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Integration of People with Mental Disorder Into Community Based Rehabilitation Model (A Pilot
and Research Based Project Supported by Royal Netherlands Embassy,
Monitored by Indian Institute of Management Ahmedabad and Implemented by |
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Volume-1,
Issue-4 |
BLIND PEOPLE'S ASSOCIATION
(INDIA) |
(This Newsletter is an Effort to Sensitize Peer NGOs, Government Officials, Students, Educated Masses and General Community on the Issue of Mental Health) |
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Dr. Bhushan
Punani Mrs. Nandini
Rawal Mrs. Vimal
Thawani Mr. Dharmendra
Kumar Jena Mr. Bharat
Joshi |
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Gujarat Scene in MH Issue and Things Need to be Done?
- 2.8 million adults suffer from Psychiatric
Morbidity. a. Broad Principles -To ensure availability and
accessibility of minimum mental health care. b. What does research suggest? - Up to 60% of depression patients can recover and
live a healthy live. c. Strengthen the public health system - Increase service provision at district levels and
decentralization of MH sector d. Strengthen the role of caregivers - Involvement of care givers in process of
diagnosis and treatment, provide general information on case handling,
financial support mechanisms- to most vulnerable. - Public-Private Partnership (Developing Incentive
Systems, Institutional Mechanism) f. Human Resources - Forums for interaction of different MH
professionals (Strengthen Multi Disciplinary Approaches) - Strengthen documentation to aid
informed interventions i. Strengthening
Institutional Mechanisms |
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Major Assets of Blind People's Association |
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If you wish to contribute any article for the E-newsletter, or would like to comment on the newsletter please do contact us at the following address. Contact Blind
People’s Association Phone-91-79-26304070,
26305082 |
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Integration of People with Mental Disorder Into Community Based Rehabilitation Model (A Pilot
and Research Based Project Supported by Royal Netherlands Embassy,
Monitored by Indian Institute of Management Ahmedabad and Implemented by |
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Volume-1, Issue-5 |
BLIND PEOPLE'S ASSOCIATION
(INDIA) |
(This Newsletter is an Effort to Sensitize Peer NGOs, Government Officials, Students, Educated Masses and General Community on the Issue of Mental Health) | |
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Dr. Bhushan
Punani Mrs. Nandini
Rawal Mrs. Vimal
Thawani Mr. Dharmendra
Kumar Jena Mr. Bharat
Joshi |
ISSUES
AND CHALLENGES IN REHABILITATION
- Rehabilitation, in its practical conception, is not only the services and techniques of functional restoration but also the organization of all the efforts of all the people involved, as well as the end result or goal of those efforts. it individual adjustment and reintegration which involves the acceptance of the programme designed to accomplish maximum restoration. - More acceptable definition is Rebuilding the capabilities (Physical, mental and social) to prepare patients to take their place in the community to the fullest extent compared to the level of their functioning before the onset and become an asset rather than liability. - It involves all professional, paraprofessional and all those who surround the patient (Family, neighbors, friends, community, NGO etc.) - Communities must learn what they produce in the way of mental problems and waste of human opportunities and with such knowledge they will rise from mere charity and ear bending or hasty propaganda to well balanced early care, prevention and general gain of health. - It is an old concept. Traditionally it means restoration of what is lost and coming back to normalcy. - National council on rehabilitation
(1943) defined it as the restoration of the handicapped to the fullest-
physical, mental, social, vocational and economic usefulness of which
one is capable. Rehabilitation- Some Facts - Earlier it was used in the context
of war disabled and now it is extended to all. Stages of Rehabilitation - Preparing for resettlement: Rehabilitation begins with diagnosis as treatment is initiated-general plans for future management should be discussed. - Bridging the Gap- as patient shows improvement, discharge is planned. support from known and trusted people both in the hospital and outside hospital is essential during the phase of bridging the gap if the experiences gained at earlier stages of the programme are to be consolidated and augmented. - Community support- continuing support will be necessary to maintain progress, provide help at times of crisis and prevent deterioration,. support can promote the confidence required to cope with the unexpected events of a rather unstructured existence. Issues - At Discharge- Family members are blank and confused therefore acceptance of patient is poor - They have disowned patient and it
becomes burdensome and stressful We Need to Ask Ourselves - Do we have distinct
philosophy and policy of rehabilitation programme? Action Required to be Taken Identify the family life, ability to work, ability to learn new information, education, ability to develop independe3nt recreational activities, interests and motivations. if you do a comprehensive assessment of these things as well as measuring the symptoms, then you can help people improve. it doesn't matter the name of the illness or where the problem comes from, rehabilitation starts with the person. it gradually teaches the person or provides the required support. In home and family support programme to be adopted, which would enable the patients to purchase services or items which will assist them in living independently in the community or with friends or family. the services or items must relate to the unique needs of the person. Psychosocial rehabilitation programs are programs in which people with severe psychiatric disorders are involved in learning how to identity and build upon strengths and abilities. this approach focuses on the remediation of disability through skills training and interventions designed to develop coping skills or modify no supportive environments. Family members and other carriers need to be recognized for the role they play in helping maintain a patients mental health and need to be included in the overall rehabilitation plan. it is also important that they receive education, support and training in how best to support the patient. family group therapy when available, may substantially reduce symptoms and frequency of episodes in the patient. as well as improving the mental health of the entire family. Listen to family members and include them into he treatment team whenever appropriate and refer families to a group therapy program if available. Areas of Inclusion - Reception Rehabilitation Service to Include - Behavior Therapy Prof. (Dr) Aruna Khasgiwala |
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Major Assets of Blind People's Association |
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Success Story Background Mr.
Firojbhai Pathan, Age- 30 years of village Jalalpor of Navsari
District was working in a Diamond company. He had a very happy
marriage life with his wife and 4 children. No one from his family
members has been reported mentally ill. Gradually Mr. Firojbhai develop
propensity of Hallucination, preferred to stay in loneliness,
willingness in staying at home and less interactions with others. His
behavior was changed and started to cry without any reasons and suicidal
thoughts also disturbed him very much.
He has been diagnosed as schizophrenic patients with 40%
Psychiatric disability in the medical
camp organized by Blind People's Association. One of the major cause of
his diseases identified by the psychiatric team was regular
consumption of alcohol and which leads to de-addiction situation
and gradually became a victim of Schizophrenic patient.
The Blind People's Association initiated the project (Integration of People with Mental Disorder into CBR Model) activities in Navsari on January 2004 and National Association for the Blind (Navasari Branch) has been appointed as the implementing agency for the specified area (Jolalpur Block). After the field staffs gone through rigorous one month training in identification of people with mental disorder Mr. Firozbhai has been identified by the field worker as Mentally ill patient during the door-to-door survey. The field workers informed his family members that he is a psychiatric patient and need treatment to come back his previous condition and informed them to bring him to the medical camp to be organized on 29th June 2004 in Jalalor. His family members brought him to the camp and he has been provided with medical/counseling services and also provided disability certificate. After the first time medical and counseling service, the fieldworkers visit his home regularly and do medical follow up with observation. Counseling services has been provided to Mr. Firojbhai as well his family members regularly. The regular medication improves his daily living skill and raise new hope in life to live as normal as past and showed his willingness to join his previous job. Fieldworkers trained him in daily living activities and do more counseling on de addiction. Gradually he involved him in house hold activities also. Now again Mr. Firozbhai join the same Diamond Industry in Jalapor and earns 4000/- per month. His family members, neighbors and general community are very happy to see him into previous situation and being well accepted by all. |
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If you wish to contribute any article for the E-newsletter, or would like to comment on the newsletter please do contact us at the following address. Contact Blind
People’s Association Phone-91-79-26304070,
26305082 |
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Integration of People with Mental Disorder Into Community Based Rehabilitation Model (A
Pilot and Research Based Project Supported by Royal Netherlands Embassy,
Monitored by Indian Institute of Management Ahmedabad and Implemented by |
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Volume-1, Issue-6 |
BLIND
PEOPLE'S ASSOCIATION (INDIA) |
(This Newsletter is an Effort to Sensitize Peer NGOs, Government Officials, Students, Educated Masses and General Community on the Issue of Mental Health) | |||
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IDEAS (INDIAN
DISABILITY AND ASSESSMENT SCALE) A scale for
measuring and quantifying disability in mental disorders
The
Persons with disability act 1995 includes mental illness as disability.
The persons with mental illness are eligible to avail all the benefits
under the persons with disability act 1995. The disabled people need
disability certificate showing more than 40% disability from the
competent authority to avail the benefits. The disability act covers
seven disabilities
The
assessment tools have already been existed for the visually impaired,
hearing impaired and orthopedic handicap and persons with mental
retardation. These people are certified by the authentic body and become
eligible by having disability certificates to avail the benefits under
the PWD Act 1995. But there was no assessment tools for the
certification of mentally ill people and yet these people are not
availed any benefits even as disabled. Looking that perspective and to
justify these people rehabilitation committee of Indian Psychiatric
Society has developed the assessment tool for disability certification
in 2002. This tool is known
as Indian Disability Evaluation and Assessment Scale in short IDEAS.
This IDEA has opened new horizon for mentally ill people. This committee
has developed clear guideline to make use of it very easy. General
Guidelines: Ø
IDEAS are suited best for the purpose of measuring and certifying
Disability. Ø
It is therefore a brief and simple instrument, which can be used,
even in busy clinical settings. Ø
Some training is required in the use of IDEAS. Ø
This is to be used only on out patients and those living in the
community. Not appropriate for in- patients. Ø
Rating should be done only based on interviews of the Primary
Care Givers. Case records and patients interviews can be used to
supplement information. Ø
Only in rare instances when no primary care giver is available
should be the rating is based only on patient interview. This should
then be documented. Ø
The gender specification “he” has been used for convenience
and refers to both genders. Ø
Probe questions help to guide one through the interview and to
help identify dysfunction in one or more activities. Patients
with only the following diagnosis as per ICD or DSM criteria are
eligible for disability benefits: Ø Schizophrenia Ø
Bipolar Disorder Ø
Dementia Ø
Obsessive Compulsive Disorder Duration
of illness: the total duration of illness should be least two years. For
the purpose of scoring, the number of months the patients was
symptomatic in the last two years (MI
2Y –months of illness in the last two years) should be determined.
Who
does the assessment? Only
the Psychiatrist can do diagnosis and certification. Trained social
workers, psychologist, or occupational therapists can do administration
of IDEAS Frequency
of Re-certification Psychiatric
Disability will be reassessed every two years and re-certified. The
feasibility of doing this in the rural areas will however have to be
examined. Items: I.
Self care : Includes taking care of body hygiene, grooming,
health including bathing, toileting, eating and taking care of one’s
health. II.
Interpersonal Activities ( Social Relationship) : Includes
initiating and maintaining interactions with others in a
contextual and socially appropriate manner. III.
Communication and Understanding : Includes communication and
conversation with others by producing and comprehending spoken/ written/
nonverbal messages. IV.
Work: Three areas are Employment/ House work/ Education measures any one
aspect. 1.
Performing in Work/ Job : Performing in work / employment (paid)
employment /self employment family concern or otherwise. Measures
ability to perform tasks at employment completely and efficiently and in
proper time. Includes seeking employment. 2.
Performing in Housework: Maintaining household including cooking,
caring for other people at home, taking care of belongings etc. Measures
ability to take responsibility for and perform household tasks
completely and efficiently and in proper time. 3.
Performing in school/ college: measures performance in education
related tasks. Scores
for Each Item: 0
– No Disability 1
– Mild Disability 2
– Moderate Disability 3
– Serve Disability 4 – Profound Disability Total
Score (range 0-20) Add
scores of the 4 items and obtain total score MI
2y months of illness in the last two years. Interview with informant and
case notes if available should be used to determine for how many months
in the last two years the patients exhibited symptoms(range 1-4) MI
2 Years < 6
months: score to be added is 1 7-12 months: add 2 13-18 months : add 3 > 18 months : add 4 Global
Disability Total
disability score + MI 2Y score = Global
Disability Score (range 1-20) Percentage: For
the purpose of welfare benefits, 40% will be cut off point. The scores
above 40% have been categorized as Moderate, Severe, and profound based
on the Global disability score. This grading will be used to measures
change overtime Score
of 0- No disability = 0%
1-7 – Mild Disability = <40%
8 and above = > 40% (8-13
moderate disability; 14-19 Severe Disability; 20 Profound Disability)
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Success Story Background
Mr. Jasubhai Zhala 30years old a
resident of Sunda village of Kapadwanj block lives in joint family
structure consisting of 7 members. He has been suffering from
schizophrenia since last 8 years. His family is engaged in agricultural
and animal husbandry activities. He was brilliant student during his
school time and only a person in his family who has completed education
upto std 12th. As
his family was dependant on him, He had joined one factory in Vatva GIDC
in Ahmedabad after passing out std 12th. He
supported his family for marriages of his two sisters. He had good and
happy marriage life having three children. He was very happy in his
family as well as in his work. Initially He had joined factory as
unskilled worker and then promoted as skilled worker. His name was
recommended as supervisor because of his accuracy and brilliancy in his
work. But some how he was not selected as supervisor and this was the
unpleasant incident for him, which led him to schizophrenia. After that
unpleasant incident he had stop to interact with any one. He was keeping
himself locked in a room for one year. During his illness his self-care
was totally impaired, communication was also impaired and
he had avoided to meet anyone and kept himself locked in open home for
last 8 years. His family members were worried about his behavior and came to conclusion that the devil spirits has totally controlled on his behavior. They had taken him to more than 10 traditional healers and expenses incurred more than Rs. 50,000. Step by step InterventionThe Blind People's Association initiated the project (Integration of People with Mental Disorder into CBR Model) activities in Kapadwanj Block on January 2004 and V.S.Gandhi Charitable Trust, Kapadwanj has been appointed as the implementing agency for the specified area (Kapadwanj Block). After the field staffs gone through rigorous one month training in identification of people with mental disorder Mr. Jasubhai has been identified by the field worker as Mentally ill patient during the door-to-door survey. The field workers informed his family members that he is a psychiatric patient and need treatment to come back his previous condition and informed them to bring him to the medical camp to be organized on 30th July 2004 in Kapadwanj.
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If you wish to contribute any article for the E-newsletter, or would like to comment on the newsletter please do contact us at the following address. Contact Blind
People’s Association Phone-91-79-26304070,
26305082 |
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