Trends of Utilization of Government Disability Benefits among Chronic Mentally Ill

Article excerpt

Byline: Kartik. Kashyap, Ravish. Thunga, Arun. Rao, N. Balamurali

Background: Mentally retarded and chronic mentally ill are being certified using IQ Assessment and Indian Disability Evaluation and Assessment Scale (IDEAS). They have been granted various benefits including monthly pension, from Ministry of Social Welfare, Government of India. The monthly pension appears to be the strongest reason for seeking certification and applying for government benefits. The caregivers appear to have only partial information and awareness about the remaining schemes. Objective: The study aims to assess the severity of disability in the mentally retarded and mentally ill who are certified for disability benefits, as well as to assess the trends of utilization of disability benefits over a 3 year period. Materials and Methods: This was a retrospective, file review based study of certificates of patients certified for mental disability in the period of January 2006 to December 2008. Certificates of a total of 1794 mentally retarded and 285 mentally ill were reviewed. The data regarding utilization of disability benefits was assessed. Results: Patients from rural areas did not avail any benefits other than the disability pension. Among Mentally Ill, Schizophrenia accounted for highest certifications. Males had higher disability compared to females, and Dementia showed highest disability as per IDEAS. Conclusion: Though initial hurdles due to disability measurement have been crossed, disability benefits are still elusive to the vast majority of the disabled. Proper awareness and education will help in reducing the stigma and in the effective utilization of benefits.

Introduction

In India, majority of the 125 million mental ill require intensive rehabilitation services. [sup][1],[2] The transient nature of the disabilities of mental illnesses and the nature of the socio-occupational impairment posed a challenge for the measurement of the disability. As this was the major hurdle in including mental illnesses into the government's social welfare benefits under the Persons with Disability Act of 1995, [sup][3] the Rehabilitation Committee of the Indian Psychiatric Society developed the Indian disability evaluation and assessment scale (IDEAS), [sup][2] which is now recommended by the Government of India to measure psychiatric disability. [sup][4]

The disabled are eligible for the following welfare schemes from the government: [sup][5],[6],[7],[8],[9]

*Disability pension/unemployment pension *Disabled person's scholarship *Insurance scheme for the mentally challenged *Adhara scheme helping to set up small shops *Telephone booth *Free education up to 18 years *Free legal aid *Aids and appliances (for multiple disabilities) *3% Job reservation (only cerebral palsy included) *Concessional bus passes *Railway concession According to Census 2001, [sup][11] there are 2.19 crore people with disabilities in India, who constitute 2.13% of the total population. Of these, 9,40,643 are in Karnataka state, with 92,631 being mentally disabled. 75% of all persons with disabilities live in rural areas, 49% are literates and only 34% are employed.

Chaudhury et al. [sup][12] found more people with schizophrenia in the rural areas and with dementia in the urban areas, with mood and anxiety disorders approximately evenly distributed. They also found that 64% of patients with schizophrenia, around 30% with mood disorders, 16.7% of anxiety disorders, had a disability of more than 40% on the IDEAS scale.

Jahan and Singh [sup][13] found that only 6% of the guardians of mentally retarded were aware of the persons with disabilities (PWD) Act. Singh and Nizamie [sup][14] reported poor awareness and underutilization of disability benefits.

Hence, in practice, disability benefits are still elusive for persons with mental disorders.

Aims of the present study

*To assess the severity of disability in the mentally retarded and mentally ill certified for disability benefits. …