MEASURING SOCIAL DISABILITIES IN MENTAL-HEALTH

Social functioning is important in relation to mental illness as it ca n limit the ability to funtion independently and because it may vary s eparately from symptoms. This paper summarises and critically reviews the development of the WHO Classification of Impairments, Disabilities and Handicaps. The value of social role theory is described followed by a classification of the relevant assessement scales in this field. Mental disorders are in general strongly associated with social dysfun ctioning, particularly in schizophrenia and the major affective disord ers. For a long time social dysfunctioning was considered an epiphenom enon and just a part of the disease process. Criteria for the diagnosi s of a mental disorder were and still are often derived from the domai ns of work and social relationships. There are at least two related re asons why social functioning deserves a closer look: 1. There is an in creasing trend to treat patients in the community instead of in the ho spital: the changing orientation on community care needs careful evalu ation with respect to its consequences. To what extent is survival in the community possible and what is the quality of life like there? Are community programs better than hospital treatment, and for whom? Ther efore, separate measurement is justified for evaluation of outcome and costs and benefits. 2. There is growing evidence that the courses of symptomatology and social dysfunctioning may vary relatively independe ntly: social disablement of a patient may be characterized much more b y social disabilities than by persistent psychiatric symptoms; the for mer may call for another kind of action than usually available. For ex ample, psychosocial rehabilitation focuses on cognitive and social abi lities of the patient which are crucial for a more or less independent life. Therefore, seperate measurement is justified for the sake of th e right choice of treatment. The usual diagnostic systems such as the ICD and the DSM offer no adequate solution to the problem of classific ation and assessment of social dysfunctioning as a consequence of ment al disorder. We have to look for other classification systems such as the International Classification Impairments, Disabilities and Handica ps (ICIDH) of the WHO (1980, 1993) which offers a conceptual model to study the long-term consequences in terms of functional disabilities a nd experienced social handicaps, and the effectiveness of health care to handle these kind of problems.