|Year : 2008 | Volume
| Issue : 2 | Page : 75-79
Special employment exchange for persons with psychiatric disability
State Nodal Officer, District Mental Health Programme and Founder M.S. Chellamuthu Trust and Research Foundation, Institute of Mental Health and Rehabilitation, Madurai, India
State Nodal Officer, District Mental Health Programme and Founder M.S. Chellamuthu Trust and Research Foundation, Institute of Mental Health and Rehabilitation, Madurai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ramasubramanian C. Special employment exchange for persons with psychiatric disability. Indian J Psychol Med 2008;30:75-9
|How to cite this URL:|
Ramasubramanian C. Special employment exchange for persons with psychiatric disability. Indian J Psychol Med [serial online] 2008 [cited 2018 Dec 10];30:75-9. Available from: http://www.ijpm.info/text.asp?2008/30/2/75/48477
| Introduction|| |
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.  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 .,  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.  The literature indicates that 75-90% of adults with SMI are unemployed in UK.  .
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.  .
According to WHO,  10% of the world population is disabled. Psychiatric disorders account for nearly one-third of the disability in the world. This disability is present in 27% of the population in the South East Asian region. In India it is estimated that 50 million people suffer from various disabilities. Out of this, 46 million individuals are moderately or severely disabled and they need rehabilitation. Of this, 50% of them have locomotor disabilities, 2-3% of them have mental retardation, and 1% of them have severe psychiatric disability.
In a recent 14-country study of disability associated with physical and mental conditions active psychosis was ranked the third most disabling condition. 
Laws for persons with disabilities enacted by the Indian parliament
Rehabilitation council of India act, 1992
According to this act, 'handicapped' indicates a person who is visually handicapped, hearing impaired, suffering from locomotor disability, and from mental retardation. Mental illness was not mentioned in the law.
Persons with disability act, 1995
"The persons with disabilities (equal opportunities, protection of rights, and full participation) act, 1995" came into enforcement on February 7, 1996. Main provisions of the act were prevention and early detection of disabilities, education, employment, nondiscrimination, research and manpower development, affirmative action, social security, grievance redressal, and prevention and early detection of disabilities. All the provisions of the act were not implemented intensively for persons with psychiatric disabilites by the Government.
National trust act, 1999
This 'act' provides for the constitution of a national body for the welfare of persons with autism, cerebral palsy, mental retardation, and multiple disabilities. Mental illness was not included in the law.
The Government of India has been implementing various welfare programs and schemes for persons with disabilities. These are:
- National institutes for the persons with disabilities
- Regional rehabilitation training centers
- District rehabilitation centers
- District centers for composite rehabilitation services
- National program for rehabilitation of persons with disabilities
- Special schools for children with disability
- Concession and facilities for the disabilities
- Integrated education of disabled children
- Economic assistance program
- Scheme of assistance to disabled persons for purchase/fitting of aids/appliances
- National awards
Travel concession for the disabled
The blind, orthopedic handicapped, and mentally retarded persons travelling alone or with an escort, on production of a certificate from Government doctor or a registered medical practitioner, is eligible to get the concession.
- The Indian airlines corporation allows 50% concession of normal economy class fare in Indian airlines.
- Locomotor disabled persons (80% and above) are allowed 50% concession of normal economy class fare in Indian airlines.
Some states provide up to 50% concession to orthopedic handicapped, mentally retarded, and blind persons in bus fare.
Payment of postage, both inland and foreign, for transmission of blind literature materials by post is exempted if sent by surface route only. Concession in telephone cost to blind persons. Government of India provides:
- Fifty percent rebate on the normal rent on the call charges
- Allots telephone on priority basis
- Preference in allotment of STD/PCO booths to handicapped persons
- Exemptions of customs duty: The Government of India exempts import duty on equipments imported to overcome the disability conditions.
- Conveyance allowance: The central Government employees who are blind or orthopedic handicapped are to be granted conveyance allowance up to INR 100 per month.
- Children's educational allowance: Government of India reimburses tuition fee in respect of physically handicapped and mentally retarded children of its employees at the rate of INR100 per month.
- Income tax concessions: Government of India provides for a deduction in income tax in respect of handicapped persons/dependants up to INR 40,000.
- Award of dealerships/agencies by oil companies: Ministry of petroleum and natural gas has reserved 7.5% of all types of dealership agencies of the public sector oil companies for physically handicapped persons.
- Reservation of jobs and other facilities for the disabled persons.
As per the order of Government of India, reservation of 3% in jobs have been made in Grade 'C' and Grade 'D' posts for the handicapped persons and age concession of 10 years has been granted in favor of them.
Recently, the Government of India has granted job reservation in Grade 'A', that is in Indian administrative service for the orthopedically handicapped persons there is a provision of preferential allotment of Government quarters to the handicapped employees.
- Physically handicapped persons recruited to posts advertised by the Government of India will be exempted from the payment of application and examination fee.
- Family pension: Children of Government employees with disability shall be eligible for the benefit of family pension throughout their life.
All the above said welfare schemes and programs have been implemented effectively for persons with other disabilities, not for persons with psychiatric disability.
Unlike other disabilities, in psychiatric disability persons have certain unique features:
- Experienced subjectively (e.g., hearing voices when alone).
- Fluctuates (e.g., disability differs with duration and nature of symptoms).
- Recurrent (e.g., disability reoccurs with fresh episode of illness).
- Affects thinking processes, emotions, and behavior.
- Involves both excesses and deficits (e.g., excesses like overspending, over talkativeness, over socializing as seen in acute manic episode; deficits like lack of socializing, decreased personal hygiene as seen in schizophrenia).
- Affects the individual as well as the family (e.g., family is burdened emotionally, financially, and in areas of health, occupation, leisure, and social relations).
- It is not visible like physical disabilities (e.g., limbs, eyes).
The present situation in the employment exchange is not congenial for persons with psychiatric disability because of
- Limited staff in limited space.
- Huge waiting list.
- No clear-cut guidance and no one to assist.
- Cumbersome procedures.
So, there is a strong need for starting a 'special employment exchange' for the mentally disabled.
| Special Employment Exchange|| |
It can be started at the local branch of IPS or by any reputed family fellowships, psychiatric social workers, or rehabilitation therapist, who can be the key persons to achieve the goal of reintegration of the mentally restored into the community through the following four means of vocational rehabilitation.
Open competitive job placement
Though it is difficult to place the mentally restored in the open competitive job placements, it is not impossible to provide this opportunity for the selected groups of patients with the clinical diagnosis of reactive psychosis, manic-depressive psychosis with infrequent attacks, and acute psychotic episodes. In our experience, many persons with the above diagnosis have been successfully performing their duties, of course, with regular follow-up programs.
This is provided for those disabled persons who because of the nature and severity of the disability cannot cope with ordinary employment. This is suitable for those with the problems of mental retardation and chronic illness (schizophrenia, repeated attacks of affective disorder in spite of regular medication).
Persons who cannot cope with the demands of vocational adjustment in the open competitive job situations, but who have the capacity to do some work with the help of any family member could be considered for self-employment schemes which are usually sponsored by different welfare schemes of nationalized banks and social welfare departments. The uniqueness of this method of vocational rehabilitation is that because of the involvement of the family members, not only the work output and income improve but also the feelings of acceptance and security are strengthened among the mentally restored, mentally retarded, and persons with residual schizophrenia and certain categories of manic depressive psychosis.
Home-bound work program
Mentally disabled persons with the categories mentioned in the self-employment rehabilitation programs can also be considered to do the work, the units of which are provided by the small scale industrialists and welfare organizations. Advantages of this method are: firstly, there is no need of financial investment on the part of the family members and secondly, the absence of problems relating to the marketing of the products.
| Advisory Board|| |
The 'special employment exchange' should have an advisory board comprising of significant employers - be an important public person, local mental health professionals, reputed NGO's who are working in the mental health field - and family members of the mentally disabled.
| Registration|| |
A letter from mental health professional or from an important public person from the local area is essential for registration. Social workers will take a detailed history and assess the patient's aptitude, retained abilities and disabilities, and his/her family background and will assist in suitably placing the person.
| Persons who are Eligible for Registration in Special Employment Exchange|| |
- Persons who lost their jobs because of the disease process.
- Individuals who were deprived of education and training opportunities due to early onset of illness.
- Clients who were left with residual psychiatric problems affecting their vocational career.
- Persons in whom there is alleviation of symptoms.
| The Functions of Special Employment Exchange|| |
- Sensitize the employers.
- Sensitize the employees, patients, and their family.
- Wide publicity should be given in the media about 'special employment exchange.'
- Social workers should find a suitable vacant position for all their clients and send the clients according to the need of the employer and employees.
- Social workers should make a periodical visit to the working place to assess the quality of the work and also to get the feedback of employee.
| M. S. Chellamuthu Trust Experience|| |
For past 15 years M. S. Chellamuthu Trust and Research Foundation, a registered nonprofit, secular voluntary organization, is working with the specific objective to enable persons with mental disabilities to acquire work and social skills and prepare them for job placement.
The trust started a job placement cell in a small way and in the past four years more than 200 persons have been placed through our effort and we are still following them to assess their drug compliance and also their ability to reintegrate in to the community.
All though more than 5% of the disability constitutes mental illness, the benefits enjoyed by this population are very meager or negligible. Government and society is apathetic on the issue since we mental health professionals have not sensitized this one. So, this is the time we should rise up to the occasion and recommend the following issues to the Government, so that there will be some hope for this unfortunate, neglected population in the future.
| Recommendation to the Government|| |
- To the job reservation quota of 3% to the disabled (blind, hearing, locomotors), and 1% quota to be added for persons with psychiatric disability.
- Vocational rehabilitation services for persons with psychiatric disability should be integrated, wherever possible, with those for the other disabled.
- As far as vocational placement programs are concerned, the psychiatric social workers play a vital role. Opportunities for employment of psychiatric social workers should be made available and implemented effectively at the regional, district, and local levels.
- At the national level, health, labor, social, and other services participating in the rehabilitation process should be interconnected.
- Vocational rehabilitation centers for persons with psychiatric disability to be started with organized vocational training on scientific lines.
- Sheltered workshops for persons with psychiatric disability in the community to be established at the district and local Levels.
- Voluntary agencies/Organizations to be involved in the vocational rehabilitation program for persons with psychiatric disability.
- Bureaucrats and officers in the Government services need to be sensitized about the laws pertaining to the psychiatric disability, provisions, and benefits mentioned in the Acts.
- Various models of vocational skills training for persons with psychiatric disability to be adopted by the Government, such as Individual Placement and Support (IPS) model,  Work-related Social Skills Training (WSST) Model,  Job Specific Social Skills Training (JSST) Model. 
- A separate cell is to be established in the health directorate of central and state Governments for vocational rehabilitation for persons with psychiatric disability.
| Conclusion|| |
An important employment problem of persons with psychiatric disability is lack of social competence and social skills necessary in the workplace. The problems include not knowing how to deal with criticisms from supervisor, how to serve customers, and how to deal with stigmatizing attitude from coworkers. Hence, skills training is imparted to the persons with psychiatric disability and prepared them to face the challenge in the work place. Vocational rehabilitation centers for persons with psychiatric disability would be able to provide such kinds of trainings at regional, district, and local level and also the special employment exchange can be an answer for all their unresolved questions.
| References|| |
|1.||Bell. 2002. |
|2.||Salyers, et al . 2004. |
|3.||Mueser, et al . 1996. |
|4.||Bond et al . 2001. |
|5.||WHO; 2001. |
|6.||Drake and Becker, 1996. |
|7.||Tsang and Pearson, 2001. |
|8.||Tsang et al .2002. |