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 Blind People's Association, Ahmedabad)

Volume-1
Issue-1
For the Month of January,06

BLIND PEOPLE'S ASSOCIATION (INDIA)  
An Effort to Sensitize Peer NGOs, Government Officials, Students, Educated Masses and General Community on the Issue of Mental Health

All donations to Blind People's Association (India) enjoy 100 % exemption from income-tax U

Editorial Team

Dr. Bhushan Punani
Executive Director 

Mrs. Nandini Rawal
Project Director

Mrs. Vimal Thawani
Project Manager

Mr. Dharmendra Kumar Jena
Project Coordinator

Mr. Bharat Joshi
Asst. Project Coordinator

Blind people's Association (BPA): 
Blind people's association works for comprehensive rehabilitation of all categories of disabled since last 5 decades . The BPA provides preventive , curative and rehabilitative services . It has center based as well as community based programs. It provides free assesistive devices to the disabled. 

The persons with disabilities act includes people with Mental illness as one of the categories of the disability , Hence BPA planed a program "Integration of People with Mental Disorder into Community Based Rehabilitation Model ". The BPA would wish to check whether the CBR model might be the right vehicle for identifying persons with mental illness  and then providing appropriate intervention. We would like to share our experiences of implementing this project and News about mental illness .  

Overview of the Project: 
The mental health sector program of the Government of Gujarat aims at (a) ensuring availability and accessibility of acceptable mental health care for all in the near future (B) encouraging application of mental health knowledge on administration of justice; (c) promoting mental health service and to stimulate efforts to provide free and competent legal services to mental health sector. 

In order to ensure that the objectives of the Legal services Authority Act are achieved in the mental health sector, the mental health mission, IIM, Ahmedabad under the joint auspices of Gujarat State Legal Services Authority has held workshops for drafting out of strategy for the State of Gujarat. 

The Department of Health and Family Welfare, Government of Gujarat has constituted an Expert Mission to recommend priority strategies and polices towards strengthening the Mental Health Sector in Gujarat. In view of the WHO report on mental health and in view of the judgment of the Honorable Supreme court of India the area of Mental Health Sector needs to be focused larger interest of justice and society at large.  

The main objectives of the project
a. Reaching out to persons with mental disorders through a community based approach through pilot programs. 
b. Development of referral linkages and human resources 
c. Community sensitization and awareness regarding common mental disorder.
d. Provision of referral and rehabilitation services to identified persons with mental disorders. 

Current Status of Gujarat in order to Provide Mental Health Services-
The government infrastructure in the mental health sector comprises four hospitals for mental health at Ahmedabad (317 beds), Vadodara (300), Janmnagar (50) and Bhuj (16). these hospitals provide psychiatric care, especially in long-term care of the mentally ill. psychiatry departments of (Government) teaching hospitals at Ahmedabad, Vadodara, Jamnagar, Surat, Rajkot and Bhavnagar provide additional 157 psychiatric beds. Psychiatric beds are also available in the teaching colleges run by municipal corporations at Ahmedabad and Surat and at private medical colleges at Karamsad and Surendranagar.  

There is a serious shortage of trained mental health professionals in the Mental Health sector. Gujarat has 163 qualified psychiatrists (0.4 per 1,00,000 of population) and less than 50 clinical psychologists. despite the fact that Gujarat has 23 general nursing colleges, there are very few trained psychiatrist nurses. other Para mental professionals such as trained social workers in this area are also scarce. the basic condition for developing and implementing community based rehabilitation and cost effective interventions in the mental health sector requires the involvement of these professionals. (Source- The Mission Report 2003-Prorities for Mental Health Sector Development in Gujarat)

What is PWD act- 
The persons with disabilities (Equal opportunities, protection of rights and full participation) Act, 1995. PWD act is an Act which give effect to the proclamation on the full participation and equality of the people with disabilities. it extends to the whole of India except the state of Jammu and Kashmir.  

Dare To Care   

When we think to talk about person having mental illness we generally used term madness or mad (Pagal) or understand as Spilt Personality to mentally ill patients. We don’t give proper response to these people and not to think about their treatment and simply saying that he is mental and mental people do not have any treatment. On other side when we talk about persons having Cancer, Diabetes and other illness knows very well he is suffering from such illness we think to give treatment and take great care of these people and provide all necessary facility. The mental illness is also one type of illness why should we differentiate this illness and attached social stigma to mental illness. Stigma is a major barrier to a positive attitude and behavior towards mental disorders and persons with mental illness among the general public.  This stigma creates a physical and psychological distance between the affected person and normal others. This stigma takes different forms depending on the illness. The patient hesitates to visit the psychiatrist is one aspect of stigma. On other hand family members are not ready to disclose to others the patient has mental illness or undergoing treatment for it. The undergoing treatment is kept in special room in the house; stop to visit him in other places. The family members and patients himself not aware about the treatment and cause of illness. They do not aware about mental health hospitals and specialist psychiatrist for the treatment even though they are well aware about other diseases and treatment.   The social stigma is community is not ready to accept the mental illness as other diseases.

But the need is aroused to take care of these mentally ill people as other people having other illness. why should we worry about these people? because the mental illness is any illness experienced by a person that affects their emotions, thoughts or behavior, which is out of keeping with their cultural, beliefs and personality and is producing negative effect on their lives or the lives of family. A person having Cancer, Diabetes and other illness knows very well he is suffering from such illness and having control over his mind and he is able to take all decisions independently and does medical treatment consciously. We should have to worry about the persons with mental disorders because the picture is totally different mental health chapter. A person is having mental illness not having control over his/ her mind and not able to take care of him self and does not have control over his /her mind and not able to take any decisions independently. These illnesses caused their mind and make their life worse and they are totally socially isolated. because mental disorders are one type of illness and it can be cured through medical intervention and psychotherapy and occupational therapy. The regular medicines follow up helps to overcome from the illness that is to be needed family support for the continuous medical follows up. On other side some mental illness caused because of some incidents and accidents. For example during the disaster period the patients having high trauma and that makes worse impact over his mind and they are suffering from posttraumatic disorders at that time they need continuous family support and cares. These people need constant supervision and social support, worm and sympathy from family members and community Only nearer community help him to overcome from this problem through sympathy. Let WE DARE TO CARE
(Bharat Joshi)

Major Assets of Blind People's Association

If you want to give any article for the E-newsletter, further development of the news letter or your remark on the new letter please do contact in the following address. 

Contact

Blind People’s Association
132ft’ Ring Road
Vastrapur, Ahmedabad
Gujarat-380015

Phone-91-79-26304070, 26305082
Email- bpaindia@satyam.net.in
Website- www.bpaindia.org

Next issue

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 Blind People's Association, Ahmedabad)

Volume-1
Issue-2
For the Month of February,06

BLIND PEOPLE'S ASSOCIATION (INDIA)  
An Effort to Sensitize Peer NGOs, Government Officials, Students, Educated Masses and General Community on the Issue of Mental Health

All donations to Blind People's Association (India) enjoy 100 % exemption from income-tax U

Editorial Team

Dr. Bhushan Punani
Executive Director 

Mrs. Nandini Rawal
Project Director

Mrs. Vimal Thawani
Project Manager

Mr. Dharmendra Kumar Jena
Project Coordinator

Mr. Bharat Joshi
Asst. Project Coordinator

Role of Care Givers Group in Working with Persons with Mental Disorder  

Care givers group are the backbone of the MH delivery system. They detect illness in an early stage and its their responsibility for the continuous care of the patient. Parents, Husbands, Wives, Children, siblings and other family members are severely affected by having a mentally ill patient in the family. If they provided with information, counseling and other types of support, they can form a crucial part in care and treatment. 

In and above the family members of the patients, Members of Panchayati Raj Institutions (Sarapanch), School Teachers, Health Workers, Village Development Officers, Local PHC/CHC Doctors and community as a whole can also be a part of care givers group. 

The Major Objectives of the Care Givers Groups are:

- To follow- up regular medications of patients  
- To Monitor the Activities of Field Workers and Plan Time to Time in Order to Provide Qualitative service 
- Help them to Avail Government Scheme for the Person with Disability
- Help them in the process of Social, Economic and Medical Rehabilitation
- Creating Awareness on Mental Health 
- Working for Curb Down Stigma   
- To Create a Conducive Environment for Better Mental Health 

The Creation of  care givers group would result in giving valuable discussion partners for service provider and administrators. they would also be effective partners for community bases NGOs and advocacy groups. in this way, institutional linkages with care givers would be established. From the side of the MH professionals attention is needed to create an attitude to actively involve care givers in the treatment process, to assist them in organizing care givers to support each other and to promote contacts with advocacy groups. 

The Blind People's Association's Model to INTEGRATE PERSONS WITH MENTAL ILLNESS INTO THE COMMUNITY  

Challenges for the Gujarat Mental Health Sector 
(Source Mental Health Policy April 2004)

Analysis of the existing situation in Gujarat indicates that a variety of promising initiatives in the field of MH are already taking place, both in rural and urban settings, by government, non-government and private practitioners. these initiative cover all levels of service provision as well as prevention and promotion activities. Even though these activities are small scale and uncoordinated, they provide valuable insights for future developments. liking at the mental health sector in Gujarat, there are a number of priorities for improving the mental health sector in Gujarat, there are a number of priorities for improving the system of MH service delivery. 

Matching of Service Demand and Delivery- It is estimated that there are 2.8 million adults with common and severe mental disorders at any point of time in Gujarat. each year about 11000 new cases of schizophrenia are added to the mental illness burden. The  population burden of all severe mental disorders is more than four times the number of persons affected by schizophrenia. Co-morbidity with physical disorders is common. the recent events of natural disaster and communal violence in Gujarat have significantly contributed to the number of reported cases of depression, trauma and anxiety. 

Taking into account the current burden of mental illness in the state, there is an urgent need to augment services. At present the services are provided in a limited number of settings and focus mainly on in-patient and out-patient care. promotion, prevention and rehabilitation are hardly covered. The MH sector not only needs to urgently improve and expand the existing facilities, but also develop new modalities of services delivery to adequately serve the demand among those needing services. 

Human Resource Development- The MH sector requires a major effort in capacity building. current services are insufficient to cope with the growing demand. Motivational level, both in private and public sector, are too low. human resources need to be strengthened in three ways: quantity, quality and organization structure. the numbers of MH professionals will need to increase., this will be for all types of professionals: 

- Psychiatrists
- Clinical Psychologists
- Psychiatric Social Workers
- Psychiatric Nurses
- Occupational Therapists
- Counselors 

MH component in other related courses (MBBS, Nursing courses, educational courses, child development courses) needs to be strengthened. The increase of professionals in the MH services leads to increases availability of services and an increases opportunity to introduce the multidisciplinary approach. These quantity and quality improvements need a large effort in training and on the job support programmes.  
   

Major Assets of Blind People's Association

Flash News- Mr. Makwana Naresh Bhojabhai of village- Limbdi was a government servant with Tuberculosis Department. He was affected by schizophrenia and in view of the fact he lost his job. Since last last two year his family were facing lots of difficulty to manage their livelihood and lost faith that he will not again come back to his normal situation as he had gone through treatment in many places . After mental health intervention started in the year 2004 in Limbdi block he was provided regular medicines and counseling support.   Now he is almost well and again acquire a government Service. He joined as Male Health Worker in Malaria Department in  Sayla Block and getting a monthly salary of rupees 2500/-. The family members of Makwana are very much thankful to mental health team of BPA, Ahmedabad. We Congratulate Nareshbhai for his achievement and wish him all the success in the future.  

Post Graduate Diploma In disability management

(A Collaborative National Programme of Manipal Academy of Higher Education- MAHE and Rehabilitation Council of India-RCI)

The “Manipal Academy of Higher Education” (A Deemed University) along with “Rehabilitation Council of India” offers program- Post Graduate Diploma In Disability Management (PGDDM).

 Objective- Candidates will be able to identify disabilities sufficiently early at the field level and to implement early intervention strategies including proper referral to specialist centres/professionals.

Duration- 1 year/2 Semesters

Study Center- Blind People’s Association (BPA), Vastrapur, Ahmedabad is an approved study center to conduct this one year Post Graduate Diploma.

 Course Fee- Rs. 15,000/-

 Eligibility- A candidate who has MBBS degree and with minimum of two years of experience may apply for admission.

 Application/Prospectus- The application/Prospectus is priced at Rs. 350/- per copy.

Note- All the amounts of fees specified above cover supply of course material such as books + 160 hours of counseling at the study centre along with supervised practical for each semester. The university does not charge any other fees. All fees must be paid by demand draft drawn in favour of the Manipal Academy of Higher Education (MAHE). Manipal payable at Manipal or Udupi.

For Details Contact to

Mr. Dharmendra Kumar Jena (Course Coordinator)
Email- bpaiceviad1@sancharnet.in
Phone-  09898456171
Website - www.manipal.edu

If you want to give any article for the E-newsletter, further development of the news letter or your remark on the new letter please do contact in the following address. 

Contact

Blind People’s Association
132ft’ Ring Road
Vastrapur, Ahmedabad
Gujarat-380015

Phone-91-79-26304070, 26305082
Email- bpaindia@satyam.net.in
Website- www.bpaindia.org

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 
Blind People's Association, Ahmedabad)

Volume-1
Issue-3
For the Month of March,06

BLIND PEOPLE'S ASSOCIATION (INDIA)  
An Organisation working for the development, provision of equal opportunity and access to all persons with disabilities

Editorial Team

Dr. Bhushan Punani
Executive Director 

Mrs. Nandini Rawal
Project Director

Mrs. Vimal Thawani
Project Manager

Mr. Dharmendra Kumar Jena
Project Coordinator

Mr. Bharat Joshi
Asst. Project Coordinator

2nd National Conference on Psychosocial Rehabilitation 

The Second National Conference on Psychosocial Rehabilitation (Indian Chapter) was organized from 25th to 27th of February, 2005 at Surya Palace Hotel, Vadodara, Gujarat. 

The themes of the Conference were;

The growing recognition that a large proportion of persons with mental illness and mood disorders experience a poor quality of life with long-term disability, persisting symptoms or a relapse of illness have given birth to the field of psychiatric rehabilitations with much emphasis on psychosocial rehabilitation. 

Treatment and rehabilitation are interconnected and offer full range of bio-psychological services in continuous and comprehensive. efforts should be made to reduce impairment, disability and handicap among the mentally disabled. in addition, a major goal of psychiatric rehabilitation is enabling the mentally disabled person and family member to be actively involved in treatment decisions and to achieve the highest feasible quality of life in the community. 

The WAPR - World Association of Psychosocial Rehabilitation is an international organization comprised of professional, non-government agencies, family members and person interested in the area of psychosocial rehabilitation. the organization works in close collaboration with many governmental and voluntary bodies for the cause of psychosocial rehabilitation especially in the area of mental health.

The Indian Chapter has been active for over a decade and its members have steadily grown in numbers. This has prompted the need for national conference for sharing experiences and a proper scientific dialogue to remove stigma; to generate awareness, to advocate for their rights and also to do their rehabilitation and resettlement. 

Major Assets of Blind People's Association

Support Groups and Psycho Social Rehabilitation  

The Support Groups are groups of people who meet regularly to share and discuss issue of common beliefs. The Support Groups are very useful in rehabilitation of mentally ill persons. This support group provide an opportunity for mentally ill persons as well as their family members to share their feelings, problems, ideas, and information with others who have similar experiences. This is such group of family members or patients who face such problems and handle the problems. This group discusses problems like how to control the aggressive behavior, techniques used. They can share the information among the group members by reading the books and newspapers and they can provide an opportunity to help each other. Ultimately the support group works by providing mutual support. This means each member of the group is both being supported by others and providing support to others. This would be very helpful to group in empowering feeling not like as patients is treated as in medical clinic.  

How to start a support group

The Support Groups are not easy to form and get going. They need, first and foremost a group of people who are interested and committed to the idea. At the initial stage, every one is not interested in Support Groups. Some people are not comfortable to share their feelings. When we are going to form support Group we have to keep in mind these points.

Group Members in Support Groups:

It is advisable to form small no Support Groups including 15 to 20 members. The small group is to be easiest to control and for observance of the group activities.

Role of the Group Leader:

The group leader might be family member or agency worker or health worker to fac ilitate group meetings in following way:

Rules and regulations of Support Groups :

(References: Where there is no Psychiatrist  by Dr. Vikram Patel)  

One day training program was conducted at V. S. Gandhi Charitable Trust (One of the Project Implementing Organization through which BPA is running its Mental Health Activities in one of its project area), where 57 patients and 38 family members  attended. Dr. Ajay Chauhan (Superintendent Mental Health Hospital, Ahmedabad) attended the training program as resource person. The program was basically to sensitize the family members of person with mental disorder. The participants were asked to share their experiences, problems they face, how they tackle them in such a situation when the patient become violent.  The members of Primary Care Givers Group stated that they had visited  traditional health practioners and spent a lots of money and did not get benefit out of it. They attended the mental health camps and the medicine had benefited them a lot. Dr Ajay then explained about the mental illness, its symptoms and need to going to a doctor  for this illness as it can be cured better if it is detected early and how do deal with patients in various situations.

(Bharat Joshi) 

 Success Story

Mr. Jasubhai Zhala, village Sunda,  block Kapadwanj, aged 30 years is a member of a joint family 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 a brilliant student during his school time and the only  person in his family who has completed education up to std 12^th.  As his family was dependant on him, he had joined one factory in Vatva GIDC in Ahmedabad after passing out std 12^th. He supported his family for marriages of his two sisters. He had a happy married 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 was then promoted as a skilled worker.  It  was decided to promote him as supervisor because of efficiency in his work. But some how he was not selected as supervisor and this was the unpleasant incident for him, which was the precipitating factor in his becoming mentally ill. After that unpleasant incident he  stopped interacting with any one. During his illness his self-care was totally impaired, communication was also impaired and he avoided  meeting anyone.  He kept himself  locked in a room since last 8 years.  His family members were worried about his behavior and came to conclusion that some evil spirits has totally controlled  his behavior. They had taken him to more than 10 traditional healers and spend more than Rs. 50,000. 

The field workers under mental health project activities had surveyed and identified Mr. Jasubhai as mentally ill and informed his family members about his illness. He was brought to the medical camp organized by Blind People's Association and due to regular medical intervention his behavior had become normal up to a large extent. After his illness, Jasubhai was unable to perform  the daily living skills and occupational skills required for a person of his age.   The field workers  counselled his family members on how to help him in daily life and house hold work and agricultural related activities. The field workers are providing him training in  daily living skills and orienting  him with  household activities and agricultural activities regularly.

He has now been restored to his original condition after 8 years.  He comes out from his  home, has become socially active and shows his willingness to start some new venture.  Now the family members of  Jasubhai are very happy and hope that he will be come Back to his previous situation and live a healthy life. 

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
Jagdish Patel Chowk, Surdas Marg,
Vastrapur, Ahmedabad
Gujarat-380015

Phone-91-79-26304070, 26305082
Email- mailto:bpaindia@satyam.net.in

vimal_2005@sancharnet.in

Website- www.bpaindia.org

Blind  People's Association,Jagdish Patel Chowk, Surdas Marg, Vastrapur, Ahmedabad,       Gujarat-380015