In order to know the extent of mental disability in the project area, identification survey was conducted in the beginning of the project period. Through this we have identified 1029 persons with mental disability in the project area till date

In the first year we have identified around 583 persons with mental disability. By 2007 around 1029 of them were identified in the project area.

Among which 49% of them are children below 18 years. Almost all the children suffering with mental retardation. and 37% of them are between the age group of 19-40 years and majority of them are suffering with schizophrenic illness and epileptic

In these activities the newborn babies and children up to one year of age would be identified and they would be screened to identify the disability. All the children below one year screened and identified as mentally disabled would be provided treatment.

The Early identification and early intervention would help family members to give attention to that child at the earliest and the intensity of the retardation would be minimized. The programme is to be done through the help of Health workers.

All the homes were visited by the staff. Especially the community care workers visit periodically and interact with care givers and the neighbours in the villages.

The following are the objectives of the caregivers’ association:

• To avail benefits provided by the Government and other agencies for the welfare of the disabled
• To make them realize the importance of parental care in the rehabilitation of their disabled members
• To consolidate the caregivers support
• To work for the integrated, total development of families of the mentally disabled
• To create awareness among the people about the sufferings of the mentally disabled
• To meet the government officials, policy makers, other NGOs and VIPs in the community and explain to them the difficulties and help needed for the disabled.
• To help them and their families share their sufferings and chalk out plans for better management of the mentally disabled members in their family.
• To take steps to have continuous treatment and training.

The Officers from District Administration participated in the Annual day function of the Nambikkai Caregivers’ Association on 18.02.2006. In the anniversary day celebration, the members submitted memorandum (mentioned below) to the District Collector and to the Additional Collector for Development.

1. In order to get regular treatment for mental illness adequate medicines can be kept in PHCs nearest to our areas.
2. Details of all mentally disabled should be gathered. Treatment and rehabilitation programmes must be initiated.
3. There are 448 children who are affected with mental retardation, for them special schools must be started, atleast one per block.
4. In the villages day care centers for the mentally ill persons and mentally retarded children can be started
5. Some of the mentally disabled are homeless, are living by erecting huts along roadside in Govt.purampokku lands. For them house, land provision and house must be built.

6. For those who are affected by the mental illness must be provided with maintenance charge of Rs.500/- per month.
7. Rehabilitation and vocational training centres must be started in each block.
8. For those who are recovered from the mental illness must be given job opportunities
9. For Nambikkai self help groups more subsidy loans must be distributed
10. The other members of the disabled family must get job opportunity and also loan to start self employment.
11. Those neglected by their wife/husband and children must be protected and the children must get care and opportunities to get education
12. Homes for the neglected mentally disabled can be started in each block.
13. In order to protect their properties, legal support and services must be available free of cost.

These groups meet once a month and exchange their views. These self-help groups are promoting savings, credit activities and are trained in small entrepreneurship. These families are being benefited by this economic development activity. Mentally disabled members in these families are benefited by this programme directly or indirectly.

Group Details:

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.

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

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.

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

Professional team:

Members of the professional team are

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