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PROGRAMMES
‘No person should suffer for want of mental health care’.
This is the guiding gospel of Dr.C.Ramasubramanian.
 
 
Satellite Centres for Vocational Training Centres at Ramnathapuram District
 
Year of starting: 2002
Location: Ramnad District
Contact Person Mr.Vigneswaran
Beneficiaries 360/ per batch. So far, 4320 were benefited
   
Brief History:
Ramnad District created history by its innovative, pioneer work in the rehabilitation of the handicap in general and the mentally disabled in particular. Struck rudely by the “Erwadi” incidents on 6th Aug 2001. When 28 innocent mentally ill persons were burned to death in a fire accident is an asylum. This incident shook the nation, more than any event, which brought to light the deplorable state of mental health care in the country and programmes. After this incident the state Government announced a series of measures to regulate the functioning of homes for the mentally ill.

It has ordered the immediate closure of all homes functioning in thatched sheds, other homes should obtain a license within a month and no home can be set up without a license. A cell was set up in every district under the chairmanship of the District Collector to ensure that the homes conform to norms.

As a mental health professional in the field of psychiatry for more than 25 years I felt that this will not be a solution and I felt the need to approach the problem and find a solution in a holistic way. As a first step we begin to implement the District Mental Health Programme and District Administration of Ramnad was involved actively in the programme. First, we conducted a one day sensitization programme for the entire Ramnad District revenue officers and officials concerned with this programme about the basic psychiatry and their role in the programme. Because most of the officials were totally ignorant of psychological disorders and also lacked motivation. The district collector showed keen interest and formed a committee comprising of the district as chairman and appointed putting other officials as members. In this we have decided to tackle the problem in four phase manner.

 
Survey:

When we started the progrmme there has no proper data about the incidence of mental illness. A door to door survey was conducted by NSS volunteers and health workers.

There were given two days intensive training on mental health and also in identification of mental illness. They were given printed questionnaire to be filled members.

After identifying the needy people, they were given education on the importance of attending the mental health camps that were to be organized and also the benefits that they are going to receive including the venue and date of camp to be declared.

 
AWARENESS PROGRAMME
Simultaneously we started the awareness programmes through out the Ramnad district. For that we have formed a cultural team called “INI”. These troops visit remote villages of Ramnad and enact street plays on mental health in the evening. The troop will be accompanied by psychiatrist and social workers. At the end of the play many questions were asked from the public and their doubts were clarified. There was a spontaneous response from the public and also a steep increase in the referral to Government Hospital. so far 125 street plays has been conducted in and around Ramnad district.
 
TRAINING PROGRAMME

Training the personnel from various departments and specially to the personnel who belong to health departments, especially medical officers in primary health centre, health workers, village health nurses etc will play a vital role in the treatment of the mentally ill persons.

To convert the institutionalized asylum based treatment of mentally ill into community based care and treatment, the training of the personnel in the health department is very essential. The WHO also insisted this along before and training was initiated in many parts of the country. Such training was also carried out in this District. The details about the number of people trained and duration of training is given below in the table.

S.No Personnel
No. People Duration of Training
1. PHC Doctor
150
15 days
2. Health Workers/ Paramedical
400
7 days
3. ICDS Functionaries
300
3 days
4. School / College Teachers
100
3 days
5. Non-medical persons
800
3 days
6. VHNS
600
2 days
7. Parents
100
2 days
8. CBR workers
250
2 days
9. NGOS and Other
50
2 days
10. Judicial Officers
50
1 day
11. Police Officials
50
1 day

Mental Health Camps:

It was organized in 12 places. The team members comprise of General physician Pediatrician, Nero Physician, Psychiatrist, Psychologist, Social worker, Vocational Therapist, DDRO, Thasildar, VAO under the leadership of the District Collector who attend all the camps which gave big moral boost to the officials and general public. The response was spontaneous and over whelming. Uniqueness of the camp was that it was the first of its kind in Tamilnadu. Under one roof the patients were examined by various specialists and treatment programme including rehabilitation programme was formulated on the spot for each patient. Various benefits including Disability Certificate, Free Bus Pass, Free Psychiatric medicines, Free Food Grains, Free land Pattas, for the landless poor disabled and also vocational rehabilitation programme. Most of the people were of lower social economic status and they had Malnutrition, skin lesion and contractures due to chaining, bone deformity because of chronic immobilization and presence of florid psychiatric features because of lack of proper psychiatric treatment. Family members were having low motivation and had lot of stigma and most of the patients were suffering from chronic Schizophrenia, Mental Retardation and Epilepsy.

 

TREATMENT PROGRAMME

A mobile psychiatric team was formed comprising of psychiatrists, Psychologist, and Psychiatric Social Workers. They used to visit one Taluk Centre daily and conduct OP Clinic. Patients were given separate OP books with different colours for easy identification. In all PHCs psychiatric medicines were made available and PHC medical officers were encouraged to treat them. For guidance these patients were referred to mobile team Psychiatrists who will screen this patient and formed a treatment schedule and refer them back to the PHCs. If the mobile team feels admission and intensive treatment is necessary they will refer the case to District Head Quarters Governmental Hospital, where we have already open a 10 bedded psychiatric ward which will take care of the treatment. If they have got any problems they will refer the case to the institute of Psychiatry, Government Rajaji Hospital, Madurai. So far 73685 patients were treated in satellite out patient Clinics.

 
REHABILITATION PROGRAMME
Rehabilitation of the disabled is to integrate them into the mainstream life which required concerted and coordinated efforts of all stake holders and the general public. Without which the efforts put in will go into vain and the disabled will find it very difficult to get himself accepted fully in the society and will face neglect, discrimination and exploitation.
 
Satellite Vocational Rehabilitation Training Centers:
Establishment of Satellite Vocational Rehabilitaiton Training Centers (VRTC) in 11places covering the entire district. Based on the assessment of the needs of the disabled, around 1500 were selected eligible for taking vocational training of various traders from these VRTCS in phase manner. At the beginning,Ramanathapuram Vocational Rehabilitation Center was started in the Collectorate Complex and M.S.Chellamuthu Trust and Research Foundation, an NGO working for the Psycho-social rehabilitation of the mentally disabled person; Madurai was assisting in providing vocational training by their staff.. Now there are 11 Vocational Rehabilitation Training Centers in the following places.

Running these centers continuously had become a difficult and challenging one. At this juncture it was wisely thought to start a Trust and the Collector himself as the chairman of the Trust and this was proposed to the Government to get their sanction and support. It was accepted and above all it was advised to other districts in the state to follow the same and this became a Government order by No.1 dated 8.1.2003. This has further encouraged and enthused the team to vigorously get into this venture. The Ramanathapuram District Trust for the Rehabilitation of the persons with Disability (RDTRPD) had come into being and started functioning. Then the Trust received funds from the DRDA through Special project and now is supporting the functioning of all centers, with qualified staff members and required equipments and materials needed for these centers.

The vocational training is an integral part of any rehabilitation programme, which will enhance the quality of life of the persons by facilitating the process of reintegration and enhance their self-esteem, which will elicit positive responses from the community. The work and the work skills will change the perception of the people towards mental disability.

The main activities of these centers are providing vocational training to the mentally challenged and physically handicapped, creating awareness to the parents and physiotherapy to the disabled. These centers are acting as satellite centers where in all the activities needed for the disabled are being organized by converging resources from various places.

These centers are managed by a Vocational Instructor, Physiotherapist and two assistants.
The following are the Vocational trades identified and training are being given

  • Production of detergent materials
    • Phenyl,
    • Washing Powder,
    • Cleaning Powder,
    • Soap Oil,
    • Washing and Bathing Soap etc.
  • Ornamental Products
  • Paper and Cloth Bag
  • Cloth File
  • Paper Cups (Tea and Ice-cream Cups)
  • Palm Products
  • Clay Products
  • Tailoring
  • Preparation of Key chains
  • Making Wire Bags
  • Mechanical and Electrical Training
  • Carpentry
  • Diary and Mushroom Cultivation
  • Preparation of sea-shell products
  • Computer and printing Training
  • Raising Nursery
  • Marketing / Clerical / Salesman Training
  • Preparing Food Products
  • Refills (Ball Pens).

In the first phase - 600 trainees were trained in 11 satellite centres. In the second phase - 500 trainees are currently involved in training.

The trained persons will be helped to get work opportunities in the society and to start their own enterprises by helping them to find out the marketing and financial support to start the enterprises. In these centers it self some economic activities and related trainings are being identified and work opportunities and income would be generated continuously for them. Those who will be placed in jobs would have regular follow up through these centers.

Peoples committee:

The Vocational Rehabilitation Training Centers are being assisted by the local committee set up for each center, comprising of village leaders, prominent persons in the community, NGOs working in the respective area, parents of disabled beneficiaries, officials representing Government Department etc. this local committee consisting of 8 members is meeting once in 1 month to plan and review activities of the Vocational Rehabilitation Training Centers.

The following are the responsibilities of this committee:

1. To help ensure the regular intake of training by all the disabled
2. To help in arranging various training suited to their locality
3. To help in marketing various products in the society
4. To help in placing the trained members in jobs
5. To promote the involvement of the family members in the care of their disabled members.
6. To promote the ideals of the center among the public and increase its participation
7. To work for the financial viability of the center etc.

Working with parents:

Working with parents is very essential because they are the ones who bear the burden posed by their disabled members. They require information, knowledge and skill to manage better their disabled members in their family environment. In the beginning of this programme few meeting with family members were conducted to create awareness about the mental disabilities. Now periodic meetings are being conducted in the center to enlighten about the importance of the vocational training, the progress they make and their role in rehabilitation activities.

Physiotherapy:

All the centers are equipped with physiotherapy equipments worth of Rs.1,50,000 with a qualified physiotherapist posted to mange this activity. The physiotherapists are regularly providing exercises in the center for those who come to the center and also visit the houses of the disabled for follow up.

Self Help Groups:

Organizing self-help groups among disabled members and their family members is taking place throughout the district. Forming self-help groups at the district level among the disabled members is the first of its kind in India. Around 180 Self Help Groups are started and most of them have started opening the bank accounts. The first self help group based at Ramanathapuram VRTC got the bank loan to start paper cup manufacturing unit in the center itself. About 20 of them have got trained in the work and started selling paper cups to TASMAC in the district and the needy people.

Entrepreneur Training Programme:

As an important break through, a memorandum of understanding (MOU) was established with Mohamed Sadhak Polytechnique, Keelakarai to assist in providing Entrepreneur Development Training Programme and Vocational Training and issuing recognized certificate to all those who are successfully completing the training through VRTCs in Ramanathapuram District. The EDP training is being conducted in different places aiming to cover 450 disabled in two months time.

Conclusion:

To conclude one can state that in short the mentally disabled persons and their families in Ramnad District not only get medical treatment but also the Rehabilitation Programme.

The importance aspect in the programme is the involvement of the family members and community leaders who will form the back an attitudinal and behavioral change among the public and today the district is reaping the fruits of change.

Process:

  • Awareness Building
  • Identification

Rehabilitation Interventions:

  • Medication Management
  • Skills development
  • Creative activities
  • Yoga
  • Counseling
  • Psycho education
  • Occupational Therapy
  • Vocational training
  • Placement
 
Client / Beneficiaries Profile:
Diagnosis - Persons with Mental Illness and Mental Retardation
Sex - Male & Female
Age wise - 15 Years to 45 years
Nativity (Rural /Urban) - Rural (Ramnad & Erwadi Blocks)
No.of beneficiaries - 80 (so far 6540 people benefited)
 

Professional team:

Members of the professional team are

  • Consultant Psychiatrist
  • Medical Officer
  • Clinical Psychologist
  • Psychiatric Social Worker
  • Psychiatric Nurse
  • Vocational Instructor
  • Creative Therapist
 
 
 
Community Based
 
 
 
 
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