chronic mental illness

A Nebulous Relationship: Chronic Mental Illness & Disability

By Jorain Ng

Today I’d like to answer a question that has befuddled the minds of many thinking about the relationship between chronic mental illness and disability. By ‘chronic’, I mean a long duration of illness, which may include periods of seeming wellness interrupted by exacerbations of acute symptoms. Chronic depression, schizophrenia and Obsessive Compulsive Disorder are such examples.

The question is simply this: Is chronic mental illness a disability?

If you came here looking for a straightforward answer, you’d be severely disappointed to know that there is none.

This is a really tricky question which answer varies according to the organisation or individual you’re asking, and so the topic deserves its own blog post.

Chronic Mental Illness is a Disability

From the standpoint of my organisation, the Disabled People’s Association, chronic mental illness is a form of disability.

We see disability as a condition which restricts a person’s mental, sensory or mobility functions. By this definition, a person with chronic mental illness should be seen as having a disability because the chronic illness, if highly debilitating, may lead to the permanent impairment of the person’s sensory, mobility or mental functions.

Muscular dystrophy (MD) is one such example. The condition is caused by muscle diseases that weaken the musculoskeletal system and hamper locomotion. A person with MD could even lose his or her ability to walk. In this sense MD is as much a chronic illness as it is a disability.

Moreover, when one considers the implications of having chronic mental illness, there can be little doubt that the effects are similar to those living with a disability.

Like persons with disabilities, those with chronic mental illness face various barriers such as stigmatisation which hinders their full and effective participation in society. The reality today is that many employees will not voluntarily disclose that they suffer from a mental health disorder. Those who do disclose on their resume often face difficulty finding suitable employment.

Singapore Government’s Stance

The Singapore government takes a different stance from that of DPA’s, which can sometimes appear to be contradictory.

Although a signatory of the United Nations (UN) Conventions of the Rights of Persons with Disabilities (CRPD), which includes chronic mental illness under the disability category, the various government agencies and ministries do not always recognise the relationship in practice.

On one hand, the National Council of Social Service (NCSS)/Social Service Institute (SSI) lists an SSI course on Mental Illness under the disability category. On the other hand, persons with chronic mental illness are not eligible for policies, schemes, and initiatives such as the Open Door Programme, which are intended for persons with disabilities.

What might be the reason for this confusing stance?

It must be noted that chronic mental illness as a disability is a modern concept recently established in the past decade.

In the past, the Singapore government saw both groups as clearly distinct from each other, and this categorisation informed the way in which policymakers formulated policies intended for persons with chronic mental illness and disabilities. What we see today is a result of years of policymaking. Removing the distinction will require radical policy changes that will affect various disability service providers and mental health agencies like the Institute of Mental Health and Singapore Association for Mental Health.

That the Singapore government is hesitant in fully committing to the definition in the UN Convention in practice is therefore not surprising.

Why the Definition Matters

This should not be news to anyone.

But how one defines or indeed categorises a condition, especially those of a permanent nature, can include and exclude a person from receiving the necessary accommodation (financial support, employment support etc.) to study and work an equal basis with others.

To borrow an earlier example, the Open Door Programme initiated by SG Enable is a policy aimed at incentivising and thereby enhancing the employability of persons with disabilities. A person with disability looking for employment may, for instance, apply for training grants to attend pre-employment and skill training. But this government-funded initiative is not available for persons with chronic mental illness simply because they do not meet the eligibility criteria.

What, then?

What does this mean for a person with chronic mental illness needing accommodation in employment and education?

Given the unofficial recognition of chronic mental illness as a disability, it will be wise for any person with chronic mental illness to approach the relevant government agencies like the NCSS for enquiries on the policies, schemes, and initiatives for persons with disabilities.

While their answers may not always be forthcoming, you can be sure that the NCSS is sympathetic to the needs of every persons living in Singapore, including those with chronic mental illness.

As of now, refashioning the categories according to the UN Convention in Singapore will be a difficult task, and one which will take years. The Singapore government will require the unanimous support from all disability agencies and mental health institutions to make it a reality. And this support can only be garnered through dialogue sessions, conferences, and consultations  – hefty work which will require all three sides to see eye to eye on pertinent areas.