/ 3 December 2020

People with disabilities can work if barriers go

Psychiatric Disability Awareness Month
Restricted: Mental health human resource availability, infrastructure and medication supply constrain the realisation of South Africa’s progressive mental health legislation, according to a study in the Health Policy and Planning journal. Photo: Halden Krog/Gallo Images/The Times

People with disabilities make up almost one billion or 15% of the world’s population, but many still struggle to find a job. Barriers to employment remain even though signatories to the United Nations Convention on the Rights of Persons with Disabilities have undertaken to “prohibit discrimination on the basis of disability with regard to all matters concerning all forms of employment, including conditions of recruitment, hiring and employment, continuance of employment, career advancement and safe and healthy working conditions”.

As we observed the International Day of Persons with Disabilities on Thursday, we hopefully did not lose sight of the fact that the pledge has not yet become a reality. Despite good protection for people with disabilities offered by our Constitution and progressive labour legislation that safeguards against discrimination and promotes affirmative strategies, including reasonable accommodation in the workplace, they continue to experience marginalisation and exclusion.

This is particularly true for people with psychosocial disability, in part because of the stigma attached. When participation in work is restricted based on unfounded assumptions, ignorance or even fear, the occupational injustice experienced by those with psychosocial disabilities and their families can have far-reaching consequences. Often they will do well at work when a good fit is achieved between their abilities and the inherent requirements of the job.

One of the reasons that people with disabilities continue to be marginalised is society tends to approach them from a “deficits” perspective, focusing on what is wrong and what they might not be able to do. The message is that disability will negatively affect work performance. What we tend to forget, is that there’s a growing body of research that confirms the importance, value and positive effects of work for people with disability, thus adding a scientific dimension to the legal and moral imperatives to guard against discrimination in the world of work on grounds of illness or disability.

This tendency to look at a person with disabilities from a deficit’s perspective is adopted from the dominant medical model that is widely used and most people are familiar with. When taking this particular medical model perspective the question asked will generally be: what is wrong with the person that might prevent them from participating in the workplace on an equal footing? 

The opposite, more productive, approach is to ask: what potentially exclusionary barriers are preventing the person with disability from participating on an equal footing in the workplace?

Then, when such barriers do not hinder the person with disability in performing the inherent requirements of the job, the focus should shift to removing identified barriers. Such an approach is underpinned by the social model of disability, which recognises that social contexts, shaped by misunderstanding, ignorance or “fear of the unknown” can prevent or limit opportunities for people with disabilities to work. The person isn’t the problem, but the contexts with barriers that hinder participation.

When people with disabilities experience restrictions in their ability to participate in the workplace, it is crucial to determine whether such restrictions affect the core functions or inherent requirements of the job. If not, the identified restrictions should not prevent entry or continued participation in work. 

To avoid discrimination, it is imperative to determine whether restrictions in ability to participate are substantially limiting a person’s prospects of entering into or advancing in employment. When considering these points, many people with psychosocial disability should not be limited in their ability to perform work, although they might require accommodation in the form of support.

Strong research evidence indicates the use of supported employment for successful entry into and performance at work for people with psychosocial disability. Supported employment has also been shown to be appropriate for use in South Africa

A study was done to determine how much support of what type was needed by people with psychiatric disability for them to successfully keep a job sustain work. These findings were then used to cost supported employment offered by occupational therapists in the role of cob coaches (someone who supports the person in the workplace), and was found to be surprisingly affordable. 

The cost of supported employment was compared to the value of disability grants and was found to be substantially lower, making supported employment a feasible option. The main contributor to low cost is the steep downwards curve in the use of supported employment services over time.

The authors of the study recommend a fixed-term return-to-work grant that is paid to providers of supported employment. Such a grant will optimise entry or return to work for people with psychosocial disability at 10% of the cost of a disability grant. 

Potential or current recipients of disability grants will thus have an optimal, well-supported opportunity to transition into work to experience the monetary and non-monetary benefits of having a job.

Work is the ultimate positive outcome for most providers and users of health and rehabilitation services. This is also true for people with disabilities. 

To fully achieve such an outcome, these services should move beyond a predominant focus on alleviating the effect of health conditions at an individual level. 

Service providers will require competencies to facilitate participation by drawing on health, employment and legal frameworks, such as is done by providers of supported employment.

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian.