All I could gather is
the following information. From it I assume that there are provisions
for mentally retarded but for the mentally ill(rehabitation) it is still
not easy.
Mental
disorders account for five of the ten leading causes of disability;
they are major depression, alcohol dependence, schizophrenia, bipolar
affective disorder, and obsessive–compulsive disorder (OCD).
Only
few developed countries such as Australia, Canada, the US, the UK, and
so forth have recognized this and are proactive in providing social
welfare measures for persons with mental illness. Although legislations
in these countries have ensured the social welfare schemes for persons
with mental illness, they continue to be underdiagnosed, underestimated
in official statistics, discriminated, and face various challenges
during the assessment of disability.
This
situation becomes worse with regard to providing care and social welfare
measures to persons with mental illness in the low- and middle-income
countries.
Further, on comparing functional
disability of mental disorders with physical disorders, it was found
that mental disorders are associated with a similar or higher negative
impact on daily functioning than arthritis and heart disease.
………………………..
(Source: A Handbook for Parents of Children with Disabilities)
The Mental Health Act, 1987
Under the Mental Health Act, 1987 mentally ill persons are entitled to the following rights:
- A right to be admitted, treated and cared in a psychiatric hospital or psychiatric nursing home or convalescent home established or maintained by the Government or any other person for the treatment and care of mentally ill persons (other than the general hospitals or nursing homes of the Government).
- Even mentally ill prisoners and minors have a right of treatment in psychiatric hospitals or psychiatric nursing homes of the Government.
- Minors under the age of 16 years, persons addicted to alcohol or other drugs which lead to behavioral changes, and those convicted of any offence are entitled to admission, treatment and care in separate psychiatric hospitals or nursing homes established or maintained by the Government.
- Mentally ill persons have the right to get regulated, directed and co-ordinated mental health services from the Government. The Central Authority and the State Authorities set up under the Act have the responsibility of such regulation and issue of licenses for establishing and maintaining psychiatric hospitals and nursing homes.
- Treatment at Government hospitals and nursing homes mentioned above can be obtained either as in patient or on an out-patients basis.
- Mentally ill persons can seek voluntary admission in such hospitals or nursing homes and minors can seek admission through their guardians. Admission can be sought for by the relatives of the mentally ill person on behalf of the latter. Applications can also be made to the local magistrate for grants of such (reception) orders.
- The police have an obligation to take into protective custody a wandering or neglected mentally ill person, and inform his relative, and also have to produce such a person before the local magistrate for issue of reception orders.
- Mentally ill persons have the right to be discharged when cured and entitled to ‘leave’ the mental health facility in accordance with the provisions in the Act.
- Where mentally ill persons own properties including land which they cannot themselves manage, the district court upon application has to protect and secure the management of such properties by entrusting the same to a ‘Court of Wards’, by appointing guardians of such mentally ill persons or appointment of managers of such property.
- The costs of maintenance of mentally ill persons detained as in-patient in any government psychiatric hospital or nursing home shall be borne by the state government concerned unless such costs have been agreed to be borne by the relative or other person on behalf of the mentally ill person and no provision for such maintenance has been made by order of the District Court. Such costs can also be borne out of the estate of the mentally ill person.
- Mentally ill persons undergoing treatment shall not be subjected to any indignity (whether physical or mental) or cruelty. Mentally ill persons cannot be used without their own valid consent for purposes of research, though they could receive their diagnosis and treatment.
- Mentally ill persons who are entitled to any pay, pension, gratuity or any other form of allowance from the government (such as government servants who become mentally ill during their tenure) cannot be denied of such payments. The person who is in-charge of such mentally person or his dependents will receive such payments after the magistrate has certified the same.
- A mentally ill person shall be entitled to the services of a legal practitioner by order of the magistrate or district court if he has no means to engage a legal practitioner or his circumstances so warrant in respect of proceedings under the Act.
…………………………………..
Office of The Chief Commissioner for Persons with Disabilities
Ministry of Social Justice and Empowerment, Government of India
GUIDELINES FOR MENTAL ILLNESS
Ministry of Social Justice and Empowerment
New Delhi, the 18th February, 2002
Subject - Guidelines for evaluation and assessment of mental illness and procedure for certification.
No. 16-18/97-NI.
- Mental illness has been recognized as one of the disabilities under Section 2 (i) of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995. "Mental illness" has been defined under Section 2(q) of the said Act as any mental disorder other than mental retardation.
- In order to prescribe guidelines for evaluation and assessment of mental illness and procedure for certification, a Committee was constituted by the Department of Health, Government of India vide Order dated 6th August, 2001 under the Chairmanship of Director General of Health Services on the basis of request made by the Ministry of Social Justice & Empowerment. The Committee has submitted its report.
- After having considered the report of the Committee, the undersigned is directed to convey the approval of the President to notify the guidelines for evaluation and assessment of mental illness and procedure for certification. Copy of the Report is enclosed herewith as ANNEXURE A.
- The minimum degree of disability should be 40%. in order to be eligible for any concessions/benefits.
- According
to the Persons with Disabilities (Equal Opportunities, Protection of
Rights and Full Participation) Rules, 1996 notified by the Central
Government in exercise of the powers conferred by sub-section (1) and
(2) of Section 73 of the Persons with Disabilities (Equal Opportunities,
Protection of Rights and Full Participation) Act, 1995 (l of 1996):
authorities to give Disability Certificate will be a Medical Board duly
constituted by the Central or the State Government. The Committee has
recommended that certification of disability for the purposes of the Act
may be carried out by a Medical Board comprising of the following
members - (a) The Medical Superintendent/Principal/
Director /Head of the Chairperson Institution or his nominee (b) Psychiatrist Member (c) Physician Member - At least two of the members, including Chairperson of the Board must be present and sign the disability certificate.
- The State Governments are, therefore, requested to constitute Medical Boards as indicated above immediately.
- Specified test as indicated in ANNEXURE A should be conducted by the medical board and recorded before a certificate is given.
- The certificate would be valid for a period of five years for those whose disability is temporary and arc below the age 18 years. For those who acquire permanent disability, the validity can be shown as 'Permanent in the certificate'.
- The Director General of Health Services,
Ministry of Health and Family Welfare shall be the final authority,
should there arise any controversy/doubt regarding the interpretation of
the definitions/classificatio
ns/evaluation tests etc.
Indian Disability Evaluation and Assessment Scale
Indian
Disability Evaluation and Assessment Scale (IDEAS) is a scale for
measuring and quantifying disability in mental disorders.
Items -
- I. Self Care: Includes taking care of body hygiene, grooming, health including bathing, toileting, dressing, eating, taking care of one's health.
- II. Interpersonal Activities (Social Relationships): Includes initiating and maintaining interactions with others in contextual and social appropriate manner.
- III. Communication and Understanding: Includes communication and conversation with others by producing and comprehending spoken/written/non-verbal messages.
- IV Work: Three areas are Employment/Housework/ Education Measures on any aspect.
- l. Performing in Work/Job: Performing in work/employment (paid) employment/self-employmen
t/ family concern or otherwise. Measure ability to perform tasks at employment completely and efficiently and in proper time. Includes seeking employment. - 2. Performing in Housework: Maintaining household including cooking, caring for other people at home, taking care of belongings etc. Measures ability to take responsibility for and perform household tasks completely and efficiently and in proper time.
- 3. Performing in school/college: Measures performance education related tasks.
Scores for each item:
0- NO disability (none, absent, negligible)
1- MILD disability (slight, low)
2- MODERATE disability (medium, fair)
3- SEVERE disability (high, extreme)
4- PROFOUND disability (total cannot do)
TOTAL SCORE
Add scores of the 4 items and obtain a total score
Weight age for Duration of illness (DOI) :
DOI: < 2 years: score to be added is 1
2-5 years: add 2 .
6-10 years: add 3
> 10 years: add 4
Global Disability -
Total Disability score + DOI score = Global Disability Score Percentages:
0 No Disability = 0%
1-6 Mild Disability = < 40 %
7-13 Moderate Disability = 40 - 70 %
14-19 Severe Disability = 71-99%
20 Profound Disability = l00%
Cut off for welfare measures = 40 %
Manual for "IDEAS" -
In
order to score this instrument, information from all possible sources
should be obtained. This will include interview of patient, the care
given and case notes when available.
I. SELF CARE: This should be regarded as activity guided by social norms and conventions. The broad areas covered are
a. Maintenance of personal hygiene and physical health.
b. Eating habits
c. Maintenance of personal belongings and living space
a. Does he look after himself. wash his clothes regularly, take a bath and brush his teeth?
b. DOES he have regular meals?
c. Does he take food of right quality and quantity?
d. What about his table manners?
e. Does he take care of his personal belongings with reasonable standard of cleanliness and orderliness?
0= No disability
Patient's level and pattern of self-care are normal, within the social cultural and economic context.
1= Mild
Mild
deterioration in self-care and appearance (not bathing. shaving,
changing clothes for the occasion as expected). Does not have adverse
consequences such as hazards to his health. No embarrassment to family.
2= Moderate
Lack
of concern for self-care should be clearly established such as mild
deterioration of physical health, obesity, tooth decay &, body
odors.
3= Severe
Decline
in self-care should be marked in all areas. Patient wearing torn
clothes would only wash if made to and would only cat ift6ld. Evidence
of serious hazards to physical health. (Malnutrition. infection. patient
unacceptable in public).
4= Profound
Total
or near total lack of self-care (Example: risk to physical survival,
needs feeding, washing, putting on clothes etc., Constant supervision
necessary)
II Inter Personal Activities
Includes
patient's response to questions, requests and demands of others,
activities or regulating emotions, activities of initiating, maintaining
and terminating interactions and activities of engaging in physical
intimacy.
Guiding Questions
a. What is his behaviour with others?
b. Is he polite?
c. Does he respond to questions!
d. Is he able to regulate verbal and physical aggression?
e. Is he able to act independently in social inter
actions?
f. How does he behave with strangers?
g. Is he able to maintain friendship?
h. Does he show physical expression of affection and desire?
Scoring
0= No
Patient gets along reasonably well with people, personal relationships No friction in inter-personal relationships.
1= Mild
Some friction on isolated occasions. Patient known to be nervous or irritable but generally tolerated by others.
2= Moderate
Factual
evidence that pattern of response to people is unhealthy. May be seen
or more than few occasions. Could isolate himself from others and avoid
company.
3= Severe
Behaviour
in social situations is undesirable and generalized. Causes serious
problems in daily living/or work. Patient is socially ostracized.
4= Profound
Patient in serious and lasting conflict, serious danger to problems of others. Family afraid of potential consequences.
III. Communication and Understanding
Understanding
spoken messages as well as written and non-verbal messages and ability
to reduce messages in order to communicate with others.
1. Questions
a. Does he avoid talking to people?
b. When people come home what does he do?
c. Does he ever visit others?
d. Is he able to start, maintain and end a conversation?
e. Does he understand body language and emotions of others such as smiling, crying, screaming, etc.,
f. Does he indulge in reading and writing?
g. Do you encourage him to be more sociable?
Scoring:
0 = No disability
Patient
mixes, talks and generally interacts with people as much as can be
expected in his socio-cultural context. No evidence of avoiding people.
1= Mild
Patient described as uncommunicative or solitary in social situations. Signs of social anxiety might be reported.
2= Moderate
A
very narrow range of social contacts, evidence of active avoidance of
people on some occasions and interference with performance of social
rules causes concern to family.
3= Severe
Evidence
of more generalized, active avoidance of contact with people (leave the
room when visitors arrive and would not answer the door or phone).
4= Profound
Hardly
has any contacts and actively avoids people nearly all the time. Eg :
may lock himself inside the room. Verbal communication is nil or a bare
minimum.
IV. Work
This includes employment, housework and educational performance. Score only one category in case of an overlap.
Employment:
Guiding Questions
a. Is he employed/unemployed?
b. If employed, does he go to work regularly?
c. Does he like his job and coping well with it?
d. Can you rely on him financially?
e. If unemployed, does he make efforts to find job?
Scoring:
0= No disability.
Patient goes to work regularly and his output and quality of work performance are within acceptable levels for the job.
1= Mild
Noticeable decline in patient's ability to work, to cope with it and meet the demands of work. May threaten to quit.
2= Moderate
Declining work performance, frequent absences, lack of concern about all this. Financial difficulties foreseen.
3= Severe
Marked decline in work performance, disruptive at work, unwilling to adhere to disciplines of work. Threat of losing his job.
4= Profound
Has been largely absent from work, termination imminent. Unemployed and making no efforts to find jobs.
In
similar ways, housewives should be rated on the amount, regularity and
efficiency in which tasks in the following areas are completed. Consider
the amount of help required completing these. Acquiring daily
necessities, making, storing and serving of food, cleaning the house,
working with those helping with domestic duties such as maids, cooks
etc., looking after possessions and valuable in the house.
Students - Assess a score on performance in school/college, regularity, discipline, interest in future
studies,
behaviour at the educational institution. Those who had to discontinue
education on account of mental disability and unable to continue further
should be given a score of 4.
…………………………………
Source: Government introduces Rights of Persons with Disabilities Bill in Rajya Sabha - Times of India
RIGHTS OF PERSONS WITH DISABILITIES BILL 2014:
Merits of the bill (detailed reference in the Times of India)
- Firstly the bill clearly defines the term ‘disability’. For a person to be considered as ‘disabled’, he shall suffer more than 40& disability. This bill seeks to increase the reservation from 3% to 5% in public sector and also to reserve seats in higher educational institutions. At present, the reservation for the disabled is only 3% in the ratio of 1% each for the physically, visually and hearing-impaired persons. As per the new bill, the reserved quota will be extended by 2%, covering two new additional categories – mentally disabled and people with multiple disabilities.
- The bill also seeks to increase the number of disabled categories covered from 7 to 19 sub-categories, however this will take time as the Rajya Sabha seeks to set up a standing committee to look into this. If the chairman Hamid Ansari agrees to send the Bill to the parliamentary panel, then it won’t be passed during the current session. The decision to refer the matter to the standing committee was taken die to the demands of the CPM members in the Upper House.
- The new bill divides the broad categories into various sub-categories, thus including a large number of disabilities within its ambit. It includes even disabilities like sickle cell disease, thalassemia and muscular dystrophy besides autism, spectrum disorder, blindness, cerebral palsy, chronic neurological conditions, mental illness and multiple disabilities.
- The bill prescribes provisions to prevent disabled persons from being harassed while obtaining disability certificates and also lays down stringent punishment of six months to five years of imprisonment and a fine from Rs 10,000 to five lakhs for any violation of its provisions.
- Other positives of the bill include setting up National Commission for Persons with Disabilities, which will have statutory powers besides establishing a dedicated National Fund for Persons with Disabilities.
Demerits of the Bill
Some Disability Rights Organizations have however criticised the bill and suggest modifications in the bill.
- Some groups have opined that it is not in conformity with the UN Convention on Rights of Persons with Disabilities
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