What's in a word?

Do you consider yourself to have a disability? A simple question for most people, it appears on most equality monitoring forms.  From dentists to libraries, sports groups and employers, everyone wants to know your race, gender, sexuality and if you consider yourself disabled.  I imagine most people find this question straightforward, its obvious right?  Well, I always hover over that question, my pen moving from yes to no, my mind contemplating what it is exactly I feel, do I feel disabled? And more importantly, what will the impact be if I say yes or no?

Bipolar Disorder is, or can be, defined as a disability under the Equalities Act of 2010 (formerly the Disability Discrimination Act) if it impairs the sufferer in carrying out daily tasks.  For example getting dressed, interacting with people, making decisions.  But Bipolar Disorder is a broad diagnosis and so it must be evaluated for each person, it isn't enough simply to say Bipolar Disorder is a disability- it can be, if it effects an individual in a way that prevents them carrying out normal activities.  On that level then I am disabled.  There are periods of my life when I cannot carry out normal tasks, like dressing, or deciding what to eat.  Or even eating at all.

While logically I can look at the criteria for disability and read all the information provided by mental health charities about mental health disability, I find it hard to reconcile that with myself.  I don't feel disabled, I don't see myself as disabled.  But perhaps that is more to do with my perception of disability, or more likely connected to my need to be independent, to not need help from anyone.  Because that is the issue. Ticking that box, especially in the context of employment leads to the second question- do you require any assistance/help for your disability.  I am still coming to terms with the idea of asking for help, admitting that perhaps I can't do everything everyone else does without a little extra support. Disability for me means admitting that I need help sometimes, not something I find easy.

There is also an element of worrying about the consequences of ticking that box, of saying I am disabled.  What will an employer think when they see that, and worse that it is a mental health problem?  A probable assumption will be that I will have lots of time off, that I won't be able to handle stress, that I might "flip out". Technically employers aren't allowed to ask you medical questions until after interview, but they are allowed to ask the disabled question because it relates to interview. So what do I do- say yes and hope they don't just chuck my application in the bin?  Or no and worry that when it comes to the medical they don't question why I didn't say yes earlier?  I just can't believe that many employers wouldn't discriminate against a mental health disability.

Ultimately the problem with this question is that it is so closed.  A small tick box that requires a yes or no answer.  It doesn't allow for an explanation, all the positives that come from it, what I can do, as opposed to the things I struggle with.  Disability is a much bigger concept than a simple yes or no, it is a broad spectrum of identity, one that I am slowly beginning to accept applies to me.

Won't someone think of the children

Last week I was on Woman's Hour, well my experience was.  It was part of a piece on mental health and parenting prompted by a call from the Care Quality Commission and Ofsted that doctors and health care professionals treating parents with mental health conditions should automatically and statutorily refer them to social services.  The report states that children whose parents have mental health problems are often poorly supported and therefore susceptible to harm.  Mental health conditions are considered to be the same as substance and alcohol abuse and are recommended to be dealt with by social services in the same way.

This recommendation is ridiculous, dangerous and insulting.  There is already an obligation by health care professionals to report anything that they think my be a child protection issue.  This requirement will not help support children, instead it will isolate women right at the point they need help and to talk.  The fact is very few women, or parents, with mental health problems are a risk to their children. Unfortunately, the few terrible instances there are of parents (usually mothers) harming their children due to mental health problems are widely covered in the media.  The reality is that 1 in 10 women will suffer with postnatal mental health problems, but the numbers that will harm their baby are tiny.  However, many women with postnatal depression and psychosis are terrified of speaking out and telling someone how they feel, for fear that they will be deemed an unfit mother and the baby will be taken away.  This is far more dangerous for the mother and baby than the mental illness itself.  Putting a statutory requirement on doctors to report women for mental illness will surely just make women more afraid to speak out about how they are feeling.

After my daughter was born and I began to become unwell, the perinatal care team were excellent in their care for me.  They understood the complexities of postnatal mental health, monitored me, and asked all the right questions.  They considered me in no way a risk to my children.  However an inexperienced Community Mental Health Nurse, without visiting me or talking to me, referred me to social services.  The anxiety and stress this caused us was enormous, and social services agreed that I was not a risk to my family.  Social services are the demon child snatchers that people often portray, but until you have been there, considering the idea that your every parenting decision, emotional state, and love of your children will be monitored, it is difficult to understand the fear.  I have always had a good understanding of social care, I have worked with them supporting families.  But when I got that phone call, in the midst of my unwell mind, I was paralysed with panic and fear.  I had always worried that people thought I shouldn't have children, because of my Bipolar, and now it was going to be tested.  A quick conversation and the worry was over. There was nothing social services needed to do or could do.

And that is another issue.  After the shock and panic had subsided I asked for their help and support.  I was on the verge of being admitted into the Mother and Baby unit, my family could do with any support that could be offered.  Except there was none.  Social care couldn't do anything for us, we qualified for nothing.  My deteriorating mental health was not a factor in deciding support for our family, income and employment was.  Because my husband works full time is a reasonably well paid job (above national average, but still quite a bit below higher tax rate) we were entitled to no help with childcare for my son, no support for mu husband as my carer.  If he had not worked then we would have been entitled to much more.  One argument  for the automatic referral to social services is that children and families receive the support and care they need.  But unless there is a planned injection of money into social care services, this is not going to happen.  They are an overstretched service as it is, unable to support all but the families most in crisis, the ones where children are in danger of harm or neglect.  If you care for your children and are trying your best, but simply need extra help in coping they cannot help as they do not have the funds. Therefore the referral is a pointless exercise which will only lead to women hiding their feelings and worries through fear of losing their children.

And as to the categorisation with substance abuse, I find this insulting and a further opportunity to stigmatise mental health conditions.  I am not disregarding alcohol and drug abuse as something that requires help from health professionals or blaming people addicted as "bringing on themselves", but mental health conditions are different in the ways in which they effect families and the sufferers and should not be lumped together in this way.  If anything the children of mental health sufferers should perhaps be seen as young carers, in the way that other children of disabled parents are. As often is the case this report shows that mental health concerns are given less support than physical health concerns.  Families coping with mental health conditions do need more support, but a automatic referral to social services is likely to be counterproductive and in fact deter women from coming forward and seeking help for their conditions. Had I thought I would be referred I would have said nothing of my feelings, my hallucinations and my need for help.  And that would have been a very bad thing.