Assignment Code: MPC-054/ASST/TMA/July 2022-January 2023

Course Code: MPC-054

Assignment Name: Services for the Mentally Ill

Year: 2022-2023

Verification Status: Verified by Professor

SECTION A

Answer the following questions in 1000 words each. 3 x 15 = 45 Marks

1. Explain community mental health and describe various community mental health models.

Ans) Community mental health refers to the support and services offered to people with mental health issues and their families in communal settings. In developing nations like India, community settings could be someone's home, a large joint family, a general practitioner's office, a government-run Primary Health Centre, Community Health Centre, or a District Hospital, a non-hospital residential facility like a Half-Way Home or hostel run by NGO, a private Psychiatrist's office/clinic, a counselling centre, or a rehabilitation centre in a community location running day programmes and providing a variety of services.

Community Mental Health Models

Integration of mental health into primary health care: Two important studies that were carried out in two separate locations in India showed that mental health and primary care can be combined. This in a sense influenced the 1982 creation of the National Mental Health Program (NMHP). Integrating mental health treatments into primary care was the aim of NMHP. Following the success of the Bellary district, the District Mental Health Program was launched as a result of the NMHP. Currently, 123 districts are using the DMHP, and a proposal exists to expand it to include all districts in the 12th Five Year Plan. Another guiding concept for integrating mental health into primary health care, in addition to convenience and feasibility, is the 10 to 25% prevalence of psychiatric disorders among primary care patients.

At first, it was determined that the employees of Primary Health Centres would handle cases involving mental health after receiving some basic training. However, the government chose to fund manpower through the DMHP due to a number of factors, including the tremendous workload of medical and surgical cases, the introduction of other mental health initiatives, etc.

Satellite Clinics: In order to reach patients who are unable to go to hospital-based facilities, some teaching hospitals in India have established outpatient care programmes. These services are frequently offered by experts from teaching hospitals who also have additional responsibilities for teaching, clinical patient care, and research. The majority of such satellite clinics operate once every week. Some institutions also offer treatment once a month.

For a satellite clinic to be successful, it is ideal that:

1. It must be situated in a medical facility, such as a dispensary, a PHC, etc.

2. For emergencies, it must have plans in place for referring patients to tertiary centres.

3. The public must be made aware of who and where to turn to for assistance after clinic hours.

4. Links with other community-based mental health treatment centres must be established.

Self Help Group (SHG) and Support Groups: Self Help Groups are voluntary, intimate groups of people who share a problem and meet for a specific reason. They are typically created by caregivers who band together for mutual support in dealing with a common disability or life-changing issue. The group's indicators and members believe that current social institutions and government programmes are not meeting their demands. Self-help groups place a strong focus on members taking ownership of their activities and engaging in face-to-face social interactions. They usually offer both material help and emotional support, are frequently cause-oriented, and spread an ideology or set of beliefs that enables members to develop stronger senses of personal identity. The description of self-help groups given by Katz and Blender (1976) is arguably the most thorough.

Alcoholic Anonymous is undoubtedly one of the most well-known SHG from the perspective of Clinical Psychiatry. People who have issues with alcohol and wish to stop drinking have formed this group. SHGs provide curative, preventive, promotional, palliative, and rehabilitative services in addition to addressing the practical issues and psychological distress of patients.

Therapeutic Community: Tom Main first proposed the idea of a therapeutic community in 1946, and Maxwell Jones popularised it. It is a residential treatment centre for many different problems, including mental illness, drug misuse, and even incarceration. TC is a secondary preventative intervention designed to lessen the effects of maladaptive behaviour and improve rehabilitation efforts using an environmental approach. It is based on the concepts of social learning theory.

According to the TC, learning happens through challenges, taking initiative, understanding, and demonstrating universal human experience. People can also change. The TC model includes components like active involvement, member feedback, role modelling, group forms for facilitating individual transformation, open communication, individual and group connections, and a special technology. Working with people who have mental illnesses in TC entails ongoing risk assessment and management, assisting clients in identifying negative facets of their personalities, and establishing in them a sense of accountability. Some TCs, such "Aatma Shakti Vidyalaya" in Bengaluru, have also included transactional analysis techniques as part of treatment.

Crisis Intervention Team (CIT) and Helpline Services: In a community, a person may frequently experience acute psychological suffering. For instance, a depressed person may have frequent suicidal thoughts, or a person under the influence may experience acute psychosis. Particularly in industrialised countries, there are groups of trained individuals accessible in such emergency situations who provide urgent care and do so right at the affected person's doorstep. These individuals make up the so-called "Crisis Intervention Team." They are an element of the case management strategy in developed countries, where any necessary services, including nonpharmacological services, are offered 24/7.

Helpline services are essentially telephone assistance and counselling for persons with health-related problems. Suicide Prevention Helpline, Smoking Cessation Helpline, Child Helpline, and other helpline programmes are related to psychiatry.

Out-patient camps: Teams of psychiatrists from Pune and Miraj in Maharashtra started this innovative strategy. Case identification and the beginning of therapy as an outpatient service were part of these early camps.

For the past 15 years, one-day camps have been held in Chandigarh by the psychiatry department of the Government Medical College and Hospital. The strategy was primarily used to identify patients and to motivate them to seek treatment at places where it would be practical. In essence, these camps were "awareness-cum-motivation" camps, with the only intervention being the start of treatment.

Para-institutional Care: A Half Way Home (HWH) is a rehabilitation centre for people who no longer need the full services of a hospital or other institution but are not yet ready to return to their communities, such as patients with mental illness or drug addicts. HWH helps those who have left highly organised institutions reintegrate into society and conform to its acceptable norms.

School Mental Health: The field of child and adolescent psychology is underdeveloped in India. The need for psychiatric treatments is great given that 15% of the population is thought to have psychiatric conditions and that 47% of the population is under the age of 19.

2. Explain the concept of counselling and guidance and describe its assessment techniques.

Ans) The terms Counselling and Guidance are used frequently in our day-to-day interactions; however, there is a need to be clear about their meaning, nature and scope when we use the terms in a professional way. Here, we can distinguish between informal and formal counselling and guidance. The former refers to counselling and guidance given to us by our parents, friends, teachers and the elderly whenever we are in any difficult situation or are depressed and frustrated or want direction and suggestion.

Here, based on their experience and expertise, they provide counselling and guidance to us. Whereas formal counselling and guidance is provided by a person trained in counselling in a professional setting with an aim to enable the person to address his or her problems and difficulties. The goal of professional counselling and guidance is self-direction, self-realisation, self-dependent, ultimately leading to becoming a fully functioning person. Counselling is thus a helping relationship which enables the person to help himself or herself.

The guidance counsellor helps the person to understand his or her needs, interests, aptitudes, aspirations and goals on the one hand; and his/ her situation and role in the family, community and the society on the other hand; and then arrive at an appropriate decision, choice and action. Thus, counselling and guidance helps us to make intelligent choices, decisions and plans. Counselling and guidance is not giving opinion, advice or providing instruction; nor it is influencing the other person’s beliefs and attitude. It is a professional relationship where the counsellor listens to the client actively and helps him/ her to understand and/ or improve his/ her behaviour, character, values and life situation. It is a facilitative relationship that allows the client to explore possibilities and alternatives so that appropriate steps and decisions can be taken.

Counselling is both an art and science. It is both a process and an action. In order for the counselling to be effective, the process through which counselling takes place needs to be effective and fulfil certain conditions to create a proper therapeutic environment/ counselling climate so that the counselling goals can be reached. It is the ability to listen and respond in a way that will help others understand their situation, solve their own problems and realise their potentials. It is the art of helping others arrive at an appropriate and effective solution/decision by their own analysis of the situation and facts. This requires skilful use of counselling skills without an attempt to influence the values and beliefs of the client. At the same time, counselling needs to follow certain steps and techniques in a systematic manner and there needs to be clear defining of roles and responsibilities of both counsellor and client. The counselling process needs to be structured with time limits and role limits being clearly specified.

Assessment Techniques In Counselling And Guidance

Interview

Interview is one of the most commonly used assessment tool. Counsellors use interview method to help gather information about clients and clarify results of other assessments. After establishing rapport, the counsellor engages in what is called intake interview or history taking in which detailed history of the client both in the past and the present is collected. In addition to the background data of the client, the appearance and behaviour of the client are also noted. History taking is the first important step to understand and analyse the problem. Data regarding different aspects of the client’s life is collected such as, information about the family, client’s educational history, medical history, work experience, social relationships, client’s behaviour, attitudes, values, coping strategies and strengths etc.

The counsellor should keep note of the following aspects during the interview:

1.  Verbal: What does the customer say?

2. Para-verbal: What does the client say, and how? What are the volume, words used, speed, tone, etc.?

3. Non-verbal: What stances and motions does the client make? What are they saying?

4. Situation: What is the aim of the interview and where is it held?

Due to the client's greater influence over the interview's topic and flow, unstructured interviews offer flexibility. Structured interviews adhere to predetermined procedures and questions and are rigorously planned and structured. In this case, more open queries are used.

Observation

Counsellors need to be adept observers who can deduce important details from observing a client's nonverbal behaviour.

These are the behaviours to look out for:

1. Appearance: Is the client neat or messy, at ease or agitated?

2. Does the patient sit or stand properly?

3. Are you keeping your gaze fixed on the client?

4. Does the customer appear disturbed, restless, nervous, etc.?

5. Do the client's movements convey anything?

Nonverbal clues play a key role in revealing the client's affective or emotional traits. Using behavioural observations in clinical settings can improve interview data or assess treatment results. There are numerous observation methods, such as: Four different categories of observation exist: A wide variety of behaviours can be observed through naturalistic observation, which observes behaviour in its natural setting; participant observation, in which the observer is also a participant and thus gets an insider's perspective on the situation; structured observation, in which the influence of outside factors that might affect the behaviour is controlled; and (d) unstructured observation.

Case Study

Case studies are used to analyse a specific situation or one specific person in depth. The idiographic method, commonly referred to as the case study approach, has its origins in clinical medicine. For data collection in case studies, a variety of methods are used, such as questionnaires, interviews, observations, diaries, psychological tests, etc. Background information is gathered, along with details about one's family background, career history, medical history, and interests and personality traits.

Psychological Tests

Psychological tests can be used to measure a sample of behaviour objectively and consistently. The word "standardisation" is important here since it indicates that the test is distinguished by a uniform process for administration, scoring, and interpretation. A good psychological exam must evaluate the things it promises to assess and be trustworthy. It should also abide with the law. Among the different psychological exam categories are assessments of aptitude, attitude, interest, achievement, personality, and IQ. These exams may be verbal, nonverbal, or performance-based, and they may be administered alone, in groups, or both.

3. Discuss the meaning, importance and process of documentation in mental health.

Ans) A group of documents that are delivered on paper, online, or through digital or analogue media, like CDs or audio tapes, can be referred to as documentation. The use of paper documents is dwindling. Information on computers is now being used more often in many large hospitals. Three domains can be distinguished in computer processing of medical data: inputs, storage, and output. Although the term "Information Science" was introduced in 1968, the term "documentation" is still often used.

Documentation, broadly speaking, is any communicative material used to describe certain characteristics of an item, system, or technique. The long-term viability of the data acquired depends heavily on the documentation. Documentation should be created in a way that makes it possible for others to use it as a resource in the future. A data collection's contents, provenance, structure, and the terms and conditions that govern its use should all be described in the documentation. It should be broad while also providing in-depth information. Additionally, documents should continue to be readable and distinguishable.

Information may arrive in different flows and waves, and it must be filtered, categorised, and arranged so that it is usable for a variety of purposes at various times. An improved labelling system is required to enable the availability and accessibility of information packages in document formats, which may aid in more rapid and effective retrieval. In other words, each document or piece of documentation will need to have a label that reflects the information's character using qualitative reasoning.

Documentation organised and compiled in accordance with this point of view also serves as a remarkably rich reservoir for collective memories inside an organisation and establishes the backdrop for comprehending both the present and the past. Consistency and close attention to detail are essential for maintaining excellent documentation. We produce, offer evidence, and transmit information through documents.

Importance of Documentation in Mental Health

Continuity of Care: Records give a case history that includes details on the illness, the sociodemographic profile, and past illnesses. These details are gleaned from a variety of sources, including family members and previous records. This is crucial for individuals with psychiatric diseases who need holistic treatment, long-term management, complex demands, or both. Particularly in situations where there is an emergency and the staff member in charge is not present, accurate and current recordkeeping is crucial. In order to maintain coordinated treatment rather than fragmented care and to be able to provide pertinent patient information at any time, good records and documentation will make communication between practitioners easier.

Better Patient Care and Better Service Delivery: Improved patient care, better long-term management, the creation of management plans, and the addition of cautionary remarks can all result from thoroughly documented records. Additionally, aggregated patient data can help with service planning and the creation of uniform treatment practises. In order to perform evidence-based research, the information gathered serves as main data. In order to provide quality documentation, the following details must be included.

1. Patient Assessment: The patient's concerns and medical history, medication history, and the results of the physical examination should all be clearly documented in the record.

2. Plan of Care: The patient's concerns, planned actions, ordered studies, obtained consent, and prescribed treatments or medications should all be documented.

3. Patient Progress Notes: Should include a summary of any modifications to care plans, all referrals and consultations, all findings, patients' reactions to therapy, and any possible drug adverse effects.

4. Patient Discharge Plan: a summary of the directions and information given to the patient and their next of kin, as well as any letters and prescriptions for follow-up care.

Process of Documentation in Mental Health

The general health care system must include mental health because it is interrelated with and not separate from physical health. The foundation of delivering healthcare is documenting what is seen, observed, interpreted, diagnosed, planned, managed, and executed. Thus, documentation is a crucial component of mental health services. The patient presents with a valuable collection of information that only retains its significance when it is accurately documented and may be reviewed at a later time for confirmation or assessment of symptoms. It's crucial to remember that the documentation is completely private. The patient's privacy must be respected, and the patient's notes must be kept private.

The patient's ailment is recorded in the documentation, which also contains sociodemographic information. This information aids in our comprehension of the patient's sociocultural surroundings and background, as well as the types of medical care, social support, and rehabilitation facilities that may be considered while managing long-term patient care. Since the delivery of mental health services takes a holistic approach to addressing the patient's family and wider sociocultural context, In mental illness, it's crucial to note any additional medical illnesses.

A crucial component of keeping an accurate clinical record of a patient's disease is collecting a thorough clinical history, history of prior illnesses, including medical, treatment, and psychiatric history, education, occupation, and personal history, as well as a complete family history. It is crucial to record the patient's presentation by performing a thorough mental state evaluation after taking down the patient's basic medical history and performing a general physical examination. It serves as a crucial pillar that advances the process of patient diagnosis.

As much as possible, the history must be recorded verbatim from the patient rather than immediately recording the physician's findings or impressions. Making an objective interpretation of the patient's clinical situation depends on this. Once everything has been evaluated, a diagnostic formulation is created, often containing the information from the history and examination that allowed us to make a diagnosis. When creating a management strategy, this is useful.

In order to manage the patient, assess the treatment plan, support a provisional diagnosis, and determine the illness' prognosis, the treating team finds the full history, examination details, and diagnostic formulation to be of enormous value. In medico-legal cases, mental health documentation is equally important. The patient records should clearly describe any drug changes, treatment changes, and diagnostic challenges because they can be a useful tool in dealing with medico-legal difficulties. The longitudinal course of the illness must be kept in mind in order to fully understand the illnesses in psychiatry. As a result, it may be necessary to update the diagnosis or alter management, all of which need to be properly documented. If more than one mental health expert is treating the patient, it aids in providing the best care possible as well as creating a solid record that helps with interpersonal communication. Consistency of care should always be ensured by the quality of the record.

SECTION B

Answer the following questions in 400 words each. 5 x 5 = 25 Marks

4. Describe the myths and misconceptions about mental illness.

Ans) Identifying and dispelling common misunderstandings about mental diseases is the first step in fostering social responsibility toward them. Because of the lack of knowledge regarding mental disorders and their causes, there may be many myths and misconceptions concerning mental health. The general population frequently misunderstands the causes of mental diseases and associates them with ghosts and evil. The causes must be understood in order for the treatment to be understood. The perception of mental diseases and those who have them is distorted by a number of misconceptions and beliefs.

"Myth refers to a storey of forgotten or vague origin, primarily religious or supernatural in nature, which strives to explain or rationalise one or more features of the world or a community," according to Bascom W. In addition to myths, it's critical to comprehend the idea of beliefs. A belief is a subjective mental interpretation generated through perception, reflection (reasoning), or communication is described as "a conviction of the truth of a claim without its verification." According to a study, 43.2 percent of urban participants, 36.9 percent of rural participants, and 44.7% of medical professionals said they would be against getting married to someone who had recovered from a mental illness.

In the same study, one-third of the participants said they would not feel at ease conversing with a recovering individual. This suggests that stigma and prejudice, in addition to the evident pain brought on by mental diseases, can carry a hidden burden. The stigmatisation of those with mental problems has endured throughout history in both high- and low-income nations. Many people still believe that supernatural forces are the primary cause of mental disease more than a few decades after it was first reported. There are also other misconceptions about what causes mental illness. One of the most significant myths about the cause of it is that it is caused by poor parenting, air pollution, loss of sperm, poor diet, prior sin, the curse of God, or the evil eye.

Myths and misunderstandings about mental illness add to the stigma, which makes many people humiliated and discourages them from getting assistance. Stigma is a mark of shame or dishonour on someone, anything about them that severely lowers their social standing.

The following are some common misconceptions and beliefs concerning mental illnesses:

1. People who suffer from mental illnesses or problems are stereotyped as being unmotivated, violent, intellectually lacking, and useless.

2. Mentally ill people are unpredictable and cannot be trusted with any activity.

3. Mental illnesses are incurable.

4. Metal ailments are caused by evil and possessions.

5. Mental illness is a result of sins committed in former lives or is a retribution from God.

There are also a lot of false beliefs about treatment. These myths are not just popular among those with lower socioeconomic status or less education; many highly educated people also hold them.

5. Explain the community mental health in Indian context.

Ans) In India, community mental health has a completely different history than in the West. People with mental illnesses have long received treatment in the community in India. Usually, the family, the greater community, and traditional healers took care of such people. Initially by the British East India Company and then by the nation's colonial rulers, asylums that would eventually become mental hospitals were established in India, mostly for British soldiers and citizens who had mental illnesses. After India's independence, more mental hospitals were constructed as well. Involving family members of patients was the subject of radical reforms that were started in mental hospitals in Amritsar, Agra, and some other facilities, including Vellore, as early as the middle of the 1950s and 1960s.

The Community Mental Health Unit at NIMHANS created a method and strategy for integrating fundamental mental health treatment with the already-available general healthcare services in India in the late 1970s and early 1980s. It was initially tested in a number of PHCs in the state of Karnataka before being made available to the entire Bellary district. The Ministry of Health and Family Welfare, Government of India, approved the overall approach that developed after five years of testing in Bellary as the "Bellary Model" of District Mental Health Program (DMHP) for phased countrywide adoption as a fully centrally sponsored programme. In India, the era of communal mental health had so quietly started.

One of the first emerging nations to create a national mental health programme was India in 1982. (NMHP). However, the Government of India has only approved budgetary allocations for the NMHP from 1996–1997, throughout the ninth (1997–2002), tenth (2002–07), and eleventh (2007–12) Five Year Plans.

The DMHP was developed to determine whether basic mental health services could be made available to the entire district. Prior to this, the population served by primary health centres had the majority of the experience with the integration of mental health care into primary healthcare. The DMHP was implemented in several states across the nation as a result of its success in Bellary.

The DMHP's objective is to provide additional mental health services to district residents with mental illnesses by utilising the existing facilities and medical staff. The needs of people with epilepsy, substance use disorders, psychosis, depression, neurosis, mental retardation, and other childhood mental health issues should be met by the mental health services. To enable the trained PHC staff to offer comprehensive care to the population, support and monitoring must be given to them on a regular basis. The growth of manpower, the accessibility of medications, the availability of treatment facilities, and awareness of mental disease and its treatment are all roles played by DMHP in community mental health.

In order for all five of these components to be well welcomed by the community, a community's leaders and representatives, such as the "Village Panchayat," "Sarpanch" (in rural areas), Municipal Councillors (in urban areas), etc., have a greater responsibility in promoting excellent mental health.

6. Explain Rehabilitation Council Act of India.

Ans) The 1992 Rehabilitation Council of India Act addresses the creation of a workforce for the provision of rehabilitation services. It was established in order to establish the Rehabilitation Council of India, which will oversee professional rehabilitation training, the upkeep of a central rehabilitation register, and other related matters. "To provide quality services to persons with disabilities, matching the best in the World," reads the body's mission statement. In order to broaden its scope, the RCI Act was revised in the Parliament in 2000. As a result, RCI in 2000 expanded its coverage to include disabilities brought on by mental illness.

According to this Act, a person who is:

1. Visually impaired.

2. Hearing impairment.

3. Unable to move because of a disability.

4. Exhibiting mental retardation

There are three chapters in the Act. The "Preliminary Chapter" is Chapter I. It includes details on the title, definition, etc. The "Rehabilitation Council of India" is discussed in Chapter II. It includes information about the constitution, the terms of office holders, executive committees, vacancies, and the dissolution of the council, among other things. The "Functions of the Council" are covered in the third Chapter.

It includes information on all of the Council's duties, including professional registration, professional behaviour, university acknowledgment of academic credentials, and facilities for test inspectors. The fact that the Council's staff would be public servants is also highlighted. This Chapter also discusses the framework for rules and regulations, including rules and regulations that must go before the Parliament.

The main government organisation, RCI, was established by an act of parliament to oversee training initiatives and courses geared toward underprivileged, disabled, and communities with specific educational needs. The Central Rehabilitation Register, which primarily contains information about all competent professionals who run and provide training and educational programmes for the targeted communities, must be kept up to date by this one and only statutory council in India.

The Rehabilitation Council of India (Amendment) Act, 2000 was introduced and subsequently notified by the Indian government in the year 2000. The Rehabilitation Council of India Act, 1992, was amended to bring definitions and debates under the purview of a bigger law, the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995.

Professionals who are eligible to apply for RCI accreditation include those in the following categories, according to RCI:

1. Orthotists and prosthetists

2. Speech therapists and audiologists.

3. clinicians in psychology.

4. Rehabilitation administrators and counsellors.

5. Managers of rehabilitation workshops.

6. psychologists for rehabilitation.

7. Social workers in rehabilitation.

8. mental retardation rehabilitation specialists.

9. speech therapists

10. Special educators and trainers for the handicapped.

11. Career counsellors, employment specialists, and placement specialists.

12. Multifunctional rehabilitation technicians and therapists.

13. specialists in orientation and mobility.

14. Professionals in community-based rehabilitation.

15. technicians for ear moulds and hearing.

16. Engineers and technicians in rehabilitation

7. Describe Indian Disability Evaluation and Assessment Scale (IDEAS)

Ans) Mental illness is recognised as a disability under the 1995 Persons with Disabilities Act. The Persons with Disability Act of 1995 allows those who suffer from mental illness to receive all of its benefits. To qualify for payments, disabled individuals must present a disability certificate from the appropriate authority demonstrating a greater than 40% disability.

Assessment methods currently exist for people with mental retardation, physical disabilities, vision impairment, and hearing impairment. These people have disabilities that have been certified by an authorised organisation, making them eligible to receive benefits under the PWD Act of 1995. But despite having a disability, those with mental illnesses could not be certified and were not eligible for any benefits. The assessment technique for disability certification was created by the rehabilitation committee of the Indian Psychiatric Society in 2002. Indian Disability Evaluation and Assessment Scale is the short name for this tool (IDEAS). To make IDEA use simple, the committee has created explicit rules.

General Guidelines

1. The most effective tool for determining and certifying disability is IDEAS.

2. As a result, it is a quick and easy tool that may be utilised even in hectic clinical situations.

3. The use of IDEAS requires some training.

4. Only community members and patients who are receiving care at home should utilise this. Not suitable for patients who are in.

5. Only the primary care providers' interviews should be used as the basis for rating. Information can be supplemented using case files and patient interviews.

6. Only rarely, when there is no primary care provider accessible, may the rating be made solely on the patient interview. Then, this needs to be recorded.

7. For convenience, all genders are referred to by the gender designation "he."

8. Probe questions support interview navigation and aid in spotting activity dysfunction in one or more areas.

Diagnostic Categories

Patients are only qualified for disability compensation if they have the following diagnoses according to ICD or DSM standards:

1. Schizophrenia.

2. Bipolar illness

3. Dementia.

4. Disorder of compulsive obsession.

Duration of illness: The disease should have lasted at least two years in total. The number of months the patient experienced symptoms over the previous two years (MI 2Y - months of illness over the last two years) should be established for scoring purposes.

Assessment Conduction

Only a psychiatrist is qualified to diagnose and certify. The administration of IDEAS can be done by qualified social workers, psychologists, or occupational therapists.

Frequency of Re-certification

Every two years, Psychiatric Disability will be revaluated and re-certified. But it will be necessary to assess whether doing this in rural areas is even possible.

8. Describe various schools of psychotherapy.

Ans) There are several schools of psychotherapy; let's go over each one individually.

Psychodynamic Therapy

The foundation of psychodynamic theory is laid by Sigmund Freud, who focused on giving the client more ego power and/or relieving them of the strain of suppressed urges so that they may be free to live their own lives. The foundation of psychodynamic therapy is the idea that issues arise as a result of unresolved, frequently unconscious tensions that often date back to infancy. The clients of this therapy benefit from increased comprehension and coping skills.

Behaviour Therapy

The major focus of behaviour therapy is to alter or modify harmful behaviour. Maladaptive behaviours are detected during this psychotherapy and then replaced or adjusted using a variety of strategies. Behaviour therapy has benefited greatly from learning theories. Also notable are Ivan Pavlov's contributions to classical conditioning and B. F. Skinner's to operant conditioning.

Following are a few of the methods employed in behaviour therapy:

1. Simple Extinction

2. Aversive Conditioning

3. Response shaping

4. Assertive Training

5. The Token Economy

6. Modelling:

7. Systematic Desensitization

8. Implosive Therapy

Humanistic Psychotherapy

The primary focus of humanistic treatment is on the client's conscious, subjective experiences. The therapist concentrates more on the here and now. The client participates much more actively than the therapist, who mostly maintains a supportive environment. Carl Rogers' client-cantered therapy is the most common type of humanistic therapy.

Client Cantered Therapy, or more lately Person Cantered Therapy, is the name of Carl Rogers' form of psychotherapy. This therapy primarily emphasises empathy, the therapist's unconditional positive respect for the client, and the therapist's expression of empathy and unconditional positive regard to the client.

Existential Psychotherapy

Existential approaches to psychotherapy have a tendency to appear when there is a groundswell of interest in existential philosophy, as well as in certain parts of the world. Rollo May and Frankel made the biggest contributions. Existentialism is a philosophy that explores the purpose of life. They hold that people's freedom to pick from the options accessible to them has a significant impact on how they shape their own moral dilemmas falls under Logotherapy. in terms of what life means to him.

Gestalt Therapy

Germany gave birth to Perls' Gestalt treatment. This therapy was developed in part by Gestalt psychologists Wertheimer, Koffka, Kohler, Lewin, and Goldstein. Gestalt theory emphasises organisation and relatedness, which contrasts with Wundt-reductionism Tichner's and mechanical behaviourism. When applied to human life, this theory integrates the various dynamic, affective, cognitive, and social aspects into one whole before being understood as a complete unity.

Interpersonal Therapy

Based on the theories of Harry Stack Sullivan, Gerald L. Klerman and Myrna Weissman provided interpersonal therapy. As the name suggests, the main focus of this therapy is on the client's current and previous social roles and interactions. During treatment, one or two issues the client is currently dealing with are taken into account. Conflicts with friends, family, or even co-workers are a concern. Additionally, it can assist people in coping with loss and sadness.

SECTION C

Answer the following questions in 50 words each. 10 x 3 = 30 Marks

9. Community care of mentally ill.

Ans) Community mental health care includes provision of crisis support, protected housing, and sheltered employment in addition to management of disorders to address the multiple needs of individuals. Community-based services can lead to early intervention and limit the stigma of treatment. They can improve functional outcomes and quality of life of individuals with chronic mental disorders and are cost-effective and respectful of human rights.

10. Domestic Violence Act.

Ans) The Indian government implemented the Protection of Women from Domestic Violence Act 2005 on October 26, 2006. The Act was approved by the Parliament in August 2005, and on September 13, 2005, the President gave his assent. In contrast to the old law, Section 498A of the Indian Penal Code, the Protection of Women from Domestic Violence Act of 2005 expressly specifies domestic violence in addition to cruelty linked to dowries.

11. Importance of community based research.

Ans) The importance of community based research is as follows:

1. Understanding of risk and protective variables in the social contexts that contribute to the development of prevalent mental diseases.

2. to lower the risks through focused action.

3. Building of a partnership or alliance where teams from academic institutions and the community collaborate to address issues of shared interest and decide on the posing of pertinent questions and the speedy dissemination of research findings.

12. Psychosocial rehabilitation

Ans) Rehabilitation for those with mental illnesses is incredibly challenging. It is impossible to exaggerate how crucial psychosocial rehabilitation is to the wellbeing of both the patient and the carers. Techniques like social skill training and occupational rehabilitation are extremely beneficial for those with mental illnesses. The disability of mental illness has only recently attracted notice.

due to mental illness and rehabilitation of the mentally ill is concerned.

13. Mental fitness certificate

Ans) The only medical experts who are asked to create legally binding documents that are frequently produced before courts and that might influence a person's life and liberty as well as his or her choices are psychiatrists. Unless it can be demonstrated otherwise, it should be accepted that a person with a mental disorder has the mental capacity to make decisions about a variety of issues.

14. Aims of psychotherapy.

Ans) Psychotherapy is more than just a discussion about an issue between two people. It is a cooperative effort directed toward certain therapeutic goals that was initiated and maintained on a professional level. These include eradicating current symptoms, altering current symptoms, delaying current symptoms, mediating problematic behavioural patterns, and fostering healthy personality development.

15. Individual and group therapy.

Ans) The focus of individual therapy is on one-on-one communication between the client and the therapist. The client receives the therapist's full and undivided attention, which enables him or her to successfully address the client's particular issues. Between three and fifteen clients participate in group therapy sessions, which are held concurrently. Because the patients may communicate, relate to one another, and understand one another's difficulties, this type of treatment is successful in giving the client group support.

16. Automatic thoughts

Ans) Automatic thoughts don't come from thought or logic. It is situation-specific and quickly, automatically, and involuntarily springs to mind. Both internal and external events have the potential to start it. People without psychological discomfort are not the only ones who have automatic thoughts; they can happen to anyone. For instance, a student reading a chapter might have the automatic thought, "I don't understand this," which might make them feel a little uneasy. He might, however, immediately reply to the idea in a positive way by saying, "I do understand some of the chapter; let me read the chapter again." It's typical to automatically assess reality and react to unfavourable thoughts in this way.

17. Positive mental health

Ans) Good mental health,  according to the World Health Organisation, is defined as a state of well-being where individuals are able to:

1. Realise their own potential

2. Work productively

3. Cope with the normal stresses of life

4. Make a positive contribution to the community.

Mental and psychological well-being encompasses the way you feel about yourself, but also the way you deal with external situations and the quality of your relationships.

18. Policies and planning

Ans) Policies can be defined as broad assertions about what is understood, which aid in decision-making and are based on aspirations, beliefs, commitments, assessments of the present situation, and ideas about desired future behaviour. Planning can be defined as the process of making decisions that must be made later rather than now. It deals with choices for goals, actions, resources, implementation, and assessment.