PART-B
3. Concluding Remarks
Handicapped persons remains a field that is least attractive to professionals due to the strain and efforts called for. Considering the need and the pressing situations for trained professionals Thakur Han Prasad Institute has evolved a need-based training modules and prepared the following personnel. Vocational training instructors, special education programmes for non- trained special teacher, grass-root level rehabilitation workers and supervisors and others.
It is because of the pressing need and requests from various NGOs for trained coordinators that Thakur Han Prasad Institute embarked on a Post-Graduate Diploma in Developmental Rehabilitation and Diploma in Special Education (MR) to clear the backlog of untrained special teachers. Inspite of various constraints THPI has not overlooked the need to develop adequate human resources. It started of with an ad hoc need-based crash programme before developing the training module into a Diploma Programme. Further, Thakur Han Prasad Institute has pursued the Osmania University and Rehabilitation Council of India to recognise the Diploma to provide the course with a status and acceptance.
THPI has pressurised the NIMH to conduct a training programme for the members of State Councils for Child Welfare in the country towards the promotion of detection of children with mental handicap and their integration. THPI played an important role in organizing a seminar of Vice-Chancellors of Universities to ponder over the inclusion of disability as a subject at the graduation and higher levels of education.
It was again at the persistence of THPI that exposure to rural programmes got included in the curriculum of Diploma in Special Education (MR) so that the course participants could get adequately equipped. In-plan and in-built documentation of services and periodical evaluation of the regular services remains a part of THPI's regular activity. Apart from carrying out research on topics of current interest. The thrust has been to merge research as part of the action programme.
the support of other NGOs, sensitizing the policy makers, educating professionals, family members and the community. Overcoming the barriers of the present socio-economic political system THPI has proved that it is possible to facilitate empowerment of persons with mental handicap to live a life with dignity in society. In doing so it had to weather many obstacles including acute shortage of all kinds of resources. But the THPI dictum stands "Rain or sunshine, money or no money the work will go on". And yes, it has made it! And it was possible only because it had a clear VISION and MISSION supported by a team committed to its realisation.
Through its very unique contributions THPI has therefore raised the status of NGOs and elevated the role of voluntary social action through professionalisation and commitment to quality of service to higher levels. THPI is set to expand its horizons to play still bigger roles as partners in the habilitation of persons with Mental Handicap. If this is possible for one NGO just anyone can do it provided there is a singular dedication to the cause and quality of service, sensitivity to the target group and the socio-economic context as well as determination to achieve its goals.
Voluntary social action can never be suppressed nor can it be extinguished. Its powers are unlimited. And in developing countries like India with its socio-economic problems and scarce resources, only an NGO action in partnership with Governmental action can ensure the rights of persons with Mental Handicap for equalisation of service and opportunities,
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Role of Voluntary Agencies for Prevention of Mental Retardation
and Mental Illness through CPR Approach
Introduction:
As rightly said 'PREVENTION IS BETFER THAN CURE' and the cost of prevention is much lower than the heavy investment on treatment and rehabilitation after the problem has occurred. Health care sector is entrusted with the primary task of providing 'Health for all by 2000 A.D.' It means absence of health problems, mental illness and disabilities such as mental retardation. Therefore prevention of the major disabling situations such as mental retardation and psychiatric illness as priority problems to be tackled should from an integral part of the health care system. This would not only lead to an effective and optimal functioning of the health sector but also solve one of the age old and ever increasing problems such as inadequate facilities, acute shortage of resources, unwillingness of professionals to work in rural areas and so on. It is in this context, that the Ministry of Health was pressed with the urgency to bring out a strategic plan of action for integrating prevention of Mental illness and Mental Retardation into the existing health systems PHC in this case as a mainstream progranmie. These two problems are focused as the prevalence rate shows that they are present in large numbers causing "distress" and "burden" to the families, communities and nation.
People's participation as vital to the successful implementation of such a strategy has been duly acknowledged. Hence the seminar intends to develop a model system with minimum infrastructure using existing Primary Health Centres (PHC) on the principles and approaches of Community Participative Rehabilitation (CPR).
To make it happen, that is integrating prevention of mental retardation and mental illness into the health system, we need to have a policy without which disability prevention will continue to receive the "least prioritized attention" by the health and other sectors. Moreover, programmes that do not clearly fall within the mandate of the health care system, are those that are most vulnerable for discontinuation at the hands of cost restraint efforts. Experiences have also shown that often health infrastructure by itself fails to yield expected results in
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the prevention of disability and this additional task is viewed as an imposed burdenvery often.
There was also overwhelming experiential evidencesto prove that some of the factors that account for the SUCCESS of suchprogrammes at community level are:
— Makingprogrammes community based
— Close supervision and effective monitoring by NGOs
— Flexibilityof the projects to adapt to the local needs andcontext.
Therefore, it was realised that PHC and other such traditional systems will not work without a certain level of local responsiveness to external
organisation or monitoring. It is in this context that the need for involving NGOs becomescrucial. We need to delineate the specific roles they can play, and the kind of support theyrequire for facilitating effective implementation of the proposed national programme. We need todevelop clear guidelines for the implementation of this approach.
In suggesting such a direction, we are mindful that there is no one "right" solution or set of programmes for any particular region. The policy wouldprovide provision to incorporate sufficient flexibility to meet challenging needs both across and withincommunities. CPR progranmies represent a wide range of options within which choices for service delivery may be made.
Besides, policy, there is a need for a Centre for information
exchange, possible coordination and periodical evaluation a Centre that will not function as a power centre or decision making apparatus, but rather as a facilitator and means to ensure that we continue to benefit
fully from exchange of knowledge, experience, success, failures, and suitability of the project. We also need to set a criteria and evolve evaluation tools to ensure the proper implementation of the proposed model.
A question may be asked as to why confine to "Mental Retardation" and "Mental Illness" alone. Does it not deviate from the commitment and philosophy of CPR towards integrated approaches? This is a onetime effort to specifically look into the needs ofthese groups so that these specific needs would not be neglected in the mainstreamprogrammes as is often the case (for e.g. in DRC programme, MR gets the lowest priority). We also
acknowledge the fact that the causal factors are common for most of the disabilities and at times there are multiple causative factors for one disability requiring inter sectorial approaches. But what we are concerned about is to make a conscious exercise specific to the prevention of Mental Retardation so that more levant aspects pertinent to any of these disabilities gets overlooked or missed.
Another subtle but very significant factor that has to be taken note of is thatMR has always been confused with MI and there has been a continuous effortto separate these 164
two as Mental Illness is a disease that can be treated with medicines whereas, mental retardation is a condition that can be improved only with regular training. The issues pertaining to these two aspects have come to a common platform for discussion. Wile discussing common approaches for integrating prevention services of MI and MR with PHC we need to treat them as separate entities.
The present seminar intends to look at...
1. The various components of prevention that we need to address to
2. Analyse and review the existing status of CPR in the implementation of preventive services for MR and MI and the role of NGOs.
3. Evolve a viable model for integrating preventive strategies of MR and MI as a national strategy through CPR approach.
4. To formulate a policy for the launching of this national strategy towards the prevention of MR and MI.
With this purpose in mind:
An attempt is made to briefly touch upon the prevention we are addressing to today, CPR as understood by us and provide an overview of the CPR programmes implemented in our country. An attempt is also made to focus on the issues that we need to address ourselves
in the light of the above.
1.1 Mental Retardation and Mental Illness:
We are addressing ourselves to two major issues viz, prevention of mental retardation and mental illness. Mental Retardation refers to significantly subaverage general intellectual functioning, resulting in or associated with concurrent impairments in adaptive behaviour, and manifested during the developmental period.
As per WHOIntemationalClassification of Diseases, mental retardation has been classified as under.
I.Q. 50
-
70 Mild MR49
-
35 Moderate MR34 - 20 Severe MR
19 & - Profound MR
The prevalence of MR as per the available estimate is 2 to 3 per cent. Services available are grossly inadequate. Services are almost nonexistent in rural areas as available services
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are concentrated in the urban areas. Misconceptions, false beliefs and practicesaccentuate the problem.
1.2 Mental Disorders:
WHO experts have reported a prevalence of 13.9% of psychiatricmorbidity in the general population. It is also estimated that 15-20 persons visiting PHC or general practitioner have in fact emotional problems which appear as physical symptoms. Health has been defined not as merely absence of ill health, but as a state of positive well-being, physical, mental and social. Mental health therefore forms an essential part of total health as such and must form an integral part of the health policy.
The various mental disorders are:
1. Acute mental disorders of varying etiology, like acute psychosis (which can become chronic if not detected and treated in time).
2. Chronic mental illness such as schizophrenia, affective psychosis, epileptic
psychosis etc.
3. Emotional illness such as anxiety, hysteria, neurotic depression.
4. Alcohol abuse and drug intake (These areas will be dealt with ingreater details)