The vital need for support services

Aditya Vikram Rametra

this write-up focuses on the need for support services for persons with severe and chronic mental illness such as schizophrenia, bipolar affective disorder and other psychosis. There are broadly three stages of treatment and long-term rehabilitation:

Acute care/hospitalisation: This is the first stage when the symptoms of the disease are acute and there is need for supervised medical treatment and therapy in a controlled environment such as a hospital or other suitable mental health establishment. Some patients with severe mental illness will need additional stay in a half-way home to facilitate their recovery and rehabilitation.

Half-way home: This is the next step after the hospitalisation phase is over, and when the patient has stabilised on medication. A half-way home, as the name suggests, is a transient place of stay between the hospital and the person’s home. Half-way homes function as rehabilitation homes, because the whole emphasis is to prepare the patient to lead a more independent life.

The average stay of a person with severe mental illness in a half-way home is between six and 18 months. The sooner someone recovers, the sooner they are able to move out and go back to their homes.

Note: If these patients are not provided the facility of a half-way home, they would either continue to unnecessarily burden the ‘acute care/hospital’ facilities, or even worse, the patients and their families would be hugely burdened by the illness as they would not be in a position to cope or care. Therefore, it is necessary to have at least one half-way home in each district.

Long-term group home: This is the final stage for those individuals who have sufficiently recovered from their mental illness, but still need active support for activities such as supervised medication, counselling, and help with financial matters, employment, travel, medical care, etc. The need for group home is most acute when the parents of persons with mental illness are either too old to take care of their wards or are simply not alive anymore. A group home, as the name suggests, is like a home where the residents live together like an extended family, with the support of mental health professionals and social workers.

The ideal number of residents is 10-15. Over time, as the residents get older, the staff must be equipped to handle both mental and physical problems.

For persons with mental illness (PMI) living in half-way homes, group homes, or even their own homes, there is a need to keep them meaningfully occupied. Therefore, there is a need for adequate number of ‘day-care and vocational’ centres in every city/district. The centre could also serve the purpose of a sheltered workshop for persons with persisting disabilities who are unable to find job placements outside.

Need for support services

How do we assess the need for support services, especially when persons with mental illness (PMI) or their families do not come out and demand their rights because of the huge stigma and discrimination in society?

Yes, we have the new Mental Healthcare Act 2017, but unless these rights are demanded and fought for, nothing would change on the ground! And unless the necessary support services and facilities are provided, PMI and their families would continue to suffer in isolation and ignominy. One way of bypassing the fear of stigma faced by PMI and their families, but still getting realistic estimates of support services required by PMI is to conduct a survey among mental health professionals on the need for support services in every district/state.

Survey for Chandigarh

We carried out an online survey among psychiatrists working in Chandigarh. A total of 31 psychiatrists (from PGI, GMCH, and private practitioners) participated in this survey conducted online during October-November.

There were three kinds of support services considered for this survey:

• Day-care vocational centre
• Half-way home (short stay)
• Group home (long stay)

Important findings

• Most psychiatrists (22) said there is a great need for all three types of support services in Chandigarh.
• While all 31 participants highlighted the need for day-care vocational centres, 28 mentioned the need for half-way homes and 25 for long-stay group homes.
• As of now, only DART (Disability Assessment, Rehabilitation and Triage), run by GMCH, Sector 32, has basic day care and vocational training services.
• There is currently no half-way home or group home in Chandigarh!
• The total number of PMI interested in availing the day care vocational centre services is over 1,000.
• The total number of PMI interested in availing the half-way home facilities in Chandigarh is over 600, of group home over 400.

The survey estimates show that approximately 30% PMI belong to the BPL/EWS category; their treatment and rehabilitation expenses will have to be borne by the government in accordance with the provisions of the new Act. The remaining PMI could pay monthly fee/charges for the support services provided.

Recommendations

• There is an urgent need to conduct a ‘needs assessment’ survey for support services in each district of the region.
• The appropriate government should make the necessary budgetary provisions for the support services required in each district.
• The necessary support facilities should be planned and established in a time-bound manner.
• It would be prudent to involve the mental health professionals and caregivers of PMI in planning and establishing the support services.
• Robust ‘monitoring and evaluation’ systems need to be put in place for the management of support services.

(The writer is a social worker and mental health advocate. He can be reached at arametra@gmail.com)