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.

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.

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.

Conjoint Couple Therapy with a Woman Survivor of Intimate Partner Violence: Strengths and Challenges.

Intimate Partner Violence (IPV) or Domestic Violence (DV) affects the mental health of women. Systemic family therapy has been found to help bring change in a couple's relationship and the cessation of violence in the relationship, provided both couples are motivated by the therapy to preserve the marital relationship. This article presents a case of offering brief tailor-made individual intervention as well as couple therapy for a woman with depression experiencing violence.

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.

Development and Validation of Yoga Program for Patients with Type 2 Diabetes Mellitus (T2DM).

This study with aim of development and validation of a yoga program for patients with T2DM was carried in view of emerging evidence of yoga as an alternative and/or complementary treatment. Classical and contemporary yoga texts were reviewed for identification of yoga practices. After reviewing research papers and yoga texts a THREE-step yoga program, in order of increasing difficulty level for T2DM was prepared. For validation of yoga program, mixed methods approach integrating qualitative and quantitative inputs was considered. Eighteen experts over three rounds of iteration contributed toward validation of yoga program. A final set of three-step yoga program was obtained which further needs to be tested in standardized randomized controlled trials.Trial Registration With Indian Council of Medical Research: Clinical Trial Registry of India; ICMR-CTRI: Development and Validation study: CTRI/2013/11/004163.

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.

Care at Doorsteps for Persons with Severe Mental Illnesses as a Part of District Mental Health Program (DMHP): A Qualitative Needs Assessment and Psychosocial Framework.

Care at Doorstep (CAD) is a home care service that includes medical and social care by skilled professionals. The purpose of this paper is to explore the need for CAD among users of the district mental health programme (DMHP) in Ramanagaram, Karnataka, India who have severe mental illness. The design of this study was descriptive where a qualitative inductive methodology was adopted. Data was collected from interviews of 20 caregivers and 7 mental health service providers linked to the DMHP. Socio demographic information was collected from participants and a semi-structured interview guides were used to explore needs and challenges in delivering care at home by the professionals. The themes that emerged from the manually transcribed and coded data were categorized as needs and challenges and used for developing a CAD model.

Recreation for Psychosocial Rehabilitation of Clients with Mental Health Disorders: A Retropective Review.

Recreation is considered as an important part of rehabilitation as it increases cognitive ability improves social and communication skills among clients with mental health disorders. As part of Psychiatric Rehabilitation Services NIMHANS, weekly recreational activities are conducted for clients with mental health disorders. A retrospective file review of clients' feedback (who participated offline and online) about the recreation session was conducted. Thematic analysis was carried out to analyze the data. Reasons and Benefits of participating in recreation challenges faced, and changes clients would want to bring in the sessions were the themes that emerged. There were differences in the structure of recreation activity conducted in online and offline mode. Overall clients were happy and interested to participate in recreation activities. Recreation should be an integral part of psychosocial rehabilitation for clients with mental health disorders.

Yoga Module Development and Validation: A Systematic Review with Methodological Guidelines.

In the past decades, more than fifty different yoga styles have been implemented in the therapeutic context to manage various diseases. Yet, not all of these yoga styles have been validated or standardized as a program. The aim of this article is to review the different methodologies used for yoga module development and to assess their quality. Three databases (PubMed, Web of Science, and Scopus) were searched using the following keywords and Boolean operators: (validation OR development OR design) AND (yoga OR mind-body) AND (module OR protocol OR program). Three thousand six hundred and seventy-one articles were enlisted, and based on the inclusion and exclusion criteria, 37 articles were narrowed down for review. Since no checklist exists to assess the quality of yoga modules, the authors designed a 23-item checklist to categorize each having low, medium, or high quality. As per the yoga module quality checklist, only 21.6% of the studies had high quality, while 75.3% of the articles had medium quality and 8.11% had low quality. A commonly used development method was literature review, while for validation, experts' scoring of the Likert scale was the preferred means. The feasibility of the module was carried out only by half of the studies. Few diseases such as cardiovascular disease, diabetes mellitus, obesity, Parkinson's disease, and obesity had more than one yoga module developed. The findings of this systematic review have shed some light on the growing need for standardized methods of yoga module development. The 23-item checklist can guide researchers in the homogeneous development strategies when designing yoga interventions in the future.

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.

Development of a Supported Education Program for Students with Severe Mental Disorders in India.

BACKGROUND: The onset of severe mental disorders (SMDs) is during adolescence or young adulthood, which affects the well-being and the educational aspirations of the students. Models of supported education practiced in the West are not culturally suitable for Indian students or the Indian education system. This study aimed to develop a Supported Education Program (SEP) for students with SMDs to help them with academic reintegration in an Indian context. METHODS AND MATERIAL: To develop the SEP, a realist review was done, followed by an in-depth interview with eight mental health professionals (MHP) and nine lecturers, using a validated interview script. After each interview, interim analysis and modifications were done to improve the rigor of the interview. After all interviews, the SEP was circulated for a second round of iteration for consensual validation by four mental health experts. The outcome of the entire process was the final version of SEP for students with SMDs. RESULTS: The final SEP had two broad themes and 18 subthemes from the qualitative thematic analysis: theme 1 included issues and strategies relevant to the client or caregivers, and theme 2 was pertinent to the education system. CONCLUSION: The SEP developed and validated for people with SMDs has distinctive components: one for the individual and caregiver and the other for the educational system.

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.

Yoga therapy for Obsessive Compulsive Disorder (OCD): A case series from India.

Yoga is an ancient science which has been found to be helpful in the management of several psychiatric disorders including Obsessive Compulsive Disorder (OCD). Yoga as add-on treatment in OCD may help address issues like partial response and adverse effects of medications. However, research in this area is sparse, which led us to explore it through this case series. In this case series we have described the benefits of 1 month of yoga as add-on treatment in patients with OCD. All patients were on stable doses of medications prior to and during yoga practice. Pre-post assessments for the core symptoms of obsession/compulsions as well as depressive and anxiety symptoms were done. The assessments showed significant improvement in Y-BOCS and HAM-D scores after 1 month of yoga. Yoga therapy could be an effective add-on therapy for the treatment of OCD.

Generic Yoga Modules for Clinical and Research Settings-Need of the Hour.

Yoga-based interventions offer significant promise in healthcare. However, meta-analyses of various yoga trials suggest that comparisons of trials are either not possible or difficult due to heterogeneity in therapeutic yoga interventions. Also, in view of emerging evidence for the role of therapeutic yoga, it is important to identify the specificity and validity of various yoga components being used in different trials. Efforts in this direction will be fruitful only if a systematic approach is adopted to develop yoga programs for various ailments. In this article, we emphasize the need for a "generic yoga" concept for designing a therapeutic yoga program for particular health issues, with the objectives of promoting scientific growth of therapeutic applications of yoga and widespread application of standardized therapeutic yoga programs within a biomedical framework. This generic therapeutic yoga will essentially highlight the development-validation process of uncopyrighted yoga programs; their components, benefits, and possible side-effects; and requirement for need-based modifications.

Tele-Yoga Therapy for Common Mental Health Disorders: Need for Assessment Tool and Guidelines.

INTRODUCTION: Tele-yoga is a cost-effective method of teaching yoga using cloud technology to relay from one source (trainer's venue) to multi-point video conferencing centers (participants' homes). However, there is a need to assess the tele-yoga trainer and the training itself to ensure safety and effectiveness. MATERIALS AND METHODS: The Tele-Yoga Trainers Assessment (TYTA) tool was developed through (a) review of existing tools, (b) key informant interviews, and (c) validation by experts. It was tested for its feasibility in six persons with common mental disorders. A trained yoga therapist conducted tele-yoga therapy sessions which was webcast from NIMHANS Integrated Center for Yoga to NIMHANS Center for Well-Being for the first 15 days and to the respective homes of the participants using "Skype" in the remaining 15 days. Participants were assessed on (a) mental well-being, (b) satisfaction with overall health and were administered the (c) TYTA tool on the 1st, 15th, and 30th day. RESULTS: The TYTA was easy to administer for assessing the performance of the yoga trainer. The qualitative case reports of individual participants depicted that over 30 days, mental well-being and satisfaction with overall health improved trainer's performance. CONCLUSION: Tele-yoga therapy is feasible with minimum technology and availability of good internet access at the relay and reception site. The trainer must be assessed for his/her suitability and be provided guidelines for achieving desired outcomes.