Effectiveness of Community Based Rehabilitation for persons with Severe Mental Disorders in a rural area of South India

Abstract

Background: People with Severe Mental Disorders (SMD) have complex needs which involve different sectors which requires the need for intra- and inter-sectoral coordination. Critical attention is required on rehabilitation to address the long-standing disabilities and multiple areas of negative impact on individuals and their families. There is a need to offer such interventions in their own community. Methodology: To examine the effectiveness of CBR programme for persons with severe mental disorders in a rural taluk of Karnataka. We tried to document the effectiveness of CBR in terms of reduction in the disability levels and illness severity and also in terms of the number of disability certificates issued, the extent of welfare benefits used, reduction in out of pocket expenditure, and the number of patients productively employed at one year follow-up. Results: A total of 171 persons with severe mental disorders completed the follow up assessment. Most of the participants were male and belonged to low socio-economic status. There was significant reduction in the disability scores, symptom severity, and out of pocket expenditure during follow up. The CBR program was effective in providing various welfare benefits to the participants and increase in the number of participants being productively employed. Conclusion: Implementing such a CBR program requires coordination of multiple stakeholders at multiple levels and using both governmental and non-governmental resources. Such interventions in the community can reduce the burden faced by individuals with SMD and their caregivers and as a whole reduce the treatment gap and out of pocket expenditure.

Keywords: Community-based rehabilitation, severe mental disorders, psychiatric disability, out-of pocket expenditure