Mental Disability: A Retrospective Study of Socio-Clinical Profile of Patients Seeking Disability Certificate at a Tertiary Care Centre in Delhi

Abstract

Background: Mental illness and mental retardation are included in persons with disabilities (Equal opportunities, protection of rights and full participation) Act, 1995” along with other causes of disabilities like blindness, hearing impairment, locomotor disability etc. The persons with disability are eligible for various social welfare benefits from the Government under this act if they have minimum 40% disability as certified by a Government medical authority . This is among one of the few studies on various mental disability related variables and socio-clinical profile of disability certificate seeking patients and is probably the only one to compare results with a similar kind of study done at the same centre five years ago. Objective: The study aims to assess the socio-demographic profile of the cases, severity of disability in the mentally retarded and mentally ill, co-morbid psychiatric and medical conditions, pattern of utilization of different government benefits and to compare results of current study with a study done at the same centre five years ago. Materials and Methods: The study was carried out in the Department of Psychiatry of a tertiary care multispecialty teaching hospital in New Delhi. This was a retrospective file-review based study of patients who were issued disability certificate for Mental retardation or Mental illness during January, 2015 to May, 2016. The subjects were diagnosed to be suffering from Mental retardation or Mental illness as per ICD-10 and disability was assessed as per guidelines issued by Government of India in 2001 for Mental retardation and for Mental illness in 2002. Indian Disability Evaluation and Assessment Scale (IDEAS) was used to assess disability in Mental illness cases. Statistical Analysis : The statistical analysis was done by using WHO'S Epi Info version 7.2. Frequency, percentages, t test and chi-square analysis were used to analyze the data. Results: Out of total 231 cases, majority were male 163 (70.6%), Hindu 211 (91.3%), under 18 years of age 160 (69.3%), unmarried 228 (98.7%), lived in nuclear family 186 (80.5%), from urban background 137 (59.3%). Total number of cases of Mental retardation were 220 (95.2%), 11 (4.7%) cases were of Mental illness. Severity wise in Mental Retardation group (220 cases) maximum number of cases were of Mild Mental Retardation 94(42.7%) having 50% disability, in Mental illness group 10 out of 11 cases had moderate disability (40-70% disability as per IDEAS Scoring). Medical co-morbidity was present in 22(9.5%) cases mainly in the form of Cerebral palsy, Epilepsy; 24(10.4%) patients had psychiatric co-morbidity in the form of Behavior problems, Attention Deficit Hyperactivity Disorder (ADHD), Conduct disorder. Maximum number of patients 177(76.6%) applied to get Monthly allowance. On comparison with a similar study done at the same centre five years back, the significant difference was low mean age of sample and increased rural representation in the present study and both the differences were statistically significant. Conclusion: Number of patients seeking disability certificate has risen as compared to previous study. Majority of the cases were male, mostly from urban background although rural representation in comparison to previous (2011) study has increased significantly. Cases of Mental Retardation outnumbers patients with Mental illness seeking disability certificates reflecting more number of Mental illness cases seeking treatment early in the course of illness and availability of better treatment options. Information related to disability and various beneficiary schemes by Government of India needs to be provided in detail so that maximum number of cases can avail other benefits along with monetary one.