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Indian Mental Disability Act
Indian Mental Disability Act
Disability
Disability: has been defined as any restriction or lack
of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap refers to the disadvantage resulting from the impairment or disability that limits or prevents the fulfilling of a role that is normal for the individual.
the disability of mentally ill persons was not adequately addressed until the Persons with Disability (Equal Opportunities, Protection of Rights and Full Participation) (PWD) Act of 1995.
Mental Retardation
Mental Retardation is a condition of arrested or incomplete development of the mind, characterized by impairment of skills manifested during the development period, which contribute to the overall level of intelligence (WHO, 2002). MR refers to the significantly sub average general intellectual functioning, resulting in or associated with concurrent impairments in adaptive behaviour and manifested during the developmental period. (AAMD, 1983)
Mental disability(illness)
A person who lacks comprehension appropriate to
her/his age was categorised as mentally disabled. This would not mean, however, that if a person is not able to comprehend her/his studies appropriate to her/his age and is failing to qualify her/his examination, she/ he was considered mentally disabled. Mentally retarded and insane persons were treated as mentally disabled. A mentally disabled person generally has to depend on her/his family members for performing daily routine.
Diseases under mental illness PWD act 1995 for which certification are done
1. Schizophrenia
the disabilities under Section 2 (i) of the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995. "Mental illness" has been defined under Section 2(q) of the said Act as any mental disorder other than mental retardation.
According to the PWD act 1995 Authorities to give Disability Certificate will be a
Medical Board duly constituted by the Central or the State Government. The Committee has recommended that certification of disability for the purposes of the Act may be carried out by a Medical Board comprising of the following members (a) The Medical superintendent/ principal /Director /Head of the Institution or his nominee (b) Psychiatrist Member (c) Physician Member At least two of the members, including Chairperson of the Board must be present and sign the disability certificate.
board and recorded before a certificate is given. The certificate would be valid for a period of five years for those whose disability is temporary and age below the age 18 years. For those who acquire permanent disability, the validity can be shown as 'Permanent in the certificate'. The Director General of Health Services, Ministry of Health and Family Welfare shall be the final authority, should there arise any controversy/doubt regarding the interpretation of the definitions/classifications/evaluation tests etc
evaluation and assessment of mental illness and the specific procedures for certification. With regard to assessment of disability related to mental illness it was agreed that the Indian Disability Evaluation and Assessment Scale (IDEAS, 2002) developed by the Rehabilitation Committee of the Indian Psychiatric Society (IPS) through a Task Force should be used with modifications for the purposes of the Act.
basic document that a person with any disability of more than 40 percent requires in order to avail any facilities, benefits or concessions under the available schemes. This is not required for getting admission in a school for formal education.
government as well as the state and UT level government provide a number of concessions/ facilities/benefits to the persons with disabilities. The benefits are provided on the basis of certain documents. The procedural requirements are different in each case. Therefore, the persons with disabilities have to do complex paper work which causes a lot of inconvenience and hindrance in availing various benefits. The Government of India has therefore issued guidelines (August, 2000) to States and UTs for issue of identity card to the persons with disabilities so as to enable them to easily avail any applicable benefits/ concessions.
to have a disability, as per the definitions given in the PWD Act (1995), will be eligible to obtain the identity card. Medical Certificate obtained from an authorized medical board constituted by the State Govt./Defence authority, is a necessary prerequisite for obtaining the card.
cerebral palsy or multiple disabilities, applications can be made by their legal guardians. Ex-servicemen should apply for identity card through the Rajya Sainik Board, Zila Sainik Board or the Army formation HQs on the basis of disability certificate given by a competent medical authority in the defence forces.
disabled person above the age of 18 years. For disabled children below 18 years of age, the card is required to be updated once in every five years. No fresh medical examination is necessary in the case of permanent disability.
information, such as identity card number, disability code, district code and a state code. A pass book will also be issued along with the identity card. This pass book is meant to contain the details of various benefits and concessions provided to its holder.
meant for persons with disabilities, shall be punishable with imprisonment for a term which may extend to two years and/or with fine which may extend to twenty thousand rupees (Section 69 of the PWD Act).
incomplete development of the mind, which is especially characterized by impairment of skills manifested during the development period which contribute to the overall level of intelligence, i.e. cognitive, language, motor and social abilities.
(standardized IQ test) is indicative of mild retardation. Understanding and use of language tend to be delayed to a varying degree and executive speech problems that interfere with the development of independence may persist into adult life.
of 35 to 49. Discrepant profiles of abilities are common in this group with some individuals achieving higher levels in visuo-spatial skills than in tasks dependent on language while others are markedly clumsy by enjoy social interaction and simple conversation. The level of development of language in variable, some of those affected can take part in simple conversations while others have only enough language to communicate their basic needs.
range of 20 to 34. In this category, most of the people suffer from a marked degree of motor impairment or other associated deficits indicating the presence of clinically significant damage to or mal-development of the central nervous system. Profound Mental Retardation: The IQ in this category estimated to be less than 20. The ability to understand or comply with requests or instructions are severally limited. Most of such individuals are immobile or severally restricted in mobility, incontinent and capable at most of only very rudimentary forms of non-verbal communication. They have little or no ability to care for their own basic needs and require constant help and supervision
Process of Certification
standardized instruments such as Stanford Binet test, Binet Kamat Test, Weschler's Intelligence Scales, Malin's Intelligence Scale for Indian Children, Seguin Form Board etc. A disability certificate is issued by a Medical Board duly constituted by the Central/State Government. At least, one shall be a specialist in the area of mental retardation, i.e., a psychiatrist, paediatrician or a clinical psychologist. The examination process will consist of three components: clinical assessment, assessment of adaptive behaviour and intellectual functioning
Format of certificate issued for mental retardation for Government benefits notified vide gazette notification no. 16-18/97-NI.I. Dated 1st June, 2001 (Similar format used at Central Institute of Psychiatry, Ranchi)
This is to certify that Shri/Smt./Kum. ______________________________Son/Daughter of______________________________of Town/City _____________________with particulars given below:a. Age b. Sex c. Signature/Thumb impression CATEGORISATION OF MENTAL RETARDATION Mild/Moderate/Severe/Profound Validity of the Certificate: Permanent Signature of the Government Doctor/Hospital with seal Chairperson, Mental Retardation Certification Board Dated: Place:
have been standardized and are accepted by Government of India for measuring disability in mental illnesses or mental retardation. Some of them are described below.
previous 2 years in which patient was symptomatic should be determined. The assessment and certification can only be done by a psychiatrist. Once issued, the temporary disability certificate is valid for a period of 5 years, thereafter re-certification has to be done.
Indian Disability Evaluation and Assessment Scale Indian Disability Evaluation and Assessment Scale (IDEAS)
is a scale for measuring and quantifying disability in mental disorders. Items I. Self Care: Includes taking care of body hygiene, grooming, health including bathing, toileting, dressing, eating, taking care of one's health. II. Interpersonal Activities (Social Relationships): Includes initiating and maintaining interactions with others in contextual and social appropriate manner. III. Communication and Understanding: Includes communication and conversation with others by producing and comprehending spoken/written/non-verbal messages. IV Work: Three areas are Employment/Housework/ Education Measures on any aspect.
(paid) employment/self-employment/ family concern or otherwise. Measure ability to perform tasks at employment completely and efficiently and in proper time. Includes seeking employment. 2. Performing in Housework: Maintaining household including cooking, caring for other people at home, taking care of belongings etc. Measures ability to take responsibility for and perform household tasks completely and efficiently and in proper time. 3. Performing in school/college: Measures performance education related tasks. Scores for each item: 0- NO disability (none, absent, negligible) 1- MILD disability (slight, low) 2- MODERATE disability (medium, fair) 3- SEVERE disability (high, extreme) 4- PROFOUND disability (total cannot do)
TOTAL SCORE
Add scores of the 4 items and obtain a total score Weight age for Duration of illness (DOI) : DOI: < 2 years: score to be added is 1 2-5 years: add 2 . 6-10 years: add 3 > 10 years: add 4 Global Disability Total Disability score + DOI score = Global Disability Score Percentages: 0 No Disability = 0% 1-6 Mild Disability = < 40 % 7-13 Moderate Disability = 40 - 70 % 14-19 Severe Disability = 71-99% 20 Profound Disability = l00% Cut off for welfare measures = 40 %
Manual for "IDEAS" In order to score this instrument, information from all possible
sources should be obtained. This will include interview of patient, the care given and case notes when available. I. SELF CARE: This should be regarded as activity guided by social norms and conventions. The broad areas covered are a. Maintenance of personal hygiene and physical health. b. Eating habits c. Maintenance of personal belongings and living space a. Does he look after himself. wash his clothes regularly, take a bath and brush his teeth? b. DOES he have regular meals? c. Does he take food of right quality and quantity? d. What about his table manners? e. Does he take care of his personal belongings with reasonable standard of cleanliness and orderliness? 0= No disability
social cultural and economic context. 1= Mild Mild deterioration in self-care and appearance (not bathing. shaving, changing clothes for the occasion as expected). Does not have adverse consequences such as hazards to his health. No embarrassment to family. 2= Moderate Lack of concern for self-care should be clearly established such as mild deterioration of physical health, obesity, tooth decay &, body odors. 3= Severe Decline in self-care should be marked in all areas. Patient wearing torn clothes would only wash if made to and would only cat ift6ld. Evidence of serious hazards to physical health. (Malnutrition. infection. patient unacceptable in public). 4= Profound Total or near total lack of self-care (Example: risk to physical survival, needs feeding, washing, putting on clothes etc., Constant supervision necessary)
demands of others, activities or regulating emotions, activities of initiating, maintaining and terminating interactions and activities of engaging in physical intimacy. Guiding Questions a. What is his behaviour with others? b. Is he polite? c. Does he respond to questions! d. Is he able to regulate verbal and physical aggression? e. Is he able to act independently in social inter actions? f. How does he behave with strangers? g. Is he able to maintain friendship? h. Does he show physical expression of affection and desire?
relationships No friction in inter-personal relationships. 1= Mild Some friction on isolated occasions. Patient known to be nervous or irritable but generally tolerated by others. 2= Moderate Factual evidence that pattern of response to people is unhealthy. May be seen or more than few occasions. Could isolate himself from others and avoid company. 3= Severe Behaviour in social situations is undesirable and generalized. Causes serious problems in daily living/or work. Patient is socially ostracized. 4= Profound Patient in serious and lasting conflict, serious danger to problems of others. Family afraid of potential consequences.
III. Communication and Understanding Understanding spoken messages as well as written and
non-verbal messages and ability to reduce messages in order to communicate with others. 1. Questions a. Does he avoid talking to people? b. When people come home what does he do? c. Does he ever visit others? d. Is he able to start, maintain and end a conversation? e. Does he understand body language and emotions of others such as smiling, crying, screaming, etc., f. Does he indulge in reading and writing? g. Do you encourage him to be more sociable?
Scoring: 0 = No disability Patient mixes, talks and generally interacts with people as much as
can be expected in his socio-cultural context. No evidence of avoiding people. 1= Mild Patient described as uncommunicative or solitary in social situations. Signs of social anxiety might be reported. 2= Moderate A very narrow range of social contacts, evidence of active avoidance of people on some occasions and interference with performance of social rules causes concern to family. 3= Severe Evidence of more generalized, active avoidance of contact with people (leave the room when visitors arrive and would not answer the door or phone). 4= Profound Hardly has any contacts and actively avoids people nearly all the time. Eg : may lock himself inside the room. Verbal communication is nil or a bare minimum.
IV. Work This includes employment, housework and educational performance. Score only one category in case of an overlap. Employment: Guiding Questions a. Is he employed/unemployed? b. If employed, does he go to work regularly? c. Does he like his job and coping well with it? d. Can you rely on him financially? e. If unemployed, does he make efforts to find job? Scoring: 0= No disability. Patient goes to work regularly and his output and quality of work performance are within acceptable levels for the job. 1= Mild Noticeable decline in patient's ability to work, to cope with it and meet the demands of work. May threaten to quit. 2= Moderate Declining work performance, frequent absences, lack of concern about all this. Financial difficulties foreseen. 3= Severe Marked decline in work performance, disruptive at work, unwilling to adhere to disciplines of work. Threat of losing his job. 4= Profound
Unemployed and making no efforts to find jobs. In similar ways, housewives should be rated on the amount, regularity and efficiency in which tasks in the following areas are completed. Consider the amount of help required completing these. Acquiring daily necessities, making, storing and serving of food, cleaning the house, working with those helping with domestic duties such as maids, cooks etc., looking after possessions and valuable in the house. Students - Assess a score on performance in school/college, regularity, discipline, interest in future studies, behaviour at the educational institution. Those who had to discontinue education on account of mental disability and unable to continue further should be given a score of 4.
conceptually it is quite different (Flynn 1991;ICF 2001). Based on IQ there is no clear guideline to assess the percentage of disability in mental retardation and it cannot be used in multiple disability seen in many cases of MR. Also it takes clinical psychologists who are too few to measure IQ. In view of these constraints ADPMR scale was developed (Nizamie et al. 2005a, b) as a unified scale keeping in view certification purposes laid down by the Government of India (MSJE 1999).
the disabled persons in our country. The following is a list of such laws which are associated with disability issues
the treatment and care of the mentally ill persons, to make better provisions with respect to their property and affairs. Although this Act describes procedures for establishing guardianship and custody of mentally ill persons and protects their rights, it does not specifically address the issue of disability associated. Nevertheless, there is mention about the provision for rehabilitation activities in psychiatric hospitals and about licensing of convalescent homes for mentally ill persons.
2. The Rehabilitation Council Act of India (RCI, 1992) Council of India Act (1992) deals with Rehabilitation
the development of manpower for providing rehabilitation services. It was created for constitution of the rehabilitation Council of India for regulating training of the professionals associated with rehabilitation, maintaining a Central Rehabilitation Register and other related issues. Handicapped in this Act means a person who is: 1. Visually handicapped; 2. Hearing handicapped ; 3. Suffering from locomotor disability; 4. Suffering from mental retardation.
Persons with Disability (Equal Opportunities, Protection of Rights and Full Participation) (PWD) Act (1995)
The Persons with Disability (Equal Opportunities,
Protection of Rights and Full Participation) (PWD) Act came into force in 1995 with the purpose of providing equal rights to disabled people and to protect their rights and full participation. It provides for education, employment, creation of barrier free environment, social security, etc. This Act is a major milestone in the care of disabled in India.
4. National Trust (For welfare of persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities) Act (1999)
Parents of severely disabled persons with autism, cerebral
palsy, mental retardation and multiple disabilities feel a sense of insecurity regarding the welfare of their wards after their death. National Trust Act of 1999, has provisions for legal guardianship of the four categories and creation of enabling environment for as much independent living as possible. It has been implementing the Supported Guardianship Scheme to provide financial security to persons with severe disabilities who are destitute and abandoned by supporting the cost of guardianship
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EDUCATION children with disabilities who have Part time classes for
completed education up to class V and could not continue their study on whole time basis. (PDA, NTA) e.g. open school system, sarve shikhsha abhiyan, evening schools etc. Special part time classes for providing functional literacy for children in the age group of >16 years (PDA, NTA) e.g. open school system, evening classes etc. Free of cost special books & equipments (PDA, NTA).
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reserved for the disabled (PDA). Special schools with vocational training facilities (PDA, NTA). Special weightage in open schools and open University (PDA, NTA). Scholarship to disabled students (PDA, NTA).
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Transport
facilities or in alternative financial incentives to parents to attend schools (PDA, NTA). Provision of redressal of grievances of parents regarding the placement of their disabled children (PDA). Individualized educational programme, home based programme.
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EMPLOYMENT
From the Ministry of personnel public revenue and
pension (Department of personal training, New Delhi) parents of the MR can not be transferred at a place where there is no facility for the training, treatment and education for their ward and Pension benefit Wards/dependents of all employs/ retirees who are governed by Family Pension Scheme 1964 will be eligible for the Family Pension Scheme. It should be paid to such son or daughter through the guardian.
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Special schools
Establishment of factories by entrepreneurs with
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Financial Assistance for Skills & Entrepreneurial Development (in the form of grant to channelising agencies/reputed training institutions for imparting skills and entrepreneurial development training to disabled persons) Eligibility Criteria for availing credit Any Indian Citizen with 40% or more disability. Age between 18 and 60 years. Annual income below Rs.5,00,000/- (Rupees Five Lakh only) per annum for urban areas and Rs.3,00,000/- (Rupees Three Lakh only) per annum for rural areas. Relevant educational / technical / vocational qualification / experience and background. Rates of Interest Sl. No.Loan AmountRate of Interest (Per Annum)1.Upto Rs.50,000/-5%2 . Above Rs. 50,000/- and upto Rs. 5 lakh6%3 .Above Rs. 5.0 lakh8% Repayment :General scheme of financing: within 10 years, Education loan-within 7 years (after 6 months from the date of completion of course or after getting the job, whichever is earlier), Micro Credit Loan: within 3 years. Rebate A special rebate of 1% on interest is given to women with disabilities in all the schemes of NHFDC. Procedure for obtaining loan Applications on prescribed format to be submitted through the State Channelising Agencies (SCAs) of NHFDC
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deduction of Rs. 75,000 out of his total income. Income tax benefit of 75000/- to parent/guardian producing affidavit that amount has been spent on the disabled person Parents having MR child can get 40,000 as income tax rebate.
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Railways
75% of fare for the disabled plus one escort up to AC
IInd class, sleeper class, if they cannot travel alone. 50% on Season Ticket
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State Governments
Disability pension
Purchase of appliances Loan
Transport facility
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Benefits
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Pension to the Disabled:, Having disability > 40%,
Financial assistance of 200/-month with income limits:
Rs. 1000/-pm for the disabled person if single If not earning, then income of parents should not exceed Rs 2500/pm in case of one child and Rs. 3000/- for parents >2 children. Can get transport facility in bus i.e. 50% of rent Petrol subsidy: 15 liter-7.50 liter amount/month; if 2500 Rs per month income
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and Reach programme for the Welfare of the persons with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities are establishment of relief institutions for providing institutional care and training of the caregivers. The National Trust gave special emphasis to programmes for: Persons with severe disabilities (Persons with >80% disability) Women with disabilities Senior citizen with disabilities (> 65 years of age)
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daughter with disability and represent them even after they are 18years of age. Legal Guardianship
For only protection of property rights For protection of rights of person with property
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abandoned persons with disabilities. Under this scheme, an amount of Rs. 500/- per month is given to 10 beneficiaries in the selected districts. The amount is required to be utilized for basic needs of food, shelter and for medical and rehabilitation needs of their disabled ward. Loan, concessions, managing investments Insurance, alternative security schemes To safeguard the interest of the child (criminal activity.)
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Registered organization
Local level committee may direct a registered
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applicant must be living in the vicinity or close proximity of the No single male shall be considered as a guardian for a female ward as in the case of female wards, the male person shall be given co-guardianship with the spouse, who shall be master co-guardian.
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Duties
To furnish an inventory: Within a period of six months from the date of his appointment, deliver to the authority which appointed him, an inventory of movable/ immovable property, with all assets, & statement of all claims, debts, loans etc. Annual accounts: Furnish with in a period of three months at the close of every financial year, an account of the property and assets in his charge; the sums received and disbursed
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disability
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Removal
Abusing or neglecting
Misappropriating or neglecting the property Upon receiving such application may remove
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3 years.b) It should have a minimum membership of 05 parents.c) It should not be a financial defaulter of central government, state government, any financial institution in the public sector, banks etc. Quantum of Loan -Quantum of loan to each Parents Association is limited to Rs. 5.00 lakh. The share of the Parents Association will be 5% of the project cost. The loan will be used by the Parents Association to implement a single or multiple activity project in which the maximum possible participation of the beneficiaries may be ensured. Rate of Interest -The interest on the loan amount will be charged as per following table-i) Upto Rs. 50,000/- - 5% p.a.ii) Above Rs. 50,000/and upto Rs. 5.0 lakh. - 6% p.a.RebateA rebate of 1% p.a. on interest for disabled woman.Repayment Period -The loan amount including interest will be repaid within 10 years in equal quarterly installments.
Mamta\" Scheme for Mentally retarded children" Sponsored By:State Funding Pattern:The State Government will provide following financial assistance to the eligible and interested NGOs. for construction and to run such school. \ Non recurring Grant \ Grant for construction of Residential School having a capacity of minimum 30 students - Rs. 50 lakhs \ Recurring grants \ 1.Cost of maintenance per student per month Rs.1000 \ 2.Honorarium for Warden Rs. 4000 p.m. \ 3.Honorarium for Cook Rs. 2000 p.m. \ 4.Honorarium for Attendant Rs. 2000 p.m. \ 5.Honorarium for Sweeper Rs. 2000 p.m. \ 6.Honorarium for Teachers maximum 3 Nos. Rs.5000 p.m. per Teacher \
Description:It is estimated that there are about 3000-4000 mentally retarded children in the State of Goa. Due to their mental health, financial conditions of the parents and non-availability of residential schools they are unable to take required education. Hence to protect the interest of education of this section of the society Residential School Complex is needed where these Children can pursue their education and develop their mental status. Beneficiaries:individual Benefit Type:Other Eligibility Criteria:All the children whose I.Q. is less than 70 as certified by the Medical authority are eligible to attend these schools with the consent of their legal guardians , appointed under the National Trust Act. How to Avail:Apply through Department of social welfare or schools. Introduced On:Thursday, December 27, 2007 Valid Upto:Thursday, December 28, 2017
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