The rights of persons with disability bill, 2014: Implications for neurological disability

Prevalence of Depression among Stroke Survivors in India: A Systematic Review and Meta-Analysis

OBJECTIVE

To estimate the prevalence of depression among stroke survivors in India.

PARTICIPANTS

Stroke survivors diagnosed with depression.

OUTCOMES

Prevalence of Depression.

METHODS

Cochrane systematic review methods were followed. The literature search was from 1960-2019. We searched the following electronic databases Medline, ERIC, Embase, IndMED, PsycEXTRA, Global Health, Cochrane, CENTRAL Register, Econ Lit, and conference abstracts to identify studies for inclusion. A search strategy was appropriately developed and performed from May 2019 to December 2019. All included studies were assessed for their content and methodological quality using JBI Critical Appraisal Checklist.

RESULTS

A total of 15 studies were included in this study. Prevalence of post-stroke depression in the studies varied from 24% to 90%. The pooled prevalence was 55% (95% CI 43%, 65%) with high heterogeneity (I2=94.83%). Prevalence also varied between the tools (HAMD -60%, GDS -70%, HADS -40%). The overall methodological quality of the included studies was very poor.

CONCLUSION

It is evident from the meta-analysis that about half of those who survive a stroke experience post-stroke depression. The methods and tools used to investigate this was not rigorous and homogeneous. Hence results of this review imply the need to rigorously assess and effectively address post-stroke depression in India. Also, this review recommends future research to ensure methodological quality and generalizability of the study findings. This would help develop scalable, innovative public health intervention for post-stroke depression in the future.

Neural functions of the aging brain: Daily living, developmental and geriatric disabilities

Neuronal, microglial, astrocytic and oligodendrocytic functions of the brain are significantly affected during normal aging, and more so if inflicted with neurological diseases. Aging is a consistent risk factor for many neurodegenerative diseases that are sporadic in nature, whereas developmental neurological disabilities stem from errors in brain development. The neuronal functions are affected in both developmental disabilities and geriatric diseases. This special issue, is based on the two-days meeting at Thiruvanathapuram, India on 'Neural Functions of Aging Brain', which had several original presentations, as well as full reviews by neurobiologists and clinicians from India. Out of these, thirteen peer reviewed contributions are published in the present Special Issue of this Journal. This 'Foreword' is also a brief overview on the current scenario of neurobiology research on developmental disabilities and ageing in India based on the manuscripts included in the special issue, vis-s-vis the global scenario. Apparently, there is a void in geriatric and developmental neuroscience research in India since huge data mining and translation, concerted efforts on clinical neuroscience research, and consistent efforts on pure basic research resulting in 'first in the field' novelty are largely missing. Overall, Indian neuroscience excels in making meaningful relevance of contemporary discoveries in neuroscience and contributing towards advances in their applications.

Critical Appraisal of Guidelines for Evaluation and Certification of Specified Neurological Disabilities

New disability law called “Rights of Persons with Disabilities Act 2016” has been acted in 2016. The United Nations’ Convention for Rights of Persons with Disabilities is the sole of this new act. Of the total 21 categories, three new neurological legal disability categories such as chronic neurological conditions, Parkinson disease (PD), and multiple sclerosis have been notified first time in the new act. The new guidelines have been notified in the year 2018 for evaluation and certification of specified disabilities. As a new addition in these guidelines, modified Rankin scale score has been added to measure locomotor disability of stroke. Certainly, newer guidelines have many lacunae also. There are no recommendations of any method of disability measurement associated with movement disorders such as PD, chronic neurological conditions such as migraine, epilepsy, and ataxia. The tables of older guidelines for disability calculation in conditions such as unconsciousness and epileptic fits have been removed in newer guidelines. Professional bodies should come into action immediately and do effort for rectifying these shortcomings and/or fallacies in new guidelines.

The Rights of Persons with Disability Act, 2016: Challenges and opportunities

India signed the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) and subsequently ratified the same on October 1, 2007. The UNCRPD proclaims that disability results from an interaction of impairments with attitudinal and environmental barriers which hinders full and active participation in society on an equal basis. Further, the convention also mandates the signatories to change their national laws, to identify and eliminate obstacles and barriers, and to comply with the terms of the UNCRPD. In this regard, the Government of India initially undertook the amendment of laws such as Persons with Disability Act, 1995 (PWD Act 1995). The Rights of PWD Act, 2016 (RPWD Act 2016) replaced the PWD Act 1995 to comply with the UNCRPD. The new act was fine-tuned considering the socio-cultural and local needs of the society, and the available resources. Persons with Mental Illness (PMI) are often stigmatized and discriminated, which hinders their full and active participation in society. This is a much larger issue, especially in women, gender minorities, backward communities, and the poor and the migrated populations. Adding to the complexities, PMIs are often not aware of their illness, refuse the much-needed treatment and often are not in a place to exercise their rights. There is an urgent need to address this issue of attitudinal barrier so that the rights of PMI are upheld. Hence, this article discusses challenges and opportunities in the RPWD Act 2016 from the perspective of PMI.

Concordance of the Indian Mental Healthcare Act 2017 with the World Health Organization's Checklist on Mental Health Legislation

BACKGROUND

India is revising its mental health legislation with the Indian Mental Healthcare Act 2017 (IMHA). When implemented, this legislation will apply to over 1.25 billion people. In 2005, the World Health Organization (WHO) published a Resource Book (WHO-RB) on mental health, human rights and legislation, including a checklist of 175 specific items to be addressed in mental health legislation or policy in individual countries. Even following the publication of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2006), the WHO-RB remains the most comprehensive checklist for mental health legislation available, rooted in UN and WHO documents and providing the most systematic, detailed framework for human rights analysis of mental health legislation. We sought to determine the extent to which the IMHA will bring Indian legislation in line with the WHO-RB.

METHODS

The IMHA and other relevant pieces of Indian legislation are compared to each of the items in the WHO-RB. We classify each item in a binary manner, as either concordant or not, and provide more nuanced detail in the text.

RESULTS

The IMHA addresses 96/175 (55.4%) of the WHO-RB standards examined. When other relevant Indian legislation is taken into account, 118/175 (68.0%) of the standards are addressed in Indian law. Important areas of low concordance include the rights of families and carers, competence and guardianship, non-protesting patients and involuntary community treatment. The important legal constructs of advance directives, supported decision-making and nominated representatives are articulated in the Indian legislation and explored in this paper.

CONCLUSIONS

In theory, the IMHA is a highly progressive piece of legislation, especially when compared to legislation in other jurisdictions subject to similar analysis. Along with the Indian Rights of Persons with Disabilities Act 2016, it will bring Indian law closely in line with the WHO-RB. Vague, opaque language is however, used in certain contentious areas; this may represent arrangement-focused rather than realisation-focused legislation, and lead to inadvertent limitation of certain rights. Finally, the WHO-RB checklist is an extremely useful tool for this kind of analysis; we recommend it is updated to reflect the CRPD and other relevant developments.