Persons With Mental Illness Research Articles

Mental illness stigma\u2019s reasons and determinants (MISReaD) among Singapore\u2019s lay public \u2013 a qualitative inquiry

BackgroundMental illnesses pose a significant burden worldwide. Furthermore, the treatment gap for mental disorders is large. A contributor to this treatment gap is the perceived stigma towards mental illness. Besides impeding one’s help-seeking intentions, stigma also impairs persons with mental illness (PMI) in other aspects of their life. Studies have found that stigma may manifest differentially under different cultural contexts. Thus, this study seeks to elucidate the determinants of stigma towards PMI among lay public in Singapore using a qualitative approach.MethodsA total of 9 focus group discussions (FGD) were conducted with 63 participants consisting of lay public Singaporeans who were neither students or professionals in the mental health field, nor had they ever been diagnosed with a mental illness. Topics discussed during the FGD were related to the stigma of mental illness. Data collected were analyzed with inductive thematic analysis method. A codebook was derived through an iterative process, and data was coded by 4 different coders. Both coding and inter-rater analysis were performed with NVivo V.11.ResultsIn total, 11 themes for the determinants of stigma were identified and conceptualized into a socioecological model. The socioecological model comprised 4 levels of themes: 1) Individual level beliefs (fear towards PMI, perceiving PMI to be burdensome, dismissing mental illness as not a real condition), 2) Interpersonal influences (upbringing that instills stigma, intergroup bias, perceived inability to handle interactions with PMI), 3) Local cultural values (elitist mindset among Singaporeans, Chinese culture of “face”, Islamic beliefs about spiritual possession and reaction towards PMI), and 4) Shared societal culture (negative portrayal by media, Asian values).ConclusionsThe findings of this study improved our understanding of the various reasons why stigma exists in Singapore. The themes identified in this study concur with that of studies conducted overseas, as some determinants of stigma such as fear towards PMI are quite ubiquitous. Specifically, the themes elitist mindset among Singaporeans and perceived inability to handle interactions with PMI were unique to this study. It is highly recommended that future anti-stigma campaigns in Singapore should incorporate the findings of this study to ensure cultural misgivings and beliefs are addressed adequately.

Profile of recipients of holistic health counselling in a psychiatric OPD in South India.

Persons with mental illness (PwMI) are prone to weight gain as a side effect of antipsychotics. Health counselling on diet, physical activity, medication adherence, expressed emotions and technology use, by health professionals, can help in managing these side-effects. The aim of this study was to identify the pre-counselling profile of the subjects such as body mass index (BMI), diet, physical activity, medication adherence, expressed emotions and technology use among PwMI; to attend the Holistic Health Clinic as part of follow-up services in the psychiatry Outpatient Department (OPD) as well as to find correlation and association between the study variables. The study involved a cross-sectional descriptive design based on convenience sampling. The sample consists of 56 patients who are receiving antipsychotics under symptom control (self-reported) and were overweight. Data were collected with a patient assessment proforma and analysed using SPSS-22. The patients referred to the holistic health counselling (HHC) had abnormal weight and BMI. The mean and SD of weight was 74.48 ± 14.07 and BMI 29.51 ± 5.15. All the participants received counselling on diet, 87.5% on physical activity, 62.5% on sleep hygiene, 55.4% on medication adherence, 8.9% on family emotional climate and only 5.4% on healthy use of technology. Weight has shown significant relation with gender (male = 80.84 ± 17.71, female = 71.09 ± 10.52, t = -2.52, p = .015) and near to significant relationship (χ2 = 7.685, p = .053) with educational status. Patients receiving second-generation antipsychotics (SGA) have lesser extra pyramidal side-effects; however, they are more prone to gain weight. Proper screening and counselling during the follow-up visit in the outpatient setting can help in identification, prevention and management of the obesity-related metabolic syndrome and cardiovascular disease (CVD), and motivate them to adopt healthy behaviours.

A comparison of criminogenic risk factors and psychiatric symptomatology between psychiatric inpatients with and without criminal justice involvement.

Research suggests distinct criminal risk factors, not mental illness, are more strongly associated with most criminal behaviors. This notion has been supported among inpatient persons with mental illness (PMI) when examining antisocial cognitions; however, other key criminogenic risk factors (the Big Four and Central Eight risk factors) have not been examined among psychiatric inpatient PMI. We hypothesized that criminal justice (CJ)-involved PMI would endorse significantly greater criminogenic risk compared to non-CJ-involved PMI and that these risk factors would significantly and accurately identify whether PMI had CJ involvement. Additionally, we hypothesized that PMI with and without a history of CJ involvement would not significantly differ on their reported psychiatric symptomatology. We examined all Central Eight criminal risk factors and psychiatric symptomatology among psychiatric inpatient PMI (N = 142) with (n = 74) and without (n = 68) CJ involvement histories. Multivariate analysis of variance and discriminant function analysis indicated significant differences between the Big Four and Central Eight criminal risk factors when classifying CJ and non-CJ groups. The Big Four risk factors correctly classified 85.9% of participants, and the Central Eight correctly classified 99.3% of participants into CJ and non-CJ groups; however, psychiatric symptoms only correctly classified 57.7% of participants into CJ and non-CJ groups. Criminal risk factors appear to be more strongly associated with CJ involvement among PMI than psychiatric symptomatology; therefore, psychotherapeutic intervention on criminal risk factors, not only mental illness, may decrease criminal recidivism among CJ-involved PMI. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effectiveness of Domestic Skills Training on Well-Being Among the Persons with Mental Illness Attending Psychiatric Rehabilitation Service

The process of psychiatric rehabilitation is collaborative, person-directed, and individualized. There is need for practice-based evidence for cost effective and resource efficient rehabilitation interventions which can be replicated in resource constrained settings. To examine the effectiveness of domestic skills training on well-being among persons with mental illness attending psychiatric rehabilitation services. Pre-experimental (one group pre-test, post-test) study with purposive sampling was used. 31 persons with mental illness (PWMI) (as per ICD-10) attending psychiatric rehabilitation services at a tertiary care centre were included in the study. Warwick–Edinburgh Mental Well-Being Scale was used to assess wellbeing. PWMI were trained in domestic skills including sequence of preparing tea/coffee, etiquettes of serving, budgeting/managing finance, and getting feedback from the consumers. The training was conducted in five sessions including demonstration by PWMI. After baseline assessment, post-test and follow up was conducted after 2nd and 4th week of training. Analysis was done by repeated measure of ANOVA. Domestic skills training improved wellbeing among PWMI. The association between wellbeing and sociodemographic characteristics was not significant. It indicates that improvement in mental wellbeing might have taken place due to training methodology.

Perception of Expressed Emotion Among Persons with Mental Illness

Expressed emotions refer to the affective attitudes and behaviors of relatives toward a family member. It has both positive and negative elements. It can be seen as an indicator of ‘emotional temperature’ in the home. The current study aims to explore persons with mental illness (PwMI) perception of expressed emotions in their relative and understand the family environment and factors related to it. An exploratory qualitative research study was conducted using focus group discussion among 18 PwMI who receive psychiatric rehabilitation services in a tertiary level psychiatric hospital in southern part of India. The collected qualitative data used thematic analysis with Atlas.ti software. Five major themes were identified from the study results. They are: Concept of illness, Negative elements of EE, and Positive elements of EE, Factors influencing the nature of EE and Future apprehensions. The present study explored patient’s perception of expressed emotions. Patients hailing from non-therapeutic family emotional climate may benefit from approaches aimed at reducing their vulnerability to a dysfunctional family environment.

Change in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project.

Accredited Social Health Activists (ASHAs) play an important role in health care in rural India. To study the change in attitude of ASHAs towards persons with mental illness (PMI) after involvement in a community-based rehabilitation program. ASHAs (n = 95) were trained to identify and refer PMI. Community Attitudes to Mental Illness scale was administered at baseline and after 18 months of training. Domains of benevolence, social restrictiveness, and community mental health ideology showed significant improvement p < 0.001. There was no change in authoritarianism domain. Engaging ASHAs in identification, referral and treatment positively changes their attitudes towards PMI.

The ethics of psychiatric care and research in resource-poor settings: The case of a research trial in a prayer camp in Ghana.

A communication in the January 2018 issue of the British Journal of Psychiatry detailed a clinical trial on persons with mental illness (PWMI), some of whom were in chains in a prayer camp setting in Ghana. The camp's advertised mission statement was to "set free those held captive by Satan" through its "ministry of fasting and prayer". This article considers the potential ethical problems raised by the clinical trial on chained PWMI against the background of Ghanaian ethnoanthropological beliefs. It highlights two significant categories of ethical issues: first, those associated with standard psychiatric practice in the treatment of persons with severe mental illness (specifically, the issue of informed consent and the use of physical restraint and seclusion in psychiatric practice); and second, issues pertaining to the study under discussion (specifically, issues of study methodology and the principle of equipoise; biological determinism as against the multifactorial paradigm of mental illness/practice, implied or assumed; misalignment between the research methodology, results, and the underlying aim of the study, bordering on epistemology and pragmatism/values; and finally, the association of the trial researchers with the practice of chaining). This article, in highlighting the ethical issues raised by the clinical trial in question, attempts to suggest what Ghanaian healthcare professionals, policymakers, and the national government can do (and how) to institute workable, enforceable measures towards ending the practice of chaining PWMI in Ghana.

Mental Healthcare Act 2017 - Aspiration to action.

There is no health without mental health. Recently conducted National Mental Health Survey quoted a prevalence of 13.7% lifetime and 10.6% current mental morbidity. To address this mammoth problem, an aspirational law was enacted titled “Mental Healthcare Act, 2017” (MHCA 2017). The act is progressive and rights based in nature. The whole dedicated Chapter 5 on “Rights of the person with mental illness” is the heart and soul of this legislation. However, the act mainly focuses on the rights of the persons with mental illness (PMI), only during treatment in hospital but is not equally emphatic about continuity of treatment in the community. The act fails to acknowledge and foster the role and contribution of family members in providing care to PMI. Although there are many positive aspects to the MHCA 2017, it may impact adversely on the mental health care in India. This article focuses on the shortcomings and challenges of the act and also makes attempts to offer alternatives considering the available resources and ground reality. Concepts such as “Advance directives” and “Nominated representatives” appear to be very attractive, idealistic, and aspirational, but not evidenced based in the Indian context considering the resources. The act fails to make an impact even after 22 months to attain the goal, and will require pervasive efforts to fulfil a purpose that directs its development. This law needs to be amended as per the local resources and requirements of the society.

Persons with mental illness and their caregivers: What do they think, feel, and perceive about marriage?

Introduction: Marriage is an important social institution. It is the basis for the family. The functions of marriage are regulation of sexual behavior, reproduction, nurturance, production of children, and socialization. Stigma associated with mental illness is a major cause for failure of marriage among persons with mental illness (PMI). Perspectives of the PMI and their family members on marriage are not explored in detail. Thus, the current study aimed to explore the perspectives on marriage of PMI and their caregivers. Methodology: Five case studies purposively selected with a significant history of marital failures due to mental illness were analyzed. In addition, three focus group discussions consisting of 17 caregivers were conducted among people who attempted to arrange the marriage for their son or daughter with mental illness. Results: Families experienced major challenges to arrange marriage for PMI; blaming the parents, caregiver burden, reduced social support, and social stigma for the entire family emerged as the major themes. Conclusion: Hence, there is an urgent need to explore the feasibility of psychosocial intervention; focusing on psycho-education on illness, removing myths related to illness and marriage, premarital counseling, and addressing the stigma within the family and in the community are imperative. Psychiatric social workers must take the lead role to address the marriage-related concerns of PMI and their family members.

The Rights of Persons with Disability Act, 2016: Challenges and opportunities.

India signed the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) and subsequently ratified the same on October 1, 2007. The UNCRPD proclaims that disability results from an interaction of impairments with attitudinal and environmental barriers which hinders full and active participation in society on an equal basis. Further, the convention also mandates the signatories to change their national laws, to identify and eliminate obstacles and barriers, and to comply with the terms of the UNCRPD. In this regard, the Government of India initially undertook the amendment of laws such as Persons with Disability Act, 1995 (PWD Act 1995). The Rights of PWD Act, 2016 (RPWD Act 2016) replaced the PWD Act 1995 to comply with the UNCRPD. The new act was fine-tuned considering the socio-cultural and local needs of the society, and the available resources. Persons with Mental Illness (PMI) are often stigmatized and discriminated, which hinders their full and active participation in society. This is a much larger issue, especially in women, gender minorities, backward communities, and the poor and the migrated populations. Adding to the complexities, PMIs are often not aware of their illness, refuse the much-needed treatment and often are not in a place to exercise their rights. There is an urgent need to address this issue of attitudinal barrier so that the rights of PMI are upheld. Hence, this article discusses challenges and opportunities in the RPWD Act 2016 from the perspective of PMI.

Cost estimation for the implementation of the Mental Healthcare Act 2017.

The Mental Healthcare Act, 2017 (MHCA) was a step that was essential, once the Government of India ratified the United Nations Convention on the Rights of Persons with Disabilities in 2007. The MHCA looks to protect, promote, and fulfill the rights of persons with mental illness (PMI) as stated in the preamble of the Act. Further, there is an onus on the state to provide affordable mental health care to its citizens. In India, mental health has always been a lesser priority for lawmakers and citizens alike. The rights-based MHCA looks to overhaul the existing system by giving prominence to autonomy, protecting the rights of the mentally ill individuals, and making the State responsible for the care. The decision to make all this happen is commendable. The annual health expenditure of India is 1.15% of the gross domestic product, and the mental health budget is <1% of India's total health budget. This article systematically analyses and describes the cost estimation of the implementation of MHCA 2017, and it is not an estimation of mental health economics. The conservative annual estimated cost on the government to implement MHCA, 2017 would be 94,073 crore rupees. The present study estimation depicts that investing in the implementation of MHCA, 2017 by the government will yield 6.5 times the return on investment analysis benefit. If the State is not proactive in taking measures to implement the MHCA, the rights promised under this legislation will remain aspirational.

Implications of Mental Healthcare Act 2017 for geriatric mental health care delivery: A critical appraisal.

The prevalence of mental health problems in older adults is increasing globally as well as in India due to population ageing. Mental Healthcare Act (MHCA) 2017 has a rights-based approach and came into force in India in May 2018. Its provisions have significant implications for promoting mental health care and protecting the rights of persons with mental illness (PMI). Older adults with mental health problems such as dementia have a high risk for loss of mental capacity, abuse, violation of their rights, and institutionalization. This act advocates the development of specialized clinical services for the older adults in mental health care institutions. It also recognizes the rights of PMI to access a range of services required, including rehabilitation services. Several provisions of the act, such as those related to mental capacity, advance directive, nominated representative, and responsibilities of other agencies, have specific challenges related to older adults with mental illness. In this article, we present a critical appraisal of the implications of MHCA 2017 in the context of the care of the older adults with mental illness.

Barriers and facilitators to implementing an urban co-responding police-mental health team

BackgroundIn an effort to reduce the increasing number of persons with mental illness (PMI) experiencing incarceration, co-responding police-mental health teams are being utilized as a way to divert PMI from the criminal justice system. Co-response teams are typically an inter-agency collaboration between police and mental health professionals, and in some cases include emergency medical personnel. These teams are intended to facilitate emergency response by linking patients to mental health resources rather than the criminal justice system, thus reducing burdens on both the criminal justice systems as well as local healthcare systems. The current study examines the barriers and facilitators of successfully implementing the Mobile Crisis Assistance Team model, a first-responder co-response team consisting of police officers, mental health professionals, and paramedics. Through content analysis of qualitative focus groups with team members and interviews with program stakeholders, this study expands previous findings by identifying additional professional cultural barriers and facilitators to program implementation while also exploring the role of clear, systematic policies and guidelines in program success.ResultsFindings demonstrate the value of having both flexible and formal policies and procedures to help guide program implementation; ample community resources and treatment services in order to successfully refer clients to needed services; and streamlined communication among participating agencies and the local healthcare community. A significant barrier to successful program implementation is that of role conflict and stigma. Indeed, members of the co-response teams experienced difficulty transitioning into their new roles and reported negative feedback from other first responders as well as from within their own agency. Initial agency collaboration, information sharing between agencies, and team building were also identified as facilitators to program implementation.ConclusionThe current study provides a critical foundation for the implementation of first-responder police-mental health co-response teams. Cultural and systematic barriers to co-response team success should be understood prior to program creation and used to guide implementation. Furthermore, attention must be directed to cultivating community and professional support for co-response teams. Findings from this study can be used to guide future efforts to implement first-response co-response teams in order to positively engage PMI and divert PMI from the criminal justice system.

Crisis intervention team training: when police encounter persons with mental illness

The Crisis Intervention Team (CIT) model is an established training program used to improve police response to encounters involving persons with mental illness (PwMI). Diversion of PwMI from the criminal justice system to appropriate treatment providers in the community is one of the primary goals of CIT. The present study examines characteristics and outcomes of encounters between citizens experiencing mental health-related crises and CIT-trained patrol officers. Findings of this study indicate encounters involving PwMI and CIT-trained officers often result in diversion to mental health services. Implications for policy and future research are discussed.

Effects of a Brief Empowerment Program for Families of Persons with Mental Illness in South Korea: A Pilot Study

ABSTRACTFamilies of persons with mental illness (PMIs) are considered important resources for PMIs rather than as contributors to their mental illness. However, these families experience not only the burden of caregiving but also social stigma and discrimination in various aspects of their lives, and their psychosocial needs tend to be overlooked. This was a pilot study to explore the effects of a brief empowerment program on the empowerment and quality of life of families of PMIs in South Korea. A repeated-measures design with a control group and pre/post-follow-up testing was used. We enrolled 18 participants (experimental group = 9, control group = 9). The experimental group participated in an empowerment program consisting of four sessions over 4 weeks. Data were collected before and after the program, and again 4 weeks later. The χ2-test, Fisher's exact probability test, t-test, and repeated-measures analysis of covariance were used, as appropriate, to analyze data. The program significantly increased empowerment (F = 4.66, p = .020) and quality of life (F = 5.83, p = .009) among participants in the experimental group over time. Its therapeutic features, such as sharing their experiences, discussion, and presentations, can be applied to create effective psychosocial interventions for families of PMIs.

Caregiving Burden and self-care among European-American and Chinese-American family caregivers of people with mental illness

ABSTRACT Family caregivers (FCs) of persons with mental illness (PMI) often experience caregiving burdens that contribute to poor mental health. As compared to European-American FCs, Asian-American FCs may experience greater caregiving burden due to an increased likelihood of cohabiting with PMIs. Yet, limited research exists on the caregiving experience of Asian-American FCs and on how self-care practice and social support mediate caregiver burden among FCs of PMIs. Using a cross-sectional mixed-method design this study explored the impact of caregiving burden on mental health outcomes among Chinese-American and European-American FCs. The quantitative data showed similar caregiving burden between the two groups and a partial mediation role for self-care practice on FCs’ mental health. The qualitative data showed that FCs from the two groups utilized different types of social support. Findings suggest the need for mental health professionals to develop intervention programs to enhance self-care practices and social support for FCs when working with PMIs.

Needs of Caregivers of People with Mental Illness- Rehabilitation Perspective

Introduction: Chronic nature of major mental illnesses can have a devastating impact on persons with mental illness (PWMI) and the caregivers. Rehabilitation is a long lasting phase of psychiatric treatment. The study focus on rehabilitation needs of the caregivers of PWMI attending psychiatric outpatient department at a tertiary care hospital. Methods: A cross sectional study was carried out at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand. A purposive sample of 100 caregivers of persons with mental illness was interviewed to assess rehabilitation needs. Information on socio-demographic profile and rehabilitation needs was ascertained by using a self-administered pre-tested questionnaire. Appropriate descriptive statistics was applied to formulate the results. Results: Findings revealed that medical needs (10.04±2.61), self-care (10.11±2.48) and stress management needs (10.20±4.72) were more compared to others needs. Few caregivers reported the incidences of facing stigma at workplace and society (9.74±2.49) because of their ward’s mental illness. Further, it also revealed that needs related to peer/community support, development of right attitude towards the care of the PWMI and management for worries and apprehension due to the condition of PWMI are quite frequently reported rehabilitation needs by the caregivers. Conclusion: A successful rehabilitation services always should be need based. Types and severity of disability of the PWMI will also play an important role in designing a structured rehabilitation programme. This study warrants further study based on large sample size to design successful rehabilitation services for persons with mental illness. Keywords- Mental illness, rehabilitation, needs, caregiver

Identifying the Prevalence of Courses on Mental Illness in Criminal Justice Education

Persons with Mental Illness (PMIs) require unique consideration and individualized attention in the criminal justice system. Research has demonstrated the prevalence with which police come into contact with these individuals, the unique considerations made by courtrooms serving PMIs, the overrepresentation of PMIs in correctional settings, and the problems PMIs experience when reentering the community from incarceration. Given the growth of attention to this area, and the increased reality of challenges that criminal justice professionals encounter when working with PMIs, this paper explores the prevalence of courses on mental illness in criminal justice undergraduate programs in the United States. The current review of over 640 curricula in the United States illustrates that courses devoted solely to the topic of mental illness in the criminal justice system are particularly rare. The importance of offering more courses in the interface between mental illness and criminal justice for future professionals in the field is discussed.

Mental health legislation: A journey back to "madhouses era?".

Byline: James. Antony The authors of the Mental Health Bill-2013[sup][1] seem to think that the new Law would be a “Magna Carta” to liberate all the mentally ill, all over the country! Their logic appears to be that with the word “care” inserted in the title, the new Law would ensure that every mentally ill person in India would enjoy the Governments' benevolence! However, ground realities are far from this. In an earlier write-up, this scribe had discussed briefly about some serious hassles which might arise, because the Bill has such a wide and textbooklike definition of mental illness.[sup][2] The over-inclusive definition would lead to a situation where even those with “minor” disorders would get “stamped” as “mental.” And, as a result, their whole family would be forced to face many stigma-related problems all their lives. In this situation, people would be ready to forsake any Government favor rather than admit to having a family member with mental illness! Many authors have brought out their different viewpoints regarding the Mental Health Bill-2013.[sup][3],[4] Many criticisms remind us of the importance of definitions of various terms used in a legislation being very clear-cut and unequivocal. However with regards to the present Bill, the definition being over-inclusive is not its only problem. The very idea of going for a definition of “mental illness” rather than defining “persons with mental illness (PMI)” is itself not a desirable approach. “Illness,” being a nontangible concept, could be useful only in a clinical situation. In a Law, various enforcement agencies as well as others have to locate the “right” candidates and deal with them as per the provisions that are laid down. To make their task easy, it would have been better to pinpoint “PMI” by having a good definition for it. In mental health legislations, right from the beginning, this principle of going for tangible concepts used to be followed. Even the “Indian Lunacy Act,”[sup][5] which got enacted more than a century ago, has precise definitions of various terms. This ensured that the number of persons who got included as “mentally ill persons” was kept to the minimum. The big advantage is that it excludes from the preview of the Law not just those with “minor” disorders, but even many victims of “major” mental diseases. And, by that one measure, the 1912 law ensured that all of them could live with dignity, exactly the way all medically ill persons do, avoiding all stigma related hurts and humiliations. Though the Mental Health Act-1987 arrived as an improvement on the old law and has many positive aspects, unfortunately, it has some shortcomings as well. The inclusion, in the preview of the law, of private hospitals and nursing homes where psychotic patients are admitted with a bystander, is one such shortcoming. This has been pointed out along with critical comments on certain other inadequacies in that particular Law, way back in 2000.[sup][7] However, the authors of the present draft Bill have not cared to consider those criticisms, while drafting the new Bill. This issue of creating unnecessary problems by including private facilities where psychiatric patients are admitted, in the preview of the new Law, is also criticized in a recent writing.[sup][8] Even while defining mentally ill persons in a restrictive manner, thereby excluding as many persons as possible, it is essential to ensure a “legal umbrella”, for two clear-cut sub-groups of major psychotics. It is for their welfare as well as for the safety of the society. First, the legal cover is needed for “acute psychotics” who refuse treatment, even while being a threat to themselves or others. …

Disability and quality of life among elderly persons with mental illness.

The present study was undertaken to understand the level of disability and quality of life of elderly persons with chronic and persistent mental illnesses and to compare it with those who were elderly but well with no illness. For the purpose 200 elderly persons with mental illness (PMI), attending psychiatric services were included in the study. A comparison group of 103 well elderly persons was drawn from the same study area as control group (CG). They were assessed using WHO-DAS and WHOQOL-BREF. Results revealed that PMI experienced higher disability compared to the CG. Deficits in the domain of moving around, getting along with people, engaging in life activities and participation in society contributed most to the high level of disability in the PMI group. PMI from rural area had higher disability compared to the urban group. As for QOL, elderly PMI had a poor quality of life compared to the CG. Quality of life was found to be negatively associated with level of disability. Higher the level of disability, lower was the quality of life. The authors opine that persons with chronic mental illness continue to experience psychiatric disability in old age and this cannot be attributed to normal aging. Level of disability has a negative impact on their quality of life.