in both governmental and non-governmental sectors in recent times in India. Although CMHPs are mandated to work in close collaboration with the community, the operationalization of community is fraught with exclusionary tendencies, particularly concerning non-cis-heteronormative sexual subjects. Mental health professionals trained in the mainstream western biopsychiatric paradigm are largely silent on the lesbian, gay, bisexual, transgender, queer, intersex and asexual identity discourses as they institute pathological and reductive conceptualization about sexualities, psychosocial disabilities and resultant sufferings. Drawing on ethnographic fieldwork carried out at two non-governmental and a governmental CMHP in Kerala, south India, I illustrate the lack of a human rights–based approach to sex and sexual orientation and gender identity, due to which pressing concerns of sexual life are mis/overdiagnosed as mental ‘disorders’ to be treated within a biomedical framework. The lack of an intersectional approach fails the marginalized sexual subjects to exert their agency, develop critical consciousness and recognize sexuality as a political issue—all vital for transformative social change. The consequence is a dehumanized mental health care system that fails to ‘archive feelings’ that are pivotal in making invisibilized worlds observable to tell ‘unwelcome truths’ that induce psychic pain. Collaborative alliances among other marginalised sections like Queer, Dalit, tribal and Crip (disability) groups are vital in resisting intra-individual prescriptions by increasingly commercializing mental health practice in a country beset by a host of social problems including poverty, discrimination and rising inequalities. It is crucial to understand systems of power (imbalance) that operate as major (social) determinants of (sexual) mental health.