Psychiatric rehabilitation in routine Indian mental health practice: A review of social protections for persons with mental health conditions

Abstract

Background:

An estimated 200 million Indians have mental health conditions – a sizeable proportion of them requiring psychiatric rehabilitation services. The numbers of mental health professionals are abysmally low. Early psycho-social rehabilitation interventions can improve functional outcomes, reducing disability. Psycho-social interventions have been made possible with the shift away from medical and charity models of disability to the establishment of social protections for vulnerable groups.

Materials and Methods:

The authors have undertaken a narrative review of all the social protection measures that can be explained to persons affected by mental health conditions and their family members. A larger tabulation is provided as an appendix to this article that has details of all the social protection measures across the states and union territories of India. This tabulation can be useful as a one-stop reference for every mental health practitioner in India toward informing persons affected by mental health conditions and their family members about how recovery journeys can be advanced. The data have been compiled after extensive searches of official government websites, information brochures, and even relevant legal provisions.

Conclusion:

For almost all the social protection measures provided by the central or state government, a disability certificate is a prerequisite. Rehabilitation today is a collaborative process aimed at community re-integration. In the absence of specialized services like those of clinical psychologists, vocational trainers, and psychiatric social workers, the psychiatrist becomes the sole point of contact. Motivated community members, recovered services users, and family members can aid mental health professionals by disseminating this knowledge further.

INTRODUCTION

Mental health conditions number among the leading causes of disability worldwide. An estimated 200 million Indians have mental health conditions[1] – a sizeable proportion of them requiring psychiatric rehabilitation services. Mental health professionals (MHPs) are scarce with 0.95 psychiatrists, 0.069 psychologists, and 0.065 psychiatric social workers per 1 lakh population.[2] In the absence of specialized services like those of clinical psychologists, vocational trainers, and psychiatric social workers, the psychiatrist becomes the sole multi-disciplinary point of contact.

Early psycho-social rehabilitation interventions can improve functional outcomes and reduce disability. They improve the quality of life. Rehabilitation efforts are considered time- and human-resource-intensive. Psychiatrists must be able to facilitate the journey from clinical remission to functional recovery.

There is a growing emphasis on policy and research focused on rehabilitation. Psycho-social interventions have been made possible with the shift away from medical and charity models of disability. Collaborative planning for such interventions can follow enquiries during review consultations such as “Are there any other issues/areas you would like me to discuss?”. The International Classification of Functioning Disability and Health[3] stipulates that disability arises in the context of the interaction of a person and the environment, being a function of biological, psychological, and socio-ecological factors.

Rehabilitation is a collaborative process aimed at community re-integration. Rehabilitation in the community, also known as home-based or domiciliary rehabilitation, involves professionals moving out from institutions to provide services locally, feasible mostly in urban, relatively resource-rich areas. In contrast, community-based rehabilitation emerged as a service for persons with disabilities (PwDs) in resource-strapped settings. Motivated community members, recovered service users, and family members can aid service providers in the delivery of such rehabilitation services. The United Nations regards social protection as a collection of policies and strategies designed to prevent or shield individuals from poverty, vulnerability, and exclusion from society throughout their lives, with special attention given to marginalized and at-risk populations.[4] A plethora of psycho-social interventions is made possible by state provisions.

For most of these social protection measures (SPMs), a disability certificate is a prerequisite.

As yet, there have been no unified resources available for practitioners to review SPMs, especially with a focus on persons with psycho-social disabilities and mental health conditions. In this regard, authors aimed to create a compilation of various SPMs that could be availed toward furthering psycho-social rehabilitation efforts in regular psychiatric practice.

MATERIALS AND METHODS

Authors undertook a multi-step focused narrative review of various SPMs being implemented for persons with mental disabilities (PMDs) across various states and union territories of India. The first step involved extensive searches of the websites and information portals of the states and union territories between July 2022 and January 2023. Concurrent focused searches were carried out by the authors on the domains of livelihood support including vocational and/or day care support, caregiver support, tax reliefs, travel supports, social activity support including marriage, educational support including vocational training, housing support including placement, health access and uptake supports including insurances, and legal aid access and support. Their last date of the update was also recorded. Furthermore, searches were conducted for webpages hosted by various state commissioners of persons with disabilities and the respective ministries of social justice and empowerment, under whose purview disability affairs are administered. Additionally, the search also extended to locate recent annual reports submitted by these commissioners and even the annual report of the chief commissioner of persons with disability. Searches for SPMs in these domains were taken up by authors SP, AS, PJ, AA, AnS, and MS and details compiled with guidance from senior rehabilitation professionals KP, JT, VS, and HA.

Thereafter, as a second step, commonly used and accessible resources were also reviewed to identify relevant information. Examples of such platforms include Punavbhava (https://punarbhava.in/), Haqdarshak (https://haqdarshak.com/), Enabled (https://enabled.in/wp/), The Center for Internet and Society (https://cis-india.org/), and Vikapedia (https://vikaspedia.in/InDG). Information so collected was tabulated, and discrepancies were resolved through iterated discussions among authors. The credibility of discrepant information was evaluated using the following parameters: whether a governmental or non-governmental source, last updates, and a third corroborating source such as a government order or any evidence of implementation, for example, a media report.

RESULTS

Disability certification

As defined in the Rights of Persons with Disability Act, 2016 (RPWD Act, 2016), only a person with a benchmark disability, that is, 40% or above, of a specified disability can be issued a disability certificate.[5] The Government of India (GoI) has launched the Unique Disability Identification Card (UDID),[6] for which an application must be submitted at http://www.swavlambancard.gov.in/home/login. The RPWD Act, 2016[5] stipulates completion within 1 month for the process from application to certification or rejection.[3] The UDID portal matches applicants to their district disability certifying authorities. Applicants may either request a fresh assessment and certification or upload an existing certificate. Furthermore, the Indian Psychiatric Society has issued an advisory on disability certification.[7]

Social protections linked to a disability certificate

Many social protections are laid down by the central and state governments for PwDs. The provisions by the central government are as follows:

1. Income tax reductions: PwDs (as per section 80U of the IT Act) or their caregivers (Section 80DD, IT Act) can avail of a deduction of INR 75,000 or 905 United States Dollar (USD) (for disability ranging from 40 to 80%) or INR 125,000 (1508 USD) (for disability extent exceeding 80%) from their taxable income. Furthermore, PwDs (Section 80DDB, IT Act) and their caregivers (Section 80DDA, IT Act) can avail of a deduction of up to INR 20,000 (241 USD) annually for treatment.[8]

2. Other taxation breaks

Rail travel concession: Persons with Disorder of Intellectual Development and their escorts can avail of a maximum concession of 75% on their tickets.[9]

Family pension options: Central government employees/armed forces/Public Sector Undertakings:

Employees have a facility to include their disabled dependents in the statutory family pensions and are also exempted from routine transfers.

The following list is illustrative (Karnataka):

1. Disability-linked allowances

   Based on the extent of disability certified, direct monetary transfers can be dispersed to PwDs. A monthly pension of INR 800 (10 USD) (disability between 40 and 75%) and INR 2000 (24 USD) (disability above 75%) is provided. In Karnataka, the applicant must further possess a Below Poverty Line (BPL) card to receive the pension. It is also prudent to facilitate the UDID card before the pensioner’s application is forwarded to the District Disability Welfare Officer. Other disability-linked allowances include an unemployment allowance. An amount of INR 1000 (12 USD) is provided for unemployed PwDs.[10,11]

2. Bus travel concession

   For road travel, a special bus pass for PwDs is available at a subsidized rate (INR 660/8 USD).

3. Marriage-based incentives

   An incentive of INR 50,000 (USD 603) is provided for marriage between PwD and an able-bodied individual. The amount can be claimed in the couple’s joint account and only after 2 years of marriage.[12]

4. State government employees’ family pensions

   This scheme allows for periodic income for disabled persons.

5. Housing allocations and preferences

   The scheme applies to rural and urban areas. An amount of INR 125,000 (USD 1508) is provided for constructing houses for PwDs. A 5% reservation applies to PwDs in all housing schemes. Preferential site allotment is also provided.[11]

The Karnataka Housing Board has been directed to provide for a 3% reservation for PwDs across all schemes initiated for economically disadvantaged groups. The reservation covers housing schemes such as Ashrayam, Grama Navagrama, and the Rajiv Gandhi Village Housing Scheme. In 2004, the reservation for PwDs in the Navagrama Scheme and Ambedkar Housing increased to 5%.

Employment schemes

The Ministry of Skill Development and Entrepreneurship has set up the National Skill Development Corporation. Its flagship schemes, the Pradhan Mantri Kaushal Vikas Yojana[13,14] provides free training opportunities in any domain of the trainee’s choice across centers in the country. It can also be availed by those who have discontinued educational/technical courses. These short-term training and certifications aim to improve qualification credentials and bridge the gap between the demand and available skills.

Another provision for skills improvement is the National Apprenticeship Promotion Program,[15,16] which includes working as an apprentice for on-the-job learning. Under this scheme, the government agency pivots as an aggregator of potential apprentices, matching them to industry requirements. Apprenticeship periods may range from 12 to 18 months with the GoI reimbursing the training organization 25% of the stipend, reducing the burden on employers.[16]

The National Skill Training Institutes provide certificate courses in various industry skills. Women may also train at national vocational training institutes (women).[17] Other post-secondary vocational education opportunities are also provided by industrial training institutes with skills training in plumbing, electrical, and mechanical work, with course durations ranging from 6 to 24 months. The course further allows for a 12-month practical industry training before certification from the National Council for Vocational Training or the State Council for Vocational Training. Trainees can extend their learning into diplomas.[18]

Through National Career Service,[19] Networks Employment Exchanges, and Special Employment Exchanges, the Ministry of Labor and Employment aids with placements. Special Employment Exchanges have been set up provide information regarding jobs reserved for PwDs in government institutions. Based on impairments and jobs identified for each PwD, the exchange facilitates the recruitment and residential training. Section 34 of the RPWD Act mandates government and government-aided establishments to reserve 4% of new employment vacancies for PwDs. Additionally, government establishments are not permitted to dismiss employees based on their disabilities. The Act mandates all establishments to develop and submit an ‘equal opportunity policy’ that details how PwDs would be included in their employment.

Self-employment was promoted by the currently non-operational National Handicapped Finance and Development Corporation.[20] The Government of Karnataka promotes entrepreneurship via the ‘Aadhaara’ Scheme, which provides interest-free loans.[21] The Mahatma Gandhi National Rural Employment Guarantee Act[22] provides employment opportunities in the agriculture and allied sectors. PwDs are included in the employment guarantee – they may benefit from specific provisions such as flexible work descriptions and schedules. Typically, employment is guaranteed to at least one member of a household, while employment for the PwD is considered additional. Many non-governmental organizations (NGOs) also provide employment-related services for PMDs. Some function as social firms with 20–50% of their workforce as PMDs, while others provide subsidized vocational training and placement opportunities.[23,24] Similar efforts have been undertaken by institutions such as Canara Bank and State Bank of India.[25,26]

Reasonable accommodations coded in the RPWD Act as “necessary and appropriate modifications and adjustments without imposing a disproportionate or undue burden on employers” are meant to overcome challenges faced by PMDs with regard to job performance PMDs.[27] Psychiatrists and other MHP can assist PMDs and families in negotiating with workplace managers for such accommodations. Examples include extended training periods, frequent supervision, flexible work hours, extended timelines, and availability of leave of absence.[27]

Daycare and engagement

Often, PMDs benefit greatly from being in a daycare setting. Persons in attendance typically are involved in some activities along with peers. With a larger aim of engagement, it has many other benefits such as promoting a regularized day schedule, reducing the face time and hence negative expressed emotions, and improving quality of life.[28] Engagement options have also been shown to reduce the frequency of problematic behaviors or symptoms.

Adult persons with intellectual disability (ID), autism spectrum disorder (ASD), or cerebral palsy (CP) can attend daycare centers under the Samarth or Vikas schemes of the National Trust. More information about nearby centers can be obtained here: https://www.thenationaltrust.gov.in/content/.

The Government of Karnataka launched a daycare program under the District Mental Health Program services called Manasadhara.[29] These centers have been proposed to be set up in all districts. Government-run mental health establishments too have day care settings, for example, at the National Institute of Mental Health and Neurosciences (NIMHANS) and the Central Institute of Psychiatry (CIP).[30] NIMHANS day care services are availed by over 110 patients in the city daily. During the pandemic, the service was reoriented and delivered online with some of the patients receiving raw materials at home for video conference supervised home-based actives.[31]

Educational schemes

Patients and families need to be informed about opportunities for continuing education. Mental illness adversely impacts the academic careers of patients.[32] The RPWD Act emphasizes inclusive education at all levels, with 5% reservation at all government-funded educational institutions. National Institute of Open Schooling (NIOS),[33] an autonomous institute set up by the GoI, aims to provide flexible educational opportunities. Education attained via open schooling is considered equivalent to that attained at regular schools. There are specific provisions for all specified disabilities, which include extra time during examinations, computer systems, scribes, and choice of alternate assignments. NIOS also offers vocational training, such as tailoring, basic computing, and beauty care. Similar institutions exist at the state level (https://ksos.co.in/). For tertiary education and training, institutes like Indira Gandhi National Open University[34] have certificates, diplomas, degrees, and doctoral programs including distance learning. The GoI, under the Department of Social Justice and Empowerment, provides financial assistance in terms of scholarships for PwDs pursuing any recognized courses. In 2020, PwDs could apply for a total of 44,520 scholarships under six component schemes, which included national and overseas scholarships.[35]

Residential rehabilitation for PMDs

Around 500,000 PMDs have been estimated to be homeless in India.[36] Homelessness has a bidirectional relationship with mental illness. Persons having long-standing mental health conditions may be abandoned by family or may wander away. There are very few affordable options for halfway or long stay homes. Homeless persons are at higher risk to develop mental illnesses such as schizophrenia (65%) or substance use disorders and related problems (30%).[37]

Suitable housing is an essential component of quality of life and health,[38] and this has been recognized in the United Nations Sustainable Development Goals.[39] PMDs have the right to live in the community as per section 19 of the Mental Health Care Act, 2017 (MHCA)[40] and section 5 of the RPWD Act. MHCA mandates the setting up of community-living options including group homes and halfway homes. RPWD Act also states that PwDs should be provided access to a wide range of residential services. Section 24 of the act states the various programs and schemes to facilitate independent community living.

Pradhan Mantri Awas Yojana envisions ‘Housing for all’ and lists PwDs belonging to lower socio-economic sections as beneficiaries.[41] The Swadhar Greh scheme for women in distress and/or domestic conflicts runs nationally and provides access to temporary shelter, maintenance, and rehabilitative services.[42,43] Nirashritara Parihara Kendra (also called beggar homes), night shelters,[44] and state homes are also options for homeless persons in Karnataka.

Deendayal Disability Rehabilitation Scheme provides grants to organizations for setting up housing options for PwDs.[45] In the state of Karnataka, short-stay homes known as Manasa Kendra are available for PMDs.[11] Similar initiatives have been undertaken by NGOs, and it may be beneficial to collaborate with such local NGOs.[46,47] A few examples outside Karnataka include The Banyan[48] and Chellamuthu Trust[49] in Tamil Nadu, Shraddha[50] in Maharashtra, and Apna Ghar[51] in Rajasthan.

Reducing health care costs

Healthcare costs in India are primarily out-of-pocket expenditures and frequently push families into poverty. Affordability concerns contribute to access and treatment gaps of mental health conditions.[36] Health insurance schemes may help in making mental health care affordable.[52]

The Central Government Health Scheme covers healthcare expenses of central government employees and dependents.[53] A similar scheme for ex-servicemen is the Ex-Servicemen Contributory Health Scheme. Employees’ State Insurance Corporation scheme reimburses healthcare expenses of select employees and their dependents. Beneficiaries working in government or private establishments employing 15 or more persons and earning monthly salaries less than INR 20,000 (241 USD) may avail this scheme.[54] These schemes are cashless and require pre-authorization.

Niramaya Health Insurance Scheme under the National Trust Act (NTA) 1999 reimburses healthcare expenses up to INR 1 lakh (1206 USD) per year, benefitting persons with CP, ASD, ID, and multiple disabilities. Annual premiums for persons above poverty line are INR 250 (3 USD) after the first subscription of INR 500 (6 USD). A similar figure for BPL families is INR 50 (0.6 USD) after the initial payment of INR 250 (USD 3).[55]

Pradhan Mantri Jan Arogya Yojana[56] is a component of the Ayushman Bharat Scheme that covers in-patient healthcare expenses for persons listed as BPL as per the Socio-Economic Caste Census of 2011.[57] In-patient mental health care under this scheme is only available at government and/or government-authorized institutions and needs renewal of authorization every 10–14 days. Costs of care for BPL families are completely covered, while those above poverty line and enrolled in this scheme may avail up to a 30% reduction.

In the state of Karnataka, a rural cooperative healthcare scheme called Yeshasvini Cooperative Health Insurance scheme provides cover for emergency and in-patient physical healthcare.[58]

Affordable Medicines and Reliable Implants for Treatment (AMRIT) pharmacies run by the Ministry of Health and Family Welfare provide drugs, implants, surgical disposables, and other consumables at average discounts up to 60% of the maximum retail price.[59] The Pradhan Mantri Bhartiya Janaushadiya Pariyojna provides generic psychotropics at very affordable prices.[60] A similar scheme in Karnataka is called Jan Sanjeevani.[61]

Caregiver concerns

In low- and middle-income countries, the primary caregivers of PMDs are their family members.[62] Their caregiving tasks involve monitoring daily needs, identifying signs of relapse, supervising medications, and providing constant emotional and financial support to the patient, which takes a toll on their physical and mental health.[63] Expressed needs of caregivers of persons with schizophrenia ranged from management of behavioral problems, social-vocational engagement, health of caregivers, education about illness, independent living skills, community re-integration, and concerns about sexual health and marriage.[64] Increased caregiver burden can lead to emotional exhaustion and caregiver ill health, signaling burnout. These may progress to anxiety or depressive disorders and increased negative expressed emotions.[63]

‘What after parents/caregiver?’ concerns

An unexpressed caregiver need is planning for long-term care. Caregivers apprehend the deterioration of clinical and living conditions of their offspring in their absence. Most parents fear that a discussion of their passing might be too emotional.[65]

Section 14 of the RPWD Act[66] allows for the institution of a limited guardian for PwDs, including those with mental illness. Guardians assist in managing moveable and immovable assets. The stipulated procedure involves applying to the district courts or collectors, which are advised to process the applications within 3 months.[67] A guardian is necessary for continued care, especially after the PwD has crossed 18 years of age.[68] Parents, siblings, spouses, children, and even NGOs may be appointed as guardians. Parents can write up their wills to ensure inclusion of their disabled wards in the estate.

Another option is to form a Trust under the Indian Societies Act,[69] where two or more individuals may come together as trustees. A trust so formed is also eligible to be a guardian. However, objectives in the trust deed must be clearly defined.[70] The RPWD Act and the MHCA, 2017 protect the rights of the PMD to manage their finances and inherit assets with support of a guardian, if needed. A similar provision is available for persons with developmental disabilities (ID, ASD, or CP) and multiple disabilities through the NTA where applications are submitted to the local level committee.[71,72]

Psychiatrists should take an initiative in discussing and co-creating a future care plan. Cues for such discussions might include noticing elderly caregivers. Participation and involvement of PMDs must be emphasized along with relatives or friends, who may be contributing to some caregiving tasks. Support systems planned should be tailored to levels of supervision required across various life areas such as basic needs, financial management, illness management, health, and so on.

Caregiver support

Often caregivers find professional support strapped for time and at times inaccessible for emotional support. Over the years, caregivers have coalesced to form support and advocacy groups. These groups have empowered themselves in successfully advocating policy and legislative change.[40,70] NTA is a result of advocacy efforts by such caregivers. Currently, there are more than 2000 parents’ associations for ID with a federation called ‘Parivaar’ for caregiver support.[72,73]

Similar movements have been successful in the inclusion of community living options, such as half-way homes and sheltered and supported accommodations. Practitioners can help caregivers link up with such support and advocacy groups.[72] Some of these include Aasha Experience (Chennai), Schizophrenia Awareness Association, Pune[74] Sambandh Health Foundation,[75] Gurugram, Action for Mental Illness India (ACMI), Association for Mentally Disabled (Bengaluru), and Families’ Alliance on Mental Illness (FACEMI).[76] These serve as a platform to exchange information and reduce the discrimination and social isolation. Every month, NIMHANS conducts an online caregiver education and empowerment program called ‘Road to Recovery’. This provides a platform for patients and caregivers to link with each other while being sensitized about aspects of mental healthcare and rehabilitation.[77]

Legal aid

PwDs and their families are more vulnerable to human rights violation, exploitation, and abuse relative to the general population. Inequities in accessing justice for PwDs and their families have been addressed via the provision of free legal aid services. As per the Legal Services Authority Act 1987, nodal authorities have been set up at the national, state, and district levels. Separate legal services committees have been set up at the Supreme Court and High Courts.[78] PwDs are included in the list of vulnerable populations for whom these services are made freely available in both civil and criminal matters. National Legal Services Authority (NALSA) aims to facilitate access to various welfare provisions. ‘Lok Adalat’ and mediation sessions may also be conducted. The NALSA is also empowered to take matters of social justice concerns, especially for PwDs and PMDs.[78,79]

MHCA, 2017 empowers PMDs with the right to obtain free legal aid. A similar right to legal aid is provided for PwDs under the RPWD Act, section 12 (1). Requests can be made to District, State and Taluk Legal Services Authority for the initiation of legal aid clinics. MHCA mandates details of such legal services be displayed within every mental healthcare establishment. Seeking legal aid involves submitting a written application with a relevant identity proof. Paralegal volunteers are present to assist those who are unable to write their applications.

DISCUSSION

An average Indian psychiatrist spends only 33 minutes for a fresh evaluation and has a daily caseload of 24.[80] These figures appear too optimistic compared to reports from eminent psychiatrists[81] or experiences from reputed mental health establishments. On the other hand, considering the paucity of trained MHPs and the large access and treatment gap, psychiatrists are better positioned as single points of access and care. SPMs may improve the quality of life as well as reduce caregiver burden. In India, involving families in such efforts will be culturally and socially appropriate. As care professionals, it would be most prudent to incorporate awareness raising and access facilitation in routine practice. Such practices will have beneficial effects on rapport, client retention, and continuity of care and adherence. It may positively impact service utilization with further impacts on policy formulation and state-supported service provision.

Psychiatrists may find increased frequency of visits and liaising with local authorities challenging. Practitioners must be persistent as meaningful results are time-consuming. Recovery in each phase is a unique and multi-dimensional journey for PMDs and caregivers. Providing rehabilitation interventions is known to be human resource-intensive; motivated/recovered patients can be engaged for peer support and delivery.

This review is the first effort to compile SPMs that could be relevant for PMDs. It is limited by factors such as the lack of an a priori search strategy, which could not be followed considering the miscellaneous and disaggregated nature of information sources and data points. This also made it difficult to confirm whether the information regarding SPMs were up to date and operational. However, the framework and information provided in this review can be used to guide future efforts.

Authors recommend inclusion of basic education regarding SPMs, especially those listed in Table 1, which compiles SPMs across India. Peer delivery, especially by those already availing SPMs, can reduce the burden on psychiatrists’ time. Psychiatrists might also consider establishing rehabilitation centers. Provisions such as Deendayal Disabled Rehabilitation Scheme may be favorable starting points. Furthermore, efforts to collate all SPMs under a single bulletin would be valuable. This bulletin would further benefit from incorporating an annual feedback mechanism to address access and uptake challenges. Existing access challenges like arbitrary limits regarding certain disability types and percentages must be addressed. A real-time system with the latest upgrades and policy changes across all states and union territories could also be established. This system would permit the government to launch certain schemes as benchmarks and drive other states to do the same. Additionally, a provision of a mandatory expiry or review date could be set to revise the SPMs. There also ought to be inflation indexing to protect these provisions from economic changes. Periodic, traceable, and real-time updates from across the country should thus be emphasized and established as an accessible and structured system. The impact and utility of such SPMs on quality of life, social justice, and inclusion must be prioritized in research efforts.

Table 1.

Social protections for persons with disabilities across India

State	Disability welfare pension	Bus travel concession	Entrepreneurial loan	Unemployment allowance	Caregiver allowance	Marriage-linked incentives
Andaman and Nicobar Islands	INR* 2500/month	PwD* <80 years – free bus pass on Ordinary/Express bus	Details not available	INR 400/month only for people <35 years	Details not available	Details not available
Andhra Pradesh	INR 3000/month	Free bus pass for all PwD* with subsidized travel for accompanying persons	Amount (unit cost) given as 50% subsidy +50% bank loan Max subsidy INR 100000 Annual income ceiling INR 100000	Mukhya Mantri Yuva Nestam scheme: INR 1000 for all unemployed youth between 22 and 35 years	Details not available	INR 1 lakh for DwND marriage
Arunachal Pradesh	INR 2000/month	Details not available	Details not available	Details not available	Details not available	Details not available
Assam	INR 300/month INR 1000/month* INR 1000/month as childcare allowance to women with disabilities* *for state govt employees	Free bus travel for all PwDs; subsidized travel rates for accompanying persons	Unemployed PwD: one-time grant INR 20000	Details not available	Details not available	Details not available
Bihar	INR 400/month	Free travel for 50 km and 50% concession on further travel	Details not available	INR 200/month for PwD BPL* Last updated: 2012	Details not available	INR 1 lakh for DwND marriage
Chandigarh	INR1000/month (Disability 40% to 70%) INR 2000/month (Disability 71% to 100%)	Details not available	Maximum loan 25 lakhs Annual family income ceiling for urban (5 lakhs) and rural (3 lakhs) Low interest loans (5–8% per annum with 1% interest rebate for women and those with non-locomotor disabilities)	Details not available	Details not available	Details not available
Chhattisgarh	INR 200/month Age 18-64 years; disability 80% or more/multiple disabilities INR 300/month Age 65 and above Website last updated in 2013	Details not available	Details not available	INR 500/month Last updated: 2012	Details not available	INR 50,000 for DwND marriage INR 1 lakh for DwD marriage
Dadra and Nagar Haveli	INR 1000	Details not available	Loan up to 5 lakh, rate of interest is 8% >5 lakh, rate of interest is 10% and 1% rebate in interest given to women	Details not available	Details not available	Details not available
Delhi	INR 2500/month	Free bus travel for all PwDs and 50% concession for accompanying escorts of those with 100% disability	Details not available	INR 1500/month Last updated: 2010	Details not available	Details not available
Goa	INR 1700/month	Free bus passes for all PwDs	Minimum 10th pass Max 20 lakhs (non-professionals) and 25 lakhs (professionals) Annual family income ceiling INR 10 lakh	Details not available	Details not available	INR 25,000 as DwND marriage
Gujarat	INR 600/month	Free travel in state bus	Low interest (5–8%) loans (% interest rebate for women with disability) Amount 3 lakh (small business), 5 lakh (agricultural activity), 5 lakh (transport), 7.5 lakh (training in higher education in India), 15 lakh (training in higher education abroad)	Details not available	Details not available	INR 1 lakh for DwD and INR 50000 for DwND
Haryana	INR 2500/month for 60–100% disability INR 2500/month for persons of short stature For women and girl acid attack victims: INR 6250 for 40–50% disability, INR 8750 for 51–60% disability, and INR 11250 for 61% disability	Free bus travel across state	Details not available	INR 1000–2000 based on educational qualification Last updated: 2010	Details not available	Details not available
Himachal Pradesh	INR 700/month for 40–69% disability INR 1250 for >70% disability	Free travel within state for all PwDs in ordinary buses	Details not available	INR 1500/month	Details not available	For DwND marriage: INR 25,000 for <75% disability INR 50,000 for >75% disability
Jammu and Kashmir	INR 1000 per month as Integrated Social Security Scheme BPL persons between 18 and 79 years are eligible for INR 1000/month and above 80 years at INR 1000/month	Details not available	Details not available	Details not available	Details not available	Details not available
Jharkhand	INR 700/month for 40% or more disability	Details not available	Details not available	Details not available	Details not available	Details not available
Karnataka	INR 600/month for 40%–75% disability INR 1400/month for≥75% disability	Free bus pass for those with visual impairment Concessional bus pass at INR 660/year for all other PwDs	Adhara scheme to promote petty business activity as income generation by PWDs. Total amount INR 35000; 20000 as interest free loan and 15000 in kind as kiosk; Max amount up to 1 lakh	Unemployment allowance of INR 1000, orally communicated by DDWO*	Details not available	INR 50000 for DwND marriage
Kerala	INR 1600/month	50% concessional travel in government and private buses for all PwDs (up to 40 kms)	Kaivalya scheme provides vocational training, career guidance, capacity building, coaching classes, and interest-free loans. Loan amount: Up to 1 lakh	Details not available	Aswasakiranam: INR 525 to care givers of bedridden intellectually disabled persons, those with autism, cerebral palsy, and mental illnesses	INR 30000 for women with disabilities getting married
			Can also be taken by family members		Swasraya: One-time assistance of INR 35000, with preferential allocation to single mothers of children with disabilities
Ladakh	Details not available	Details not available	Details not available	Details not available	Details not available	Details not available
Lakshadweep	INR 700/month	Details not available	Details not available	INR 500–1000 based on educational qualification	Details not available	Details not available
Madhya Pradesh	INR 600/month	50% concession for bus travel	Details not available	Details not available	Details not available	DwND marriage 2 lakh DwD marriage- 1 lakh
Maharashtra	INR 600/month	66.67% bus travel concession for intellectual disability 75% travel concession for blind and disabled people 50% travel concession for companions with blind and disabled people above 65% disability	Scheme of Seed Capital: financial assistance up to INR 150000 Subsidy at 20% of said total project expenses or INR 30000 Rest 80% to be raised by PwD through loan	Details not available	Details not available	INR 50,000/- for DwND marriage
Manipur	INR 300/month INR 1500/month as maintenance grant	Free bus travel within the state	Details not available	INR 400–1000/month	INR 1500	INR 30000 as DwND or DwD marriage
Meghalaya	INR 500/month	Details not available	Details not available	INR 1000 per month	Details not available	Details not available
Mizoram	INR 350/month	INR 1000/month for PwDs who are state employees Free bus travel for all other PwDs	INR 2450 for petty business INR 4000 for pig/poultry farming	INR 3000/year for those unemployed for >2 years	Details not available	Details not available
Nagaland	INR 300/month	Free bus travel for all PwDs within the State	Details not available	Details not available	Details not available	Details not available
Odisha	INR 500/month	Free travel for PwMI* Half rate for escorts	Low interest (4%) loan over 5-year repayment period for low-income groups including PwDs up to 20000 (home loan) or up to 15000 (any other purpose)	Details not available	Details not available	INR 50000 for DwND or DwD marriage
Puducherry	INR 2000/month for 40–65% disability INR 2500/month for 66–85% disability INR 3500/month for 86–100% disability INR 2700/month for age 60–79 years INR 3800 for age >80 years	Free bus travel for all PwDs	PwDs in the state are routed to NHFDC*	Variable dependent upon educational qualification from INR 200 to 500 2012 information	Details not available	INR 25000 for DwND marriage INR 50000 for DwD marriage
Punjab	INR 1500/month	Free bus travel for visual impairment and 50% concessions for all other PwDs	Punjab Divyangjan Shaktikaran Yojana includes details regarding vocational training, scholarships, etc.; details regarding self-employment options not available	INR 450/month- qualification up to 12th standard INR 600/month- qualification above 12th standard	Details not available	Ashirward scheme: INR 21000 at time of marriage for women with disabilities INR 42000 for DwND marriages
Rajasthan	Women<55 years - INR 750/month Women 55–75 years INR 1000/month Men <58 years INR 750/month Men 58–75yrs INR 1000/month Men/Women >75 yrs– INR 1250/month People with leprosy – INR 1500/month	Details not available	Annual family income ceiling 2 lakh Maximum financial assistance 5 lakh, of which INR 50000 can be subsidy and rest can be provided as loan	Currently INR 3500 under The Mukhyamantri Yuva Sambal Yojana, to increase to INR 4500, is awaiting implementation	Details not available	Details not available
Sikkim	INR 1500/month	Free bus travel for those with visual impairment	Details not available	Details not available	Details not available	One-time grant of INR 2 lakh for DwND marriages
Tamil Nadu	INR 1500/month	Free bus travel up to 100 kms in district ¼ rate across state	PwDs in the state are routed to NHFDC	SSLC and below INR 600/month Higher secondary course INR 750/month Degree and above INR 1000/month	Details not available	DwND marriages INR 25000/and gold coin. If either partner had degree/diploma, INR 50000 provided along with gold coin.
Telangana	Aasra Pension: INR 3016/month for people with 40% and above disability	Free travel for all PwDs in ordinary busses and 50% concessional travel in Deluxe buses	PwDs in the state are routed to NHFDC	INR 3016 under Telangana unemployment allowance scheme Not specific for PwD	Details not available	INR 1 lakh for DwND marriages
Tripura	INR 2000/month for >60% disability INR 500/month: persons living with leprosy and AIDS	Free bus pass for all PwDs in state bus	Details not available	INR 1000	Details not available	Details not available
Uttar Pradesh	INR 1000/month for >40% disability	Free travel for all PwDs in the state bus	Shop construction scheme for PwD: Loan cum grant assistance totally 20000 construction (one time) and 10000 operational (one time)	Details not available	Details not available	INR 15,000/- man with disability in a DwND INR 20000/- woman with disability in DwND marriage INR 35,000/- in DwD marriage.
Uttarakhand	INR 1500/month for 40% and above	Free bus travel for all PwDs	Details not available	Details not available	INR 700 for guardians of PwD between 0 and 18 years of age	Details not available
West Bengal	INR 1000/month	Free travel for all PwDs in the state bus and tram	Economic assistance up to INR 10000/- for families in low-income bracket for setting up petty business or vocational training toward self- employment	Details not available	Details not available	Details not available

*INR=Indian rupee, PwD=Person with disability/disabilities, NHFDC=National handicapped finance and development corporation, BPL=Below poverty line, DwD=Disabled with disabled, DwND=Disabled with non-disabled, DDWO=District disability welfare officer, PwMI=Persons with mental illness

CONCLUSIONS

Often, the psychiatrist becomes the sole multi-disciplinary point of contact. SPMs are an important step toward inclusion and aid psycho-social rehabilitation. Motivated community members, recovered service users, and caregivers can aid MHPs by disseminating knowledge about SPMs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.