Need-based rehabilitation program for women with mental illness under long-term admission in a Tertiary Care Hospital: A feasibility study.

BACKGROUND: In keeping with the rights perspective, the rehabilitation needs of the women under long-term admission (LTA) in 'closed wards' of Tertiary Care Hospitals (TCHs) are different, often unfulfilled, and need to be addressed. METHODOLOGY: The study used a qualitative exploratory research design. In phase, I, the rehabilitation needs of Women with Mental Illness (WMI) were assessed. In phase II, a rehabilitation program was developed and implemented in the ward where WMI were admitted. In phase III, the feasibility of the implementation of the Rehabilitation Program was tested. RESULTS: The needs expressed by WMI were personal, economic, vocational, social, emotional, educational, relationship, recreation, reintegration, and health needs. They also expressed needs related to their rights such as privacy, making personal choices, access to mobile phones, holding bank accounts, etc. The stakeholders felt that WMIs who get well should be segregated from people who are acutely ill and given access to interact with other groups of people. Based on the themes elicited, a rehabilitation program was developed and implemented through networking and liaising with various departments of the institute, other Government, Non-Governmental Organizations, volunteers, and corporates. The rehabilitation program was found to be feasible with systemic changes being brought about at the institutional level. CONCLUSION: In keeping with a rights-based approach TCHs need to implement need-based rehabilitation programs for WMI under LTA to improve their living conditions and quality of life.

Vocational skill training programs for persons with intellectual disability (PID) and trainers' perspective during and post vocational skill training.

Background: Employment is one of the primary goals of persons with intellectual disabilities (PID). Employment can lead to positive psychosocial and economic benefits for people with ID, but people with disabilities are not afforded this opportunity to contribute to society through work due to multiple challenges, as well as the transition from vocational skill training to getting employed for PID is more challenging. Materials and Methods: Seven vocational skill trainers were chosen from the seven vocational skill training centres offering skill training for PID and located in urban Bengaluru were selected using a purposive sampling design for this study. The trainers were interviewed to understand their perspectives on challenges during and post vocational training for PID. Results: Training offered to PID in several vocational centres ranged from unskilled to semi-skilled. A range of barriers including gaps in awareness and knowledge of the various training programs for PID challenges associated with their transition after training, unique challenges in placing the trained PID into external organizations, stigma, and attitudinal barriers associated with disability are described to be influencing the skill training of PID and their subsequent employment. Conclusion: Skill training offered for PID across the centres with significant challenges while providing the training and supporting their transition into the community for employment. The challenges of the PID need to be studied at a broader level through including all the stakeholders.

Unequal Representation of Persons with Disabling Mental Health Conditions in the Quota-Based Employment Reservations Notified by a Public Service Commission.

Introduction: The Rights of Persons with Disabilities (RPwD) Act 2016 of India intends to achieve greater representation of persons with benchmark disabilities (PwBD) at government establishments and reserve at least 4% of employment vacancies for PwBD. Of this 4%, 1% is reserved for PwBD with disabling mental health conditions (PwBD-MHC) and multiple disabilities, and 1% each for PwBD due to other disabling conditions like blindness, hearing, and locomotor impairment. Methods: We analyzed all the employment vacancy announcements (EVAs) made by the Indian union public service commission (UPSC) during the calendar year 2020 for their adherence to quota-based employment reservations (QBER). Results: Eighteen vacancy advertisements made during the year 2020, for a total of 1370 posts under various departments, announced a total of 57 posts as reserved for PwBD under the QBER system, satisfying the minimum 4% quota. However, none of these posts is reserved for PwBD-MHC. Further, only 7 out of 1370 were described as suitable for PwBD-MHC, implying that 1363 are not suitable for them. Conclusions: The QBER system and the subdivision of quotas are well-intended to achieve the minimum representation of PwBD across all categories of jobs. However, the EVAs by UPSC in the year 2020 did not reserve any posts for PwBD-MHC and perhaps inadvertently excluded them from consideration for the majority of posts announced even under the unreserved category.

Reasonable Accommodation at the Workplace for Professionals with Severe Mental Illness: A Qualitative Study of Needs.

BACKGROUND: Professionals with Severe Mental Illness (PwSMI) often face challenges in obtaining and retaining employment. For equal and effective participation, they may require reasonable workplace adjustments. The recently legislated Rights of Persons With Disabilities Act 2016 in India defines such adjustments as reasonable accommodations. METHODS: In-depth qualitative interviews were conducted with 15 consenting PwSMI availing psychiatric rehabilitation services at a tertiary mental health institute in India, five mental health professionals, and five employers. The audio-recorded interviews were transcribed and coded manually by two independent investigators. Inductive content analysis approach was used for qualitative analysis. RESULTS: The detected themes included modifications in work schedule, supports to improve work efficiency, modifications in the work environment, modifications in the work-related appraisal, supportive employer policy, and integration of services. The participants described the term "undue burden" to be ambiguous. CONCLUSIONS: The reported reasonable accommodations are non-structural and mainly dependent on human assistance. Vocational rehabilitation and job reintegration efforts can focus on guided negotiations between employers and PwSMI. This is dependent on at least some degree of disclosure. Awareness regarding reasonable accommodation and stigma reduction is necessary for successful implementation.

Admission of persons with disabilities into nursing and midwifery courses: Progress made by the Indian Nursing Council.

India's Persons with Disabilities Act, 1995 (PWD Act, 1995) mandated a minimum enrollment reservation of 3% for persons with disability (PwDs) across all educational courses supported by government funding. Following this, the Indian Nursing Council (INC) issued regulations limiting such an enrollment quota to PwDs with lower limb locomotor disability ranging between 40%-50%. The Medical Council of India (MCI) also restricted admissions under the PwD category to PwDs with a lower limb locomotor disability to comply with the Act. The Rights of Persons with Disabilities (RPwD) Act, 2016, which replaced the PwD Act, 1995, raised the minimum reservation to 5% for all government-funded institutions of higher education and extended this reservation to PwDs under 21 different clinical conditions, rather than the seven conditions included under the PwD Act, 1995. Following the enactment of the RPwD Act, 2016, the MCI issued regulations that allowed PwDs with locomotor disability and those with a few other types of disabilities in the range of 40%-80%, to pursue graduate and postgraduate medical courses, while the INC has not made any changes. This article addresses the complexities of inclusion of PwDs in the healthcare workforce, offers suggestions for inclusive measures; and compares the INC admission regulation released in 2019 to the MCI 2019 admission guidelines for graduate and postgraduate medical courses.

'Family centric rehabilitation' for persons with mental illness in India: Conceptual framework using evidence-based case studies'.

PURPOSE OF THE STUDY: In India, people live in a collective society wherein family members are the primary caregivers for the person suffering from mental illness (PMI). Psychiatric rehabilitative models are individual-centric, focusing on individual level skills (emotional, social, self-management and vocational) and development to enhance successful community reintegration. If the entire family is considered to be a unit for rehabilitation, i.e. family centric rehabilitation, the possibility of empowering the family to function effectively is higher despite the illness. The objective of the case study is to conceptualize the framework 'Family centric Rehabilitation'. METHODS: Case study design. RESULTS: Family centric rehabilitation can be conceptualized as 'a process that facilitates families, dysfunctional due to PMI, to reach their optimal level of independent functioning by harnessing resources available within the community'. Family centric rehabilitation focuses on enhancing global functioning of the "family unit", in essence all members, rather than just the PMI. Strategies deployed include concurrently addressing and minimizing anticipated challenges across domains including medical, psychosocial, vocational as well as economic, thereby aiding in recovery of the family unit as a whole. CONCLUSIONS: Family centric rehabilitation is an important culture specific concept that aims to provide optimal level of functioning of all family members and can contribute to the family achieving self-sustenance, a sense of autonomy and empowerment.

Development of vocational potential assessment tool and counseling module for persons with severe mental disorders.

OBJECTIVE: To develop and validate the vocational potential assessment tool and counselling module for persons with severe mental disorders (SMD). METHOD: The tool and the module were developed through review of existing assessment tools, individual interviews and focused group discussions with key stake holders- persons with SMD, caregivers, expert mental health professionals and employers. The developed tool and module were validated by experts. RESULT: The process of tool and module development was conducted simultaneously and included 11 persons with SMD, 9 caregivers, 9 experts and 9 employers. A total of 38 themes were obtained through individual interviews and focused group discussions. The developed tool and module along with a scoring key were validated by 6 mental health experts. CONCLUSION: The tool is easy to use and comprehensive, takes approximately 45 min to 1 h for assessment. The module provides a framework for vocational counselling. The scoring key provides a guideline for professionals during assessment.

Vocational challenges in severe mental illness: A qualitative study in persons with professional degrees.

BACKGROUND: Employment is a significant stepping stone towards recovery for persons with severe mental illness. In the last two decades there has been increasing focus on obtaining professional courses and degrees for employment in India. AIM: To understand the challenges faced by persons with severe mental illness with professional degrees in obtaining and maintaining employment. METHODS: We interviewed 31 individuals with severe mental illness, who had professional degrees, using qualitative interviews. These interviews explored factors that facilitated as well as those that hindered the process of obtaining and sustaining jobs. RESULTS: Factors that were identified as facilitators for obtaining and maintaining employment included personal strengths, social support, accommodative work environment, disclosure, support from mental health professionals and services. Factors that were identified as hindering for obtaining and maintaining employment included symptoms of the illness, side effects of medications, stigma, poor social support, academic underachievement, disjointed work history, poor workplace environment and specific cultural, gender issues. CONCLUSION: Factors such as workplace accommodations, creating an environment that is permissive of disclosure, using family support and support from mental health professionals will facilitate employment. Addressing factors that hinder such as stigma, academic under-achievement, improving workplace environments, social support will also be important in vocational recovery.

Recurrent Episodes of Dissociative Fugue.

Dissociative fugue is rare entity to encounter with possible differentials of epilepsy and malingering. It is one of the dissociative disorders rarely seen in clinical practice more often because of the short lasting nature of this condition. This might also be because of organized travel of the individuals during the episodes and return to their families after the recovery from episodes. This is a case description of a patient who has experienced total three episodes of dissociative fugue. The patient has presented during the third episode and two prior episodes were diagnosed as fugue episodes retrospectively based on the history. Planned travel in this case by the patient to a distant location was prevented because of early diagnosis and constant vigilance till the recovery. As in this case, it may be more likely that persons with Dissociative fugue may develop similar episodes if they encounter exceptional perceived stress. However, such conclusions may require follow-up studies.