The Rights of Persons with Disabilities Act, 2016: Does it address the needs of the persons with mental illness and their families

Experiences of family carers in providing care to children with intellectual disabilities in India: A qualitative evidence synthesis

BACKGROUND

India has a significant prevalence of people with intellectual disabilities. Despite their higher prevalence, they receive poor support. Therefore, this review aims to explore the experiences of family carers in providing care for children with intellectual disabilities in India.

METHODS

A qualitative evidence synthesis was undertaken, searching databases such as MEDLINE, CINAHL, Web of Science, and PsycInfo up to October 2023. Grey literature was also searched for unpublished studies, with two reviewers assessing methodological quality. Eleven eligible studies, mostly qualitative in design, were included in the review. The data synthesis followed a thematic approach.

RESULTS

The synthesis found five themes representing family carers' experiences and perspectives. These were 'resilience and acceptance', 'parental response', 'care dynamic', 'preparing for transition to adulthood' and 'parental advocacy'.

CONCLUSION

Family carers hold diverse views, while almost all consider providing care complex and challenging, with few positive experiences.

Formal support and service needs of family caregivers of adults with intellectual and/or developmental disabilities in India

BACKGROUND

Despite the enactment of disability laws/policies in India, research shows that caregivers of adults with intellectual and/or developmental disabilities experience inadequate formal supports/services due to dissemination barriers and lack of awareness about them. To address discrepancy between caregivers' support needs and the professionals' understanding of their needs, the study proposed to conduct a caregiver needs assessment so that culturally-tailored programs are developed.

METHOD

A strengths-based mixed methods needs assessment was conducted with a convenience sample of 100 caregivers in Hyderabad, India. One hundred caregivers completed the survey and 15 caregivers participated in semi-structured interviews.

RESULTS

Caregivers needed more and improved formal supports/services, particularly from the government. Caregivers faced systemic and attitudinal barriers, and personal impediments to accessing them. Needs differed by care recipients' intellectual disability level, gender, and intellectual disability related conditions.

CONCLUSIONS

Researchers, service providers and policymakers need to adopt innovative strategies to improve formal supports/services access.

Measuring the financial impact of disabilities in India (an analysis of national sample survey data)

BACKGROUND

People with disabilities are vulnerable because of the many challenges they face attitudinal, physical, and financial. The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resources for the country and seeks to create an environment that provides equal opportunities, and protection of their rights, and full. There are limited studies on health care burden due to disabilities of various types.

AIM

The present study examines the socioeconomic and state-wise differences in the prevalence of disabilities and related household financial burden in India.

METHODS

Data for this study was obtained from the National Sample Survey (NSS), 76th round Persons with Disabilities in India Survey 2018. The survey covered a sample of 1,18,152 households, 5,76,569 individuals, of which 1,06,894 of had any disability. This study performed descriptive statistics, and bivariate estimates.

RESULTS

The finding of the analysis showed that prevalence of disability of any kind was 22 persons per 1000. Around, one-fifth (20.32%) of the household's monthly consumption expenditure was spent on out-of-pocket expenditure for disability. More than half (57.1%) of the households were pushed to catastrophic health expenditure due to one of the members being disabled. Almost one-fifth (19.1%) of the households who were above the poverty line before one of members was treated for disability were pushed below the poverty line after the expenditure of the treatment and average percentage shortfall in income from the poverty line was 11.0 percent due to disability treatment care expenditure.

CONCLUSION

The study provides an insight on the socioeconomic differentials in out-of-pocket expenditure, catastrophic expenditure for treatment of any kind of disability. To attain SDG goal 3 that advocates healthy life and promote well-being for all at all ages, there is a need to recognize the disadvantaged and due to disability.

Effect of Curcumin and Coenzyme Q10 Alone and in Combination on Learning and Memory in an Animal Model of Alzheimer's Disease

The most frequent neurodegenerative illness among senior people and the main cause of dementia is Alzheimer's disease. The present dementia medications available only help with the symptoms of cognitive deficits and have several negative effects. The current study's goal is to assess the effects of curcumin and coenzyme Q10, two herbal medicines, both separately and in combination, on learning and memory before comparing them to the industry standard drug. A total of 42 adult healthy Wistar rats were used in our study. In this experiment, rats were given daily doses of 2.5 mg/kg of body weight of scopolamine hydrobromide for 7 days to induce Alzheimer's disease. On the eighth day, behavioural testing was conducted. Following testing, scopolamine and the test medications were given daily for the following 21 days. On days 29 and 30, behavioural testing was conducted once more, and then animals were slaughtered. Brain homogenate was produced for the estimation of molecular and biochemical markers. Curcumin has demonstrated a dose-response relationship, with a higher dose (200 mg/kg b.w. p.o.) being more effective than a lower dose (100 mg/kg b.w. p.o.). Similar to the greater dose of curcumin, coenzyme Q10 (200 mg/kg b.w. p.o.) has also been found to improve memory and learning. Higher doses of curcumin and coenzyme Q10 had more pronounced and meaningful effects. Acetylcholinesterase and TNF levels increased in scopolamine-induced memory impairment, but these effects were restored by the test medications, and improved by the combined therapy. These outcomes are comparable to those of the common medication memantine. As a result, we may infer from our results that curcumin at higher doses and its combination with coenzyme Q10 (200 mg/kg b.w. p.o.) have a significant impact on cognitive impairment in animal models of Alzheimer's disease and can be utilised alone or as an add-on therapy for the condition.

Working with adults with intellectual challenges to enhance their employability skills

The employability of the intellectually challenged has received little attention in the past. In order to fill this research gap, the present study was undertaken. The study is centered on the experiences of six intellectually challenged individuals who received employability training at a non-governmental organization. A focus group discussion along with a case study was conducted. The researchers employed the Rigorous and Accelerated Data Reduction (RADaR) technique to analyze the data from the focus group discussion. Results from both the focus group discussion and the case study revealed that the training program has had a significant impact on the lives of the participants and has aided them in becoming economically empowered and independent.

“Medicines is all that I can sometimes offer them”: challenges of providing primary diabetes care to persons with disabilities in Tamil Nadu

Background

Persons with disabilities have a higher risk for and poorer outcomes of type 2 diabetes. Primary health care providers face several challenges in providing primary diabetes care for them. This study was conducted to explore the challenges faced by primary health care providers in delivering primary diabetes services to persons with disabilities.

Methods

We performed a qualitative research study by conducting in-depth interviews among 13 primary health care providers including medical officers, staff nurses, community health workers and a physiotherapist. We adopted a descriptive qualitative research approach to data collection and analysis.

Results

Primary health care providers often could only prescribe medications to persons with diabetes by proxy due to poor accessibility of the facilities. They felt that these patients also had poor compliance to treatment. They felt that the lack of standard guidelines for diet and exercise for persons with disabilities prevented them from giving them appropriate advice on the same and even if they did, persons with disabilities would find it very difficult to adopt dietary changes and physical activity as they were dependent on others for even their daily activities. They also felt that they couldn’t perform annual screening tests due to lack of accessibility to higher facilities. Some primary care providers did local innovations such as formation of peer support groups, utilization of resources of other programs to reach out to persons with disabilities and innovative physical activity techniques to care for persons with disabilities. They recommended that there is a need for specific guidelines for management of diabetes among persons with disabilities, treatment of chronic diseases among persons with disabilities must be incentivized and there must be intersectoral coordination between social welfare department and health department to achieve the goal of care for persons with disabilities.

Conclusions

Primary health care providers faced substantial challenges in providing primary diabetes care for persons with disabilities. There is a need for an effective public health policy to address these challenges.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08246-1.

Does authentic leadership develop inclusive classrooms: a model examination?

Purpose

The present study aims to statistically prove the theoretical model on inclusive higher education provided by Srivastava and Shree (2019), which analyzes the effect of authentic leadership (AL) on inclusive classrooms (ICs) with the intervening role of academic optimism (AO) and art-based innovation pedagogies.

Design/methodology/approach

This current study collected data through a questionnaire method from higher education faculty and the faculty's immediate leaders. Statistical methods like descriptive analysis, confirmatory factor analysis (CFA) and multiple regression analysis were conducted to evaluate the variables, model fit and hypothesis, respectively.

Findings

The results indicated a positive effect of AL on ICs via the partial mediating role of AO. However, unlike the proven theoretical model, the moderating role of art-based innovation pedagogy between AO and the IC was not supported.

Originality/value

The implications of this study advanced the theoretical aspect of the model while providing managerial suggestions that can be applied to support the development of ICs in educational institutions.

Clean intermittent catheterization in long-term management of neurogenic bladder in spinal cord injury: Patient perspective and experiences

OBJECTIVES

Bladder dysfunction due to spinal cord injury has a significant impact on the overall health and quality of life of an individual. Clean intermittent catheterization is the gold standard for bladder management and is recommended due to having the lowest complication rate. Transitions from intermittent catheterization to other less optimal strategies, such as indwelling catheter, are quite common. However, the research documenting patient perspectives, and epidemiological and demographic factors related to such transition is limited.

METHODS

Data from patients with spinal cord injury rehabilitated with clean intermittent catheterization were collected. Demographic and epidemiological details of the patients were documented from the inpatient records. Appropriate statistical tests were applied to the values.

RESULTS

Among the 45 participants, 68.89% continued clean intermittent catheterization. In those who discontinued clean intermittent catheterization, the median duration of practicing clean intermittent catheterization was 3.5 months. The commonest difficulty among compliant patients was carrying out clean intermittent catheterization in outdoor environments due to the unavailability of toilet facilities. Urinary tract infection was the most common (17.78%) complication noted. Dependence (20.00%) was a major procedural difficulty followed by pain. Adaptations to remain continent in special conditions were diapers and condom catheters. The duration of clean intermittent catheterization practiced influenced discontinuation of clean intermittent catheterization. With an increase in the duration of clean intermittent catheterization practiced after discharge, the risk of discontinuation of clean intermittent catheterization decreased with an adjusted odds ratio of 0.773 (95% confidence interval 0.609-0.982).

CONCLUSIONS

People with spinal cord injury have many challenging issues in the regulation of bladder function at their level inclusive of procedural difficulties, environmental barriers and medical complications, and understanding of which will help to establish a comprehensive and a holistic program to provide remote/community care.

Public Health Perspectives of Geriatric Mental Health Care

BACKGROUND

In older adults (aged 60 years and above), mental health problems are gaining public health importance because of the increasing prevalence, disease burden, disability, morbidity, and mortality. Epidemiological studies on major mental health disorders such as depression and dementia in older adults have contributed to a better understanding of the distribution and determinants of these conditions. Identifying potential risk factors has stimulated interventional research on preventing these conditions under the public health framework towards their management. The increasing burden of geriatric mental health conditions like dementia in developing countries like India can contribute to significant challenges if there is no adequate strengthening of the public health response. This includes scaling up the measures of prevention, public awareness, early diagnosis, and quality health and social care equitably available to all sections of the population. The Decade of Healthy Ageing (2021-2030) provides the opportunity for concerted and coordinated initiatives to improve intrinsic capacity (physical and mental) and offer an age-friendly environment to enhance the functional ability of all older adults.

METHODS

This article reviews the critical public health issues related to geriatric mental health in India.

The Work of Workplace Disclosure: Invisible Chronic Conditions and Opportunities for Design

Health disclosure at work is complicated for people with invisible chronic conditions. Due to the lack of visible symptoms, invisible conditions affect the work life of people in ways that are not obvious to others. This study examines how people disclose and conceal their conditions in the workplace and opens the design space for this topic. In the first phase, we analyzed posts on two subreddit forums, r/migraine and r/fibromyalgia, and found a range of strategies that individuals use to disclose or conceal their conditions. In the second phase, we created five technological design concepts based on these strategies that were shown to eight people with migraines or fibromyalgia in semi-structured interviews. Based on these phases, we contribute understandings of disclosure and concealment of invisible conditions in the workplace for future research, such as potential areas for intervention ranging from individual to societal level efforts, as well as the potential and limitations of relying on empathy from others.

Cost estimation for the implementation of the Mental Healthcare Act 2017

The Mental Healthcare Act, 2017 (MHCA) was a step that was essential, once the Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities in 2007. The MHCA looks to protect, promote, and fulfill the rights of persons with mental illness (PMI) as stated in the preamble of the Act. Further, there is an onus on the state to provide affordable mental health care to its citizens. In India, mental health has always been a lesser priority for lawmakers and citizens alike. The rights-based MHCA looks to overhaul the existing system by giving prominence to autonomy, protecting the rights of the mentally ill individuals, and making the State responsible for the care. The decision to make all this happen is commendable. The annual health expenditure of India is 1.15% of the gross domestic product, and the mental health budget is <1% of India's total health budget. This article systematically analyses and describes the cost estimation of the implementation of MHCA 2017, and it is not an estimation of mental health economics. The conservative annual estimated cost on the government to implement MHCA, 2017 would be 94,073 crore rupees. The present study estimation depicts that investing in the implementation of MHCA, 2017 by the government will yield 6.5 times the return on investment analysis benefit. If the State is not proactive in taking measures to implement the MHCA, the rights promised under this legislation will remain aspirational.

The Rights of Persons with Disabilities Act 2016: Mental Health Implications

India's ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) necessitated the need for a rights-based, biopsychosocial model of disability, which was endorsed in the Rights of Persons with Disabilities (RPwD) Act, 2016. This article examines the Act, its rules, and guidelines provided by the Government of India, from a mental health perspective, and compares it to its predecessor, the Persons with Disabilities (PwD) Act, 1995. The RPwD Act provides clearer definitions of various constructs, a greater focus on rights of PwD, and guidelines for assessment and certification of disabilities. There is, however, an underemphasis on mental illnesses in the reservation and legal decision making, and a move toward centralizing the process of disability certification. Also, there is a lack of clarity about screening instruments to be used, resource allocation to implement the provisions, and the guidelines for inclusive education. This article suggests recommendations that could strengthen some of these provisions.