Special Employment Exchange for Persons with Psychiatric Disability
Ramasubramanian, C., Indian Journal of Psychological Medicine
Byline: C. Ramasubramanian
Work is therapeutic and essential for an individual's physical survival and psychological well-being. It is an important part of a cultural role, which occupies much of an individual's time, supplies a source of income, provides a basis of identity, and contributes to one's physiological and psychological well-being in the society.[sup]  Many research studies found that participation in paid work activity led to an increase in quality of life and improvement in motivation toward activities. In a 10-year follow-up study conducted by Salyers et al .,[sup]  in UK, mental health consumers reported that work improved multiple areas of their lives, which included more self-confidence and hope about the future, and less boredom and loneliness.
In the absence of necessary vocational training facilities leading to vocational rehabilitation either in the mental hospital setting or community settings, the mentally disabled persons become more and more dependent on the families which in turn are increasingly frustrated with these individuals and ultimately such unhealthy chain reactions result in patients being thrown out of the families. Thus, wandering becomes their main activity, begging becomes their vocation, and public's mockery becomes reward from the society. Especially when the mentally ill happens to be the head of the family or the only bread winner of the family, lack of vocational rehabilitation programs may lead to many untold miseries. The plight of the children and helpless wife is pathetic. The family gets totally disorganized - young children are forced to give up their schooling in order to earn their livelihood through hard child labor; wife, if not supported either by the relatives or by the social security measures, becomes the personification of sadness and hopelessness. Such family situations, more often than not, become the target of antisocial elements too.
Vocational rehabilitation of people with Severe Mental Illness (SMI) has become the focus of psychiatric practice, for the past two decades. The increasing awareness of the low employment rates of people with SMI has speeded up a growing interest in vocational rehabilitation among mental health professionals.[sup]  The literature indicates that 75-90% of adults with SMI are unemployed in UK.[sup]  . Many action-oriented programs resulting from systematic exploration of the rehabilitation potentials are being initiated and implemented for the welfare of the blind, deaf-mute, and orthopedically handicapped. For example, there are 13 vocational rehabilitation centers organized by the ministry of Labor Employment and Training, Government of India, functioning in different state capitals that deal with the problems of the physically handicapped. Even the special employment exchanges are concerned with the welfare of the physically handicapped. But in the case of mentally disabled - either mentally ill or mentally retarded - only sporadic attempts are made to fully utilize the inherent potentials. Unfortunately, there is neither special employment exchange nor any vocational rehabilitation center for the welfare of the mentally disabled persons.
Current Scenario of Mental Disability in India
A WHO-World Bank study in 1993 revealed four of the top ten conditions resulting in disability are mental disorders worldwide. These are schizophrenia, depression, obsessive compulsive disorders, and alcoholism.
In India, it is estimated that about 10% of the general population suffers from common mental disorders, with 1% having major psychiatric illness. In spite of vigorous treatment with continuous medications, about 30% of chronic patients with psychotic illness suffers from various disabilities.[sup]  .
According to WHO,[sup]  10% of the world population is disabled. Psychiatric disorders account for nearly one-third of the disability in the world. …