Vocational rehabilitation in persons with mental illness in India: A scoping review.

BACKGROUND: Employment has a therapeutic impact, enhances community integration and improves the quality of life of persons with mental illness (PwMI). Vocational rehabilitation (VR) models must be sensitive to existing needs and resources. Several VR models have been tested in high income countries. Mapping different VR models in India would help both practitioners and policymakers. AIM: The study aimed to comprehensively review VR models tested among PwMI in India. METHODS: We adhered to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. We included interventional studies, case studies and grey literature carried out for the VR of PwMI in India. The search was done in PubMed, PsychInfo, worldwide science and Web of Science. Google Scholar was used to supplement the search. A Boolean search using MeSH terms was carried out for the period January 2000 to December 2022. RESULTS: A total of twelve studies (one feasibility study, four case studies, four institute-based intervention studies and two studies reporting NGOs' role) were included in the final synthesis. The studies included in the review were either quasi-experimental studies or case based. Types of VR included supported employment or place and train or train and place models, case management and prevocational skills training. CONCLUSION: Limited studies exist on VR in PwMI from India. Most studies assessed a restricted set of outcomes. The experiences of NGOs should be published so that practical challenges can be understood. There is a need for public-private partnerships in designing and testing services and should involve all the stakeholders.

Multivariate associations between cognition and neighborhood geospatial characteristics in schizophrenia.

Cognitive impairment contributes to functional impairment in schizophrenia. Yet, little is known about how environmental characteristics are related to cognition in schizophrenia. By examining how cognition and the environment are intertwined, it may be possible to identify modifiable risk and protective factors that can improve cognitive outcomes in schizophrenia. We aimed to identify multivariate associations between cognition and three geospatial characteristics (built-space density, habitable green spaces, and public spaces for social interaction) within one's immediate neighborhood among individuals with schizophrenia. We recruited participants with schizophrenia from three sites - an urban metropolitan and two towns in southern India. We administered standard cognitive assessments and performed a principal axis factoring to identify episodic memory, cognitive control, and social inference-making factors for use in further analyses. We estimated geospatial characteristics of an individual's neighborhood, i.e., up to 1 km2 around the residence, by sourcing data from Google Earth. We performed unconditional and conditional (to examine the effect of clinical covariates) canonical correlation analyses to understand the multivariate relationship between cognition and geospatial characteristics. We analyzed data from 208 participants; the first canonical cognitive variate (higher social inference-making and poorer cognitive control) shared 24% of the variance (r = 0.49; P < 0.001) with the first geospatial variate (lower built density and poorer access to public spaces). Years of education, age at onset, and place of residence significantly modulated this relationship. We observe differential associations of the built environment with social and non-social cognition in schizophrenia, and highlight the clinical and demographic characteristics that shape these associations.

Feasibility testing of a peer support programme for prisoners with common mental disorders and substance use.

BACKGROUND: The prevalence of mental disorders and substance use among prisoners is high. Convicted prisoners of 'good behaviour' can be part of a peer support system in prisons. AIM: To evaluate the feasibility of a peer support programme for prisoners with common mental disorders and substance use in prison. METHOD: The study used a mixed method research design, with a quasi-experimental approach (single group pre-post without control). It was conducted in two phases: Phase I. Thirty-five peers/convicted prisoners were recruited through advertisements on the prisoners' community radio station. Volunteers with good behaviour reports were given training over 5 days to recognise mental and substance use disorders and provide basic peer support in prison; their attitudes and knowledge were tested before and after the training. PHASE II: Feasibility of the peer support programme was tested by (i) recording the number of cases identified and referred, (ii) pre- and post-evaluation of well-being, coping, and symptom severity of those supported and (iii) evaluating qualitatively the experience of the peer supporters and service users. RESULTS: Thirty-five peer supporters identified 49 cases over 3 months. These cases showed significant improvement in well-being (Z -1.962; p < 0.050) and reduction in symptom severity (Z -1.913; 0.056). There was a significant improvement in the peers supporters' self-esteem from pre- to post-training (t -3.31; p < 0.002), improvement in their benevolence (t -4.37; p < 0.001) and a significant reduction in their negative attitudes to mental illness (Z -3.518; p < 0.001). A thematic model of peer support encompassed self-experienced benefits for the peer supporter, wider recognition of peer supporters in the prison, challenges to this kind of support, experience of training and visions for future work. CONCLUSION: The peer support programme was experienced positively by the peer-supporters and supported. Common mental disorders, substance use and suicidality were recognised and appropriately referred. A full-scale evaluation of this promising programme is warranted.

Prevalence of mental disorders in South Asia: A systematic review of reviews.

Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.

Development and validation of a peer support programme for the prisoners with mental and substance use disorders in India.

Background: The prevalence of mental health problems and substance use disorders is high in prisons. There is a need to develop effective and sustainable models in prison to address their mental health demands. Aim: The study aimed to develop and validate a peer support programme (PSP) for prisoners with common mental and substance use disorders (SUD). Method: The PSP was developed by reviewing the literature and expert interviews and validated by seven experts. Result: The expert interview brought out a total of 10 themes. The final components included in the content of the peer support interventions were information about mental health issues, identification of the cases, basic counseling skills, psycho-education, early warning signs and symptoms, managing substance use by motivational interviewing, and suicidal gatekeeping. Conclusion: This study describes the development of a comprehensive PSP, and it needs to be tested to examine its feasibility and effectiveness in addressing mental health problems in prison settings.

Psychosocial Interventions for Prisoners with Mental and Substance Use Disorders: A Systematic Review.

Purpose of the Review: The prevalence of mental and substance use disorders is three to five times higher than that of the general population. Psychosocial interventions are effective in identifying and managing mental health and substance use disorders. This article aims to review the randomized control studies which have used nonpharmacological interventions alone or in combination with pharmacological interventions for managing mental and substance use disorders in prison/correctional settings. Collection and Analysis of Data: Studies included were randomized control trials and pilot randomized studies that assessed the impact of psychosocial interventions for prisoners with mental disorders and substance use disorders. A comprehensive search for articles was done by the primary author (Sreekanth Nair Thekkumkara) in the following databases: PubMed, ProQuest, PsychArticles, and Google Scholar (search engine), for the period June 1, 2000, to December 31, 2020. Results and Conclusions: The 21 studies included in the review had a sample size of 34 to 759. The settings of all the interventions were the prison and different types of psychosocial interventions were provided across the studies. The average duration of intervention ranged between 10 min and 120 min with the frequency of one to six sessions per week for 1 to 36 months. All the 21 Randomized Control Trials (RCTs) were nonIndian studies. Overall, the results of the included studies showed significant improvement postintervention (motivational intervention, interpersonal therapy, cognitive behavior therapy, positive psychology intervention, music therapy, and acceptance and commitment therapy) on primary outcome measures such as symptom severity of depression, anxiety, and substance abuse prisoners. Positive effects were observed on secondary outcome measures such as motivation, aggression, follow up rates, and recidivism. A limited number of studies have focused on evaluating psychosocial interventions in prison settings. Most of the interventions were tested in prisoners with substance use disorder alone or in those with dual diagnoses and in high-income countries.

Hybrid Supported Employment Approach for Persons with Intellectual Disabilities in India: Evidence Based Case Studies.

Studies have reported that persons with developmental disabilities have the lowest rate of labor force participation, relative to other disabilities due to various factors. This paper presents two cases studies of persons with ID who were successfully provided a hybrid supported employment approach of 'train and place model' and 'place and train model' by the Psychiatric Rehabilitation Services (PRS) team. Conducted a retrospective file review highlighting the process of supported employment approach adapted for persons with ID. The ethical approval was obtained from the Institute Ethical Committee. The hybrid supported employment approach focuses on enhancing client's vocational potential and skills, prepare for job ready, find a suitable job placement. Further, the approach helped in improving the sense of independence self-esteem and quality of life of the clients. A hybrid supported employment approach could be an effective method in aiding persons with developmental disabilities in India seek, get, and keep jobs; it will also help them deal with unique challenges they face in the workplace as well as loss of or gaps in employment. Involvement of families in the intervention will help minimize negative expressed emotions and distress.

A Community Participation Initiative During COVID-19 Pandemic: A Case Study From India.

BACKGROUND: A community participation initiative of stitching personal protective equipment (PPE), masks, and face shields for healthcare professionals working in the hospital during the COVID-19 pandemic was conducted using a case study design. METHODS: The hospital tailoring unit was used to cater to the in-house demand for stitching safety gear kits for healthcare professionals. A transect walk was conducted to survey hospitals for selecting material for stitching the safety gears and to draw up a plan to meet future demand. The psychiatric social worker induced a community participatory initiative using the method of social work of community organization. A flyer was prepared to invite participants with prior experience in tailoring for this initiative. All participants were trained by the master trainers of the tailoring unit. The participants were also interviewed about their views on this initiative in an informal interview. RESULTS: A total of 83 participants, including 26 individuals (8 volunteers and 18 who received an honorarium), 2 boutiques (n = 12), and 1 government organization, participated in the activity (n = 45). A total of 1700 complete PPE kits and 13,000 masks were stitched during this period. The participants reported that the benefit of being a part of this initiative was reduced boredom, sense of purpose and satisfaction, and improved mental health due to structured activity. CONCLUSIONS: A community participation initiative using the principles of community organization, a method of social work, can help produce desired outputs and improve the well-being of the participants.

'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.