The culture in which we find ourselves unconsciously instills a commitment to the world around us. Our will is not as ours as we believe and would like. The environment limits our behavior and inhibits or accelerates our decisions. We are part of a larger whole that nourishes or destroys us.
The closure of sanatoriums and macro-centers, where people with mental illness were isolated, gave rise to a new vision in society of mental illness.
However, today, without sufficient coverage of services and benefits, people with mental illness are a group that is very likely to fall into social exclusion.
The Welfare State has made available to people benefits and services. The recognition, declaration and qualification of the degree of disability (R.D. 1971/1999) and more recently the System for Autonomy and Care for Dependency (SAAD). Both have benefits that try to improve the lives of people with recognized disabilities or dependency.
The evolution of the different classifications of functionality and, by extension, of their strategies have been giving increasing weight to contextual factors, extrinsic to people. Factors such as the welfare, state and health conditions, functioning, activities and participation.
The vital project is a criterion that determines how often the person performs what tasks and in what places. The SAAD contemplates the vital project of the dependent person in all areas of life. It refers to each occupational role throughout the life cycle of the person; childhood, preschool age, adolescence, maturity and old age. In the stages of development and associated roles.
The dependency law was born with the intention of attending to the needs of those people who, because they are in a situation of special vulnerability, require support to develop the essential activities of daily life, achieve greater personal autonomy and be able to fully exercise their rights to citizenship
In the R.D. 1971/1999 of disability There was already a specific scale (ATP) in which the need for a third person could be recognized, starting at 75% disability. Although, what it did not contribute and still does not provide to the dependent person are the aids or benefits that are recognized in the SAAD. On the other hand, it has other benefits, such as the economic complement to the non-contributory benefit, the parking card, tax ...
Therefore, what introduced the Dependency Law was a disguised reform of a Royal Disability Decree that already existed. The third person disability scale (ATP) was repealed for a single scale, for the entire Spanish state, for people over 3 years old (BVD) and another for children under 3 years old (EVE).
Complaints from associations of the mentally ill are more than justified, because the total score in the assessments is well below expectations. This is because the tasks to be assessed in the BVD do not sufficiently reflect the particularities of the person with mental illness.
There are other reliable and valid questionnaires, even transcultural, more oriented to people with mental illness, sensitive to the level of support they receive.
In The Questionnaire for the Evaluation of Disability of the World Health Organization introduces the development of a new Disability Assessment instrument Who - Das II. The domains that were taken were:
- Compression and communication with the world.
- Ability to handle in the environment.
- Personal care.
- Relationship with other people.
- Daily life activities.
- Participation in society.
Of these domains the items were formulated, considered by the experts, to evaluate the level of difficulty in the development of basic activities of daily life. (ABVD).
But this Who-Das II questionnaire was not taken into account in the SAAD. Due to the desire from the SAAD to want to include all the pathologies with a single BVD, rather than attending to the specific needs and the particular characteristics of the different population groups.
In this sense, people with mental illness are a population group that in many cases fails to enjoy the SAAD's portfolio of resources, either because the scale is not sufficiently sensitive to particular conditions and risk, or because there are no adequate services or benefits.
Today, people with mental illness are very difficult to enter the SAAD network of services and instead they are very likely to be in a situation of social exclusion, especially if they do not have vital external support.