COMMUNITY MENTAL HEALTH AND DEVELOPMENT PROGRAM IN SOUTH INDIA 2008-2011
Item
- Title
- COMMUNITY MENTAL HEALTH AND DEVELOPMENT PROGRAM IN SOUTH INDIA 2008-2011
- extracted text
-
• I
•j
BASIC NEEDS INDIA
"Mterffal 'PteaM aad Z)eaeCafimeat
ll
i
BM?CTfes:.
.T&
^■'
M
Si
COMMUNITY
MENTAL HEALTH
AND
DEVELOPMENT
PROGRAM
IN
SOUTH INDIA
isM* ■■■
I
!
1
i
I
I L'
i
k.-
I
I
ta'
■RC
■-
>■■■
W:
' '
fnMH
2008-2011
A Report
Presented by
Gururaghavendra C.E
Program Officer
South India Program
Email: gura@basicneedsindia.org
Cibin Jacob V
Program Coordinator
South India Program for Kerala and Tamil Nadu
Muniraja T
Program Coordinator
South India Programfor Karnataka andA ndhra Pradesh
Basic Needs India
Bangalore
Phone: 080-254 53875Bangalore
Phone: 080-254 53875
Owt 'TKetft&i cutd
Sftcict &c/iutct {fawwM-cty. 'TKeataC
and 'DeaeCo/iment 'Pna^nant
In Remembrance of Mr. D.M. Naidu
Mr. D.MNaidu the founder director of BNI passed away after a brief period of hospitalization on 15th
March, 2011 at Bangalore. A memorial service is planned by his family on 27th March, 2011 at Association
of the Persons with Disabilities (APD). The outpourings of condolences and expressions of grief and loss
from several quarters and groups across the country and some foreign countries has been a testimony to
the contributions and endearing qualities of this simple person.
Naiduji (as he is referred to) after spending over two and a half decades at APD, (much of it in senior
leadership role) had a short term with CAPART, heading its Disability Wing. He teamed up with Mr.
Chns Underhill subsequently, to co-found BNI a decade ago, recognizing the urgency and the low priority
given to mental health by the concerned governance group. At a time when mental health was
synonymous with psychiatrists and mental hospitals, psychiatric drugs and the pervasive stigma, BNI was
a philosophy and an approach that was ahead of its times. The inspiration and ground level strategies
came from the empowerment approach of community development, which was tested on the ground
through pilot programs ably by Naiduji. Central to this unfolding pilot was a deep respect for the mentally
ill person, put into operation right from the beginning, through ‘consultation’ with Persons with Mental
Illness (PWMI) in developing the program. The community mental health and development (CMH&D)
approach demonstrated an alternative, person friendly, participatory, demystified and replicable way for
mental health promotion. Very quickly, Mi; Naidu and his small team undertook expansion of the work
through parmership into several states to demonstrate its replicability in different situations.
Community Mental Health And Development Program In South India - A Consolidated Report
VI
Sustaining these rapid developments was Naiduji’s resourcefulness and the able guidance of the strong
trustees group that was put together.
Naiduji’s strengths were his deep sensitivity for the most
marginalized, along with his managerial competence, wide network linkages and the respect he attracted
through his simplicity and directness. Under Naiduji’s directorship and with the steadfast support and
guidance of the Trustees, the pilot initiative grew to partnership presence in several states. BNI
successfully transitioned to a purely Indian identity and saw its growth into a nationally recognized
resource group (and put in place a team to take it forward) all in the short span of ten year's. The
CMH&D approach also expanded to several countries, wherein the initiators came to him to leam their
basic lessons.
As the community based and development oriented mental health work unfolded in several states, the
need for national level advocacy became an urgent concern with Naiduji. He was motivated by factors
such as, the magnitude of the (un-responded) needs of the affected persons in the country, the nascent
stage of the development of CMH&D and hence, the non representation of the ‘voices’ of the poor
marginalized PWMI in decision making at the governance level. Tie has been quite central to the evolving
advocacy processes on behalf of the poor mentally ill persons at the national level. It has been stated by
his friends from the national alliance that he has been a binding force, in the contextual reality of differing
interest groups, individual egos and contradicting positions. He passionately championed
the cause of
his constituency and yet retained the relationship and respect of persons of other interest groups and
professional groups. His enduring strengths have been, his simple lifestyle, transparent actions, willingness
to be sensitive to another and differing view point and a sharp earthy wit.
Mr. Naidu was himself a 'wounded healer^ stricken with polio at age of one year and several other
lifelong
afflictions and conditions. He is reported to have confided that the greatest challenge he had
overcome was the emotional trauma around his physical disability as a child and that he felt equipped to
Community Mental Health And Development Program In South India - A Consolidated Report
VII
face all other challenges that came his way subsequently. He struggled and sought on an eveiyday basis to
maintain a balanced judgment, in the face of the emotional conditions that was part of his make-up.
Accepting that his end had come, his last days he used for positive affirmation of his numerous friends
and younger associates and communicating that he was a contented person as he departs.
We at BNI will miss him and also hope to move to celebrating our journey together, while we continue on
our larger journey ahead.
N\(AvCi KftlLLfttki
Fortlie BNI team
Community Mental Health And Development Program In South India - A Consolidated Report
VIII
TABLE OF CONTENTS
LIST OF TABLES XII
LIST OF FIGURES XV
ABBREVIATIONS XVIII
Preface XXI
Acknowledgements XXIV
BNI'S COMMUNITY MENTAL HEALTH AND DEVELOPMENT PROGRAM 1
BNI's Community Mental Health and Development Model 2
Organization Partnership with BNI3
Types and Criteria of Partnership 4
Primary Partners and Involvement Criteria 4
Secondary Partners and Involvement Criteria 4
Working Areas of Partners 5
Introduction to Partner Organizations 7
PROCESS OF THE STUDY 12
Background of the Study 12
Aims 14
Rationale for the Study 14
Planning the Study 15
Drawing out the Objectives 15
Developing Proposal Based on the Objectives 16
Specifying the Objectives of the Study 16
Other Considerations 17
Population and Sample 17
Methods of Data Collection 21
Observation 21
Case Study 21
Interviews 22
Community Mental Health And Development Program In South India - A Consolidated Report
IX
Tools for Data Collection 22
Consultation Meetings on the Study with the Partners 23
Capacitating the Partners for the Study 23
Field Testing the Interview Schedule 23
Developing the Formats for Collating Data 24
Collecting Data from Partner Organizations 24
Collating Data at BNI24
Analyzing the Data and Development of the Final Report 25
Moving Forward 25
SOCIO-DEMOGRAPHIC PROFILE OF PWMI IN CMH&D PROGRAM 26
Section 1: Basic Demographic Data of PWMI in CMH&D Program 26
Section 2: Socio-Demographic Data of PWMI in CMH&D Program 38
Section 3: Economic Status Data of PWMI in CMH&D Program 46
Poverty and Mental Illness 46
DIAGNOSIS, TREATMENT AND ACCESS TO TREATMENT 52
Stigma and Discrimination 53
Diagnosis and Categorization of Mental Illnesses 54
Regularity in Undergoing Treatment and Stabilization 57
Side Effects and Relapse 59
Dropout from Treatment 62
Summary of Findings 67
SOCIAL INCLUSION: COMMUNITY AND SOCIAL PARTICIPATION 69
Family decision making by PWMI 70
Contribution of PWMI to the Income of the Family 72
PWMI Involved in Productive Work 74
PWMI Involved In Community and Social Activity 76
Inclusion of PWMI in to Community Groups 77
Summary of the Findings 81
ACCESSING ENTITLEMENTS AND SOCIAL SECURITY SCHEMES 83
Summary of the Findings 90
MOVING FORWARD: MAJOR FINDINGSAND RECOMMENDATIONS 92
Community Mental Health And Development Program In South India
A Consolidated Report
x
Highlights of the study findings 93
Recommendations 96
SYMPTOMS OF MENTAL ILLNESS 101
Categories of Mental Illnesses 101
Severe Mental Illness 102
Common Mental Disorders 104
Others 111
Mental Retardation (MR) 114
LIST OF STATISTICAL TABLES CORRESPONDING TO FIGURES PRESENTED IN THE REPORT 115
Chapter 3 Socio-Demographic Profile of PWMI in CMH&D Program 115
Chapter 4 DIAGNOSIS, TREATMENT AND ACCESS TO TREATMENT 121
Chapter 5 Social Inclusion: Community and Social Participation 126
Chapter 6 Accessing Entitlements and Social Security Schemes 129
INTERVIEWER'S JOURNAL 131
Community Mental Health And Development Program In South India - A Consolidated Report
XI
LIST OF TABLES
Table 1.1
Partners in Karnataka
5
Table 1.2
Partners in Andhra Pradesh
6
Table 1.3
Partners in Tamil Nadu
6
Table 1.4
Partners in Kerala
7
Table 2.1
District-wise and Partner-Organization-wise Distribution of PWMI in the
CMH&D Program of South India
18
Table 2.2
Partner Organizations and Distribution of PWMI in the CMH&D Program In
Kerala
19
Table 2.3
Partner Organizations and Distribution of PWMI in the CMH&D Program in
Karnataka
19
Table 2.4
Partner Organizations and Distribution of PWMI in the CMH&D Program in
Andhra Pradesh
20
Table 3.1
Distribution of Identified PWMI in CMH&D Program Based on Categories of
Mental Illness
115
Table 3.3
Sex-wise Distribution of PWMI Identified in CMH&D Program
116
Table 3.4
Sex-wise Distribution of PWMI in CMH&D Program on the Basis of Categories
of Illness.
117
Table 3.5
PWMI Based on Marital Status
117
Table 3.7
PWMI Based on Marital Status and Sex
118
Table 3.8
Prevalence Of Mental Illness in Children, Young and Older Persons in CMH&D
Program
118
Table 3.9
PWMI in CMH&D Program Based on Age And Sex
118
Table 3.10
PWMI in CMH&D Program Based on Caste
119
Table 3.12
PWMI in CMH&D Program Based on Caste And Sex
119
Table 3.13
Identified PWMI in CMH&D Program Based on Categories of Mental Illness
And Education
119
Table 3.14
Identified PWMI In CMH&D Program Based on Education and Sex
120
Community Mental Health And Development Program In South India - A Consolidated Report
XII
0
Table 3.15
PWMI in CMH&D Program Based on Occupation
120
Table 3.16
Identified PWMI Based on Types of Illness And Annual Income
121
Table 4.1
Distribution of PWMI Based on Sex And Diagnosis
121
Table 4.2
PWMI in CMH&D Program Based on Stat us of Treatment
122
Table 4.3
PWMI Stabilized After Treatment Based on Sex
122
Table 4.4
PWMI Reporting Side Effects Based on Sex
123
Table 4.5
PWMI Reporting Side Effects Based on Types of Illness
123
Table 4.6
PWMI Reporting Relapse of Symptoms Based on Sex
123
Table 4.7
PWMI Reporting Relapse of Symptoms Based on Types of Illness
123
Table 4.8
PWMI Drop-out from Treatment Based on Sex
124
Table 4.9
Reason for PWMI Drop-out from the Program Based on Illness
124
Table 4.10
Reasons for Death of PWMI According to Illness
125
Table 4.11
PWMI Consulting Village Quacks
125
Table 4.12
PWMI Accessing Treatment from Different Sources Based on Types of Illness
125
Table 5.1
PWMI Involved in Decision-Making According to Categories of Mental Illness
126
Table 5.2
PWMI Involved in Decision-Making Based on Sex
126
Table 5.3
PWMI Contributing to the Income of the Family
126
Table 5.4
PWMI Contributing to the Income of the Family Based on Sex
127
Table 5.5
PWMI Involved In Productive Work Based on Illness
127
Table 5.6
PWMI Involved In Productive Activity Based on Sex
127
Table 5.7
PWMI Involved In Community and Social Activity Based on Illness
127
Table 5.8
PWMI Involved In Community And Social Activity Based on Sex
128
Table 5.9
Inclusion of PWMI into Community Groups Based on Sex
128
Table 5.10
Inclusion of PWMI into Community Groups Based on Illness
128
Table 5.11
Inclusion of Caregivers of PWMI into Community Groups Based on Sex
128
Community Mental Health And Development Program In South India - A Consolidated Report
xm
Table 6.1
Accessing Entitlements and Social Security Schemes By PWMI Based On Sex
129
Table 6.2
Accessing of Disability Identity Cards By PWMI
129
Table 6.3
PWMI Accessing BPL Cards
129
Table 6.4
Distribution of Persons Accessing BPL Cards According to Illness
129
Table 6.5
PWMI Under MNREGA Program Based on Sex
130
Table 6.7
Distribution of PWMI under MNREGA Program According to Illness
130
Community Mental Health And Development Program In South India - A Consolidated Report
XIV
LIST OF FIGURES
Figure 3.1
Distribution of Identified PWMI Based on categories of Mental Illnesses
27
Figure 3.2
Percentage Distribution of PWMI Based on the categories of Illnesses
29
Figure 3.3
Sex- Wise Distribution of PWMI Identified In CMH&D Program
30
Figure 3.4
Sex-Wise Distribution of PWMI Based on the category of Illness
32
Figure 3.5
PWMI Based on Marital Status
33
Figure 3.6
PWMI Based on Marital Status
34
Figure 3.7
PWMI Based on Marital Status And Sex
34
Figure 3.8
Prevalence of Mental Illness In Children, Young and Older Persons
36
Figure 3.9
PWMI Based on Age and Sex
37
Figure 3.10
PWMI Based on Caste
39
Figure 3.11
Identified PWMI Based on Caste
40
Figure 3.12
PWMI in CMH&D Program Based on Caste and Sex
41
Figure 3.13
Identified PWMI Based on Categories of Mental Illness and Education
42
Figure 3.14
Identified PWMI Based on Education and Sex
43
Figure 3.15
PWMI Based on Occupation
47
Figure 3.16
Identified PWMI Based on Types of Illnesses And Annual Income
49
Figure 3.17
PWMI Based on Levels of Income
50
Figure 4.1
Distribution of PWMI Based on Sex And Diagnosis of Illness
55
Figure 4.2
PWMI Based on Status of Treatment
57
Figure 4.3
PWMI Stabilized after Treatment Based on Sex
58
Figure 4.4
PWMI Reporting Side Effects Based on Sex
59
Community Mental Health And Development Program In South India - A Consolidated Report
xv
Figure 4.5
PWMI Reporting Side Effects Based on types of Illness
Figure 4.6
PWMI Reporting Relapse of Symptoms Based on Sex
Figure 4.7
PWMI Reporting Relapse of Symptoms Based on types of Illnesses
Figure 4.8
Dropout from Treatment Based on Sex
Figure 4.9
Reasons for PWMI Dropout from the CMH&D Program Based on Illness
Figure 4.10
Reasons for Death of PWMI According to Illness
Figure 4.11
PWMI Consulting Village Quacks
Figure 4.12
PWMI'S Access of Treatment from Different Sources Based on Types of Illness
Figure 5.1
PWMI Involved in Decision Making According to Categories of Mental Illness
Figure 5.2
PWMI in CMH&D Program Involved in Decision Making Based on Sex
Figure 5.3
PWMI Contributing to the Income of the Family
Figure 5.4
PWMI Contributing to the Income of the Family Based on Sex
Figure 5.5
PWMI Involved in Productive Work Based on Illness
Figure 5.6
PWMI Involved in Productive Work Based on Sex
Figure 5.7
PWMI Involved in Community and Social Activity Based on Illness
Figure 5.8
PWMI Involved in Community and Social Activity Based on Sex
Figure 5.9
Inclusion of PWMI into Community Groups Based on Sex
Figure 5.10
Inclusion of PWMI into Community Groups Based on Illness
Figure 5.11
Inclusion of Caregivers Of PWMI Into Community Groups Based on Sex
Figure 6.1
Accessing Entitlements and Social Security Schemes by PWMI Based on Sex
Figure 6.2
Accessing of Disability Identity Cards by PWMI
Figure 6.3
PWMI Accessing BPL Cards
Figure 6.4
Distribution of People Accessing BPL Cards According to Illness
Figure 6.5
PWMI under NREGA
Community Mental Health And Development Program In South India - A Consolidated Report
60
60
61
62
63
64
65
66
71
72
73
73
74
75
76
77
78
79
80
84
85
86
87
87
XVI
Figure 6.6
PWMI under NREGA Based on Sex
88
Figure 6.7
Distribution of PWMI under NREGA According to Illness
89
Community Mental Health And Development Program In South India - A Consolidated Report
XVII
ABBREVIATIONS
ADD DIP
Action on Disability and Development Direct Intervention Program
ADD India
Action on Disability and Development
ADS
Alcohol Dependence Syndrome
AIDS
Acquired Immuno Deficiency Syndrome
AP
Andhra Pradesh
ASSA
Amar Seva Sangam Aykudi
AVHV
Anantha Vikallangula Hakkula Vedhika
BNI
Basic Needs India
BPAD
Bipolar Affective Disorder
BPL
Below Poverty Line
CAP ART
Counsel for Advancement of Peoples Action and Rural Technology
CBO
Community Based Organization
CBR
Community Based Rehabilitation
CMD
Common Mental Disorder
CMH&D
Community Mental Health and Development
CPMR & MI
Cerebral Palsy Mental Retardation and Mental Illness
CPZ
Chlorpromazine
DMHP
District Mental Health program
ESAI
Education Social Action Initiatives
GASS
Grameena Abyudaya Seva Samsthe
GIVAM
Grameena Ikyatha Vikalangula Abhivridhi Mandali
GTCS
Generalized Tonic- Clonic Seizure
HIV
Human Immuno Vims
ID
Identity
IGP
Income Generation Program
IKP
Indira Kranthi Patham
IRCDS
Integrated Rural Community Development Society
MBC
Most Backward Caste/ Communities
Community Mental Health And Development Program In South India - A Consolidated Report
XVIII
MGNREGA
Mahatma Gandhi National Rural Employment Guarantee Act
MR
Mental Retardation
NBJK
Nav Bharat Jagriti Kendra
NF
Narendra Foundation
NGO
Non-Governmental Organisation
NIMHANS
National Institute of Mental Health And Neuro Science
NMHP
National Mental Health Program
NREGA
National Rural Employment Guarantee Act
NREGS
National Rural Employment Guarantee Scheme
OBC
Other Backward Caste/Communities
OCD
Obsessive Compulsive Disorder
PHC
Primary Health Centre
PSW
Psychiatric Social Work
PUG
Pre University Course
PWD
Person with Disability
PWMI
Person with Mental Illness
RDT
Rural Development Trust
SACRED
Social Action for Child Rehabilitation Emancipation and Development
SC
Scheduled Caste
SCORD
Society for Community Organization and Rural Development
SDTT
Sir Darobji Tata Trust
SHG
Self Help Group
SIP
South India Program
SJDT
St Joseph Development Trust
SMD
Severe Mental Disorder
SOCHARA
Society for Community Health Awareness, Research and Action
ST
Scheduled Tribe
Std
Standard
TCT
Thirumalai Charity Trust
TIA
Transient Ischemic Attack
TN
Tamil Nadu
Community Mental Health And Development Program In South India - A Consolidated Report
XIX
TRED
Trust for Rural Education and Development
TSSS
Talessery Social Service Society
UK
United Kingdom
VO
Voluntary Organization
VOSARD
Voluntary Organization for Social Action and Rural Development
WHO
World Health Organization
WORD
Women’s Organization for Rural Development
Community Mental Health And Development Program In South India - A Consolidated Report
XX
ental health refers to our cognitive and emotional wellbeing - it is about how we think, feel
and behave. Mental health includes a person's ability to enjoy life - to attain a balance
between life activities and efforts to achieve psychological resilience.
Today, over a billion people in the world live with some form of disability. In the years ahead, mental
illness is going to be of concern as the prevalence of illness will rise due to several factors including the
vast ageing populations, higher risk of illness in older people, increase in chronic health conditions,
neo-liberalization policies that affect the poor, inequitable development. This disability (mental illness)
has a direct impact on mental health that disables an individual from dealing with everyday life.
The need to empower people living with mental health problems is the need of the hour and a
collective effort must be made to remove the barriers, which prevent people with mental health
problems from participating in activities of their communities, getting equal access to health care,
education and employment.
Community Mental Health And Development Program In South India - A Consolidated Report
XXI
As a result, BNI through its work has tirelessly engaged with communities, partner organizations and
policy makers, to empower communities in dealing with mental health issues and disability rights and
livelihood. The present study on the Community Mental Health and Development Program in South
India endeavors to understand the South India program in its entirety - status of PWMI in order to have
an understanding of issues involved in improving the lives of PWMI with the hope that it will influence
policy makers, which in turn improve the lives of people with mental health problems.
Community Mental Health and Development Program in South India is a consolidated report of the
Community Mental Health and Development program in South India implemented by BNI.
Community Mental Health and Development Program in South India delves closely into the lives of
people with mental health problems, delving into a key strategy that CBR are an important way to
respond to the needs of PWMI. PWMI have poorer health outcomes, lower education achievements,
less economic participation and higher rates of poverty.
The study examines the multiple social barriers in accessing services that include fundamental rights,
which includes right to life, health, education, employment and access to information. These difficulties,
this study shows, are further exacerbated for the less advantaged communities, children, the elderly
and the vulnerable.
Community Mental Health And Development Program In South India - A Consolidated Report
XXII
Community Mental Health And Development Program In South India makes suggestions to all
stakeholders - BNI and its partners, communities, including academicians, students studying the
issues of mental health in India, government bodies, civil society organizations, including mental health
and disabled people’s organizations and medical practitioners seeking to look at the community
interventions of mental health in the pursuit that an enabling environment will be created.
PWMI often do not have a voice. They should be central to our endeavors. BNI hopes and continues to
work in bringing the voice of the voiceless to the fore with the hope of an egalitarian world.
Gitin (Juot /
Community Mental Health And Development Program In South India - A Consolidated Report
7
XXIII
J
Acknowledgements
Nl dedicates this study to late Mr. D.M. Naidu who was the visionary and guide to initiate
this South India study. Throughout the study, we constantly fell back on his insights on communities
and his messages remain with us.
We would like to thank the contributors, partner organizations, field support staff, staff members of
organizations, the participants of the study and peer reviewers, editors of this Report.
Acknowledgement is also due to the report advisors of BN I, all BNI staff for offering their support and
guidance. Without their dedication, support and expertise this study would not be possible.
The Report also benefited from the efforts of many other people, in particular, individuals from all
partner organizations for their assistance and support in the data collection: Mr. Thippana Director,
SACRED, Ananthapur; Ms. Lakshmi Prasanna, Mental Health Coordinator; Ms. Deepika - Accounts
and Administration; Ms. Amali, Director, GASS Doddaballapura; Mr. Ravi Kumar, Mental Health
Community Mental Health And Development Program In South India - A Consolidated Report
XXIV
Coordinator; Mr. Putta Raju, Coordinator; Ms. Lakshmidevamma, Field staff; and Mr.Ravi Nayak,
field staff.
Thanks are due to the following: Mr. Rajanna, Director Narendra Foundation; Mr. Rajagopal Secretary, Narendra Foundation; Mr. Natesh, Mental Health Coordinator; Mr. Sudindara,
Coordinator: Swami Vivekananda Federation; Mr. Hampanna, Assistant Director SAMUHA; Mr.
Basappa; and all the team members and volunteers of SAMUHA.
Thanks are due to ADD India, in particular: Ms. Nisha Printer
Director; Mr. Neel Kumar, Program
Coordinator; Ms. Benita - Program Coordinator; and Ms. Bhuvaneshwari - Program Coordinator.
Thanks are due to Ms. Rajul Padmanabhan, Director Vidya Sagar and Mr. Nazir Jahangir,
Coordinator Vidya Sagar.
The Report benefited from the efforts of all the Directors and Coordinators of secondary partners in
Tamil Nadu and Kerala.
We like to express our deep appreciation to the individuals with mental illness, caregivers, who
participated in this study.
Community Mental Health And Development Program In South India - A Consolidated Report
XXV
Thanks are also due to the following: Dr. Sudipto, Consultant Sir Dorabji Tata Trust and Ms.
Tasneem, Program Officer Health, Sir Dorabji Tata Trust for their continued support and
encouragement through the project study.
We are thankful to Dr. Janardhana (ex colleague of BNI), Assistant Professor, Department of PSW,
NIMHANS, Bangalore for the analysis and cross tabulation of the field data.
We would like to thank Ms. Lavanya Devdas, Communication and Advocacy Specialist, Society for
Community Health Awareness, Research and Action (SOCHARA) for documentation, editing, and
designing the book to provide a structural order to the Report. She has rendered critical insights to
the report. Her help in providing pictorial representation of the mammoth amount of data collected,
with help in analysis and interpretation of the data has benefited the report greatly.
BNI immensely thanks Dr. Saraswathi for guiding the South India Program team in reorganizing
chapters and in finalizing the report in terms of interpreting the data presented, summarizing and
highlighting the findings and their implications and in making recommendations. Her insights in to the
several different aspects of the study have helped in making the presentation more meaningful.
BNI also wish to thank Ms Valli Seshan, and all the trustees of BNI: Dr Thelma Narayan, Mr. Ram
Mohan, Dr. Rajaram, Ms. Malika Rama Rao, Mr. Ramachandran, Mr. Thyagaraju, Ms. Vandana
Community Mental Health And Development Program In South India - A Consolidated Report
XXVI
Bedi, Dr. Mani Kalliath for their encouragement and valuable inputs throughout the yearlong study of
the report.
We hope that the encouragement will help in building on this study to further the cause of mental
health interventions in India.
Community Mental Health And Development Program In South India - A Consolidated Report
XXVII
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
BNI’S COMMUNITY MENTAL HEALTH
AND DEVELOPMENT PROGRAM
This chapter introduces you to the philosophy of BNI and BNIs
Commuriity Mental Health and Deudopmmt prc^am in South- India
2008 throuof 2011.
NI grew out of the belief that the rights of people who experience mental illness, especially th<ie
poor and the marginalized, must be addressed not only at individual level but also in the context
of the wider dynamics in the community and society Major resources available in the mental health
sector are institution-based rehabilitation or hospital based services, both are seen limited and impractical
for the needs of poor PWMI, especially for those living in rural areas.
BNI initiated a developmental and rights based model of mental health promotion, building on the
existing experiences of Community Based Rehabilitation (CBR), as opposed to the prevalent medical
model. Its experience so far with active involvement of all stakeholders has been very positive, which can
be phrased as stakeholders’ model.
Community Mental Health And Development Program In South India - A Consolidated Report
1
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
The purpose of BNI is to initiate programs that actively involve PWMI and their care givers to enable
them to meet their basic needs and to ensure that their basic rights are respected and fulfilled. In so
doing, to stimulate and support activities in other organizations that promotes the cause and influence
pubHc opinion and public policy on mental health issues’.
BNI’s Community Mental Health and Development
KEYPOINTS
£7 Development and Rights Based
Model
Model
Program that involved
BNI’s Community Mental Health and Development (CMH&D)
PWMI
ffil Collaboration - to infuse
model has evolved through a series of consultations with affected
public opinion and public
policy
persons, family members and partner NGOs. The model consists of
five modules based on the needs and expectations expressed by different stakeholders.
Community
Mental Health
9
►
Capacity
Buildins
Administration
and Management
Sustainable
Livelihood
.jilt
■I
lili
Research, Policy
and Advocacy
Community Mental Health And Development Program In South India - A Consolidated Report
2
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
Organization Partnership with BNI
Readying M to partners in oier ei$t states of India (Karnataka, A ndhra Pradesh,
Tamil Nadid, Kerala, Bihar, Jharkand, Maharashtra and Orissa) has been one of
the great strengths of BNI. This partnership continues to strengthen CBR forpeople
■mth mental health and endeavors to toitdo rmny dies.
n order to satisfy the essential needs of PWMI and to ensure their basic rights BNI decided to be a
‘ resomce oi'gamzation and the strategy or approach opted was working through partnership rather
intervene directly at the ground. With the strategic approach of partnership BNI registered as a Trust in
2001, and since then it has been working with paitner organizations in rural areas in parts of 46 districts in
the States of Karnataka, Andhra Pradesh, Tamil Nadu, Kerala, Jharkhand, Bihar, Orissa,
Maharashtra and in Bangalore-Urban areas.
MENTAL
HEALTH
BANGALORE
IN
Since 2004, BNI has been reaching out to urban poor in 100 slums (about
URBAN
Over 1400 families are supported
in the Bangalore urban. A lot has
to be achieved to bring urban
mental health in the
one hundred thousand population) in Bangalore city worl
in
partnership with three NGOs. With active involvement of various
public implementing and resource partners, BNI is touching the lives of
domain of advocacy.
approximately 1,400 families in Bangalore Urban.
To initiate and implement mental health program BNI evolved GMH&D model through a series of
consultations with affected persons, family members and partner NGOs. The model consists of five
modules based on the needs and expectations expressed by different stakeholder (community mental
health, capacity building, sustainable livelihoods, research policy and advocacy and administration and
management).
Community Mental Health And Development Program In South India - A Consolidated Report
3
BN I'S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
Types and Criteria of Partnership
Over the years, BNI has built the strength of partnership. In 2002 and 2003, BNI developed its
partnership network to four organizations across India: Samuha Samarthya in Karnataka, ADD India and
Vidya Sagar in Chennai in Tamil Nadu and Navbharath Jagmthi Kendra in Bihar and Jharkand.
Primary Partners and Involvement Criteria
In 2001, BNI collaborated with the primary partners meeting the core philosophy of BNI:
•
Organizations involved in CBR for people with disabilities (PWD) were considered imperative,
as mental health/illness could be included in such organizations. Bringing in the cross-disability
sector was seen as important as mental illness is considered a disability.
•
Realizing that the learning’s of smaller organizations will be concrete and easily manageable.
•
Organizations evolved from the same geographical area where they are working, (CBO’s) where
the culture and the needs of the local people are thoroughly understood and well-established
relationship with the local communities.
•
Small organizations are open to learn and at the same time these partners will be the laboratories,
which enable BNI to experience, leam and to expand.
•
Direct partnership with the partner’s.
Secondary Partners and Involvement Criteria
In 2003, BNI expanded its reach including the secondaiy partners to enable a greater outreach to its
programs. The philosophy behind this involvement was in terms of:
•
Involvement of organizations that ate rooted in CBR for PWD were considered imperative, as
the issues of mental health/illness could be introduced in such organizations.
•
Large organizations had the adequate human resource and infrastructure to implement the
program
Community Mental Health And Development Program In South India - A Consolidated Report
4
B N I ’ S
•
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
Resource organizations are in disability sector.
Resource organizations in turn were working with their ow partners reaching larger population
and could support the partners financially.
With this, BNI saw the coming together of like-minded, community
KEYPOINTS
A transition from an individual, oriented organizations. Samuha Samarthya implemented the BNI
medical perspective to a structural,
social perspective is the key to CBR.
model directly, and ADD India and Vidya Sagar implemented the
The shift from a “medical model” to project through their partners, hence
were termed as secondary
a Social model” is imperative to
partners (Vidya Sagar worfe with four partners in Tamil Nadu and
community participation
ffii Collaboration - to infuse public
ADD India works with five partners in Tamil Nadu and two partner
opinion and public policy.
in Kerala).
Working Areas of Partners
Karnataka
Table 1.1 Partners in Karnataka
Name of NGO partner
SAMUHA
Grameena Abyudaya
Seva Samsthe (GASS)
Narendra
Foundation
District
Blocks
Koppal
Koppal taluk
Gangavathi
Raichur
Karwar
Bangalore
Rural
Tumkur
Deodurga_____
Haliyala_____
Doddaballapura
Number of
Gram
Panchayats
31________
16________
33
Number of
Revenue
Villages
67
25
74
23
298
268332
Pavagacia
33
112
184139
Population
686184
Community Mental Health And Development Program In South India - A Consolidated Repor?
5
B N I ’ S
COMMUNITY
AND
HEALTH
MENTAL
DEVELOPMENT
PROGRAM
Andhra Pradesh
Table 1.2 Partners in Andhra Pradesh
Name of
NGO partner
District
Blocks
SACRED
Anantapur
Anantapur
Rural Mandal
Peapully
Thuggali
Pathikonda
Kurnool
Number of
Gram
Panchayats
25
Number of
Revenue
Villages
45
26
19
15
51
50
26
Population
364830
Tamil Nadu
Table 1.3 Partners in Tamil Nadu
Population
1
Number of
Gram
Panchayats
16
Number of
Revenue
Villages
34
49247
Nilgiris
1
10
123
69728
SJDT
Theni
1
31
118251
SJDT
Dindigul
1
30
35488
Resource
Center
WORD
Kanyakumari
1
16
26
200000
Pudukottai
2
43
292
203592
272821
Partners of
ADD India
District
Number
of Blocks
SCORD
Thiruvarur
ESAI Trust
Partners of Vidya Sagar
ASSA
Thirunelveli
2
60
145
IRCDS
Thiruvallur
3
51
197
Nazrath
Illam
TCT
Erode
1
10
104
Vellore
2
40
250
74653
Community Mental Health And Development Program In South India - A Consolidated Report
6
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
Kerala
Table 1.4 Partners in Kerala
Partners of
ADD India
District
Number of
Blocks
Number of
Gram
Panchayats
Number
of
Revenue
Villages
Population
TSSS
Kannur
1
4
42
32550
VOS ARD
Idikki
2
2
29
10208
Note
The data shown in the tables for the states is based on organization inputs.
Introduction to Partner Organizations
Social Action for Child Rehabilitation Emancipation and Development (SACRED)
in Andhra Pradesh
SACRED is a non-profit, social, secular voluntai}- oiganization, which is committed for the most deprived
and underprivileged sections of the society. The main aim of SACRED is to equalize the disabled people
to able bodied and make their active participation for their own development.
SACRED started work in 1997 with two villages and later expanded to 40 villages of Ananthapur district
and 56 villages in Kumool district. Action for Disabilities, UK and CAPART, New Delhi funds the
organization.
SACRED has promoted Block level cross disability oiganization called GIVAM at Ananthapur Rural
Block and federation is owning and implementing the GBR program. SACRED, with the support of
other three nei‘twork partners IKP, RDT and Timbuktu has promoted district level federation of the
disabled called Anantha Vikallangula Hakkula Vedhika (AVHV).
Community Mental Health And Development Program In South India
A Consolidated Report
7
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
Narendra Foundation in Karnataka
Narendra Foundation is a rural development project, registered on 2nd December 1997 with a
Community-Based approach to disability and development. It covers the entire Pavagada taluk, which is
one of the backward taluks in Tumkur district. Action Aid India has collaborated with Narendra
Foundation (NF) in promoting disability intervention.
The vision and mission of NF constitute - ensuring dignity of life and empowerment of Persons with
Disabilities (PWD) and community participation. In order to meet the overall aims of the organization,
the work of the project is carried out through the following sectors like community organization,
education, health and vocational training and income generation. NF also works to set up women's self
help groups and networks with oi'ganizations for community development activities.
NF has promoted taluk level federation called Swami Vivekananda Federation. Ciurently the federation is
advocating for the rights of PWD including PWML
Gramina Abyudaya Seva Samsthe (GASS) in Karnataka
GASS is a registered voluntary organization established in 1996 works for the empowerment of PWD and
other under privileged persons in the community. The association commenced its services in
Doddaballapura town with initially 75 and later 150 villages from 1996 onwards.
GASS has involved in many activities like medical intervention to the disabled through general health
camps, integrated education for disabled, self employment program, community development activities
and so on. As a part of its activity, a mental health centre was established to provide ongoing assessment,
Community Mental Health And Development Program In South India - A Consolidated Report
8
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
treatment and medical support for the people who are suffering from mental illness with the support of
Community Psychiatry Unit of NIMHANS, Bangalore.
GASS advocated with Health and Family welfare Department and merged the medical camp and all the
documents including case files are included in to primary health care.
Note
SACRED, Narendra Foundation and GASS are associated with BNI since 2000-01.
SAMUHA in Karnataka
SAMUHA is a voluntary organization established in 1987, based in Northern Karnataka, SAMUHA has
undertaken community development programs with a special focus on vulnerable people, including
People with HIV/AIDS and Disability. 'SAMARTHYA,' the disability unit of SAMUHA has been
working through self-help groups and community-based organizations of people with disabilities at the
taluk, district and state levels.
Samarthya also acts as a resource group for other programs on disability issues through training, exposure
visits and guidance. Samarthya works in three districts — Raichur, Koppal and Karwar.
Note
BNI is working with SAMUHA since 2002.
As the organization shows interest to work with mentally ill, BNI arranged an initial meeting with the staff
who expressed their interest to work in area of mental health. The scope of the organization is to reach
Community Mental Health And Development Program In South India - A Consolidated Report
9
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
large number of people and the strength is well-defined in the organizational systems and funding
strategies.
Action on Disability and Development India (ADD India) in Tamil Nadu and Kerala
ADD India is a resource organization in the disability sector registered in the year 1987 ADD India works
with persons with disability through advocacy, using a rights-based approach. 'While ADD India works
directly in three districts of Tamil Nadu, Andhra Pradesh and Karnataka. They also network with other
disability organizations working in rural areas and provide training on the rights-based approach.
Note
ADD India has 32 partners in South India, of which 10 partners are associated with BNI
since 2003.
Vidya Sagar in Tamil Nadu
Vidya Sagar is a resource organization registered in the year 1985. The focus of Vidya Sagar's work is on
persons with cerebral palsy and other disabilities through a CBR approach. Vidya Sagar coordinates the
activities of NGOs involved in CBR work and facilitates the identification of persons with disability,
including children. It runs institutional programs through a school for children with disability, vocational
training and human resource development, a post graduate cotuse in special education for children with
cerebral palsy, training of parents, staff and volunteers.
Note
BNI is working with four partners of Vidya Sagar since 2003.
Community Mental Health And Development Program In South India - A Consolidated Report
10
BNI’S
COMMUNITY
MENTAL
HEALTH
AND
DEVELOPMENT
PROGRAM
Nav Bharat Jagriti Kendra (NBJK) in Bihar and Jharkhand
NBJK has been working in the field of socio-economic development of rural areas since 1971 and on
various issues. The operational areas always have been Bihar and Jharkhand. It is working with as many as
2.1 million people and is supported by many partners and voluntary organizations. NBJK is working with
issues like gender disparity, education, health, small group support and rural entrepreneurship to name a
few. It has several financial and intellectual partners who are in constant support. As the states Bihar and
Jharkhand are among the poorest states there are lots of challenges in front of NBJK to implement
programs in favor of poor people.
This community mental health and convergence of services program started in the year 2002, is being
implemented by NBJK through 25 partners across Bihar and Jharkhand. These 25 voluntary
organizations are spread over 32 block of 15 districts. Bihar and Jharkhand were one state till 15th
November 2000 when southern pan of Bihar state was declared a separate state as Jharkhand. Now,
under this mental health program there are 14 VOs working in Bihar and 11 VOs are in Jharkhand. This
CMH&D program is implemented through NBJK with 25 partner VOs in Bihar and Jharkhand.
Note
BNI is working with NBJK since 2002.
Community Mental Health And Development Program In South India - A Consolidated Report
11
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Chapter
PROCESS OF THE STUDY
This chapter ddies into the study process and rretlooddc^ used in the CMH& D
program
"T n the year 2001, BNI entered into partnership with six organizations in south India to implement a
A project on mental health under the CMH&D model.
Background of the Study
The partners Grameena Abhyudhaya Seva Sa ms the (GASS), Narendra Foundation and SAMUHA
in Karnataka and SACRED in Andhra Pradesh implemented the project
COLLABORATION
THROUGH
THE
STUDY_____________________
directly, hence were called the primary partners. Whereas, ADD India and
Vidyasagar implemented the project through their partners, hence were
ffil Several organizations have
come together in 20 districts
in four states to engage in the
assessment of mental health
interventions.
termed as secondary partners. All the partners together implemented this
model initially for seven years 2001 to 2008) with financial and technical
support from BNI and the last three years (2008 to 2011) with only
technical support (working Panchayats/Taluks/Blocks of partners of 20 districts in South India).
Community Mental Health And Development Program In South India - A Consolidated Report
12
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Tire first phase of this project was completed in March 2008. The main activities
Karnataka
Grameena Abhyudhaya Seva
Samsthe
carried out in this phase under this model were identification of PWMI and linking
Narendra Foundation
them to treatment facilities, livelihood
support and linkages, building community
Samuha
support groups and inclusion of PWMI and family members in those groups and
activating the sterns related to treatment at PHCs and district hospitals through advocacy.
To continue on the learning from first phase, BNI renewed the partnership with its
Andhra Pradesh
SACRED
partners for three more years from April 2008-March 2011. Under this it
was agreed
that BNI will provide technical support to the partners, and they in turn will
continue and sustain the p:irocess by strengthening the caregivers associations, the federations and the state
level alliance of partners.
Further, the pnmaiy stakeholders were enabled to
access their entitlements from the government. The
processes agreed with the partners are:
•
Documentation of the work outcomes and the gaps perceived.
•
Influencing public opinion through advocacy on aspects of CMH&D model.
Public awareness promotion through appropriate media towards stigma reduction and inclusion of
PWMI in family and society.
Focus on implementation of the National Mental Health Program (NMHP) with greater emphasis
on involvement with the community.
Promoting organizations of poor mentally ill persons, caregivers and supporters.
Demanding greater allocation of resources towards the broader needs of poor mentally ill pereons
and their carers.
•
Strengthening the South India Alli;iance for Mental Health to be effective towards governmental
provisioning of mandated seivices.
Community Mental Health And Development Program In South India - A Consolidated Report
13
PROCESS
•
AND
METHODLOGY
OF
THE
STUDY
Network with other activist groups to advocate for PWMI to excise their rights and to access their
entitlements.
Aims
The overall aims of the Community Mental health and Development Program in South India - are:
•
To provide a deeper understanding on the functioning of GBR that serves as a strategy for mental
health interventions.
•
To provide information on mental health of vulnerable communities in South Indian states of
Karnataka, Tamil Nadu, Andhra Pradesh and Kerala.
•
To provide governments and civil society with a comprehensive view of mental health and the
crosscutting problems, through providing analysis of the responses obtained from the NGO
partners regarding the PWMI.
•
To provide a foundation for additional research based on the analysis of the findings in the four
states of South India. This will help BNI and its partner organizations in their intervention
programs.
•
To make recommendations for action at state, national and international levels.
Rationale for the Study
With this background the CMH&D Program in South India study was undertaken to examine the
state of mental health - the cross cutting rights, issues and 1 actol's in South India program of BNI, namely
GMH&D, from a community health, public health perspective, looking at recognizing the socio-cultural
factors in mental health along with the support of care-givers with promotive aspects of interventions of
mental health.
Community Mental Health And Development Program In South India - A Consolidated Report
14
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Planning the Study
Through the process of intense discussion, deliberation and the common collective knowledge in each
member of BNI, because of many years of working in the area, proved insightful in drawing out the plan
for the study.
The BNI team had discussions at multiple levels, from stakeholders, organizations, communities,
caregivers, and people with mental illness, to enable a deeper understanding of the impact that programs
have had in communities. In addition, the team looted at the letter of understanding with the partners
(April 2008-March 2011).
Recommendations were sought from Sir Darobji Tata Trust (SDTT) and drawing the objectives for the
consolidation. A brief assessment of the status of the partners in relation to program, data and relationship
with BNI based on the previous field visits by the South India program (SIP) team was discussed vividly.
Drawing out the Objectives
•
To know the status of PWMI and their families.
•
To understand how the panne13 involving stallholders are sustaining the program
•
To consolidate the learning of the program and replicate the same in future newer programs.
•
To derive potentials for future directions.
Community Mental Health And Development Program In South India - A Consolidated Report
15
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Developing Proposal Based on the Objectives
Based on the objectives a small proposal on consolidation study of South India Program was developed
and sent to SDTT
The proposal included:
•
Honorarium for persons at partners to collect required data.
•
Honorarium for one associate at BNI.
•
Travel for data managers and associate.
Mr. Gururaghavendra. GE, the Program Officer- South India Program, was to lead the study process
with the support of South India Program team members under the guidance of Mr. DMNaidu.
Specifying the Objectives of the Study
This study aims at assessing the effectiveness of the outcomes agreed upon by BNI and its partners as
mentioned above and the objectives are:
•
To enable BNI to understand how the program is sustained by the partner's and the
involvement of other stakeholders in sustaining the program.
•
To gain further insights into the socio-economic aspects of the communities, delving into
the status of PWMI and their families and the benefits harnessed through various networks.
•
To help the audience of this report - organizations working in the development sector, policy
makers, communities, researchers and anyone interested in community mental health and to
consolidate our experiences in creating a discussion to enable further strengthening and
refining the model of intervention to allow mental health interventions in the country.
•
To examine the South India program, its success, learning’s in the light of the funding of the
program for seven years and without funding for three years.
•
To help BNI to plan for the next three years and to guide the newer programs on the basis of
lessons learnt.
Community Mental Health And Development Program In South India - A Consolidated Report
16
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Other Considerations
•
Identifying a person for each partner to work on this consolidation of information implied in the
stated objectives and BNI to offer the required training to do this work
•
Collecting and consolidating quantitative data in the agreed format and parameters.
Collecting qualitative data like impact of awareness programs in the community, orientation and
training to community groups, inclusion of PWMI and their family members in to community
groups, impact of advocacy efforts on availability of treatment facilities at the PHC and district
level.
Collecting information on strategies adopted, partner wise, to strengthen and sustain the program
and how the data is used by them at different levels.
Focusing on especially on persons with severe mental disorder and not merely on the quantitative
figures comprising mostly of common mental disorders (CMD).
•
Enquiring on the partners’ entry and exit plans to be followed during the three years of non
funding support.
•
Identifying issues and concerns of PWMI to be taken up with the government by the care givers
associations and federations.
Population and Sample
The population of the study consisted of all the PWMI in the CMH&D program in South India. The
sample consisted of the number of PWMI who participated in the study. The following tables present
the figures.
Note: Limitation of the Study
The
The study includes only the socio-demographic profile of identified persons with PWMI and
it does not take into account the socio-demographic
10-demographic profile
profile of
of the
the general
general population
population of
of the
the
working areas of BNI partners.
Community Mental Health And Development Program In South India
A Consolidated Report
17
PROCESS
AND
METHODLOGY
THE
OF
STUDY
District-wise and Partner-Organization-wise Distribution of PWMI in the
CMH&D Program of South India (2008-2011) and Participants in the
Consolidation Study (2011) of BNI
TAMIL NADU
Table 2.1 District-wise and Partner-Organization-wise Distribution of PWMI in the
CMH&D Program of South India
N ame of the
Organization
Data according to
three years reports
(2008-11) (population of PWMI)
i according to the
updated database - consolidation study
■
Female
Total
102
99
201
249
100
113
213
44
112
19
32
51
104
97
201
97
102
199
186
201
52
102
197
140
233
44
78
205
90
326
434
96
180
402
I11
252
0
82~
159
218
0
78"
270
470
0
210
0
184
0
394
0
87
76
168
49
255
125
_________
ESAI Trust
Male
Female
Total
115
97
212
Thiruvarur
SCORD-Tanjore
130
119
68
SJDT-Dindigul
SJDT-Theni
Resource Center
Vizhuthugal
ADD DIP
WORD
Voice Trust
59
239
247
107
199
89
342
206
133
0
97
0
230
0
___ 1768HBBI585
___ _33!
1269
1299
2568
ASSA
IRCDS
149
156
48
TCT
TRED
143
H7
T
160
1
'Ms
91
Community Mental Health And Development Program In South India - A Consolidated Report
18
PROCESS
AND
METHODLOGY
OF
THE
STUDY
KERALA
Table 2.2 Partner Organizations and Distribution of PWMI in the CMH&D Program
in Kerala
Name of the
Organization
TSSS
VOSARD
Total
Data according to
three years reports
(2008-11) (population of PWMI)
Data according to the
updated database — consolidation study
Male
75
80
Female
94
86
Total
169
166
Male
0
155
180
335
88
88
Female
Total
0
0
81
169
81.
169
KARNATAKA
Table 2.3 Partner Organizations and Distribution of PWMI in the CMH&D Program
in Karnataka
Name of the
Organization
GASS
Narendra
Foundation
SAMUHA
Total
Data according to
three years reports
(2008-11) (population of PWMI)
Data according to the
updated data base - consolidation study
Male
349
Female
539
Total
888
Male
276
Female
459
Total
735
233
215
921
1675
448
1691
174
145
319__________
230
260
3027
680
864
490
1544
770
1352
Community Mental Health And Development Program In South India - A Consolidated Report
19
PROCESS
AND
METHODLOGY
THE
OF
STUDY
ANDHRA PRADESH
Table 2.4 Partner Organizations and Distribution of PWMI in the CMH&D Program
in Andhra Pradesh
Name of the
; organization
Data according to three years reports (2008- Data according to the updated database
11) (population of PWMI)
- consolidation study
■
I SACRED
Total (South
India
Program)
Male
I 426
Female
317
a/-,, /"S'"
3701
Total
I 743
■ lljj
Male
267
Female
218
||Total
485
2304
2462
4766
SO
3757
7458
J
The variation between the figures of PWMI as obtained from the three year reports of the partnerorganizations and the figure obtained from the up-dated database during the consolidation study were
due to:
•
Rigorous advocacy efforts of the partner organization resulting in provision of psychiatric
services in the taluk and district hospitals by the health department and the PWMI from the
CMH&D program availing such facilities - resulting in withdrawal of CMH&D program
from Karwar and Raichur districts of Karnataka (GASS and SAMUHA) and hence data
base could not be updated.
•
Exclusion of those with epilepsy and mental retardation and also those PWMI who were
regular in attending camp but were from outside the program area (NF and SACRED).
•
Non provision of the required information (Vizhuthugal and Voice trust).
•
Not being in partnership for 2008-2011 (TRED and TISS).
Out of a total of 7458 PWMI in the CMH&D South India program of BNI 4766 PWMI were in
the consolidation study (about 64%). The female PWMI were higher in number than the male
PWMI though the variation is negligible. In other words, consolidation study included almost
equal number of male and female PWMI. There were variations among the four states in male-
Community Mental Health And Development Program In South India - A Consolidated Report
20
PROCESS
AND
METHODLOGY
OF
THE
STUDY
female PWMI figures - Tamil Nadu and Karnataka had higher number of females, Andhra
Pradesh and Kerala had greater number of males. The figures show variations among the partner
organizations with reference to male/female figures.
Methods of Data Collection
Observation
Observation technique was followed throughout the study from the services point of view to see the
services rendered by the partner organizations, keeping in background the mental health guidelines, local
needs and infrastructure availability. For the case studies, details regarding living conditions, demographic
and socio cultural factors of the patients were collected.
Case Study
This study is mainly based on the qualitative data and case studies on PWMI. Within the case studies,
quantitative information was gathered, looking at the finer nuances of the social and family dynamics
based on caste, occupation, monthly income and others.
In the case studies, emphasis was placed on personal information and demographic information of the
families, substance abuse, stigma, human rights violation and the patients’ perception of the problem
Emphasis was also given on the perception of the problem and occturence of illness of PWMI, family
members and caregivers, the place of living, issues of migration, major stress factors that impact the well
being of the individual, information about the community outreach program, details of any previous
medical interventions (in the context of type of practitioners, cost and satisfaction), need for mental health
services, suggestions to improve the existing facilities, problem with present facilities and the people and
family members perception of services, mental health, stigma and illnesses.
Community Mental Health And Development Program In South India
A Consolidated Report
21
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Interviews
Informal interviews were conducted with the PWMI and their family members when the field staff visited
the families. Through the interviews with families, enquiries were made to understand the accessibility to
information regarding government entitlements, services available in the districts and individual
perception of mental health and the needs expressed by peisons.
Interviews with community members on the improvement of the PWMI, their own perception of the
illness, the changes in the perception of the illness through the years, the community support in providing
livelihood opportunities, inclusion of PWMI into the support groups or self help groups in the
community and support in accessing social entitlements were also taken into account.
Both the case studies and the informal interviews with the PWMI and their family members gave valuable
insights about the perception of participants regarding mental health conditions and the services available,
whether the treatment has been successful or not, reasons for the relapse of symptoms, the
discontinuation of treatment, or moving to alternative modes of support like faith healers and quacks. The
informal interviews helped in exploring processes, relationships and its consequences in detail.
Tools for Data Collection
Structured and unstructured interview schedule were used mainly to collect the information for the study.
Apart from this, secondary data from various sources and in some cases informal unstructured interviews
were carried out. A copy of the interview questionnaire is found in Appendix 3, Interviewer’s Journal.
Community Mental Health And Development Program In South India - A Consolidated Report
22
PROCESS
AND
methodlogy
OF
THE
STUDY
Consultation Meetings on the Study with the Partners
The consultations meei?ting with partners were earned out to help:
•
Discuss the concept and importance of the study.
•
Strengthen the relationship with partners.
Draw mutual consent and agreement to initiate and accomplish the study.
Capacitating the Partners for the Study
For the data collection and collation capacity building in several areas was essential:
Interview schedule was prepared based on the outcome parameters/indicators
The same interview schedule was discussed with few selected partners to test whether the
required data could be collected
•
Translating the questionnaire in to regional languages.
Onentmg the partners on individual interview schedule (BNI team oriented Karnataka and
Andhra Pradesh partners directly, in Tamil Nadu and Kerala BNI oriented the nodal partners
ADD India and Vrdya Sagar. Nodal partners oriented the secondary partners).
Field Testing the Interview Schedule
•
Partners were asked to monitor five interview schedules each.
•
The interview schedules were collated at BNI level and the gaps in the data were identified.
The BNI team reoriented the partner teams to monitor the data collection process, examining the
gaps in the pilot test of the interview. The gaps were built to fix the interpretation and responses
of the feedback received in the interviews.
Community Menta! Health And Dev^^^^^dia
A Consolidated Report
23
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Developing the Formats for Collating Data
BNI developed the formats to help the collation of data. Several of the following methods were taken into
account:
•
Upgrading, editing and modifying the existing excel database. There was an attempt to add
additional fields of social demographics in the database.
•
Consolidated data format based on the parameter indicators was developed.
•
Developed a qualitative interview schedule to collect qualitative data from the project directors
and the coordinators.
•
Partners were trained on the above formats.
•
Monitoring visits were made by the BNI team regularly.
Collecting Data from Partner Organizations
The process of collecting data at the partner organizations considered the following technical details:
•
Monitoring individual interview schedules by the partners by visiting each individual families and
collecting data.
•
Updating the case files based on the current status.
•
Updating the excel data base partner wise.
•
Transferring the data in to the consolidated format.
Collating Data at BNI
BNI collated the data partner wise, both excel data and the consolidated data. At the same time identified
gaps in the data were listed discussed with the partner's and sent back to the partners for further
clarifications on the same. Based on the responses from the partners the same gaps were filled and data
were edited.
Community Mental Health And Development Program In South India - A Consolidated Report
24
PROCESS
AND
METHODLOGY
OF
THE
STUDY
Analyzing the Data and Development of the Final Report
Wading through the mammoth data was a formidable task The several aspects of field information
that looked at the personal, socio-cultural-economic aspects had to be collated. This meant long
hours of re-working on chunking the information on the findings. For example, infomation on the
gender differences with mental health, concerns of employment based on employment, age, religion,
caste and other factors were taken into consideration.
Moving Forward
CMH&D Program in South India - charts out the ground reality of the status of mental health of the
underpnvileged sections in our society. This aspiration of the report is to work ahead, through
partnerships and collaboration to encourage further participation and inclusion of PWMI. The fact that
many people have been involved at different levels to address community mental health interventions, the
aspiration of all is that this report contributes to concrete actions at all levels and across all sectors, to work
towards one goal - to help promote social and economic development and the achievement of the human
rights of PWMI across India.
Note
The data from the partners reached BNI in the month of March 2011.
Community Mental Health And Development Program In South India - A Consolidated Report
25
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Chapter
___
I
SOCIO-DEMOGRAPHIC PROFILE OF
PWMI IN CMH&D PROGRAM
This chapter describes the PWMI identifi£dintheCMH&
South
India This erandnes the disthbution of PWMI with seiere and omrm mental
disorders according to their sex, mental status and age.
Section 1: Basic Demographic Data of PWMI in CMH&D
Program
MENTAL
HEALTH
DEMOGRAPHICS
IN
I N I D A
|Q3 India is a country with an approximate area of 3287 thousand square kilometer (UNO, 2001). Its population is 1.081 billion and
the sex ratio (Men per hundred Women) is 106 (UNO 2004). The literacy rate us 68.4 % for men and 45.4% for women. The
proportion of population under the age of 15 years is 32 % and the propoilion of population above the age of 60 years is 8%.
The life expectancy at birth is 60.1 years for males and 62 years for females. The healthy life expectancy at birth is 53 years for
males and 54 years for females.
Figure 3.1 Distribution of Identified PWMI in CMH&D Program based on Categories of Mental
Illnesses depicts the distribution of PWMI identified in CMH&D program in terms of the types of
illnesses.
Community Mental Health And Development Program In South India - A Consolidated Report
26
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Figure 3.1 Distribution of Identified PWMI Based On Categories of Mental
Illnesses
cu
(D
Idukki
18,93
Thiruvallur
18.40
I
|
T~
0.00 qo.oo
58.82
37.81
I
-041,18:^
0.00 0 0.00
81.06
LoiWq | [□ 3.62 □ 1.28
03
Major%
Vellur
72.17
Minor%
Dindigul
Epilepsy%
Thiruvarur
60.09
MR%
Pudukottai
□ 69.31
2-^
Kurnool
_£= (D
•o -o
cu
< Q_
Chikkaballapursp E___
42.28
|
I.
51.72
Bangalore Rural
0.00
40.00
0.00
J 5.21 0 0.00
y
j □ 0.00 □ 0.00
04818"
| o.oo qo.oo
65.98
0.00 qo.oo’
100:00
20.00
6.14
!□ 0.00 qo.oo
r~
Bangaloreaof
|
I □15;10^
P57.72
I
19.45^<]
100.00
34.02
0.00
QOIOO.OO DO-OO
74.40
78.72
Tumkur
’W";.. 'JpQ.OO □o.qo
100.00
Raichur
03
039.91
1.44
79.69
03
C
q22.61?: n 0.50 □ 0.00 ■
I
I..
Yadagiri
Koppal
qzuW^r iin0.43 □o.oo
1 ■
76.88
Anantapur
03
□ 0.00 □ O.oo
0 62.19
'
Kanyakumari
E
. - □35.69:’7^^na0-39 qo.oo-
76.30
Tanjore
Nilgris
ho.oo do-oo
£l 0.80 □ 11.20
63.92
Them'
ZJ
~~T~~
69.60
Thirunelveli
03
.
81.07
!□ o.oo o ooo
60.00
80.00
100.00
120.00
The distribution of PWMI according to the categories of Mental Illness shows:
•
In general, majority (2805 PWMI out of 4766) suffered severe mental illness (58.85%) and fairly
good number (that is 1883 out of 4766, 39.51%) were going through common mental illnesses.
Very small percentages of those identified were reported to have epilepsy (1.22%) and mental
Community Mental Health And Development Program In South India - A Consolidated Report
27
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
retardation (0.42%) which are not really within the scope of the program. This is an evidence of
the program achieving its objective of taking in a large number of PWMI, severe and common.
•
Here again there are variations in number of PWMI with severe and common mental illnesses
among districts within a state and among different states. Karnataka state had more of PWMI
with major mental illness with two districts of Bangalore rural and Koppal contributing to this
picture. In both the districts of Andhra Pradesh, majority were with major mental illness. The
figures presented for one district in Kerala shows majority were in the category of minor mental
illnesses. In Tamil Nadu, out of the ten districts, in eight districts majority were with major
mental illness. And in two districts of Nilgiris and Thiruvallur, more members were with minor
mental illness.
•
It is interesting to note that the village communities in the study, not only sought help for major
mental illnesses, but also for minor mental illnesses. This could be seen as people becoming more
conscious of treating mental health problem that are not only severe but also the minor ones.
The CMH&D program implemented seemed to have brought in this awareness in the rural
south India. It may be due to changing beliefs related to mental illnesses and their treatments,
from the religious rituals and other traditional practice to the medical, physical, psychological and
social care with the creation of community awareness in support of PWML
Community Mental Health And Development Program In South India - A Consolidated Report
28
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Figure 3.2 Percentage Distribution of PWMI Based on the Categories of
Illnesses
□ Major
□ Minor
1.13
0.42
39.51
□ Epilepsy
□ MR
58.94
The diagram showing distribution of PWMI based on the categories of illness Majority (58.94 %)
suffered severe mental illness, 39.51% suffered common mental disorder and less than 2% had epilepsy
and mental retardation. As the majority were in the category of major mental illness, the focus of SIP was
definitely on this category.
These figures indicate that CMH&D program focused not only on cases of severe mental illnesses but
also on common mental disorder and thus on total mental health care. This also seems to indicate that
village communities sought help for severe as well as common mental disorder pointing to the awareness
created and the involvement of people in the mental health program.
Social hierarchy exists in society in terms of sex of individuals. An analysis of data regarding the
distribution of PWMI according to sex was made. The results are presented in Figure 3.3 Sex- wise
Distribution of PWMI Identified in CMH&D Program:
Community Mental Health And Development Program In South India - A Consolidated Report
29
PROFILE
SOCIO-DEMOGRAPHIC
CMH&D
WITH
PERSONS
0 F
MENTAL
ILLNESS
I N
PROGRAM
Figure 3.3 Sex- wise Distribution of PWMI Identified in CMH&D Program
0)
'147.93
152.07
Idukki
39.20
Thiruvallur I
..
Thirunelveli |
I
H
' J 62.75
• . :: : <
I 37725
149.25
Nilgris
150.75
;
Kanyakumari
:
i 46.38
"153.62
I 42.1 _7
Vellur L.LZ
I '
j
Dindigul r - _ ' _
'... L...
Pudukottai
Kurnool
2
Anantapur
< CL
147.29
Female%
56.71
"□52.
52.41
HZ.SO
•________
. ........... ,
50.00
50.00
■
Raichur
ra
ro
c
Male%
____
F A/-' -
Yadagiri
05
—□53.05
146.95
^52.71
_c
(D
T5 “O
C
]57.83
—□51.26
ZT48.74
--------------- —
1 hi ruva ru r
2 c/)
58.89
...
j 41.11
Tanjore I
Z
Z 65.88
—
Theni
Z5
"O
05
] 60.80
■
Koppal
148.94
51.06
_______________
i 45.97
j 54.03
■—□53.92
JIGTOS
Tumkur
05
Chikkaballapura
o.oo
Bangalore Rural Z
1100.00
'
^7^37 70
]62.30
Bangalore
1100.00
0.00
20.00
40.00
60.00
80.00
100.00
120.00
Community Mental Health And Development Program In South India - A Consolidated Report
30
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
In the CMH&D program of BNI in partnership with organizations in four states in South India, the data
on the identified PWMI, as presented in Figure 3.3 Sex- wise Distribution of PWMI Identified in
CMH&D Program show:
• The women and men PWMI identified were almost equal. Of the 4766 PWMI 2440 (51.20%)
females and 2326 (48.80%) were males, with a slightly higher number of females than males.
• There is variation seen among the states and the districts with reference to the difference in the
number of men and women PWMI. States of Andhra and Tamil Nadu show more males then
females. Whereas in states of Karnataka and Keiala there were more females than males.
• In Tamil Nadu, of the 10 districts, five districts had more males than females and the other five
districts had identified more females than males. In the two districts of Andhra the variation is quite
wide. In Karnataka, the district of Tumkur showed wide differences. The variations in numbers of
men and women PWMI are wider in certain districts than certain other districts.
• These variations could be real or may be due to the total duration of the program, the sex of the
field staff, the nature of the community in terms of their beliefs and attitudes towards mental illness of
men and women, the stigma attached to this, awareness and cooperation of the community and so on.
This point out the need to understand the reality, and or the reasons for variation in number of men
and women PWMI in the program so that efforts are made to help all PWMI in the community to
participate in the program The implementation can be effective with district wise planning as the
variations seen could be taken in to account.
Community Mental Health And Development Program In South India - A Consolidated Report
31
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Figure 3.4 Sex-wise Distribution of PWMI Based on the Category of Illness
40.00
MR
] 60.00
~
Epilepsy
50.00
50.00
43.76
Minor
Major
□ Male
□ Female
HZ56-24
J47-78
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
type of illnes
The above graph presents the frequency of persons reporting mental illness by sex with reference to
major, minor, epilepsy and mental retardation categories of illness. Severe mental disorder in male was
high compared to female (52.22 % to 47.78 %). Whereas under the category on common mental disorder
women showed high level of prevalence of mental illness (56.24%:43.76%).
Sex-wise depiction of PWMI in the above graph shows that both men and women with major and minor
mental illnesses were identified in CMH&D program of South India, though there is some variation in the
number and percentage - more men with major mental illnesses and more women with minor mental
illnesses. Almost equal number of men and women in the program indicates that the program seemed to
have focused on both men and women, with an edge over women than men. When the figures for both
major and minor illnesses are considered together, women were larger in number than men.
The reason for the women in larger number compared to men may be because of the triple role played by
women and the responsibilities they tend to cany with a secondaiy status they are pushed into.
Community Mental Health And Development Program In South India - A Consolidated Report
32
SOCIODEMOGRAPHIC
CMH&D PROGRAM
PROFILE
O F
PERSONS
WITH
MENTAL
ILLNESS
I N
It is evident that the CMH&D program is gender-aware, meaning women are development actors as well
as men.
‘Marital status’ of an individual is socially important, especially for women. The two graphs (Figures 3.5,
PWMI Based on Marital Status and 3.7, PWMI Based on Marital Status and Sex) and the Figure
3.6 PWMI Based on Marital Status brings to focus the prevalence of mental illness with reference to
marital status and also with reference to sex.
Figure 3.5 PWMI Based on Marital Status
0.00
0.00
0.00
0.00
MR%
I
Epilepsy%
] 100.00
0.00
0.00
0.00
■ Widow
] 45.10
| 54.90
□ Separated
□ DivDrced
I2-50
® Married
f61
Minor% &
□ Unmarried
iiiiat
J20.95
I 75.15
ri
Major%
63.94
0.00
20.00
40.00
60.00
80.00
100.00
120.00
Community Mental Health And Development Program In South India - A Consolidated Report
33
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
O F
PERSONS
WITH
MENTAL
ILLNESS
I N
Figure 3.6 PWMI Based on Marital Status
□ Unmarried
□ Married
0.94%
□ Divorced
1.73%
0.43%
28.85%
□ Separated
Widow
r
68.05%
Figure 3.6 shows PWMI based on marital status in the identified PWMI’s majority (68.05%) were
married and 28.85% were unmarried, divorced and separated were 0.43% and 0.94 % respectively.
Out of the identified PWMI 1.73% had lost their spouses.
Figure 3.7 PWMI Based on Marital Status and Sex
0.25
0.60
Male%
0.10
■ Widow
62.57
2l6.48
□ Separated
□ Divorced
Female%
3.13
□ Married
1.26
□ Unmarried
0.75
73.18
21.69
0.00
20.00
40.00
60.00
80.00
Community Mental Health And Development Program In South India - A Consolidated Report
34
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Figure 3.5 shows the percentage distribution of identified PWMI based on their marital status
according to the types of mental illness. The prevalence of both severe and common mental illnesses
was liigh with persons who are married (63.94% and 75.15% respectively than those who are
unmarried. The reason could be due to the stresses the family responsibilities and issues bring to the
married persons. The data for the unmarried indicate nearly 33.4% with severe mental disorders and
nearly 21 /o wrth common mental disorders. Thrs could be due to the social issues - delays in getting
married due to not finding suitable match, custom of divorce, love failures, failures in education and
employment.
Thrs appears to be a matter of concern. A further probe into the reasons may show pointers in
helping these young persons.
The persons divorced and separated and widowed though smaller in number and percentage, a total
of 65 persons (2.6%) suffered severe mental illnesses; and 64 persons (3.9%) were with common
mental disorders.
This could be due to the inferior social ranking and subordination of these categories of persons
resulting in low self - esteem. Further information on the status of these groups could be of value in
improving their condition of mental health.
The sex-wise distribution of PWMI based on marital status (Figure 3.7) shows that married
women have a higher prevalence of mental illness (73.18) as compared to the men with mental illness
who are married (62.57).
The study shows that a higher percentage of unmarried or single men suffer mental illness (36.48%) in
comparison with single or unmarried women (21.69%).
Community Mental Health And Development Program In South India - A Consolidated Report
35
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
The data on PWMI according to sex and marital status show that a higher percentage of married
women were with mental illness, it is not merely the stresses of family responsibilities that marriage
brings to women but in addition they are placed in subordinate position with little or no power to
make decisions regarding their own health and exercising their reproductive rights.
The ‘stages of life’ brings with them stage specific issues in life. The importance of looking at the
prevalence of mental illness according to age groups is recognized. The following graph brings out the
results of analyzing the distribution of PWMI according to their age groups, as shown in
Figure 3.8.
Figure 3.8 Prevalence of Mental Illness in Children, Young and Older
Persons
0.00
0.00
0.00
MR%
] 100.00
□ Above 60
Epilepsy%
□ 41-60
21-40
6.96
135.53
_________
Minor%
1J 4.25
~14.88
32.89
Major%
0.00
20.00
40.00
□ Below 20
| 53.27
57.00
60.00
80.00
100.00
120.00
Figure 3.8 Prevalence of Mental Illness in Children, Young and Older Persons shows that
under the categories of major, minor and epilepsy, a majority of the identified PWMI belong to the
Community Mental Health And Development Program In South India - A Consolidated Report
36
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
age group
group ot
of 21-40
21-40 (( major
major mental
mental illness
illness being
being 57%,
57%, minor
mi
age
mental illness being 53.27% and epilepsy
being 50.75%). The prevalence of epilepsy in adolescents and persons below 20 years is 35.82%.
Figure 3.9 PWMI Based on Age and Sex
3000
J
2500 |
El Male
□ Female
2000
___
1500
-
1000
J
500 j0
-• .
Below 20
21-40 ■
41-60
Above 60
□ Male
130
1322
735
139
□ Female
128
1316
867
129
The representation of mental illness based on age and sex shows that there is more or less equal
representation of male and female in all the age groups. Out of the identified majority of the people in
both male and female belong the to the age group of 21 -40.
The prevalence of mental illness in the program area seem to be quite high during the most productive
years of life, i.e, between 21 to 40 years. The CMH&D program brought to focus the age-group which
required all attention to help them improve the quality of their lives.
Community Mental Health And Development Program In South India - A Consolidated Report
37
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Section 2: Socio-Demographic Data of PWMI in CMH&D
Program
"A
ental illness is increasing cutting across several groups in society. This becomes severe with
_<L V JL vulnerable groups. The gravity of the issue for the poor, the dalits, and persons with disability
often need far greater support to help them through the conditions. Health including mental health is a
fundamental right. Availing treatment is a right and today the situation is most critical.
Caste seems to be crucial in any development work A study of the PWMI in CMH&D program
according to their caste groups bnngs out the inclusion/exclusion of those who are in the lower rungs of
the social ladder. Figure below depicts caste- wise distribution of PWMI in the program.
Community Mental Health And Development Program In South India - A Consolidated Report
38
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Figure 3.10 PWMI Based on Caste
MR%
o.oo
o.oo
o oo
■ |i|
_____
50.00
50.00
1.96
| 7.84
121.57
Epilepsy%
J?| 64.71
3.92
■ MBC
□ S.T
□ S.C
® OBC
5.58
16.98
□ General
] 16.68
Minor%
] 12 76
158 01
M
■ 8.62
5.44
] 16.08
Major%
?’
8.45
0.00
10.00
| 61.40
.1.
20.00
30.00
40.00
50.00
60.00
70.00
The graph on distribution of PWMI based on caste and the types of illness shows that except with MR, a
majority of the identified PWMI belong to other backward communities (OBQ.
Among the identified PWMI, majority were from OBC in all the three categories of mental illness namely
severe, common and epilepsy
Severe mental illness: 61.40 %
Common mental illness: 58.10%
Epilepsy: 67.71%
Among those belonging to Scheduled Caste (SQ and Schedule Tribe (ST), high percentage of SCs
suffered both severe mental illness (16.08%) and minor mental illness (16.68 %) and in epilepsy (21.57%).
Community Mental Health And Development Program In South India - A Consolidated Report
39
PROFILE
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
People belonging to ST had severe mental illness (5.44%) common mental illness (6.98 %) and epilepsy
(7.84 %). In caste groups other than the OBC, SC, ST and MBC representation in all the types of illness
other than MR is about 4% to 10%.
Figure 3.11 Identified PWMI Based on Caste
7.37
10.08
6.04
a General
a
a oec
16.35
i-
SX
HS.T
MBC
60.15
Sixty percent of the PWMI identified were OBC whereas SCs were 16%, STs were 6%, MBCs were
7%. This pattern of representation of caste groups is reflected in the categories of illness specified. In
general, almost 90% of PWMI belonged to the low socio-economic groups and hence from vulnerable
sections of the village communities.
Caste wise analysis show that about 61% suffered major mental illness, approximately 38% had minor
mental illness. In every caste group, persons with severe mental illness were more in number than persons
with common mental disorders.
CMH&D program catered to the vulnerable sections of the communities the population un- reached by
the health programs of the government.
Community Mental Health And Development Program In South India - A Consolidated Report
40
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
MENTAL
WITH
ILLNESS
IN
Besides caste- discrimination, sex- discrimination is yet another social issue. The inclusion of PWMI not
only from the lower castes that is important but within those castes, inclusion of women becomes
essential. Figure 3.9 shows the distribution of PWMI with reference to caste and sex.
Figure 3.12 PWMI in CMH&D program Based on Caste and Sex
MBC
t
149
Female
S.T h-y
o
T)
03
o
Male
124
S.C
OBC
General
0
500
1000
1500
2000
2500
3000
General
OBC
S.C
S.T
MBC
Male
176
1151
331
124
149
Female
226
1247
321
117
145
Figure 3.12 on the PWMI based on Caste and Sex shows in general that among OBC and Scheduled
Caste the female representation was higher than male representation. In MBC and ST male representation
of persons with mental health problems was higher than women with mental health problems.
Women in any society and in Indian rural society in particular occupy a secondary status and since they
have a place next to men in accessing and availing any services such as skill development and economic
improvement, maintenance of good health or meaningful education. In CMH&D program the identified
Community Mental Health And Development Program In South India - A Consolidated Report
41
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
O F
PERSONS
WITH
MENTAL
ILLNESS
I N
PWMI show women in quite large number as compared to men. This brings out clearly the focus of
CMH&D on vulnerable groups caste or sex or literacy levels.
Educational level of individuals seems to play a role in individual’s status in society. The graph
here depicts the educational level of PWMI according to the types of illnesses.
Figure 3.13 Identified PWMI Based on Categories of Mental Illness and
Education
] 66.67
. ..1
0.00
0.00
MR
16.67
16.67
0.00
] 62.75
0.00
Epilepsy
□ 1.96
□ illiterate
i 0.00
27.45
m Master degree
I 7.84
□ Degree
□ PUC
] 52.29
"0^7
~| 2.26 [
Minor
4.12
J ; '
E3 8th std to 10th std
□ 1st std to 7th std
J 25.25
__________ | 15.81
] 56.21
0.16 i
~] 2.85
Major
| 4.25
26.64
[
0.00
19.90
10.00
20.00
30.00
40.00
50.00
60.00
70.00
Figure 3.13 on PWMI based on categories of illness and education shows that the majority of
identified PWMI (in all the types of illness) were illiterate. In all the types of illness other than mental
retardation, at least 25% of the identified had basic education (8th to 10lllStd education). Identified PWMI
with higher education were in small percentage. Here again the focus is on the vulnerable section of the
people with little or no education.
Community Mental Health And Development Program In South India - A Consolidated Report
42
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
CHILDREN
WITH
PROFILE
MENTAL
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
RETADATION
CQ Children with mental retardation are more vulnerable to mental illness. Children with mild mental retardation
may become very aware of their limited abilities compared with other children and may show emotional and
behavioral problems in the classroom (such as hyperactivity). As they grow older, their difficulty in making
friends may make them depressed and angry. Sexual problems may arise. Children with more severe mental
retardation often have brain damage, which can make them more vulnerable to psychoses. If a child with
mental retardation shows a change in behavior, you should suspect a mental illness.
‘Gendef is a social issue as it has been already stated. Here again an analysis is made with educational level
and sex of PWMI.
Figure 3.14 Identified PWMI Based on Education and Sex
41.45
illiterate
] 58.55
62.50
Master degree
Degree
□ Male%
. ... ~
PUC
ni
66.06
□ Female0/©
33.94
1
Sth std to 10th std [
|
1st std to 7th std
56.10
] 43.90
’ fl 51.45
J48.55
0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00
Figurc 3.14 shows PWMI based on education and sex. It indicates that among the non-literate, the
prevalence of mental illness among women is higher (58.55% in women to 41.45% in men).
Community Mental Health And Development Program In South India - A Consolidated Report
43
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
There is a pattern visible in the data presented shows that women’s literacy is lower than that of men as is
evident in the national Census. The picture that emerges is that, illiterate and semi-illiterate men and
women form a substantial proportion. Whereas persons with different levels of literacy, more men were
identified than women. It could be just that men are in larger number in all these groups of educated
persons. It maybe the status they occupy as men and men with low to high education, it was the privilege
given to them by the family and community.
CMH&D’s focus on non-literate persons, the most vulnerable, is evident. With improving educational
level, men more privileged, seem to have an edge over women. This could be seen as a result of the
secondary status occupied by women. The family may get more concerned about men’s mental illness.
The men with education, the bread winner could gain priority in getting treated more than women with
low or high education, as women with or without education have a subordinate position.
It is clear that mental illness was seen in all categories of persons with or without formal education.
CMH&D’s focus on non-literates stands out.
The number of men and women with mental illness was almost equal for persons who had completed
primary education (class one to class seven). It is 51.45 for men and 48.55 for women.
The prevalence of mental illness in men was greater in persons with secondaiy education (class eighth to
class ten) with 56.10% men and 43.90% women.
The critical age of adolescent young persons in the age group of 18 to 20 ysars where young persons have
either completed or dropped out at pre-university level, show that the prevalence of mental illness was far
greater among men - 66.06% in comparison to their female counterpart - 33.94%.
Community Mental Health And Development Program In South India - A Consolidated Report
44
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Through the interviews it was found that this age was often critical, as childhood experiences and
challenges of adolescent development are often complex. Children in this age are given to heightened
curiosity, sexual exploration and substance abuse being some reasons.
The prevalence of mental illness among men was greater with Masters Degree (62.50% men and 37.50%
women).
Out of the identified population among persons holding a Bachelors Degree, 75.24% men were suffering
from mental illness.
Inequality in education is an indicator to show that the lesser the education, the opportunities for upward
mobility in employment, better lifestyle are compounding problems. Often the social inequity undermines
education opportunities for children and women leading to greater stress in livelihood opportunities
hampering growth and development. Among men with more and more education unemployment
resulting in non-earning may cause problems related to mental health.
Note
Bailing persons who are non-literate, the prevalence of mental illness is high among men in
all the education segments/levels.
Community Mental Health And Development Program In South India - A Consolidated Report
45
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Section 3: Economic Status Data of PWMI in CMH&D
Program
Earnnicij^-bdrigis orjeof the key dements todi^fiedliurig. This section looks at
the finer inckcators of Indihood opportunities, income, enployment that directly
influences the wdlbeing of persons.
E
conomic wellbeing is one of the key elements to any individual realizing his/her full potential.
It becomes critical for a person with disability, mental illness or for any individual bom into
poverty. This often impedes the potential for growing to ones full potential. A few indicators for the
economic well-being of an individual are employment, income, wealth, occupation, along with the access
to social security.
Note
BNI looks at the wellbeing of a PWMI in its all-compassing forms. The involvement of an
individual with mental illness in any form of productive work is therapeutic to the well-being of
the individual. This directly has an impact on the social status of the family as it improves the
economic security of the family. PWMI, their caregivers, the family and community have
expressed this aspect.
Poverty and Mental Illness
Poor PWMI are not only vulnerable due to their condition, but also the vulnerability brought about by
poverty, which is a consequence and to some extent cause of their condition. One of the main reasons
that people find it hard to accept PWMI as equal, is that they do not see them as capable of contributing
to the household or the community. For decades, researchers have shown that poverty and mental illness
Community Mental Health And Development Program In South India - A Consolidated Report
46
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
are correlated; the lower a person's socioeconomic status, the greater are his or her chances of having
some sort of mental disorder. Poverty exacerbates mental illness.
Figure 3.15 PWMI Based on Occupation
....................
Not working
................
587
Skilled work
|79|
Self employment
8
'I
r-
194
R~~| 91
Private job iE 45
Household work
420
Government job
21
Daily wages
Animal husbandry
Agriculture
□ Female
□ Male
1 160 |
697
I
ffi 32
ri59T~" 285..
r
0
500
1000
1500
The PWMI identified in the CMH&D Program based on occupation shows the varied nature of
occupation of PWMI (Figure 3.15). They were involved in agriculture, animal husbandry, daily wage
earning, household work, and others.
Majority of PWMI identified were daily wage earners, with 697 being women and 673 being men (1370
persons). The daily wage earners also partake in agricultural activates.
Note
Total number of people involved in varied occupation as indicated in the table is 3987. For
additional information, see tables listed in Appendix 2, List of Statistical Tables
Corresponding to Figures Presented in the Report.
Community Mental Health And Development Program In South India - A Consolidated Report
47
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
Daily wage earners work in agricultural fields, constmction work, carpentry, weaving and NREGA
The study shows that a total of 1117 persons (587 women and 530 men) are not involved in any
productive work. It was observed that the PWMI who were in the symptomatic state, had poor family
support, little or no enthusiasm of the community to integrate the individual, stigma and hence were
unemployed.
Note
In Andhra Pradesh, the NREGA program has provided opportunities for people with
disabilities including PWMI to seek 100 days of employment. Tamil Nadu, Kerala and
Karnataka do not recognize the importance and need for integrating disabled persons and
mentally ill within the NREGA program.
Community Mental Health And Development Program In South India - A Consolidated Report
48
cmh^o'VrVgVaV"10
PR0F,LE of arsons w.th mental illness in
Figure 3.16 Identified PWMI Based on Types of Illnesses and Annual
Income
| 0.00
] 16.67
MR%
"
183.33
0.00
119.61
Epilepsy%
■[ 70.59
t-Y
□ Abo\e 24000
[J 3.92
□ 12000 to 24000
® 6000 to 12000
Minor%
□ Below 6000
28.90
E3 39.73
j
[26.05
~|2.93
Major%
^~[ 22 19
H57 44
| 17.44
0.00
20.00
40.00
60.00
80.00
100.00
The income level has a direct impact on the quality of lifp of an individual. There is an urgent need to
improve the situation of PWMI in low-income families and communities.
Income of 6000 to 12000 Rupees
57.44% of people suffering from severe mental illness fall under the annual income bracket of 6000 to
12000 rupees. 39.73% of persons having common mental illness fall under this income bracket.
Looking at the data presented it is clear almost all the persons identified with mental illnesses in the
CMH&D Program were in poverty. The World Bank figures show that five out of 10 Indians live on less
than Rs.11.25 per head per day, which is considered the poverty line. This is approximately Rs.20, 000/Community Mental Health And Development Program In South India - A Consolidated Report
49
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
O F
PERSONS
WITH
MENTAL
ILLNESS
I N
per annum. Taking this as a base, it could be said the CMH&D program’s focus was very much
on persons living in poverty.
Annual Income below 6000 Rupees
17. 44% of persons with severe mental illness, 26% of persons with common mental illness come under
the annual income of below 6000 mpees (Figure 3.17).
Figure 3.17 PWMI Based on Levels of Income
20.-9
Below 6300
S'
■11^
r5000 to 12300
12000 to 24000
?•' AbOv'C 24000
Over 50.97 % of the PWMI in the sample study were in the income group of Rs.6000-12000 per annum,
24.68% of PWMI were in the income group of 12000 to 24000.
Community Mental Health And Development Program In South India - A Consolidated Report
50
SOCIO-DEMOGRAPHIC
CMH&D PROGRAM
PROFILE
OF
PERSONS
WITH
MENTAL
ILLNESS
IN
From the above findings, it is clear that the CBR approach of the CMH&D Program of BNI was
inclusive''^ meaning, brought within the program all those who were not reached by even government
health programs-the focus was clearly on the economically poor and socially excluded groups. The very
inclusion promises that this model is a viable and meaningful one as a developmental approach to
community mental health.
Summary of the findings on the soc io-semographic profile of P\VMI in the CMH&D program of
BNI in South India brings out that the program was developmental with:
Inclusion of men and women in equal numbers; both married and unmarried men and women and
belonging to all age groups young, middle-aged and old majority in 21-40 age groups.
Inclusion of vulnerable sections of the communities, the population not reached generally by the
government health program-meaning:
Majority belonging to OBC, SC and ST.
> Large number of women than men.
i
> Majority non-literates.
>
Majority in poverty vrith an annual income of less than Rs.12.000/-per annum.
> Majority on daily wage labor or unemployed.
Community Mental Health And Development Program In South India - A Consolidated Report
51
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Chapter
DIAGNOSIS, TREATMENT AND
ACCESS TO TREATMENT
This chapter examines the diag^iosis, impact of treatment and access to health care
sendees forPWML
NI has looked at the social model for mental health interventions. PWMI often have to brave
considerable stigma that is attached with mental disorders. Furthermore, lack of information
about mental illness and available help for and treatment make it difficult for PWMI to avail the services.
Mental health care has always been influenced and determined by contemporary beEefs and India is no
different. Traditionally, PWMI were often cared in temples and religious institutions, based on the
principles that mental illness is a form of spiritual affliction and could thus be cured by religion.
Superstition with inadequate mental health services in the community make PWMI subject to various
harmful treatments. They are subjected to black-magicians, village quacks - witches and physical abuse in
the name of treatment. They are kept outside the margin of the community meaning chained, locked in
the rooms, wandering in the streets, staying forever in closed wards of asylums, hospitals, etc.
Community Mental Health And Development Program In South India - A Consolidated Report
52
)
Mh-ioo
DIAGNOSIS,
TREATMENT
and
access
to
TREATMENT
Stigma and Discrimination
A large section of PWMI are still inside their houses without any treatment, because their family members
do not recognize the illness or they find it embarrassing to own a family member who is mentally ill,
commonly called mad’. There is a fear that they would be victims of disgrace and indignity and thereby
they lose the status or acceptance they enjoy in the community. The stigma is so tremendous, that people
feel ashamed and deny the illness. Therefore, the first and foremost element that shrouds the realm of
mental illness is stigma attached to it. The very thought of someone in the family getting mental ilhess is a
big shock and they do not want to believe it.
Due to stigma attached to the families,, PWMI become
thevictrms
vi<
-----------of discriminatron and human rights
abuse. The discrimination is seen from the family members and goes right up to the policy makers and
state authonties. The attitude of the pubEc is that, who care what we do for PWMI. PWMI are treated as
second-class citizens with no adequate facilities given by either the state or the central government. As a
result, they face chronic ill health, and are an economic and social burden to the community leading to
social destitution. Soon families lose hope and are left to the mercy of others.
CMH&D
UWH&D Program
I rogram in South India offers iinsights into some of these aspects, highlighting the changes
that were visible at the grassroots level through the training programs for PWMI and their caregivers and
the community. Strengthening of partner oiganizations have made a sea changing impact in the way
mental illness is seen in the areas where the program is implemented.
Community Mental Health And Development Program In South India - A Consolidated Report
53
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
MENTAL HEALTH FACILITIES IN THE COUNTRY/PROGRAM AREA_______
ffil Most of the district hospitals are not fully equipped and supplied with psychiatric
medicines to treat PWMI; most often they are referred to multi specialty centers in the
capitals/big towns. The medical professionals view mental health as an alien subject and do
not give importance to either learn or practice in their day-to-day practice. There are 42
mental hospitals in the country with the bed availability of 20,893 in the government sector
and another 5096 in the private sector hospital settings to take care of an estimated
1,02,70,165 people with severe mental illness and 5,12,51,625 people with common mental
disorders needing immediate attention. The psychiatric medicines are supplied only in few
primary health centers, community centers and the district hospitals. Medicines such as
Amitriptyline, Lithium, Chlorpromazine (CPZ), Phenobarbital, Phenytoin sodium,
Haloperidol, Carbamazepine, Imipramine and Resperidone are made available in few district
hospitals. The rates of Resperidone (better drug than CPZ in terms of side effects) are
cheaper than CPZ. Drugs like CPZ are purchased in surplus, which has lesser utility (For
example, in Karnataka). Adequate laboratories facilities are lacking in the district hospitals to
find out the serum level for lithium administration. In the primary health centers, except in
some districts, where District Mental Health Program is operational, the government
distributes none of these drugs regularly.
Diagnosis and Categorization of Mental Illnesses
€
In the CMH&D Program in South India, PWMI were examined by qualified psychiatrists and the
diagnosis regarding the kind of mental illness of individual cases was made and recorded in individual files.
There were compiled and categorized and presented in Figure 4.1.
Community Mental Health And Development Program In South India - A Consolidated Report
54
DIAGNOSIS,
TREATMENT
AND
ACCESS
T O
TREATMENT
Figure 4.1 Distribution of PWMI Based on Sex and Diagnosis of Illness
Substance abuse
0
M R
5
Personality Disorder
0
Hysteria
5
CPMR&MI
0
Dementia
4
Behavioural problem
6
5
06
9
1
2
2
1
TIA | □ 0
Somataform disorder
38
□65
Schizophrenia P—-——
B 856
I
Psychosis p
Panic disorder
□□17254
4
o
26
ft □33
Phobia
EJ 314
Male
Parkinson
3
02
OCD u
12
Ba33
31
Major Depression
n
58
Nerosis
6
Epilepsy
Mr& Psychosis
6
22
3 a 26
GTCS
Female
10
1
3
Dysthymia tj □ 90
O 36
556
=□□700
Depression
Delusional disorder
5
0 24
BPAD
144
177
Anxiety disorder
169
9
147
ADS
0
200
400
600
800
1000
Severe Mental Illness *
PWMI based on diagnosis, show that under severe mental illness, the prevalence of schizophrenia
was high, where 856 men and 796 women were diagnosed with schizophrenia.
Community Mental Health And Development Program In South India - A Consolidated Report
55
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Psychosis was the second most prevalent illness in 254 women and 314 men.
Bipolar affective disorder was the third most prevalent illness seen in 144 women and 177 men.
In general, the diagnosis showed that a large number of both men and women had schizophrenia,
psychosis and bipolar affective disorder. Slightly higher number of men than women had severe
mental illnesses. This could be because men are given medical attention earlier than women.
Common Mental Illness*
Under common mental illness, 700 women and 556 men were diagnosed with depression.
Anxiety was the second most prevalent illness
Majority of those who were diagnosed with common mental illnesses had depression and anxiety.
Note
A detailed description of symptoms of mental illnesses is presented in Appendix 1
Symptoms ofMental Illness.
* Adetailed description of Symptoms ofMental Illnesses is presented in
Appendix I
Diagnosis of the types of mental illness, with reference to sex, showed higher number of men in the
category of severe mental illness, as compared to women. The variation between men and women with
schizophrenia was four percent and in psychosis and bi-polar affective disorder the variation is much
wider, about 10 percent men were higher in number than women. In the category of minor or common
mental disorders, women were higher in number than men, showing a 10% variation.
Community Mental Health And Development Program In South India - A Consolidated Report
56
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Regularity in Undergoing Treatment and Stabilization
Figures 4.2 and 4.3 depict the PWMI going through treatment process consistently and their stabilization
(Becoming free from symptoms of illness).
Data on illnesses were further analyzed for regularity of PWMI in going through their treatment, with
reference to the types of illnesses. Figure 4.2 PWMI Based on Status of Treatment presents the results
of this analysis.
Figure 4.2 PWMI Based on Status of Treatment
MR%
" I14-29
85.71
32~84
Epilepsy%
67.16
□ Irregular
□ Regular
165-11
.. ■
Minor%
34.89
51.12
Major%
0.00
!p8.88
20.00
40.00
60.00
80.00
100.00
Figure 4.2 PWMI Based on Status of Treatment, shows that persons with common mental illness
were often irregular with their treatment, (over 65.11%).
Community Mental Health And Development Program In South India - A Consolidated Report
87
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
PWMI were far more regular in treatment. (48.88%) as compared to persons with common mental illness
(34.89%).
Through the interviews, it was found that persons with common mental illness were often irregular
because the symptoms thin out with treatment and the individual feels that she/he is cured of the illness;
common mental illness sometimes can also be treated with alternative treatment such as counseling. The
fear of stigma often inhibits the PWMI to continue treatment.
Stabilization or becoming free from symptoms of mental illness is most important, as it is an expectation
that is crucial to CMH&D program Figure 4.3 shows the proportion of men and women stabilized.
Figure 4.3 PWMI Stabilized after Treatment Based on Sex
Not applicable
Female
202 216
.......... .......
1071
No
Male
"
.1
O)
i
Yes
■HR7
1010
/
I
I
0
500
1000
1500
2000
2500
Figure 4.3 shows that of the total identified 4766 PWMI, 2177 were stabilized (45.68%). The reasons for
PWMI who were not stabilized are mainly side effects and relapse of symptoms.
Nearly half of those with severe mental illness were regular, which seem to be a good percentage. The
percent of PWMI stabilized was about 46% which is less than half. Considering the number still under
treatment (See Figure 4.8) at the time of the study, the percent stabilized seems to be quite impressive.
Community Mental Health And Development Program In South India - A Consolidated Report
58
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Side Effects and Relapse
Data were further analyzed for those reporting side effects and relapse. The results of such analysis are
presented in the Figures 4.4 through 4.7.
Figure 4.4 PWMI Reporting Side Effects Based on Sex
Female
43
No
I
•S
Yes
Male
2298
<D
O
44 •
0
122
1000
2000
3000
4000
Yes
No
Male
122
2204
Female
142
2298
5000
Majonty of persons reported no side effects to the medicines for both severe and common mental illness.
Only 142 women and 122 men reported that they had side effects to the medicines that they were taking.
The community based rehabilitation and training to the family members did have a positive impact in
identifying and addressing the problems of side effects in treatment and drugs. For example, the field staff
and caregivers were trained to understand the kinds of side effects of psychiatric drugs. On the
identification of these side effects, measures to tackle these were suggested: for example, consultations
with the psychiatrist to understand the dosage or monitoring the frequency of taking the prescribed drugs
were effective.
Community Mental Health And Development Program In South India - A Consolidated Report
59
DIAGNOSIS,
AND
TREATMENT
ACCESS
T O
TREATMENT
Figure 4.5 PWMI Reporting Side Effects Based on Types of Illness
3000
2500
a 1777
2000
s Yes
1500
e No
1000
S3 155
ffl 106
500
4
® 63
B0 07
0
Major
Minor
Epilepsy
MR
Only 155 persons with severe mental illness reported side effects and 106 people with common mental
illness reported side effects.
Figure 4.6 PWMI Reporting Relapse of Symptoms Based on Sex
2166
No
2275
0)
o.
JS
o
160
Yes
s Mate
165
I
M Female |
Yes
No
H Male
160
2166
■ Female
165
2275
Community Mental Health And Development Program In South India - A Consolidated Report
60
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Vast number of people reported that they had no relapse of symptoms (male: 2166 and Female: 2275).
160 men and 165 women confirmed that symptoms had relapsed.
The field staff and caregivers were trained to identify the indicators of relapse. The inclusion of PWMI
who were stabilized was included in the self-help groups and this helped the community groups to
monitor the treatment and interventions.
The interventions in providing livelihood opportunities and access to social entitlements supported
the persons and their families in terms of treatment, travel and assisting in other basic needs.
Figure 4.7 PWMI Reporting Relapse of Symptoms Based on Types of
Illnesses
3000
■ 2596
2500
■ 1778
2000
Relapse
1500
■ Yes
■ No
1000
■ 105
500
■ 7 ■ 60
■ 0 «7
Epilepsy
MR
0
Major
Minor
The persons who reported no relapse of symptoms on severe and common mental illness were 2596 (for
severe mental illness) and 1778 (for common mental illnesses).
Community Mental Health And Development Program In South India - A Consolidated Report
61
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Figures 4.4 through 4.7 indicate that the number reporting side effects and relapse of symptoms was
quite low showing the effective monitoring by the community in the CMH&D program The variations
between men and women with reference to the two variables showed slightly higher number of women
than men. With the women forming 51%in the CMH&D program this variation is almost nil or
negligible.
Dropout from Treatment
Figures 4.8 and 4.9 shows the PWMI dropping out of treatment in CMH&D program
Figure 4.8 Dropout from Treatment Based on Sex
Death C
Side effects i
Not applicable
(/)
c
o
(/)C3
e216
21
21
Male
28
31
7TE
Migrated
198 0 181
I
57
52
Family negligence
EH
107
122
Completed treatment
[0
63
62
Self decision
Female
T''Z'D''1'‘761 ...L,.1644
No information
<D
202
------ 1
0
1000
2000
3000
4000
Note
The field that indicates Not Applicable, persons are on treatment. The numbers of
persons in treatment were 1761 women and 1644 men out of a total of 3405 people
interviewed in the sample study.
Community Mental Health And Development Program In South India - A Consolidated Report
62
TREATMENT
DIAGNOSIS,
AND
ACCESS
TO
TREATMENT
At the time of study, 3405 persons were part of the mental health program in their respective districts.
The rest of the persons 1361 (28.6%) had dropped out for reasons ranging from, family negligence,
migration and self-decision to discontinue treatment due to reasons of side effects and others.
The variation between men and women was quite meager. The reasons for dropping out were mainly
death (nearly 9%) migration (about 8%), family negligence (5%) and self-decision (3%).
Figure 4.9 Reasons for PWMI Dropout from the CMH&D Program Based on
Illness
290
300
250 076
49
200 no
" t9 ■ 77^
.
z T
D4
D0 □1
o
150
□ 177 □ 64
J|
I
nl
J
0
(D
(D c
£
(D
Q
o. £ 05E
E roO CD
O ~
LL
Q
C
Q
M-
® 126
20
□ 36
II DO
D0
100
50
216
162
1
0
2
0
8
0
0
0
I I Fz
C
O
CD '(/>
& (0 O
CD
CD
~O
CD
C
“O
^2
0)
2
s ■8 £oa?
o N w £
b
I
05
CD
Q
Major
H Minor
Epilepsy
MR
Under severe mental ilhess, the significant reason for dropout was death (290). Other important reasons
were the families and family negligence. Under common mental illness, death and migration of families
were important factors for the dropout rate.
Further probe into the causes of death was made. Figure 4.10 presents the findings in terms of the
categories of illnesses.
Community Mental Health And Development Program In South India - A Consolidated Report
63
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Figure 4.10 Reasons for Death of PWMI According to Illness
□ Major
□ Minor
□ Epilepsy
120
100
80
□ 48
60
□ 21
□ 14
□0
40
20
J.
0
.I
□0
□0
7.
§
?£
Is
I
■
£
a>
E
o
8
Q
!
I £
X
<D
8 ?
« h.
a.
T
□2
o
<
I
tn
8
E
I
0
z
Out of the reported 418 deaths, a large number of persons were with severe mental illness (Figure 4.10).
Out of the total 418,115 people died due to age and natural death, 48 due to physical health problems and
there was no information on 77 deaths.
In the severe mental illness category, death due to mental illness was 21 and 19 committed Suicide.
In the common mental illness category, 36 people died due to age and natural death, 19 due to physical
health problems and there was no information on 44 deaths.
Success Indicator
of fodhioMl pncke of eooWi, quacks for foe solution to foe Mend
Illness was considered as an indicator of the success of CN4H&D Program. Also, see Figure 4.11.
Community Mental Health And Development Program In South India - A Consolidated Report
64
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Figure 4.11 PWMI consulting Village Quacks
No
□ 51.60%
□ 44.36%
o Female%
El Male%
Yes
1.773C] 2.27%
0.00
20.00
40.00
60.00
80.00
100.00
120.00
A high percentage of identified PWMI (both men and women) reported that they did not consult faith
healers/village quacks. The results of training individuals, family members and community had gone a
long way in addressing practices prevalent in the absence of medical services. In addition, there were
noticeably immediate positive changes with medical intervention.
The CMH&D program, through its awareness program among the village communities seemed to have
reached the people to seek the medical-psycho-social model of the program over the traditional faith
healing approaches.
Success Indicator
.
Accessing treatment required by PWMI in government health care system is another important
mdicator of the success of the CMH&D Program. Figure 4.12 shows a positive relation to the access
to treatment.
------ _____-----
Community Mental Health And Development Program In South India - A Consolidated Report
65
DIAGNOSIS,
treatment
and
access
to
treatment
Figure 4.12 PWMI’s Access
Types of Illness
80.00 -i--------
70.00
60.00
s
I
50.00
□ Govt Hospital
£
s Mental health camp
■
CD
□ private hospital
----- -----
40.00
30.00
□ Not on treatment
s
o
XT
CM
c^j
20.00
10.00
0.00
O
CO
ID
■
Major%
o
cn
o
o
■L—: j b
in
O
□ Organization
cn cn
CXI C\J
xr xr
Minor%
.. M™ - -. 1—
Epilepsy%
S I
b
MR%
57. 71 % of persons with severe mental illness and 45.51 % persons with common mental illness had
access to treatment in government hospitals (including epilepsy (59.70) and MR (71.43).
Note
_r'; are dependent on access to
The significance of Figure 4.12 is that it shows that majority of the people
all the 20 districts, at least at the
government by the primary stakeholders, community and the partner organizations.
Community Mental Health And Development Program In South India - A Consolidated Report
66
DIAGNOSIS,
TREATMENT
and
access
to
treatment
Summary of Findings
The data presented in the figures show
X The diagnosis of mental illnesses of the identified PWMI in CMH&D Program showed that majority >
(2805) of both men and women were suffering with severe mental illnesses such as schizophrenia,
psychosis and bipolar affective disorder.
This shows that the OMH&D program focused mainly on PWMI with major mental illnesses. Quite a good
number (1883) were found with minor mental illnesses such as depression and anxiety Wn analyzed, the i
findings according to sex showed a higher number of women in the category of common mental disorders. The 4
vanations between men and women in both the categories were in the range of four to ten percent. This implies
that the program was gender sensitive. Taking care of common mental disorder as a measure of prevention of
getting to the state of severe illnesses can be seen as a positive step.
x Persons with severe mental illnesses were more regular with treatment as compared to persons with
common mental disorders. Tins was due to the symptoms thinning out with treatment quicker in
common mental iUnesses and also due to their seeking alternate treatment such as counseling.
Regarding “stabilization” or becoming free from symptoms of mental illness, the data showed that 46% of '
those treated were stabilized. Considering the number still under treatment at the time of the study '
stabilization of 46% is quite a good percentage.
X The number and percent of PWMI reporting Side effects was quite low (only 264) showing a positive
impact of the program in identifying and addressing the problems of side effects.
Community Mental Health And Development Program In South India - A Consolidated Report
67
DIAGNOSIS,
TREATMENT
AND
ACCESS
TO
TREATMENT
Summary of Findings
X The “relapse of symptoms" of mental illness was reported in a small number of cases (only 325). This
can be definitely attributed to the program inputs of the training of caregivers and community groups to :
identify symptoms of relapse and monitor the treatment and interventions such as livelihood opportunities
and access to social entitlements supporting treatment, travel and basic needs.
X The data regarding the ‘drop-out’ of PWMI from the program showed 28.6% (1361 out of 4766). The
■
reasons for dropping out -were death (9%), migration (8%), family negligence (5%) and self-decision (3%).
........ J
Further probing into the reasons for death, it was found that ageing and natural death was the main
reason in 152 cases (36%). The other reasons were reported to be physical health problem in 67cases
(16%), mental health problems in only 35 cases (8%) and accidents and alcoholism in 16(4%). Reasons for
about one third of deaths could not be identified.
Another important outcome is the reduced consultation with quacks and increased utilization of
government health care systems. All these could become a reality because of the various inputs of the
program, training of caregivers and community groups, livelihood opportunities and access to social
entitlements, advocacy and moving the government system for providing the needed services.
Area of Focus for Future Programs
•
Although one sees an important outcome in the reduced consultation with quacks and a
systematic increase in the utiEsation of government health care systems, one sees a slightly
disturbing finding on the ‘drop-out’ of PWMI from the program.
There is an urgent need to strengthen communities and add greater foucs in the commuinity
rehabilitation and the related area of work This must be considered seriously in future program.
Community Mental Health And Development Program In South India - A Consolidated Report
68
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
SOCIAL INCLUSION:
COMMUNITY AND SOCIAL
PARTICIPATION
This (hapter dehes into zfe support system that are inperatiee for a PWMI, the
care^usys andfamily Stigru ef the illness cripples the individual further, shunning
the PWMI to a comer. There is a needfor indushe deedoprrentforpeople idth mental
illness in the community, mainstream health, education, social and employment sectors.
These safety nets g) a long wy in the iidl-beingof theindiddual.
ommumty based rehabilitation programs lead to positive changes, often challenging negative
attitudes in communities, leading to greater visibility and participation by people with mental
illness. Community participation is a systematic way to remove barriers and enhance social development.
It is about putting PWMI first. Through the study of mental health interventions in South India,
important changes were seen when attempts were made to promote the need for inclusive development
for people with disabilities in terms of education, access to employment and information.
Community Mental Health And Development Program In South India - A Consolidated Report
69
4
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
A sharing of cultural spaces and belongingness go a long way in healing and rehabilitation. Community
and social participation emphasizes the need to promote the empowerment of people with mental illness.
This seeks:
Participation in family decision-making
Contribution to family income
Involvement in productive work
Involvement in community and social activities
Inclusion in community groups
Inclusion of care-givers in community groups
Note
The social inclusion of PWMI was studied keeping the total number of 2029 responses of
PWMI. The percentages derived in the figures are based on the responses of 2029 PWMI.
Family Decision Making by PWMI
Figures 5.1 and 5.2 present the distribution of PWMI with reference to their participation in family
decision-making according to the categories of mental illness and according to sex.
Community Mental Health And Development Program In South India - A Consolidated Report
70
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Figure 5.1 PWMI Involved in Decision Making According to Categories of
Mental Illness
30.00
26.12
26.47
■ 29.18
25.00
E3 17.00
20.00
h Yes
15.00
No
10.00
E9 0.99 H 0.25
5.00
0.00
Major%
Minor%
Epilepsy%
Figure 5.1 PWMI Involved in Decision Making shows that 56.28% of the PWMI were involved in
decision making; whereas the other 43.72% were not involved in decision-making.
Persons with common mental illness were involved in decision making, in larger percentage than persons
with severe mental illness.
Based on the individual and family interviews it was evident that, earlier, persons were not part of
decision-making. After the recovery from the illness and with the ability of the individual to contribute to
the status of the family, the families involved them in decisions like marriage, education of children,
property related issues and others.
Community Mental Health And Development Program In South India - A Consolidated Report
71
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Figure 5.2 PWMI in CMH&D Program Involved in Decision Making Based
on Sex
35.00
30.00
25.00
20.00
15.00
10.00
5.00
0.00
■■
Yes
B Female%
B Male%
No
PWMI involved in decision-making were greater for women (30.85%) than for men (25.43). It is
understandable taking the number with severe mental illness was more among men than women.
Contribution of PWMI to the Income of the Family
Figures 5.3 and 5.4 depict the distribution of PWMI reported to be contributing to the income of the
family
Community Mental Health And Development Program In South India - A Consolidated Report
72
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Involved in IGP and contributing to family income
EJ 0.44
Epilepsy%
a 0.79
O 39.103
________ j
Minor%
ES 7.15
ra No
a Yes
® 38.64
Major%
S 13.95
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
Only 13.95% of PWMI with severe mental illness and 7.15% of PWMI with minor mental illness
reported that they contributed to family income.
Figure 5.4 PWMI Contributing to the Income of the Family Based on Sex
45.00%
40.00%
35.00%
30.00%
25.00%
Q Female %
20.00%
e Male %
15.00%
10.00%
5.00%
0.00%
Yes .
.
No
contributing to family income
Community Mental Health And Development Program In South India - A Consolidated Report
73
SOCIAL
INCLUSION:
COMMUNITY
AND
PARTICIPATION
SOCIAL
Figure 5.4 PWNH Contributing to the Income of the Family Based on Sex shows, out of the
identified PWMI 21.88% are contributing to the financial status of the family. Out of the total 21.88%
female contributes 10.40% and male 11.48%.
Therefore there is a need to strengthen individual skills to cany out occupation, family encouragement to
involve PWMI, and community involvement to create opportunities for greater involvement of PWMI in
such activities.
PWMI Involved in Productive Work
Figures 5.5 and 5.6 depict the involvement of PWMI based on categories of mental illness.
Figure 5.5 PWMI Involved in Productive Work Based on Illness
involved in productive activities with out earning
0 0.25
Epilepsy%
K3 0.99
@ 18.53
Minor%
3Y8S
K 26.27
S 26.32
Major%
0.00
' E No
27.65
5.00
10.00
15.00
20.00
25.00
30.00
Community Mental Health And Development Program In South India - A Consolidated Report
74
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Figure 5.5 PWMI Involved in Productive Work Based on Illness shows that out of the total 54.95%
of the PWMI were involved in productive activities without earning, in that 26.32% were people with
severe mental illness, 27.65% are people with common mental illness and 0.99% are people with epilepsy.
Figure 5.6 PWMI Involved in Productive Work Based on Sex
involved in productive activities with out earning
35.00%
30.00%
25.00%
p
1
fl
I ’J
20.00%
15.00%
s Female%
n Male%
10.00%
5.00%
0.00%
Yes
No
Figure 5.6 PWMI Involved in Productive Work Based on Sex shows that out of the identified
54.95% of PWMI who were productive, 30.06% were females and 24.89% were males.
Some of the common productive activities people involved were agricultural activities like sheep and goat
raring, dairy farming, working in the agricultural land and taking care of household activities. It is evident
that PWMI from rural background have more opportunities to involve themselves in productive activities
because of rural culture and environment. During the study, many caregivers expressed that they were
relieved from stress and were able to go out and earn their livelihood.
Community Mental Health And Development Program In South India - A Consolidated Report
75
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
PWMI Involved in Community and Social Activity
Figures 5.7 and 5.8 bring out the extent of involvement of PWMI in terms of their percentage in
community and social activity.
Figure 5.7 PWMI Involved in Community and Social Activity Based on
Illness
participation in social activities
40.001
37.65
035^58
fl
35.00
yy
%
30.00
25.00
20.00
15.00
10.00
5.00
0.00
■ 17.00 pWl
I
Major%
■ 8.53
■ Yes
WI
® No
■ 0.99 B 0.25
____
Minor%
Epilepsy%
Figure 5.7 PWMI Involved in Community and Social Activity Based on Illness, shows that out of
the total 26.52% of people with mental illness who participated in community and social activities, 17%
were are people with severe mental illness, 8.53% were people with common mental illness and 0.99%
were people with epilepsy.
Community Mental Health And Development Program In South India - A Consolidated Report
76
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Figure 5.8 PWMI Involved in Community and Social Activity Based on Sex
Participation in social activities
45.00%
40.00%
35.00%
30.00%
25.00%
a Female%
20.00%
b Male%
15.00%
10.00%
5.00%
0.00% I
Yes
No
Figure 5.8 shows that out of the total identified 26.52% of PWMI, who were participating in community
and social activities, 12.47% were female and 14.05% were male.
The study shows that the paracipaton of people with mental illness in community and social activities was
comparably less because, of various factors like stigma, inadequate awareness, lack of family and
community support.
Inclusion of PWMI in to Community Groups
Figures 5.9 and 5.10 bring out a
picture of the numbers of PWMI who were membere of the
community groups such as self-help groups, womens groups and co-operative banks.
Community Mental Health And Development Program In South India - A Consolidated Report
77
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Figure 5.9 Inclusion of PWMI into Community Groups Based on Sex
□ Female a Male
□)
£
W
No
1641
1853
.E
■c
3
O
799
Yes
0
500
1000
1500
2000
2500
3000
3500
4000
Figure 5.9 Inclusion of PWMI into Community Groups Based on Sex, shows that a total 1272
people were included in to community groups, out of whom 799 were female with mental illness and 473
were male with mental illness.
Community Mental Health And Development Program In South India - A Consolidated Report
78
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Figure 5.10 Inclusion of PWMl into Community Groups Based on Illness
1
El 2
5
MR
Epilepsy | D17
Yes
50
Minor ...a
Major
1350
9717 .. CZZZZ2ZZ..
0
No
500
1000
1500
® 2092
2000
2500
Major
Minor
2092
1350
Epilepsy
-----50
MR
m No
Yes
717
533
17
5
3000
2
Figure 5.10 Inclusion of PWMI into Community Groups Based on Illness, shows that out of the
total of 4766,1272 PWMI were included in to community groups in which 717 were people with severe
mental illness, 533 were people with common mental illness, 17 were people with epilepsy and 5 were
mentally retarded.
Stabilized people with mental illness were included in to community groups such as self help groups of
people with disabilities, self-help groups of women and co-operative banks of women, people with severe
mental illness were included more in to self help groups of disabled and this indicate the level of
awareness and acceptance that mental illness is one of the disability. This social inclusion is supportive in
getting loans for livelihoods and to advocate for the rights of PWMI.
Community Mental Health And Development Program In South India - A Consolidated Report
79
SOCIAL
COMMUNITY
INCLUSION;
AND
SOCIAL
PARTICIPATION
Figure 5.11 Inclusion of Caregivers of PWMI into Community Groups
Based on Sex
e
x
cn
No
Female
Male
3000
3500
1607
c
■o
0)
TD
o Yes
.E
0
500
1000
1500
2000
2500
Figure 5.11 Inclusion of Caregivers of PWMI into Community Groups Based on Sex shows that
1646 caregivers of PWMI were included in to community groups, in which 833 were female and 813 were
male.
The caregivers of PWMI were included in to community groups such as self help groups of PWD (few
caregivers of severly/chronically mentally ill were represented) self help groups of women and co
operative banks of women. This indicate the level of awareness and acceptance of PWMI in the
community and community mobilization. This social inclusion suppon getting loans for livelihoods in
advocateing for the rights of PWMI. It is also enabling the community to understand the issues and needs
of caregivers of PWMI.
Community Mental Health And Development Program In South India - A Consolidated Report
80
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Summary of the Findings
The data presented in Chapter 5: Social Inclusion: Community and Social Participation, shows:
y About 56% of PWMI with severe mental illness participated in family decision-making. More women
participated (55 /o) in family decis ion-making than men (45%). It may be because that a greater number
of women were in the categoiy of minor mental illness and more men were in the category of major
mental ilhess.
About 22% contributed to family income out of which less than half (10%) were women and about 12%
were men. Majority (78%) did not contribute to family income which point to the need for strengthening
their skills in income generation. Lesser number of women PWMI were contributing to family income as
compared to men, 14% with severe mental illness and 7% with common mental illness were contributing
to family income.
Involvement in productive work without earning by PWMI showed that about 55% were involved in
productive work, out of which 30% were women and 25% men.
K total of 26%of PWMI was
involved in
i: community and social activity. Out of this 17% were with
--------------severe mental illness and 9% with common mental disorders. Out of the total 27%, 13% were women
and about 14% were men.
X A total of about 27% were in the SHGs. Out of this 15% were PWMI with severe mental illness and
11% were with common mental disorders. Out of the total about 17% were women and 10% were men.
Inclusion of caregivers in SHGs was considered important as their life is intertwined with that of PWMI.
A total of about 35% of caregivers were included in SHGs. Out of this 17% were the caregivers of
PWMI with severe mental illness and about 15% were those care-givers taking care of persons suffering
with common mental illness.
Community Mental Health And Development Program In South India - A Consolidated Report
81
SOCIAL
INCLUSION:
COMMUNITY
AND
SOCIAL
PARTICIPATION
Looking at all of the above:
One can see that over 50% of PWMI participated in family decision-making and also in
Productive work without earning money. In these, there were more women than men.
S Only 22 to 26% of PWMI were involved in contributing to family income, in community and
social activity. There were more men than women though the variation between them were only
one to two percent.
Higher percent of women were in SHGs than men. As women self-help groups were more
common, this was quite possible for women.
Ilf
Success Indicator
CMH&D program is making its way
wayi®o
into the area of ‘social inclusion’ for
forPWMI
PWMI Starting within the
• CnO/_ TiW/A/TT
i/M-TXTr* TXTrAiAr
o*nmmrr 1C 1*1^0
family, over 50% FW involved in decision-making and productive work without earning,
is the
first step in social inclusion. Getting into wider community seemed to have come in to some extent.
extent,
wrj.
i-----------------------------With efforts that _________
are more_______
intensive
this should be possible.
Community Mental Health And Development Program In South India - A Consolidated Report
82
ACCESSING
ENTITLEMENTS
AND
SOCIAL
SECURITY
SCHEMES
ACCESSING ENTITLEMENTS AND
SOCIAL SECURITY SCHEMES
People mtlo mental illness require a rang of support and sendees to help them
drrougf dodr eueryday needs. This section deals Tdth entitlements and social security
schemes that are supportive to PWMI and the extent of their gtting them
|
ersons with mental illness need support and services to help them through everyday challenges
-L.
of life. Several factors come in the way of realizing their right to dignified living. The factors of
age, sex, critical stages of life, employment, fast changing socio-economic situations, greater exposure to
environmental risks, socio-economic status of the family, culture and availability of resources, that often
vaned remarkably across states and regions, often impact the condition of the person with mental health.
Entitlements and social security schemes of the government are important in exercising the rights of
PW The study listed the following schemes of the government that could be availed byPWMI:
•
Poverty alleviation scheme
•
Travel concession pass
•
Below poverty line card (BPL)
Community Mental Health And Development Program In South India - A Consolidated Report
83
ACCESSING
ENTITLEMENTS
•
Disability pension
•
Disability card
AND
SOCIAL
SECURITY
SCHEMES
The BPL card and disability card are basic identity cards with which the rights of disability pension, travel
concession and pardcipation in various poverty alleviation schemes could be realized. The present study
collected information from PWMI in CMH&D program, on their availing the schemes listed. The
collected data were analyzed and presented in figures in the following pages.
Figure 6.1 Accessing Entidements and Social Security Schemes by PWMI Based on Sex shows
the number of PWMI availing each of the schemes according to sex.
Figure 6.1 Accessing Entitlements and Social Security Schemes by PWMI
Based on Sex
Number of people accessing
Poverty alleviation schemes
Number of people accessing
Travel Concession pass
Schemes
Number of people accessing
BPL cards
□ Female
1027
□ Male
Number of people accessing
Disability Pension
Number of people availing disability ID
Cards
0
200
400
600
800
1000
1200
1400
Community Mental Health And Development Program In South India - A Consolidated Report
84
ACCESSING
ENTITLEMENTS
AND
SOCIAL
SECURITY
SCHEMES
Figure 6.1 shows the male- female ratio of accessing social entitlements. The study shows number of
persons who accessed BPL cards was 2183 (1156 female and 1027 male).
915 PWMI (415 female and 500 male) had accessed poverty alleviation schemes like housing, loans and
beneficianes of 3% allocation of resources under Panchayth Raj institutions.
485 persons with severe mental illness (241 female and 244 male) had accessed disability identity cards.
423 persons with severe mental illness were (194 female and 229 male) accessing disability pension. 126
PWMI had accessed concession travel pass in bus and train. The study shows male female
representations in accessing social entitlements were almost equal.
Figure 6.2 depicts the percent of PWMI in CMH&D program that did/did not access disability cards.
Figure 6.2 Accessing of Disability Identity Cards by PWMI
Total%
Yes,
11.67%
□ Yes
® No
No, 88.33%
Figure 6.2 Accessing of Disability Identity Cards by PWMI shosw 11.67% of the total identified
PWMI had accessed disability identity cards.
Community Mental Health And Development Program In South India - A Consolidated Report
85
ACCESSING ENTITLEMENTS AND SOCIAL SECURITY SCHEMES
The number of PWMI accessing disability identity cards were comparatively less reasons being only
severe and chronic PWMI are eligible, secondly the PWMI are unable to produce the continuous
treatment records for minimum period of two years and lack of implementation of uniform policy in
relation to issue of disability identity cards in southern states.
Figure 6.3 and Figure 6.4 brings out the percent of PWMI in CMH&D program, who accessed/did
not accessed BPL cards.
Figure 6.3 PWMI Accessing BPL Cards
Total%
No
45%
Yes
55%
□ Yes
m No
Out of the total identified PWMI 55% of the families had accessed below poverty line cards (Figure
6.3). This study shows that majority of the families with whom BNI was working belonged to below
poverty line.
Community Mental Health And Development Program In South India - A Consolidated Report
86
ACCESSING
ENTITLEMENTS
AND
SOCIAL
SECURITY
SCHEMES
Figure 6.4 Distribution of People Accessing BPL Cards According to
Illness
MR% f
Epilepsy %
0.33
0.00
1.16
1.37
Minor%
Yes
41-55
Majoro/o
0.00
No
33.15
I
~9 □ 65.35
57.08
_______
10.00
20.00
30.00
40.00
50.00
60.00
70.00
Figure 6.4 Distribution of People Accessing BPL Cards Accenting to Illness, shows that out of
the total persons accessing below poverty line cards majority (57.08%) were people with severe mental
illness.
Figure 6.5 through Figure 6.7 show the percent of PWMI participating in NREGA according to sex
and according to categories of mental illness.
Figure 6. 5 PWMI under NREGA
Total %
Yes
20%
Yes
No
No
80%
Community Mental Health And Development Program In South India - A Consolidated Report
87
ACCESSING ENTITLEMENTS AND SOCIAL SECURITY SCHEMES
Figure 6.5 PWMI under NREGA, shows 20% of the total identified PWMI were involved and
benefitting under NREGA
Figure 6.6 PWMI under NREGA Based on Sex
El 47.21
■ E 52-79
No
____
_______
El Male%
/?J
k
42.00
44.00
T
46.00
^>53|21 □ Female%
□ 46.79
48.00
50.00
52.00
54.00
Figure 6.6 PWMI under NREGA Based on Sex shows that male female percentage of PWMI
involved in NREGA program. Out of the total people involved, 53.21% were male and 46.79% were
female. The study shows active involvement and representation of male-female beneficiaries under the
program.
Community Mental Health And Development Program In South India - A Consolidated Report
88
ENTITLEMENTS
ACCESSING
AND
SOCIAL
SECURITY
SCHEMES
Figure 6.7 Distribution of PWMI under NREGA According to Illness
0100.00%
MR%
~~~~
i no.ooVo
Minor%
9 0 74.51%
Z
Epilepsy%
—“n 25.49%
No
_____
10 80.33%
19.67%
;'!i' d
Major%
0.00%
B 79.34%
fa 20.66%
20.00%
40.00%
Yes
60.00%
80.00%
100.00%
Figure 6.7 Distribution of PWMI under NREGA according to Illness shows out of the total
identified, PWMI (20.66%), persons with common mental illness (19.67%) and persons with epilepsy
(25.49%) were benefiting from NREGA program. The study shows equal representation of persons with
severe and common mental illness under NREGA program. Participation in poverty alleviation schemes
was only 19% accessing disability cards and pension. Probably acceptance of mental illness as a disability
by the government took quite long and hence the percentage availing was small. Travel concessions may
be the most recent entitlement, as it had been availed by only a few.
Note
NREGA is a national scheme guaranteeing
<
100 days of work for everyone below the
poverty line. NREGA was recently renamedI as Mahatma Gandhi National Rural
Employment Guarantee Scheme (MGNREGA).
Community Mental Health And Development Program In South India - A Consolidated Report
89
ACCESSING
ENTITLEMENTS
AND
SOCIAL
SECURITY
SCHEMES
Summary of the Findings
From the data presented in Chapter 6, Accessing Entitlements and Social Security Schemes^ it is
found that BPL card and disability cards are basic identity cards with which the rights of disability pension,
travel concession and participation in various poverty alleviation schemes could be realized. The data as
shown in graphs presented in this chapter indicate:
The most accessed byPWv'H was the BPL card even here, out of the total of 4766 PWMI, only
2183 (about 40%) accessed BPL cards; this included 24% women and 22% men.
X Disability cards were accessed by a very small number 485 out of 4766, (10%). The variation
between men and women was meager, 244 men (5%), 241 women (5%).
X Disability pension was obtained by a total of 423 (about 9%) out of which men were 229(about 5%)
and women were 194(4%).
X Poverty alleviation schemes were availed by a total of 915(19%). Number of men availing the
I
scheme were 500(aboutl0.5%) and women were 415(8.5%).
X Travel concession passes given to disabled were availed by very few people: a total of 126 PWMI
1
(2.6%) more men (1.7%) than women (0.9%).
I
Area of Focus for Future Programs: Accessing entitlements and social security schemes
It appears that a majority of the PWMI in the CMH&D program have not accessed Entitlements
and Social security schemes. A beginning had been made with nearly half the persons accessing
BPL cards.
Community Mental Health And Development Program In South India - A Consolidated Report
90
ACCESSING
ENTITLEMENTS
AND
SOCIAL
SECURITY
SCHEMES
Area of Focus for Future Programs: Ensuring NREGA is utilized optimally
Accesses to information, entitlements, bureaucratic challenges in accessing entitlements and
utilization of government schemes are crucial in realizing the rights of persons with mental health
problems.
Oily 20% of PWMI in the CMH&D program had availed this scheme. More men (53%) availed the
scheme than women (about 47%). Around 20% each of PWMI with major and minor mental
illnesses availed the scheme. Availing the rights of PWMI in terms of the government schemes
seemed a challenging task CMH&D program needs to focus intensely on advocacy programs by the
stakeholders groups and federation.
Community Mental Health And Development Program In South India □ A Consolidated Report
91
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
MOVING FORWARD:
MAJOR FINDINGS AND
RECOMMENDATIONS
This (hapter summrizes the report’s finchr^ about -uhat is knoun about rrmtal
health and makes final reoomnrndations to assist stakMders in oiorwning the
harriers that are experienced by PWMI.
MH&D in South India implemented by BNI had an in-built component of maintaining a data
base of all the PWMI identified. This was the responsibility of the partner organizations who
implemented the program. BNI introduced the tools for the purpose and guided them. The information
from the data-base was summarized periodically in the fonn of quarterly reports.
Maintaining a database of the magnitude of 7458 PWMI, with all the information about the PWMI
tracking them over the years and all the inputs of the program and their responses to these inputs was not
an easy task in an essentially oral culture, in which writing is not a part of life and living. In spite of this
genuine difficulty, the database was maintained to a large extent. Evaluation of CMH&D South India
Program by Sir Dorabji Tata Trust raised certain questions of importance regarding PWMI in the
program over the years. The present study made further efforts to update the information about PWMI
Community Mental Health And Development Program In South India
A Consolidated Report
92
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
as there were gaps to be filled, for which BNI requested the partner organizations to re-visit the PWMI,
then families and village communities and gather the information required and organize them for analysis
and consolidation.
The consolidation of the data was in terms of:
> Socio-demographic profile of PWMI
> Diagnosis, treatment and access to treatment
>
Social Inclusion: community and social participation
> Accessing entitlements and social security schemes
Highlights of the study findings
I General
The program implementation is a collective effort of BNI, partner organizations (primary and
secondary), the field personnel, the PWMI; the families of PWMI, the village community, the village
level community organizations. Tracking of PWMI over the years is dependent on every one of
these players. This is just to bring home the complexity of the process of keeping track of every
individual PWMI.
II Socio-demographic profile of PWMI
1. Data on PWMI is quite huge with a total of 4766 with 2304 men and 2462 women; 2805 with
severe mental illness and 1883 with minor mental disorders; besides 58 cases of epilepsy and 20
cases of mental retardation. The findings of database of such magnitude are valuable.
2. The program approach is developmental in that it focused on mentally ill persons who were
economically poor, living in poverty and most vulnerable sections of society, mostly belonging
to backward communities, scheduled castes and scheduled tribes and non-literates.
Community Mental Health And Development Program In South India - A Consolidated Report
93
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
3. The program is gender-sensitive in that it included almost equal number of men and women. In
almost all the aspects studied, men and women were found, with some variations. The variations
were not very wide.
4. Looking in depth at the profile of the PWMI especially with reference to the program areas,
brought out variations among districts within a state and among different states.
Ill Diagnosis, Treatment and Access to Treatment
1. The program focused on PWMI with severe mental illnesses much more than persons with
minor mental disorders.
2. The inclusion of a fairly large number of persons with minor mental disorders could well be
taken as a positive move by the villagers paying attention to minor mental illnesses early and
could also be a measure of prevention of occurrence of severe mental illnesses.
3. Tracking revealed that course of treatment was fairly regular in the case of PWMI with severe
mental illnesses and not so regular in the case of those with minor mental illnesses for reasons
that they felt cured or they sought alternative treatment such as counseling
4. The results showed that the program had done remarkably well in monitoring ‘side effects’ of
4
medicines given to PWMI and ‘relapse of symptoms’ in PWMI with about 6% reporting ‘Side
effects’ and 7% with ‘relapse of symptoms’. These results could be attributed to training or
capacity building of care-givers, partner organizations and community groups in identifying
symptoms of side-effects and relapse and also taking action.
5. Stabilized (free from symptoms) PWMI constituted 46%, fairly a good percentage, considering
the number of PWMI still under treatment at the time of the study.
6. Drop-out of PWMI from the program could be considered a bit high, 28.6% - a third of this
number died, another third migrated leaving about 5 % of PWMI dropping out due to family
negligence and 3% deciding on their own. When deaths were probed further, ageing and natural
deaths and physical health problems were major causes in more than half of the total deaths.
Only about one eighth of deaths were due to mental health problems, alcoholism and accidents.
The causes of about a third of PWMI deaths could not be identified
Community Mental Health And Development Program In South India - A Consolidated Report
94
MOVING
7.
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
The other signs of progress were studied in terms of proportion of families of PWMI coming
out of the traditional belief system of faith healing and proportion accessing government health
system for further treatment. The results revealed a clear trend of consultation with faith healers
(only 4 /o reporting such consultation) and a large number (60 %) accessing government health
programs treatment facilities for mental illness for the district level hospitals were made available
mainly due to the ‘advocacy5 efforts of the CMH&D program through tireless engagement with
the government by the primary stake holders and partner organizations.
IV Social Inclusion: Community and Social Participation
1. It was not only “stabilization” of mentally ill persons that was aimed at by the CMH&D
program. It was also working towards ‘nurturing stabilization 9 through confidence building
process of social inclusion. This was studied in terms of:
a. Participation of PWMI iin family decision-making which showed involvement of 55%
women and 45% men.
b. PWMTs contribution to family income 10% women and 12% men.
c. Involvement in productive work without earning 30% women and 25% men.
d. Involvement in social and community activities 17% women and 10% men. Membership
r
in SHGs 17% women and 10% men; care-givers membership in SHGs (35%).
In every one of the above, the participation proportion of PWMI with severe mental illness and
with common mental disorders also showed the percentage in proportion to their respective
numbers in the program, meaning more of PWMI with severe mental illness as compared to
PWMI with common mental disorders.
V Accessing Entitlements and Social Security Schemes
Giving support to the economically poor and socially vulnerable PWMI through their ‘Rights’ of
accessing entitlements and social security schemes were facilitated by the CMH&D program. This
was visualized as facilitation obtaining
basic identity cards, namely, BPL card and disability card,
Community Mental Health And Development Program In South India - A Consolidated Report
95
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
which are necessary requirement for exercising the rights of the disabled persons, travel concessions
and poverty alleviation schemes.
The study findings showed a total of 40% (24%women and 22%men) had accessed BPL card and
only 10% (5% women and 5% men) had accessed disability card; About 9% (5%women and 4%
men) had received disability pension; about 19% (8.5%women and 10.5% men) availed poverty
alleviation schemes; only 2.6% availed travel concession passes (0.9% women and 1.7% men; about
20% of PWMI had participated in NREGA - slightly less than 10% women and more than 10 %
men.
Recommendations
The above findings of the CMH&D of South India program clearly brings out that this model is
Functional and hence Valuable in reaching the rural and urban socio-economic groups of PWMI with
considerable success. This is a pointer to take this Tested functional model to areas other than those
already covered.
In the process of implementation and from the findings of the study consolidating the data it was found
that certain program areas are strong and certain other areas need further strengthening. Based on these
strengths and needs the following recommendations are made:
1. Working intensely with partner organizations has been a valuable experience. In this specific
experience so far, it was mainly working with Community Based Organizations (CBO) with CBR
focus for cross-disability. It is recommended that organizations in the fields of disability, health and
development interested in including mental health component in their existing programs could
become partners of BNI. A set of criteria for partnership could be developed.
A preliminary meeting of the project holder and staff of the CBO expressing their willingness could
be organized by BNI and faciliute them to meet PWMI, record and understand problems and issues,
share their perceptions, discuss and explore the possibility of inclusion of a mental health program as
Community Mental Health And Development Program In South India - A Consolidated Report
96
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
part of their development work. This could be followed by a due process of assessing the profile of
the organization and joint program planning for the CMH&D program and nurture the partnerships
wrth inputs needed based on a Memorandum of Understanding (MOU).
2. Ue CMH&D program study findings show that the approach is developmental and that the program
is also gender-sensitive. These are basic strengths of the program and it should be ensured that these
strengths are kept alive in future programs as well.
3. As it was found that there were variations in the profiles of the PWMI among the districts within a
state and among states, it is recommended that planning for programs with partner organizations be
area-specific.
In this context, it is also recommended that the concept of District Level Initiatives (DU) approach
be introduced as the current partnership pattern of one partner in one district has limitations. With the
DH approach, it is visualized that selecting four or five partners in one district will help strengthen
district level approach as well as coverage.
4. It was found that program mcluded both persons with severe mental illnesses (such as schizophrenia,
psychosis and br-polar affective disorder) and also persons with minor mental disorders (such as
anxiety and depressron). Creation of a program environment that brings in all those who need the
services within their own familiar area of living is crucial for the success of the program. This is again a
basic tenet of the program that was in focus and this needs attention in all the future programs as well.
5. Regularity in undergoing treatment on the pan of the PWMI with severe mental illness leading to
stabilization, momtonng side-effects of medicines, relapse of symptoms, following-up with necessary
action to keep these adverse effects minimal were considered the effects of a strong capacity building
input in CMH&D program especially for care-givers, field personnel and the community groups. It is
recommended that a resource team in training stake holders and partner organizations should form
the core of BNI as training at different levels visualized and implemented in the current program
have contributed to the success of the program
Community Mental Health And Development Program In South India - A Consolidated Report
97
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
It is also recommended that training materials be developed on the basis of the rich program
experiences, in the form of Handbooks or Manuals for use with Senior Development Practitioners,
field staff or grass root level workers.
6. The findings point to a need for keeping a watch on PWMI dropping out of the program. Though
reasons such as ageing and natural death and migration are not within the reach of the program
activities, careful identification of the reasons for dropping out and also deaths is a program area that
requires strengthening. It is recommended that necessary steps be taken to include this kind of
information in the tools used for collection of basic data; and also strengthen the skills of the staff of
partner organizations in continued monitoring of PWMI for at least specified period of time and also
strengthen the documentation skills of the personnel within the project or making it mandatory to
have a person with skill in documentation on the staff of partner organizations. It is also
recommended that for enabling development of the required skill in documentation the following
tools incorporating the best practices are developed and used in training programs of the field-staff:
•
Check-lists for side-effects and management
•
Check-list for relapse and management
•
Check-list for drop-out and management
•
Check-list for the causes of drop-out and deaths
•
Check-list for ‘individual rehabilitation plan’
7. Documentation of important information requires special attention especially in an oral culture, where
written word has little or no relevance. The module on capacity building/training though included
documentation as a unit, which helped in collection of information to some extent, strengthening this
considering the limiutions of availability of skills required, should become an area of focus in planning
and implementation of CMH&D. It is recommended that special means to record the spoken word
of the participants be searched and experiences of other development programs could be gathered to
arrive at an understanding of recording of oral communication in the program area.
8. The findings that the communities seeking the faith healers were minimal and seeking government
health facilities at the district level were becoming the norm point to the ‘advocacy5 efforts of the
Community Mental Health And Development Program In South India - A Consolidated Report
98
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
CMH&D program through tireless engagement with the Government officials by the primary stake
holders and partner organizations. It is recommended that the ‘advocacy* component be further
strengthened through building In strategies for advocacy with up-dated relevant information such as
relevant legislations (Acts), UNCRPD and allocation of Government resources and orienting the
partner oiganizations and primary stakeholders. It is also recommended to orient and network with
departments like NRHM, DMHP, disability, revenue and judiciary.
9. It is recommended to explore the possibilities of negotiating with universities for including mental
health components in school and college curriculum and also of introducing PG Diploma on GBR
approach to mental health in the universities. This is an urgent requirement for enabling programs to
have the personnel at the field level and at the oi^anizational level.
10. The findings on participation of PWMI in family decision-making, in productive work with or
without earning an income and in community groups such as self-help groups, disabled groups
showed that a good beginning has been made in taking the PWMI through a difficult but essential
process of social inclusion. The central focuses of these efforts were on involving them in social and
livelihood activities. It is recommended that this component of ‘livelihood’ activities especially
through developing occupational skills and becoming active members of SHGs be strengthened
through analysis of already existing information from the program experience, gaining insights and
putting these insights into the program planning.
11. Findings on providing support to PWMI through facilitating them to exercise their ‘rights’ of
accessing entitlements and social secunty schemes show clearly that it is a challenging task. It implies,
on the one hand advocacy with government departments of health, education, social and employment
sectors to reach every one without discrimination and on the other hand to empower people with
mental illness to exercise their nghts it is recommended that program plans to pay attention to these
two important issues.
12. In this context, it is recommended that concerted efforts be made in building and strengthening
primary stake holders, namely, PWMI, care-givers and cross-disability federations especially in terms
of providing follow-up care, accessing social entitlements, advocate for their rights and linking them
Community Mental Health And Development Program In South India - A Consolidated Report
99
MOVING
FORWARD:
MAJOR
FINDINGS
AND
RECOMMENDATIONS
to relevant mass movements such as mass disability groups, health movements, dalit and women’s
movements and concerned district and state level government departments and officials.
13. It is recommended that BNI to take measures to inform funding agencies about CMH&D program
experiences and underline the urgent need to include ‘mental health’ as one of the priority areas of
funding.
Community Mental Health And Development Program In South India - A Consolidated Report
100
SYMPTOMS
OF
MENTAL
ILLNESS
SYMPTOMS OF MENTAL ILLNESS
TIjis Appendix lists the common farm of mental illness raring from severe mental illness,
common mental illness and otherfarm of mental illness are reflected in this study The
symptom of imntal illness and its premlene is seen throng thefinder® m this report are
referred and afined here
Ik /T emal
'S the P^hological state of an individual who is functioning at a satisfactory level of
-1. V -1 emotional and behavioral adjustment. Ihe Med lexicon’s medical dictionary defines mental health as
----------------------------------------an "emotional, behavioral and social maturity or normality, the absence
mental
illness
DISORDER
Mental illness disorders are
widespread in the population with
an estimated 1 % of the
of mental or behavioral disorder, a state of psychological well-being in
which one has achieved a satisfactoiy integration of one's instinctual
drives acceptable to both oneself and one's social milieu, an appropriate
population having severe Mental
ilhesses and 5-15% having
balance of love, work and leisure pursuits."
common Mental illnesses.
Categories of Mental Illnesses
There are seven broad categories o£ mental illnesses:
Common mental disorders (depression and anxiety
Community Mental Health And Development Program In South India - A Consolidated Report
101
SYMPTOMS
OF
MENTAL
ILLNESS
Panic disorder, phobia, obsessive compulsive disorder, post traumatic stress
‘Bad habits’ such as alcohol dependence or drug misuse
Severe mental disorders (psychoses)
Mental retardation
Mental health problems in the elderly
Mental health problems in children
Severe Mental Illness
In the severe type of mental disorders, patients talk and behave very noticeably abnormally. The functions of
the body and mind are severely disturbed, affecting the person’s entire functioning and activities.
This group of mental disorders consists of three main types of illnesses: acute (brief) psychoses, schizophrenia,
manic-depressive disorder (also called bipolar disorder). These illnesses are rare. However, marked behavioral
problems and strange and unusual thinking characterize them. These are the disorders most typically associated
with mental illness. The majority of patients in psychiatric hospitals suffer from these psychoses.
Some common features of severe mental illness are:
Major mental disorders begin in young adulthood.
They tend to be chronic and seriously disabling.
Around one per cent of our population is affected by severe mental illness.
They have high risk of becoming homeless.
They are a heavy emotional and financial burden for the caregivers.
They remain largely untreated.
The illness affects their social and working life.
Community Mental Health And Development Program In South India - A Consolidated Report
P1
1
102
SYMPTOMS
OF
MENTAL
ILLNESS
Schizophrenia
The key features of schizophrenia are:
A person with schizophrenia will expenence some of the following symptoms:
PHYSICAL
Strange complaints, such as the sensation that an animal or unusual objects are inside
his/her body.
FEELING
Depression
A loss of interest and motivation in daily activities
Feeling scared of being banned
THINKING
Difficulty in thinking clearly
Strange thoughts, such as believing that others are trying to harm him/her or that
his/her mind is being controlled by external forces (such thoughts are also called
‘delusions’)
BEHAVING
Withdrawal from usual activities
Restlessness, pacing about
Aggressive behavior
Bizarre behavior such as hoarding rubbish
Poor self-care and hygiene
Answering questions with irrelevant answers
IMAGINING
Hearing voices that talk about him, particularly nasty voices (hallucinations)
Seeing things that others cannot (hallucinations)
Mania
A person with Mania will experience some of the following symptoms:
FEELING
•
Feeling on top of the world
•
Feeling happy without any reason
Community Mental Health And Development Program In South India - A Consolidated Report
103
SYMPTOMS
OF
MENTAL
ILLNESS
Irritability
THINKING
Believing that she has special powers or is a special person
Believing that others are trying to harm her
Denying that there is any illness at all
BEHAVING
Rapid speech
Being socially irresponsible, such as being sexually inappropriate
Being unable to relax or sit still
Sleeping less
Trying to do many things but not managing to complete anything
Refusing treatment
IMAGINING
Hearing voices that others cannot (often, these voices tell him/her that he/she is an
important person who can do great tilings).
Acute or Brief Psychoses
The symptoms are similar to those of schizophrenia and mania. The key is that the symptoms begin suddenly
and last less than a month. The typical symptoms seen are:
Severe behavioral disturbance such as restlessness and aggression
Hearing voices or seeing things others cannot
Bizarre beliefs
Talking nonsense
Fearful emotional state or rapidly changing emotions (from tears to laughter)
Common Mental Disorders
Cbmmon mental illnesses (also called neuroses) cannot be easily defined. Unlike in severe mental illness or
psychoses, in common mental illness, the persons do not lose touch with reality and they are able to meet the
ordinary demands of everyday living. For all purposes, they appear normal and carry on with their work and
Community Mental Health And Development Program In South India - A Consolidated Report
104
SYMPTOMS
OF
MENTAL
ILLNESS
life. They generally have a good understanding of their problems. While they may not always cause much
distress to others in the family and they do cause a lot of distress to themselves. Though disturbed to varying
degrees, the person usually is not disabled completely and is able to carry on with his/her work and social life.
The basic features of common mental illness are excessive mental tension and worry. All of us get tense or
worried from time to time, especially when faced with difficult problems. However, we are able to cope with
the situations and overcome these tensions or worry with passage of time. If the tension or worry is too intense
or prolonged, they tend to interfere with our sense of well being and disturb our normal functioning.
Many persons with common mental illness have feelings of inadequacy and inferiority — they lack self
confidence. (Many a time, the feeling of ‘inferiority’ may be turned opposite into egotistic behavior). This leads
them to perceive common, every day problems as difficult and threatening. This constantly produces tension
and worry and these individuals prefer to avoid facing these problems, ultimately resulting in physical or
psychological complaints.
Many persons with common mental illness may have problems such as a difficult relationship, a family confEct
and an unhappy marriage, difficulty at work place, persistent financial problems, serious and chronic physical
illness in the family or a death of a close relative or friend.
Everyone experiences mental tension or unhappiness when faced difficult problems in life. However, in the
case of persons with common mental illness, these tensions, worries and unhappiness become part of their life
style, leading to constant feelings of msecurity and a need for support from others.
The exact symptoms of common mental illness can vary markedly from one person to another. Patients show
either excessive or exaggerated emotional reaction to a stress or unhappy situation. They have symptoms like
anxiety, fear, sadness, vague aches and pains and other bodily symptoms. They are aware of their problems and
seek help (but more often, for the physical symptoms).
Community Mental Health And Development Program In South India - A Consolidated Report
105
SYMPTOMS
OF
MENTAL
ILLNESS
Depression
Depression means feeling low, sad, fed up or miserable. Almost everyone suffers similar emotion sometimes in
life. To some extent, it can even be called ‘normal’.
MENTAL
ILLNESS
DISORDER___________
Mental illnesses can affect persons of any age,
caste or religion. They can be poor or rich,
rural or urban. Mental illnesses are not the
result of personal weakness, lack of character,
or poor upbringing. Mental illnesses are
treatable.
For example, following the death of a close friend or
relative, one could be overtaken by grief and
depression. But, there are times when depression starts
to interfere with everyday living. Then it becomes a
problem. For example, everyone gets spells of feeling
sad but most people manage to cany on with life and the feeling of depression fades off. Sometimes, the
depression lasts for long periods, even longer than a month. It may be accompanied with symptoms such as
tiredness and difficulty in concentrating. These feelings make it difficult for the person to work or look after
children at home. The person may attempt suicide or talk of it. If depression begins to interfere with life and
lasts for a long period of time, then we can assume that the person is suffering from an illness.
If detected early and given appropriate care, medication or counseling and psychotherapy, the person can
become completely normal. A person with depression problem may have a tendency to get it again, when faced
with a crisis and would require the necessary help again. In general, depression is higher in women than men.
About 18 to 23% of all women and 8 to 11% of all men have ‘depression episodes’ at some time or the other in
their lives. Of these, six per cent of the women and three per cent of the men may require hospitalization at
some time.
Community Mental Health And Development Program In South India - A Consolidated Report
106
SYMPTOMS
OF
MENTAL
ILLNESS
The Key Features of Depression
A person with depression will expenence some of the following symptoms:
PHYSICAL
Tiredness and a feeling of fatigue and wealmess generally.
Vague aches and pains all over the body
FEELING
Feeling sad and miserable
A loss of interest in life, social interactions, work, etc.
Guilty feelings
thinking
Hopelessness about the future
Difficulty in making decisions
Thoughts that he/she is not as good as others (low self-esteem).
Thoughts that it would be better if he/she were not alive
Suicidal ideas and plans
Difficulty in concentrating
BEHAVING
Disturbed sleep (usually reduced sleep, but occasionally too much sleep)
Poor appetite (sometimes increased appetite)
Reduced sex drive
Anxiety
Anxiety is a sensation of feeling afraid and nervous. Like depression, this is normal in certain situations. For
example, a person going to give a speech or going for a job interview or a student going for an examination will
Community Mental Health And Development Program In South India A Consolidated Report
107
SYMPTOMS
OF
MENTAL
ILLNESS
feel nervous, anxious and tense. Some people seem to be always anxious but yet seem to cope. Like depression,
anxiety becomes an illness if it lasts long (generally more than two weeks) and interferes with the person’s daily
life.
Anxiety and depression affect a large number of people. Generalized anxiety disorder is a condition that is
commonly seen in people. According to a rough estimate more than 30% of patients attending medical or
surgical problems have one or more symptoms of anxiety or depression. However, it is often unrecognized and
not addressed because the attention is on the physical illnesses only. The characteristic feature of anxiety
disorder is excessive fear and worry. They fear that the worst might happen whether it is relationships, work,
school, finances or health. The person suffering from anxiety disorder finds it difficult to control the worry and
fear and carry on with normal activities.
Most people with a common mental disorder have a mixture of symptoms of depression and anxiety. Most
never complain of the feeling and thinking problems but instead experience physical and behavioral symptoms.
This could be for many reasons they may feel talking of their psychological symptoms will lead to them being
c
labeled as a ‘mentally ill’.
The Key Features of Anxiety
A person with Anxiety will experience some of the following symptoms:
PHYSICAL
Feeling his/her heart is beating fast (palpitations)
A feeling of Suffocation
Dizziness
Trembling, shaking all over
Community Mental Health And Development Program In South India - A Consolidated Report
108
SYMPTOMS
OF
MENTAL
ILLNESS
Headaches
Pins and needles (or sensation like ants crawling) on his/her limbs or face
FEELING
Feeling as if something terrible is going to happen to him/her
Feeling scared
THINKING
Worrying too much about his/her problems or his/her health
Thoughts that she is going to die lose control or go mad (These thoughts are often
associated with severe physical symptoms and extreme fear).
Repeatedly thinking the same distressing thought again and again despite efforts to
stop thinking them.
BEHAVING
Avoiding situations that he/she is scared of, such as market places or public transport.
Poor sleep
In addition to depression and anxiety, the following three varieties of common mental disorders may be seen
commonly with specific or unusual complaints:
J
Panic Disorder
Panic is when anxiety occure in severe attacks, usually lasting only a few minutes. The characteristic of panic
disorder is the suddenness of fear that comes and takes over the person. They are associated with severe
physical symptoms of anxiety and make the sufferers feel terrified that something terrible is going to happen.
A person may complain of having a heart attack. But when investigated, no abnormalities are found. Panic
disorder is a chronic but treatable problem. But the person’s social and work abilities maybe affected seriously,
He/she may have a poor quality of life and frequent relapses. Often unrecognized, this problem is often treated
with excessive use of medicines. People under panic attacks are seen to breathe much faster than usual. This
Community Mental Health And Development Program In South India - A Consolidated Report
109
SYMPTOMS
OF
MENTAL
ILLNESS
leads to changes in the blood chemistry which cause physical symptoms. (Conscious and slow breathing can
help in undoing the effect of the panic attack.)
Phobic Disorders
Phobia is as an irrational fear where the person tries to avoid the feared object, activity or situation. The fear
could be in relation to something like animal (cat or cockroach) or water or heights. The presence or thought of
the feared object or animal causes distress in the person who also usually, recognizes that his fear reaction is
excessive. It disrupts his ability to function normally. Even if he/she knows his fear is silly and there is no
reason for it, he/she still wants to avoid the object or situation.
Common situations that cause phobia or even a panic attack are crowded places such as markets and buses,
closed spaces like small rooms or lifts and in social situations such as meeting people. In severe cases, the
person may even stop going out of the house altogether.
Obsessive-Compulsive Disorder (OCD)
Many of us have habits and routines, which help to organize daily Eves. But if a person develops a pattern of
behavior which takes too much time and interferes with his/her daily Hfe, then he/she is said to have OCD.
OCD is an intriguing and often disabEng syndrome characterized by two distinct phenomenon Obsessions and
Compulsions. Obsessions are unwanted and persistent ideas, unages and impulses that run through the
person’s mind repeatedly. Sometimes, these thoughts come only occasionaUy and are only mildly annoying.
However, at other tunes, the thoughts come constantly and cause noticeable distress. A Compulsion is a
behavior that is performed in response to the obsessions. The individual puts his thoughts into actions as per
the rules he/she has made for him/herself, even though the person knows these are unnecessary or stupid, in
an attempt to control the distress caused by the obsession. The obsessions and compulsions can become so
frequent that they affect the person’s concentration and lead to depression people with OCD hide their
Community Mental Health And Development Program In South India - A Consolidated Report
110
SYMPTOMS
OF
MENTAL
ILLNESS
problem to avoid embarrassment. Often these people are labeled as perfectionist/hygienic person. Studies have
established that it is a fairly common syndrome with a prevalence of over 2%.
Post Traumatic Stress Disorder (PTSD)
These symptoms appear in a person after an exposure to a traumatic, life threatening accident or a natural
disaster like earthquake or floods or man-made disaster like a bomb blast and riots. Some people involved in or
witnessing it develops a group of symptoms termed ‘Acute Stress Reaction’. These symptoms may go away
gradually over a period of a month or so in most people. But in some susceptible individuals, these symptoms
persist and cause severe distress and inability to function.
Others
Alcohol and Substance Dependence
This is among the most common of mental illnesses although people may call them ‘bad habits’ and not illness.
These are generally divided according to the substance involved - alcohol, opium, marijuana, cocaine etc. They
are also classified according to the clinical state in which the person is: addiction state, complications of
use/abuse and withdrawal symptoms.
A person with alcohol and substance dependence will experience some of the following symptoms:
PHYSICAL
•
Stomach problems, such as gastritis and ulcers
•
Liver disease and jaundice
•
Vomiting blood
•
Vomiting or sickness in the mornings
•
Tremors, especially in the mornings
•
Accidents and injuries
Community Mental Health And Development Program In South India - A Consolidated Report
111
SYMPTOMS
OF
MENTAL
ILLNESS
Withdrawal reactions, such as seizures (fits), sweating, confusion
FEELING
Feeling Helpless and Out of Control
Feeling Guilty about his Drinking Behavior
THINKING
A strong desire for alcohol.
Continuous thoughts about the next drink
Thoughts of suicide.
BEHAVING
Sleep difficulties
The need to have a drink in the day-time.
The need to have a drink early in the morning, to relieve physical discomfort.
Drug - Substance Abuse
A person who misuses dings will experience some of the following symptoms:
PHYSICAL
Breathing problems, such as asthma.
Skin infections and ulcere if he/she injects drugs.
Withdrawal reactions if the ding is not taken, such as nausea, anxiety, tremors, diarrhea,
stomach cramps, sweating.
FEELING
Feeling helpless and out of control.
Feeling guilty about taking drugs.
Feeling sad and depressed.
THINKING
A strong desire to take the drug.
Continuous thoughts about the next occasion of drug use.
Thoughts of suicide.
Community Mental Health And Development Program In South India - A Consolidated Report
112
SYMPTOMS
OF
MENTAL
ILLNESS
BEHAVING
Sleep difficulties.
Irritability, such as becoming short-tempered.
Stealing money to buy drugs; getting in trouble with the police.
Childhood Behavior Problems
These are mostly disturbances of behavior and conduct occurring in stressful family situations or as part of the
child s development. The behavior is not appropriate to the age or circumstances of the child.
Psychosexual Disorders
Psychosexual disorders are of two types: sexual dysfunction and sexual deviation. In sexual dysfunction, there is
lack of normal sexual interest or response. In sexual deviation, the behavior is unusual and violates the social
norms of the society.
Organic Mental Disorders
These disorders are caused directly by damage to the structures of brain. The underlying disease maybe in the
brain itself or may be in other parts of the body. The important symptoms and signs of the disorders are:
disorientation to time, place and people, poor understanding and calculation, memory problems, emotional
instability, self neglect and absence of awareness of the same.
Community Mental Health And Development Program In South India - A Consolidated Report
113
SYMPTOMS
OF
MENTAL
ILLNESS
Mental Retardation (MR)
MENTAL
RETADATION___________
Mental retardation means that mental functions are not as well
£3 Mental retardation is not an illness, developed as expected for the age of the child. Children with MR
but a condition present from an early
stage of life (usually from birth) have difficulty with learning new things. The disability may affect all
which lasts for the rest of the
aspects of a child’s development, from learning how to sit and walk
person’s life. There is no cure or
treatment for MR
to learning how to eat and talk Much can be done to improve the
quality of life for the child and family. MR can be mild, moderate or severe. The vast majority of children with
MR have the Mild variety.
You can identify the degree of MR from a careful history of the child’s
development.
Note
Many times, persons with MR may also have mental illness of some kind because of other
problems along with MR or because of the way the family and community treat them, without
understanding their condition. In such cases, the community worker has to find out the
symptoms of the mental illness and have him treated for it.
People with MR can also experience different types of mental illnesses, such as, hallucinations,
severe depression, and phobias. In such a case, the illness can be treated.
Community Mental Health And Development Program In South India - A Consolidated Report
114
T'HSrTB0rLSoTTAT'5TICflL
I nt
to
corresponding
tables
figures
presented
in
REPORT
Appencfix
I
LIST OF STATISTICAL TABLES
CORRESPONDING TO FIGURES
PRESENTED IN THE REPORT
The Appendix list out the Statistical Tables that corresponds to thefigures represented in
theCMH&D Prcgramtn South India report
•2
I i L>I>
leof
11 ill
m
1
Table 3.1 Distribution of Identified PWWII in CMH&D Program Based on Categories of Mental
Illness
District
Bangalore
Bangalore Rural
Major
Minor
Epilepsy
0
2
249
483
0
2
0
732
1
0
1
154
0
■
—
Chikkaballapuia
'o^
Tumkur
165
Koppal
126
172
0
Raichur
148 I
39
1
.....
■
Yadagiri
153
29
10
Anantapur
218
57
18
319
.. 298
—-...........
.. ... .
-——
188
192
293
Community Mental Health And Development Program In South India - A Consolidated Report
115
LIST OF STATISTICAL
THE REPORT
TABLES
District
|
CORRESPONDING
TO
FIGURES
PRESENTED
MR
4
Kumool
4
0
0
Pudukottai
384
162
8
0
554
Thiruvarur
128
85
0
0
213
Dindigul
153 i
45
1
0
199
381
66
17
6
470
76 i
125
0
0
201
30
21
0
0
51
Theni
206
64
0
0
270
J Thirunelveli
163
91
1
0
255
Thiruvallur
23
87
1
14
125
■ Vellur
166
63
1
0
230
32
137
0
0
169
2805
1883
58
20
4766
Kanyakumari
y|B
:\
Nilgris
.
Tanjore
Idukki
.. 11;.. ■
Total
Table 3.3 Sex-wise Distribution of PWMI Identified in CMH&D Program
Total%
Fetnale%
[Maleno
2
0.04
100.00
0.00
276
732
15.36
62.30
37.70
1
0
1
0.02
100.00
0.00
Tumkur
147
172
319
6.69
46.08
53.92
Koppal
161
137
298
6.25
54.03
45.97
Raichur
96
92
188
3.94
51.06
48.94
Yadagiri
2
2
4
0.08
50.00
50.00
Aiiantapur
89
98
187
3.92
47.59
52.41
Kumool
129
169
298
6.25
43.29
56.71
Pudukottai
292
262
554
11.62
52.71
47.29
Thiruvarur
100
113
213
4.47
46.95
53.05
Dindigul
Kanyakumari
97
252
102
199
4.18
48.74
51.26
218
470
9.86
53.62
46.38
Nilgris
102
99
201
4.22
50.75
49.25
District
Female
Male
Bangalore
2
0
Bangalore Rural
456
Chikkaballapura
Community Mental Health And Development Program In South India - A Consolidated Report
116
IN
L 1ST
THE
OF
TABLES
STATISTICAL
CORRESPONDING
TO
FIGURES
PRESENTED
REPORT
Tanjore
19
32
51
1.07
37.25
62.75
Theni
111
159
270
5.67
41.11
58.89
ThirunelveE
87
168
255
5.35
34.12
65.88
Thiruvallur
76
49
125
2.62
60.80
39.20
Vellur
133
97
230
4.83
57.83
42.17
Idukki
88
81
169
3.55
52.07
47.93
Total
2440
2326
4766
100.00
51.20
48.80
■
..
Table 3.4 Sex- wise Distribution of PWMI in CMH&D Prog ram on the Basis of Categories of
Illness
Type of illness
Female
Male
I TotalEM Total% ■, Female%
Major
1342
1467
2809
58.94
47.78
Male%
I | 52.22
Minor
1059
824
1883
39.51
56.24
43.76
Epilepsy
27
27
54
1.13
MR
12
8
20
0.42
60.00
40.00
Total
2440
2326
4766
100.00
51.20
48.80
Total
Total %
.
50.00
Table 3.5 PWMI Based on Marital Status
Marital Status
Major
Minor 5
Unmarried
821
344
28
6
1199
28.85
Mimed
1571
1234
23
0
2828
68.05
Divorced
5
13
0
0
18
0.43
Separated
29
10
0
0
39
0.94
Widow
31
41
0
0
72
1.73
Total
2457
1642
51
6
4156
100.00
■
.................... ■■■•■
Community Mental Health And Development Program In South India - A Consolidated Report
•
■■■
.................................
117
'
IN
TABLES
LIST OF STATISTICAL
THE REPORT
CORRESPONDING
TO
FIGURES
PRESENTED
Table 3.7 PWMI Based on Marital Status and Sex
-
Marital Status
Female
Male
Total
Unmarried
465
734
1199
28.85
38.78
61.22
Married
1569
1259
2828
68.05
55.48
44.52
Divorced
16
2
18
0.43
88.89
11.11
Separated
27
12
39
0.94
69.23
30.77
Widow
67
5
72
1.73
93.06
6.94
2144
2012
4156
100.00
51.59
48.41
J - . .w
Total
Male%
Table 3.8 Prevalence of Mental Illness in Children, Young and Older Persons in CMH&D
Program
Age groups
Major
Below 20
: 147
MR
21-40
Total%
80
24
7
258
5.41
1003
34
0
2638
55.35
41-60
'924
669
9
0
1602
33.61
Above 60
137
131
0
0
268
5.62
j 2809
1883
67
7
4766
100.00
Total
Table 3.9 PWMI in CMH&D Program Based on Age and Sex
Age groups
<
i m-mI
I
Total
Below 20
128
■ 130
258
5.41
49.61
50.39
21-40
1316
1322
2638
55.35
49.89
50.11
41-60
867
735
1602
33.61
54.12
45.88
Above 60
129
139
268
5.62
48.13
51.87
Total
2440
2326
4766
100.00
51.20
48.80
Community Mental Health And Development Program In South India - A Consolidated Report
118
IN
LIST OF STATISTICAL
THE REPORT
TABLES
CORRESPONDING
TO
IN
PRESENTED
FIGURES
Table 3.10 PWMI in CMH&D Program Based on Caste
Caste
MR
General
205
192
2
3
402
10.08
OBC
1489
873
33
3
2398
60.15
S.C
390
251
11
0
652
16.35
S.T
132
105
4
0
241
6.04
MBC
209
84
1
Total
2425
1505
51
6
294
7.37
....
.
3987
100.00
•
Table 3.12 PWMI in CMH&D Program Based on Caste and Sex
Total
Male%
ffl.
General
226
176
402
10.08
56.22
43.78
OBC
1247
1151
2398
60.15
52.00
48.00
S.C
321
331
652
16.35
49.23
50.77
S.T
117
124
241
6.04
48.55
51.45
MBC
145
149
294
7.37
49.32
50.68
Total
2056
1931
3987
100.00
51.57
48.43
Table 3.13 Identified PWMI in CMH&D Program Based on Categories of Mental Illness and
Education
Epilepsy
MR
Total
Total %
1st std to 7th std
240
238
4
0
482
12.09
8th std to 10th std
646
380
14
1
1041
26.11
PUC
103
62
0
166
4.16
Degree
69
34
1
1
' 0
104
2.61
Master degree
4
4
0
0.20
1363
787
32
0
4
8
illiterate
2186
54.83
Total
2425
1505
6
3987
100.00
Community Mental Health And Development Program In South India - A Consolidated Report
119
LIST OF STATISTICAL
THE REPORT
TABLES
CORRESPONDING
TO
FIGURES
PRESENTED
Table 3.14 Identified PWMI in CMH&D Program Based on Education and Sex
[ Female
Male
Total
Total%
Female%
Male%
•234
248
482
12.09
48.55
51.45
Sth std to 10th std
457
584
1041
26.11
43.90
56.10
PUC
56
109
165
4.14
33.94
66.06
Degree
26
79
105
2.63
24.76
75.24
Master Degree
3
5
8
0.20
37.50
62.50
Illiterate
1280
906
2186
54.83
58.55
41.45
Total
2056
1931
3987
100.00
51.57
48.43
Female%
| Male%
Education/
Qualification
1st std to 7th std
■
............................................................................................. _
.
Table 3.15 PWMI in CMH&D Program Based on Occupation
Occupation
Female
Male
Agriculture
159
285
444
11.14
35.81
64.19
Animal Husbandry
30
32
62
1.56
48.39
51.61
Daily wages
697
673
1370
34.36
50.88
49.12
Government Job
19
21
40
1.00
47.50
52.50
Household work
420
160
580
14.55
72.41
27.59
Private Job
15
45
60
1.50
25.00
75.00
Self Employment
50
91
141
3.54
35.46
64.54
Skilled work
79
94
173
4.34
45.66
54.34
Not working
587
530
1117
28.02
52.55
47.45
Total
2056
1931
3987
100.00
51.57
48.43
Community Mental Health And Development Program In South India - A Consolidated Report
120
IN
LIST OF STATISTICAL
THEREPORT
TABLES
CORRESPONDING
TO
FIGURES
PRESENTED
IN
Table 3,16 Identified PWMI Based on Types of Illness and Annual Income
Below 6000
423
392
2
6000 to 12000
1393
598
36
5
: 2032
I 20.49
50.97
12000 to 24000
538
435
10
1
984
24.68
Above 24000
71
80
3
0
154
3.86
Total
2425
1505
51
6
3987
100.00
817
Chapter 4 DIAGNOSIS, TREATMENT AND ACCESS TO TREATMENT
Table 4.1 Distribution of PWMI Based on Sex and Diagnosis
Diagnosis
Total
Total%
Female%
Male%
9
147
9
316
0.19
6.63
0.00
53.48
100.00
46.52
144
24
177
5
321
29
6.74
0.61
44.86
82.76
55.14
17.24
Depression
Dysthymia
700
90
556
36
1256
126
26.35
2.64
55.73
71.43
44.27
28.57
GTCS
3
1
4
0.08
75.00
25.00
Air & Psychosis
26
22
48
1.01
54.17
45.83
Neurosis
Major Depression
6
63
6
58
12
121
0.25
2.54
50.00
52.07
50.00
47.93
Epilepsy
33
31
64
1.34
51.56
48.44
OCD
12
10
22
0.46
54.55
45.45
Parkinson
2
3
5
0.10
40.00
60.00
Phobia
33
26
59
1.24
5^.93
44.07
Panic Disorder
0
4
4
0.08
0.00
100.00
Psychosis
254
314
568
11.92
44.72
55.28
ADS
Anxiety Disorder
0
169
BPAD
Delusional Disorder
Community Mental Health And Development Program In South India - A Consolidated Report
121
■
LIST OF STATISTICAL
THE REPORT
TABLES
CORRESPONDING
Male%
1652
34.66
48.18
51.82
38
1
103
1
2.16
0.02
63.11
0.00
36.89
100.00
2
8
0.17
75.00
25.00
Male
Schizophrenia
796
856
Somatoform Disorder
TIA
65
0
■
•
J
6
' ;
. : '
PRESENTED
Female%
I Female
......................
FIGURES
Total%
Diagnosis
Behavioral problem
TO
'
' 'J'.'.:' .
Dementia
4
2
6
0.13
66.67
33.33
GPMR&MI
■ o:
i
i
0.02
0.00
100.00
Hysteria
5
9
14
0.29
35.71
64.29
Personality Disorder
0
1
1
0.02
0.00
100.00
MR
! 5
6
11
0.23
45.45
54.55
5
2326
0
2440
Substance Abuse
Total
IN
0.10
100.00
5
4766
100.00
48.80
0.00
51.20
Table 4.2 PWMI in CMH&D Program Based on Status of Treatment
Person on Treatment
Major
Minor
Epilepsy
MR
Total %
IO!
......
Regular
1373
657
45
6
2081
43.66
Irregular
1436
1226
22
1
2685
56.34
Total
2809
1883
67
7
4766
100.00
Table 4.3 PWMI Stabilized after Treatment Based on Sex
Male I
Stabilization
Total%
Yes
1167
1010
2177
45.68
53.61
46.39
100.00
No
1071
1100
2171
45.55
49.33
50.67
100.00
Not applicable
202
216
418
8.77
48.33
51.67
100.00
Total
2440
2326
4766
100.00
51.20
48.80
100.00
Community Mental Health And Development Program In South India - A Consolidated Report
122
LIST OF STATISTICAL
THE REPORT
TABLES
TO
CORRESPONDING
FIGURES
PRESENTED
Table 4.4 PWMI Reporting Side Effects Based on Sex
Side
Effects
Yes
a fl
142
No
Total
Female | Male
Total
j Total%
Female%
Male%
| Total
122
j 264
5.54
53.79
46.21
100.00
2298
2204
4502
94.46
51.04
48.96
100.00
2440
2326
4766
100.00
51.20
48.80
100.00
Table 4.5 PWMI Reporting Side Effects Based on Types of Illness
Side effects
Major
Minor
Epilepsy
| MR
Total
I Total %
Yes
155
106
4
0
265
5.56
No
2654
1777
63
7
4501
94.44
Total
2809
1883
67
..... ; 7
4766
iooJd
'
Table 4.6 PWMI Reporting Relapse of Symptoms Based on Sex
Relapse
Female
Male
Total
Total% | Female%
Male%
Yes
1165
; 160
325
6.82
| 50.77
49.23
I No
2275
2166
4441
93.18
51.23
48.77
Total
2440
2326
4766
100.00. . ! 51.20
48.80
s__
Table 4.7 PWMI Reporting Relapse of Symptoms Based on Types of Illness
Relapse
Major
Minor
Epilepsy
MR
Total
Total %
Yes
213
105
7
0
325
6.82
No
2596
1778
60
7
4441
93.18
Total
2809
1883
67
7
4766
100.00
Community Mental Health And Development Program In South India - A Consolidated Report
123
IN
LIST OF STATISTICAL
THE REPORT
TABLES
CORRESPONDING
TO
FIGURES
PRESENTED
Table 4.8 PWMI Drop-out from Treatment Based on Sex
Reasons for drop outs
Female
Male
Total
Total%
Female%
Male%
Completed Treatment
63
62
125
2.62
50.40
49.60
; Family Negligence
122
229
4.80
46.72
53.28
Self Decision
107
57^“
52
109
2.29
52.29
47.71
Migrated
198
181
379
7.95
52.24
47.76
No Information
31“
28
59
1.24
52.54
47.46
Not Applicable
1761
1644
3405
71.44
51.72
48.28
Side Effects
21
21
42
0.88
50.00
50.00
| Death
202
216
418
8.77
48.33
51.67
Total
2440
2326
4766
100.00
51.20
48.80
Total
Total %
Table 4.9 Reason for PWMI Drop-out from the Program Based on Illness
Reasons for Dropouts
Major Minor
MR
81
0
125
2.62
Completed Treatment
76
11 0
49
Family Negligence
177
49
3
0
229
4.80
Self Decision
64
77
4
1
146
3.06
Migrated
216
20
162
1
0
379
7.95
36
0
0
56
1.17
0
0
0
8
0.17
No Information
Side Effects
Death
290
126
2
0
418
8.77
Not Applicable
1958
1384
57
6
3405
71.44
Total
2809
1883
67
7
4766
100.00
Community Mental Health And Development Program In South India - A Consolidated Report
124
IN
ThVrVpORT TIST,CAL
TABLES
CORRESPONDING
TO
FIGURES
PRESENTED
Table 4.10 Reasons for Death of PWMI According to Illness
Reason for Death
Major
Minor
Epilepsy
MR
Age and Natural Death
115
36
1
0
152
3.19
Due to Mental Illness
21
14
0
0
35
0.73
Physical Health problem
48
19
0
0
67
1.41
Accident
8
6
0
0
14
0.29
Alcoholism
2
0
0
0
2
0.04
Suicide
19
7
0
0
26
0.55
No Information
77
44
1
0
122
2.56
Not Applicable
2519
1757
65
7
4348
91.23
Total
2809
1883
67
7
4766
100.00
Total
__ _
Table 4.11 PWMI Consulting Village Quacks
Male
Yes
36
Male%
46
82
4.04
43.90
56.10
------ i.....
No
1047
900
1947
95.96
53.78
46.22
Total
1083
946
2029
100.00
53.38
46.62
on Types of Illness
Source of Treatment
Major
Govt. Hospital
1621
857
Mental health Camp
8
Private Hospital
MR
Total
Total %
40
5
2523
52.94
5
1
0
14
0.29
334
211
12
1
558
11.71
Not on Treatment
697
715
13
1
Organization
149
95
1
0
1426
29.92
. ... .. . —...... . . .
245
5.14
Total
2809
1883
67
7
I
4766
v*-?-
100.00
t .
Community Mental Health And Development Program In South India - A Consolidated Report
'•?
■
125
IN
LIST OF STATISTICAL
THE REPORT
TABLES
CORRESPONDING
TO
FIGURES
PRESENTED
IN
Chapter 5 Social Inclusion: Community and Social Participation
Table 5.1 PWMI Involved in Decision-Making According to Categories of Mental Illness
Participation in
Family Decisions
Major
Yes
No • ■■
530
592
537r^N-b45 :::
Total
1067'
Minor
i-
MR
Epilepsy
■
937
■
'
'
:■<
■
i
'
Total
Total %
■■
20
0
1142
56.28
5
0
887
43.72
25
0
2029
100.00
Table 5.2 PWMI Involved in Decision-Making Based on Sex
Participation ini
Family Decisions
Yes
Female
i
626
Male
Total
Total%
Female%
Male%
516
1142
56.28
54.82
45.18
No
457
430
887
43.72
51.52
48.48
1083
946
2029
100.00
53.38
46.62
Total
..
Table 5.3: PWMI Contributing to the Income of the Family
Involved in IGP
and contributing
towards Family
Income
Major Minor Epilepsy
Yes
283
145
No
784
Total
1067
444
13.95
7.15
0.79
21.88
792
16
9
1585
38.64
39.03
0.44
78.12
937
25
2029
52.59
46.18
1.23
Community Mental Health And Development Program In South India - A Consolidated Report
100.00
126
LIST 0F STAT|STICAL
THE REPORT
tables
corresponding
TO
FIGURES
PRESENTED
Table 5.4 PWMI Contributing to the Income of the Family Based on Sex
Involved in IGF and Female Male
contributing
towards Family
Income
Yes
211
233
No
872
713
Total
1083
946
Total
Total%
Female% Male%
444
21.88
47.52
52.48
1585
78.12
55.02
44.98
2029
100.00
53.38
46.62
I
Table 5.5 PWMI Involved in Productive Work Based on Illness
Involved in any
productive activities
without earning
Yes
Major Minor
Epilepsy
MR
Total
Total %
534
561
20
0
1115
54.95
No
533
376
5
0
914
45.05
Total
1067
937
25
0
2029
100.00
Table 5.6 PWMI Involved in Productive Activity Based on Sex
Involved in any
productive activities
without earning
Female
Male
Total
Total%
Female%
Male%
Yes
610
505
1115
54.95
54.71
45.29
No
473
441
914
45.05
51.75
48.25
Total
1083
946
2029
100.00
53.38
46.62
Based on Illness
Participation in any
Social Activities
Yes
No
Total
Major
Minor
Epilepsy
MR
Total
Total %
345
173
20
0
538
26.52
722
1067
764
937
5
25
0
0
1491
2029
73.48 ||
100.00
Community Mental Health And Development Program In South India
A Consolidated Report
127
IN
STATISTICAL
LIST
OF
THE
REPORT
TABLES
TO
CORRESPONDING
FIGURES
PRESENTED
Participation in any
Social Activities
Female
Male
Total ■SI
Total%
Female%
Male%
Yes
7 253 : •
j 285
538
26.52
47.03
52.97
830
661
1491
73.48
55.67
946
2029
100.00
53.38
44.33
46.62
No^
'
Total
UH 1083
IN
Table 5.9 Inclusion of PWMI into Community Groups Based on Sex
PWMI Included in to
the SHG
Yes
Female
Male
Total
Total%
Female%
I Male%
799
473
1272
26.69
62.81
37.19
No
1641
1853
3494
73.31
46.97
53.03
Total
2440
2326
4766
100.00
51.20
..
48.80
I
Table 5.10 Inclusion of PWMI into Community Groups Based on Illness
PWMI Included in to
the SHG
Yes
Major
No
2092
2809
Total
717
K
Minor Epilepsy
MR
Total
Total %
533
17
5
1272
26.69
1350
50
2
3494
73.31
1883
67
7
4766
100.00
Table 5.11: Inclusion of Caregivers of PWMI into Community Groups Based on Sex
Caregivers included in Female Male
the SHG’s
813
833
Yes
Total
Total%
Female°/o
Male%
1646
34.54
50.61
49.39
No
1607
i 1513
3120
65.46
51.51
48.49
Total
2440
2326
4766
100.00
51.20
48.80
Community Mental Health And Development Program In South India - A Consolidated Report
128
LIST
THE
OF
STATISTICAL
TABLES
CORRESPONDING
TO
REPORT
cc<
FIGURES
IN
PRESENTED
I
lemes
Table 6.1 Accessing Entitlements and Social Security Schemes by PWMI Based on Sex
Schemes
Male
Female
Total
Number of people availing Disability Certificate.
244
241
485
Number of people accessing Disability' Pension
Number people accessing BPL cards
Number of people accessing Travel Concession
Pass
Number of people accessing Poverty Alleviation
Schemes
229
1027
194
1156
423
2183
83
43
126
500
415
915
1
Table 6.2: Accessing of Disability Identity Cards by PWMI
Disability
Identity card
Yes
No
Total
Female
Male
Total
241
1903
2144
244
1768
2012
485
3671
4156
Male%
11.67
88.33
100.00
49.69
51.84
51.59
50.31
48.16
48.41
1
Table6. 3: PWMI Accessing BPL Cards
No
Female
1156
900
Male
1027
904
Total Total%
2183 54.75
1804 45.25
49.89
47.05
50.11
Total
2056
1931
3987
51.57
48.43
BPL Card Holder
Yes
100.00
Female% Male%
52.95
Table 6.4 Distribution of Persons Accessing BPL Cards according to Illness
BPLCaid
Holder
Yes
Major Minor Epilepsy MR Total
MajofYo
Minor%
Epilepsy%
MR% •
1246
907
30
0
2183
57.08
41.55
1.37
0.00
No
1179
598
21
6
1804
65.35
33.15
1.16
0.33
Community Mental Health And Development Program In South India - A Consolidated Report
129
LIST OF STATISTICAL
THE REPORT
TABLES
CORRESPONDING
BPLCard
Holder
Major
Minor Epilepsy I MR Total
Total
2425
1505
51
3987
6
FIGURES
TO
PRESENTED
IN
Epilepsy0/.,
MR%
1.28
•,0.15. '
Majoi% Minoi%
' 37.75
60.82
Table 6.5 PWMI under MNREGA Program Based on Sex
"
Member in MNREGA
Female
Male
Total
Yes
No
379
1677
2056
431
1500
1931
810
3177
3987
'
I—
’
...... '■'■I
Total
Male%
20.32
79.68
100.00
46.79
52.79
51.57
I
53.21
47.21
48.43
Table 6.7: Distribution of PWMI under MNREGA Program According to Illness
. 7.
Member in
MNREGA
Major Minor Epilepsy
•^7 ' ' 7777177 7 ^ 7 . <
' ' :
7
Yes
1 501
296
13
0
810
61.85
36.54
1.60
No
L924
12C9
38
6
3177
60.56
38.05
1.20
0.19
Total
2425
1505
51
6
3987
60.82
37.75
1.28
0.15
Majot% Minoi%
Epilepsy%
Community Mental Health And Development Program In South India - A Consolidated Report
0.00:
.......
130
INTERVIEWER’S
JOURNAL
Appencfix
INTERVIEWER’S JOURNAL
Tloe Interueu^'s Journal describes the intenuerciin^ techniques, the questionnaire,
procedure for filling the questionnaire and discussion on eadj question cf all the
questionnaires. This chapter also proudes the details of allfiddieork procedures.
Community Mental Health and Development Program
i
- Consolidation Study
2010 2011
Interview Schedule
Name of the Organization:
Personal Information
1. File Number
2.
Name:
Father/ Husband's Name:
3. Address
Village___________
Panchayath /Ward
Taluk / Block
District_________
Phone Number
4. Age/ Date of Birth
5. Sex
| MALE
| FEMALE^
6. Religion
7.
Caste
Community Mental Health And Development Program In South India - A Consolidated Report
131
INTERVIEWER’S
JOURNAL
8. Belongs to SC/ST/OBC. If Yes, specify:
9. Educational level
10. Other skills/ trainings
11. Occupation
12. Marital status: Single/Married/ Widow/ Separated/ Divorced
13. Onset (beginning) of illness was before or after marriage :
A. If the onset of illness was before marriage, whether the person got married after treatment
and stabilization
B. Annual income of the individual
History of Mental Illness
14.
Onset of illness and causes:
15.
Treatment taken and duration:
16. Mode of identification: PWMI/ Self / SHG / Fed / Staff / Volunteers / Others.
17. Other information's (if any).
Family Details;
SL
No
1
Name Age
Relationship with
the Client
Level of
Education
Occupation
skills
Remarks if
any
Annual
Income
2
2
45^
6
1 7 . Total income of the family: Up to rupees' 6000/-year, '6000-'12000, '12000-'24000, and
above' 24000/-
Current Status;
18.
19.
Common
Severe
Regular
Irregular
Diagnosis:
Is person on treatment?(Yes /No) if No, give the details:
If Yes, status of the treatment:.
Community Mental Health And Development Program In South India - A Consolidated Report
132
INTERVIEWER’S
JOURNAL
20. Present treatment from
A. Government hospital (PHC, CHC, TQH, DH, MC, CAMPS, OTHERS).
B. Private practitioners/ hospitals
C. Non Pharmacological treatment (Ayurveda, Meditation, Counseling, Yoga, Homeopathy, Others)
D. Partner organization
21. Present medicines from
A. Government hospital (PHO, CMC, TQH, DH, MC, CAMPS, OTHERS)
B. Private practitioners (hospital)
C. Non Pharmacological treatment (Ayurveda, Meditation, Counseling, Yoga, Homeopathy, Others)
D. Partner organization:
E. Partial from Govt:
2 2 .
Support for Treatment
A.
Earning and Contributing (Self finance):
B. Family contribution:
C. Community support:
D. Others:
___________
2 3 .
Side effects? (Yes/No) (If Yes. mention the side effects and how you are
managing?
_____________________
24. Completed treatment and gone back to the pre-morbid level of functioning:
2 5 .
Stabilized?
2 6.
Relapse? (Yes /No) if Yes, give reason
2 7.
Drop-Out? (Yes/No) if Yes, give reason:.
28. If the family is permanently migrated? Give details:.
29. Death ?(Yes/No) if Yes, give details:
3 0 .
Any other health problems?(Yes/No) if Yes, mention the problem and causes:
31. Are you taking treatment (Yes/No) if Yes, give details
32. Participation in family decisions? (Yes/No)
Community Mental Health And Development Program In South India - A Consolidated Report
133
INTERVIEWER’S
JOURNAL
33. Primary care within the family (details):
34. Community support(details):
35. Attitude of community towards PWMI? (details)
36. Participation in Social / community life? (Details)
37. Membership in any Community groups? (Yes/No) if Yes, mention the name of the group
38. Participation in the Community group meeting?
Regular
Irregular
39. If irregular, mention the reasons:
40. What information you are getting from the meetings and how is it benefiting you?
41. Undergone any training through the groups? if Yes, give details.
42. Even now are you approaching village quacks and black magicians?.
43. Participation in awareness programs :.
44. Participation in advocacy programs:
45. Have you experienced being in shackles/ solitary confinements recently?.
46. Relationship with spouse (husband/wife) and family members:.
47. Are you aware of disability/ mental health acts?.
48. Person's activities at home:.
l
49. Activities outside the home:,
50. Engaging in income generation activity:.
51. Sources of income generation activities (Self, Family, SHG, Panchayaths, Bank, Corporation, Org,
Any other:
52. To previous Job:.
53. Undergone vocational or any other trainings?.
54. Loans availed and state of repayment:.
Community Mental Health And Development Program In South India - A Consolidated Report
134
INTERVIEWER’S
JOURNAL
55. Are you getting equal opportunity in job? equal wages and equal respect in the community?
56. Are you having (owning) any assets? (details)
57. Are you making savings?.
58. BPL card holder:.
59. Economic status of the family:.
60. Member in MNREGA (Self / family member)?.
61. Accessing any welfare schemes or poverty alleviation schemes?
A . Disability ID cards:
B . Bus pass:
C. Train pass:
D . Pensions (details)
E . Loans (details)
F. Housing / Plot (details]
G . Utilization of 3% allocation of resources and from which department?
H . Training and employment (details) :
_______________
62. Any other schemes (Yes /No) If Yes, give details:
63. Any other information you would like to share?.
64. Present needs of person:.
65. Source of Information: self/parent/sibling/sion or daughter/relative/others
66. Field staff s Note:
Date:
Name of the field staff/volunteer:
Coordinator's signature
Signature:
Community Mental Health And Development Program In South India - A Consolidated Report
135
- Media
16897.pdf
Position: 2814 (3 views)