Memorandum from the British Psychological
Society (DDB 50)
SUMMARY
1. This submission is concerned with the
meaning of disability.
2. We support the inclusion of cancer, HIV
and MS in the definition of disability.
3. In our view the provisions of the draft
Bill do not provide equitable access to legal protection from
discrimination for people with a broader range of cognitive and
mental health problems.
4. Psychologists are particularly concerned
with the impact of physical, cognitive and mental health problems
on a person's capacity to reason and communicate their thoughts
and feelings. At present, the definition of "normal day-to-day
activities" does not adequately address these areas. Thus,
cognitive disabilities such as psychosis, autism spectrum disorders,
acquired brain damage, are not properly recognised.
5. We believe the requirement that cognitive
disorder and mental illness needs to be clinically well recognised
is not easy to clarify, as, for example, there is considerable
controversy about areas such as attention deficit disorder and
autism spectrum disorders. The differential requirement for physical
disability and for cognitive and mental disorders is, in our view,
essentially inequitable.
6. We are not as concerned as Mind about
the question of the duration of the illness as part of the definition.
We are aware of the necessary balance between securing rights
and the costs of maintaining these. Also, the proposal would produce
inequity if a particular group were made an exception. However,
we agree that the negative impact of a disability is not necessarily
related to the duration of illness.
With 40,000 members, the British Psychological
Society is the representative body for psychologists and psychology
in the UK. Its Royal Charter charges the Society with national
responsibility for the development, promotion and application
of psychology for the common good.
The BPS welcomes the opportunity to contribute
written evidence to the committee and would be happy to submit
further oral evidence, if appropriate.
The Society has expertise in the scientific
understanding and practical implementation of psychology. Chartered
psychologists with specialist expertise of working with clinical
populations are aware of many of the issues for people living
with a disability, and are particularly concerned about the psychological
impact of discrimination and stigma.
Our comments are intended to advance two broad
aims: to assist in the effective implementation of the Bill, a
bill whose policy intentions we support, and to encourage a coherent
and psychologically informed approach to this legislation.
1. INTRODUCTION
The BPS welcomes the inclusion of the medical
conditions, cancer, HIV and multiple sclerosis, into the Bill
but notes that there are other physically and neurologically disabling
conditions which are not included.
We support the position of MIND, the Disability
Rights Commission, The Disability Task Force and the Royal College
of Psychiatry, that there still remain disabling conditions not
covered by the legislation. People with mental illness are not
afforded the same legal protection as other disabled groups.
2. DEFINITION
OF DAY-TO-DAY
ACTIVITIES
The Act defines a disabled person as someone
with "a physical or mental impairment which has a substantial
and long-term adverse effect on his ability to carry out normal
day-to-day activities".
The areas identified as day-to-day activities
do not presently include the activity of reasoning, and communicating
thoughts and feelings. At present, a person who has an illness
which affects their ability to judge reality, for example due
to psychosis or depression or head injury, is not protected if
all the other criteria are met. This means that a group of people
who have problems with judgement, whether this be as a result
of severe mental illness or of brain damage, even to the extent
that they may require compulsory treatment, are not able to have
their rights preserved. An example of this issue is being considered
at present through an appeal against an Employment Tribunal that
a person with Asperger's Syndrome and Autism does not satisfy
the statutory definition of disability (DRC/02/5289). This group
is most likely to attract stigma, and accordingly experience discrimination.
As psychologists we are aware of the importance
of effective communication in combating discrimination for any
client group. If a person does not have problems with speech or
hearing, but they cannot express themselves or be understood due
to the effects of their illness or injury, whether it be the "pressure
of speech" that can accompany psychosis, the mutism that
sufferers of depression can experience, or the difficulties with
speech and language that people with stroke or brain injury can
struggle with, the lack of understanding of these conditions by
ordinary people can lead to them being ignored or, worse, shunned,
and again can mean that people who are recovering are not able
to regain their right to work and participate in society.
Accordingly, we support the recommendations
for amendments made by Mind,
"add to the list of day-to-day activities"
(i) thought processes, perception of reality, emotions or judgement.
To (h) add "or ability to care for oneself",
AND (i) perception of reality; (j) ability to communicate.
3. PROCESS—ASSESSMENT
AND DETERMINATION
OF DISABILITY
The tribunal evidence required to assess a person's
case for discrimination includes reports on a person's activities
and capacity to understand. However, the WHO in its 2001 ICD classification
includes impairment in participation as well as activity in its
definition of disability. At present, although the question of
transport is addressed, the day-to-day activity of interacting
with other people is not fully reflected in the assessment.
The inclusion of cognitive and communication
problems as outlined above would acknowledge the limits to participation
in everyday life that some sufferers of serious mental illness,
learning disability and brain injury experience.
Chartered clinical psychologists have expertise
in the assessment of cognitive functioning for people with mental
health problems, learning difficulties and acquired brain damage,
and may be able to usefully contribute to the evidence considered
in tribunals.
4. "CLINICALLY
WELL RECOGNISED"
REQUIREMENT
The BPS acknowledges the need to ensure the
Act operates for people with conditions that are well understood.
The government and employers may be concerned with bearing the
cost of ensuring non-discriminatory practice, and are not in a
position to accept too wide a range of problems, where the primary
issues may be socially rather than clinically defined. However,
the same argument applies to physical illness as well as mental
illness. At present, a person with non specific back pain may
be able to access this legislation, whereas a person with manic
depression, potentially subject to compulsion, may not.
It is difficult to measure the cost implications
of discontinuing the requirement for mental health problems, but
since the Regulatory Impact Assessment has estimated the recurrent
costs to employers and the government of £100,000 to include
three diseases without this restriction, we would suggest that
the impact is not likely to be as substantial.
We support the recommendation of the Disability
Rights Task Force, that the advantages and disadvantages of removing
the limitation be properly reviewed.
5. SUBSTANTIAL
AND LONG-TERM
ADVERSE EFFECT
The impact of a disability is not necessarily
linked to the duration of the dysfunction. A person who has asthma
may be asymptomatic for much of the time, but may experience life-threatening
symptoms in specific conditions. We acknowledge the need to set
a cut off point that recognises the balance between the rights
of the disabled person and the cost to the government and employers
to uphold these rights. This decision is essentially a political
question, not within the remit of one professional body. We would
argue that any definitions of duration should be equitable across
all types of disability.
February 2004
| 
