Attitudes of staff and consumers toward human rights of persons with psychosocial and mental disabilities

I New Uni e si y o Lisbon, Facul y o Medical Sciences; Wo ld Heal h O ganiza ion, Depa men o Men al Heal h and Subs ance De iciency A i udes o S a and Consume s owa d Human Righ s o Pe sons wi h Psychosocial and Men al Disabili ies S uden : Abdelaziz Osman This disse a ion is submi ed in pa ial ul illmen o he equi emen s o he In e na ional Mas e s o Men al Heal h Policy and Se ices Academic Supe iso : P o esso Ped o Ma eus NOVA Medical School. 2017 II 1. Ti le 1.1 Desc ip i e, c oss sec ional s udy, o desc ibe ypes o a i udes o s a and consume s owa d human igh s o pe sons wi h psychosocial and men al disabili y, wi h emphasis on in eg a ion in o he communi y; he e idence is om he h ee main psychia ic hospi als in Kha oum, he capi al o Sudan. 1.2 A i udes o S a and Consume s owa d Human Righ s o Pe sons wi h Psychosocial and Men al Disabili y 1.2.1 By: D . ABDELAZIZ AWADELSEED ALHASSAN OSMAN In e na ional Mas e in Men al Heal h Policy and Se ices NOVA Medical School, Lisbon, Po ugal 1.2.2 Supe iso : Ped o Ma eus P o esso a NOVA Medical School, Lisbon, Po ugal 1.2.3 Moni o Faculdade De Ciencias Medicas Da Uni e sidade No a De Lisboa 1.2.4 S udy si es Tigani El-Mahi, Taha Baashe and Elid issi psychia ic hospi als in Kha oum, he capi al o Sudan 1.3 P ojec de ails P ojec submi ed in Pa ial Ful illmen o he Requi emen s o he Deg ee o In e na ional Mas e in Men al Heal h Policy and Se ices in he Medical School o New Uni e si y o Lisbon, Po ugal 2017 III I would like o dedica e his s udy o my amily: my wi e Taysee , my sons Ome and Ahmed and my daugh e s Leena and Deema. Wi hou he commi men and s ead as suppo p o ided by my amily, I would no ha e been able o ca y ou his endea o . Th oughou my p o essional ca ee , my amily has been an abiding and sus aining sou ce o s eng h, encou agemen , and inspi a ion o which I am e e nally g a e ul. IV I would like o exp ess my hanks o my supe iso P o esso s Ped o Ma eus, o his guidance supe ision, help, aluable ad ices, unlimi ed encou agemen and pa ience in spi e o his o he clinical and academic commi men s. I am g ea ly indeb ed o he s a o he Cen e o E hical Educa ion, Uni e si y o No e Dame, U.S.A, o he pe mission o use pa o hei in en o y (Guide o using he A i udes owa d Human Righ s In en o y (ATHRI)), in de eloping my ques ionnai e. I would like o acknowledge he unlimi ed e o s o my colleagues in Al- Amal complex o men al heal h/ A a / KSA, o hei e o s in ansla ion and back ansla ion o he ques ionnai e and hei e o s in conduc ing he pilo s udy. My hanks o he s a o Tigani El-Mahi, Taha Baashe and Elid issi psychia ic hospi als in Kha oum, Sudan o hei g ea help and pa icipa ion in his s udy. I am g a e ul also o he pa ien s who pa icipa ed in his s udy. My g a i ude o my iend D . Anas, consul an psychia is o helping me in he s a is ical wo k and analysis To all hose who con ibu ed o make his hesis come o ligh , I am mos g a e ul. V Summa y Backg ound: The new e a o Reco e y o ien ed men al heal h p ac ice is based on human igh s and culmina ing by he con en ion on he igh s o pe sons wi h disabili ies (CRPD, 2008) and WHO Quali yRigh s ToolKi , 212. Objec i es: This s udy was designed o add ess a i udes o s a and consume s owa d human igh s o pe sons wi h psychosocial and men al disabili ies and hei inclusion in o communi y. Examining s a and consume s‘ a i udes will highligh de ici s in he knowledge ega ding he magni ude o his p oblem and will in o m he in ended aising o awa eness and aining in his a ea. Me hods: A ques ionnai e was dis ibu ed o pa icipan s who we e 104 s a membe s (psychologis , psychia ic nu ses, social wo ke s and doc o s) and 100 consume s a he h ee main psychia ic hospi als in Sudan. Included in he ques ionnai e was he Human Righ s o pe sons wi h psychosocial disabili y a i ude ques ionnai e (HRQ_6) which was designed by he esea che based on (CRPD) as well as Communi y Li ing A i udes Scale Men al Re a da ion - Sho Fo m (CLAS), demog aphic i ems ( o example, age, gende , and ma i al s a us) and one ques ion abou eco e y in men al heal h. Sco es on he HRQ_6 and he 4 CLAS subscales (Empowe men , Simila i y, Exclusion, and Shel e ing) we e epo ed, and analyses o a iance we e pe o med o iden i y ac o s associa ed wi h each subscale sco e. The consume s‘ sco es we e compa ed wi h s a ‘s sco es. The HRQ_6 sco es we e co ela ed wi h he 4 CLAS subscales. Resul s: Two hund ed and ou pa icipan s om s a and consume s ac oss he h ee main psychia ic hospi als in Sudan. The pa icipan s‘ o bo h g oups had nega i e a i udes owa ds human igh s o pe sons wi h psychosocial and men al disabili ies. Also he pa icipan s‘ a i ude sco es a o ed Empowe men and Simila i y o e Exclusion and Shel e ing. S a and consume s; Men and women; and doc o s and o he p o essional g oups; esponded di e en ly. P e ious aining on human igh s had no impac on he a i ude o he s a . The e was co ela ion be ween he HRQ_6 and he 4 CLAS subscales. The esea ch p o ided a much-needed window on he p ocess o aining and aising awa eness wi h ega d o human igh s o pe sons wi h psychosocial and men al disabili ies and hei inclusion in o he communi y. Conclusion: S a and consume s hold a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies ha we e inconsis en wi h he eco e y o ien ed men al heal h p ac ice. Mo e esea ches a e needed o unco e how a i udes owa ds human igh s de elop in ou communi y, as well as how aining on human igh s can in luence a i udes. VI Sumá io In odução: A no a e a da p á ica de saúde men al, o ien ada pa a a Recupe ação, é baseada em di ei os humanos, endo culminado na con enção sob e os di ei os das pessoas com de iciência (CRPD, 2008) e no WHO Quali yRigh s ToolKi , 2012. Objec i os: Es e es udo oi concebido pa a a alia as a i udes dos p o issionais e dos u en es em elação aos di ei os humanos das pessoas com doenças men ais e incapacidades psicossociais, e a sua inclusão na comunidade. A a aliação das a i udes dos p o issionais e dos u en es i á des aca os dé ices de conhecimen o sob e a ampli ude des es p oblemas e con ibui á pa a o aumen o da consciencialização e capaci ação nes a á ea. Mé odos: Um conjun o de ques ioná ios oi dis ibuído a 104 p o issionais (psicólogos, en e mei os de saúde men al, assis en es sociais e médicos) e 100 u en es, nos ês p incipais hospi ais psiquiá icos do Sudão. Es e conjun o incluiu um ques ioná io sob e a i udes ace aos di ei os humanos das pessoas com incapacidade psiquiá ica, HRQ_6 (elabo ado pelo au o com base na CRPD), a Escala de A i udes sob e a Vida Comuni á ia - Ve são Cu a (CLAS-Sho Fo m), dados sócio demog á icos (ex: idade, gêne o e es ado ci il), e uma ques ão sob e ecupe ação em saúde men al. As pon uações na HRQ_6 e as 4 subescalas CLAS (Empowe men , Simila i y, Exclusion e Shel e ing), são desc i os, assim como a análise da a iância ealizada pa a iden i ica a o es associados aos esul ados de cada subescala. As pon uações dos u en es o am compa adas com as pon uações dos p o issionais e os esul ados do HRQ_6 o am co elacionados com as 4 subescalas CLAS. Resul ados: duzen os e qua o pa icipan es, en e p o issionais e u en es nos ês p incipais hospi ais psiquiá icos do Sudão. Os pa icipan es de ambos os g upos i e am a i udes nega i as em elação aos di ei os humanos de pessoas com incapacidades psicossociais e men ais. Adicionalmen e, as pon uações sob e as a i udes a o ece am a Capaci ação e a Simili ude quando compa ados com a Exclusão e o Ab igo. As espos as o am di e en es en e os g upos de p o issionais e de u en es, homens e mulhe es e en e médicos e ou os g upos p o issionais. A o mação p é ia em di ei os humanos não e e impac o na a i ude dos p o issionais. Hou e co elação en e o HRQ_6 e as 4 subescalas do CLAS. O es udo possibili ou uma isão mui o necessá ia pa a o p ocesso de capaci ação e conscien ização em di ei os humanos de pessoas com doenças men ais e incapacidades psicossociais, e sua inclusão na comunidade. Conclusão: os p o issionais e os u en es man êm a i udes em elação aos di ei os humanos das pessoas com doenças men ais e incapacidades psicossociais que são incompa í eis com a p á ica de saúde men al o ien ada pa a a ecupe ação. É necessá ia mais in es igação pa a descob i como es as a i udes em elação aos di ei os humanos se desen ol em na nossa comunidade, bem como a o ma como a o mação sob e di ei os humanos pode in luencia as a i udes. VII Resumen In oducción: La nue a e a de la p ác ica de salud men al, o ien ada a la ecupe ación, se basa en de echos humanos, culminando en la con ención sob e los de echos de las pe sonas con discapacidad (CRPD, 2008) y en el WHO Quali yRigh s ToolKi , 2012. Obje i os: Es e es udio ue concebido pa a e alua las ac i udes de los p o esionales y de los usua ios en elación a los de echos humanos de las pe sonas con en e medades men ales e incapacidades psicosociales, y su inclusión en la comunidad. La e aluación de las ac i udes de los equipos y de los usua ios des aca á los dé ici s de conocimien o sob e la ampli ud de es os p oblemas y con ibui á al aumen o de la concien ización y capaci ación en es a á ea. Mé odos: Se dis ibuyó un conjun o de cues iona ios a 104 p o esionales (psicólogos, en e me os de salud men al, asis en es sociales y médicos) y 100 usua ios en los es p incipales hospi ales psiquiá icos de Sudán. Es e conjun o incluyó un cues iona io sob e ac i udes en e a los de echos humanos de las pe sonas con discapacidad (po ejemplo, la edad, el géne o y el es ado ci il), y la p egun a sob e la ecupe ación de la calidad de ida en salud men al. Las pun uaciones en la HRQ_6 y las 4 subescalas CLAS (Empowe men , Simila i y, Exclusion y Shel e ing), se desc iben, así como el análisis de la a ianza ealizada pa a iden i ica ac o es asociados a los esul ados de cada subescala. Las pun uaciones de los usua ios se compa a on con las pun uaciones de los p o esionales y los esul ados del HRQ_6 se co elaciona on con las 4 subescalas CLAS. Resul ados: doscien os y cua o pa icipan es, en e p o esionales y usua ios en los es p incipales hospi ales psiquiá icos de Sudán. Los pa icipan es de ambos g upos u ie on ac i udes nega i as en elación a los de echos humanos de pe sonas con discapacidades psicosociales y men ales. Adicionalmen e, las pun uaciones sob e las ac i udes a o ecie on la Capaci ación y la Simili ud cuando compa adas con la Exclusión y el Ab igo. Las espues as ue on di e en es en e los g upos de p o esionales y usua ios, homb es y muje es y en e médicos y o os g upos p o esionales. La o mación p e ia en de echos humanos no u o impac o en la ac i ud de los p o esionales. Hubo co elación en e HRQ_6 y las 4 subescalas de CLAS. El es udio posibili ó una isión muy necesa ia pa a el p oceso de capaci ación y concien ización sob e los de echos humanos de pe sonas con en e medades men ales e incapacidades psicosociales, y su inclusión en la comunidad. Conclusión: los p o esionales y usua ios man ienen ac i udes hacia los de echos humanos de las pe sonas con en e medades men ales e incapacidades psicosociales que son incompa ibles con la p ác ica de salud men al o ien ada a la ecupe ación. Es necesa ia más in es igación pa a descub i cómo es as ac i udes hacia los de echos humanos se desa ollan en nues a comunidad, así como la o ma en que la o mación sob e de echos humanos puede in lui en las ac i udes. VIII A es a ion I decla e ha his wo k is o iginal excep whe e indica ed by special e e ence in he ex and no pa o he disse a ion has been submi ed o any o he deg ee. Any iews exp essed in he disse a ion a e hose o he au ho . The disse a ion has no been p esen ed o any o he uni e si y o examina ion. Signed: Abdelaziz Osman IX Con en s Co e page............................................................................................................................I UNIVERSIDADE NOVA DE LISBOA .............................................................................I Faculdade de Ciências Médicas .........................................................................................I A i udes o S a and Consume s owa d Human Righ s o Pe sons wi h Psychosocial and Men al Disabili ies .......................................................................................................I Ti le.....................................................................................................................................II DEDICATION ......................................................………................................................III ACKNOWLEDGMENTS..... …………...........................................................................IV Summa y……….................................................................................................................V Sumá io……………………………………………………………….………………….VI Resumen…………….…………………………………..………………………………VII A es a ion.......................................................................................................................VIII Con en s..............................................................................................................................X Lis o Tables and Figu es.................................................................................................XI Abb e ia ions...................................................................................................................XII 1. Pa one..........................................................................................................................1 1.1.In oduc ion ...................................................................................................................2 1.2. Li e a u e e iew...........................................................................................................4 1.2.1. Sudan in B ie .........................................................................................................4 1.2.2. De ini ion o e ms...................................................................................................5 1.2.3. Li e a u e on a i ude..............................................................................................6 1.2.4. Li e a u e on human igh ........................................................................................9 1.2.5. Human igh s o pe sons wi h psychosocial and men al disabili ies.....................11 1.2.6. People wi h Men al Heal h Condi ions as a Vulne able G oup............................14 2. Pa wo........................................................................................................................18 2.1.Chap e one - G ounds, Objec i es and Hypo hesis....................................................19 2.1.1. G ounds.................................................................................................................20 2.1.1.1.In oduc ion............................................................................................................20 4 1.2. Li e a u e Re iew 1.2.1. Sudan in B ie : Sudan, loca ed in no heas A ica. Na ional name: Jamhu ya as-Sudan. To al a ea: 1,156,673 sq. mi (1,861,484 sq. km) measu es abou one- ou h he size o he Uni ed S a es6. The cu en popula ion o Sudan is 40,986,180 as o Tuesday, Decembe 19, 2017, based on he la es Uni ed Na ions es ima es7. Sudan popula ion is equi alen o 0.54% o he o al wo ld popula ion. Sudan anks numbe 35 in he lis o coun ies (and dependencies) by popula ion7. The popula ion densi y in Sudan is 23 pe Km2 (59 people pe mi2). 35% o he popula ion is u ban (14,195,253 people in 2017)7. The median age in Sudan is 19 yea s7. Li e expec ancy in Sudan 63.71 yea s6 .The e a e abou 19 majo e hnic g oups and a u he 597 subg oups8. In 2013, he o al adul li e acy a e and he emale adul li e acy a e we e es ima ed a 74.24% and 66.40%, espec i ely9. I s neighbo s a e Chad and he Cen al A ican Republic on he wes , Egyp and Libya on he no h, E hiopia and E i ea on he eas , and Sou h Sudan on he sou h6. The Red Sea washes abou 500 mi o he eas e n coas . I is a e sed om no h o sou h by he Nile, all o whose g ea ibu a ies a e pa ly o en i ely wi hin i s bo de s6. Sudan, once he la ges and one o he mos geog aphically di e se s a es in A ica, spli in o wo coun ies in July 2011 a e he people o he sou h o ed o independence a e almos 50 yea s o un es and a bad ci il wa 10. Jus as Sudan's ci il wa seemed o be coming o an end, ano he wa in ensi ied in he no hwes e n Da u egion10. Many people in he popula ion ha e been exposed o auma ic e en s and huge iola ion o human igh s11. Repo ing o auma ela ed p oblems is e y poo 11. The use s ea ed in men al heal h acili ies a e p ima ily diagnosed wi h mood diso de s, schizoph enia and o he psycho ic diso de s and anxie y diso de s12. Majo heal h p oblems in Sudan -apa om men al heal h p oblems- include: mala ia, measles, ube culosis, enal ailu e, malignancies and malnu i ion13. In a eas wi h poo sani a ion o he sou h and wes , wa e - bo ne diseases like chole a a e a h ea 13. The p oblems o ecei ing adequa e heal h ca e a e pa icula ly high in u al egions, which lack ained s a and acili ies. Howe e , spending on heal h is below he 9% le el ecommended by he Wo ld Heal h O ganiza ion (WHO) 13. Mos o Sudan‘s doc o s and medical s a wo k in he owns/ ci ies, whe e he pay is highe . E en so, he e a e oo ew doc o s – only h ee o e e y 10,000 people – and hospi als can be o e c owded13. 5 The as majo i y o people wi h psychological p oblems and a subs an ial numbe o people wi h physical p oblems ea ed by adi ional and ai h heale s due o public belie e ha illness and in pa icula men al illness is caused by a supe na u al powe such as de ils, e il spi i s, and magic14, 15. 1.2.2. De ini ion o e ms: 1.2.2.1. Human igh s (HR): a e he undamen al igh s ha humans ha e by he ac o being human, and ha a e nei he c ea ed no can be ab oga ed by any go e nmen 16. 1.2.2.2. Disabili y: is an umb ella e m, co e ing impai men s, ac i i y limi a ions, and pa icipa ion es ic ions. An impai men : is a p oblem in body unc ion o s uc u e; an ac i i y limi a ion is a di icul y encoun e ed by an indi idual in execu ing a ask o ac ion; while a pa icipa ion es ic ion is a p oblem expe ienced by an indi idual in in ol emen in li e si ua ions (WHO de ini ion)5 . 1.2.2.3. A i ude: a p edisposi ion, owa d any pe son, ideas o objec s, i con ains cogni i e, a ec i e and beha iou al componen s17. 1.2.2.4. Psychosocial and Men al disabili y (PMD): is an in e na ionally ecognised e m unde he Uni ed Na ions Con en ion on he Righ s o Pe sons wi h Disabili ies, used o desc ibe he expe ience o people wi h impai men s and pa icipa ion es ic ions ela ed o men al heal h condi ions. These impai men s can include a loss o abili y o unc ion, hink clea ly, expe ience ull physical heal h, and manage he social and emo ional aspec s o hei li es18. 1.2.2.5. Men al illnesses (MI): a e heal h condi ions in ol ing changes in hinking, emo ion o beha io (o a combina ion o hese). Men al illnesses a e associa ed wi h dis ess and/o p oblems unc ioning in social, wo k o amily ac i i ies19. 1.2.2.6. S igma: is a combina ion o s e eo yped belie s, p ejudiced a i udes, and disc imina o y beha io s owa d ou -g oups—bu anscending each componen , gi en he global na u e o he aspe sions cas — esul ing in educed li e oppo uni ies o hose who a e de alued20. S e eo ype: is a cogni i e ―sho hand‖ o desc ibe a gi en social g oup, which may con ain a ge m o u h bu which is likely o lead o igid cha ac e iza ions o g oup membe s20. P ejudice: li e ally ―p ejudgmen ,‖ his e m e e s o nega i ely inged a ec i e esponses o membe s o ou -g oups20. Disc imina ion: he limi a ions on he igh s o ou -g oups o hose who a e socially cas iga ed; he beha io al componen o s igma iza ion, beyond cogni i e s e eo ypes and a ec i e p ejudices20. 6 1.2.3. Li e a u e on a i ude: 1.2.3.1. A i ude concep : Allpo de ined an a i ude as a men al o neu al s a e o eadiness, o ganized h ough expe ience, exe ing a di ec i e o dynamic in luence on he indi idual‘s esponse o all objec s and si ua ions o which i is ela ed21. Acco ding o Schneide , ‗A i udes a e e alua i e eac ions o pe sons, objec s, and e en s. This includes you belie s and posi i e and nega i e eelings abou he a i ude objec 22. He also added ha a i ude can guide ou expe iences and decide he e ec s o expe ience on ou beha iou s22. Thus, indi idual‘s disposi ion becomes an a i ude i i con ains in some pa s, aspec s o knowing and ac ing22. Mo eo e a ec i e componen o ou a i ude consis s o a pe son‘s e alua ion o liking o emo ional esponse o some objec s o pe son17. The cogni i e componen e e s o he way he objec o pe son is pe cei ed. I is in ac he men al pic u e o med in he indi idual‘s b ain. This includes he pe son‘s hough s, belie s and knowledge abou he objec 17. The beha iou componen in ol es he pe son‘s o e ac s di ec ed owa ds ano he pe son o g oup o pe sons o objec s17. A simila de ini ions is adop ed by (Eagly & Chaiken) ‗A i udes a e e alua ions o a pa icula pe son, beha io , belie , o concep . Fo example, you p obably hold a i udes owa d he U.S. p esiden (a pe son), Abo ion (a beha io ), a i ma i e ac ion (a belie ), o a chi ec u e (a concep ) 23. A simple de ini ion o a i ude is a mindse o a endency o ac in a pa icula way due o bo h an indi idual‘s expe ience and empe amen 22. Ba on and By ne also ga e a simila de ini ion o a i ude which is, ‗A i udes can be de ined as las ing, gene al e alua ions o people (including onesel ), objec s, o issues24. A i ude is las ing because i pe sis s ac oss ime. A momen a y eeling does no coun as an a i ude24. This is simila o a s a emen made by Vaughan & Hogg, ‗A i udes a e ela i ely pe manen - pe sis ac oss imes and si ua ions25. A momen a y eeling in one place is no an a i ude.‘ The e o e, i you encoun e ed a b ie eeling abou some hing, i does no coun as an a i ude. Mo eo e , Vaughan & Hogg de ined a i ude as, ‗A ela i ely endu ing o ganiza ion o belie s, eelings and beha iou al endencies owa ds socially signi ican objec s, g oups, e en s o symbols o a gene al eeling o e alua ion (posi i e/ nega i e) abou some pe son, objec o issue‘25. In b ie , i could be said ha , a i ude is a posi i e o nega i e e alua ions o eelings ha people ha e owa ds o he people, objec s, issues o e en s, i.e. A i ude is he gene al way people eel owa ds socially signi ican objec s and mos a i udes a e las ing25. 7 1.2.3.2. Componen s o A i ude: Componen s o a i udes can be ca ego ized acco ding o he ABC model. In he ABC model o a i ude, ‗A‘ ep esen s o he a ec i e componen s o a i ude, ‗B‘ ep esen s o he beha iou al componen s and ‗C‘ ep esen s he cogni i e componen o a i ude25. The a ec i e componen o he a i ude e e s o how we eel abou ce ain a i ude objec s. In o he wo ds, i e e s o ou emo ional eac ions owa ds he a i ude objec 24, 25. I includes ou posi i e and nega i e eelings owa ds he objec . The e o e, he a ec i e componen o an a i ude e lec s how much we like o dislike an a i ude objec . Meanwhile he beha iou al componen e e s o ou beha iou al in en ions, o how we ac acco ding o he a i ude ha we ha e. This componen includes ou beha iou al endency owa ds an a i ude objec . Basically, i e e s o how we a e inclined o ac owa ds an a i ude objec 24, 25. The beha iou al componen o he a i ude will de e mine how we ac owa ds an a i ude objec . On he o he hand, he cogni i e componen e e s o wha ou knowledge o he a i ude objec . In o he wo ds, he cogni i e componen e e s o wha we know abou he a i ude objec and he p ocess ha goes on o o ming and using an a i ude24. The cogni i e componen o an a i ude includes ou hough s and ideas abou he a i ude objec 25. Fo example, a pe son‘s nega i e a i ude owa ds a pe son wi h psychosocial disabili y could be di ided in o he h ee ollowing componen s. Fi s ly, he a ec i e componen could be he pe son‘s nega i e eelings o ea owa ds he pe son wi h psychosocial. Then, he beha iou al componen could be he pe son‘s endency o mo e away om ha pe son o be gua ded suspicious when he o she is nea such pe son. Finally, he cogni i e componen could be he pe son‘s knowledge ha pe sons wi h psychosocial disabili ies a e dange s and hey can endange people‘s li es. 1.2.3.3. A i ude o ma ion and a i ude change: An a i ude is o med by he exci a ion o a need in he indi idual. This need may a ise wi hin he indi idual o be igge ed by a ele an cue in he en i onmen . To induce a i ude change he exp ession o an old a i ude o i s an icipa ed exp ession mus be seen o gi e sa is ac ion no longe 24. One way o changing people is o change hei a i udes and opinions. A i udinal change o opinion change is a ype o change in which he change agen exe cises social in luence23. This p ocess o changing a i udes is called pe suasion, one o he cen al concep s in social psychology. The ease wi h which a i udes can be changed depends on a numbe o ac o s, including: 8 Message sou ce: a i ude communica o who is physically and socially a ac i e p oduce g ea e a i ude change han hose who a e less a ac i e; cha ac e is ic o he message: o example, wo sided messages (communica ion ha p esen s wo poin s o iew and hen p esen s a gumen s o coun e he opposing iew) also called wo-sided appeal, a e mo e pe suasi e han one sided messages and cha ac e is ic o he a ge : o example in elligen people and men a e mo e esis an o pe suasion23. Types o a i udes owa d pe sons wi h psychosocial disabili y esul in s igma iza ion o hese people. S igma has nume ous nega i e e ec s on pe sons wi h psychosocial disabili y such as di icul ies ob aining housing, disc imina ion among employe s ‗hi ing p ac ices, loss o amily and social suppo , and sel -s igma26. The amoun o s igma expe ienced is so powe ul ha some consume s epo i is mo e debili a ing han he illness i sel 27. Essen ially, he way people pe cei e and ea men al heal h clien s is wo se han he psychia ic symp oms hey expe ience3. We need o be awa e abou he elemen s o a i ude change o change a i udes owa ds pe sons wi h psychosocial and men al disabili ies. I ‘s ime o look a he ac s and dispel some o he my hs su ounding men al illness. 1.2.3.4. Wha can we do abou s igma and disc imina ion? I is i s impo an o ha e ongoing educa ion ega ding men al illness so people can unde s and wha men al illness is and how i migh impac hose su e ing o be os acized and ejec ed. This educa ion should be conduc ed by p o essional who a e commi ed o he human igh s, knowledgeable ega ding men al illness and socially a ac i e and in elligen . We need o use cen al ou e p ocessing a he han he pe iphe al ou e p ocessing, o comp ehend ou messages ega ding men al heal h issues because cen al ou e p ocessing gene ally leads o s onge , mo e las ing a i ude change23. I is also impo an o o e suppo o hose who migh be ying o cope and deal wi h men al illness o le hem know ha i is no a weakness o admi o expe iencing men al illness, a he s eng h o ask o help1. This will also help hose who a e dealing wi h men al illness o come o wa d o ecei e he help hey need. 1.2.4. Li e a u e on human igh s: Human igh s a e almos a o m o eligion in oday's wo ld. They a e he g ea e hical ya ds ick ha is used o measu e a go e nmen 's ea men o i s people. A b oad consensus has eme ged in he wen ie h cen u y on he o ic 9 ha ames judgmen o na ions agains an in e na ional mo al code p esc ibing ce ain bene i s and ea men o all humans simply because hey a e human and wi hin many na ions poli ical deba es age o e he denial o abuse o human igh s28. 1.2.4.1. Theo y o human igh s: (1)Human igh s can be seen as p ima ily e hical demands. They a e no p incipally ―legal,‖ ―p o o-legal‖ o ―ideal-legal‖ commands. E en hough human igh s can, and o en do, inspi e legisla ion, his is a u he ac , a he han a cons i u i e cha ac e is ic o human igh s29. (2) The impo ance o human igh s ela es o he signi icance o he eedoms ha o m he subjec ma e o hese igh s. Bo h he oppo uni y aspec and he p ocess aspec o eedoms can igu e in human igh s. To quali y as he basis o human igh s, he eedoms o be de ended o ad anced mus sa is y some ― h eshold condi ions‖ o (i) special impo ance and (ii) social in luence-abili y28. (3) Human igh s gene a e easons o ac ion o agen s who a e in a posi ion o help in he p omo ing o sa egua ding o he unde lying eedoms. The induced obliga ions p ima ily in ol e he du y o gi e easonable conside a ion o he easons o ac ion and hei p ac ical implica ions, aking in o accoun he ele an pa ame e s o he indi idual case. The easons o ac ion can suppo bo h ―pe ec ‖ obliga ions as well as ―impe ec ‖ ones, which a e less p ecisely cha ac e ized. E en hough hey di e in con en , impe ec obliga ions a e co ela i e wi h human igh s in much he same way as pe ec obliga ions a e. In pa icula , he accep ance o impe ec obliga ions goes beyond olun ee ed cha i y o elec i e i ues28. (4) The implemen a ion o human igh s can go well beyond legisla ion, and a heo y o human igh s canno be sensibly con ined wi hin he ju idical model in which i is equen ly inca ce a ed. Fo example, public ecogni ion and agi a ion (including he moni o ing o iola ions) can be pa o he obliga ions—o en impe ec —gene a ed by he acknowledgmen o human igh s. Also, some ecognized human igh s a e no ideally legisla ed, bu a e be e p omo ed h ough o he means, including public discussion, app aisal and ad ocacy (a basic poin ha would ha e come as no su p ise o Ma y Wolls onec a , whose A Vindica ion o he Righ s o Woman: wi h S ic u es on Poli ical and Mo al Subjec s was published in 1792)28. (5) Human igh s can include signi ican and in luenceable economic and social eedoms. I hey canno be ealized because o inadequa e ins i u ionaliza ion, hen, o wo k o ins i u ional expansion o e o m can 10 be a pa o he obliga ions gene a ed by he ecogni ion o hese igh s. The cu en un ealizabili y o any accep ed human igh , which can be p omo ed h ough ins i u ional o poli ical change, does no , by i sel , con e ha claim in o a non- igh 29. (6) The uni e sali y o human igh s ela es o he idea o su i abili y in unobs uc ed discussion—open o pa icipa ion by pe sons ac oss na ional bounda ies. Pa isanship is a oided no so much by aking ei he a conjunc ion, o an in e sec ion, o he iews espec i ely held by dominan oices in di e en socie ies ac oss he wo ld (including e y ep essi e ones), bu h ough an in e ac i e p ocess, in pa icula by examining wha would su i e in public discussion, gi en a easonably ee low o in o ma ion and uncu bed oppo uni y o discuss di e ing poin s o iew. Adam Smi h‘s insis ence ha e hical sc u iny equi es examining mo al belie s om, in e alia, ―a ce ain dis ance‖ has a di ec bea ing on he connec ion o human igh s o global public easoning29. 1.2.4.2. The His o ical O igins o Human Righ s: In 539 B.C., he a mies o Cy us he G ea , he i s king o ancien Pe sia, conque ed he ci y o Babylon. Bu i was his nex ac ions ha ma ked a majo ad ance o Man. He eed he sla es, decla ed ha all people had he igh o choose hei own eligion, and es ablished acial equali y. These and o he dec ees we e eco ded on a baked-clay cylinde in he Akkadian language wi h cunei o m sc ip 30. Known oday as he Cy us Cylinde , his ancien eco d has now been ecognized as he wo ld‘s i s cha e o human igh s. I is ansla ed in o all six o icial languages o he Uni ed Na ions and i s p o isions pa allel he i s ou A icles o he Uni e sal Decla a ion o Human Righ s30. 1.2.4.3. The Sp ead o Human Righ s: F om Babylon, he idea o human igh s sp ead quickly o India, G eece and e en ually Rome. The e he concep o ―na u al law‖ a ose, in obse a ion o he ac ha people ended o ollow ce ain unw i en laws in he cou se o li e, and Roman law was based on a ional ideas de i ed om he na u e o hings31. Documen s asse ing indi idual igh s, such as he Magna Ca a (1215), he Pe i ion o Righ (1628), he US Cons i u ion (1787), he F ench Decla a ion o he Righ s o Man and o he Ci izen (1789), and he US Bill o Righ s (1791) a e he w i en p ecu so s o many o oday‘s human igh s documen s31. 11 The Magna Ca a, o ―G ea Cha e ,‖ was a guably he mos signi ican ea ly in luence on he ex ensi e his o ical p ocess ha led o he ule o cons i u ional law oday in he English-speaking wo ld31. By 1948, he Uni ed Na ions‘ new Human Righ s Commission had cap u ed he a en ion o he wo ld. Unde he dynamic chai manship o Eleano Roose el , he Commission se ou o d a he documen ha became he Uni e sal Decla a ion o Human Righ s. Roose el , c edi ed wi h i s inspi a ion, e e ed o he Decla a ion as he ―in e na ional Magna Ca a o all mankind.‖ I was adop ed by he Uni ed Na ions on Decembe 10, 194830. In i s p eamble and in A icle 1, he Decla a ion unequi ocally p oclaims he inhe en igh s o all human beings. A icle 1 ―All human beings a e bo n ee and equal in digni y and igh s32. They a e endowed wi h eason and conscience and should ac owa ds one ano he in a spi i o b o he hood.32‖ Human igh s ad oca es ag ee ha , six y yea s a e i s issue, he Uni e sal Decla a ion o Human Righ s is s ill mo e a d eam han eali y. Viola ions exis in e e y pa o he wo ld. Fo example, Amnes y In e na ional and o he sou ces show ha indi iduals a e: To u ed o abused in a leas 81 coun ies Face un ai ials in a leas 54 coun ies Res ic ed in hei eedom o exp ession in a leas 77 coun ies No only ha , bu ulne able g oups such as women, child en, e hnic mino i ies and pe sons wi h disabili ies in pa icula a e ma ginalized in nume ous ways, he p ess is no ee in many coun ies, and dissen e s a e silenced, oo o en pe manen ly. While some gains ha e been made o e he cou se o he las six decades, human igh s iola ions s ill plague he wo ld oday31. 1.2.5. Human igh s o pe sons wi h psychosocial and men al disabili ies 1.2.5.1. In oduc ion: People wi h men al illness ha e long been subjec ed o c uel y, neglec , idicule, disc imina ion, ma ginaliza ion, and s igma. The s igma associa ed wi h hese condi ions means ha people expe ienced exclusion and ejec ion by he socie y33. S igma has been ound o be a p ima y de e en o indi iduals who need men al heal h se ices as well as impac ing hose al eady ecei ing se ices20. Wo ld heal h o ganiza ion (WHO) s a ed ha : (All people wi h men al diso de s ha e he igh o ecei e high quali y ea men and ca e deli e ed h ough esponsi e heal h ca e se ices. They should be p o ec ed agains any o m o inhuman ea men and disc imina ion3. Abou 15% o he wo ld's popula ion li es wi h some o m 12 o disabili y, o whom 2-4% expe ience signi ican di icul ies in unc ioning34. Al hough in he las wo decades, he wo ld has wi nessed a signi ican change in he quali y o li e and social pa icipa ion o pe sons wi h psychosocial and men al disabili ies, based on he issues o human igh s, s ill he e is a huge iola ion o he igh s o his ulne able g oup, in low and middle-income coun ies35. Sudan is one o he low income g oup coun ies36. In Sudan, no na ional human igh s e iew body exis s. Re iew/inspec ion o human igh s p o ec ion o pa ien s in men al hospi als is spo adic and inconsis en . None o he men al heal h s a wo king in men al hospi als ecei ed any o mal aining on human igh s12. The en y in o o ce o he UN Con en ion on he Righ s o Pe sons wi h Disabili ies (CRPD) in May 2008 ma ked he beginning o a new e a in he e o s ― o p omo e, p o ec and ensu e he ull and equal enjoymen o all human igh s and undamen al eedoms by all pe sons wi h disabili ies, and o p omo e espec o hei inhe en digni y‖4. Mo eo e CRPD adop ed he social model o disabili y, in which he disabili y is ecognized as he consequence o he in e ac ion o he indi idual wi h an en i onmen . Also psychia ic disabili ies a e included among o he disabili ies o he i s ime4. 1.2.5.2. Con en ion on he Righ s o Pe sons wi h Disabili ies (CRPD) Wha is (CRPD)? The Con en ion on he Righ s o Pe sons wi h Disabili ies is an in e na ional human igh s ea y o he Uni ed Na ions in ended o p o ec he igh s and digni y o pe sons wi h disabili ies. Pa ies o he Con en ion a e equi ed o p omo e, p o ec , and ensu e he ull enjoymen o human igh s by pe sons wi h disabili ies and ensu e ha hey enjoy ull equali y unde he law. The Con en ion has se ed as he majo ca alys in he global mo emen om iewing pe sons wi h disabili ies as objec s o cha i y, medical ea men and social p o ec ion owa ds iewing hem as ull and equal membe s o socie y, wi h human igh s4. The Con en ion adop s a social model o disabili y, and de ines disabili y as including hose who ha e long- e m physical, men al, in ellec ual o senso y impai men s which in in e ac ion wi h a ious ba ie s may hinde hei ull and e ec i e pa icipa ion in socie y on an equal basis wi h o he s. The ex was adop ed by he Uni ed Na ions Gene al Assembly on 13 Decembe 2006, and opened o signa u e on 30 Ma ch 2007. Following a i ica ion by 13 he 20 h pa y, i came in o o ce on 3 May 2008124. Cu en ly, Sudan is a pa y coun y o bo h he con en ion and he op ional p o ocol37. The Con en ion ollows he ci il law adi ion, wi h a p eamble, in which he p inciple ha "all human igh s a e uni e sal, indi isible, in e dependen and in e ela ed‖ o Vienna Decla a ion and p og amme o Ac ion is ci ed, ollowed by 50 a icles. Unlike many UN co enan s and con en ions, i is no o mally di ided in o pa s4. Summa y o he con en ion: A icle 1 de ines he pu pose o he Con en ion: o p omo e, p o ec and ensu e he ull and equal enjoymen o all human igh s and undamen al eedoms by all pe sons wi h disabili ies, and o p omo e espec o hei inhe en digni y A icles 2 and 3 p o ide de ini ions and gene al p inciples including communica ion, easonable accommoda ion and uni e sal design. A icles 4–32 de ine he igh s o pe sons wi h disabili ies and he obliga ions o s a es pa ies owa ds hem. Many o hese mi o igh s a i med in o he UN con en ions such as he In e na ional Co enan on Ci il and Poli ical Righ s, In e na ional Co enan on Economic, Social and Cul u al Righ s o he Con en ion Agains To u e, bu wi h speci ic obliga ions ensu ing ha hey can be ully ealized by pe sons wi h disabili ies. Righ s speci ic o his con en ion include he igh s o accessibili y including he in o ma ion echnology, he igh s o li e independen ly and be included in he communi y (A icle 19), o pe sonal mobili y (a icle 20), habili a ion and ehabili a ion (A icle 26), and o pa icipa ion in poli ical and public li e, and cul u al li e, ec ea ion and spo (A icles 29 and 30). In addi ion, pa ies o he Con en ion mus aise awa eness o he human igh s o pe sons wi h disabili ies (A icle 8), and ensu e access o oads, buildings, and in o ma ion (A icle 9). A icles 33–39 go e n epo ing and moni o ing o he con en ion by na ional human igh s ins i u ions (A icle 33) and Commi ee on he Righ s o Pe sons wi h Disabili ies (A icle 34). A icles 40–50 go e n a i ica ion, en y in o o ce, and amendmen o he Con en ion. A icle 49 also equi es ha he Con en ion be a ailable in accessible o ma s. Guiding p inciples o he Con en ion: The e a e eigh guiding p inciples ha unde lie he Con en ion: 20 Chap e I - GROUNDS, OBJECTIVES AND HYPOTHESIS 2.1.1. G ounds 2.1.1.1. In oduc ion: Men al heal h in Sudan as in o he s A ican coun ies was exclusi ely monopolized by ai h heale s, Za conduc o s, exo cis s, and shee quacks un il he mid- wen ie h cen u y14. Nei he he Ki chene a my in ading Sudan in 189839, no he subsequen colonial adminis a ion, con empla ed in oducing any men al heal h componen in hei Mili a y Medical Co ps o in hei la e Sudan Medical Se ice40. Nei he had he es ablished 1924 Ki chene School o Medicine (KSM) include any didac ic o clinical ins uc ion in men al heal h14. No wonde ha none o he i s gene a ion o Sudanese g adua es om KSM exp essed any in e es in dealing wi h pa ien s wi h men al heal h p oblems14. The singula excep ion was a 1935 g adua e who s unned his ela i es and colleagues by his c azy decision (a ha ime) o choice men al heal h as a ca ee . His o y o psychia y in Sudan is closely ela ed o P o esso Tigani El-Mahi (1911-70) who was he i s Sudanese and na i e A ican psychia is . He in oduced he i s psychia ic acili y in Sudan. He la e became he i s Men al Heal h Ad iso in he Eas Medi e anean Regional O ice o he Wo ld Heal h O ganiza ion. He was he i s p o esso o psychia y in Sudan. His disciple, Taha Baashe (1922-2008), sha ed and ca ied o wa d El-Mahi‘s isions and plans. Thei join con ibu ions cons i u ed he ene s o wha has become known as he El-Mahi-Baashe he i age14, 41. Whene e he his o y o Psychia y in he Sudan is discussed, i would be app op ia e o men ion El-Mahi and Baashe he i age. El-Mahi ounded he i s Psychia y clinic in Al Amlak dis ic in Bah i ci y and in 1950 he co- ounded Kobe Men al Asylum41. Baashe ounded many men al heal h ins i u es including Bah i psychia y clinic in 1959, Kha oum Psychia y clinic in 1962 and Tigani El-Mahi Teaching Hospi al in197141. He is igh ully he genuine a he o he so called ―open-doo psychia y ea men policy‖, as he adop ed accep ing pa ien s and hei amilies o inpa ien s ea men , and en ed houses nea he clinic o ha pu pose41. Baashe also ounded psychia ic uni s in all p o inces o he Sudan. He and his colleagues s a ed om he e y beginning o b idge he gap be ween adi ional healing and psychia y14, 41. Tene s o El-Mahi-Baashe he i age as s a ed by P o esso Sheikh Id is14, 41: a. De elop men al heal h se ices s a ing om he base o he py amid o he communi y, h ough ou pa ien acili ies, o gene al hospi al 21 wa ds, o small-size sho -s ay psychia ic hospi als, o la ge size longe -s ay he apeu ic ehabili a ion hospi als. b. Rec ui , ain, and coo dina e mul i-disciplina y men al heal h eams c. In ol e, psycho-educa e, and suppo he amily as an essen ial pa ne in he p e en ion, ea men , and ehabili a ion. d. Inco po a e men al heal h se ices in he gene al heal h p og am s a ing om he p ima y heal h ca e cen e . e. Collabo a e wi h espec able adi ional heale s, especially in epu able and ime-hono ed ai h- he apeu ic illages. . Encou age scien i ic esea ch wi h emphasis on epidemiology, psychopa hology, he apeu ics, socio-cul u al and mul idisciplina y s udies. g. T ain and quali y u u e gene a ions o men al heal h p o essionals in unde g adua e, pos -g adua e, and con inuous p o essional de elopmen . h. C ea e and main ain ac i e pa icipa ion in local, egional and global p o essional o ganiza ions and ac i i ies. 2.1.1.2. S a emen o he p oblem Despi e he ad anced iew o he pionee s in psychia y a a e y ea ly ime, un o una ely many obs acles p e en ed he achie emen o wha hey wan ed o men al heal h in Sudan. The e we e a subs an ial numbe o ba ie s o implemen hese p inciples in o de o de elop a good men al heal h sys em in he coun y. These ba ie s include s igma, human igh s iola ions, lack o poli ical well, p o essional ba ie , lack o awa eness, lack o ained men al heal h ca e p o ide , b ain d ainage, po e y and many o he heal h p oblems ha we e conside ed as p io i ies by he s akeholde s12. In Sudan, men al heal h sys em has h ee ypes o men al heal h acili ies; classical psychia ic hospi als, psychia ic uni s in gene al hospi als and asylums. The as majo i y o he iny inancial esou ces and a subs an ial pa o human esou ces ha a e a ailable a e di ec ed owa ds hese acili ies12. Psychia ic hospi als and psychia ic uni s a e un by he minis y o heal h. Asylums con ain mos o he ch onic pa ien s, homeless pa ien s and pa ien s wi h c iminal esponsibili ies, a e un by police and look like p isons. Howe e mos o hese acili ies need o be s eng hened 22 and de eloped u he in e ms o s a , ea men acili ies and li ing acili ies12. None o hese acili ies p o ide ac i e ollow-up ca e in he communi y and almos no p o essional communi y men al heal h se ice. P ima y heal h ca e s a aining on men al heal h issues is weak, as is in e ac ion be ween he p ima y heal h and men al heal h sys em. The e is an imbalance in a o o men al hospi al inpa ien ca e. Few acili ies a e de o ed o child en and adolescen s12. Up o he momen o conduc ing his s udy, he asylums we e he main acili ies all o e he coun y excep Kha oum - he capi al- o pe sons wi h psychosocial and men al disabili ies who we e kep in e y na ow cells in an inhumane manne , wea ing di y clo hes o no clo hing a all. Ve y ew medica ions we e a ailable as we e ained s a membe s and i a pa ien becomes exci ed, hen unmodi ied elec ocon ulsi e he apy (ECT) is he only op ion!. Since he a i ude can p edic beha io 42, he esea che hypo hesized ha he s a and consume s a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies a ec he ex en o which he inclusion philosophy becomes eali y. The issues o human igh s o people wi h psychosocial and men al disabili ies wo ldwide a e lagging behind. The e is no na ional men al heal h legisla ion is in 25% o coun ies wi h nea ly 31% o he wo ld‘s popula ion. In he Eas e n Medi e anean Region only 57% ha e such legisla ion 3. Sudan's men al heal h policy was e o mula ed in 2006-2008. The las e sion o men al heal h legisla ion da es back o 1998 and equi es upda ing12 and he cu en men al heal h ac d a which is unde app o al con ains a icles wi h majo human igh s iola ions. Up o he esea che knowledge un il now he e is no s udy add essing he a i ude owa d human igh s o pe sons wi h psychosocial disabili ies in Sudan. The e a e many s udies o a i ude owa d pe sons wi h men al diso de s we e done in Sudan by many colleagues in he ield o men al heal h, o ins ance Anas, 2011 and Khalid, 2015 among medical s uden s and p ima y heal h ca e p o ide s espec i ely. They e ealed nega i e a i udes owa d pe sons wi h psychosocial disabili ies. Bu no one add ess he a i udes o men al heal h 23 ca e p o ide s owa d hei pa ien s o he a i udes o he consume s owa d hemsel es o men al illness. 2.1.1.3. Signi icance o he s udy: This s udy explo ed some o he majo ba ie s ha a e p e en ing pe sons wi h psychosocial disabili ies o expe ience hei human igh s (especially ull inclusion and pa icipa ion in he communi y), by examining he s a membe s' and consume s' a i udes owa d his popula ion's human igh s. The esul s o his s udy will in o m aining o s a and consume s on human igh s issues. 2.1.2. Objec i es: 2.1.2.1. Gene al Objec i e: This s udy was designed o desc ibe he a i udes o s a and consume s owa d human igh s o pe sons wi h psychosocial and men al disabili ies and hei in eg a ion in o he communi y, wi hin Kha oum he capi al ci y o Sudan. 2.1.2.2. Speci ic Objec i es: 2.1.2.2.1. To b ing o a en ion he issues o human igh s o pe sons wi h psychosocial disabili ies by examining s a 's and consume s' a i udes owa d hese igh s. 2.1.2.2.2. To p o ide in o ma ion on he gene al a i udes o s a 's and consume s' owa d human igh s. 2.1.2.2.3. To desc ibe ypes o a i udes o s a and consume s owa d human igh s o pe sons wi h psychosocial and men al disabili y and hei in eg a ion in o he communi y. 2.1.2.2.4. To explo e he possible p edic o s o a i udes o s a and consume s owa d human igh s o pe sons wi h psychosocial and men al disabili y and hei in eg a ion in o he communi y. 24 2.1.2.2.5. To see he di e ence be ween s a 's and consume s' a i udes owa d human igh s o pe sons wi h men al and psychosocial disabili y. 2.1.2.3. Subsidia y objec i e: 2.1.2.3.1. A s ep in he cons uc ion and he s anda diza ion o Human Righ s o pe sons wi h psychosocial and men al disabili y a i ude ques ionnai e (HRQ_6). 2.1.3. S udy hypo heses: 2.1.3.1. S a and consume s ha e nega i e a i udes owa d he human igh s o pe sons wi h psychosocial and men al disabili ies which will a ec he p ocess o in eg a ion in o he communi y. Null hypo hesis: S a and consume s ha e neu al a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies 2.1.3.2. S a membe backg ound a iables including age, gende ,academic discipline, senio i y, ma i al s a us, his o y o men al diso de , con ac wi h psychia ic se ices as a use and he ole, may ha e an e ec on his/he a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies. Null hypo hesis: s a membe backg ound a iables ha e no e ec on his/he a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies. 2.1.3.3. Consume backg ound a iables including age, gende , ma i al s a us, numbe s o yea s using he se ice, diagnosis, le el o educa ion and sel -es eem may ha e an e ec on his/he a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies. Null hypo hesis: consume backg ound a iables ha e no e ec on his/he a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies. 25 2.1.3.4. Consume s' a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies will be mo e posi i e han he s a a i udes. Null hypo hesis: The e will be no di e ence be ween he consume s' a i udes and he s a a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies. 26 2.2. CHAPTER TWO: METHODOLOGY 27 CHAPTER 2: METHODOLOGY This chap e will desc ibe he p ocedu e upon which he esea ch is based. A su ey is de ised and conduc ed in o de o assess he a i udes o s a and consume s owa d human igh s o pe sons wi h psychosocial and men al disabili ies and hei in eg a ion in o he communi y .The main objec i e behind his su ey was o guide and in o m he aining and aising he awa eness ha would be ca ied ou amongs s a and consume s in Sudan, o be e iden i y, accep and deal wi h pa ien s o men al illness. 2.2.1. S udy design: This s udy was a non-expe imen al, c oss-sec ional desc ip i e, hospi al based s udy. 2.2.2. S udy popula ion: The pa icipan s o his s udy was consis o s a p o essionals (social wo ke s, nu ses, psychologis and doc o s) and hei pa ien s. The sample Numbe = 204, was consis o 100 consume s and 104 s a membe s. Pa icipan s we e selec ed h ough con enience sampling. In o med consen was ob ained om all he pa icipan s. To ensu e con iden iali y, pa icipan names we e no aken and he samples we e iden i ied only by a numbe code. All o he s in ol ed in he p ojec we e old ha no in o ma ion would be eleased abou indi idual pa icipan s. 2.2.2.1. C i e ia o pa icipa ion in his s udy we e including: 1. P o essional s a membe o consume in one o he main h ee psychia ic hospi als in Kha oum. 2. Wo king a leas o h ee mon hs in men al heal h ield (s a ). 3. Accep ing o pa icipa e in he s udy. 2.2.2.2Exclusion c i e ia we e including: 1. S a membe s who spen less han h ee mon hs in men al heal h ield. 2. Re usal o con inue in he s udy a any ime du ing he da a collec ion. 2.2.3. S udy a ea: The s udy was ca ied ou be ween May 2016 and Feb ua y 2017 in Kha oum ci y, he capi al o Sudan. I is a ci y o 8 million popula ion6, 7 and h ee main psychia ic hospi als wi h a ound 400 beds and e y busy ou pa ien s (OPD) and eme gency(ER) clinics wi h a ound 200 consume s 28 pe day. The h ee main psychia ic hospi als in Kha oum, Sudan, whe e his s udy was conduc ed a e: (1) Tigani El-Mahi Teaching Hospi al o Men al Heal h (EETHMH): his is he la ges ci il men al heal h in Sudan, was buil in 1971 and named a e P o esso El-Mahi (Fa he o A ican Psychia y). , ounded in Omdu man (Kha oum wes ), and con ains 100 beds15. (2) Baashe hospi al Psychia ic Hospi al: is an ex ension o he i s psychia y acili y in Sudan which ounded by El-Mahi in 1950 and enewal by Baashe in 1959, in Bah i (Kha oum no h), and con ains 50 beds15. (3) Elid issi Psychia ic Hospi al (EPH): is he s a e hospi al o ea ing pa ien s wi h men al illness and c iminal esponsibili ies and pa ien s who a e dange ous o hemsel es o o he s, ounded in Bah i (Kha oum no h), and con ains 250 beds15. These hospi als a e he majo public psychia ic hospi als in Sudan, ecei e pa ien s om all o e he coun y and om di e en social classes .They ac as he main e ia y hospi als o men al heal h in he coun y, al hough hey can ecei e pa ien s di ec ly h ough OPD o ER, also hey a e he main hospi als o men al heal h aining in Sudan. The a e age o admission pe day a ies om h ee pa ien s in Baashe hospi al o en pa ien s in Tigani El-Mahi and Elid issi15. 2.2.4. Sampling and ec ui men : Sampling was con enien sampling. A e we ha e ecei ed pe mission, he ques ionnai e was dis ibu ed o he s a and he consume s who we e sa is y he c i e ia, be ween May 2016 and Feb ua y 2017. E e y pa icipan was me pe sonally and gi en his/he ques ionnai e o ensu e ha he/she is esponded o i . Pa icipan was gi en A abic language e sion o a ques ionnai e ha ook app oxima ely 25 minu es o comple e. The ques ionnai e included he Communi y Li ing A i udes Scale Men al Re a da ion - Sho Fo m (CLAS). The esponden s we e asked o indica e he ex en o which hey ag eed o disag eed wi h he s a emen s in he Communi y Li ing A i udes Scale Men al Re a da ion - Sho Fo m (CLAS), 17 i ems and Human Righ s o pe sons wi h psychosocial and men al disabili ies a i ude ques ionnai e which is de eloped by he esea che based on CRPD (included some ques ions no ound in he 29 CLAS). Each s a emen was sco ed by he esponden using a 6-poin Like -like scale. 2.2.5. Va iables: Two se s o da a we e collec ed: 2.2.5.1. a. Dependen a iables: Communi y Li ing A i udes Scale (MR)-Sho Fo m (CLAS), 17 i ems (Hen y e al., 1996), Human Righ s o pe sons wi h psychosocial and men al disabili ies a i ude ques ionnai e de eloped by he esea che based on CRPD, 25 i ems and one ques ion ega ding eco e y (a ainable o no ). 2.2.5.2. b. Independen a iables: Gende Age Ma i al s a us Child en (consume s) The esponsibili y owa ds sel (consume s) The esponsibili y owa ds o he s (consume s) Academic discipline o le el o educa ion Role o job Numbe o yea s (wo king in o using he se ice) His o y o men al illness (s a only) (HMI) Close pe son his o y o men al illness (CPHMI) P e ious con ac wi h men al heal h se ices as a use (s a only) T aining on human igh s 36 a ainable o e e yone; while (11%) o he consume s belie e ha eco e y is no a ainable a all om men al illness, none o he s a membe s belie es so; he majo i y o bo h g oups (54% om he consume s and 63.5% o he s a membe s) belie e ha eco e y is a ainable only o some clien s. Some consume s we e spen mo e han en yea s wi h men al illness (5%) and mo e han one hal (53%) su e om men al illness o less han i e yea s. Twen y se en consume s (27%) indica ed ha hey ca ied he ull esponsibili y owa d sel and eigh een (18%) epo ed ha he esponsibili y owa d onesel was ca ied ou ully by o he s. Fo y i e consume s Less han one-hal (45%) epo ed ha hey we e looking a e o he people such as child en o pa en s. Figu e 1: Pe cen age o he esponden s acco ding o hei age: 37 Table 1: Selec ed Demog aphics o he esponden s: Va iable F equency Pe cen Hospi al El-Mahi 67 32.8 Baashe 51 25.0 El-Ed isi 86 42.2 To al 204 100.0 Type Consume 100 49.0 S a 104 51.0 To al 204 100.0 Gende Male 96 47.1 Female 106 52.0 To al 202 99.0 Ma i al s a us Ma ied 69 33.8 Single 97 47.5 Widowed 13 6.4 Di o ce 22 10.8 To al 201 98.5 38 Figu e 2: Pe cen age o he consume s acco ding o hei occupa ion: 39 2.3.2. Pa icipan s’ A i udes: As measu ed by he a i ude owa d Human Righ s o pe sons wi h psychosocial and men al disabili ies Ques ionnai e (HRQ_6) and he Communi y Li ing A i ude Scale-sho o m (CLAS), he esponden s‘ iews owa d human igh s o pe sons wi h psychosocial and men al disabili y can be cha ac e ized as nega i e a i ude ha was below o jus a he minimal esponse ha in a o o basic human igh s o hose people, which was (4.00 o HRQ_6, Empowe men and Simila i y and 2:00 o Isola ion and Shel e ing). HRQ_6 mean was (3.76) and SD was (0.44), CLAS subscales empowe men (a i udes owa d sel -ad ocacy and empowe men ) and simila i y ( he pe cei ed simila i y o pe sons wi h psychosocial and men al disabili ies o onesel ) we e as ollows: empowe men mean was (4.00) and SD was 0.78 and simila i y mean was 4.36 and SD was 0.76. CLAS subscales exclusion ( he desi e o he esponden o exclude pe sons wi h psychosocial and men al disabili ies om communi y li e) and shel e ing ( he ex en o which he esponden belie es ha pe sons wi h psychosocial and men al disabili ies need o be shel e ed o p o ec ed) we e as ollows: exclusion mean was (2.40) and SD was 1.00 and shel e ing mean was (3.83) and SD was 0.83. The esponden s we e a o ing Empowe men and Simila i y o e Exclusion and Shel e ing Table (2) p o ides he mean o he HRQ_6 i em sco es: The ques ion N Min i Max Mean SD 1. In Sudan no need o men al heal h legisla ion o p o ec he igh s o pe sons wi h psychosocial and men al disabili ies. 204 1.00 6.00 4.5098 1.47053 2. All na ions should wo k owa d libe y and jus ice o all including pe sons wi h psychosocial and men al disabili ies 204 1.00 6.00 4.6029 1.27275 3. Pe sons wi h psychosocial and men al disabili ies should be able o ha e a oice in how hey deal wi h hei own 204 1.00 6.00 4.5147 1.17644 40 physical well-being, wi h hei heal h and wi h hei illnesses 4. Pe sons wi h psychosocial and men al disabili ies should be able o lead, con ol, exe cise choice o e , and de e mine hei own pa h o eco e y 204 1.00 6.00 4.1324 1.16903 5. Occasionally i is easonable o deny he igh o o e o some g oups o pe sons wi h psychosocial and men al disabili ies; o ins ance o pe sons wi h se e ypes o schizoph enia 204 1.00 6.00 3.1814 1.29472 6. Teenage s wi h psychosocial and men al disabili y should be allowed o ecei e all ypes o medical and psychosocial ea men s wi hou pa en al consen 204 1.00 6.00 3.3088 1.54974 7. I is legi ima e o au ho i ies o cu ail he ac i i ies o pe sons wi h psychosocial and men al disabili ies which a e socially unaccep able; o ins ance wande ing along he s ee wi h di y clo hes 204 1.00 6.00 3.2402 1.51060 8. All ci izens should be gi en ull cons i u ional igh s bu ci izens wi h psychosocial and men al disabili ies should no expec o be gi en all hose igh s 204 1.00 6.00 3.6814 1.47606 9. Pe sons wi h psychosocial and men al disabili ies should no ha e o wo y abou unwa an ed in usions by he go e nmen , amily and iends in o hei p i a e li es 204 1.00 6.00 3.2598 1.39533 10. Books should be banned i hey a e w i en by pe sons wi h psychosocial and men al disabili ies who ha e been in acu e psycho ic s a e du ing he ime o w i ing. 204 1.00 6.00 3.7451 1.42245 11. Police should no ha e o ge sea ch wa an s when hey a e pu suing suspec s wi h known se e e men al illness. 204 1.00 6.00 3.4902 1.50366 12. Disc imina ion agains because o psychosocial and men al disabili y is jus i iable some imes 204 1.00 6.00 3.2304 1.25194 13. We should no was e ime o suppo pe sons wi h psychosocial o men al disabili ies o ake hei decisions abou sel , when we a e 100% su e hey a e no able o make decisions 204 1.00 6.00 3.5931 1.39180 14. Pe sons wi h psychosocial and men al disabili ies should ha e he igh o in ol e he adi ional heale s in hei managemen plan 204 1.00 6.00 3.8725 1.26079 15. Pe sons wi h psychosocial and men al disabili ies p obably shouldn' be hi ed o jobs equi ing conside able con ac wi h he public since hey could beha e in a s ange way 204 1.00 6.00 3.6765 1.43950 16. As soon as a pe son shows signs o men al dis u bance, he should be hospi alized 204 1.00 6.00 2.6127 1.25240 17. Counselo s should encou age pe sons wi h psychosocial and men al disabili ies o conside aining o become doc o s, pilo s, ca pen e s, mili a y o ice s and o he occupa ions ha i wi h hei po en ials ega dless o hei illness 204 1.00 6.00 3.7843 1.40462 18. Fo pe sons wi h psychosocial and men al disabili ies is be e o gi e wel a e assis ance a he han o encou age employmen in o de o p o ec hem 204 1.00 6.00 3.4167 1.37103 19. F eedom o speech should be a basic human igh excep o pe sons wi h psychosocial and men al disabili ies because hey can emba ass hei amilies and iends 204 1.00 6.00 3.8529 1.53384 41 20. The en i onmen should be adap ed o he needs o pe sons wi h psychosocial and men al disabili ies e en i doing so is expensi e 204 1.00 6.00 4.2990 1.28032 21. The Con en ion on he Righ s o Pe sons wi h Disabili ies (CRPD) could dis up socie y wi h i s emphasis on ea ing pe sons wi h psychosocial and men al disabili ies like o he s 204 1.00 6.00 3.7647 1.27249 22. Teache s wi h psychosocial and men al disabili ies can be good ole models o ou child en, jus like anyone else. 204 1.00 6.00 4.0686 1.37364 23. Publishe s, speake s, p o essionals and o he s since hey a e no in ending s igma can use s igma izing e ms such as psycho ic, schizoph enic and demen ed ins ead o usual e ms such as pe sons wi h psychosis, wi h schizoph enia and wi h demen ia. 204 1.00 6.00 3.7696 1.38281 24. Pe sons wi h psychosocial and men al disabili ies should enjoy legal capaci y on an equal basis wi h o he s in all aspec s o li e. 204 1.00 6.00 3.7941 1.31560 25. Pe sons wi h psychosocial and men al disabili ies should no be dep i ed o hei libe y unlaw ully o a bi a ily, and ha any dep i a ion o libe y is in con o mi y wi h he law, and ha he exis ence o a disabili y shall in no case jus i y a dep i a ion o libe y. 204 1.00 6.00 4.2353 1.28789 N Mini Max Mean SD Human Righ s o pe sons wi h psychosocial and men al disabili ies a i ude Ques ionnai e (HRQ_6) 204 2.46 5.28 3.7648 .43954 42 Figu e (3) p o ides he HRQ_6 means dis ibu ion: Table 3 p o ides he means and s anda d de ia ions o he CLAS i ems and subscales. The ques ions N Mini Max Mean SD 1. Pe sons wi h psychosocial and men al disabili ies should no be allowed o ma y and ha e child en 203 1.00 6.00 4.487 7 1.3692 5 2. A pe son would be oolish o ma y a pe son wi h psychosocial and men al Disabili y 204 1.00 6.00 4.465 7 1.3182 3 3. Pe sons wi h psychosocial and men al disabili ies can plan mee ings and con e ences wi hou assis ance om o he s 201 1.00 6.00 4.487 7 1.2102 2 4. Pe sons wi h psychosocial and men al disabili ies can be us ed o handle money esponsibly 201 1.00 6.00 4.465 7 1.2496 6 5. The opinion o a pe son wi h psychosocial and men al disabili y should ca y mo e weigh han hose o amily membe s and p o essionals in decisions a ec ing ha pe son 204 1.00 6.00 3.776 1 1.1490 8 6. Shel e ed wo kshops o pe sons wi h psychosocial and men al disabili ies a e essen ial 204 1.00 6.00 3.671 6 1.2332 8 43 7. Inc eased spending on p og ams o pe sons wi h psychosocial and men al disabili ies is a was e o ax dolla s 203 1.00 6.00 3.568 6 1.2116 4 8. Homes and se ices o pe sons wi h psychosocial and men al disabili ies downg ade he neighbo hoods hey a e in 202 1.00 6.00 3.965 7 1.3229 1 9. Pe sons wi h psychosocial and men al disabili ies a e a bu den o socie y 203 1.00 6.00 2.275 9 1.1539 1 10. Homes and se ices o pe sons wi h psychosocial and men al disabili ies should be kep ou o esiden ial neighbo hoods 203 1.00 6.00 2.707 9 1.3608 7 11. Pe sons wi h psychosocial and men al disabili ies need someone o plan hei ac i i ies o hem 203 1.00 5.00 2.172 4 1.2113 2 12. Pe sons wi h psychosocial and men al disabili ies do no need o make choices abou he hings hey will do each day 203 1.00 6.00 2.443 3 1.2509 4 13. Pe sons wi h psychosocial and men al disabili ies can be p oduc i e membe s o socie y 202 2.00 6.00 3.886 7 1.0660 7 14. Pe sons wi h psychosocial and men al disabili ies ha e goals o hei li es like o he people 202 1.00 6.00 3.443 3 .97154 15. Pe sons wi h psychosocial and men al disabili ies can ha e close pe sonal ela ionships jus like e e yone else 203 1.00 6.00 4.673 3 1.0910 6 16. Pe sons wi h psychosocial and men al disabili ies should li e in shel e ed acili ies because o he dange o li e in he communi y 203 1.00 6.00 4.683 2 1.2944 3 17. Pe sons wi h psychosocial and men al disabili ies usually should be in g oup homes o o he acili ies whe e hey can ha e he help and suppo o s a 203 1.00 6.00 4.645 3 1.2915 7 Subscale N Mini Max Mean SD Empowe men 197 2.20 5.80 4.0030 .78180 Exclusion 200 1.00 5.00 2.4050 1.00675 Shel e ing 203 1.50 5.75 3.8313 .82776 Simila i y 201 2.50 6.00 4.3570 .75730 The s a s‘ mean sco es di e ed om hose o he consume s (mo e posi i e) on he HRQ_6 and he CLAS subscales Empowe men , Exclusion, Shel e ing and Simila i y subscales. S a had mo e posi i e a i udes han he consume s in HRQ_6 (mean 3.92 s 3.60, = 5.32, d 202, P <0.000); and in he ou CLAS ac o s, Empowe men (mean 4.15 s 3.85, = 2.68, d 195, P <0.008), Simila i y (mean 4.65 s 4.05, = 6.09, d 199, P <0.00), Exclusion (mean 1.96 s 2.87, = 7.22, d 198, P <0.000) and Shel e ing (mean 3.66 s 4.01, = 3.14, d 202, P <0.002). 44 Table 4 epo s (HRQ_6) & CLAS subscale means o he compa ison be ween s a and consume s. HRQ_6: Consume o S a Mean N S d. Consume 3.6079 100 .34177 S a 3.9156 104 .47078 To al 3.7648 204 .43954 CLAS subscales: Consume o S a Empowe men Exclusion Shel e ing Simila i y Consume Mean 3.8505 2.8724 4.0125 4.0530 N 95 98 100 99 S d. De ia ion .87809 .94518 .62802 .71898 S a Mean 4.1451 1.9559 3.6553 4.6520 N 102 102 103 102 S d. De ia ion .65289 .85046 .95430 .67501 To al Mean 4.0030 2.4050 3.8313 4.3570 N 197 200 203 201 S d. De ia ion .78180 1.00675 .82776 .75730 45 Figu e (4) p o ides compa ison be ween s a and consume s on CLAS subscale sco es: Female pa icipan s had mo e posi i e a i udes han male pa icipan s in h ee ac o s: exclusion, shel e ing and simila i y and P alues we e (P <0.015, P <0.002 & P <0.014 espec i ely. Pa icipan s om Eled isi psychia ic hospi al in compa ison wi h he pa icipan s om he o he wo hospi als had mo e nega i e a i udes in HRQ_6 (P <0.006). While he consume s om Eled isi psychia ic hospi al had mo e posi i e a i udes in empowe men ac o (P <0.002), he consume s om El-Mahi psychia ic hospi al had mo e nega i e a i udes in exclusion ac o (P <0.000). 52 men al heal h se ices in Sudan), samples showed ha bo h g oups had nega i e a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili y. These nega i e a i udes a e consis en wi h WHO epo on men al heal h in Sudan which e ealed ha human igh issues in Sudan a e spo adic and inconsis en 12. This pa e n o a i udes is pa allel o he nega i e a i udes owa d igh s o pe sons wi h psychosocial and men al disabili y wo ldwide3, 34, 35 and 43 The esponden s gene ally we e a o ing Empowe men and Simila i y o e Exclusion and Shel e ing. This ela i ely posi i e a i ude may be explained in pa by he inna e desi e o jus ice and equali y44 and he e ec o di e en ypes o media a e A ab Sp ing. The s a sample had posi i e a i udes han he consume s sample on he HRQ_6 and all CALS ou subscales and his con i m ou hypo hesis ha s a will ha e mo e posi i e a i udes owa d human igh s o pe sons wi h men al heal h p oblems han he consume s. This esul is in con as wi h (Du de any) who ound ha he consume s' a i udes we e mo e posi i e in ela ion o empowe men han hose o hei s a 45. Bu in he exclusion, simila i y and shel e ing ac o s, no di e ences we e ound be ween s a and consume s. This di e ence could be explained by he ac ha consume s sample in Du de any s udy, we e a communi y sample; mo e o e he consume s awa eness in Is ael ega ding hei igh s migh be was much be e han ha in Sudan. Sex di e ences in a i ude we e no ed; emale pa icipan s had mo e posi i e a i udes han male pa icipan s owa d inclusion o pe sons wi h men al heal h p oblem in he communi y. This pa e n o indings may be consis en wi h a p e ious s udy by C oss SE & Madson L om USA ha sugges s women a e mo e o ien ed owa d ela ionships, in e dependence, and empa hy han a e men46. The nega i e a i udes owa d human igh s o he pa icipan s om Eled isi hospi al on HRQ_6 may be explained by he ac ha his hospi al is un by police and includes pa ien s wi h c iminal cases. 53 In Sudan since he medical model o disabili y is p edomina ed, doc o s a e he only di ec ly in ol ed s a who make decisions ega ding assessmen and managemen , o he p o essionals in he eam play mino oles and hey a e in ol ed only when he doc o asks hem o do some so o in e en ion, e.g. doc o s gi e o de o o al medica ions in inpa ien as well as in ou pa ien se ing di ec ly o he amily membe s who nu se he pa ien h oughou he illness and no o he nu se who is in ol ed only in pa en e al medica ions and elec ocon ulsi e he apy (ECT)!. Ou indings suppo he p e ious wo k o Al ed Ngi ababyeyi om Rwanda (Ngi ababyeyi. A, 2012) who e ealed ha , di ec ly in ol ed s a showed mo e posi i e a i udes owa d inclusion o pa ien s wi h men al diso de ; doc o s in ou s udy had mo e posi i e a i udes han he o he p o essional g oups (psychologis s, social wo ke s and nu ses). The abo e esul (doc o s ha e mo e posi i e a i udes owa d pe sons wi h psychosocial disabili y) coupled wi h ou inding ha , ( hose om he s a membe s who had ecei ed lowe educa ional le el (Diploma) had nega i e a i udes owa d simila i y ac o han hose who ecei e highe educa ional le els) could con i m p e ious s udies om Is ael (Du de any, 2000; Hen y, Keyss, Balacaza , & Jopp, 1996). In hese s udies he highe he s a membe s' posi ion, he mo e libe al and humanis ic a e hei a i udes. They end o be less au ho i a i e, es ic i e and less s igma ic owa d pe sons wi h men al disabili y. In ac , in Sudan he men al heal h s a membe s who ecei e only diploma (mos o hem a e nu ses) a ely hey expose o aining o educa ional subjec ega ding men al heal h issues. The e o e hese esul s could con i m a p e ious s udy om USA by Hun Cou ney Shel on & Hun B andon in 2004. In his s udy hey ound ha he educa ional in e en ion had a signi ican impac on bo h pa icipan s' knowledge le els and hei a i udes, e en a e con olling o gende and p io expe ience wi h people wi h disabili ies Those om he s a membe s who we e wo king mo e han 10 yea s in men al heal h ield had mo e nega i e a i ude owa d simila i y ac o , his esul con i m p e ious s udies om Is ael such as (Du de any, 2008) which con i m he p e ious s udies (Du de any, 2000; Hen y e al., 1996b; McReynold, Wa d, & Singe , 2002) and s a ed ha young pe sons ha e 54 mo e posi i e a i udes han olde people. They a e mo e ole an and libe al han olde membe s o s a . As hey acqui e g ea e senio i y in he ield, hey end o keep mo e o a dis ance and iew psychia ic disabili ies mo e scien i ically han humanis ic ally. Those om he consume s who had o he people unde hei di ec esponsibili y e ealed mo e posi i e a i udes owa d empowe men and simila i y ac o s, his esul can con i m a p e ious s udy om USA (Ryan D. Kme , 2013) who e ealed he posi i e e ec o al uism on sel -es eem and cogni ion. F om he s a , hose who had expe ienced di ec psychosocial o men al heal h ouble wi h one o he close ela i es o iends e ealed signi ican posi i e a i udes in Exclusion ac o . This esul may con i m he in e na ional s udies which showed ha con ac wi h people wi h men al illness can esul in posi i e a i udes owa d hose people, as well as inc eases he le el o com o in in e ac ing wi h hem (e.g., Ge hing &Wheele , 1992; A ens, 1993; Beckwi h & Ma hews, 1994; Nikolaos Kazan zis , 2009). In his s udy s a aining on human igh s didn‘ e eal any mo e posi i e a i udes; his may explained ha he aining didn' ha e he desi ed e ec . I can be due o poo ly designed p og ammes, an ine ec i e aine s o inadequa e ime o aining. In e es ing enough we ound ha , doc o s in his s udy had mo e posi i e a i udes owa d eco e y om men al illness han o he p o essional g oups. This esul ecalls op imism ega ding he u u e o e o m o men al heal h in Sudan, because mos o he men al heal h p og ams a e led by doc o s. The posi i e a i udes ega ding eco e y showed by consume s who we e ully esponsible owa ds sel , may con i m he impo ance o Responsibili y as one o he 10 undamen al componen s o Reco e y47. The e we e signi ican co ela ions be ween (HRQ_6) and CLAS subscales. This esul achie ed ou subsidia y objec i e which was o pu a s ep in he 55 cons uc ion and he s anda diza ion o Human Righ s o pe sons wi h psychosocial and men al disabili y a i ude ques ionnai e (HRQ_6). In sum, his s udy ep esen s one o he i s o explo e he a i udes o s a and consume s owa d human igh s o pe sons wi h psychosocial and men al disabili ies and hei in eg a ion in o he communi y in Sudan and in he egion. This s udy e ealed he huge gap in human igh s aining in men al heal h ield coupled wi h lack o knowledge ega ding eco e y o ien ed men al heal h se ices. The pas e a o medical model o disabili y domina ing he pic u e in men al heal h se ices in Sudan, he e o e he gene al heme o hinking in his s udy was in line wi h his ac . T aining and knowledge can make he di e ence in a o o social model o disabili y is suppo ed by he ollowing: -S a a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies we e much be e han he consume s. -Among he s a doc o s had mo e posi i e a i udes owa d human igh s o pe sons wi h psychosocial and men al disabili ies han o he s a membe s in men al heal h ield. The e o e wi h sui able aining hey can lead he e o m in men al heal h se ices. 2.4.2. Limi a ions o his s udy: Se e al conside a ions ecommend some cau ion in in e p e ing hese indings. Fi s , Al hough HRQ_6 is based on con en ions on he igh s o pe sons wi h disabili y, s ill is no s anda dized ool o assess a i udes owa ds human igh s o pe sons wi h psychosocial and men al disabili ies. Also he CLAS has no p e iously been used wi h a Sudanese sample. Second, all he p oblems o ansla ion we e he e when we ansla ed CLAS and HRQ_6 and will s ill emain beside he in luence o cul u al ac o s, so some concep s migh no be accu a ely iden ical due o cul u al ac o s. 56 Thi d, compa ison g oups om he same cul u e and backg ound we e no a ailable due o lack o s udies in his a ea. Fou h, he pa icipan s may no be e y accu a e in answe ing he ques ionnai es. Fi h, he sample is a con enien sample, so bias esul s and mis ep esen a ion o da a a e expec ed o some ex en . Finally, some ac o s in his s udy could in luence he e ec o each o he . e.g., mos o he nu ses had lowe educa ional le el han he o he p o essional g oups and we e wo king o mo e han 10 yea s in he ield o men al heal h. 57 2.5. CHAPTER FIVE: CONCLUSION AND RECOMMENDATIONS 58 Chap e 5 - Conclusion and Recommenda ions 2.5.1. Conclusion In sum, in his s udy, we a emp ed o examine he a i ude o s a and consume s owa d human igh s o pe sons wi h men al heal h p oblems and he di e ences be ween he wo g oups. The esul s in gene al showed nega i e a i ude o bo h g oups consis en wi h backg ound o human igh s issues in ou communi y. S ill he e we e signi ican di e ences be ween he wo g oups wi h he s a had mo e posi i e a i ude han he consume s. The di e ences in a i udes among he s a we e mainly a esul o hei educa ion and p o essional ole. Mos o he s a had been educa ed on he medical model, and hei belie s s ill e ained some o he ba ie s. The p ac ical applica ion o he con en ion on igh s o pe sons wi h disabili ies (CRPD) in men al heal h ield s ill is a away especially in low income coun ies! This s udy ep esen s one o he i s o explo e s a and consume s‘ a i udes owa ds human igh s o pe sons wi h men al heal h p oblems. I is hoped ha his wo k will highligh human igh s aining gap in men al heal h ield as well as in ou communi y. All he s akeholde s in men al heal h ield should be commi ed o espec ing all human igh s o he consume s including hei igh s o inclusion in o he communi y. The concep o eco e y o ien ed men al p ac ice among bo h g oups no well o med ye . Finally, his s udy demons a es ha human igh s‘ aining in men al heal h se ices is no a p io i y in Sudan. 59 2.5.2. Recommenda ions i. P o ec ion o Human igh s is he back bone o he e ec i e men al heal h se ices. Based on he esul o his s udy, s akeholde s in men al heal h in Sudan should design e ec i e p og ammes wi h adequa e ime o human igh s aining h oughou all men al heal h p og ams in Sudan. ii. S ill he e a e many a eas o explo e wi hin he ield o human igh s when add essing men al heal h se ices in Sudan. The WHO Quali yRigh s ool ki can be used o assess quali y o men al heal h se ices in Sudan. iii. G ass oo s ad oca es a e needed o aise he le el o awa eness ega ding human igh s o pe sons wi h psychosocial and men al disabili y in ou communi y and among men al heal h ca e p o ide s. i . The e is a need o u he esea ch on he a i udes owa ds igh s o pe sons wi h men al heal h p oblem among public g oups, communi y leade s, ai h heale s, non-psychia ic heal h ca e p o ide s and o he s akeholde s in men al heal h ield. . The e is u gen need o men al heal h policies and laws in Sudan o imp o e condi ions o people wi h men al disabili ies. i. Communi y-based se ices and suppo s as al e na i es o ins i u ional ca e should be adop ed by s akeholde s in men al heal h se ices. 60 2.6. CHAPTER SIX: REFERENCES 61 CHAPTER 6 - REFERENCES Lis o e e ences 1. The Wo ld Heal h Repo : 2001: Men al Heal h: New Unde s anding, New Hope. Gene a, Wo ld Heal h O ganiza ion, 2001. 2. WHO, Men al Heal h Policy and Se ice Guidance Package, he Men al Heal h Con ex book, 2003 3. WHO, Resou ce book on men al heal h, human igh s and legisla ion, 2005. 4. UN, Con en ion on he Righ s o Pe sons wi h Disabili ies, 2006. 5. WHO, Wo ld epo on disabili y, 2011. 6. Wikipedia, Sudan, A ailable a : h ps://en.wikipedia.o g/wiki/Sudan 7. Wo ldome e s, Popula ion, Sudan, 2017. A ailable a : h p://www.wo ldome e s.in o/wo ld-popula ion/sudan-popula ion 8. And ew Mwanik, E hnic G oups o Sudan, 2017. A ailable a : h ps://www.wo lda las.com/a icles/ he-e hnic-g oups-in-sudan.h ml 9. Uni ed Na ions Educa ional, Scien i ic, and Cul u al O ganiza ion (UNESCO) Ins i u e o S a is ics, 2013. A ailable a : h p://www.indexmundi.com/ ac s/sudan/li e acy- a e 10. B.B.C NEWS, Sudan Coun y P o ile, 2017. Web: h p://www.bbc.com/news/wo ld- a ica-14094995 11. Repo o he In e na ional Commission o Inqui y on Da u o he Uni ed Na ions Sec e a y-Gene al, Gene a, 2005. Web: h p://www.un.o g/news/dh/sudan/com_inq_da u .pd 12. WHO-aims epo on men al heal h sys em in Sudan, 2009. 13. Po e y and heal h, Ou A ica. Web: h p://www.ou -a ica.o g/sudan/po e y- heal hca e 14. Sheikh Id is A Rahim; he Mahi-Baashe He i age; he Sudanese jou nal o psychia y; Volume 1 – Issue 2, Ap il, 2011. 15. His o y o psychia y in Sudan, Sudanese psychia ic associa ion. A ailable a : h p://www.sudanesepsychia is s.o g/index.h m 16. Uni e sal decla a ion o human igh s, 1948. 17. Zimba do, P. G., & Ebbesen, E. B., In luencing A i udes and Changing Beha io . Reading, MA: Addison Wesley Publishing Co,1960. [Re ised, 1977]. 18. Na ional Disabili y Insu ance Scheme, 2014. A ailable a : h ps://mhaus alia.o g/gene al/ge ing-ndis- igh -people-psychosocial-disabili y. 19. Ame ican psychia ic associa ion, wha is men al illness 2015. Web: h ps://www.psychia y.o g/pa ien s- amilies/wha -is-men al-illness 20. S ephen P. Hinshaw and And ea S ie ., S igma as Rela ed o Men al Diso de s. Annu. Re . Clin. Psychol. 2008. 4:367–93 21. Allpo , G. W, A i udes, Handbook o Social Psychology, Cla k Uni e si y P ess, Wo ces e , Mass, 1935. 22. Je ey Pickens, A i udes and Pe cep ions, chap e 3, 2005. 23. Robe S. Fledm,an, unde s anding psychology, eigh h edi ion, 2008 68 36. Pe sons wi h psychosocial and men al disabili ies should enjoy legal capaci y on an equal basis wi h o he s in all aspec s o li e. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 37. Pe sons wi h psychosocial and men al disabili ies should no be dep i ed o hei libe y unlaw ully o a bi a ily, and ha any dep i a ion o libe y is in con o mi y wi h he law, and ha he exis ence o a disabili y shall in no case jus i y a dep i a ion o libe y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 38. Pe sons wi h psychosocial and men al disabili ies should no be allowed o ma y and ha e child en S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 39. A pe son would be oolish o ma y a pe son wi h psychosocial and men al Disabili y S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 40. Pe sons wi h psychosocial and men al disabili ies can plan mee ings and con e ences wi hou assis ance om o he s. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 41. Pe sons wi h psychosocial and men al disabili ies can be us ed o handle money esponsibly. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 42. The opinion o a pe son wi h psychosocial and men al disabili y should ca y mo e weigh han hose o amily membe s and p o essionals in decisions a ec ing ha pe son. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 43. Shel e ed wo kshops o pe sons wi h psychosocial and men al disabili ies a e essen ial. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 44. Inc eased spending on p og ams o pe sons wi h psychosocial and men al disabili ies is a was e o ax dolla s. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 45. Homes and se ices o pe sons wi h psychosocial and men al disabili ies downg ade he neighbo hoods hey a e in. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 46. Pe sons wi h psychosocial and men al disabili ies a e a bu den o socie y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 47. Homes and se ices o pe sons wi h psychosocial and men al disabili ies should be kep ou o esiden ial neighbo hoods. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 48. Pe sons wi h psychosocial and men al disabili ies need someone o plan hei ac i i ies o hem. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 49. Pe sons wi h psychosocial and men al disabili ies do no need o make choices abou he hings hey will do each day. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 50. Pe sons wi h psychosocial and men al disabili ies can be p oduc i e membe s o socie y. 69 S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 51. Pe sons wi h psychosocial and men al disabili ies ha e goals o hei li es like o he people. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee. 52. Pe sons wi h psychosocial and men al disabili ies can ha e close pe sonal ela ionships jus like e e yone else S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 53. Pe sons wi h psychosocial and men al disabili ies should li e in shel e ed acili ies because o he dange o li e in he communi y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 54. Pe sons wi h psychosocial and men al disabili ies usually should be in g oup homes o o he acili ies whe e hey can ha e he help and suppo o s a . S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee Glossa y Con en ion on Righ s o Pe sons wi h Disabili ies (CRPD): is an in e na ional human igh s ea y o he Uni ed Na ions. Pa ies o he Con en ion a e equi ed o p omo e, p o ec , and ensu e he ull enjoymen o human igh s by pe sons wi h disabili ies and ensu e ha hey enjoy ull equali y unde he law. Reco e y: Reco e y in men al heal h is o egain meaning ul li e in spi e o se ious men al illness Men al heal h legisla ion: In Sudan, cu en ly a new e sion o men al heal h ac is eady o implemen a ion. The las e sion da es back o 1998 Shel e ed wo kshops: e e s o an o ganiza ion o en i onmen ha employs people wi h disabili ies sepa a ely om o he s. 70 The In e na ional Mas e in Men al Heal h Policy and Se ices No a Medical School New Uni e si y o Lisbon Po ugal Ques ionnai e o assess he A i udes o S a and Consume s owa d Human Righ s o Pe sons wi h Psychosocial and Men al Disabili ies (S a ) D . Abdelaziz Osman ca ies ou his s udy as a inal yea p ojec o he In e na ional Mas e o Men al Heal h Policy and Se ices, he Uni e si y o New Lisbon, Po ugal. The aim o he s udy is o assess he a i ude owa d human igh s o pe son wi h psychosocial and men al disabili ies, o ecommend he ypes o aining equi ed in his a ea in o de o imp o e men al heal h se ices in ou coun y and egion. We app ecia e so much you pa icipa ion in his s udy. Iden i y will be anonymous and in o ma ion will be used o esea ch pu poses only. Kindly, ill he ollowing ques ions: (pu a √). Filling in he ques ionnai e akes abou 15 minu es. Please ead he ins uc ions, be o e illing in he ques ionnai e, ead each ques ion, including he answe ing op ions, be o e gi ing an answe , choose he answe ha is mos applicable o you si ua ion, and choose only one answe , unless s a ed di e en ly. Please ill in his ques ionnai e only o you sel and you si ua ion. The ques ionnai e will be collec ed by ou eam du ing no mal wo king hou s. Feel ee o wi hd aw om he s udy a any pa o he p ocedu e. Feel ee o con ac D . Abdelaziz a his email add ess wede [email p o ec ed]m o azza[email p o ec ed]om . 6. Numbe s o yea s wo king in MH: less han 5 yea s 5 o 10 yea s mo e han 10 yea s 6. Las deg ee: Diploma Bachelo Pos g adua ion s udies in men al heal h ield 7. Ha e you expe ienced you sel any psychosocial o men al oubles/p oblems? Yes No 8.Ha e you di ec ly expe ienced any psychosocial o men al oubles/p oblems wi h one o you ela i es/close iends? Yes No 9. Did you ha e any con ac o a men al heal h se ices as a use ? Yes No 10. Numbe s o yea s wo king in Men al Heal h: less han 5 5 o 10 mo e han 10 11. Wha do you hink abou Reco e y om men al illness? Is a ainable o e e yone Is a ainable o some people Is no a ainable a all 12. Ha e you ecei ed any aining on human igh s? Yes No Following a e a couple o s a emen s abou he igh s o pe sons wi h men al disabili ies. We would like o know whe he you ag ee wi h he s a emen o no and in wha deg ee. I you do no ha e a s ong opinion, please y o ind ou i i is mo e like ‗ag ee o mo e like ‗disag ee. I you eally do no know, you can selec one o he wo op ions ―somewha disag ee o somewha ag ee‖, ha you a e com o able wi h. 3. Ma i al s a us Single Ma ied Di o ce Widowed 2. Hospi al Elmahi Baeshe Elid eisi 2. Gende Male Female No answe 4. Age ( yea s ) 5. Cu en p o essional job Doc o Nu se Psychologis Social wo ke 71 13. In Sudan no need o men al heal h legisla ion o p o ec he igh s o pe sons wi h psychosocial and men al disabili ies. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 14. All na ions should wo k owa d libe y and jus ice o all including pe sons wi h psychosocial and men al disabili ies S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 15. Pe sons wi h psychosocial and men al disabili ies should be able o ha e a oice in how hey deal wi h hei own physical well-being, wi h hei heal h and wi h hei illnesses. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 16. Pe sons wi h psychosocial and men al disabili ies should be able o lead, con ol, exe cise choice o e , and de e mine hei own pa h o eco e y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 17. Occasionally i is easonable o deny he igh o o e o some g oups o pe sons wi h psychosocial and men al disabili ies; o ins ance o pe sons wi h se e ypes o schizoph enia S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 18. Teenage s wi h psychosocial and men al disabili y should be allowed o ecei e all ypes o medical and psychosocial ea men s wi hou pa en al consen . S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 19. I is legi ima e o au ho i ies o cu ail he ac i i ies o pe sons wi h psychosocial and men al disabili ies which a e socially unaccep able; o ins ance wande ing along he s ee wi h di y clo hes S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 20. All ci izens should be gi en ull cons i u ional igh s bu ci izens wi h psychosocial and men al disabili ies should no expec o be gi en all hose igh s. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 21. Pe sons wi h psychosocial and men al disabili ies should no ha e o wo y abou unwa an ed in usions by he go e nmen , amily and iends in o hei p i a e li es. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 22. Books should be banned i hey a e w i en by pe sons wi h psychosocial and men al disabili ies who ha e been in a se e psycho ic s a e du ing he ime o w i ing S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 23. Police should no ha e o ge sea ch wa an s when hey a e pu suing suspec s wi h known se e e men al illness S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 24. Disc imina ion agains because o psychosocial and men al disabili y is jus i iable some imes S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 72 25. We should no was e ime o suppo pe sons wi h psychosocial o men al disabili ies o ake hei decisions abou sel , when we a e 100% su e hey a e no able o make decisions. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 26. Pe sons wi h psychosocial and men al disabili ies should ha e he igh o in ol e he adi ional heale s in hei managemen plan S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 27. Pe sons wi h psychosocial and men al disabili ies p obably shouldn' be hi ed o jobs equi ing conside able con ac wi h he public since hey could beha e in a s ange way S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 28. As soon as a pe son shows signs o men al dis u bance, he should be hospi alized S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 29. Counselo s should encou age pe sons wi h psychosocial and men al disabili ies o conside aining o become doc o s, pilo s, ca pen e s, mili a y o ice s and o he occupa ions ha i wi h hei po en ials ega dless o hei illness S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 30. Fo pe sons wi h psychosocial and men al disabili ies is be e o gi e wel a e assis ance a he han o encou age employmen in o de o p o ec hem S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 31. F eedom o speech should be a basic human igh excep o pe sons wi h psychosocial and men al disabili ies because hey can emba ass hei amilies and iends. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 32. The en i onmen should be adap ed o he needs o pe sons wi h psychosocial and men al disabili ies e en i doing so is expensi e. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 33. The Con en ion on he Righ s o Pe sons wi h Disabili ies (CRPD) could dis up socie y wi h i s emphasis on ea ing pe sons wi h psychosocial and men al disabili ies like o he s. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 34. Teache s wi h psychosocial and men al disabili ies can be good ole models o ou child en, jus like anyone else. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 35. Publishe s, speake s, p o essionals and o he s since hey a e no in ending s igma can use s igma izing e ms such as psycho ic, schizoph enic and demen ed ins ead o usual e ms such as pe sons wi h psychosis, wi h schizoph enia and wi h demen ia. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 36. Pe sons wi h psychosocial and men al disabili ies should enjoy legal capaci y on an equal basis wi h o he s in all aspec s o li e. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 73 37. Pe sons wi h psychosocial and men al disabili ies should no be dep i ed o hei libe y unlaw ully o a bi a ily, and ha any dep i a ion o libe y is in con o mi y wi h he law, and ha he exis ence o a disabili y shall in no case jus i y a dep i a ion o libe y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 38. Pe sons wi h psychosocial and men al disabili ies should no be allowed o ma y and ha e child en S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 39. A pe son would be oolish o ma y a pe son wi h psychosocial and men al Disabili y S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 40. Pe sons wi h psychosocial and men al disabili ies can plan mee ings and con e ences wi hou assis ance om o he s. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 41. Pe sons wi h psychosocial and men al disabili ies can be us ed o handle money esponsibly. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 42. The opinion o a pe son wi h psychosocial and men al disabili y should ca y mo e weigh han hose o amily membe s and p o essionals in decisions a ec ing ha pe son. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 43. Shel e ed wo kshops o pe sons wi h psychosocial and men al disabili ies a e essen ial. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 44. Inc eased spending on p og ams o pe sons wi h psychosocial and men al disabili ies is a was e o ax dolla s. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 45. Homes and se ices o pe sons wi h psychosocial and men al disabili ies downg ade he neighbo hoods hey a e in. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 46. Pe sons wi h psychosocial and men al disabili ies a e a bu den o socie y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 47. Homes and se ices o pe sons wi h psychosocial and men al disabili ies should be kep ou o esiden ial neighbo hoods. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 48. Pe sons wi h psychosocial and men al disabili ies need someone o plan hei ac i i ies o hem. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 49. Pe sons wi h psychosocial and men al disabili ies do no need o make choices abou he hings hey will do each day. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 50. Pe sons wi h psychosocial and men al disabili ies can be p oduc i e membe s o socie y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 51. Pe sons wi h psychosocial and men al disabili ies ha e goals o hei li es like o he people. 74 S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 52. Pe sons wi h psychosocial and men al disabili ies can ha e close pe sonal ela ionships jus like e e yone else. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 53. Pe sons wi h psychosocial and men al disabili ies should li e in shel e ed acili ies because o he dange o li e in he communi y. S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee 54. Pe sons wi h psychosocial and men al disabili ies usually should be in g oup homes o o he acili ies whe e hey can ha e he help and suppo o s a . S ongly disag ee. Disag ee. Somewha disag ee. Somewha ag ee. Ag ee. S ongly ag ee Glossa y Con en ion on Righ s o Pe sons wi h Disabili ies (CRPD): is an in e na ional human igh s ea y o he Uni ed Na ions. Pa ies o he Con en ion a e equi ed o p omo e, p o ec , and ensu e he ull enjoymen o human igh s by pe sons wi h disabili ies and ensu e ha hey enjoy ull equali y unde he law. Reco e y: Reco e y in men al heal h is o egain meaning ul li e in spi e o se ious men al illness Men al heal h legisla ion: In Sudan, cu en ly a new e sion o men al heal h ac is eady o implemen a ion. The las e sion da es back o 1998 Shel e ed wo kshops: e e s o an o ganiza ion o en i onmen ha employs people wi h disabili ies sepa a ely om o he s.