National Workshop on Mental Health Rehabilitation on 28th Oct 2011

National Workshop on Mental Health Rehabilitation (Stakeholders’ Consultative Meeting) on 28th October 2011 Background Note Introduction Rehabilitation has been defined by the WHO as the application of measures aimed at reducing the impact of disabling conditions and enabling disabled people to achieve social integration. Implicit in this definition are two components. First, an active process through which a person adapts or acquires the skills needed to mitigate the constraints of disease, and second, an acknowledgement that there may also need to be changes in the environment, including the attitudes of non-disabled people, if optimal social integration is to be achieved. The ideal rehabilitation service provides a comprehensive, continuous, coordinated, collaborative and patient-oriented approach. Continuum of Care The full range of comprehensive mental health services in any contemporary society which should be available includes a variety of outpatient & inpatient services for acute / short-term treatment, crisis intervention & rescue services, and community rehabilitation service viz. Day Care Centres, Occupational / Vocational Rehabilitation Centres, and Residential Care Centres. The concept of continuum of care is also important so as to ensure smooth transition & phase-wise application of different types of services for each patient & his/her family, as per the need in the life course of the person with mental illness. Needless to say, the range of services has to go beyond availability, to ensure accessibility & affordability for all sections of the Society. Psychiatric rehabilitation: Indian perspective Psychiatric rehabilitation in India can be divided into two phases. In the first phase, comprising the first 25 years since independence, most of the services were hospital based and largely confined to the government mental hospitals. The emphasis was on keeping the long-stay patient occupied with some form of work or activity. It is the second phase, from the early 1970s that saw concerted efforts being made to reintegrate the patient with the family and the community. In contrast to the slow and sporadic growth of psychiatric rehabilitation in the hospital setting, the response in the community has been very encouraging. These initiatives have largely come through NGOs. Community-based rehabilitation Community-based rehabilitation (CBR) is very appropriate in the Indian cultural setting, where social and community bonds are quite strong and deep-rooted. The challenge of CBR, and its success, depends on whether people with disabilities, their families and communities, and the concerned governmental agencies pertaining to health, education, welfare and social service can work together to make use of the resources in the community. The ultimate goal for majority of mentally ill person is to achieve right to living independently in the community as per article “ 19” of the UNCRPD. It is the most desirable goal, & now statutory obligation of the state, however, there are varying dimension to the process which need to be recognized and it has to be stepwise process. o Preparedness and sensitization of the community o Preparedness of professionals, NGO, civil society to work towards this goal. o The development of system and infrastructure conductive to the goal. Need for the National workshop The field of mental health rehabilitation is making rapid advance worldwide but in India there is slow and sporadic growth of psychiatric rehabilitation. There needs to be a consensus on the best possible model suited to the unique needs of the entire community. In this background, a national level workshop is being organized on rehabilitation in mental health to discuss the various models/approaches, the needs and difficulties and to attempt to arrive at a consensus on the way ahead. The need for such workshop can be justified in the light of the following background: - 1. Experience of tertiary care mental health institution like IHBAS The IHBAS has been constantly and vigorously doing the rehabilitation activities especially in the line of deinstitutionalization and rehabilitating the long stay patients back into the family / community. However, the basic need of mental health services for effective rehabilitation of the person with mental illness aimed at reducing the impact of disabling conditions and enabling disabled people to achieve social integration has always been felt and considered a significant barrier. The homelessness is a significant area of concern which is significantly linked to the deinstitutionalization coupled with lack of range of rehabilitation services in the community. 2. Users and Carers’ perspective In our experience after frequent interaction with the users and carers’ groups in the last few years on various forums and occasions, the similar need has been echoed from the users and carers’ group and there is significant need felt for having Community Based Rehabilitation (CBR) model and services even for the person with mental illness living with the families. 3. UNCRPD and recent policy initiative by the planning commission India has ratified the UNCRPD. The ultimate goal for majority of mentally ill person is to achieve right to living independently in the community as per article “ 19” of the UNCRPD. It is the most desirable goal, & now statutory obligation of the state, The planning commission has constituted a working group on ‘empowerment of persons with disability’ in order to formulate the 12th Five Year Plan (FYP) in the disability sector. The working group has formulated a draft report which has been discussed and finalized in the recent meeting of the working group held on 03rd October, 2011. The draft report has been compiled keeping in mind the spirit of the UNCRPD and mental health rehabilitation has been highlighted as a thrust area under the policy for 12th FYP and proposals related to the same have been incorporated in the draft report. Keeping in view the need felt from various stakeholders as mentioned above and policy initiative being undertaken by the policy makers in the background of the UNCRPD, it is felt perceived need that this is the most appropriate time to consult and interact with multiple stakeholders and crystallize ideas which can be conveyed to the working group on empowerment of Persons with Disability (PwD) as in next 3 months time the report of the working group will be submitted to the planning commission for consideration for 12th FYP. The Workshop details In this background, a national level Stakeholders Consultative Meeting on Mental Health Rehabilitation is being organized by IHBAS in collaboration with Sambandh Health Foundation, an NGO with partial funding from the said NGO on 28th October, 2011. We have requested World Association for Psychosocial Rehabilitation (WAPR) India Chapter to be the co-organizer for this workshop. Since this workshop will cover issues of ground realities of Mental Health Rehabilitation, the scope of this workshop does not cover Mental Retardation, Neuro-rehabilitation including Dementia and related geriatric disorders, substance use disorders and issues of law and legislation on rehabilitation Specific Objectives: 1. To assess needs and service gap regarding Mental Health Rehabilitation services in India 2. a) To enlist the a) Types of rehabilitation services/models currently available in the country and b) To review and appraise about the proposals under consideration/development in the area of Mental Health Rehabilitation 3. To establish networking with various Government and Non-governmental organizations working in the field of rehabilitation for mutual experience sharing. 4. To identify and enlist the essential and necessary components of Mental Health Rehabilitation. 5. To enumerate various sectors and agencies contributing to and needed to join efforts in rehabilitation services. The invitees and participants for this workshop include technical experts in the field of Mental Health Rehabilitation, NGOs working at the ground level, Users and Carers’ groups, Mental Health Professionals from Government and Private Settings, Member Secretaries of State Mental Health Authorities as well as senior level Government administrative officials and policy makers. The role of the organizing agencies for the workshop is delineated as: · IHBAS as a tertiary care Neuropsychiatric Institute and academic body is to provide technical expertise, infrastructure, advocacy as well as coordinate with concerned Ministries and Government bodies. · Sambandh Health Foundation is expected to bring in the civil society’s concerns, caregivers’ perspectives. · World Association for Psychosocial Rehabilitation (WAPR) India Chapter will be bringing in professional perspective in mental health rehabilitation; best practice models and takes the recommendations to other forums for wider dissemination. Methods and Approaches to be used: This workshop being a National Consultative Meeting of all stakeholders will use panel discussions method on the themes mentioned below to facilitate the dialogue. Each panel discussion will have about four panellists from the related disciplines who will put across their remarks and key messages based on their experience and expertise. Each panel discussion will be of one hour and each panellist will get 4-5 minutes each followed by discussion for half an hour and summarization of important points. There will be no lectures or presentations. The identified themes include: 1. Overview 2. Alternatives to hospital care : Deinstitutionalization and other services 3. Continuum of care: Types of rehabilitation facilities 4. Needs for rehabilitation services: users & carers perspectives 5. Possible consequences of inadequate rehabilitation services This workshop is expected to have discussions focusing on the concept on continuum of care, its components, how many of these components are available at present and what are the possible mechanisms to create such facilities and how to sustain it in long term. At the end of the workshop it is hoped to achieve better understanding and consensus about possible models of Mental Health rehabilitation besides establishing the urgent need for such model. Monitoring & Evaluation and follow up: (a) Evaluation Feedback Questionnaire (b) 1) Networking through World Association for Psychosocial Rehabilitation (WAPR), India Chapter ii) Implementation of emerging ideas related to Mental Health Rehailitation (WAPR), India Chapter ii) Implementation of emerging ideas related to Mental Health Rehabilitation (c) Initiation of Residential and non residential rehabilitation services across Delhi in one year and across the country in 12th Five Year Plan (d) The recommendations and outcome of the workshop which will be submitted (within 3 months) to the planning commission through the Working Group on empowerment of Persons with Disabilities is expected to influence the Mental Health Rehabilitation policy for 12th Five Year Plan proposals under MOS&JE and MOH&FW, GOI NATIONAL WORKSHOP ON MENTAL HEALTH REHABILITATION (Stakeholders Consultative Meeting) Organised by IHBAS in Collaboration with Sambandh Health Foundation Date: 28th October (Friday), 2011 Timing: 09:30 AM to 05:30 PM Venue: Mini Auditorium, 2nd Floor, Academic Block, IHBAS, Delhi PROGRAMME SCHEDULE 09:30 AM-10.00 AM Inaugural session 10:00 AM-10.30 AM TEA BREAK 10.30 AM -11.30 AM Overview of Indian Experience on Mental Health Rehabilitation- Canadian Experience on Mental Health Rehabilitation- NGO perspective on Mental Health Rehabilitation Civil Society’s perspective on Mental Health Rehabilitation Recent Initiatives at Mental Health Rehabilitation in Delhi State 11:30 AM-12.30 AM Panel Discussion on Alternatives to hospital care : Deinstitutionalization and other services 12:30 AM-01.30 PM Panel discussion on Continuum of care: Types of rehabilitation facilities 01:30 – 02:00 PM LUNCH 02:00 – 03:00 PM Panel Discussion on Needs for rehabilitation services: users & carers perspectives 03:00 – 04:00 PM Panel Discussion on Possible consequences of inadequate rehabilitation services 04:00 – 05:00 PM Synthesizing : Summary of individual sessions 05:00 – 05: 30 PM Valedictory Session