7 - Rehabilitation Pscyhology

Rehabilitation Psychology
PAPER- 2 UNIT-7
Syllabus:
Primary, secondary and tertiary prevention

programmes-role of psychologists; Organising of
services for rehabilitation of physically, mentally and
socially challenged persons including old persons,
Rehabilitation of persons suffering from substance
abuse, juvenile delinquency, criminal behaviour;
Rehabilitation of victims of violence, Rehabilitation of
HIV/AIDS victims, the role of social agencies.
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BEAUTIFUL MIND IAS STUDY GROUP
2015
P2 Unit 7 - Rehabilitation Pscyhology
Contents
A. Primary, Secondary & Tertiary prevention programmes - role of psychologists ........................ 3
A.1 Primary Prevention ........................................................................................................................3
A.2 Secondary Prevention ...................................................................................................................3
A.3 Tertiary Prevention ........................................................................................................................3
A.4 Approaches to Prevention .............................................................................................................4
A.4.1 Situation – Focused, Competency – Focused Prevention .....................................................4
A.4.2 Sites of Prevention ................................................................................................................4
A.5 WHO PROVIDE PREVENTIVE CURE? ..............................................................................................5
A.5.1 Treatment in the Community ...............................................................................................5
B. Organising of services for rehabilitation of physically, mentally and socially challenged persons
6
B.1 Rehabilitation of Elderly ................................................................................................................6
B.1.1 Characteristics of old age ......................................................................................................8
B.2 Likely Psychological problems of Old age ......................................................................................9
B.2.1 Go e e t s Role i the Reha ilitatio of Aged ............................................................. 11
B.3 How to help elderly? .................................................................................................................. 13
B.4 Rehabilitation for Alcoholism and drug addiction...................................................................... 16
B.4.1 Drug Addiction ................................................................................................................... 20
B.4.2 Theories of Drug addiction ................................................................................................ 21
B.5 Treatment for Substance Induced Disorder ............................................................................... 27
B.6 Juvenile Delinquency .................................................................................................................. 27
B.6.1 Factors Contributing to Delinquency ................................................................................. 28
B.6.2 Rehabilitation of Juvenile Delinquents .............................................................................. 30
B.7 Rehabilitation of HIV/AIDS Victims............................................................................................. 31
B.7.1 HIV AIDS in India ................................................................................................................ 36
B.7.2 National AIDS Control Programme (NACP-IV) ................................................................... 38
B.7.3 Care and Support of People Living with HIV/AIDS ............................................................. 39
B.7.4 Care and Support Centres (CSC): ....................................................................................... 40
B.8 Victims of violence...................................................................................................................... 41
B.9 Problems of Rehabilitation in India ............................................................................................ 46
B.9.1 General Suggestions for rehabilitation .............................................................................. 47
B.10 Manpower Development scheme under NMHP ........................................................................ 49
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A. Primary, Secondary & Tertiary prevention programmes - role of

psychologists
Three types of prevention span the entire range of mental health intervention.
A.1 Primary Prevention

Primary Prevention is concerned with the general reduction of new cases of disorders and is
administered to everyone in a particular population, population for instance all students at a school or
all pregnant women whether or not they might be at a particular risk.
Scientific information about cause and effect is very important in primary prevention. For example,
knowledge of the possibility of harm to the unborn child has persuaded many women not to smoke or
drink during pregnancy. Physicians are much more careful about prescribing medications for pregnant
women because of information linking even seemingly harmless drugs with birth defects. Knowledge of
the harmful effects of nicotial addiction has led psychologists to conduct research on ways to discourage
children from beginning to smoke cigarettes. Another example of primary prevention is premarital
counseling. Marital problems and divorce are highly correlated with maladaptive behavior. Premarital
counseling is aimed at encouraging couples to anticipate any problems and to develop ways of coping
with them before marriage.
A.2 Secondary Prevention

Secondary Prevention is more selective than primary prevention because it is limited to a subgroup of
the population that is at a higher risk for developing a mental disorder, with psychological, social and
biological factors as the bases for determining risk.
The aim of secondary prevention is to reduce the potential disability of an existing abnormal condition.
For example, if a child with phenylketonuria is identified early, a special diet can prevent serious
retardation. Children who are behind in intellectual and social development as a result of living in
homes where little stimulation and individual attention are available can be helped to gain more normal
development through special enrichment programmes. These programmes can help the child catch up
in the developmental process and gain skills that will make later school achievement more likely.
Another example for secondary prevention is providing support groups for people who have recently
experienced traumatic event.
A.3 Tertiary Prevention

Tertiary Prevention is for people already diagnosed as having an illness. Tertiary prevention is aimed at
reducing the impairment that has resulted from a given disorder or event. This is achieved through
rehabilitation and re-socialization. For example, behavioral therapy for a hyperactive child may help him
or her become more attentive in school and more accepted by other children despite the continuing
problems associated with the condition.
Counseling or group therapy after a traumatic event such as injury and permanent paralysis from an
automobile accident may provide the social supports that edu e a pe so s ul e a ilit to the added
stress of coping with new disability. Rehabilitation of those who have committed crimes is another
important area of tertiary prevention. Often offenders serve a prison sentence and are discharged back
into the community without either adequate skills of impulse – control or the practical skills to get a job.
The same difficult transitional situation is often faced by people who have been hospitalized for a
schizophrenic disorder and later discharged directly into the community without any further attention
or support.
Prevention measures have been developed in many cases in which biophysical factors are known to
cause maladaptive behavior. However, the effects of detrimental social factor have frequently been
ignored or neglected. It is much easier to detect and control the effects of an enzyme deficiency in
newborn infants than it is to detect and control the pervasive influence of poverty and racism. But
ignoring these causes and correlates of maladaptive behavior will not decrease their influence.
When prevention methods are successful, risk factors that lead to abnormal behavior are reduced or
eliminate. In general, priority in efforts to achieve prevention is given to serious conditions that have
high rates of incidence, and for which effective methods are available.
A.4 Approaches to Prevention

A.4.1 Situation – Focused, Competency – Focused Prevention
Prevention can be approached from two perspectives. Situation – Focused prevention is aimed at
reducing or eliminating the environmental causes of disordered behavior, while competency – focused
prevention is o e ed ith e ha i g people s a ilit to ope ith o ditio s that ight lead to
maladaptive behaviors. Situation – focused approaches seek to change the environment, for example,
by making it less stressful. Competency – fo used app oa hes seek to st e gthe people s opi g skills
so as to make them more resistant should various types of stress arousing situations arise.
Either of these approaches might be applied to divorce, an example of stressful situation that often
leads to maladaptive behavior. Early educational programmes illustrate a competency focused
p e e tio . The t ai i g the p o ides i og iti e a d so ial skills fa ilitates the hild s early school
adjustment and may also have positive long – term effects.
A.4.2 Sites of Prevention

1. The Family: - The family is an important focus for prevention efforts. Parents affect their
hild e s de elop e t f o the o e t of o eptio , th ough the ge es the o t i ute,
the parental environment, and the physical and psychological environment in which the
children grow up. Parenting practices that have been linked to aggressive behavior in children
include failure of supervision or monitoring aggressive or abusive behavior, over
permissiveness, inconsistency and rejection. Parental conflict and divorce are also areas where
interventions at any of the three prevention levels can be helpful to the entire family. Child
abuse and spouse abuse are other examples of harmful behaviors that can be treated by
intervention at all levels of prevention. For some other types of problems parents can be
trained to act as therapists toward their children.
2. The School: - Many family problems, behavior problems, and problems associated with learning
are not identified until a child begins school. Special interventions by the class room teacher and
by school mental health workers can prevent many behavior disorders in children. Interventions
that st e gthe hild e s so ial a d og iti e skills a also help p e e t thei late d oppi g
out of school.
3. The Community: - Community agencies or organizations can provide satisfying experiences for
children that may help them develop positive interests and skills. They can bring children into
contact with caring adults as well as provide access to new ideas. Police officers play an
important role in prevention. They may serve as positive role models and if trained in
prevention techniques, may help deter family violence by defusing confrontation. Crisis and
suicide prevention centres can lower suicide rates and reduce social isolation. Suicide
postvention programmes are designed to help those who knew the person who died. They are
usually presented in organizational settings to help those who knew and worked with the
suicide victim, deal with feelings of guilt and anger and to decrease the chances of additional
suicide.
A.5 WHO PROVIDE PREVENTIVE CURE?

Prevention of maladaptive behavior and providing appropriate therapeutic responses when it does
occur have implications for our basic social institutions as well as for specific programmes for groups or
treatment with individuals.
 Para-professionals: - Paraprofessionals, who do not themselves have specialized mental health

training but who are similar in cultural background to those to be served often make important
contributions to prevention and treatment.
 Self – help groups: - Self – help groups made up of people with a common problem can be
helpful to many people who experience stress or loss.
 Community Psychologists: - Community psychology is concerned with the role of social systems
and community environment in prevention.
A.5.1 Treatment in the Community
An integrated network of community services can help prevent hospital read mission for the chronically
mentally ill. Communities also may prevent institutionalization by making adequate treatment facilities
and housing such as group homes.
A.5.1.1 Problems with Community Programs

Community programs need to provide integrated treatment and support services as well as more
continuity in service delivery for those who have chronic problems with maladaptive behavior.
A.5.1.2 Improving Treatment in the Community

A variety of treatment programmes can offer alternatives to full time residential hospitalization. These
include partial hospitalization through day hospitals or dormitory inns. Once patients are discharged
from the hospital half – way houses an adequate case management system can be important in keeping
them out of the hospital. Although deinstitutionalization has helped to empty hospitals of long – term
patients the lack of funding of alternative programs has resulted in an increased frequency of
readmissions of patients of hospitals for short term stays. Treatment programs of all types should offer
support for family members as well as patient and recognize the importance of families in treatment.
For example, prevention efforts have been directed at one of the most serious and prevalent
maladaptive behaviors of childhood, juvenile delinquency.
B. Organising of services for rehabilitation of physically, mentally and
socially challenged persons
B.1 Rehabilitation of Elderly
Population ageing is a global issue, which has been recognized to have implications on the health care
and social welfare systems. The process whereby the proportion of children in the population decreases
a d those of old pe so s i eases is k o as the agei g of populatio . The glo al populatio of
elderly has constantly been increasing during the second half of the last century. This has been possible
due to easy availability of life saving drugs, control of famines, and various communicable diseases,
better awareness and supply of nutrition and health facilities and comparatively better overall standard
of living. These achievements have resulted in drastic reduction in mortality rates and substantial
increase in the life expectancy at birth and the overall span of people. This phenomenon has been
experienced by developed countries in the mid of 20th century. During the last thirty years, this has
been emerging as a significant problem in developing countries also.
The number of people 60 years and over in the globe is 673 million in 2005 and is expected to increase
to 2 billion by 2050, almost a triple increase and the first quarter of 21st century is going to be called as
The age of agei g . Mo e de eloped egio s ha e al ost o e-fifth of their population over 60 years but
8 per cent in the less developed regions. And the share of older persons living in these countries is
expected to rise from 64 per cent to nearly 80 per cent in 2050.
India, like many other developing countries in the world, is presently witnessing rapid ageing of its
population. According to World Population Prospects, UN Revision, 2006, the population of aged in
I dia is u e tl the se o d la gest i the o ld. E e though the p opo tio of I dia s elde l is s all
compared with that of developed countries, the absolute number of elderly population is on the high.
There has been tremendous increase in the number of elderly population since independence in India
from 20.19 million in 1951 (5.5 per cent of total population) to 43.17 million in 1981 and 55 million in
1991. According to 2001 census around 77 million population is above 60 years which constitutes 7.5
per cent of the total population of the country. This number is expected to increase to 177.4 million in
2025. (The growth rate of the population (1991-2001) of elderly has been higher (2.89) than overall
growth rate (2.02) of the total population. According to World Population Data Sheet- 2002, 4 per cent
of the Indian population are in the age group of 65+ which accounts for 41.9 million. This phenomenon
of growing population of senior citizens has been the result of recent successes in the achievement of
better health standards and a longer span of life for our citizens. Due to this dependency ratio for the
old had risen from 10.5 per cent in 1961 to 11.8 per cent in 1991; it is projected to be 16.1per cent by
2021.
Defining the Concept
Ageing is a continuous, irreversible, universal process, which starts from conception till the death of an
i di idual. Ho e e , the age at hi h o e s p odu ti e o t i utio de li es a d o e te ds to e
economically dependent can probably be treated as the onset of the aged stage of life. Old age is the
last phase of hu a life le, hi h is agai u i e sall t ue. The use of the o ds elde l , olde
pe so s , a d se io itize s , i oth popula and scholarly work gives the impression that they are a
homogenous group, but in fact there is considerable variation between and among various categories of
older people and also between societies. As such it is difficult to provide a clear definition. Different
writers have viewed ageing in different contexts as the outcome of biological, demographic,
sociological, psychological or other processes.
The WHO defines those aged 60 -74 years as elderly. In 1980 the UN recommended 60 years as the age
of transition for the elderly segment of the population, and has been categorized as follows:
1. Young Old- between the ages of 60-75 years.
2. Old-Old- between the ages of 75-85 years.
3. Very Old- 85 years and above
World Population Data Sheet- 2002 considers aged population as population in the age group of 65+ as
old. In the Indian context, the age of 60 years has been adopted by the census of India for the purpose
of classifying a person as old, which coincides with the age of retirement in government sector. The
terms Young-Old for 60 to 69, Old-Old for 70 to 79 and Oldest Old for 80 to 89 have been used.
Changing Social Structure and Institutions
Indian society is undergoing rapid transformation under the impact of industrialization, urbanization,
technical and technological change, education and globalization. Consequently, the traditional values
and institutions are in the process of erosion and adaptation, resulting in the weakening of
intergenerational ties that were the hallmark of the traditional family. Industrialization has replaced the
simple family production units by the mass production and the factory. Economic transactions are now
between individuals. Individual jobs and earnings give rise to income differentials within the family.
Push factors such as population pressure and pull factors such as wider economic opportunities and
modern communication cause young people to migrate especially from rural to urban areas.
With the rapidly increasing number of aged compounded by disintegration of joint families and ever
increasing influence of modernization and new life styles, the care of elderly has emerged as an
important issue in India. Providing care for the aged has never been a problem in India where a value
based joint family system was dominant. However, with a growing trend towards nuclear family set-up,
and increasing education, urbanization and industrialization, the vulnerability of elderly is rapidly
increasing. The coping capacities of the younger and elder family members are now being challenged
under various circumstances resulting in neglect and abuse of elderly in many ways, both within the
family and outside.
Sociologically, ageing marks a form of transition from one set of social roles to another, and such roles
are difficult. Among all role transformation in the course of ageing, the shift into the new role of the
old is o e of the ost o ple a d o pli ated. I a ag i ultu e ased t aditio al so iet , he e
hild e follo ed thei pa e t s o upatio , it as atu al that the e pe tise and knowledge of each
generation were passed on to the next, thus affording older persons a useful role in society. However,
this is no longer true in modern society, in which improved education, rapid technical change and new
forms of organization have often rendered obsolete the knowledge, experience and wisdom of older
persons. Once they retire, elderly people find that their children are not seeking advice from them
anymore, and society has not much use for them. This realization often results in feeling of loss of
status, worthlessness and loneliness. The growth of nuclear families has also meant a need for changes
in role relations. Neither having authority in the family, nor being needed, they feel frustrated and
depressed. If the older person is economically dependent on the children, the problem is likely to
become even worse.
Nuclear households, characterized by individuality, independence, and desire for privacy are gradually
replacing the joint family, which emphasizes the family as a unit and demands deference to age and
authority. Children who migrate often find it difficult to cope with city life and elect to leave their old
parents in the village, causing problems of loneliness and lack of care givers for old parents. Parents in
this circumstance cannot always count on financial support from their children and may have to take
care of themselves. They continue to work, although at a reduced pace.
Another development impacting negatively on the status of older people is the increasing occurrence of
dual career families. Female participation in economic activity either as workers or as entrepreneurs has
increased considerably in the recent past in the urban informal sector, and the middle class formal
sector, as well as in the rural areas. In the rural informal sectors, increased expenditure on education,
health and better food require high incomes. This development has implications for elderly care. On the
one hand, working couples find the presence of old parents emotionally bonding and of great help in
the caring for their own children. On the other hand, high costs of housing and health care are making it
harder for children to have parents live with them. This is true both in rural and urban areas.
Hence the changing factors in the family in its structure and function are undermining the capacity of
the family to provide support to elderly and the weakening of the traditional norms underlying such
suppo t leadi g to egle t a d a use of olde people i fa il .
B.1.1 Characteristics of old age

1. Failing Health and Physical Strength
It has ee said that e sta t d i g the da e a e o . The agi g p o ess is s o ous ith faili g
health. While death in young people in countries such as India is mainly due to infectious diseases, older
people are mostly vulnerable to non-communicable diseases. Failing health due to advancing age is
complicated by non-availability to good quality, age-sensitive, health care for a large proportion of older
persons in the country. In addition, poor accessibility and reach, lack of information and knowledge
and/or high costs of disease management make reasonable elder care beyond the reach of older
persons, especially those who are poor and disadvantaged.
To address the issue of failing health, it is of prime importance that good quality health care be made
available and accessible to the elderly in an age-sensitive manner. Health services should address
preventive measures keeping in mind the diseases that affect – or are likely to affect – the communities
in a particular geographical region. In addition, effective care and support is required for those elderly
suffering from various diseases through primary, secondary and tertiary health care systems. The cost
(to the affected elderly individual or family) of health has to be addressed so that no person is denied
necessary health care for financial reasons. Rehabilitation, community or home based disability support
and end-of-life care should also be provided where needed, in a holistic manner, to effectively address
the issue to failing health among the elderly.
2. Diminishing financial strength (economic einsecurity)
The problem of economic insecurity is faced by the elderly when they are unable to sustain themselves
financially. Many older persons either lack the opportunity and/or the capacity to be as productive as
they were. Increasing competition from younger people, individual, family and societal mind sets,
chronic malnutrition and slowing physical and mental faculties, limited access to resources and lack of
awareness of their rights and entitlements play significant roles in reducing the ability of the elderly to
remain financially productive, and thereby, independent.
Economic security is as relevant for the elderly as it is for those of any other age group. Those who are
unable to generate an adequate income should be facilitated to do so. As far as possible, elderly who
are capable, should be encouraged, and if necessary, supported to be engaged in some economically
productive manner. Others who are incapable of supporting themselves should be provided with partial
or full social welfare grants that at least provide for their basic needs. Families and communities may be
encouraged to support the elderly living with them through counseling and local self-governance.
3. Coping with loss of spouse

4. Coming to terms with Death
B.2 Likely Psychological problems of Old age

1. Emotional alienation (Isolation)
Isolation, or a deep sense of loneliness, is a common complaint of many elderly is the feeling of being
isolated. While there are a few who impose it on themselves, isolation is most often imposed
purposefully or inadvertently by the families and/or communities where the elderly live. Isolation is a
terrible feeling that, if not addressed, leads to tragic deterioration of the quality of life.
It is important that the elderly feel included in the goings-on around them, both in the family as well as
in society. Those involved in elder care, especially NGOs in the field, can play a significant role in
facilitating this through counseling of the individual, of families, sensitization of community leaders and
group awareness or group counseling sessions. Activities centered on older persons that involve their
time and skills help to inculcate a feeling of inclusion. Some of these could also be directly useful for the
families and the communities.
2. Neglect
The elderly, especially those who are weak and/or dependent, require physical, mental and emotional
care and support. When this is not provided, they suffer from neglect, a problem that occurs when a
person is left uncared for and that is often linked with isolation. Changing lifestyles and values,
demanding jobs, distractions such as television, a shift to nuclear family structures and redefined
priorities have led to increased neglect of the elderly by families and communities. This is worsened as
the elderly are less likely to demand attention than those of other age groups.
The best way to address neglect of the elderly is to counsel families, sensitise community leaders and
address the issue at all levels in different forums, including the print and audio-visual media. Schools
and work places offer opportunities where younger generations can be addressed in groups.
Government and non-government agencies need to take this issue up seriously at all these levels. In
extreme situations, legal action and rehabilitation may be required to reduce or prevent the serious
consequences of the problem.
3. Abuse
The elderly are highly vulnerable to abuse, where a person is willfully or inadvertently harmed, usually
by someone who is part of the family or otherwise close to the victim. It is very important that steps be
taken, whenever and wherever possible, to protect people from abuse. Being relatively weak, elderly
are vulnerable to physical abuse. Their resources, including finances ones are also often misused. In
addition, the elderly may suffer from emotional and mental abuse for various reasons and in different
ways.
The best form of protection from abuse is to prevent it. This should be carried out through awareness
generation in families and in the communities. In most cases, abuse is carried out as a result of some
frustration and the felt need to inflict pain and misery on others. It is also done to emphasize authority.
Information and education of groups of people from younger generations is necessary to help prevent
abuse. The elderly should also be made aware of their rights in this regard.
Where necessary, legal action needs be taken against those who willfully abuse elders, combined with
counseling of such persons so as to rehabilitate them. Elderly who are abused also require to be
counseled, and if necessary rehabilitated to ensure that they are able to recover with minimum
negative impact.
4. Fear
Many older persons live in fear. Whether rational or irrational, this is a relevant problem face by the
elderly that needs to be carefully and effectively addressed.
Elderly who suffer from fear need to be reassured. Those for whom the fear is considered to be
irrational need to be counseled and, if necessary, may be treated as per their needs. In the case of those
with real or rational fear, the cause and its preventive measures needs to be identified followed by
appropriate action where and when possible.
5. Boredom (Idleness)
Boredom is a result of being poorly motivated to be useful or productive and occurs when a person is
unwilling or unable to do something meaningful with his/her time. The problem occurs due to forced
inactivity, withdrawal from responsibilities and lack of personal goals. A person who is not usefully
occupied tends to physically and mentally decline and this in turn has a negative emotional impact.
Most people who have reached the age of 60 years or more have previously led productive lives and
would have gained several skills during their life-time. Identifying these skills would be a relatively easy
task. Motivating them and enabling them to use these skills is a far more challenging process that
requires determination and consistent effort by dedicated people working in the same environment as
the affected elders.
Many elderly can be trained to carry out productive activities that would be useful to them or benefit
their families, communities or environment; activities that others would often be unable or unwilling to
do. Being meaningfully occupied, many of the elderly can be taught to keep boredom away. For others,
recreational activities can be devised and encouraged at little or no additional cost.
6. Lowered Self-esteem
Lowered self-esteem among older persons has a complex etiology that includes isolation, neglect,
reduced responsibilities and decrease in value or worth by one-self, family and/or the society.
To restore self-confidence, one needs to identify and address the cause and remove it. While isolation
and neglect have been discussed above, self-worth and value can be improved by encouraging the
elderly to take part in family and community activities, learning to use their skills, developing new ones
or otherwise keeping themselves productively occupied. In serious situations, individuals – and their
families – may require counseling and/or treatment.
7. Loss of Control
This problem of older persons has many facets. While self-realization and the reality of the situation is
acceptable to some, there are others for whom life becomes insecure when they begin to lose control
of their resources – physical strength, body systems, finances (income), social or designated status and
decision making powers.
Early intervention, through education and awareness generation, is needed to prevent a negative
feeling to inevitable loss of control. It is also important for society – and individuals – to learn to respect
people for what they are instead of who they are and how much they are worth. When the feeling is
severe, individuals and their families may be counseled to deal with this. Improving the health of the
elderly through various levels of health care can also help to improve control. Finally, motivating the
elderly to use their skills and training them to be productive will help gain respect and appreciation.
8. Lack of Preparedness for Old Age
A la ge u e of people e te old age ith little, o o, a a e ess of hat this e tails. While
demographically, we acknowledge that a person is considered to be old when (s)he attains the age of 60
years, there is no such clear indicator available to the individual. For each person, there is a turning
poi t afte hi h s he feels ph siologi all o fu tio all old . This e e t ould take pla e at a age
before or after the age of 60. Unfortunately, in India, there is almost no formal awareness program –
even at higher level institutions or organizations – for people to prepare for old age. For the vast
majority of people, old age sets in quietly, but suddenly, and few are prepared to deal with its issues.
Most people living busy lives during the young and middle age periods may prefer to turn away from,
and not consider, the possible realities of their own impending old age.
The majority of Indians are unaware of the rights and entitlements of older persons.
The problem of not being prepared for old age can only be prevented. Awareness generation through
the work place is a good beginning with HR departments taking an active role in preparing employees to
face retirement and facing old age issues. For the majority who have unregulated occupations and for
those who are self-employed, including farmers, awareness can be generated through the media and
also through government offices and by NGOs in the field. Older people who have faced and addressed
these issues a e e uited to add ess g oups at a ious fo u s to help people p epa e fo , o ope
with, old age.
Other Psychological Problems
The common psychological problems that most of the older persons experience are : feeling of
powerlessness, feeling of inferiority, depression, uselessness, isolation and reduced competence. These
problems along with social disabilities like widowhood, societal prejudice and segregation aggravate the
frustration of elderly people. Studies report that conditions of poverty, childlessness, disability, in-law
conflicts and changing values were some of the major causes for elder abuse.
B.2.1 Government’s Role in the Rehabilitation of Aged

Since independence the Indian government has been committed to supporting the old people in our
society with certain interventionist welfare methods. The year 1999 was declared by the UN as the
International Year of Older Persons followed on 13th Jan 1999, by the Government of India approving
the National Policy for Older Persons for accelerating welfare measures and empowering the elderly in
ways beneficial to them. Maintenance and Welfare of Parents and Senior Citizens Act, 2007 provides
legal sanctions to the rights of the elderly. In addition constitutional provisions for old age security, old
age pension, establishing old age homes, expanding geriatric services, liberalizing housing policy for
elders have also been undertaken.
Social security benefits
In the context of changing intergenerational relationships, economic dependence on children is a major
factor determining the quality of life of elderly. As such, social security by the state assumes great
importance. Unfortunately, at present, there is very little in terms of social security from the state in
India. Only those who work in the public sector or for large private companies have benefits such as
pensions and provident funds. However, for the most of the 90 per cent of elderly persons who work in
the informal sector, there are scarcely any benefits. The only available benefits for the poor are:
a. The National Old age Pension of 75 rupees per month, which is universal but available only to
destitute people over the age of 65 years.
b. Various state schemes, with benefits ranging between Rs.60 to Rs. 250 per month, meant
generally for people aged 65+ and below the poverty line, and
c. Benefits for widows, with benefits below Rs. 150 per month.
With the constantly increasing cost of health care and housing, these benefits fall far short of supporting
even minimal basic needs. The right of parents without any means of their own to be supported by their
children has been recognized by section 125(I) (d) of the Code of Criminal Procedure 1973, and section
20 (3) of the Hindu Adaptation and Maintenance Act, 1956. More recently, in 1996, the Government of
the state of Hi a hal P adesh passed the Pa e ts Mai te a e Bill e ui i g hild e to take a e of
parents with no means and to provide assistance to those neglected by their children. The Governments
of Maharashtra, Goa and others are in the process of passing similar bills.
Role of Old Age Homes as care givers
The concept of the old age home, though not very common in India, is not unknown. The first old age
home was established in Bangalore in 1983 by the Bangalore Friends-in Need society and was called the
o Ho e . A o di g to Help Age I dia esti ates, the e a e i stitutio s at p ese t, pe haps a
majority of them in urban areas. Kerala has the largest number of old age homes. More than 60 per cent
of the old age homes in India are of the charitable type, meant for destitute or very poor persons. About
pe e t of the a e of the pa a d sta t pe a d a othe pe e t a e i ed. A out 5 pe e t
of the homes were for women exclusively. In recent years, there has been rapid increase in the number
of old age homes and they are gradually gaining acceptance, especially by those who see these
i stitutio s as a ette alte ati e tha li i g i a so s ho e he e ou a e ot a ted. The e is a
debate going on i I dia at p ese t a o g se io s o ga izatio s, o go e e tal o ga izatio s a d
others about whether this growth should be allowed, supported or curbed. There is a strong feeling that
proliferation of old-age homes would make it easier for children to shirk their responsibility for taking
care of their aging parents by placing them in institutions. Increasing institutionalization of elderly
people would lead to erosion of the desirable traditional family values and may even lead to the
breakup of the institution of family itself. While this is the possibility in view of decline in traditional filial
obligations among children and lack of an adequate social security safety net, there is also need for
various types of institutions to accommodate the increasing number of elderly parents whose children
are unable or unwilling to care for their parents.
I spite of the go e e t s a d NGO s effo ts i eha ilitati g the aged i I dia the a e still the ost
vulnerable group facing multiple problems and hence require proper care and attention. Ageing is a
atu al p o ess. Old age is a i u a le disease . But o e e e tl J.S. Ross o e ted, You do eed
old age, ou p ote t it, ou p o ote it, a d ou e te d it . A a is as old as he feels a d o a as old
as she looks. Hence there is need for proper care and protection for the elderly in the changing
scenario. Following suggestions may go a long way in changing the life of elderly in India:
1. Efforts should be made to strengthen the family care, because the preferred source of support
for the aged is still the family - informal system where the notion of care is embedded within a
tradition of social obligations that are understood and reciprocated. The reciprocal care and
support within multi-generational families of parents, grandparents and children should be
encouraged. Traditional values of filial obligations can also be reinforced in school curricula and
through the media.
2. The Institutional care must be able to enhance relationships within families that incorporate
oth ou g a d old pe so s. The e is a eed fo effe ti e legislatio fo pa e ts ight to e
cared for by the children.
3. The existing health care systems are not sufficient to meet the physical and health needs of the
ageing population such as old age security, establishing old age homes, expanding geriatric
services and liberalizing the welfare policy for older persons. It is necessary to increase public
awareness of the need for protection of this sub group. There is a great need to protect the
target group i.e. rural old, and old women, and widows.
4. There is also need for the elderly to remain active, to know that they still have a part to play in
the family or community to which they belong and can make a useful co contribution to nation
and society as a whole.
B.3 How to help elderly?

1. Providing material help:
Through social security programs like pensions, medical insurance, separate counters etc.
Article 41 of the Directive Principles of State Policy in the Indian Constitution, specifies that the
State shall, within the limits of economic capacity, provide for assistance to the elderly. The
National Policy on Older Persons, recently announced by the Government of India (Government
of India, 1999)mandates State support for the elderly with regard to health care, shelter and
welfare. Social security has been made the concurrent responsibility of the Central and State
Governments. The policy recognizes that older persons could render useful services in the
family and in the society. However, it emphasizes that employment in income generating
activities after super- annuation should be the choice of the individual.
Section 125 of the Criminal procedure Code, 1973, specifies the rights of parents without any
means for maintenance to be supported by their children having sufficient means. If any person
refuses or neglects to maintain their parents a magistrate may order such a person to make a
monthly allowance for the maintenance of his/ her mother or father at a monthly rate not
exceeding Rs.500 (Natarajan, 2000). Government Pension scheme has become the most sought
after income security scheme. The policy seeks to ensure that the settlement of pension,
provident fund, gratuity, and other retirement benefits is made promptly. It is also proposed to
set up a Welfare fund for the old age persons.
Regarding health care for the elderly, the goal of the policy is to provide affordable health
ervices. In this process it envisages to have the cooperative efforts of the public health services,
private health services and private medical care. Development of health insurance is also being
given high priority.
Mobile health services, special camps, and ambulance services are being thought of, for making
the health care facilities to reach the elderly.
2. Management of emotional tie with family:
At any age, the family provides the indivi dual the emotional, social, and economic support. The
ability of the aged persons to cope with the changes in health, income, social activities, etc. at
the older ages, depends to a great extent on the support the person gets from his/ her family
members. This support, it may be said, is more culturally based rather than development
dependent. For instance, in India, the cultural values emphasize that the elderly members of the
fa il e t eated ith ho o a d espe t
JOINT FAMILY IS MORE THAN STAY ING TOGETHER: The Indian Family (One for all and all for
One) Joint families are like microcosms of an entire world. They are the first training grounds,
where people learn interpersonal skills. People in joint families learn lessons of patience,
tolerance, cooperation and adjustment. They also learn what it means to take collective
responsibility. When young people live with senior members of the family from the time they
are born, they grow up appreciating, admiring and loving them. They also learn to adjust
because they realize that as younger people, they have the flexibility of adjusting and changing
whereas older people often get caught up in patterns of functioning.
India, like most other traditional, eastern societies is a collectivist society that emphasizes family
integrity, family loyalty, and family unity. More specifically, collectivism is reflected in the
readiness to cooperate with family members and extended kin on decisions affecting most
aspects of life, including career choice, mate selection, and marriage.
In India, families in the past adhered to a patriarchal ideology, followed the patrilineal rule of
descent, were patrilocal, had familialistic value orientations, and endorsed traditional gender
role preferences. The Indian family is considered strong, stable, close, resilient, and enduring
(Mullatti 1995). The traditional, ideal and desired family in India is the joint family. A joint family
includes kinsmen, and generally includes three to four living generations, including uncles,
aunts, nieces, nephews, and grandparents living together in the same household. It is a group
composed of a number of family units living in separate rooms of the same house. The family
supports the old; takes care of widows, never-married adults, and the disabled; assists during
periods of unemployment; and provides security and a sense of support and togetherness
(Chekki 1996; Sethi 1989). With the advent of urbanization and modernization, the modified
extended family has replaced the traditional joint family but in it also, many functional
extensions of the traditional joint family have been retained.
It is been seen that in old age, individuals cease to play certain roles. This role loss may be due
to death of a kinship member, retirement or resignation from associations. As a result of this ,
their role play is very much reduced and they start feeling lonely and isolated. But in Indian
context, one good factor is that the retired men and women have a whole new bunch of roles
to play. They still have their roots in the family. Developing connections with a younger
generation helps older adults to feel a greater sense of fulfillment. In fact , it is advantageous
for both the groups as on one hand it helps the elderly transfer whatever they have achieved
emotionally and socially in their entire life and on the other hand the kids gets multiple
perspectives on reality which makes them more socially adjusted.
The role of g a dpa e ts i hild e s li es is a ied. It is i pe ial at ti es, uted at othe s a d
goes underground whenever required but the entire time solid and absolutely dependable.
Grandparents often bridge the gap between parents and their children. Rebellious independent
children who are trying to find their feet are almost always at loggerheads with their parents.
The role of the grandparents can be very important here as they act as impartial judges and are
able to convey their feelings to both parties.
In the Indian culture many children see their best friends in there grandparents and can express
themselves without any fear of judgment and scolding from them. Such relationship between
grandparents and grandchildren in our culture helps in n number of ways. Some of which are:
 Provide an opportunity for both to learn new skills
 Give the child and the older adult a sense of purpose
 Help children to understand and later accept their own aging
 Invigorate and energize older adults
 Help reduce the likelihood of depression in the elderly
 Reduce the isolation of older adults
 Fill a void for children whose parents are working
 Help keep family stories and history alive
 Helping in inculcating family values
 Giving them company, advice, being supportive in parent-child relationships, helping
when they need it, and mediating any conflicts with the parents.
 Serve the function of friendship, companionship and solidarity.
 Explain them the importance of values like honestly, solidarity, togetherness, helping
behavior with the help of moral stories and by playing role models.
 Making them aware of all the rituals and cultural heritage of India and its past.
 Imbibing in them a sense of proud of being a part of such a diverse cultural heritage.
 Bringing them close to their land by reciting folk songs and telling its meaning and
importance in their lives.
 Try to bring in their interest in very small but very peaceful activities like planting
seeds, bird watching, walking on grass etc
 Grandchildren on the other hand try to make their grandparents more aware of the
recent technology and its usefulness.
Teaching about own values, culture and being in cooperation with others; all the more staying
with grandparents has given the Indian children a broader perspective of world around, the
changes which has happened in the culture and how to cope up with those changes by being
away from selfishness and close to harmony and love.
3. Councelling:
Ageing is an artefact of life. When wild animals become ill or maimed they die because they
can't feed themselves. In humans, where once a heart attack, stroke or organ failure
would probably have killed a person, to-day many of these conditions can be treated with the
possibility of extending life (Medical model of life). Sadly, often that extension of life has
debilitating consequences.
Along with all the physical pain and debilitating illness, there is also the mental pain and loss in
people's lives. Elderly people may feel worthless, inadequate, fearful, and vulnerable. There can
be many losses in their lives, such as family, friends, jobs, houses, and independence.
Whatever science comes up with over the next few decades in terms of further organ repair and
replacement, and however our diets are improved and we take more exercise and generally
look after our bodies, there will still be debilitating illness, depression, anxiety and loneliness to
deal with in old age. There is a fine line between living and existing, between quality and
quantity of life. And whether a person chooses to live with whatever life delivers them or
whether they choose (if possible) to end that life, there will be a need for counselling.
Olde people s ea tio s to e e ts a d situatio s a e o diffe e t to that of the est of the
population and their capacity to cope will vary from person to person.
4. Enhancing religious / spiritual connectivity:
Studies have identified that spiritual beliefs contribute to psychological well-being (PWB) in
older people. Dein and Stygall (1997) reviewed a number of studies that examine the use of
religion in coping with chronic illness. They concluded that, particularly among older people,
religion is effectively used as a coping strategy and can have positive effects on adjustment.
Empirical evidence is available in India and other countries to show a direct relation between
spirituality, stress and quality of life. Comprehensive research evidence shows that spiritual
beliefs and practices help many physical and mental illness, reducing both symptom severity
and relapse rate, speeding up and enhancing recovery, as well as rendering distress and
disability easier to endure. Spiritual care is a way of helping older people in their search for hope
and meaning, especially as they face issues of grief, loss and uncertainty.
5. Old age homes /community help for urban population
When senior citizens are unable to lead an independent life in their own homes, they may
require residential care facility. Residential care involves accommodation, ranging from
independent housing to shelteres housing schemes. In residential homes, the needs of the
elderly can be me by care assistants with relatively little training. Nursing care involves trained
nurses and is for individuals with more medical problems. Studies form Madurai (India have
shown that living in residential homes is not a barrier in social integration of elderly. Community
based interventions like community parks, places of religious worship etc. are important as
early interventions - as they improve the subjective well being and quality of life of the elderly.
These services also strive to give greater degree of functional ability and independence.
B.4 Rehabilitation for Alcoholism and drug addiction

WHO states Al oholi s a e those e essi e d i ke s hose depe de e upo al ohol has attai ed su h
a degree that it shows a noticeable mental disturbance or an interference with their physical and
mental health, their interpersonal relations and their smooth, social and economic functioning, or who
sho the p od o al sig s of su h de elop e ts .
The various classifications of Alcoholism are as follows: - To Kennedy, drinkers are classified as: (1)
Occasional (2) Social (3) Weekend (4) Spree (5) Plateau classes of drinkers and (6) Alcoholics – defined
as Skid – row type.
Although alcoholisms is not a new personal and social problem and has been reported in many cultures
for centuries,
Psychodynamics of Alcoholism: - As a es ape e ha is to d o the pai of life s f ust atio s o to

overcome a fear of being socially regressed, Chotlos and Deiter state.
The alcoholism may be regarded as a self – induced medicated escape from anxiety for whom
inebriation is an unhappy coincidence of tension reduction in society and the individual. However, the
investigators view the problem of drinking in terms of its disadvantageous consequences, personal and
social disintegration of family, work and other interactions.
Le e t s e ie of al oholis e plai s the diffi ulties i si ple e pla atio of al oholis a o g su h

varied cultures as those of Jews, Irish, Mexicians, American Indians, Japanese, Chinese and French.
Personal and social norms also function the peculiarly linked relations between alcoholism and sex
where a woman alcoholic in many ways differs from her male counterpart more so than appears to be
the case in many other psychological disorders and symptoms. Hilsh presents six dimensions along
which woman alcoholics appear to differ from men.
 First, from the onset of moderate social drinking, it usually takes far less time for a woman to
become an alcoholic.
 Second, although they may not consume as much as men, they tend to become more
intoxicated, more frequently, more quickly and in the final stages they become sicker alcoholics.
 Third, their psychosexual life appears to be more completely involved in alcoholism.
 Fourth, they sho ore acti g out a d i pulsi e li i g out of u derlyi g perso ality a d
institutional problems, when intoxicated, than men do. (Few women alcoholics behave much the
same drunk as when they are sober as is the case with many men alcoholics. Their intoxicated
behavior is not only different is the case with many men alcoholics. Their intoxicated behavior is
not only different and intra psychically more intense but much more devastating in effect).
 Fifthly, they not only make more suicidal attempts but actually more women alcoholics commit
suicide successfully.
 Sixth, if their alcoholism is checked they more frequently develop other serious
psychopathological states of symptoms so that they remain chronically ill.
A drunkard is the annoyance of mind, the trouble of civility, the spoil of property, the distraction of
atio alit , the eli i atio of hu a it a d the ele atio of utalit ., the o sta le s t ou le, his ife s
oe, his hild e s so o , his eigh ou s s off, his own shame and the courts criminal. In short, he is a
tub of will, a spirit of unrest, a thing below a beast and a monster of a man. Alcoholism may be a crime
in itself or may be directly related to violations of certain laws such as those prohibiting public
intoxication and drunken driving. Second, it may indirectly contribute to violations of other laws such as
those prohibiting murder, rape, assault and battery, vagrancy and non – support of family. Anyhow it
weakness inhibitions, breaks family ties, enhances the divorce rate, produces domestic discord, affects
individual efficiency, results in poverty, loosens social control, increases immorality, creates disrespect
for law and causes the crime wave.
Explaining Alcoholism: - since alcohol acts as a narcotic sedative or depressant, some individuals built
up a dependence on it in order to anesthetize their failures and frustrations, anxieties, and inferiority. It
is a source of pleasure and conviviality for at least half of the adult population. According to Woodman,
the e a e o ditio s i a pe so s e pe ie e ith al ohol hi h p odu e a addi tio : a a deg ee of
emotional arousal, with regard to drinking (b) the repeated occurrence of stress situations along with
drinking (c) taking in enough alcohol on such occasions so that a tension reducing effect is felt. In many
cultures people drink alcoholic beverages with food and they are expected to drink and to offer it on
occasions. But many consume alcohol to make them more sociable because it lowers inhibitions.
The psychoanalytic interpretation points out that alcoholism is an expression of oral – sadistic
tendencies, sexual frustrations of impotence, repressed homosexuality and self – destructive
tendencies. Psychiatry contemplates that alcoholism is psychogenic in origin and is a socio-pathic types
of personality disorder.
Chafetz and Demore identify three sets of factors which singly or jointly can lead to addictive drinking.
Alcoholism is the result of a disturbance and deprivation in early infantile relations accompanied by
related alteration in basic physiochemical responsiveness; The identification by the alcoholic with
significant figures in daily life who satisfy their need for personal power by use of alcohol, and a socio
cultural milieu that causes ambivalence, conflict and guilt at the end in the use of alcohol.
Stages in Alcoholism
1. Pre alcoholic phase: - In this phase, drinking is socially motivated, but in indulged in for the relief
which the drinker experiences by making him a prospective alcoholic. He seeks relief daily and requires
more and more alcohol for sedation. This phase usually takes place in a period of six months to two
years.
2. Prodromal Phase: - This lasts from six months to 4 or 5 years. This phase is characterized by:
 Blackouts (amnesia) and complete dependence on alcohol.

 Surreptitious drinking
 Preoccupation with alcohol
 Avoiding reference to drinking
 Guilt feeling about drinking
Gradually the alcoholic avoids references to alcohol in conversation and is increasingly subject to
blackouts. Moreover, this phase includes near physical collapse, mental remorse and self disgust. It
masks his real feeling towards himself and his role aspirations and also increases feelings of isolation.
3. Crucial phase: - During this phase the drinker loses control and gets drunken ones he starts. He finds
rationalization for his drinking to safeguard social pressures. He develops defensive behavior to
compensate for his loss of esteem. His behavior becomes markedly aggressive. He manifests persistent
remorse. He drops his friends and quits his job. His behavior becomes alcohol – targeted. He
reinterprets his interpersonal relationships. He pities himself and attempts geographic escape. His
family begins to withdraw from social contacts for fear of embarrassment. At this point he is almost a
slave to drink. He develops immeasurable resentments and alcoholic feelings.
4. Chronic phase: - During this phase, the alcoholic is subject to prolonged periods of intoxication. His
ethical judgment deteriorates his thinking becomes impaired, indefinable fears pain him. The tremors
develop, his psychomotor abilities become inhibited, his drinking takes on an obsessive character, his
powers of rationalization fail, he admits defeat, he generates vague religious desires, he drinks with
persons far below his social status. There will be an overwhelming compulsion to drink and he is quite
incapable of controlling his drinking. He now drinks to live and lives to drink. His behavior shows an
almost complete loss of time sense. The social function of alcohol has completely vanished and the
alcoholic has become desocialized.
Socio – Cultural factors related to Alcoholism: - Drinking patterns vary in terms of the beverages used,
the i u sta es u de hi h d i ki g takes pla e, the ti e, the a ou t a d the i di idual s o
attitude and that of others toward his drinking. All drinking patterns are learned just as any other
behavior is learned. There are no universal drinking patterns for average citizens. The knowledge, ideas,
norms and values involved in the use of alcoholic beverages, which have passed on from generation to
generation have maintained the continuity of an alcohol culture.
Drinking plays a significant role in everyday interpersonal affairs. Alcohol is used by many people to
celebrate national holidays such as Christmas, New Year, and to rejoice in victories, whether those of
war, the football field or the ballot box. The father may celebrate the birth of a child with a drink all
round. Promotions, anniversaries, special events of achievement by the family and close friends often
call for a drink. Businessmen may negotiate contracts over a few glasses and meeting an old friend is
often the occasion for a drink.
Even some Church ceremonies and the bereavement of death are accompanied by alcoholic beverages.
The custom of drinking together to symbolize common feeling and unity is almost universal in present
day culture. Thus embedded in the culture pattern is the notion that is alcohol is magic, which, in
sorrow or in joy, in elation or in depression, in rebellion, against the misery of travail and the restraints,
which helps at time the human spirit and permits it to soar into the heavens, unhampered by the ills of
the flesh.
Many problems drinkers are processed into it. They are encouraged by informal drinking groups to use
alcohol as a way to adjust to anxiety and difficulty arising from role and other conflicts in interpersonal
relations in social situation. Many drinking groups in society emphasize alcohol as a temporary solvent
for personal troubles. The sensitive person, who is attracted to such groups is essentially taught to lean
on alcohol. Then he is accepted by a friendly group. If he drinks excessively, he may lose his job, his
friends and his wife and even he may be arrested and placed in jail. He is involved in a circular process
whereby his excessive drinking creates additional problem for him which he can only face with the aid
of further excessive drinking. The condition of true alcoholism has been established.
Group associations and cultural factors, therefore, play an important part in determining who becomes
an excessive drinker and who does not. It modern society, group patterns of excessive drinking, of
companions, of social class, and of religious and ethnic groups is important.
Control, Treatment and Prevention of Alcoholism
As far as the treatment and prevention of alcoholism is concerned, there are various plans and
programs that might prove of value. Efforts to control consumption of alcoholic beverages may be
classified into 5 major groups.
1. Law enforcement and moral sanctions: - National prohibition as coercive instruments to eliminate
drinking.
2. Legal regulations: - With the intention of restricting the time and place of drinking and the availability
of liquor to particular age, sex and other socio – economic groups.
Various indoctrination methods of encourage moderation or abstinence.
3. An institutional – reorganization approach: - Introduce substitute forms of tension relief into the
social structure. At the most intensive level, alcoholism is traced to fundamental defects in the socio –
cultural arrangements to abolish unemployment, slums and dependency in the course of changing
fundamental values of society.
4. A variety of therapeutic approaches: - Generally therapy combines medicine and dugs, psychiatry,
psychology, social case work, and Alcoholics Anonymous in clinic.
There are four types of treatment and prevention of alcoholism:
(1)Aversion treatment (2) Education (3) Psychotherapy and counseling (4) Alcoholics Anonymous.
 Aversion Treatment: - An alcoholic is a patient in aversion treatment. The patient is given

something to make him vomit at the same time that he takes a drink. Thus an undersigned
nausea is conditioned along with the satisfaction of the craving for alcohol. But the method is
costly as it requires hospitalization. Moreover, the effect is not always lasting and treatment
must be repeated.
 Education: - Through education, people as well as alcoholics may be made to realize that (1)
alcoholics can be helped and are worth helping; (2) alcoholism is a disease called Alcohol
Dependence Syndrome; (3) alcoholism is a public health problem and therefore it is a public
responsibility. At present there is no effective proposal for prevention of alcoholism except
education. There should be governmental programmes on alcoholism which can help to co –
ordinate work in this area, furnish information to the public and develop treatment and
education programs. To carry out these education programmes, there should be trained staff,
hospitals, and sanatoria, medical specialists, Alcoholics Anonymous groups, etc. Through an
effe ti e edu atio p og a e, the al oholi s eha ilitatio a e e ha ed si e his
compulsive drinking is due to social rejection, ostracism and isolation stemming from
experiences of drinking of a non – compulsive nature.
 Psychotherapy and counseling: - Group psychotherapy is employed with alcoholics. It is usually

led by a professional person. In psychotherapy, the cure depends upon showing that the real
problem is not the craving for alcohol itself but a more deeply rooted emotional problem and
upon finding a solution for that deeper problem.
 Alcoholics Anonymous: - The most dramatic cure for alcoholism is Alcoholics Anonymous The
principle treatment involved is conversion, assisted by the visits and fellowship of ex –
alcoholics, who have been cured by the same route. In this, alcoholics must volunteer for
membership in Alcoholics Anonymous, indicating a desire to give up drinking. This change in
attitude is a major step toward abstinence.
Alcoholics, Anonymous groups have been used by courts, penal institutions, treatment clinics, and
physicians in conjunction with treatment of alcoholics. Alcoholics Anonymous, a fellowship group of
compulsive drinkers has a single purpose to help alcoholics remain sober.
The only requirement for membership for AA is a desire to stop drinking. Over the past 45 years,
thousands of alcoholics have achieved sobriety by rigidly following the AA way of living outlined in 12
steps and by their willingness to guide their lives in accordance with the AA programme.
Twelve Steps of Alcoholics Anonymous:-
1. We admitted, we were powerless over alcohol and that our lives had become unmanageable.
2. Came to believe that a power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understand him.
4. Made a searching and fearless and moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible except when to do so would injure them
or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we
understand Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to
alcoholics and to practice these principles in all our affairs.
B.4.1 Drug Addiction

Our whole life and thinking is centered around drugs in one form or other, the getting and using and
finding ways and means to get more. We use to live and live to use. Very simply, an addict is a man or
woman, whose life is controlled by drugs. Lawrence Kolb states, a d ug that is regularly taken to
p odu e u usual e tal ea tio s athe tha fo a spe ifi edi al eed is a addi ti g d ug .
Many such drugs exist. Some are stimulants and some are depressants. All can be harmful when ued for
non – medical purposes. The stimulants by increasing physical and mental perception bring the addict
into more intimate contact with the environment and give him an increased sense of power. The
depressants on the other hand by decreasing physical perception or the acuity of certain mental
processes enable the addict to escape innate difficulties and disagreeable features or situations of the
environment. Drug addiction accounts for the largest number of deaths only to be surpassed by two
other major illnesses.
Psychology of Addiction: - The following factors should be considered:
1. Under preoccupation with the drug.
2. Increasing the quantity of the drug to the get the same effects.
3. Impairment in social and economic functioning.
4. Development of physical dependence.
5. Development of psychological dependence.
6. Impairment of physical or psychological health
B.4.2 Theories of Drug addiction

1. Biochemical – psychological theories:
There are many who give up drugs by themselves.
If a person is addicted to one, he should stick to the same addictive drug. But in reality many drug
abusers have used more than and drug. To explain this, one has to put forth the theory of multiple –
biochemical deficit systems paralleling each other or even interacting with one another. This theory
puts the blame on the biochemical deficit and pre – disposition; hence, takes away the blame from the
patient. If one accepts this theory one sees the drug abusers as a sick person who is having a monkey on
his back which he has to rid himself of with a little help form us. If one rejects this theory then the drug
user may feel that he has the monkey plus society on his back which he finds difficulty o tackle at the
same time.
2. Psychological Theory: - Freud, who advocated the theory of infantile sexuality, suggested that drug
addicts have their personality development fixated at the oral level or the individual regresses to an oral
level of psychological development. This theory was postulated when the predominant drug abuse was
only alcohol. This theory suffers from certain defects. Again, being an oral personality these persons
could find pleasure in alternatives like eating, love making, talking, playing, etc. One should realize that
F eud s theo as postulated, when drugs like L.S.D. and amphetamines which are purely pleasure –
giving substances were not in use. If one accepts this theory, one has to resort to psycho – analysis as a
a of t eat e t a d Ei stei o se es, the g oups ho ould i ediatel benefit from this theory
are the couch – ake s i e e o u it .
3. Nutritional theories
 Wasterfield – Reduced intake of food leads to increased intake of drugs or alcohol.

 Mardones – Deficiency of Vitamin B leads to addiction.
 Williams – Need for rapid source of energy makes a person increase his intake of drugs or
alcohol.
4. Environmental Theories
 Retreat or Flight: - Negroes in Harlem, retreat into drug use when they recognize that there is
little likelihood of their actually escaping from the negative impact of their environment
This theory assumes:
Poverty and drug availability generally lead, more often than not, to drug abuse.
Horton believes that in a society, basic security and anxiety have a direct bearing on the
prevalence of drug abuse.
This is resorted to when other forms of retreat such as change of place, job environment, etc.,
which provide psychological mechanisms of withdrawal are not available.
 Cultural and Ethnic factors: - Addiction is low among Jews and Chinese, high among the Irish.
This patterns is maintained for a few generations even if these ethnic groups migrate to another
country like America. After the first few generations, the drug habit becomes the same as that
of the country of domicile.
Addiction as a Syndrome of Psychiatric illness: - It may be the symptom of major psychiatric illness like
 Schizophrenia or manic depressive illness, etc.
 Anxiety neurosis or neurotic depression, etc.
Under these circumstances, the alcoholisms is called symptomatic. Abnormal personality is a cause of
alcoholism
1. Reactive alcoholic person – Depressive personality – Depressive stress – Alcohol – Deepening of

Depression – Increased intake of Alcohol.
2. Addictive alcoholic person becomes addict because of
 Inadequate Personality
 Antisocial Personality
Most of the alcoholics or drug abusers seem to be having normal personality though the last word has
not been said yet.
Perpetuation of Alcoholism or Addiction: Vicious Cycle
A. Pharmacological vicious cycle
Drugs – tolerance – increased intake of alcohol – physical dependence – withdrawal symptoms –

increased intake of drugs.
B. Cerebral vicious cycle
Drugs – cerebral tissue damage – disintegration of behavior – increased intake of drugs.
C. Psychological vicious cycle
Drugs – shame and guilt – increased intake of drugs to get rid of unpleasant feelings.
D. Social vicious cycle
Drugs – social rejection from the family and society.
Social isolation – increased intake of drugs.
Three major factors were listed as the main reasons for taking drugs by students themselves:
1. Pee g oup pleasu e it s the thi g to do .
2. Pleasure and
3. Curiosity
Specific risk factors associated with drug use included the following:
 Broken Family
 Unhappy family relationships
 Not practicing any religion
 Regular parental use of depressants – alcohols
 Parental use of one or more packets of cigarettes per day
 Poor academic achievement
 Low self – esteem
 Lack of ambition for the future
 Non – participation in extra – curricular activities
 Involvement in political or protest movements
 Drug use among friends
 Drug use among siblings
The continued use of an addicting drug, which leads to drug addiction, is a state of periodic or chronic
intoxication, detrimental to the individual and to society, produced the repeated consumption of a drug,
natural or synthetic. Its characteristic include: (1) an overpowering desire or need (compulsion) to
continue taking the drug ad to obtain it by any means: (2) a tendency to increase the dose; (3) a psychic
sometimes a physical dependence on the effects of the drug. The harm that the user suffers varies with
the degree of his personality disorder. Furthermore, one or more f the following related but distinct
conditions are always present.
1. Tolerance, which means that there is a gradual decreases in the effect produced by the
repeated administration of the drug, and the user must take progressively larger amounts to
secure the initial euphoric or analgesic effect.
2. Physical dependence results in abstinence illness when the drug is withheld.
3. Habituation or psychological dependence.
Counseling for drug addiction:
- Counseling is a deliberate effort to help a person in a rational way to sort out his problems, to clarify
the conflicts and issues in his life and to discuss the feasibilities of various courses of action. This is done
to enable the person to assume the responsibility of making choices. It requires knowledge and skill to
help the patient use available resources to improve his situation.
Counseling is conducted with the purpose of helping the patient to be more keenly aware of his
situation and to himself in relation to his situation, and where change is indicated to help him find
methods to bring about the change.
Counseling process
The counselor provides new information (problem classification and setting objectives) which leads the
patient –
 To change in new behavior, and
 To adopt new attitudes and values.
Ten plain principles to follow
 Understand who an addict is and what addiction is, its symptoms, etc.
 Addiction is a family illness, hence the entire family needs help and assistance never refer to an
addict as a drunk or a dope.
 In working with an addict confront him directly with the problem of addiction. Since addiction in
an illness, counselor should feel comfortable to talk to the patient about the abuse.
 The realities and values of addicts will be different from that of others. They may even be
distorted. Accept it as part of the distance.
 Ignore the past. Use the present for the future. Emphasize potential rather than performance.
 Approach an addict with compassion and understanding not with logic and argument.
 Establish short – term goals for recovery.
 Relapses an occur during the process of recovery. It is important that the understanding at this
juncture.
 Maintain confidentiality.
Motivation: - During the first contact with an addict, it is essential to find out to what extent he is open
to help a d hat ki d help, if a , he desi es. To dis o e the atu e of a addi t s oti atio the
following questions should be in the mind of the counselor as he listens and talks with the patient.
What does the drug addict see as his problem?
From his point of view, is his drug – taking a problem or a solution?
Does he feel that he needs help from others, if so what kind of help does he want?
Does he want someone to pacify his family, intervene with his boss or does he need help regarding his
financial problems?
Generally an addict has inadequate motivation, especially if he sees drug ac a solution, or if he wants
reforming and changing people around him, if he wants to avoid the consequences of his immature
behavior? For some addicts their motivation may be fixed. Tlety may be pulled in opposite direction by
inner forces. A part of their mind want to stop but another part drives them to continue taking drugs.
At times the pain of taking drugs and the fear of the probable consequences of continuing the drug
outweighs the craving for the drug. When this happens, the addict hirs the bottom or become open to
help. A hangover period following a binge may p ese t hitti g the otto , a state of e otio al
e epti it du i g hi h the addi t s defe se agai st e og izi g his eed fo life a e te po a il
cracked by the physicians along with emotional pain which he had experienced. In the case of resistant
addicts two principles can be followed:
Avoid doing anything which would destroy the possibility of developing a helpful relationship at some
later time. Preachings, sermons, and pleadings should be avoided.
Attempt to sow seeds of understanding of the person and of addiction, which may take root and
eventually help the addict to open up to help.
You a t help a addi t u til he is ead . It is a da ge ous half – truth. The danger is that the
counselor will use it to avoid his responsibility which is to dis o e , sti ulate, o ilize the addi t s
latent motivation towards accepting help.
Initial contact: - When an addict meets a counselor for the first time, he may not admit himself as an
addict. It is not necessary to discuss whether the person is an addict or only an occasional user of drugs.
The most important issues is whether he is satisfied with his life, the way it has been going for the past
years and whether drugs affected his life in any way.
Most of the addi ts ha e a oti a le a ea hi h is a sensitive area where he feels hurt or is aware
that he needs help. It would be something he is worried about or afraid of, angered or frustrated about.
When the hurt areas are discovered by encouraging the addict to talk about his drug abuse – what he
takes, with whom, how he feels, what happens after talking the drug etc. Early in counseling, the addict
is defensive. He may be much more concerned about his drug abuse, than he admits to the counselor at
this point. But if the counselor resists the temptation to put too much pressure on him, he may
gradually reveal more of truth as the relationship grows stronger.
Here are some o the factors, which causes the addict to avoid facing his need for help. His fear of the
pain of abstinence, his fear of not belonging to drinking or drug – taking group, which he enjoys; his
feeli g that the d ug is all that o ks fo hi , the lo to his self – esteem on admitting loss of control,
his fear of recognizing that he has a socially unacceptable condition, his fear of what it might do to his
education, family or social relations to be identified as an addict. It is important that these inner barriers
to admitting his need for help be discussed with understanding the empathy by the counselor.
Listening: - Listening is the most important technical tool needed by counselor. Listening requires
supp essi g o e s u ge to i te upt, eassu e o ask a se ies of i fo atio al uestio s. Liste i g i
depth means listening with the third ear of being sensitive to the feelings behind the words and the
subtle message communicated in food, posture, and facial expression. Intensive listening allows the
counselor to begin to sense how the addict feels about himself, others and his problems. He begins to
see how life looks through his eyes. Listening and responding with warm understanding serves to
esta lish the fi st sta ds of the i te pe so al idge alled appo t o e hi h the ou seli g p o ess
moves back and forth.
Denial: - A major obstacle to long – term recovery in the addict is a defense mechanism. It is a
psychological mechanism, which operates unconsciously. Facing the reality of addiction can be very
threatening to an addict and this is the main cause for denial. Many addicts have rationalized their
behavior for so long that they have developed an almost reflex action of defensiveness when challenged
about the addiction. The label of immorality attached to addiction also makes addicts not to accept
their drug problems.
A simple denial
The act of refusing to acknowledge that addiction to drugs is creating social, psychological and
emotional problems.
Minimizing
The act of minimizing either the extent of drinking or the nature of problems caused by it.
Diversion
The act of blaming the family or situation for their addiction.
Blaming
The act of blaming the family or situation for their addiction.
Emotional Blackmail: - The act of utilizing the emotions such as hostility to avoid dealing with the
problem of addiction.
Early confrontation with deniers is most ill – advised.
Initial goal in counseling deniers is to have a contract with clients to return to the treatment institution.
Discuss drug use during initial meetings in an unthreatening manner.
A e the e e e ti es he it is diffi ult fo ou to ha dle d ugs?
Ha e ou e e thought of utti g do d ugs?/
Ha e do ou thi k ou life ight ha ge if ou uit usi g d ugs?
Let s e a i e h ou pa e t is so upset a out ou d ug a use .
Confrontation should be done only after a comfortable relationship is established with the patient and it
should be done in a low key manner.
A crisis related to drug abuse or even a hangover may serve as a lead to confrontation. Employing a
supportive and non – judge e tal app oa h, the ou selo ight sa , I guess e a e goi g to ha e to
take a lose look at ou d ug a use .
Relapse: - the addict may avoid the counselor after a ship because of his guilt feelings. Under such
circumstances, It may be wise for the counselor to take the initiative in re – establishing contact. This
helps the addict to understand that the counselor is not judging him or is angry with him because he
had a slip. The ou selo s espo se to esu ed d ug use should o espo d to the severity of the
relapse – a brief relapse should be taken in a low – ke , s patheti a e , ot as I told ou so
attitude. A major resumption of drug consumption should be tackled more seriously.
Counseling should be firm that patient must avoid situations which in the past have elicited use of
drugs.
Analyse feelings of stress that have evoked drug use in the past.
Signs like irritability, pre – occupation, etc which lead to slips, when noticed, should warn of an
upcoming slip and necessary precautions should be taken.
Missed appointments or not attending AA meetings from an otherwise regular person is also a warning
signal. Patient being drugged at the time of counseling – if the patient is passive, send him back with an
appointment for another day.
Avoid references, to their inappropriate behavior as it is likely that they may become unmanageable.
Show a sympathetic attitudes till he leaves.
B.5 Treatment for Substance Induced Disorder

Treatment for alcohol dependence begins with detoxification, d i g out , hi h is a o pa ied
physical symptoms of withdrawal. Specific types of drugs have been developed to ease the withdrawal
symptoms. A community approach is used by Alcoholics Anonymous, an organization dedicated to
helping alcoholics become abstinent and rehabilitate themselves through mutual social support.
Individual psychotherapy does not tend to be helpful for alcoholics, but family therapy may be useful to
restructure relationships after drinking has stopped. Learning approaches include aversive conditioning
and covert sensitization have been used to help people stop drinking. In the cognitive approach,
drinkers are taught to monitor their behavior and determine the types of situations that are likely to
tempt them to drink. Relapse-prevention programmes help people gain effective coping responses to
prevent drinking. These programmes also help people cope with the abstinence - violence effect, the
guilt and self blame people feel when their coping lapses and they take one or more drinks. Some
researchers and therapists believe that some people who have a history of alcohol abuse can learn to
practice controlled drinking and use alcohol in moderation. Others believe that abstinence from all
alcohol is the only way to deal with problem drinkers.
Community level programmes regulating access to alcohol and penalizing driving after alcohol use may
e helpful. P e e tio p og a es that tea h ou g people a out al ohol s effe ts a d help the to
learn effective coping responses in situations where alcohol is served may be even more useful.
Development of effective prevention approaches can be facilitated by identification of risk factors for
over use of alcohol (for example, family conflict and neighbourhood disorganization)
B.6 Juvenile Delinquency

Juvenile delinquent is any young person whose conduct is characterized by antisocial behaviour that is
beyond parental control and subject to legal action.
It includes criminal behaviour, especially that carried out by a juvenile. Depending on the nation of
origin, a juvenile becomes an adult anywhere between the ages of 15 to 18, although the age is
sometimes lowered for murder and other serious crimes. Delinquency implies conduct that does not
conform to the legal or moral standards of society; it usually applies only to acts that, if performed by an
adult, would be termed criminal. It is thus distinguished from a status offense, a term applied in the
United States and other national legal systems to acts considered wrongful when committed by a
juvenile but not when committed by an adult.
In Western countries, delinquent behaviour is most common in the 14- to 15-year-old age group. At age
14, most delinquent conduct involves minor theft. By age 16 or 17, more violent and dangerous acts,
including assault and the use of a weapon, become prevalent. Most delinquents do not continue this
behaviour into their adult life, for, as the circumstances of their lives change and they get a job, marry,
or simply mature out of their turbulent adolescence, their conduct usually falls in line with societal
standards. Although the evidence is ambiguous, most delinquents adjust to a noncriminal life, yet the
proportion of delinquents who become criminals is higher than that of non-delinquents. In the United
States, boys make up 80 percent of the delinquent population, and this rate is similar throughout
Europe and Japan.
Schools are often the forum in which delinquent behaviour originates. Most delinquents perform poorly
in school and are unhappy in the school environment. Many delinquents are dropouts who leave school
at an early age but have no job opportunities. Juvenile gangs often perform delinquent acts, not solely
out of frustration with society but also out of a need to attain status within their group. A gang can
provide the rewards a juvenile cannot get from his school or other institution.
The te deli ue efe s to iolatio of the p o isio s of Child e s A t i States i I dia a d also the
provisions in the Indian Penal Code, by an individual between six and eighteen years of age. All the
States i I dia ha e Child e s A t a d i stitutio s deali g ith hild e ho iolate the p og a e of
the Acts, like reception Home or Remand Homes, Juvenile Courts, and Approved Schools. However the
state of Madhya Pradesh does ot ha e Child e s A t, ith the esult hild e a e t ied i adults Cou ts
and when they are punished, they are punished, they are sent to prisons along with adults.
The Mi ist of Ho e Affai s, Go e e t of I dia, pu lishes C i e i I dia a nually, which gives

statistics regarding delinquency and crime in India. The data for this publication are from the office of
the Di e to Ge e al of Poli e, i ea h State, hi h ai tai Resea h Cells to olle t i fo atio
regarding delinquency and crime in their territories. Since this the only source of data, we have no other
alternative except to quote the figures, reported in the publication to give an indication of rate of
delinquency or crime in India.
There has been a steady increase in the incidence of delinquency, Shanmugam has given figures from
1961 to 1974. He has shown that the percentage of juvenile crime to total crime increased from 2.58 to
3.41 in 1974. If we take into account the total population of the country which was 534.3 millions in
1970, the volume of juvenile crime per one lakh of population was 5.1, but in 1981 with population of
667.6 million, the volume has increased to 8.9 per lakh of population. The increase during the eleven
year – period from 1970 to 1981, namely 3.8 is considerable indeed. The percentage of juvenile crime to
adult critize also increased from 2.8 to 4.4 i.e., by 1.6 per cent.
B.6.1 Factors Contributing to Delinquency

Each year between 4.5 % of teenagers are referred to the courts for suspected offences other than
traffic violations. Delinquent behavior seems to have many causes, ranging from poor living conditions
to a psychopathic or antisocial personality disorder to psychosis. Some of the following conditions have
also been identified with delinquency.
 Poor physical and economic conditions in the home and neighbourhood
 Rejected or lack of security at home
 Exposure to antisocial role models within or outside the home, and antisocial pressures from
peer – group relationships
 Lack of support for achievement in school
 The expectations of hostility on the part of others
There are several factors, individually and collectively, contributing the delinquency. The factors may be
considered under genetic, physiological, psychological and social. These different factors interact in
different ways to contribute to delinquency. Among the genetic and physiological factors presence of an
extra chromosome, epilepsy and mental retardation are important. It is found, some epileptics are
prone to violent behavior because of lowered inhibiting controls in the brain. Children and youths with
epileptic tendencies are generally found to be hyperactive, impulsive and emotionally unstable and
when they are exposed to stress conditions, they are found to react violently.
 Socio – Economic and Cultural Factors: - Delinquency is found to be related to low socio –
economic status. This finding however, is being questioned. In the Indian context children and
youths belonging to high socio – economic families, though they commit offences do not find
their way to Approved Schools, because of the influential status of their parents in the society,
with the result all the studies of delinquents are confined to those who are housed in institution
and they were found to be from low socio – economic families. Barnes and Teaters reports a
study of college students through a questionnaire in which a list of behaviors from the Penal
Code violations of which people will be convicted, are given and the students were asked to
underline them. Of course usual procedure of asking the students not to mention their names
and asking them to drop the answered questionnaire in a box, was followed. The results of the
study indicate that 100 per cent of men and women students violate one or more of the
provisions in the Penal Code. They remained outside the prison, because they were not
apprehended by Police and tried in Court of Law.
 Sociopathic Delinquents: - Some delinquents are sociopaths. Sociopathy is found to have both
constitutional and socio – psychological factors. Sociopathy is found more among devidivists,
that is those who commit two or more offences within six months of their release, them among
first offenders. It is found that fathers of Sociopaths, more than mothers, are sociopaths. Some
of the sociopathic traits found in fathers of delinquents are alcoholism, anti – social attitude,
frequent and long absence from home, etc. There are cases of sexual relationships with
daughters. Sociopaths came into conflict with authority from early childhood, with the result,
they have poor school or work record.
 Psychological Factors: - Delinquents are found to have low intelligence as compared with non –
delinquents. Individuals with low intelligence are not able to understand social norms and
conform to them. They are also easily susceptible being easily lead by adult criminals. It is
reported that five per cent of delinquents are mentally retarded. There are also studies which
are not needed and they are also sex – deviants. The delinquent with high psychoticism, reveals
a long history of stress, with consequent emotional disturbance leading to violent outbursts.
Personality factors are reported to be related to delinquency. Gluek and Gluek studied boy build
of deli ue ts usi g Sheldo s theory of body types. Their results indicate predominance of
mesomorphy with endormorphy, with personality traits associated with those body types such
as hyperactivity, impulsiveness, pleasure and excitement seeking and outgoing nature. Using
E se k s theory of personality, there have been studies in UK and India, confirming his theory
of crime, namely that delinquents and criminals will be characterized by extraversion,
neuroticism, psychoticism and criminal propensity. He also found low – educational level of
parent, movie attendance, broken- home conditions and lack of emotional ties among the
e e s of deli ue t s fa il as i po ta t fa to s o t i uti g of deli ue , thus
supporting multifactor theory of delinquency.
B.6.2 Rehabilitation of Juvenile Delinquents

In the Indian context, there are only limited rehabilitative measures for delinquents. Immediately after
the a est of the ju e iles the poli e the a e housed te po a il i a Re eptio Ho e o a
Re a d Ho e , a es gi e to te po a shelters for the arrested juveniles indifferent States.
During the period of their stay in these homes, probation officers attached to them, interview the
juveniles, get in touch with their parents, through other probation officers in various districts, if the
juveniles come from outside the place of arrest. In cities like Chennai, Mumbai, Kolkata, and Delhi,
where there are Juvenile/Child Guidance Centres, the reports regarding physical and psychological
aspects of the juveniles are also available. With the available reports, the juvenile Court Magistrates,
who try the juveniles are also available. With the available reports, the juvenile Court Magistrates, who
try the juveniles recommend the juveniles to be sent back to their parents if parents are alive and are
willing to take the juveniles back home or to send them to one of the institutions, namely Junior
Approved School or Senior Approved School. The period of institutionalization of a juvenile ranges from
2 to 5 years. During this period the juveniles are made to study and also to learn a vocation. There are
Approved Schools which provide education up to Secondary School Stage, instruction being offered by
trained teachers as in ordinary schools. Some of the Approved Schools have services of psychologists
and part – time psychiatrists, though related to the number of inmates in the institutions, the number
of psychologists, and psychiatrists, is inadequate. The delinquents need individual study and
rehabilitation programme, in view of the fact, the factors contributing to delinquency in each case are
different. Most of the delinquents have a long history of delinquency, though officially, they may be first
or second offenders. For example, truancy from school and absenteeism from place of work is found to
be related to also cases of mildly retarded delinquents and psychopathic delinquents mixed up in the
institution. Both these kinds of delinquents, need to be dealt with by clinically trained psychologists. In
fact in countries like UK, there are special schools for these kinds of delinquents.
Juvenile delinquency can be approached at different levels of prevention. Primary prevention often
takes form of programmes aimed at improving living conditions and school achievements. Secondary
prevention programmes concentrated on young people who have shown early signs of delinquency. For
example, there might be a special intervention focused on helping youngsters who have committed
minor nonviolent offences such as theft or truancy behave less impulsively. At tertiary prevention level
individual and family therapy is undertaken.
Efforts have been made to identify potential delinquents at an early age in order to provide preventive
treatment. Such predictions of delinquency generally depend not only on the child's behaviour in school
but also on the quality of the child's home life. There are many elements that delinquents share in their
home lives. Their parents are frequently heavy drinkers who are involved in crime themselves and are
unable to provide emotional or financial support for their children. Discipline is inconsistent and often
relies on physical force. Most attempts to detect future delinquents have failed, however. Indeed, it has
been found that the stigma of being identified as a potential delinquent often causes the child to
commit delinquent acts.
It is the responsibility of the state to deal with delinquent offenders. Probation, the most commonly
used method of handling delinquents, is an arrangement whereby the delinquent is given a suspended
sentence and in return must live by a prescribed set of rules under the supervision of a probation
officer. Probation is most frequently granted to first offenders and delinquents charged with minor
offenses. Probation can be a mandate of law, or it can be left to the court's discretion. Probation
requires the delinquent to lead a moderate, productive lifestyle, with financial responsibilities. If these
requirements are not met, the delinquent may be placed in an institution. A delinquent will sometimes
be placed in the foster care of a stable family, as a final method of keeping a juvenile out of an
institution.
The treatment of delinquents on probation and in institutions ranges from a strict disciplinarian method
to a more psychological approach, centring on psychoanalysis and group therapy. The probation officer
must attempt to combine authority and compassion in the twin role of enforcer and social worker. This
makes the role of the probation officer extremely difficult, while the responsibilities are great. Despite
the problems of the probation system, studies have indicated that probation is effective in a majority of
all cases.
B.7 Rehabilitation of HIV/AIDS Victims

The year 2001 was the 20th anniversary of the initial reports of a mysterious deadly immune-system
disorder that came to be known as AIDS. The medical community, international AIDS organizations, and
especially the media saw the occasion as a time to reflect upon the relentless epidemic that had killed
more than 21 million people on every continent and from every walk of life. In 2001 an estimated 36
million people were living with HIV infection.
The long-held hope for an AIDS vaccine continued to be pursued. Although as many as 80 potential
vaccines had been tried in humans, only one had reached large-scale human trials. About 8,000
volunteers at high risk for HIV in North America, The Netherlands, and Thailand had received either an
experimental preventive vaccine developed by the California-based firm VaxGen or a placebo.
Periodically they were being tested for HIV. The trials would continue until 2002–03.
At the 8th Conference on Retroviruses and Opportunistic Infections, held in Chicago in February,
HIV/AIDS treatment specialists voiced a loud cry for newer and saferdrugs and pointed out that the
highly lauded combination-d ug the apies, also k o as AIDS d ug o ktails, e e ot o ki g fo
thousands of patients. Clinicians reported a range of adverse effects associated with the life-prolonging
drugs, including high cholesterol, diabetes, fat accumulations in the neck and abdomen, weakened
bones, and nerve damage in the extremities. Among the many experimental drugs that were described
at the conference, perhaps most promising was a new class called entry inhibitors, which blocked the
binding of HIV to key receptors on the cell surface.
Excitement about new treatments, however, had little relevance for the millions of people in less-
developed countries living with HIV, many of whom had no access totreatment. The high cost of existing
drugs and their unavailability to the vast majority of HIV/AIDS sufferers had aroused considerable ire
among government officials and others trying to combat AIDS in less-developed countries. To make
treatment more accessible, a handful of pharmaceutical companies in India, Thailand, and other
countries began producing cheaper generic versions of the patented agents used in drug cocktails, a
move vigorously opposed by the multinational companies holding the patents. As sentiments against
the drug giants mounted, however, several conceded to pressure and slashed their prices on AIDS drugs
for less-developed countries, and a few waived their patent rights. Some 39 major companies that
manufactured AIDS drugs had sued South Africa in 1998 in an effort to bar the country from importing
cheaper drugs. In April 2001 the companies dropped their case.
UN Secretary-General Kofi Annan called the battle against AIDS one of his personal priorities when he
initiated a global fund to allot between $7 billion and $10 billion annually to combat a trio of diseases
that continued to ravage the Third World—AIDS, tuberculosis, and malaria. Addressing the delegates to
the fi st UN su it o AIDS, held i Ne Yo k Cit i Ju e, A a said, This ea e ha e see a
turning point. AIDS can o lo ge do its deadl o k i the da k. The o ld has sta ted to ake up.
Chi a as o e ou t that oke up to its AIDS isis. I August its deput health i iste , Yi Dakui,
ad itted that the ou t as fa i g a e se ious epide i of HIV/AIDS a d that the go e e t
had ot effe ti el ste ed the epide i . A esti ated % of Chi a's ases e e a o g
intravenous drug users. The Chinese government claimed that about 600,000 citizens were infected
with HIV, whereas the UN estimated the number at more than one million.
In the U.S. the incidence of new HIV infections among homosexual African American men aged 23 to 29
as alled e plosi e. CDC su e s fou d that % of e i this g oup e e HIV-positive.
By name of acquired immunodeficiency syndrome it is a fatal transmissible disease of the immune

system caused by the human immunodeficiency virus (HIV). HIV slowly attacks and destroys the
immune system, the body's defense against infection, leaving an individual vulnerable to a variety of
other infections and certain malignancies that eventually cause death. AIDS is the final stage of HIV
infection, during which time fatal infections and cancers arise.
The emergence of AIDS
AIDS was first reported in 1981 by investigators in New York and California. Initially most cases of AIDS
in the United States were diagnosed in homosexual men, who contracted the virus primarily through
sexual contact, and in intravenous drug users, who became infected mainly by sharing contaminated
hypodermic needles. In 1983 French and American researchers isolated the causative agent, HIV, and by
1985 serological tests to detect the virus had been developed.
HIV/AIDS spread to epidemic proportions in the 1980s, particularly in Africa, where the disease may
have originated. Spread was likely facilitated by several factors, including increasing urbanization and
long-distance travel in Africa, international travel, changing sexual mores, and intravenous drug use. By
2002 AIDS had claimed over 25 million lives worldwide. Approximately 40 million people throughout the
world are infected with HIV. People living in sub-Saharan Africa account for more than 70 percent of all
infections, and in some countries of the region the prevalence of HIV infection of inhabitants exceeds 10
percent of the population. Rates of infection are lower in other parts of the world, but the epidemic is
spreading rapidly in eastern Europe, India, South and Southeast Asia, Latin America, and the Caribbean.
In China the government estimated that up to 850,000 people had contracted HIV by 2000—more than
half of them having acquired the virus since 1997. In the United States the incidence of HIV/AIDS has
stabilized at about 40,000 new infections per year. One-third of all new cases are women, for whom the
primary risk factor is heterosexual intercourse.
Transmission
HIV is transmitted by the direct transfer of bodily fluids, such as blood and blood products, semen and
other genital secretions, or breast milk, from an infected person to an uninfected person. The primary
means of transmission worldwide is heterosexual intercourse with an infected individual; the virus can
enter the body through the lining of the vagina, penis, rectum, or mouth. HIV frequently is spread
among intravenous drug users who share needles or syringes. Prior to the development of screening
procedures and heat-treating techniques that destroy HIV in blood products, transmission also occurred
through contaminated blood products; many people with hemophilia contracted HIV in this way. Today,
the risk of contracting HIV from a blood transfusion is extremely small. In rare cases transmission to
health care workers may occur by an accidental stick with a needle used to obtain blood from an
infected person. The virus also can be transmitted across the placenta or through the breast milk from
mother to infant; administration of antiretroviral medications to both the mother and infant around the
time of birthreduces the chance that the child will be infected with HIV. HIV is not spread by coughing,
sneezing, or casual contact (e.g., shaking hands). HIV is fragile and cannot survive long outside of the
body. Therefore, direct transfer of bodily fluids is required for transmission. Other sexually transmitted
diseases, such as syphilis, genital herpes, gonorrhea, and chlamydia, increase the risk of contracting HIV
through sexual contact, probably through the genital lesions that they cause.
AIDS is a zoonosis, an infection that is shared by humans and lower vertebrate animals. A virus that is
genetically similar to HIV has been found in chimpanzees in western equatorial Africa. Interestingly, this
virus, known as simian immunodeficiency virus (SIV), does not readily cause disease in chimpanzees.
The practice of hunting and butchering chimpanzees for meat may have allowed transmission of the
virus to humans, probably in the first half of the 20th century. A different form of SIV that infects African
green monkeys may have given rise to the virus called HIV-2. HIV-2 can cause AIDS, but it does so more
slowly than HIV-1. Worldwide, the most common human immunodeficiency virus is HIV-1. HIV-2 is
found mostly in western Africa.
HIV is transmitted by the direct transfer of bodily fluids, such as blood and blood products, semen and
other genital secretions, or breast milk, from an infected person to an uninfected person. The primary
means of transmission worldwide is heterosexual intercourse with an infected individual; the virus can
enter the body through the lining of the vagina, penis, rectum, or mouth. HIV frequently is spread
among intravenous drug users who share needles or syringes. Prior to the development of screening
procedures and heat-treating techniques that destroy HIV in blood products, transmission also occurred
through contaminated blood products; many people with hemophilia contracted HIV in this way. Today,
the risk of contracting HIV from a blood transfusion is extremely small. In rare cases transmission to
health care workers may occur by an accidental stick with a needle used to obtain blood from an
infected person. The virus also can be transmitted across the placenta or through the breast milk from
mother to infant; administration of antiretroviral medications to both the mother and infant around the
time of birth reduces the chance that the child will be infected with HIV. HIV is not spread by coughing,
sneezing, or casual contact (e.g., shaking hands). HIV is fragile and cannot survive long outside of the
body. Therefore, direct transfer of bodily fluids is required for transmission. Other sexually transmitted
diseases, such as syphilis, genital herpes, gonorrhea, and chlamydia, increase the risk of contracting HIV
through sexual contact, probably through the genital lesions that they cause.
Course of infection
The course of HIV infection involves three stages: primary HIV infection, the asymptomatic phase, and
AIDS. During the first stage the transmitted HIV replicates rapidly, and some persons may experience an
acute flulike illness that usually persists for one to two weeks. During this time a variety of symptoms
may occur, such as fever, enlarged lymph nodes, sore throat, muscle and joint pain, rash, and malaise.
Standard HIV tests, which measure antibodies to the virus, are initially negative because HIV antibodies
generally do not reach detectable levels in the blood until a few weeks after the onset of the acute
illness. As the immune response to the virus develops, the level of HIV in the blood decreases.
The second phase of HIV infection, the asymptomatic period, lasts an average of 10 years. During this
period the virus continues to replicate, and there is a slow decrease in the CD4 count (the number of
helper T cells). When the CD4 count falls to about 200 cells per microlitre of blood (in an uninfected
adult it is typically about 1,000 cells per microlitre), patients begin to experience opportunistic
infections, i.e., infections that arise only in individuals with a defective immune system. This is AIDS, the
final stage of HIV infection. The most common opportunistic infections are Pneumocystis carinii
pneumonia, tuberculosis, Mycobacterium avium infection, herpes simplex infection, bacterial
pneumonia, toxoplasmosis, and cytomegalovirus infection. In addition, patients can develop dementia
and certain cancers, including Kaposi sarcoma and lymphomas. Death ultimately results from the
relentless attack of opportunistic pathogens or from the body's inability to fight off malignancies.
A small proportion of individuals infected with HIV has survived longer than 10 years without developing
AIDS. It may be that such individuals mount a more vigorous immune response to the virus or that they
are infected with a weakened strain of the virus.
Diagnosis, treatment, and prevention
Tests for the disease check for antibodies to HIV, which appear from four weeks to six months after
exposure. The most common test for HIV is the enzyme-linked immunosorbent assay (ELISA). If the
result is positive, the test is repeated on the same blood sample. Another positive result is confirmed
using a more specific test such as the Western blot. A problem with ELISA is that it produces false
positive results in people who have been exposed to parasitic diseases such as malaria; this is
particularly troublesome in Africa, where both AIDS and malaria are rampant. Polymerase chain
reaction (PCR) tests, which screen for viral RNA and therefore allow detection of the virus after very
recent exposure, and Single Use Diagnostic Screening (SUDS) are other options. Because these tests are
very expensive, they are often out of reach for the majority of the population at risk for the disease.
Pharmaceutical companies are developing new tests that are less expensive and that do not need
refrigeration, allowing for a greater testing of the at-risk population around the world.
There is no cure or effective vaccine for HIV infection. Efforts at prevention have focused primarily on
changes in sexual behaviour such as the practice of abstinence and the use of condoms. Attempts to
reduce intravenous drug use and to discourage the sharing of needles have also led to a reduction in
infection rates in some areas. HIV infection is treated with three classes of antiretroviral medications.
Protease inhibitors, which inhibit the action of an HIV enzyme called protease, include ritonavir,
saquinivir, indinavir, amprenivir, nelfinavir, and lopinavir. Nucleoside reverse transcriptase (RT)
inhibitors (e.g., abacavir [ABC], zidovudine [AZT], zalcitabine [ddC], didanosine [ddI], stavudine [d4T],
and lamivudine [3TC]) and non-nucleoside RT inhibitors (e.g., efavirenz, delavirdine, and nevirapine)
both inhibit the action ofreverse transcriptase. Each drug has unique side effects, and, in addition,
treatment with combinations of these drugs leads to additional side effects including a fat-redistribution
condition called lipodystrophy.
Because HIV rapidly becomes resistant to any single antiretroviral drug, combination treatment is
necessary for effective suppression of the virus. Highly active antiretroviral therapy (HAART), a
combination of three or more RT and protease inhibitors, has resulted in a marked drop in the mortality
rate from HIV infection in the United States and other industrialized states since its introduction in
1996. Because of its high cost, HAART is generally not available in regions of the world hit hardest by the
AIDS epidemic. Although HAART does not appear to eradicate HIV, it largely halts viral replication,
thereby allowing the immune system to reconstitute itself. Levels of free virus in the blood become
undetectable; however, the virus is still present in reservoirs, the best-known of which is a latent
reservoir in a subset of helper T cells called resting memory T cells. The virus can persist in a latent state
in these cells, which have a long life span due to their role in allowing the immune system to respond
readily to previously encountered infections. These latently infected cells represent a major barrier to
curing the infection. Patients successfully treated with HAART no longer suffer from the AIDS-associated
conditions mentioned above, although severe side effects may accompany the treatment.Patients must
continue to take all of the drugs without missing doses in the prescribed combination or risk developing
a drug-resistant virus; viral replication resumes if HAART is discontinued.
Social, legal, and cultural aspects
As with any epidemic for which there is no cure, tragedy shadows the disease's advance. From wreaking
havoc on certain populations (such as the gay community in San Francisco in the 1980s) to infecting
more than one-third of adults in sub-Saharan African countries such as Botswana at the turn of the 21st
century, AIDS has had a devastating social impact. Its collateral cultural effect has been no less far-
reaching, sparking new research in medicine and complex legal debates, as well as intense competition
among scientists, pharmaceutical companies, and research institutions.
In order to raise public awareness, advocates began promoting the wearing of a loop of red ribbon to
indicate their concern. Activist groups lobbied governments for funding for education, research, and
treatment. Support groups provided a wide range of services including medical, nursing, and hospice
care, housing, psychological counseling, meals, and legal services. Victims were memorialized in the
more than 44,000 panels of the AIDS Memorial Quilt, which was displayed worldwide both to raise
funds and to emphasize the human dimension of the tragedy. The United Nations designated December
1st as World AIDS Day.
Regarding access to the latest medical treatments for AIDS, the determining factors tend often to be
geographic and economic. Simply put, developing nations often lack the means and funding to support
the advanced treatments available in industrialized countries. On the other hand, in many developed
countries specialized health care has caused the disease to be perceived as treatable or even
manageable. This perception has fostered a lax attitude toward HIV prevention (such as safe sex
practices or sterile needle distribution programs), which in turn has led to new increases in HIV infection
rates.
Because of the magnitude of the disease in Africa, and in sub-Saharan Africa in particular, the
governments of this region have tried to fight the disease in a variety of ways. Some countries have
made arrangements with multinational pharmaceutical companies to make HIV drugs available in Africa
at lower costs. Other countries, such as South Africa, have begun manufacturing these drugs themselves
instead of importing them. Plants indigenous to Africa are also being scrutinizedfor their usefulness in
developing various HIV treatments.
In the absence of financial resources to pay for new drug therapies, many African countries have found
education to be the best defense against the disease. In Uganda, for example, songs about the disease,
nationally distributed posters, and public awareness campaigns starting as early as kindergarten have all
helped to stem the spread of AIDS. Prostitutes in Senegal are licensed and regularly tested for HIV, and
the clergy, including Islamic religious leaders, work to inform the public about the disease. Other parts
of Africa, however, have seen little progress. For example, the practice of sexually violating very young
girls has developed among some HIV-positive African men because of the misguided belief that such
acts will somehow cure them of the disease. In the opinion of many, only better education can battle
the damaging stereotypes, misinformation, and disturbing practices associated with AIDS.
Laws concerning HIV and AIDS typically fall into four broad categories: mandatory reporting, mandatory
testing, laws against transmission, and immigration. The mandatory reporting of newly discovered HIV
infections is meant to encourage early treatment. Many countries, including Canada, Switzerland,
Denmark, and Germany, have enacted mandatory screening laws for HIV. Some countries, such as
Estonia, require mandatory testing of prison populations (in response to explosive rates of infection
among the incarcerated). Most of the United States requires some form of testing for convicted sex
offenders. Other legal and international issues concern the criminalization of knowing or unknowing
transmission (more prevalent in the United States and Canada) and the rights of HIV-positive individuals
to immigrate to or even enter foreign countries.
In the United States some communities have fought the opening of AIDS clinics or the right of HIV-
positive children to attend public schools. Several countries—notably Thailand, India, and Brazil—have
challenged international drug patent laws, arguing that the societal need for up-to-date treatments
supersedes the rights of pharmaceutical companies. At the start of the 21st century many Western
countries were also battling the reluctance of the Vatican, some Muslim nations, and other countries
such as China to single out homosexuals, prostitutes, and drug dealers for special attention out of fear
of appearing to condone their lifestyles.
For the world of art, HIV/AIDS has been double-edged. On the one hand, AIDS removed from the artistic
heritage of the late 20th century some of the most talented photographers, singers, actors, dancers,
and writers in the world. On the other hand, as with the tragedy of war and even the horror of the
Holocaust, AIDS has spurred moving works of art as well as inspiring stories of perseverance. From Paul
Monette's Love Alone, to John Corigliano's Symphony No. 1, to the courageousway U.S. tennis star
Arthur Ashe publicly lived his final days after acquiring AIDS from a blood transfusion—these, as much
as the staggering rates of infection, comprise the legacy of AIDS.
B.7.1 HIV AIDS in India

Prevention is the mainstay of the strategic response to HIV/AIDS in India as 99 percent population of the
country is uninfected. The HIV prevalence pattern in the remaining one percent population largely
determines the prevention and control strategy for the epidemic in the country.
Who is at risk?
The HIV prevalence trend in the country shows disproportionately higher incidence of the infection
among certain population groups. An analysis of Annual Sentinel Surveillance data (2003-2005) shows
that female sex workers (FSWs), men-who- have-sex-with-men (MSM) and injecting drug users (IDUs)
have disproportionately higher incidence of HIV infection. Whereas HIV prevalence in the general
population is 0.88 percent, its prevalence among FSWs is 8.44%, IDUs 10.16%, MSM 8.74% and among
the attendees of STD clinics it is 5.66%( see the table below). To gain control over HIV/AIDS spread in
the country therefore effective interventions are needed for HRGs.
HIV Prevalence among High Risk Groups
Site type Number of percent percent percent

Sites +ve 2003 +ve 2004 +ve 2005
2003-2005
Female Sex Workers 32 - 83 10.30 9.43 8.44
Injecting Drug Users 18 – 30 13.30 11.20 10.16
Men having Sex with Men 9 – 18 12.10 7.50 8.74
ANC population 266 – 267 0.87 0.89 0.88
STD population 163-175 5.61 5.55 5.66
86 percent Transmission through Sexual Route
E ide e also suggests that I dia s HIV/AIDS epide i is la gel due to u safe se o ke -client
interactions. About 86 percent HIV incidence in the country is from unprotected sex. Perinatal
transmission of the infection is 2.72 percent, whereas 2.57 percent HIV infection is due to transfusion of
infected blood or blood products. Though HIV transmission through injecting needles is only 1.97
percent of overall prevalence, it is the major route of the infection transmission in the north-east
region.
Epidemic in General Population
Through MSM and sex worker-client interactions the infection spreads to general population. As a
majority of men with MSM behaviour are married and a majority of sex worker clients are migrant
labours and truck drivers, they pose the risk of infecting their spouses and unborn children.
Targeted Interventions for Prevention, Care and Treatment
For the overall reduction in the epidemic, targeted interventions (TIs) are aimed to effect behaviour
change through awareness raising among the high risk groups and clients of sex workers or bridge
populations. These interventions are aimed to saturate three high risk groups with information on
prevention; address clients of sex workers with safe sex interventions, and build awareness among the
spouses of truckers and migrant workers, women aged 15 to 49 and children affected by HIV or
vulnerable population groups.
Apart from prevention of HIV infection, TIs facilitate prevention and treatment of sexually transmitted
diseases as they increase the risk of HIV infection, and are linked to care, support and treatment
services for HIV infected.
TIs Approach
Given the HRGs special vulnerabilities, prevention strategies include five elements — behaviour change,
treatment for sexually transmitted infections (STI), monitoring access to and utilisation of condoms,
ownership building and creating an enabling environment.
In fact impetus to enabling environment under NACP-III drives the prevention strategy. It encourages
peer led interventions by community based organisations or NGOs both in the rural and urban areas
and focuses on clients of sex workers, partners of MSM and IDUs. All TIs are rights based, they empower
the communities. NGOs/CBOs engaged in TIs are networked and linked to general healthcare facilities
to ensure that HRGs access them without stigma or discrimination; they are also linked to Community
Care Centres, Counselling and Testing Centres and ART centres. The prevention strategies are thus
linked to care and treatment, and empower the community against stigma and discrimination.
TIs for FSW
Targeted interventions among female sex workers bring awareness about health implications of unsafe
sex and HIV/AIDS issues. The TIs reduce sex workers vulnerability to STIs and HIV/AIDS through
promotion of:
· STI services
· Condom use
· Behaviour Change Communication (BCC) through peer and outreach
· Building enabling environment
· Ownership building in the community
· Linking prevention to HIV related care and support services
Specific TIs for IDUs
Apart from targeted interventions for general population, the following specific interventions
are provided to IDUs to reduce their vulnerability.
· Detoxification, de-addiction and rehabilitation
· Needle exchange
· Substitution therapy
· Abscess management and other health services
Specific TIs for MSM
· Use of lubricants and appropriate condoms
· Behaviour Change Communication (BCC) through peer and outreach
· Building enabling environment
· Linking prevention to HIV related care and support services
B.7.2 National AIDS Control Programme (NACP-IV)

I dia s AIDS Co t ol P og a e is globally acclaimed as a success story. The National AIDS Control
Programme (NACP), launched in 1992, is being implemented as a comprehensive programme for
prevention and control of HIV/ AIDS in India. Over time, the focus has shifted from raising awareness
to behaviour change, from a national response to a more decentralized response and to increasing
involvement of NGOs and networks of PLHIV.
Goals & Objectives:
 Objective 1: Reduce new infections by 50% (2007 Baseline of NACP III)

 Objective 2: Comprehensive care, support and treatment to all persons living with HIV/AIDS
Key Concerns and Challenges for NACP-IV
1. Need to consolidate successes gained, by sustaining prevention focus besides effectively

addressing the challenges
2. Given the experience of previous phases where the programme focused on saturating the
coverage, NACP- IV needs to advance towards focusing on ensuring higher quality of services
under interventions while sustaining the coverage.
3. Emerging Epidemics in certain low prevalence states and districts due to Migration to high
prevalence areas, that is increasingly being identified as an important factor driving the
epidemic in several north Indian districts, and epidemics related to IDU, MSM, Transgenders &
young sex workers
4. With increasing coverage of treatment and decreasing AIDS-related mortality, a significant
number of people are likely to require first and second line ART treatment during the 12th Plan
period. Major challenge for the programme will be to ensure that the treatment requirements
are fully met without sacrificing the needs of prevention
5. Regions with different maturity levels of the epidemic will require different resources and
services. Emerging epidemics in selected regions will need greater prevention focus while care
and support in the setting of matured epidemic, particularly management of 2nd line ART, will
need a robust management and financing strategy. These need to be mapped out.
6. International finances for HIV/AIDS programme are shrinking. NACP-III had less than 10% of
domestic budgetary support. NACP-IV will require a significantly greater element of domestic
budgetary support.
7. Integration with larger health system to ensure sustainability. Need to address the challenge of
competing priorities and varying capacities of health systems in different states to provide
access to quality HIV/AIDS services
8. Ensuring social protection schemes for people infected and affected with HIV/AIDS through
mainstreaming of HIV/AIDS with other ministries
9. Stigma and Discrimination that is still prevailing against the vulnerable population, persons and
families infected and affected with HIV, especially at work place, healthcare settings and
educational institutions.
10. NACP- IV has to address the need for innovation within all key programme strategies for
integration of services, quality assurance at all service delivery points, coverage saturation,
treatment adherence, data quality and use, etc.
B.7.3 Care and Support of People Living with HIV/AIDS

HIV infection is not the end of life. People can lead a healthy life for a long time with appropriate
medical care. Anti-retroviral therapy (ART) effectively suppresses replication, if taken at the right time.
Successful viral suppression restores the immune system and halts onset and progression of disease as
well as reduces chances of getting opportunistic infections – this is how ART is aimed to work.
Medication thus enhances both quality of life and longevity.
The care, support and treatment needs of HIV positive people vary with the stage of the infection. The
HIV infected person remains asymptomatic for the initial few years; it manifests by six to eight years. As
immunity falls over time the person becomes susceptible to various opportunistic infections (OIs). At
this stage, medical treatment and psycho-social support is needed. Access to prompt diagnosis and
treatment of OIs ensures that PLHAs live longer and have a better quality of life.
Under NACP–II, focus was given on low-cost care, support and treatment of common OIs. Apart from
further improving the availability, accessibility and affordability of ART treatment to the poor, NACP-III
plans to strengthen family and community care through psycho-social support to the individuals, more
particularly to the marginalised women and children affected by the epidemic, improve compliance of
the prescribed ART regimen, and address stigma and discrimination associated with the epidemic.
To achieve this objective, 350 Community Care Centres are planned to be set up during the programme
period (2007- 2012) in partnership with PLHA in high prevalence and moderate prevalence districts.
These centres will be established based on the epidemiological profile and PLHA load of the districts,
and linked to the nearest ART centre. The centres will provide counselling for drug adherence,
nutritional needs, treatment support, referral and outreach for follow up, social support and legal
services. State AIDS Prevention and Control Societies will ensure access of high risk groups to
community care centres through linkages between TIs and the centres.
By strengthening local responses, NACP–III seeks high levels of drug adherence (>95 percent) and
compliance of the prescribed ART regimen. This approach to care, support and treatment also creates
awareness about the prevention of HIV infection and, thus, is a very significant part of NACP–III in
a hie i g NACO s issio of o tai i g a d e e si g HIV/AIDS i ide e i I dia.
Care and Support for Children
Approximately 50,000 children below 15 years are infected by HIV every year. So far, care and support
response to these children was at a very minimal level. NACP–III plans to improve this through early
diagnosis and treatment of HIV exposed children; comprehensive guidelines on paediatric HIV care for
each level of the health system; special training to counsellors for counselling HIV positive children;
linkages with social sector programmes for accessing social support for infected children; outreach and
transportation subsidy to facilitate ART and follow up, nutritional, educational, recreational and skill
development support, and by establishing and enforcing minimum standards of care and protection in
institutional, foster care and community-based care systems.
B.7.4 Care and Support Centres (CSC):

The overall goal of Care, Support and Treatment (CST) component under NACP IV is to provide universal
access to comprehensive, equitable, stigma-free, quality care, support and treatment services to all
PLHIV using an integrated approach.
Based on the recommendation and priorities of NACP IV working group on care and support, the
strategy of implementation of the care and support is being completely revamped to ensure cost
effectiveness and sustainability. All care and support component of NACP III CCC, DIC & DLNs are
brought under one roof to provide community based care and support services.
Under NACP IV, Care & Support Centers (CSCs) are established and linked to ART centres with the goal
to improve the quality & survival of life of PLHIV. The CSCs serve as a comprehensive unit for treatment
support for retention, adherence, positive living, psychosocial support , referral, linkages to need-based
services, and providing an enabling environment for PLHIV. This will be part of the national response to
meet the needs of PLHIV, especially those from the high risk groups, and women and children infected
and affected by HIV. CSCs are run by civil society partners including District Level Networks (DLN) and
non-government organizations (NGOs).
Important Services Provided by Care and Support Centers:
Broadly, the following services are being provided by care and support Centres:
Counselling Services: counselling support is provided on a wide-range of issues (psycho-social support,

disclosure of HIV status, treatment education and adherence, positive living and positive prevention,
nutrition, sexual and reproductive health issues such as family planning and pregnancy, discordant
couples, home based care) through one-to-one counselling or couple/family counselling. Children and
adolescents living with HIV are also be provided counselling services on HIV status disclosure, ART
adherence, personal hygiene, eating healthy and hygienic food, coping with emotions etc. Counselling
services are available at the CSC through trained counsellors and messages are reinforced in the field
through outreach workers and peer counsellors.
Outreach services: These services include follow up of PLHIV for treatment adherence, repeat CD4
testing; tracking Lost to follow-up (LFU) & MIS cases, and motivating family members for HIV testing;
reinforcing counselling messages; and providing/facilitating home-based care.
Referrals and linkages: Another important service provided by the CSC is the establishment of linkages
and provision of referrals to various service providers in the area for addressing medical and non-
medical needs. The PLHIVs are also supported to access and avail social entitlements and social welfare
schemes.
Advocacy and communication: To create an enabling environment and access to services without
stigma and discrimination, CSC supports the PLHIV through various advocacy initiatives at local, state
and national levels. A discrimination response team is set up at the CSC level to respond to incidents of
denial of services reported in the area due to discrimination. Quarterly advocacy meetings with various
stakeholders and media advocacy events are planned to influence policy.
Support group meetings: Support group formation is aimed at providing a platform for PLHIV to share
their concerns and learn from each other. Regular support group meetings are organized and
information on various themes are provided to build skills of PLHIV to lead quality life.
Vocational Training and Life Skill Education: One of the important service of CSC is to provide life skill
education and vocational training to the clients with special emphasis on women and youth. Theoretical
aspects of life skills are incorporated into the ongoing educational and training components and the
vocational training is provided through linkages with vocational training institutes under government
departments as well as corporate sectors. The clients are also linked to various income generation
activities available in the area.
Training on Home Based Care Services: PLHIV and their care givers in the family are trained on basic
infection control practices at home, management of general ailments and minor infections at home, and
identification of signs and symptoms of health issues requiring immediate medical care. Clients are
provided with information about the nearest available health care facilities and importance of good
health seeking behaviour
B.8 Victims of violence

Violence comes in different shapes and sizes. Some of the forms of violence include:
1. Sexual violence
2. Communal violence
3. Caste based violence
4. Ethnic violence
5. Terrorism
6. Genocide
7. Human trafficking etc.
The victims in such cases could be a single individual or several individuals or a whole community.
Social and legal concept that, in the broadest sense, refers to any abuse that takes place among people
living in the same household, although the term is often used specifically to refer to assaults upon
women by their male partners. Estimated annual figures for the number of women in the United States
who are subjected to psychological, verbal, emotional, or physical abuse by a male partner range from
two to four million. Additional statistics indicate that domestic violence ranks as the leading cause of
injury to women from age 15 to 44 and that one-third of the American women murdered in any given
year are killed by current or former boyfriends or husbands.
Perpetrators of domestic violence come from all socioeconomic, cultural, and educational backgrounds.
The stresses of poverty contribute to violence and seem to make the problem more common among
those at the bottom of the class structure, but nonetheless most poor people are not violent. Being
reared in abusive circumstances makes men more likely to be abusers and women more likely to be
victims, but most children reared under these conditions are neither abusers nor victims. In a few cases
men are beaten by women, although rarely do men suffer serious physical injury.
Frequently there is no workable solution for female victims of domestic violence. For some victims the
unrelenting cycle of violence produces diminished self-esteem, helplessness, depression, and
exaggerated feelings of imprisonment, even the belief that they deserve abuse. More material obstacles
stand in the way of most victims. Many are financially dependent on their abusers, and, since many
abuse victims are mothers, they particularly fear being unable to support their children if they leave a
violent partner. Many fear reporting the crime because the police can offer no reliable protection
against men's retaliation. One of the worst problems is that typical abusers often become most violent
and vengeful precisely when women try to leave; numbers of women have been murdered by husbands
literally inside courthouses as they try to press charges or to win orders of protection.
In the early 1800s most legal systems implicitly accepted wife-beating as a husband's right, part of his
entitlement to control over the resources and services of his wife. Feminist agitation in the 1800s
produced a sea change in public opinion, and by the end of the 19th century most courts denied that
husbands had any ight to hastise thei i es. But fe o e had ealisti sou es of help, a d ost
police forces did nothing to protect women. The 1967 training manual for the InternationalAssociation
of Chiefs of Police stated that arrests in instances of domestic viole e e e to e ade o l as a last
eso t.
The revived women's movement of the 1970s brought the issue of domestic violence into the open.
Feminists encouraged battered women to speak up and to refuse to accept blame for their
victimization. Women's organizations pressured police to treat domestic violence as they would treat
any other assault, established battered women's shelters where victims and their children could find
safety, help, counseling, and legal advice. The increased visibility of these campaigns raised public
awareness of the issue and sympathy for victims. This sympathy has been reflected in courts' increased
willingness to convict abusers and to allow women who have killed their abusers to use a self-defense
plea when applicable. The antiviolence against women movement won some public funding for shelters
and led to the formation of national advocacy groups such as the National Coalition Against Domestic
Violence. In 1994 U.S. Congress passed the Violence Against Women Act, and in 1995 President Bill
Clinton established the Violence Against Women Office in the Department of Justice; this office
attempts to aid and coordinate the work of federal, state, and local agencies on the issue of domestic
violence.
CASE IN POINT: SEXUAL VIOLENCE
Sexual violence is a significant cause of physical and psychological harm and suffering for women and
children. Although sexual violence mostly affects women and girls, boys are also subject to child sexual
abuse. Adult men, especially in police custody or prisons may also be subject to sexual violence, as also
sexual minorities, especially the transgender community.
Sexual violence takes various forms and the perpetrators range from strangers to state agencies to
intimate partners; evidence shows that perpetrators are usually persons known to the survivor.
The World Health Organisation (WHO) defines Sexual Violence as "any sexual act, attempt to obtain a
sexual act, unwanted sexual comments/ advances and acts to traffic, or otherwise directed against a
person's sexuality, using coercion, threats of harm, or physical force, by any person regardless of
relationship to the victim in any setting, including but not limited to home and work." (WHO, 2003)
Sexual assault, a form of sexual violence, is a term often used synonymously with rape. However, sexual
assault could include anything from touching another person's body in a sexual way without the
person's consent to forced sexual intercourse --- oral and anal sexual acts, child molestation, fondling
and attempted rape. Forms of Sexual Violence include:
• Coerced/forced sex in marriage or live in relationships or dating relationships.

• Rape by strangers.
• Systematic rape during armed conflict, sexual slavery.
• Unwanted sexual advances or sexual harassment.
• Sexual abuse of children.
• Sexual abuse of people with mental and physical disabilities.
• Forced prostitution and trafficking for the purpose of sexual exploitation.
• Child and forced marriage.
• Denial of the right to use contraception or to adopt other measures to protect against
STIs.
• Forced abortion and forced sterilization.
• Female genital cutting.
• Inspections for virginity.
• Forced exposure to pornography.
• Forcibly disrobing and parading naked any person.
Health consequences of sexual violence
Sexual violence, in addition to being a violation of human rights, is an important public health issue as it
has several direct and indirect health consequences. Survivors of sexual violence may present to health
care services with varying signs and symptoms. For those survivors who do not reveal a history of sexual
violence, the following signs and symptoms should prompt one to suspect the possibility of sexual
abuse/assault:
Physical health consequences:
• Severe abdominal pain.

• Burning micturition.
• Sexual dysfunction.
• Dyspareunia.
• Menstrual disorders.
• Urinary tract infections.
• Unwanted pregnancy.
• Miscarriage of an existing fetus.
• Exposure to sexually transmitted infections (including HIV/AIDS).
• Pelvic inflammatory disease.
• Infertility.
• Unsafe abortion.
• Mutilated genitalia.
• Self-mutilation as a result of psychological trauma.
Psychological health consequences:
Short term psychological effects:
• Fear and shock.

• Physical and emotional pain.
• Intense self-disgust, powerlessness.
• Worthlessness.
• Apathy.
• Denial.
• Numbing.
• Withdrawal.
• An inability to function normally in their daily lives.
Long term psychological effects:
• Depression and chronic anxiety.

• Feelings of vulnerability.
• Loss of control/loss of self-esteem.
• Emotional distress.
• Impaired sense of self.
• Nightmares.
• Self-blame.
• Mistrust.
• Avoidance and post-traumatic stress disorder.
• Chronic mental disorders.
• Committing suicide or endangering their lives
Role of the health facility and components of comprehensive health care response
Health professionals play a dual role in responding to the survivors of sexual assault:
 The first is to provide the required medical treatment and psychological support.
 The second is to assist survivors in their medico- legal proceedings by collecting evidence and
ensuring a good quality documentation.
After making an assessment regarding the severity of sexual violence, the first responsibility of the
doctor is to provide medical treatment and attend to the survivor's needs. While doing so it is pertinent
to remember that the sites of treatment would also be examined for evidence collection later.
Clinical guidelines for responding to IPV and sexual assault, WHO, 2013:
Health-care providers should, as a minimum, offer first-line support when women disclose violence.
First Line support includes:
• Ensuring consultation is conducted in private.

• Ensuring confidentiality, while informing women of limits of confidentiality.
• being non-judgmental and supportive and validating what the woman is saying.
• providing practical care and support that responds to her concerns, but does not
intrude
• asking about her history of violence, listening carefully, but not pressuring her to talk
(care should be taken when discussing sensitive topics when interpreters are involved)
• helping her access information about resources, including legal and other services that
she might think helpful
• assisting her to increase safety for herself and her children, where needed
• providing or mobilizing social support- If doctors are unable to provide first-line
support, they should ensure that someone else at the health facility is available to do
so.
Role of family, friends and community :
Recovery from sexual violence is dependent on the extent of support received from family, friends and
community. Health professionals are best suited to engage with family and discuss ways of promoting
survivors' well-being. It must be discussed with all care givers that survivor should not be held
responsible for the assault. Judgments such as; she should have been a eful , she should have
esisted make the survivors journey to recovery more difficult.
The Ministry of Health and Family Welfare feels that sensitive handling can reduce self- blame and
enhance healing for survivors. It also recognizes the critical role of health professionals in their interface
with the police, CWCs and judiciary. Such inter-sectoral collaboration is essential to provide services and
deliver justice. The health system is committed to setting up services for survivors.
Usually the rehabilitation takes the following steps:
 Provide medical assistance to the person suffering from violence

 Provide psychological assistance to both victim and perpetrator of Violence, if required. Health
facilities can be instructed to handle all cases of Violence/suspected Gender Based Violence
compassionately and to encourage them to seek the help of psychologist/psychiatrist.
 Help the law enforcing agencies to bring to book the perpetrators of Violence by conducting the
necessary medico-legal examination. The assurance that the perpetrators are punished gives
some psychological relief to the victim.
 Provide compensations to victims
 Where the victims are vulnerable to further attacks/backlashes they are kept in safe houses.
 Attempt to reintegrate the victim with society
CASE IN POINT: VIOLENCE AGIANST WOMEN
Under the Legal Service Authority Act 1987, all women are entitled to free legal aid.
The Ministry of Women and Child Development (MWCD), has introduced a Centrally Sponsored Scheme
for setting up One Stop Centre (one Centre in every State/UT). The scheme aims at facilitating/providing
medical aid, police assistance, legal counseling/court case management, psycho-social counselling and
temporary shelter to women affected by violence for implementation during the remaining period of
12th Five Year Plan i.e. 2015-2016 and 2016-2017.
The compensation part of the rehabilitation of victims of violence including rape is governed by
provision of Section 357A of the Code of Criminal Procedure which states that every State Government
in co-ordination with the Central Government shall prepare a scheme for providing funds for the
purpose of compensation to the victim of crime including rape. As per section 326 A of the IPC, Criminal
Law Amendment Act 2013 apart from making punishment stringent, for acid attack, it provides for just
and reasonable fine to meet the medical expenses of the victim and this shall be paid to victim. The
amendment also provides that all the hospitals, public or private, have been mandated to provide free
medical treatment to all victims of acid attack and rape. The Ministry is implementing Ujjawala- a
Comprehensive Scheme for Prevention of Trafficking and Rescue, Rehabilitation, Re-Integration and
Repatriation of Victims of Trafficking for Commercial Sexual Exploitation.
The Ministry of Women and Child Development is also administering Swadhar and Short Stay Home
Schemes for relief and rehabilitation of women in difficult circumstances, including the victims of rape.
B.9 Problems of Rehabilitation in India

The most neglected invisible problem of the society in a developing country like India is the burden of
mental problem, its effects and its outcome in the coming years. The World Health Organisation has
warned that many countries will be unable to cope with a predicted boom in Mental Illness over the
e t de ade. A o di g to D . G o B u dtla d, the fo e head of WHO, If e do t deal ith Me tal
Illness, there is a burden not only on Mentally Ill, on their families, their communities, there is an
e o o i u de if e do t take a e of people ho eed ou a e a d t eat e t.
Few Facts
- In India over 125 million people suffer from Mental Illness.

- Prevalence rates have increased due to poverty, illiteracy, urbanization,
industrialization, discrimination, better diagnostic methods, increased
public awareness.
- After all drug treatment 33% of patients do not improve.
Shortage of Government funding: But even then the government had no other option but to allocate
funds on physical illness or disabilities like cancer, AIDS or any other problem than on Mental Illness.
Lack of economic resources along with lack of professionals in the field has made the scenario even
bleaker and worse. In India till date a person suffering from mental illness fails to receive any support
either from Government or from any organisation. Disability Card, which is issued for all other
disabilities except mental illness have remained a dream for us those who are living in West Bengal.
Even the support of Disability Commissioner in this issue failed to provide any needed solution.
Shortage of trained manpower: India is faced with acute shortage of qualified mental health
professionals; adversely affecting the implementation of Community based mental health services
(DMHP). To provide an impetus to the development of Manpower in Mental Health, Government of
India launched Manpower Development Scheme in 11th Five Year Plan. Manpower Development
Scheme has two sub schemes;
A. Development of Centres of Excellence in Mental Health

B. Scheme for Manpower Development in Mental Health popularly known as Scheme B.
The mental problem is an invisible problem and so people cannot feel it or visualize the impact of the
problem. Neither can they understand the impact it can create on the individual who is affected and his
family members. The society is apprehending them as a burden and not putting efforts to utilize their
potentialities or putting adequate efforts to change them again in to a productive member of the
society.
The problem with illness like Schizophrenia is even more. They often remain a burden to the society.
Some live their whole lives within the four walls of their dark room, remaining secluded and accepting a
sedentary lifestyle where they spend the day and night without doing any effective work. They live their
life on the mercy of other family members.
It is really difficult for the family members too, to make arrangement for a non-productive family
e e s food, lothi g, shelter and ever increasing cost of pharmaco-therapy. So these people, who
are suffering through no fault of t heir own, are sent to homes or government hospitals, which are even
worse than jails. Little attention is paid to their human rights, their feelings or their emotions –although
a large part of their problem centres on feelings and emotions. Some start believing that they are not
members of this world anymore – they are here by mistake or by chance not by choice. For some the
agony is unbearable and they comit suicide. – some dare not as they are too weak physically and
mentally to take a bold step like that.
To improve the quality of life of these persons rehabilitation centers are needed. These can provide
them with vocational training to give them hope: to work on bringing back motivation, to remove their
apathy and lack of drive and to make them capable to start earning.
It is seen that in urban populations the most important need for a person suffering from mental illness
like schizophrenia is work and economic independence. So vocational training has the possibility of
making them productive and is a method to reach more people.
B.9.1 General Suggestions for rehabilitation
Vocational training- People from both western & eastern world can overcome the burden of the disease
if they can successfully employ themselves in creative productive works. Even in India, where a person
gets too much support & does not need to earn money due to over protectiveness of parents, -the
prognosis & functional level remains below others who are actively participating in rehabilitation
process.
Selection of Vocational Training- Selection of Vocational training depends on the individual aptitude
ability & interest of the candidate. Often the parents who accompany the patient have a preconceived
idea a out thei hild s apa ilities. The ofte t to guide us & dis ou age us a out so e Vo atio al
training which they think cannot be suitable for their child. It has been seen so far that almost everyone
has some creative abilities and if this can be successfully utilized it can help them in the long run to
overcome their problems and help them towards becoming a productive member of society. They can
utilize skills learned to help them reduce their anxiety and in some cases to earn their livelihood.
A Few Simple Methods of Vocational training-

Collage works often help people to reduce their anger & aggression, water colours & works with plaster
of paris helps them to overcome compulsive tendencies in them.
To unfold the hidden capabilities of these person we always encourage them to explore their
capabilities starting from simple drawing, fabric works, glass painting, Block printing with vegetables,
colourful earthen pots, colourful earthen wall hangings, jute works, jute decorative folders, bead work,
bead ornaments, animals made of beads, mobile cover, embroidery etc.
Few Simple Techniques- At First we ask the clients to explore with colours & draw pictures. Within a few
eeks, e a thus ide tif the pe so s apa ilities in drawing, painting & fabric works. Those who
cannot draw or paint well or if they have trembling hands for which they do not have control over their
brush are asked to cut the vegetables like potatoes, ladies finger whichever is available in their home in
different shapes. They are then asked to clolour card/ file / clothes through the blocks developed by
them or their friends from these vegetables. This is the simplest & attractive training programme where
a client becomes active in a very short period of time. Other clients who are working for years together
then give the final touch to the handicraft products developed by them.
Fabric works- Fabric works can also be started with block printing. As we lack funds we cannot afford to
waste our clothes in the hands of person who are yet to gain control over their fabric works. For this
reason starting with their own old ganjee or clothes help to practice them without any wastage. They
too feel proud decorating their own clothes themselves. As they gain control we give them clothes to do
it. We often give strips of clothes where they do the fabric works, and then it is stitched to the ganjee or
shirt, which then looks attractive.
Glass Painting- This can be a very good handicraft product. To start with we often asked them to do
simple geometric figures & then proceed to more complex drawing patterns.
Earthen pots, wall hangings- This too is started with line drawing, or geometrical figures, which is later,
developed in to attractive drawings/paintings.
Handicrafts Works-This is started with Kantha stitch, stitching falls in a sari & then they learn other
stitches & make table cloths, table mats, napkins, Handkerchief, tea cosy trey clothes, salwar suits, saris
etc.
Marketing the products- Marketing the products is not very easy especially in India where handicraft
items are readily available. The success of this sort of rehabilitation programme for persons with mental
illness depends on the perseverance, the ability to motivate others, to make it a mental health
o e e t. If the pa e ts g oup akes it a p a ti e to u & o l u the p odu ts ade thei
hild e the it a e eas to get the i itial a ket. This e tai l does t ea that the ill u o l
the products made by their own child- but think of all suffers as their children & buy the products made
the . If this a e ade a o e e t like s adeshi o e e t de eloped Ga dhiji a e
developed. And if the parents, their family members & friends have feelings for the cause & can start
developing the habit of buying the products made by these persons with mental illness, then may be
one day we will be able to economically rehabilitate every one of them; may be we would be able to
change the world for them.
But we must be very rigid about the quality of the products, as no one should buy the products made by
them out of sympathy.
Computer- Computer training is suitable not only for the Western world but also for eastern world .We
are providing computer training for years together and all our clients are computer literate.
Computer often provides a tool for psycho education, social rehabilitation & economic rehabilitation
too. The person who comes to our center at first lacks the self-confidence and self-identity. They are not
sure about themselves. Writing their names on computer screens in different styles gives them the
pleasure to learn more. The knowledge of the Internet helps them to get proper psycho education
about their sufferings and possible solutions. This helps them to learn about their difficulties in a safe,
criticism-free environment.
As they generally lose control over their lives – gaining control over a machine like computer helps them
to gain confidence & desire to gain control over their lives. Computer training along with spoken English
classes often helps them to get some jobs in nearby areas. They can even do computer typing in small
computer institutes that have grown enormously in India or other developing countries.
The role of Parents in Vocational Training- Parents have a very important role to play in the
rehabilitation of persons suffering from mental illness. It has been seen that supportive parents who are
not overprotective can help their child to gain adequate confidence & functional level & on the other
hand too much overprotective parents creates a hindrance towards the growth & development of their
affected child.
Vocational training along with learning few basic life skills for their proper functioning like going to the
bank, depositing electricity bills, marketing the day to day products, taking a few responsibilities at
home, looking after their parents, helps to improve their functional level and make them self-
dependent. We also have some fixed responsibilities for all the clients at the centr: eg some setting the
mat on the floor; some distributing the tea, some selling the products during exhibition; elder clients
helping the younger ones to learn the training programmes. As we have to run the center without any
monetary support from government or any organisation we try to utilize the human resources of our
clients. This not only reduces the running cost but also helps to regain the lost confidence of our clients.
Social rehabilitation – This is the most important need for the people suffering from these disorders.
Whenever, any human being suffers from any disease or crisis it is human to want the support, the
comfort of family members, friends and community. This culture still now prevails in India – though
there is a breakdown of extended family, due to the impact of Western influence on Indian society – but
till now there is a huge difference between the lifestyle of Indians and that of the western world. Till
now people care for their family members; parents support their children till their death and siblings
take care of their affected family member. Till now the Rehabilitation centers run by the self-support
groups of India are more effective than those run by professionals. In this background where the
bondage of love and understanding is important, social rehabilitation of the sufferers is important.
Due to stigma, due to hopelessness, due to fear of rejection – the sufferers often try to avoid interacting
with the society. This creates a barrier. Self Support groups helps them to first get the social acceptance.
I a still lo ed & a ed so a g oup e e s help the to get the eeded suppo t & guida e.
It is really surprising to see how they help their fellow friends during the annual tours from our center.
A few important things for proper rehabilitation are developing the feeling of togetherness, the
o dage, the lo e, the fa il feeli g – that we all belong to the same family / community. This helps a
lot to overcome their deep-rooted insecurities & anxieties.
B.10 Manpower Development scheme under NMHP

Govt. of India Ministry of Health & Family Welfare : National Mental Health Program - Scheme for
Manpower Development in Mental Health (Scheme B)
India is faced with acute shortage of qualified mental health professionals; adversely affecting the
implementation of Community based mental health services (DMHP). To provide an impetus to the
development of Manpower in Mental Health, Government of India launched Manpower Development
Scheme in 11th Five Year Plan. Manpower Development Scheme has two sub schemes;
C. Development of Centres of Excellence in Mental Health
D. Scheme for Manpower Development in Mental Health popularly known as Scheme B.
11 Centres of Excellence have been established as targeted in the plan period. Therefore, in the current
plan period there is no scope to develop more Centres of excellences in the country.
Under scheme B the target was to develop manpower in the field of mental health by
establishing/strengthening :
 30 departments of Psychiatry
 30 departments of Clinical Psychology
 30 departments of Psychiatric Social Work and
 30 departments of Psychiatric Nursing in the country

7 - Rehabilitation Pscyhology

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Rehabilitation Psychology

Primary, secondary and tertiary prevention

A. Primary, Secondary & Tertiary prevention programmes - role of

A.1 Primary Prevention

A.2 Secondary Prevention

A.3 Tertiary Prevention

A.4 Approaches to Prevention

A.4.2 Sites of Prevention

A.5 WHO PROVIDE PREVENTIVE CURE?

 Para-professionals: - Paraprofessionals, who do not themselves have specialized mental health

A.5.1 Treatment in the Community

A.5.1.1 Problems with Community Programs

A.5.1.2 Improving Treatment in the Community

Defining the Concept

1. Young Old- between the ages of 60-75 years.

2. Old-Old- between the ages of 75-85 years.

3. Very Old- 85 years and above

Changing Social Structure and Institutions

B.1.1 Characteristics of old age

2. Diminishing financial strength (economic einsecurity)

3. Coping with loss of spouse

B.2 Likely Psychological problems of Old age

8. Lack of Preparedness for Old Age

Other Psychological Problems

B.2.1 Government’s Role in the Rehabilitation of Aged

Social security benefits

In the context of changing intergenerational relationships, economic dependence on children is a major

Role of Old Age Homes as care givers

B.3 How to help elderly?

B.4 Rehabilitation for Alcoholism and drug addiction

Psychodynamics of Alcoholism: - As a es ape e ha is to d o the pai of life s f ust atio s o to

Le e t s e ie of al oholis e plai s the diffi ulties i si ple e pla atio of al oholis a o g su h

 Blackouts (amnesia) and complete dependence on alcohol.

Control, Treatment and Prevention of Alcoholism

Various indoctrination methods of encourage moderation or abstinence.

There are four types of treatment and prevention of alcoholism:

 Aversion Treatment: - An alcoholic is a patient in aversion treatment. The patient is given

 Psychotherapy and counseling: - Group psychotherapy is employed with alcoholics. It is usually

Twelve Steps of Alcoholics Anonymous:-

B.4.1 Drug Addiction

Psychology of Addiction: - The following factors should be considered:

1. Under preoccupation with the drug.

3. Impairment in social and economic functioning.

4. Development of physical dependence.

5. Development of psychological dependence.

6. Impairment of physical or psychological health

B.4.2 Theories of Drug addiction

There are many who give up drugs by themselves.

 Wasterfield – Reduced intake of food leads to increased intake of drugs or alcohol.

This theory assumes:

 Schizophrenia or manic depressive illness, etc.

 Anxiety neurosis or neurotic depression, etc.

1. Reactive alcoholic person – Depressive personality – Depressive stress – Alcohol – Deepening of

2. Addictive alcoholic person becomes addict because of

Perpetuation of Alcoholism or Addiction: Vicious Cycle

A. Pharmacological vicious cycle

Drugs – tolerance – increased intake of alcohol – physical dependence – withdrawal symptoms –

B. Cerebral vicious cycle

Drugs – cerebral tissue damage – disintegration of behavior – increased intake of drugs.

C. Psychological vicious cycle

Drugs – social rejection from the family and society.

Social isolation – increased intake of drugs.

1. Pee g oup pleasu e it s the thi g to do .