Course Name –Psycho- Social Rehabilitation

Faculty Name – Dr Heenakshi Bhansali

Psycho- Social Rehabilitation

 COURSE DESCRIPTION

• The course aims to provide understanding about basic concepts of

Rehabilitation in terms of Individual, family and Community.

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 Mental Health of Person with Disabilities
• Psychosocial rehabilitation is the process that facilitates opportunities for
persons with chronic mental illness to reach their optimal level of
independent functioning in society and for improving their quality of life.

• Community-based rehabilitation is a multi-dimensional approach to

improve the function and quality of life to a mentally ill person. The
evidence promotes community-based psychosocial rehabilitation as a
feasible option for low and middle-income countries as it can be
effectively delivered by trained lay health workers under supervision by
the mental health specialist.

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Mental Health of Person with Disabilities
• The mental health spectrum ranges from good mental health to poor
mental health and/or serious mental illness. Many people experience
small fluctuations on the milder end of the spectrum due to the normal
challenges of daily life. However, others fluctuate or stabilize on the end
of poor mental health or mental illness.

• People with disabilities face a variety of structural and ideological

challenges that have little to do with their actual limitations. These
societal stigmas are often at the root of poor mental health and mental
illness among individuals with disabilities, rather than their disability
itself.
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Mental Health of Person with Disabilities

• Community-based psychiatric rehabilitation is an integrated model

that consolidate efforts of multiple professionals, pharmacological
intervention, patients’ key caretakers and sensitization of community
members on mental illness.

• Salient characteristics of this approach aid rapid recovery and

reintegration of persons with mental illness with family and the
community.

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 Mental Health of Person with Disabilities

• The World Health Organization recommends community-based

psychiatric rehabilitation to improve quality of life and ensure
inclusion and participation of persons with mental illnesses. However,
limited number of psychosocial rehabilitation centers exist despite
alarmingly high incidence of mental illnesses.

• Rehabilitation activities primarily comprised of routine activities,

outreach activities, and livelihood activities.

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 Mental Health of Person with Disabilities

• Routine activities: The daily routine included prayer, yoga along with
laughter therapy, light physical exercise, group discussion, recreational
activities and training them for daily living skills, social skills, life skills to re-
integrate them with the family and community.

• Outreach activities: In addition to these, centres regularly organized training

for the staff, mental health awareness camps in the community to educate
people about mental health, diagnose and treat mentally ill patients, and
issues disability certificates to persons with mental illness to access various
social protection and other Government schemes.
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 Mental Health of Person with Disabilities

• Livelihood activities: The center encourages patients to engage in

livelihood activities particularly manufacturing handmade products.
The profits earned were equally shared amongst patients. At the day-
care center, the center provides a pick-up and drop facility for
ensuring the regularity of patients in livelihood activities.

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 Barriers to Mental Health of Person with
Disabilities
People with disabilities face a wide variety of obstacles when it comes
to obtaining good mental health.

Social Stigmas & Ableism

• Individuals with disabilities are often reduced to their disability, rather
than being treated as valuable and contributing members of society.
Known as ableism, these damaging stigmas devalue those with
disabilities by dismissing them as being “less than” people without
disabilities.

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 Barriers to Mental Health of Person with
Disabilities
Provider Misconceptions
• Some mental health providers feel that people with disabilities must
be “fixed” in order to fully participate in their communities, but this
isn’t the case. As a result, having a disability is perceived as a defect,
rather than a small aspect of a person that simply makes them
different.
• In many cases, mental health providers view mental illness as a direct
result of having a disability, instead of an independent challenge.
Mental health conditions are lumped together with other disability
symptoms, causing mental illness.

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 Barriers to Mental Health of Person with
Disabilities
Poverty & Unemployment

• Many individuals with disabilities have difficulty securing full-time

jobs and often face overt employment discrimination. And those who
do work are often stuck with temporary work or part-time jobs, which
don’t usually include healthcare benefits. At the same time,
government disability benefits aren’t enough to cover the expenses of
living independently

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 Barriers to Mental Health of Person with
Disabilities
Prohibitive Costs
• Mental health services for developmental disabilities and physical
limitations including medication expenses can be high, and they
aren’t always covered by government benefits.
• Many people end up paying for medical expenses out of pocket, and
they typically prioritize their physical health over their mental well-
being. Prohibitive costs may also cause housing insecurity and
homelessness, both of which can contribute to poor mental health or
mental illness.

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 Impact of Mental illness on
Caretakers
• Chronic nature of major mental illnesses can have a devastating
impact on persons with mental illness and the caregivers.
• Families represent the key resource persons in the care of patients
with mental illness. Families are assigned the role of primary
caretakers for two reasons.
• First, there is a paucity of trained mental health professionals
required to execute psychosocial interventions.
• Second, most Indian families would like to be meaningfully involved in
all aspects of care of their ill relative.

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 Impact of Mental illness on
Caretakers

• Mental illness not only affects the PWMI but also their family
members, friends and neighbours who directly and indirectly
involved in their care.

• Family members become direct target and they face problems,

scarcity and challenges in the care of mentally ill resulting in
needs among caregivers commonly known as ‘rehabilitation
needs’.

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 Impact of Mental illness on
Caretakers

• Caregivers play an important role in providing day to day care to

their ward and feel constrained due to unfulfillment of their own
personal and professional needs.

• Caregiver is an occupation that can encompass 24 hours in a day;

7 days in a week with no sick leave, no payback or no praise. These
challenges put the caregiver to experience many physical and
psychological problems termed ‘burden’.

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 Impact of Mental illness on
Caretakers

• Family psychoeducational interventions can help family members

cope with various distressing symptoms. Studies show that family
psychoeducation programs have significant benefits in areas other
than symptom and relapse management for the family member with
a chronic psychiatric disorder.

• Psychoeducation and skills training are conducted in a multiple family

group format always lowered the family burden and improves
relatives' sense of self-efficacy regarding the ill family member.
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 Impact of Mental illness on
Caretakers
• Participating in a multiple family group meeting can reduce the stress,
isolation and stigma experienced by family members; the burden of
care no longer seems unique, and families can exchange helpful
suggestions and coping techniques with each other.

• Family intervention increases the level of the patient's social

competence, decreases the subjective burden on relatives, changes
the communication pattern and the overall interaction within the
family.

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 Impact of Mental illness on
Caretakers
• Mental Health Professionals need to be sensitive toward family and
caretakers burden and offer interventive inputs that will help reduce
this burden.

• These inputs could be in the form of emotional support to the

primary caregivers, offering day care and sheltered workshop facilities
to the severely disabled, and even assisting the economically deprived
disabled individual or a well member of his or her family to obtain
gainful employment.

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 Impact of Mental illness on
Community
• Community psychiatry movement started more than 100 years ago, with
the purpose of rehabilitation of the persons with mental illnesses in the
community after a prolonged hospitalization in the mental hospitals. There
were also concerns about violation of basic human rights of the persons
with mental illness and the ill effects of institutionalization.

• Community mental health refers to the treatment of persons with mental

health problems in community setups. Such setups include community
mental health clinics and other health services located in the community,
primarily any service away from a custodial care mental health setting.

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 Impact of Mental illness on
Community
Three causes for the deinstitutionalization identified:
1) The first cause was the development of effective psychotropic drugs
in the 1950s. These enable patients with a psychiatric disability to
live a relatively normal life in the community, supported by
outpatient care facilities.
2) The second cause was the emergence of a civil rights paradigm for
disabled people. It states that they should be treated in the least
restrictive environment possible.
3) The third cause of deinstitutionalization was the hope of cost
reduction, since institutional care is notoriously expensive.
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 Impact of Mental illness on
Community
• In Indian community, traditionally the persons with mental illnesses have
been taken care by the family members. During the colonial rule by the
British, a number of asylums or mental hospitals were opened in India,
mostly for the British soldiers and the British who suffered from mental
illnesses.

• Most of these hospitals continued after India got independence in 1947,

and many more were built in the next few decades. In the last three
decades, many reforms have been initiated in the mental hospitals in
India by involving the family members of the persons admitted and those
attending the outpatient services.
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 Impact of Mental illness on
Community
• Globally, the gradual closure of the mental hospitals has occurred due to the
issues of repeated cases of ill-treatment of patients, geographical and
professional isolation of the institutions and the staff, poorly targeted financial
resources, poor staff training, failure of management and leadership, and
inadequate inspection and quality assurance procedures.

• On the other hand, the mental hospitals in India have modified by developing
training facilities, expanding outpatient and community services, and also
downsizing the inpatient units. The strength of joint family, marriage, religion
and faith-based coping and healing have all contributed to a large number of
persons with various mental disorders being taken care of in the community in
India.
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 Impact of Mental illness on
Community
• Involving families in taking care of the patients under care of mental
health services have been a unique contribution from India. It was
initiated by Dr. Vidya Sagar in 1950s at Amritsar Mental Hospital
followed by the Mental Health Centre at Christian Medical College,
Vellore, and All India Institute of Mental Health, Bengaluru, in 1960s.

• Family members would actually be admitted along with the persons

with mental illness to be a part of the care for the patient. This
practice has been continued in most of the general hospital
psychiatric units.

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 Impact of Mental illness on
Community
• National Mental Health Program was launched with the objectives to ensure the
availability and accessibility of minimum mental healthcare for all in the
foreseeable future, particularly to the most vulnerable and underprivileged
sections of the population; to encourage the application of mental health
knowledge in general healthcare and in social development; and to promote
community participation in the mental health service development, and to
stimulate efforts toward self-help in the community.

• Another important development in community psychiatry in India is the

increasing role of voluntary organizations in developing small-size locally relevant
community-based psychiatric care facilities such as day care centers, vocational
training centers, sheltered workshops, half-way homes, and long stay homes
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 Impact of Mental illness on
Community
Positive effects of deinstitutionalisation
1. Better quality of life
2. Improved skills
3. Better quality of care

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 THANK YOU

For queries Email: Heenakshi.bhansali@mitwpu.edu.in