Skill Sets and Novel Approaches for Rehabilitation of Persons with Mental Disorders

Mental illnesses account for a substantial portion of global disease burden: they are a top contributor to years lived with disability, and fifth largest contributor to disability-adjusted life years (Charlson, Ferrari et al., 2018). Current best treatment practices include medications, which are largely palliative, but not curative. Indian government initiatives including the pathbreaking Rights of Persons with Disability Act, 2016 (RPWD Act) (Ministry of Social Justice and Empowerment India, 2016) are hampered by societal lack of knowledge of rights, prejudice against persons with mental illness (PMI) and stigma due to mental illness preventing optimal utilization. While stigma is a more overarching term indicating knowledge attitudes and behaviour towards people with mental illness, prejudice indicates the negative attitude of the public towards those with mental illnesses. Social changes in India, such as shrinking families, ageing parents and consequent lack of family support lead to further marginalization of PMI. Meeting the needs of PMI should go beyond clinical treatment of the individual. Novel models and innovative approaches are required to integrate PMI into society and create conditions whereby the benefits of existing treatment and policies can be fully realized. The socio-ecological model is a framework for understanding the needs of PMI, and critically, to pinpoint approaches to maximize care. We discuss novel approaches to support PMI that operate at the individual, community, and policy level of the socio-ecological model. Proximal approaches, which involve treating the individual experiencing mental illness directly, include palliative care and cognitive remediation. Housing first is a supportive model of care that operates at the community level, while policy-based interventions are distal, and therefore likely to have the broadest impact. We discuss the current base of evidence for each of these models; they need to be evaluated in Indian settings.