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Mental Disability Assessment Gazette Notification 2024 [IDEAS] — Transcript

by Prof. Suresh Bada Math · 4,598 words · 761 segments · language en · Watch on YouTube

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0:04[Music]
0:14[Music]
0:17Hello friends today we going to discuss
0:19about mental disability assessment
0:222024 I'm Dr sesh bmat professor of
0:25Psychiatry working at National Institute
0:28of Mental Health and neuros senses
0:30Bangalore in this video I'll be
0:32discussing about mental disability
0:34assessment which was notified on 12th
0:37March
0:392024 let's understand
0:41disability as per United Nations
0:44convention on right to persons with
0:46disability the disability
0:48definition which was given by the United
0:51Nation is very clear it is an evolving
0:55concept and results from the interaction
0:58between the persons with imp a
1:00Ms and attitudinal and environmental
1:04barrier that hinders their full and
1:07effective participation in society on
1:10equal basis with
1:12others this definition emphasizes that
1:15disability is not just a medical
1:17condition or an
1:19impairment but also results from the
1:21societal and environmental barrier that
1:25prevents the persons were disabled to
1:28equally participate in the
1:31society especially with mental
1:33disability the attitudal barrier of the
1:37general
1:38public the people in policy makers
1:43position and also the employees or the
1:47employers who are working there would
1:50not like to accommodate a person with
1:52mental
1:53illness they believe the person with
1:56mental illness is useless they are dis
2:00minated and
2:01stigmatized this attitudinal barrier is
2:04one of the biggest challenge for person
2:07with mental disability for them to
2:09participate in the
2:12society now let's look into the
2:14challenges with regard to mental
2:16disability
2:17assessment first and the foremost the
2:20diagnosis of mental illness is very
2:23difficult to diagnose unless a qualified
2:27psychiatrist sits with them as them
2:31thoroughly mental illness are dynamic in
2:34nature they fluctuate and also they are
2:38epid episodic in
2:40nature hence the earlier gazet
2:43notification discussed about temporary
2:46disability certificate and the permanent
2:49disability
2:50certificate let's look into the the
2:52newer Gazette notification what does it
2:54say about this temporary and permanent
2:58disability which is given for mental
3:01disability along with mental
3:04disability the myths stigma
3:08discrimination which is prevailing in
3:10society is huge because of this the
3:13attitudinal barrier for the effective
3:17participation of a person with mental
3:19illness is a big
3:22challenge with regard to provision of
3:24early diagnosis and treatment can reduce
3:28disability remark
3:30ably person with mental illness often
3:33finds it very difficult to communicate
3:35the challenges what they go through
3:38every day in their
3:40life not only
3:42this especially across the world limited
3:47access to mental health care
3:50nonavailability of psychotropic
3:51medication
3:53continuously nonavailability of
3:56Rehabilitation especially in the
3:57government setting all also comes in the
4:01way of their
4:04recovery as I mentioned societal
4:07attitude is the biggest
4:09challenge many a Time the people say
4:12mental disability is a invisible one
4:15because most of it is attitudinal at the
4:19same time stigma and discrimination and
4:22labeling them they are mentally ill
4:25hence they are not involved in any
4:27decision making or or allowed for
4:31Effective
4:33participation now let's look into the
4:36how The Gazette notification of 12th
4:38March 2024 discusses about mental
4:42disability there was a committee setup
4:45and the subcommittee for the assessment
4:48of mental disability these are the
4:52members Professor pankaj Varma sir was
4:55the chairperson along with six other
4:58people where
5:00the members of this committee let's look
5:04into this how this committee has done
5:06their
5:07job if you look at this Gazette
5:10notification it is more than 800 pages
5:15that means if you download that and go
5:18through it it is very difficult to find
5:20where mental disability assessment is
5:23there hence I have given the page
5:26numbers item number 24 deals with mental
5:29illness
5:30which is given in page number
5:33496 the ideas assessment is in appendix
5:3713 that is in page number
5:40848 if there is a suspicion if a person
5:44with mental illness
5:46also has intellectual disability that
5:50means his IQ is low then you need to do
5:54IQ assessment and also ideas
5:58separately since since the person has
6:00two different disabilities one is
6:03intellectual
6:04disability another one is mental illness
6:07that is mental disability hence you need
6:10to apply multiple disability formula for
6:13the assessment that has been clarified
6:16in this Gazette
6:18notification with regard to certifying
6:21permanent
6:23disability before you certify you have
6:25to make sure at least the person is
6:28suffering for continuously for 2
6:31years if it is less than 2 years you can
6:34give time validity disability
6:37certificate that means it will be given
6:40for 2 years maybe 5 years that means it
6:43is a kind of temporary
6:45disability person with mental illness
6:48who have who have not received any
6:50treatment and it is well known
6:52especially with
6:54schizophrenia the treatment Gap is huge
6:57and invariably 5 to six years is drug
7:00Nave that means many of them have not
7:03received any treatment before they come
7:05for treatment that
7:07means before you assess disability as
7:10soon as they come you have to make sure
7:13they have given or they have received
7:15adequate
7:16treatment that means we can give only
7:20the temporary disability that means
7:22timed validity disability certificate
7:24can be
7:26given before you give permanent
7:28disability make sure you have given
7:31adequate
7:33treatment adequate treatment is based
7:35upon the disability board discussion
7:39whether the person has received adequate
7:42trial for adequate duration and it is
7:46treatment resistant and the person has
7:49disability based upon that the permanent
7:52disability certificate is
7:54given if the treatment Nave patient
7:58reports to the OPD and they request for
8:01disability certificate in such a
8:03scenario the treating
8:05psychiatrist or the psychiatrist who is
8:07attending them for the first time need
8:10to educate the patient patient's family
8:13members and tell them there is a need
8:17for adequate treatment then only the
8:19permanent disability certificate can be
8:21given otherwise they are eligible for
8:25time validity disability
8:28certificate for a person with mental
8:30illness who have taken psychiatric
8:32treatment but did they do not have any
8:37medical records in such a scenario what
8:39to do this is the commonest scenario
8:42which we see in government
8:44hospitals the patient and the family
8:46members report to us and say that I have
8:49been taking treatment since 20 years
8:51from a psychiatrist in a private setting
8:55but I do not have any records what shall
8:58be done in such a scenario where the
9:00patient do not have any medical records
9:04again you need to educate them and tell
9:08them we will be able to give only the
9:10time validity disability certificate
9:13that is temporary you'll be given only
9:15for 2 years and the repeat assessment
9:18has to be done after 2 years in that
9:21period they have to come for regular
9:23followup and to evaluate how much he has
9:27improved permanent disability
9:28certificate ation will be issued based
9:31on the assessment of residual
9:34disability despite the
9:37appropriate
9:39evidence-based
9:40medication with adequate dosage and
9:43duration has been given without that the
9:46permanent disability should not be
9:48given with regard to who can be doing
9:52the
9:52assessment invariably there is something
9:55called as medical Authority earlier it
9:58was considered as a disability board the
10:00medical Authority the chairperson will
10:02be either the medical superent CMO or
10:05the civil
10:07surgeon further there should be a
10:09psychiatrist who will be doing the
10:12assessment the third person can be a
10:14psychiatrist physician clinical
10:17psychologist psychologist Rehabilitation
10:21psychologist and psychiatric social
10:23worker this Gazette notification has
10:26clearly
10:27mentioned across India there is a short
10:29AG of specialist in such a scenario if
10:32the government do not have the
10:35psychiatrist or the clinical
10:37psychologist psychiatric social worker
10:40or the
10:41physician the person from the private
10:44setting can be called to be in the
10:47medical Authority position and they will
10:49be signing in that position but however
10:53the chairperson must be a government
10:56employee and who is a medical superent
10:59CMO and civil surgeon this Gazette
11:02notification has helped many patient and
11:06is going to help many other
11:08people now let's go into ideas that is
11:12Indian disability evaluation scale for
11:14mental illness invariably we need to
11:17collide information from the patient
11:20patient caregiver and the medical
11:23records invariably if the psychiatrist
11:25has been seeing the patient for longer
11:28duration and he knows the patient very
11:32well patient's family members medical
11:34records are very well preserved the
11:36disability certificate can be given
11:39immediately if it is a new case you need
11:42to assess them thoroughly you need to
11:44ask for the medical records you may
11:46require to do inpatient admission and
11:51observation although the ideas which has
11:54been notified in the page number
11:57848 up and index 13 says that idea is
12:01good for op based assessment only that
12:05means it should not be used in IP
12:07setting is a big question which we need
12:10to ask if you look at the general
12:12guidelines which has been notified Under
12:15The Gazette notification clearly says
12:17ideas are suited for the purpose of
12:20measuring and certifying disability if
12:23it is there a brief and a simple
12:25instrument which is available which can
12:27be used in a busy clinical set
12:29and some training may be required and
12:32this is used only on outpatient basis
12:36and not appropriate for
12:38inpatients that means we should not give
12:42this disability certificate for
12:44inpatient that's what I can infer by the
12:48gazet notification that means we need to
12:51issue this disability certificate once
12:54they are in the outpatient coming for
12:57regular followup and still they have not
13:00improved if you have admitted the
13:02patient in IP setting invariably they
13:05are severe acute case that's what the
13:09the the drafter of this ideas has been
13:13thinking about hence my dear
13:16friends if you have to do ideas for
13:20person with mental illness it clearly
13:22has been notified in the page number 8
13:25848 that it is not appropriate for
13:28impatients
13:30what is appropriate is very difficult to
13:32Define here should we use it in
13:34impatient or not is a big question that
13:37needs to be clarified over a period of
13:39time maybe an amendment may be required
13:41for this hence please use this ideas
13:45only in outpatient setting and when we
13:48have medical records and when you know
13:51the patient is suffering for more than
13:53two years then only you you issue dis
13:57permanent disability certificate
13:59if you look at this again in the page
14:01number 849 it clearly says now the ideas
14:07or the mental disability can be given
14:09only for four
14:11illnesses that is
14:13schizophrenia bipolar disorder dementia
14:16and
14:17OCD what about other
14:19illness what about
14:21aerophobia what about recurrent
14:24depressive disorder what about the
14:27cognitive deficits
14:29what about substance abuse and
14:32dependence what about the people with
14:35borderline personality disorder Damia
14:39double depression schizoaffective
14:41disorder you cannot issue now that's
14:44what the gazet notification says this is
14:47the original ideas which was notified by
14:50the IPS that is Indian Psychiatric
14:53Society and it was submitted to the
14:55government of India unfortunately
14:59the same has been brought here although
15:01it has positive things but now you are
15:05restricting the ideas only for four
15:08disorders and not giving disability
15:12certificate for many other illnesses can
15:15be a violation of their rights because
15:19right to persons with disability 2016 is
15:22very clear that means we need to give
15:26for all mental illness this can be
15:29considered as one of the drawback of
15:31this
15:32notification further who can assess it
15:36is the only the psychiatrist who can
15:38assess and sign the other people who can
15:40do the assessment can be trained social
15:44worker psychologist and occupational
15:47therapist every psychiatric disability
15:50to be reassessed every two years unless
15:53it is notified or signed by the medical
15:56Authority as a permanent one and unless
15:59if it is the person is suffering from
16:01more than two years then only the
16:03permanent disability certificate can be
16:05given let's look into the domains of
16:08ideas there are four domains like the
16:11earlier one one is the self-care second
16:14one is communication and understanding
16:16third one is interpersonal
16:18activities and the fourth one is work
16:21and all these four
16:23domain considers to be a total
16:26disability scores and each domain is
16:29scored over
16:32four points zero is no disability one is
16:37mild disability two is moderate three is
16:40severe and four is profound disability
16:44that means in the four domains the
16:46maximum score is four 4 into 4 is the 16
16:50is the total disability score to know
16:53the global disability score one need to
16:56have this total disability score Plus as
16:59the duration of illness then only it
17:01will become Global disability score the
17:04duration of illness also is scored the
17:06maximum score is four so the total
17:09Global disability score the maximum will
17:11be 20 so that means my dear friends the
17:15total disability score plus duration of
17:18illness four item into 4 is 16 and
17:21duration of illness is four the maximum
17:23score is 20 now let's understand the
17:26global disability score how the
17:29assessment is done and how the duration
17:31of illness is calculated the first let's
17:34discuss about the
17:36self-care the self-care how it is
17:39assessed this should be regarded as an
17:42activity Guided by social norms and
17:45Convention that means based upon where
17:49the person is
17:50staying whether he is in a maybe in a
17:54area where it is very cold and they take
17:57bath once maybe a week once in a week or
18:02maybe daily or maybe daily twice if he
18:06is in a very sweating area or maybe in a
18:10person like in Rajasthan so the
18:13self-care needs to be based upon social
18:15norms and Convention that is the word
18:18it's very
18:19specific let's look into how the domain
18:22of selfcare is there how it has to be
18:25assessed maintenance of personal hygiene
18:28how the physical health what his eating
18:30habits maintenance of personal
18:32belongings and leaving space does he
18:35look after himself whether he washes his
18:37clothes regularly does he take bath does
18:40he brushes his teeth does he have
18:43regular meals does it take food of right
18:46quality and quantity what about his
18:48stable manners does it take care of his
18:51personal belongings with reasonable
18:52standard of cleanliness and
18:55orderliness now let's discuss about how
18:58the scoring is is done for the domain
19:00self-care zero means no disability one
19:04is mild itation but does not have any
19:06adverse Health
19:08consequences
19:09two there is a detoriation and Mild
19:14adverse Health
19:15consequences there may be physical
19:17health problem obesity tooth decay body
19:21order is there the third evidence of
19:26serious Hazard to f physical health
19:30malnutrition infection patient is
19:34unacceptable in public the person has a
19:37ha matted hair unhygienic ragged clothes
19:42can be considered three fourth is a
19:45constant supervision is required for
19:49self-care if nobody takes care of them
19:52their health dorat very fast now let's
19:56look into the interpersonal
19:59activities what are the anchor
20:02points here in interpersonal activity
20:04what is the social
20:06relationship patient's response to
20:09question how does a request what are his
20:13demands what about his activities how
20:16does he regulates emotion in Social and
20:19interpersonal situation whether he has
20:21activities who can initiate maintain and
20:25terminate the interaction activities of
20:28engage in physical
20:29intimacy further what is his behavior
20:32with others is he polite rude does he
20:36respond to question is he able to
20:38regulate verbal and physical aggression
20:41is he be able to act independently in
20:43social interaction how does he behave
20:46with strangers is he able to maintain
20:48friendship and relationship does he show
20:51a physical expression of affection and
20:53desire now let's look into the scoring
20:57with regard to interpers personal
20:59activities first one is if there is some
21:02friction on isolated occasion one is
21:07given second one is few occasions of
21:10that could be
21:11isolated himself from others and avoid
21:15companies third one is severe behavior
21:18problems in Social situation undesirable
21:21and generalized and he causes problem in
21:24daily living or work patient is socially
21:28OST ized the family refuses to take him
21:32outside invariably they believe if you
21:34take him outside he may misbehave and
21:37the people will come to know about his
21:39mental illness hence in the such a
21:43scenario three is given profound in such
21:46a scenario where the patient is serious
21:49has l in Conflict serious dangers to
21:53others and self in such a scenario there
21:56should be a one person available to
21:58monitor them that is four now let's look
22:01into the domain three communication and
22:05understanding in this the anchor points
22:08with regard to is understanding the
22:10spoken messages as well as written and
22:12nonverbal messages and ab ability to
22:15deduce messages in order to communicate
22:18with others now let's look into what are
22:20the question you need to ask does he
22:23avoid talking to people when people come
22:26home does he interact with them does he
22:28visit is it friends relatives social
22:31function does it start maintain and end
22:34conversation does he understand the body
22:37language of others does he understand
22:39the emotions of others does he indulge
22:42in Reading Writing do you encourage him
22:44to be more social so let's look into the
22:48scoring the scoring when is done patient
22:51is described as
22:52uncommunicative solitary in Social
22:55situation signs of social anxiety may be
22:57reported
22:59the two a very narrow range of social
23:03contact evidence of active social
23:05avoidance of people on some occasion and
23:08interference with performance of social
23:10rules and causes concern to the family
23:14three evidence of more
23:17generalized active avoidance of contact
23:19with people leaving the room when the
23:22visitors come do not go to any social
23:25function avoids the social function
23:27fourth one
23:29hardly has any contact actively avoids
23:32the P avoids people he may have
23:35delusions he may think that people are
23:37trying to harm him he may lock himself
23:40in the room and the communication is
23:43very minimal in such a scenario four has
23:46to be given now let's look into the the
23:49final one about the
23:51work the work has to be assessed based
23:54on the employment if she is a housewife
23:57what is the housework
23:59educational performance with regard to
24:01student score only one on the category
24:04in case of overlap that means if it is a
24:07housewife you need to assess the
24:09housewife area only if the person is a
24:12student you need to assess only the
24:13student and if he is working you need to
24:17assess the work the question is he
24:19employed or unemployed if he is employed
24:22does he go to work regularly does he
24:25like his job what about his coping with
24:27his job
24:28stress can you rely him on financially
24:32if unemployed does he make any effort to
24:35find the job what are his efforts to go
24:39to job if he's given a job will he's
24:42able to go to regularly does he make
24:44efforts to work with regard to
24:47concentration and
24:48attention in similar ways with regard to
24:52housewife you need to assess whether
24:54they are able to do work regularly
24:57whether they are able to efficiently
24:59cook whether they are able to clean the
25:01house keep it neat and tidy whether they
25:04are able to maintain the stress of being
25:06a housewife and able to cook for the
25:09whole family here you need to look into
25:12the acquiring the daily Necessities
25:15making storing serving food cleaning the
25:17house utensils and also looking after
25:20the maids cooks and looking after The
25:23Possession and valuable in the house
25:25will be considered as a work for
25:27housewives
25:29with regard to students assistant score
25:31on the performance of school and college
25:34going regularly discipline interest in
25:37future studies and his behavior in the
25:41college needs to be noted those who had
25:43discontinued education on account of
25:45mental illness we need to score four for
25:49them if you look at the
25:51scoring one there is a noticeable
25:54decline in patients ability to work to
25:57cope with it and meet the demands of
25:59work May threaten to quit very often but
26:01is going to work regularly two is
26:03declining with work performance frequent
26:06absence from the work lack of concern
26:10about all this regarding his
26:12responsibility financial difficulties
26:14are
26:15foreseen the three has to be scored when
26:18there is a mark decline in the work
26:20performance disruptive at work unwilling
26:24to ader to the work or discipline at
26:28work or the rules of at work threat of
26:31losing the job is there fourth as
26:34largely absent from the work termination
26:37is imminent suspension has been given
26:40unemployed making no efforts to find the
26:43job now let's look into the global
26:45disability score as I mentioned here the
26:48total disability score plus the duration
26:50of illness will be considered as Global
26:53disability score for the duration of
26:55illness how to score now now here for
27:00the purpose of duration of illness month
27:03of illness in the last two year has to
27:05be
27:06calculated if the person has less than 6
27:09months of illness the score one has to
27:11be given if the patient has illness for
27:147 to 12 months two has to be
27:16given if the patient is suffering from
27:20illness for more than 13 to 18 months
27:23that is between the 13 and 18 months
27:25three has to be scored if the patient
27:27has more than 18 months of illness then
27:30four has to be given here the duration
27:33of illness means he has to be ill
27:35continuously that is what is mention of
27:38months of illness in the last two years
27:41if the patient recovers within one month
27:44that means you have to score only one if
27:47the patient has illness since past two
27:50years and is continuously ill for only
27:52one year then you have to give the score
27:55of two that means
27:58months of being ill in the last two
28:02years that should be used for scoring
28:05now if you look at the low Global
28:07disability score total disability score
28:10plus the dis duration of illness each
28:13item is 4 into 4 16 and plus duration of
28:16illness four the total disability score
28:19the maximum Global disability score will
28:21be 20 let's look into this each domain
28:25has four 0 1 2 3 4 that is selfcare
28:28interpersonal activities communication
28:31and understanding and work that becomes
28:33the total score and the duration of
28:35willness 0 1 2 3 4 that will be added
28:39and total score will be 20 so let's look
28:42into one of the patient if he scores one
28:46on self-care four on interpersonal
28:49activities with regard to communication
28:51and understanding his scores one and
28:53with regard to work four that means he
28:56has lost the job and he's not making any
28:58efforts to find the job if you look at
29:01the total disability score will be 10
29:04for the assessment for the P purpose of
29:06duration of illness it is between 6
29:10months to 12 months so you'll be giving
29:13the score 2 so 10 + 2 will become 12 so
29:18the global disability score will be 12
29:21so here you'll not be able to give the
29:24exact
29:25percentage similar to the previous gazet
29:27notific ification this gazet
29:29notification also gives the range if it
29:33is 0o 0% disability if the score is
29:36between 1 to 7 that means it is less
29:38than 40% if the patient has 8 and above
29:41that means above
29:4340% is the number you have to give that
29:47means you'll be giving above 40% if the
29:50patient is scores eight and above if the
29:52patient is scores between 8 and 13 in
29:55the case wiget which we discussed it
29:57will be 12
29:58that means you'll be
30:00giving the disability as moderate if the
30:03patient scores somewhere between 14 to
30:0519 it will be termed as severe if the
30:09patient has 20 you'll be telling that as
30:11profound unfortunately we do not have
30:14the exact percentage that is 75%
30:1960% unfortunately many of the policy
30:22makers many of the people who are
30:24sitting in a employer's position in the
30:28government do not understand that the
30:31mental disability is given in the range
30:33not in the percentage hence many time
30:36they are refusing to give or uphold the
30:39mental disability certificate issue in
30:42such a in such a scenario whenever an
30:45employee refuses the mental disability
30:47based upon the range given as moderate
30:50severe or profound if they refuse to
30:53give please understand under the right
30:56to persons with disability Act of 2016
30:59you are having the rights please
31:02approach the disability Comm
31:04commissioner of the state and tell so
31:06and so employee employer is refusing to
31:09honor as per this gazet notification
31:12which clearly says that if I am scoring
31:1412 and it is moderate disability they
31:17have to give my rights that is the only
31:21way to go
31:22forward now let's look into the critique
31:24of this gazed notification
31:28they are clarified the duration of
31:30illness the previous notification had a
31:33very difficulty in understanding how to
31:35score duration of illness now they have
31:37given the clarity that is MI 2y that is
31:40months of illness in the past 2 years to
31:43be utilized for scoring that is a very
31:46good positive plus
31:47Point Clarity has been given with regard
31:51to treatment many a Time the patient may
31:53not take treatment and but he wants
31:55disability certificate hence adequate
31:57treatment has to be given as the clarity
32:00has been given with regard to medical
32:02records if it is not there time validity
32:05certificate has to be given again the
32:07clarity has been given Clarity on
32:10bringing the private psychiatrist into
32:13the medical Authority has been given and
32:17notified further mental disability again
32:20the score is is given in the range that
32:24means many a Time many of the employers
32:27Mir refuse to accept such certificates
32:30the only way is to approach the
32:32disability commissioner and give
32:34complaint telling that in spite of gazet
32:36notification they're
32:38refusing unfortunately this gazet
32:41notification gives opportunity for only
32:44four disorders that is schizophrenia
32:47dementia OCD and
32:49bpad and remaining disorders cannot be
32:54notified or cannot be given disability
32:57certificate and again the disability
32:59certificate is appropriate only for
33:01outpatient cases you cannot issue for
33:04inpatient cases that means it is said
33:07inappropriate for impatient
33:09case wish this committee should have
33:14considered developing a new scale which
33:18could have been comprehensive which
33:20could have looked into all other
33:22disabilities if you look at the
33:24literature now with regard to ideas
33:28there are literature which poures in
33:30with regard to ideas has been used in
33:33various disorders like depression sexual
33:37disorders
33:38agobia anxiety disorders Gad double
33:43depression even few case wigets with
33:46regard to personality disorders
33:48especially borderline personality
33:49disorders has also been noted that means
33:54the current Gazette notification can be
33:56considered as discriminating nature if
33:59they have other mental illness to
34:03conclude the idea scales which was
34:06originally notified by the Indian
34:08Psychiatric Society has been adopted by
34:10the government unfortunately only the
34:13four illnesses have been given the other
34:15mental illness has been kept outside the
34:17Ambit it can be used only in
34:20outpatient now it is time to look for
34:23the new disability scale although the
34:27idea medas which looks into only four
34:30illnesses but this was a definition
34:33which was there before
34:36uncrpd the current un crpd's definition
34:39is very wide which talks about
34:41disability as an evolving concept which
34:44is an interaction between the impairment
34:48and environmental and attitudinal
34:51barrier
34:52especially in the current Society the
34:56attitudinal barrier to towards the
34:58person with mental illness is huge that
35:00means the disability has to be given for
35:03all mental illness which is not been up
35:06upheld in the current GED
35:08notification thank you very much for
35:11giving your valuable time stay safe
35:14[Music]

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