New ESRI Research Highlights the Importance of Social Support to the Well-being of People with Mental Health Disability

A new research report on Understanding Emotional, Psychological and Mental Health (EPMH) Disability in Ireland: Factors Facilitating Social Inclusion was published today jointly by the ESRI and the National Disability Authority. The report examines the circumstances of people with emotional, psychological and mental health (EPMH) disability. Disability is understood as a limitation in the person’s activities arising from both the person’s condition and aspects of the environment. More than one-third of those with a disability have an EPMH disability. The research draws on a detailed statistical analysis of over 3,000 adults with EPMH disability who were interviewed as part of the 2006 National Disability Survey (NDS) conducted by the Central Statistics Office. This study, which has a particular emphasis on understanding the factors that enable people with EPMH to participate in social life and work, represents the first large-scale Irish study to focus on the social inclusion of this group. The National Disability Survey covered nine different types of disability and 87 per cent of those with an EPMH disability had at least one other type as well, most often mobility & dexterity disability (52%), remembering & concentrating disability (50%) or chronic pain (45%). Social Inclusion Stigma is a significant issue for people with EPMH disability.  Although most of this group (over 80%) find family, friends and health care providers supportive, the proportions are lower (between 45% and 58%) for other public and private service providers, employers and strangers. People with an EPMH disability are also more likely than people with mobility & dexterity disability to avoid participating in activities because of the attitudes of other people (39% versus 22%). People with an EPMH disability differ widely in the extent to which they experience difficulties in their everyday lives because of their condition: 23% report ‘just a little’ difficulty while 36% experience ‘a lot’ of difficulty or have some everyday activities they cannot do at all. High levels of difficulty are more common among those with bipolar disorder (compared to depression), where the person has a number of different types of disability or has bad health. Social support and an absence of stigma were also important to individuals’ experiences: social support was associated with a lower level of difficulty while avoiding participation because of the attitudes of others was associated with a higher level of difficulty in everyday life. Most people with EPMH disability (88%) had participated in face-to-face social activities in the previous four weeks, including going to a social venue with family/friends, visiting family/friends in their homes and being visited at home by family/friends.  The factor which reduced participation the most was poor health, but social support was also very important. Work Experience Although working-age people with EPMH disability are less likely than the general population to be in employment (only 18% were in employment at the time of the interview), most had been in employment at some point in the past (69%). Of those in employment in the past, just over three-quarters left their job for reasons related to their disability – most often poor health.  Among those not currently in employment, just over half would be interested in a job if the circumstances were right. The most important factor in enabling people with EPMH disability to take up employment is (or would be) flexible working arrangements such as shorter hours or flexible working times. Bad health and the presence of a mobility & dexterity disability are found to reduce the likelihood that someone with EPMH disability will be in employment but are not major factors in distinguishing between those who would be interested and those who would not be interested in employment. The impact of social support and stigma were not large when other characteristics were taken into account but problems with the attitudes of other people made it less likely that those interested in work would actually be in a job. Policy implications There were three broad implications for policy which we draw from these findings.

• The overlap between EPMH disability and other types of disability highlights the need for an integrated approach to service delivery that takes account of the physical health needs of people with EPMH disability and takes account of the mental health needs of people with a physical disability.
• Since many people with EPMH disability first experience the disability during their working years, retention in employment is important to their social inclusion. Services to both the employer and the person with a disability are needed to retain people with EPMH disability in employment.
• Addressing stigma on the part of the general population – including employers and those providing public and private services – needs to remain on the agenda of mental health and disability policy.  This issue needs to be addressed in a number of ways: through the education system; by means of general educational campaigns targeting adults; through training for those who deal with the public; through implementation of equality policies in organisations and through equality legislation to protect people with a disability from discrimination.

Report author Dorothy Watson said

“Two issues which emerged throughout the study were the strong overlap between physical disability and emotional, psychological & mental health (EPMH) disability and the importance of attitudes of other people. Both individual factors (such as general health and presence of other types of disability) and environmental factors (including the attitudes of other people) have a significant impact on the well-being and participation of people with EPMH disability.”

Note to Editors: 1. This study was commissioned by the National Disability Authority. The views expressed in this report are those of the authors and are not attributable to either the National Disability Authority or the ESRI. 2. The study is jointly published by the National Disability Authority and the Economic and Social Research Institute.