|Year : 2015 | Volume
| Issue : 1 | Page : 51-56
Profile of inmates of a special school for the mentally ill and disabled in Kancheepuram district, Tamil Nadu: An institution based cross-sectional study
Saurabh RamBihariLal Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India
|Date of Web Publication||14-Jan-2015|
Dr. Saurabh RamBihariLal Shrivastava
3rd floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur-Guduvancherry Main Road, Sembakkam, Kancheepuram - 603 108, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Context : The health care and social welfare needs of persons with mental illness and differently abled persons should not be ignored. Aim: The aim of the study is to assess the socio-demographic and morbidity profiles of the inmates in the special school and to explore the reasons that have contributed to their admission in the school. Materials and Methods: A cross-sectional descriptive study of six months duration (September 2013 to February 2014) was conducted in a special school for mentally ill and differently abled people of Kanchipuram district in Tamilnadu. All the inmates staying in the school during the study period were included as study participants. The socio-demographic profile of the inmates was obtained with the help of caretaker/family members/records maintained by the center while their morbidity profile was explored with the help of specialists from different departments. Statistical analysis was done using SPSS version 18 and the frequency distributions and percentages were calculated for all the variables. Results: Most of the study participants, 31 (56.4%) were from the 40-60 years age group. Overall, 51 (92.7%) inmates were suffering from some type of mental disorders with/without multiple disabilities while 4 (7.2%) inmates were enrolled in the special school because of their old age. The unwillingness of the family members to take care of the affected person was cited as the most common cause in 32 (58.1%) of the inmates for enrolling in the special school. Conclusion: Most of the inmates of the special school were suffering from mental illnesses with/without multiple disabilities. A definite improvement in the quality of life of inmates has been observed after the extension of healthcare services by the medical college.
Keywords: Disabled, persons with mental illness, rural, Tamil Nadu
|How to cite this article:|
Shrivastava SR, Shrivastava PS, Ramasamy J. Profile of inmates of a special school for the mentally ill and disabled in Kancheepuram district, Tamil Nadu: An institution based cross-sectional study. CHRISMED J Health Res 2015;2:51-6
|How to cite this URL:|
Shrivastava SR, Shrivastava PS, Ramasamy J. Profile of inmates of a special school for the mentally ill and disabled in Kancheepuram district, Tamil Nadu: An institution based cross-sectional study. CHRISMED J Health Res [serial online] 2015 [cited 2020 Jan 28];2:51-6. Available from: http://www.cjhr.org/text.asp?2015/2/1/51/149346
| Introduction|| |
Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity by the World Health Organization.  Mental health has been identified as the main pillar in an individual well-being and in the effective functioning of a community/society.  According to the recent estimates released by the World Health Organization, it has been revealed that more than 450 million people suffer from some type of mental disorders worldwide and this figure is about to increase further in years to come.  Moving ahead to another vulnerable section of the society - the differently abled-on an average of more than a billion people (15% of the world's population) suffer from some kind of disability (physical/intellectual), which often results in social stigma and also affects the integrity of the family in the long run. , The health care and social welfare needs of vulnerable population such as persons with mental illness and differently abled persons should not be neglected or ignored. ,
In India, mental health services, and services for differently abled individuals are limited both in terms of number of facilities as well as trained professionals. , Most of the health care establishments for the welfare of the mentally ill/differently abled individuals are limited within the urban settings. Furthermore, the mere presence of a treatment facility does not guarantee that these settings will be used by those who need them the most. , Different types of special schools are functioning in India both in the government and the non-government sectors. Each of these special homes has a target population, such as children with special needs, differently abled individuals, person with mental illness and orphaned. In-fact, different studies have revealed that most of the time there is a significant delay from the patient side in accessing mental health services either because of lack of awareness or the associated stigma. ,
The global mission is to ensure accessibility, availability and affordability of primary health care services to all segments of people, including the persons with mental illness and differently abled individuals, irrespective of the geographical barriers. , The tertiary healthcare center located in the rural pocket of Kanchipuram district, has decentralized the wide gamut of preventive, curative and psychological rehabilitative services to the inmates of a special school and home for the persons with mental illness and multiple differently abled individuals-Anbagam, and to the residents from neighboring areas. In addition to the curative medical treatment by the specialist doctors, basic laboratory investigations and free medicines have also been given to the beneficiaries with the assistance of trained and qualified team of nurses, laboratory technicians and pharmacists within the premises of the special school.
Individuals are enrolled in the special school if there is no one in home to take adequate care of the patients at domiciliary level provided relatives ensure that they will come to meet their wards once every month. In addition, for enrolling individuals in the special school, relatives have to provide two documents (viz. medical certificate issued by a qualified psychiatrist/physician, and a recommendation certificate issued from the local governing body based on the medical certificate by the doctor). The funding of the trust and the care of the inmates is under the provisions of the National Trust Act (also conducts awareness campaigns, provide vocational support by conducting training, extends insurance cover, support for schooling, etc.)  and through the voluntary donations made by the members of the community. However, the inmates are only trained in maintaining their personal hygiene and doing routine activities (viz. cleaning of center, washing their clothes, etc.) at the center, and no vocational training is provided to them.
The objectives of the present study are to assess the socio-demographic and morbidity profiles of the inmates in the special school, and to explore the reasons that have contributed to their admission in the school.
| Materials and Methods|| |
Settings and design
A cross-sectional descriptive study was conducted among the inmates of a special school-Anbagam-in Kanchipuram district, Tamil Nadu. Only one home was selected for the study, as it is the only special school present within a radius of 20-25 kilometers around the institute. It is a trust-run home for the persons with mental illness, differently abled and old-aged persons working for supporting the marginalized and vulnerable sections of the society since last 14 years. In addition to the residential facilities, the special school provides food to the inmates and takes care of their medical needs. As far as medicine expenses are concerned, the patient relatives have to bear them/reimburse them whenever they visit the special school for meeting their wards. The center does not offer any type of vocational opportunities for the inmates.
The study duration was for six months (September 2013 to February 2014), conducted among the inmates of the special school who belonged to three distinct categories, namely mentally ill, differently abled and old-aged individuals. Universal sampling method was employed and thus all inmates were enrolled in the study. Total sample size for the study was 55.
All inmates of the special school who was present at the time of the study were included as the study subjects.
Persons who had gone to their native places, and were unavailable during the study period were not included in the study.
A semi-structured questionnaire was used for eliciting the information from the study participants. This questionnaire was pre-tested in the month of August on five inmates (roughly 10% of the final sample size), and depending on the responses, the questionnaire was modified. These inmates were not included in the final study analysis. The questionnaire was tested to ascertain the reason for enrollment, on patients who were enrolled in the special school for a transient period only. The questionnaire included several domains of questions including their socio-demographic details (viz. age, sex, religion, education, occupation, marital status, place of origin), reason for enrolling in the special school, duration of stay in the special school, and follow-up visit by relatives, if any.
The study related information was obtained by interviewing the care-taking nurse, supporting staff of the special school, and the relatives of the inmates. Assistance of the psychiatrist was taken to clinically evaluate the inmates and categorize them according to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).  The family members of the inmates were informed well in advance, and were requested to visit the special school, to elicit the questionnaire-related information. All the relatives who visited the special school during the entire duration of the study (only relatives of four inmates turned up) were interviewed to ascertain the natural history of illness. All the elicited information was re-checked with the medical/record file of individual persons maintained at the special school to corroborate the authenticity of the information. Subsequently, each of the inmates was assessed clinically by the specialists-psychiatrist, dermatologist, physician, orthopedician for exploring their morbidity profile.
Institutional ethical clearance was obtained prior to the start of the study. In addition, permission was obtained from the director of the special school before starting the study. Written informed consent was obtained directly from physically differently abled and old-aged persons; whereas the written consent of guardians was obtained in case of the mentally ill patients. Utmost care was taken in order to maintain privacy and confidentiality.
Data entry and statistical analysis was done using Statistical Package for the Social Sciences software (SPSS) version 18. Frequency distributions and percentages were computed for all the variables.
| Results|| |
These results represent the baseline findings of the special school, after the tertiary care institute has initiated provision of healthcare services. [Table 1] reveals about the socio-demographic profile of the inmates. The mean age of the study group was (45.26 ± 12.46 years), and most of the inmates 31 (56.4%) were from the 40-60 years age group. Out of the 55 study subjects, 2 (3.6%) were graduates (Bachelor of Science in Chemistry). About 12 (21.8%) of the study participants were employed prior to the onset of their illness. Also 3 (5.4%) female inmates had been divorced because of their underlying psychiatric condition while 36 (65.5%) inmates were single.
[Table 2] depicts the distribution of mental disorders among the inmates of the special school. Overall, 51 (92.7%) inmates were suffering from some type of mental disorders with/without multiple disabilities while 4 (7.2%) inmates were enrolled in the special school because of their old age. Only two inmates had both intellectual disability and co-existing psychotic condition. Each of the 51 (viz. persons with mental illness/mental disorders) inmates was managed with the help of different class of antipsychotics and anti-depressants. The inmates were periodically followed up and their drug dosages have been titrated based on the severity of the disease/improvement under clinical symptoms.
[Table 3] represents the distribution of other morbidities identified by separate specialist from the clinical departments. Overall, only four inmates had both mental illness and some form of physical disability (viz. deaf-1, hemiplegic-1, and mal-union secondary to fracture of upper limb-2). Among all ailments, skin diseases-21 (38.1%) were the most frequent followed by physical disabilities. Although, one of the inmates was a known case of hypertension and was on antihypertensive medications, four more inmates were newly diagnosed with diabetes and hypertension in the current initiative of the tertiary healthcare establishment. Newly diagnosed patients were started on antihypertensive and oral hypoglycemic drugs based on the blood pressure and blood sugar measurements.
|Table 3: Distribution of other health-related morbidities among the inmates|
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[Table 4] explains about the reasons cited by the inmates/caretakers/family members for enrolling into the special school. Among all inmates, 23 (41.8%) were staying in the special school for more than three years while 19 (34.5%) were part of the school for the last 1-3 years. The most common reason for enrolling in the special school was due to unwillingness of the family members of 32 (58.1%) inmates to take care of their affected wards. As part of the enrolling policy of the special school, it has been made mandatory that relatives of each of the inmates have to visit their patients once in a month. Further, an inmate who has shown significant improvement in their mental health during their stay in the special school or if the relatives are willing to take back the patient, they can be transferred back to their family on request.
| Discussion|| |
The present study was conducted as a part of the preventive and curative services offered by the tertiary health care center to the inmates of a special school. From the perspective of socio-demographic profile, 3 (5.4%) of the female inmates were divorcees after they were diagnosed to be suffering from psychiatric conditions. This reflects the existence of public stigma with the psychiatric condition and the minimal awareness among the general population about the psychiatric illnesses that can be completely treated with appropriate drug therapy and adequate family support.
It was observed that the majority of inmates who actually required regular psychiatric/clinical monitoring were staying in special school without any medical attention prior to the initiation of current initiative. Findings of a review have also revealed that the majority of mentally ill persons are either in jails or in prisons than being in hospitals for the management of their illness.  Although it is not a comparable group, but our study is a novel study, and similar studies have not been performed till date.
In the present study settings, almost 51 (92.7%) inmates were suffering from some type of mental disorders with/without multiple disabilities. In another health care home, musculoskeletal disorders were the most common among the orphans.  In another setting, injuries were the most common morbidity identified.  The probable reason for variability in the type of patients admitted to the current settings is either because of non availability of a specialized mental healthcare institution in the neighboring areas or due to the different enrollment criteria practiced in other schools.
A significant improvement was observed in the behavior of almost all the inmates such as reduction in the symptoms of the illness and a gradual increase in the appetite of some of the inmates, who were not having adequate meals. Furthermore, most of the inmates are now continuously participating in recreational activities (like singing poem/songs, participation in running/musical chair events) with a marked reduction in the incidence of aggressive events.
The current study identified that the most common reason for enrolling in the special school was the unwillingness of the family members to take care of their wards due to their abnormal behavior and the social stigma associated with psychiatric illnesses. However, 18 (32.7%) inmates cited that they have come to the special school because of the non-availability of any nearby facility/trained personnel. Similar findings in terms of the dearth of competent professionals and geographical disparity in the location and number of mental healthcare institutes have also been emphasized. , In fact, as per the recent recommendations of the World Health Organization, there is a need to formulate and implement a comprehensive mental health policy to ensure a significant impact on the mental health of populations.  In fact, under the National Trust Act, various schemes of capacity building, training and care and shelter through its registered organizations have been implemented wide across the country.  Furthermore, a special bill has been passed by the Government of India - The rights of persons with disabilities bill, 2012, to ensure holistic development of the person with disabilities and reduce inequality and discrimination. 
Current study findings have also revealed that 23 (41.8%) were staying in the special school for more than three years while 19 (34.5%) were part of the school for the last 1-3 years. Similar results were obtained in the findings of another study done in mental hospitals in the United States.  Further, special schools had a releasing policy for releasing the inmates once they start feeling better or relatives are willing to accept the patient again. But in another study, it was observed that no uniform criteria/guidelines were in place for releasing the patient. 
Owing to the small sample size, findings of the present study cannot be generalized across the country. In addition, because of non-availability of the relatives at the time of study, satisfaction level of the inmates' family members, and the probable reasons/etiology for the onset of the disease could not be ascertained.
| Conclusion|| |
To conclude, most of the inmates of the special school were suffering from mental illnesses with/without multiple disabilities. The unwillingness of the family members to care for their wards was the main reason for enrollment in the special school. Furthermore, a definite improvement in the quality of life of inmates has been observed after the extension of health care services. This initiative is definitely a stepping-stone towards improving the quality of life of the community and health indicators of the region, in general.
| Acknowledgement|| |
Authors like to acknowledge the contribution of the Psychiatrist (Dr. M Thenral), Dermatologist (Dr. Geetha and Dr. Rameshwari), Physician (Dr. Prabhakaran) and Orthopaedician (Dr. Abdul Khadir) for their continuous clinical support during the study period.
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[Table 1], [Table 2], [Table 3], [Table 4]