Psychosocial disabilities, often arising from mental health conditions, affect millions of people globally, impacting their ability to function socially, emotionally, and professionally. Despite the prevalence of these disabilities, they are often misunderstood and stigmatized, creating significant barriers for those living with them.
To gain a deeper understanding of psychosocial disabilities, we sought the expert insights of a seasoned psychiatrist, Dr. Fagbo Oluwabusayo Olufunmilola, is a highly experienced healthcare professional with over ten years of expertise, including six years of specialized training in psychiatry. She is the founder and CEO of Mindbulb Healthcare Services Limited and Mindbulb Health Foundation. She sheds light on the realities faced by individuals with these conditions. In this interview, we explore the clinical aspects, challenges, and necessary support mechanisms for those affected, as well as the crucial role that mental health professionals and society play in fostering recovery and inclusion. Below is the excerpt from the interview
Question – How do you define psychosocial disabilities in your practice?
Response: Alright Marion, so the first thing I want to do is define mental health because, honestly, I’d feel strange talking about it without a clear definition. Mental health, at its core, is a state of well-being where each person recognizes their potential, can handle the usual stresses of life, works productively, and contributes to their community. Now, if we look at the World Health Organization’s definition of health, they talk about physical, mental, and social well-being, not just the absence of disease. That’s why you hear the phrase, there’s no health without mental health.
Mental health is a social concept. We’re talking about people, not illnesses here. The Convention on the Rights of Persons with Disabilities defines psychosocial disabilities as stemming from societal barriers, not from the conditions themselves. So, it’s not the mental illness that disables people, but the discrimination and lack of inclusion they face because of those conditions.
In psychiatry, we break down psychosocial disabilities into three terms: impairment, disability, and handicap. Impairment refers to the mental health symptoms patients experience—things like cognition or behavior issues, which could be positive or negative. For example, dementia affects memory, leaving people psychosocially disabled. Behavior is another key part. People often stigmatize our patients because of behaviors seen as “odd”—like a patient who strips naked in public. You’d likely be confused, even avoid them, right? Or a patient hearing voices, talking to themselves, or speaking irrationally out of context—that’s part of the impairment.
Then, disability is the limitation caused by those symptoms, affecting my patients’ ability to perform daily activities, like just going to work. Mental illness, like high blood pressure or diabetes, is a chronic medical condition. It’s manageable when patients understand their condition, take their medication, and regularly attend follow-up appointments.
Question – What are the most common mental health conditions that lead to psychosocial disabilities?
Response: Thank you, Marion. So, we’ve got a lot of different mental disorders, and honestly, one of the most common and significant is schizophrenia. It’s basically a disturbance in the mind—a distortion in a person’s thought patterns that causes psychosis. For example, a patient might tell you they’re hearing voices, but they’re the only one who can hear them. Or they’re seeing things that aren’t really there, which we call hallucinations. You’ll also see them not sleeping and having unusual beliefs, like thinking people are out to get them. They’ll explain these beliefs in detail, but as you listen, you’ll realize it’s not real.
These kinds of conditions often lead to psychotic disorders like schizophrenia or acute psychosis. Sometimes it’s substance-induced, like from cannabis or other hard drugs, which can trigger psychosis. Then, you’ve got dementia, which affects older adults, typically around 60 and above. It involves memory issues, like severe forgetfulness or even getting lost in their own home. And we also talk about intellectual disabilities, such as autism. These are all examples of mental disorders that manifest in different ways.
Question – How do psychosocial disabilities differ from other types of disabilities?
Response: unlike other disabilities—like physical disabilities where someone might lose a limb, be in a wheelchair, or be visually or hearing impaired—those are easy to spot, right? They’re visible. But with psychosocial disabilities, it’s all about the brain, and the brain controls everything in the body. So, when the brain is ill, what’s left to control it? This illness can show up in many different ways, sometimes as odd behaviors, like a patient dancing for no reason. In psychiatry, we’ve got different kinds of symptoms—positive ones, like hearing voices no one else can hear, and negative ones, like a patient not eating, standing in strange postures for days, or even staying mute and not talking. That’s called catatonia.
The thing is, people often misunderstand these symptoms. Take bipolar disorder, for instance. During a manic phase, a person can become very irritable and even rude. If you don’t understand what’s going on, you might think they’re just being stubborn and punish them. But this isn’t stubbornness—it’s a mental illness. People don’t always get that, which is why advocacy is so important and thank you Marion for this kind of platform because I know this can go everywhere and people are going to listen. This isn’t just about someone being difficult; it’s about real symptoms like increased irritability, a spike in sexual drive or energy, or even deep sadness that lasts for weeks. When we talk about depression, it’s not just normal sadness—it’s persistent, low energy, no interest in anything, not eating. Once these things go on for at least two weeks, that’s when we start thinking, okay, does this person have depression?
Question – What challenges do individuals with psychosocial disabilities typically face in their daily lives?
Response: When we talk about the challenges patients with mental illness face, it’s a lot. We’re dealing with issues across the board—government, family, healthcare facilities, society, jobs, and even personal struggles like self-stigma. For example, imagine a patient has a severe relapse and strips naked in public. How do you expect them to live in that environment afterward? That’s self-stigma, different from public stigma. Sure, public stigma exists, but self-stigma hits harder—it destroys their self-esteem and makes it impossible to function.
One major challenge is access to mental health services. There’s a massive treatment gap in low- and middle-income countries like Nigeria. We have just 1 psychiatrist per million people, and with the Japa syndrome, where our doctors are leaving for other countries, it’s even worse. So even if a patient can afford care, there’s often no one available to treat them. And mental healthcare isn’t fully integrated into community healthcare in Nigeria, so patients from rural areas have to travel to urban centers, which costs money and time. By the time they arrive, their condition might already be severe. It’s a mess—primary healthcare is underfunded, while tertiary hospitals in urban areas get more attention.
Another problem is the belief system. Many people in Nigeria still think mental illness is caused by spirits or some kind of attack. Even a psychiatrist I know went to church first when they had symptoms, instead of seeking medical care. That’s why continuous education and advocacy are crucial. I’m not dismissing people’s beliefs, but when we have a diagnosis like schizophrenia, there are treatments that work. Prayer is fine, but mixing medications with herbs or other things can be dangerous due to drug interactions. Patients often go to traditional or faith healers first, spend a lot of money, and then come to us when things get out of control—by then, they have little money left to pay for treatment.
Another challenge is the out-of-pocket payment system. Most of our patients pay for treatment directly, and that limits their ability to get what they need. Patients may even lie about their symptoms because they can’t afford the medication. They’re stuck choosing between buying food or buying drugs because our medications often increase appetite. And doctors will tell them not to take meds on an empty stomach, so it’s a tough situation.
Finally, patients face social limitations—they can’t work, they’re excluded from society. Even when stable, getting a job is hard because of public stigma. It’s a lot for people with mental illness to deal with.
Question – What role does stigma play in the treatment and management of psychosocial disabilities?
Response: There’s self-stigma and public stigma, and they both play a huge role in how people with mental illness cope. With self-stigma, the patients themselves internalize all the negative beliefs about mental illness, and when they do that, it leads to shame, low self-esteem, and hesitancy to seek help. And if they don’t get help, their condition just gets worse.
Then there’s public stigma—the way society treats them. They face discrimination, especially when it comes to jobs. Many of them can’t even enter certain communities, and some have been deserted by their own families. Often, families don’t understand that their loved one’s behavior is because of an illness. Many people even lose their marriages over it. For instance, there are these myths that mental illness, like postpartum psychosis or depression, is transferable—people believe if a mother with psychosis feeds her baby, the child will somehow “catch” it. That’s just a myth, but it causes so much harm. Let my pregnant patients breathe!
Public stigma also leads to social exclusion and unfair treatment, making it harder for these patients to access the support they need. The fear of being shamed stops them from seeking help and even from following through with treatment. I’ve seen wealthy patients who refuse to come to the psychiatry facility because of the stigma—they’d rather have us come to their homes. They know they need help but don’t want to be seen at a mental health clinic.
Question – How do you approach treatment for patients with psychosocial disabilities?
Response: As a mental health psychiatrist, managing patients isn’t just about prescribing medication—it’s about using the bio-psychosocial model, which ties together biological, psychological, and social aspects of care. The social side is so important for any form of recovery. When a patient comes in, we don’t just prescribe a drug and move on; we have to consider everything around them—their financial situation, their family, and their living conditions. For example, if a patient is living in a one-room apartment, I can’t prescribe a new drug that costs ₦300,000, no matter how effective it is.
It’s not all about the medication; it’s also about understanding the patient’s home and work life, which is why clacking (taking a detailed history) can take an hour for a new patient. Our job involves talking, asking questions, and helping the patient understand their illness. Many patients come in without insight into their condition—they don’t even realize they’re ill, which is why some are admitted involuntarily. But as they settle down and we start explaining things, they begin to understand what’s happening to them.
Rehabilitation is key in treating psychosocial disabilities. Mental health is a journey, not a destination. Rehabilitation services help patients regain confidence and reintegrate into society. For instance, someone with depression or anxiety, who isn’t psychotic, can still work and function well. The challenge is that the stigma around mental health doesn’t distinguish between conditions; people might think you’re seeing a psychiatrist for something severe, even if it’s just insomnia. The goal is to help these patients reintegrate and live productive lives in their communities.
Question – What are the key factors that contribute to successful management and recovery?
Response: Just like with other medical illnesses, early intervention is key for mental health. When a patient experiences their first episode and you bring them in early, they don’t go through a long period of untreated psychosis. But if someone’s been dealing with psychosis for 10 years before getting help, they’ve already lost so much—social skills, their ability to function—all of that could have been avoided. That’s why we need the government to integrate mental health services into primary healthcare. It would make access so much easier for people in need.
Family and community support are also crucial. We have to keep raising awareness and reducing the stigma around mental health. Religious leaders should talk to their congregations—whether it’s in churches, mosques, or shrines—about mental illness and the importance of taking medication. It’s a community effort.
Occupational therapy is another vital part of managing mental health. Some patients lose skills during their illness, but we can help them relearn things—even while they’re still admitted—like barbing hair, for instance. They can use those skills to start a business when they’re stable.
The government also needs to create job opportunities that accommodate people with mental illness, providing vocational support alongside medical services. This is happening in other countries, and we should be following that example. Even here in Nigeria, in places like Abia State, there are rehabilitation services where patients farm and work, especially those who are staying long-term in the hospital. It’s a step in the right direction.
Question – How can families and communities support individuals with psychosocial disabilities?
Response: Families need to provide both financial and emotional support, but more than that, they should avoid being hostile to patients. When relatives speak harshly or act in ways that are overly emotional, it can make it harder for our patients to recover. Some won’t get better in such environments. They also need to ensure patients follow up regularly and help them take their medications properly. It’s not just a matter of handing them the medicine and saying, Take this. We’re dealing with the mind here—sometimes the brain doesn’t even allow the patient to recognize the need for treatment. Relatives need to take an active role in giving them the medication directly.
Question – In your opinion, what changes are needed in public policy to better support individuals with psychosocial disabilities?
Response: I’m really glad this question came up, because it’s great timing. As of January 5, 2023, Nigeria’s National Mental Health Act was signed into law, and this is a huge step forward in modernizing our mental health sector. The law now protects the rights of people with mental health issues, which is very encouraging. But the real issue isn’t the lack of policies—it’s about implementing them effectively. We’re urging the government and stakeholders to develop policies that support mental health rehabilitation, especially community-based services. These will help patients recover and reintegrate into society more smoothly.
One important approach is task sharing, where non-specialists, like those in primary healthcare, are trained to handle some basic mental health needs, such as counseling. The WHO is already supporting this with guidelines, and integrating mental health into the general healthcare system is crucial. We also need to focus on schools, particularly with the rise in mental health disorders caused by substances like cannabis and alcohol. School-based programs are essential to create awareness early. When I speak with patients struggling with substance abuse, many of them started in secondary school. We need to show them the reality of mental illness and what it can do to their lives, starting from a young age.
Dr Fagbo can be contacted via Email at fagbobusayo@gmail.com and Instagram: @mindbulbwithdr_booston
This interview was conducted by Marion Abolarin, MSc Student of Mass Communication (2023/2024), University of Lagos, following the training on Disability Reporting facilitated by Blessing Oladunjoye, Publisher of BONews Service.