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KNOWLEDGE REGARDING RIGHTS OF MENTALLY ILL

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AMONG CAREGIVERS

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DyF.i
aPr
ebrr
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SHAHANA.S
.Mcna

Govt. College of Nursing, Kozhikode

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DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

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MASTER OF SCIENCE IN NURSING

KERALA UNIVERSITY OF HEALTH SCIENCES

2021
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KNOWLEDGE REGARDING RIGHTS OF MENTALLY ILL
AMONG CAREGIVERS

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By
SHAHANA.S

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Dissertation submitted to the

KERALA UNIVERSITY OF HEALTH SCIENCES

DyF.i
Thrissur

In partial fulfilment of the requirements for the degree of

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MASTER OF SCIENCE IN NURSING

ebrr MENTAL HEALTH NURSING

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Under the guidance of

Mrs. SINDHU KIZHAKKEPPATTU

.Mcna

And

Mrs. JAYANTHI. M. R
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And

Dr. HARISH. M. T
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Govt. College of Nursing,

Kozhikode
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DECLARATION BY THE CANDIDATE

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I hereby declare that this dissertation entitled Knowledge regarding rights of

mentally ill among caregivers is a bonafide and genuine research work carried out

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by me under the guidance of Mrs.Sindhu Kizhakkeppattu, Assistant Professor,

Mrs.Jayanthi M.R, Associate Professor (CAP), Govt. College of Nursing, Kozhikode

and Dr. Harish.M. T, Professor, Department of Psychiatry, Govt Medical College

DyF.i
Kozhikode.

aPr
ebrr Shahana.S
cslti
.Mcna

23.07.2021

Kozhikode
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CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled Knowledge regarding rights of

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mentally ill among caregivers is a bonafide research work done by Shahana. S in

partial fulfilment of the requirement for the degree of Master of Science in Nursing.

DyF.i
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Mrs. Sindhu Kizhakkeppattu, M.Sc (N), M.Phil(N)

Assistant Professor
ebrr Govt. College of Nursing, Kozhikode
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Mrs. Jayanthi M. R, M.Sc. (N)

Associate Professor (CAP)

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Govt. College of Nursing, Kozhikode

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23.07.2021
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Kozhikode
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ENDORSEMENT BY THE PRINCIPAL

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This is to certify that the dissertation entitled Knowledge regarding rights of

mentally ill among caregivers is a bonafide research work done by Shahana.S in

partial fulfilment of the requirement for the degree of Master of Science in Nursing.

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DyF.i
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Prof. Ponnamma K .M, M.Sc.(N)

Principal
ebrr Govt. College of Nursing

Kozhikode.
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.Mcna
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23.07.2021

Kozhikode
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COPYRIGHT

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DECLARATION BY THE CANDIDATE

I hereby declare that the Kerala University of Health Sciences, Kerala shall

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have the rights to preserve, use and disseminate this dissertation in print or electronic

format for academic / research purpose.

DyF.i
aPr
Shahana.S

ebrr
cslti
23.07.2021

Kozhikode
.Mcna
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ACKNOWLEDGEMENT

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The investigator expresses a deep sense of gratitude to all those who contributed
their support in completing this dissertation. The investigator extends her sincere
gratitude to Prof. Ponnamma K.M, Principal, Govt. College of Nursing, Kozhikode for

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her valuable support, suggestions and encouragement for successful completion of the
study.

The researcher expresses her sincere gratitude to Mrs. Sindhu Kizhakkeppattu,

DyF.i
Assistant Professor, Govt. College of Nursing, Kozhikode for her excellent guidance,
constant encouragement, generous support and scholarly suggestions throughout the
endeavour.

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The researcher acknowledges her obligation to Mrs.Jayanthi.M. R, Associate
Professor (CAP), Govt. College of Nursing, Kozhikode for her suggestions, incessant
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support, abundant encouragement and directions for the successful completion of the
dissertation.

The researcher acknowledges her obligation to Dr. Harish M. T, Professor,

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Department of Psychiatry, Govt. Medical College Hospital, Kozhikode for her
suggestions, incessant support, abundant encouragement and directions for the
.Mcna

successful completion of the dissertation.

The investigator indebted to Prof. Mary Joseph, Vice Principal, Govt College
of Nursing, Kozhikode, for her critical guidance, invaluable support and timely help to
carry out this study.
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She extends her sincere gratitude to Prof. Dr. (Mrs.) GeethaKumary V. P,

Former Vice Principal, Govt. College of Nursing, Kozhikode for her inspiring
encouragement, valuable suggestions and support.
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The investigator owes a great deal to Dr. Biju George, Assistant Professor,
Department of Community Medicine, Medical College, Kozhikode for the generous
assistance extended for the analysis of data.
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The researcher is highly indebted to Mr. Saleem.T. K, Assistant Professor,

Govt. College of Nursing, Kozhikode for his valuable ideas, corrections, and whole
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hearted encouragement. The investigator expresses her deepest thanks and sincere

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appreciation to Mr Nabeel P, Asst professor, Govt College of Nursing, Kozhikode for
the immense guidance and support for the successful completion of this study.

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The investigator is extremely thankful to the members of the Scientific Review
Committee and Institutional Ethics Committee of Govt. College of Nursing,
Kozhikode, for permitting her to conduct the study. The investigator extends her

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respectful gratitude to the Principal and Medical Superintendent of Govt. Medical
College, Kozhikode who gave the administrative sanction to conduct the study.

DyF.i
The investigator also expresses her sincere gratitude to all the teaching and non-
teaching staffs of Govt. College of Nursing, Kozhikode, for their kind cooperation,
valuable suggestions and constant support for the successful completion of the

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dissertation. She expresses her sincere thanks to all the experts who willingly helped
her through content validation as well as translation and re-translation of the tool.

The investigator owes sincere thanks to library staff and DTP Operator, Govt.
ebrr
College of Nursing, Kozhikode, staffs in Outpatient departments of Govt. Medical
College Hospital, Kozhikode, the staffs of Info soft and Prayag Color Laser,
Kozhikode, her friends, parents and other family members for the help rendered in
cslti
shaping this dissertation.

The investigator expresses her whole hearted gratitude to all the participants for
.Mcna

their willingness to participate and the co-operation rendered during the study. Words
fail to express her sincere gratitude to her classmates, seniors and juniors for their
constant support, encouragement and positive criticism.
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Above all, she owes her success to God Almighty.

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Shahana.S

Kozhikode

23.07.2021
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ABSTRACT

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Mental health problems raise many rights issues. People with mental illness are

exposed to rights violation within and outside the health care context, because of lack

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of awareness, people with mental illness and their families do not exercise their rights.

The present study aimed to assess the knowledge regarding rights of mentally ill among

caregivers of patients with mental illness in Kozhikode District. The objectives of the

DyF.i
study were to assess the knowledge regarding rights of patients with mental illness, find

out association between knowledge regarding rights of mentally ill among caregivers

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of patients with mental illness and selected variables. The conceptual frame work for

the study was based on Nola J Pender’s Health Promotion Model. A non-experimental
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descriptive survey design was used for the study. The study was conducted in Outpatient

clinics of Department of Psychiatry, Govt Medical College Hospital, Kozhikode. Sample

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consisted of 120 caregivers of patients with mental illness who were selected by using

non probability consecutive sampling technique. The socio personal data were collected
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by using semi structured interview schedule. The knowledge regarding rights of

mentally ill among caregivers of patients with mental illness assessed using semi

structured interview schedule contains 25 questions divided into 5 domains. The

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collected data were analysed using descriptive and inferential statistics. The study

findings revealed that nearly half of the participants (43.9%) had poor knowledge and

only 17.1% had good knowledge regarding rights of mentally ill and mean knowledge
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score were 9.81. There was significant association between knowledge regarding rights

of mentally ill among caregivers of patients with mental illness and age, education,

occupation and relationship with the patient. The findings have several implications in
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nursing practice, education, administration and research.

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Keywords: Rights of mentally ill; Knowledge; caregivers

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TABLE OF CONTENTS

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List of tables

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List of figures

List of appendices

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Chapters Titles Page No.

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1. INTRODUCTION 1-22

2. REVIEW OF LITERATURE 23-37

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3. METHODOLOGY 38-48
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4. ANALYSIS AND INTERPRETATION 49-77

5. RESULTS 78-84
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6. DISCUSSION, SUMMARY AND 85-100

CONCLUSION
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REFERENCES 101-109

APPENDICES 110-136
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LIST OF TABLES

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SI No. Title Page No.

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1. Distribution of participants based on age, sex and religion. 51

2. Distribution of participants based on occupation and monthly 53

income.

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3. Distribution of participants based on relationship with patient 55

4. Distribution of the participants based on diagnosis and 56

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duration of diagnosis

5. Distribution of the participants based on mode of treatment 57

6.
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Distribution of participants based on frequency of

readmissions
58
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7. Distribution of participants based on last hospitalization and 59

duration of last hospitalisation

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8. Distribution of participants based on physical comorbidities 61

9. Distribution of participants based on minimum, maximum, 63

mean, standard deviation of knowledge regarding rights of

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patients with mental illness

10. Distribution of participants based on minimum, maximum, 64

mean, standard deviation of section wise knowledge

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regarding rights of patients with mental illness.

11. Distribution of participants based on knowledge regarding 65

civil rights of patients with mental illness

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12. Distribution of participants based on knowledge regarding 66

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criminal rights of patients with mental illness.

13. Distribution of participants based on knowledge regarding 67

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fundamental rights of patients with mental illness

14. Distribution of participants based on knowledge regarding 68

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diagnosis and treatment rights of patients with mental illness

15. Distribution of participants based on knowledge regarding 69

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rights of rehabilitation services and rights of mentally ill in

special circumstances

16. Significance of association between knowledge regarding 71

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rights of mentally ill and selected variables

17. Significance of association between knowledge regarding 72

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rights of mentally ill and age, education, occupation and

relationship with the patient

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18 Significance of association between knowledge regarding 73

rights of mentally ill and age of participants

19 Significance of association between knowledge regarding 74

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rights of mentally ill and education of participants

20 Significance of association between knowledge regarding 75

rights of mentally ill and occupation of participants

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21 Significance of association between knowledge regarding 76

rights of mentally ill and relationship with patient of

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participants
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LIST OF FIGURES

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SI. No. Title Page No.

1. Conceptual framework based on Nola J Pender’s health 22

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promotion model to assess the knowledge regarding the

rights of mentally ill among caregivers of patients with

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mental illness.

2. Schematic representation of the study to assess the 41

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knowledge regarding rights of mentally ill among

caregivers of patients with mental illness

3. Distribution of participants based on education status 52

4.
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Distribution of participants based on marital status 54

5. Distribution of participants based on psychiatric comorbidities 60

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6. Distribution of participants based on knowledge regarding 62
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rights of patients with mental illness

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LIST OF APPENDICES

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SI. No. Title Page No.

SECTION A: ENGLISH

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A Approval letter from Institutional Ethics Committee 110

B Permission letter from Principal of Government Medical 111

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College, Kozhikode

C List of experts for content validity 113

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D Informed consent 114

E Tool 1: semi structured interview schedule to assess the 115

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socio personal data of the caregiver and clinical data of the

patients.
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F Tool 2: semi structured interview schedule to assess the 118

caregiver’s knowledge regarding rights of patients with

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mental illness

G List of abbreviations 121

SECTION B: MALAYALAM
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H Informed consent 122

I Tool 1: semi structured interview schedule to assess the 123

socio personal data of the caregiver and clinical data of the

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patient.

J Tool 2: semi structured interview schedule to assess the 126

caregiver’s knowledge regarding rights of patients with
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mental illness
K Information leaflet- Rights of patients with mental illness 129
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CHAPTER 1

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INTRODUCTION

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Background of the problem

Need and significance of the study

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Statement of the problem

Objectives

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Operational definitions

Assumptions

Hypotheses
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Conceptual framework
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CHAPTER 1

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INTRODUCTION

Positive thinking, or an optimistic attitude, is the practice of focusing on the

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good in any given situation. It simply means, approach the good and bad in life with

the expectation that things will go well. It can have a big impact on mental and physical

DyF.i
health. Mental, physical and social health are vital strands of life that are closely

interwoven and deeply interdependent. Mental health is crucial to the overall wellbeing

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of individuals, societies and countries.1 The World Health Organization defines mental

health as a “state of well-being in which every individual realizes his or her own

potential, can cope with the normal stresses of life, can work productively and fruitfully,
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and is able to make a contribution to her or his community”. 2 This definition implies

that mental health is reliant on the wide array of supports and resources that facilitate
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individual engagement at the highest level of gainful employment and in other

community roles. These factors include health, the availability of adequate housing,
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favourable conditions for work, and freedom from discrimination and all these

dimensions are closely related and directly affect each other.

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A person who is able to understand the facts, rationalize the doubts, interpret

the views and solves the problem tactfully is considered mentally healthy but a person

who has clinically significant disturbance in cognition, emotion regulation or behaviour

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that reflects a dysfunction in the psychological, biological and developmental processes

underlying mental functioning is considered as a mentally ill. Hence, mental illness

refers to a wide range of mental health conditions disorders that affect the mood,
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thinking and behaviour.3

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Human needs are unlimited. Based on demands we can satisfy our needs, only

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those having good insight will be able to identify their demands. Whereas a mentally

ill person not having insight, so they are not considered as an individual in the

sophisticated society. The mentally ill person is not able to protect their basic rights

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due to impaired judgement. People with mental illness encountering rights violations in

meeting their basic needs are a reality to be found in every corner of the globe .4

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The Preamble to the Constitution of India assures equal treatment and equality

of opportunity and status to all the citizens. Every person with a mental illness has the

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same basic rights as every other person, specifically including the rights set out in the

International Covenant on Civil and Political Rights (ICCPR) and the rights recognized

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in the Declaration on the Rights of Disabled Persons; that discrimination on the basis

of mental illness is not permitted and that people being treated for a mental illness must
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be accorded the right to recognition as a person before the law.4 Despite the adequate

legislations, we often come across the facts about the way people with mental illness
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are treated in community and various psychiatric institutions.5 Further, World Health

Organization (WHO) states that we are “facing a global human rights emergency in

mental health” as many countries lack the basic legal framework to protect those with
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a disability.6 A free India was not an exception, as evident by the National Human

Rights Commission report7 which highlighted the gross inadequacies and subhuman

living conditions in mental hospitals. Furthermore, India's dismal record of rights

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violations of the mentally ill was glaringly exposed with the death of 25 patients at an

“asylum” in Tamil Nadu.8 The lack of awareness about the rights or their violations, as

seen in the Erwadi tragedy and similar cases, is the result of social stigma, prejudice,
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and other social and economic factors linked with mental illness.9
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Community care has been a paradigm shift for psychiatric treatment worldwide.

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The establishment of a comprehensive community support system, an environment that

allows the people with mental illness to experience all the rights of citizenship as other

individuals do, and tolerance and non-discrimination in the local community. 10 But still

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there are high levels of bullying, harassment, and exploitation experienced by people

with mental health problems while living in the community. In addition, they continue

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to ‘suffer from widespread, systematic discrimination and are consistently denied the

rights and services to which they are entitled’.11

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The shift to community-based psychiatric services has formalized the role of the

caregiver. The role of family becomes even greater in a developing country like India.12

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A large part of the mental healthcare takes place in the community making the family

as the primary care provider. The caregiver who takes care of them often undergoes
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severe stress. From the caregivers view it was understood that support systems are poor,

fear of poor acceptance of neighbourhood for keeping the affected individual at home
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still exist. This is happening due to lack of awareness regarding rights of patients with

mental illness.

Family members are often the primary caregivers of people with mental
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disorders. They provide emotional and physical support, and often have to bear the

financial expenses associated with mental health treatment and care. It is estimated that

one in four families has at least one member currently suffering from a mental or
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behavioural disorder. In addition to the obvious distress of seeing a loved one disabled

by the consequences of a mental disorder, family members are also exposed to the

stigma and discrimination associated with mental ill health. Rejection by friends,
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relatives, neighbours and the community as a whole can increase the family’s sense of
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isolation, resulting in restricted social activities, and the denial of equal participation in

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normal social networks.13

The myths and misconceptions associated with mental disorders negatively

affect the day-to-day lives of sufferers, leading to discrimination and the denial of even

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the most basic human rights. All over the world, people with mental disorders face

unfair denial of employment and educational opportunities, and discrimination in health

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insurance and housing policies. In certain countries, mental disorders can be grounds

for denying people the right to vote and to membership of professional associations. In

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others, a marriage can be annulled if the woman has suffered from a mental disorder.

Such stigma and discrimination can, in turn, affect a person’s ability to gain access to

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appropriate care, recover from his or her illness and integrate into society. 14

People with mental illness experiencing a wide range of violation of rights of

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mentally ill. 15Majority of the mentally ill were excluded from the community life and

denied basic rights such as shelter, food, and clothing; and this could be due to stigma
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and misconceptions associated with mental illness. Mentally ill also discriminated

against in the fields of employment, education and housing. As a consequence, many

people with mental disabilities are living in extreme poverty which in turn, affects their
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ability to gain access to appropriate care, integrate into society and recover from their

illness.16

Considering the high prevalence of right violation in community, because of

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lack of awareness, people with mental illness and their families do not exercise their

rights. The aim of present study was to assess the knowledge regarding rights of
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mentally ill among the caregivers of patients with mental illness and association

between the knowledge and selected variables. Association between knowledge

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regarding rights of patients with mental illness and selected variables provide useful

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information regarding rights of patients with mental illness among caregivers of

patients with mental illness and helps to reduce the violations of rights of patients with

mental illness and provided them with a better care.

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Background of the study

DyF.i
Mental disorders can affect the way people think and behave, their capacity to

protect their own interests and, on rare occasions, their decision-making abilities.

Secondly, persons with mental disorders face stigma, discrimination and

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marginalization in our society. Stigmatization increases the probability that they will

not be offered the treatment they need or that they will be offered services that are of
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inferior quality and not sensitive to their needs. Marginalization and discrimination also

increase the risk of violation of their civil, political, economic, social and cultural rights
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by mental health service providers and others.17

The prevalence of COVID-19-related mental health problems is emerging. A

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nationwide survey of participants from China recruited through convenience sampling

(n = 1210) reported that 16.5% of individuals exhibited severe depressive symptoms,

and 28.8% moderate to severe anxiety symptoms. Another nationwide online survey
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using convenient sampling in China estimated that the prevalence of anxiety disorders,

depressive symptoms and reduced sleep quality was 35.1, 20.1 and 18.2%, respectively.

An online study (n = 4872) from Wuhan, China, found a 48.3 and 22.6% prevalence of
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depression and anxiety among the general adult population. The largest study

conducted in China (n = 52 730) found 35% of respondents experienced psychological

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distress as assessed by the COVID-19 Peritraumatic Distress Index.18

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People with mental disorders experience some of the harshest living conditions

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in many societies. They face economic marginalization, at least in part because of lack

of awareness of legal protections against improper and abusive treatment. They are

often denied opportunities to be educated, to work or to enjoy the benefits of public

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services or other facilities. There are many instances of laws that do not actively

discriminate against people with mental disorders but place improper or unnecessary

DyF.i
barriers or burdens on them.13

WHO also estimates that about 7.5 per cent Indians suffer from some mental

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disorder and predicts that by end of this year roughly 20 per cent of India will suffer

from mental illnesses According to the numbers, 56 million Indians suffer from

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depression and another 38 million Indians suffer from anxiety disorders. According to

World Health Organisation, the burden of mental health problems is of the tune of 2,443
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disability-adjusted life years per 100,000 populations, and the age-adjusted suicide rate

per 100,000 populations is 21.1.6

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A literature review identifies and examines human rights violations experienced

by individuals with mental illness on a global level. The study shows that Individuals

with mental illness are experiencing human rights violations on a global scale both
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within and outside of psychiatric institutions. These violations include denial of

employment, marriage, procreation, and education; malnutrition; physical abuse; and

negligence. The study concluded that more supports need to be instilled, especially
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within the context of low- and middle-income countries lacking adequate staffing and

accessible services. Furthermore, legislation needs to be modified, updated, or created

with relevant systems in place to make these laws enforceable. 19

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A report by the United Nations Human Rights points out that people with mental

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health conditions and those with psychosocial disabilities experience disproportionately

higher rates of poor physical health; and have a reduced life expectancy a 20-year drop

for men and 15 years for women - compared with the general population. Stigma is also

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a significant determinant of quality care and access to the full range of services they

require. Interrupted or restricted access to education limits gainful employment

DyF.i
opportunities for people with mental health conditions and those with psychosocial

disabilities, thus perpetuating social inequality. Multiple and intersecting forms of

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discrimination continue to impede the ability of people with disabilities belonging to

racial and ethnic minorities to realize their right to mental health.20

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The findings of a systematic review on human rights violations in COVID-19

response, with a focus on vulnerable populations, and its association with mental health
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and psychological well-being revealed that, the vulnerable populations to be at a high

risk for mental distress. Limited mobility rights disproportionately harmed psychiatric
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patients, low-income individuals, and minorities who were at higher risk for self-harm

and worsening mental health. Other vulnerable groups such as the elderly, children, and

refugees also experienced negative consequences. The review emphasizes the need to
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uphold human rights and address long term mental health needs of populations that

have suffered disproportionately during the pandemic.21

People with psychosocial disabilities and those with mental health conditions
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are incapable of exercising agency over decisions that concern them, which in turn

compromises their care. Discrimination, harmful stereotypes and stigma in the

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community, family, schools and the workplace prevent healthy relationships, social

interactions and the inclusive environments that are needed for anyone’s well-being.
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Lack of caregiver’s knowledge regarding rights of mentally ill such as civil rights,

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criminal rights, fundamental rights, diagnosis and treatment related rights and rights of

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rehabilitation and special circumstances leads to compromised care of the patients with

mental illness.

THE MENTAL HEALTHCARE ACT, 2017, is one of the acts that provide for

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mental healthcare and services for persons with mental illness and to protect, promote

and fulfil the rights of such persons during delivery of mental healthcare and services

DyF.i
and for matters connected therewith or incidental thereto. This act put forward that

Every person will have the right to access mental healthcare services. Such services

aPr
should be of good quality, convenient, affordable, and accessible. This act further seeks

to protect such persons from inhuman treatment, to gain access to free legal services

ebrr
and their medical records, and have the right to complain in the event of deficiencies in

provisions. Chapter five of the mental health care act discusses the fundamental Rights
cslti
of persons with mental illness. The rights included are 1) Right to access mental health

care 2) Right to community living 3) Right to protection from cruel, inhumanity and
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degrading treatment 4) Right to confidentiality 5) Right to access medical records 6)

Right to personal contacts and communication 7) Right to legal aid 8) Right to make

complaints about deficiencies in provision of treatment.22A better understanding of

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caregiver’s knowledge and awareness regarding rights of patients with mental illness

may improve the quality of life of patients with mental illness and able to provide a

better care.
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Need and significance of the study

Mental health includes subjective well-being, perceived self-efficacy,

at

autonomy, competence, inter-generational dependence and recognition of the ability to

realize one’s intellectual and emotional potential. It has also been defined as a state of
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or
well-being whereby individuals recognize their abilities, are able to cope with the

d it
normal stresses of life, work productively and fruitfully, and make a contribution to

their communities. Mental health is about enhancing competencies of individuals and

communities and enabling them to achieve their self-determined goals. Mental health

nE
should be a concern for everyone in the society, rather than only for those who suffer

from a mental disorder. Mental health problems affect society as a whole, and not just

DyF.i
a small, isolated segment. They are therefore a major challenge to global development.

No group is immune to mental disorders, but the risk is higher among the poor,

aPr
homeless, the unemployed, persons with low education, victims of violence, migrants

and refugees, indigenous populations, children and adolescents, abused women and the

ebrr
neglected elderly. It becomes ever more apparent that mental health is crucial to the

overall well-being of individuals, societies and countries. 13

cslti
A mental disorder, also called a mental illness or psychiatric disorder is a

behavioural or mental pattern that causes significant distress or impairment of personal

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functioning. Mental illness has a long history of being stigmatized in societies around

the globe. Mental illness is surrounded by ignorance, superstition and feeling of fear

among the public. Many patients suffering with mental illness are often taken to
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different religious places and healers before coming for treatment to a mental health

hospital.14

Mental disorders represent four of the ten leading causes of disability

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worldwide. A study conducted by the National Institute of Mental Health and

Neurosciences (NIMHANS) concluded that 13.7% of Indians suffer from mental

illnesses and 10.6% of this requires immediate intervention. Out of these, nearly 1.9%
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of the population suffers from a severe mental disorder which includes schizophrenia,
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bipolar mental disorders.23

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A Global Burden of Disease Study by world health organization conducted in

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the year 1990 to 2017 declares that one in seven Indians were affected by mental

disorders of varying severity in 2017 and the proportional contribution of mental

disorders to the total disease burden in India has almost doubled since 1990. WHO also

nE
estimates that, in India, the economic loss, due to mental health conditions, between

2012-2030, is 1.03 trillion.24

DyF.i
National mental health survey, conducted in different districts of Kerala reveals

that 11.6% of the population above 18 years of age has one or other mental illness which

aPr
when translated into actual numbers will come to around 27,70,000. 25

People with mental illness experiencing a wide range of rights violations.

ebrr
Majority of the mentally ill may be excluded from community life and denied basic

rights such as shelter, food and clothing; and this could be due to stigma and
cslti
misconceptions associated with mental illness. Mentally ill are also discriminated

against in the fields of employment, education and housing.

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According to world health organization (WHO) fact sheet updated April 2020

revealed that there is a human rights emergency in mental health. All over the world

people with mental disabilities experience a wide range of human rights violations. In
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many countries people do not have access to basic mental health care and treatment

they require. In others, the absence of community based mental health care means the

only care available is in psychiatric institutions which are associated with gross human
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rights violations including inhuman and degrading treatment and living conditions.

Even outside the health care context, they are excluded from community life and denied
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basic rights such as shelter, food and clothing, and are discriminated against in the fields

of employment, education and housing due to their mental disability. Many are denied
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the right to vote, marry and have children. As a consequence, many people with mental

d it
disabilities are living in extreme poverty which in turn, affects their ability to gain

access to appropriate care, integrate into society and recover from their illness. 26

A comparative study conducted among 70 patients with mental illness and 70

nE
mentally ill population from one of the districts in Kerala showed that there were

significant deficits in overall fulfilment of perceived human rights, specifically in the

DyF.i
in the interindividual and work domains. Significant deficits were also detected in

certain items related to health care and community. The study concluded that mentally

aPr
ill perceive considerable deficits in the fulfilment of human rights in various areas. 27

A descriptive study conducted among general population by a charity by the

ebrr
name ‘Live Love Laugh Foundation’ at the beginning of 2018 concluded that 87% of

the participants showed awareness, out of which 71% of them used the word ‘stigma’
cslti
or associated terms with mental illnesses. Therefore, it is the law which has to step into

the picture to bridge the gap of social acceptance and grant various rights to people who
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suffer from mental illnesses. This becomes all the more important due to the growing

awareness rights of mentally ill.28

A descriptive study conducted to assess the influence of poverty in meeting

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human rights needs among recovered women with mental illness at family and

community level among randomly selected (n = 100) recovered women with mental

illness at a tertiary care centre. The findings of the study revealed that below poverty
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line (BPL) participants were not satisfied in meeting their physical needs such as

"access to safe drinking water”, “served in the same utensils", had adequate food and
at

allowed to use toilet facilities. The human rights need in emotional dimension, that is,

afraid of family members and hurt by bad words were rated higher in above poverty
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line (APL) participants. Similarly, 88.9% of women from APL group expressed that

d it
they were discriminated and exploited by the community members. More than three-

fourths of BPL participants (76.1%) believed that there were wondering homeless

mentally ill in their community. 29

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Given the inherent vulnerability of those with mental health issues and the

stigma of being a burden on society, Stigma and discrimination can result in a lack of

DyF.i
access to health and social services. Furthermore, people with psychosis are at high risk

of exposure to rights violations, such as long-term confinement in institutions. Health

aPr
systems have not yet adequately responded to the burden of mental disorders. As a

consequence, the gap between the need for treatment and its provision is wide all over

ebrr
the world.30

Knowledge on Mental health legislation for community is an essential part of

cslti
delivering high quality mental health care and is especially necessary to protect the

rights of individuals receiving such care. At present many people lack appropriate
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literacy on mental health legislation and consequently many individuals with mental

illness are deprived safe, effective, person-centred services. This has a significant

impact on occupational, personal and family life. Mental Health Care Act, 2017 is one
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of such steps of the legislators to provide them with various rights.

Family members are often the primary caregivers of people with mental

disorders. They provide emotional and physical support, and often have to bear the
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financial expenses associated with mental health treatment and care. It is estimated that

one in four families has at least one member currently suffering from a mental or
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behavioural disorder. In addition to the obvious distress of seeing a loved one disabled

by the consequences of a mental disorder, family members are also exposed to the
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stigma and discrimination associated with mental ill health. Rejection by friends,

d it
relatives, neighbours and the community as whole can increase the family’s sense of

isolation, resulting in restricted social activities, and the denial of equal participation in

normal social networks.31

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The rights of mentally ill are acknowledged for this population and also that

rights violations are globally recognized and curtailed. Individuals with mental health

DyF.i
issues are maltreated and marginalized due to the nature of their illness. This trend is

attributed to a number of factors including culture, ethnicity, religion, language, and

aPr
poverty.19

From the caregivers view it was understood that support systems are poor, fear
ebrr
of poor acceptance of neighbourhood for keeping the affected individual at home still

exist. Also, it was clearly understood that before proper medical attention they were
cslti
treated by faith healing practices where patients were treated in inhumane manner. And

only in advanced stage of mental illness or if they become unmanageable only, they
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were brought to the hospital. it is the responsibility of the psychiatric nurse to ensure

that their actions promote welfare of patients. Psychiatric mental health nurse are rich

providers of Psychiatric mental health services to the patient as well as to their

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caregivers.32

There is paucity of data in this area of research in India, especially in Kerala

this area is under researched and no significant study materials available on this subject.
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The researcher came across certain previous researches, data and also similar situations

in clinical areas where the general public and caregivers of patients with mental illness
at

had poor knowledge regarding rights of mentally ill. The researcher’s informal

discussions with colleagues, hospital and office staffs, caregivers of patients with
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or
mental illness revealed that more than half of them are less knowledgeable. Many of

d it
the caregivers lacks knowledge on rights of mentally ill and services provided for them

and many of the patient rights are violated.

The existing knowledge regarding rights of mentally ill among caregivers of

nE
patients with mental illness are therefore needed to be studied to enrich the knowledge

level of caregivers. During clinical posting the researcher has witnessed few cases of

DyF.i
right violations; and also, the victims and caregiver had poor knowledge regarding the

rights of patients with mental illness and the mental health services offered to them.

aPr
Thus, the researcher decided to conduct a study to assess the knowledge regarding

rights of mentally ill among caregivers accompanying patients who are attending out-

ebrr
patient department of psychiatry in Govt. Medical College Hospital, in Kozhikode

District.
cslti
Statement of the problem

A Study to assess the knowledge regarding rights of mentally ill among

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caregivers of patients with mental illness attending Outpatient Clinics, Department of

Psychiatry, Govt. Medical college Hospital, Kozhikode.

Objectives
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 Assess the knowledge of care giver regarding rights of patients with mental

Illness.
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 Find out the association between the knowledge regarding rights of mentally ill

among caregivers of patients with mental illness and selected variables.

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Operational definitions

d it
Knowledge: Knowledge refers to the awareness and information regarding rights of

mentally ill among caregivers of patients with mental illness and assessed by the

response to items of the knowledge questionnaire.

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Rights of Mentally Ill: They are the fundamental normative rules about what is allowed

DyF.i
to mentally ill persons according to Mental Health Care Act (2017), chapter 5, in this

study it includes:

aPr
 Right to access mental health care

 Right to community living


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Right to protection from cruel, inhumanity and degrading treatment

Right to confidentiality

 Right to access medical records

cslti
 Right to personal contacts and communication

 Right to legal aid

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 Right to make complaints about deficiencies in provision of treatment

Care giver: refers to a person who resides with the mentally ill patient one month or more and

is responsible for providing care to that person and includes a relative or any other person who
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performs this function, related by blood or marriage or by adoption who is accompanying the

patients in the Outpatient Clinics, Department of Psychiatry, Govt. Medical College Hospital,

Kozhikode.
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Selected variables: Includes socio personal variables and clinical variables.

Socio personal variables: Includes age, gender, religion, education, occupation, marital status,
at

family income of the caregiver and relationship with the patient.

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Clinical variables: Includes diagnosis, duration since diagnosis, mode of treatment, frequency

of readmissions, last hospitalization, duration of last hospitalization, psychiatric comorbidities

d it
such as depression, anxiety and substance use and physical comorbidities such as diabetes,

hypertension, thyroid abnormalities, obesity, and extrapyramidal side effects of patients with

nE
mental disorder.

Patients with mental Illness: persons who are clinically diagnosed as having schizophrenia

DyF.i
and mood disorders as per ICD-10 criteria and under the treatment of a psychiatrist.

Assumption

aPr
The study will be based on following assumptions:

 The caregiver of patients with mental illness has some knowledge regarding rights of


ebrr
patients with mental illness.

Socio-personal variable may influence the knowledge of the caregiver on rights of

cslti
patients with mental illness.

 Clinical variable of patients may influence the knowledge of the caregiver on rights of
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patients with mental illness.

 Caregiver with knowledge of rights of mentally ill will be able to protect the

rights of patients with mental illness.

Hypotheses
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H1: There is a significant association between the knowledge regarding rights of

mentally ill among caregiver of patients with mental illness and selected socio-personal
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variables.

H2: There is a significant association between the knowledge regarding rights of

at

mentally ill among caregiver of patients with mental illness and selected clinical

variables.
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Conceptual framework

d it
The conceptual framework of the study is based on Revised Health Promotion

Model by Nola J Pender (2006). This model describes the multidimensional nature of

persons as they interact with their environment to pursue health. Health promotion is

nE
directed at increasing a client’s well-being. Health promotion is defined and

differentiated from disease prevention or health protection. Health promotion is defined

DyF.i
as behaviours motivated by the desire to increase wellbeing and actualize human health

potential. Health promotion is directed at increasing a client’s level of well-being. The

aPr
model focuses on the following three areas,

1. Individual characteristics and experiences.

ebrr
2. Behaviours specific cognition, affect

3. Behavioural outcomes.
cslti
The individual characteristics and experiences

Include prior related behaviours and personal factors such as biological,

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psychological, and socio-cultural factors.

In this study prior related behaviours

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Are existing knowledge regarding rights of mentally ill and lack of access to

information sources. Personal factors include biological factors such as age, gender.

Psychological factors include awareness and attitude regarding rights of patients with
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mental illness. Socio cultural factors are religion, education, occupation, marital status,

family income and relationship with the patient.

at
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Behaviours specific cognition and affect

d it
Include perceived benefit of action, perceived barriers to action, perceived self-efficacy,

activity related affect, interpersonal influences, situational influences, all of which led

to a commitment to a plan of action and consideration of immediately competing

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demands and preferences.

DyF.i
Perceived benefits of action

Are anticipated positive outcomes that will occur from health behaviour. In this

aPr
study, it includes acquiring knowledge regarding rights of mentally ill in order to

protect the rights of patients with mental illness. The researcher providing information

leaflet on rights of patients with illness including civil rights, criminal rights,
ebrr
fundamental rights, diagnosis and treatment related rights and rights in rehabilitation

and special circumstances.

cslti
Perceived barriers to action
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Are anticipated, imagined or real blocks of understanding a given behaviours.

Perceived barriers influence action directly by blocking that action or indirectly by

decreasing any commitment to action. In this study perceived barriers of action include
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lack of knowledge regarding rights of patients with mental illness, poor socio -

economic status, unfavourable attitude, influence of media, negative responses from

health professionals and religious beliefs

ewd

Perceived self-efficacy

Is the perceived ability to achieve a behaviour. It is influenced by activity related

at

affect. As the affect becomes more positive, self-efficacy is viewed as greater. In this

study, perceived self-efficacy includes personal competency to understand and gain

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or
knowledge regarding rights of patients with mental illness and to protect the rights in

d it
their daily life.

Activity related affect

nE
Refers to negative and positive behaviours associated with actually doing the

health promoting behaviours. In this study, activity related affect includes subjective

DyF.i
positive feelings like readiness and motivation to understand regarding rights of

patients with mental illness and protect the same and subjective negative feelings like

inadequate knowledge and lack of readiness. Interpersonal influences are cognitions

aPr
concerning behaviours, belief or attitude of others.

Interpersonal and situational factors

ebrr
In this study, interpersonal influences include the Family members, relatives,

friend’s neighbours and health care providers. Situational influences include mass
cslti
media influences like TV, radio, newspaper, and health magazines, availability and
.Mcna

access to health promoting behaviours, area of residence, educational status, personal

and religious beliefs and cultural factors.

Commitment to plan of action

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Initiates the behaviour. The underlying cognitive processes are commitment to

carry out a specific action at a given time and place with specified persons or alone

irrespective of competing preferences and identification of definitive strategies for

ewd

eliciting, carrying out and reinforcing the behaviour. Both commitment and identified

strategies are necessary. In this study, commitment to a plan of action includes

at

modification of knowledge of caregivers under mental health care act, 2017 regarding

rights of patients with mental illness with the help of the information leaflet on rights
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of patients with mental illness.

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or
Immediate competing demands and preferences

d it
Immediate competing demands are those alternative behaviours over which

individuals have low control because there are environmental contingencies such as

work or family responsibilities. Competing preferences are alternative behaviour over

nE
which an individual exerts relatively high control. In this study immediate competing

demands include low control and high control. Low control includes age, gender,

DyF.i
education, occupation, socioeconomic status. High control includes improvement of

knowledge regarding rights of patients with mental illness and readiness to improve the

aPr
knowledge.

Behavioural outcomes
ebrr
The desired behavioural outcome is health promoting behaviour. The purpose

of health promoting behaviour is for the client to realize a positive health outcome such
cslti
as improved functional ability or improved quality of life. In this study health

promoting behaviour is gaining adequate knowledge regarding rights of patients with

.Mcna

mental illness to protect the rights of mentally ill with the help of information leaflet.

Conceptual framework of the present study is shown in Figure 1.

winw
ewd
at
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r
to
20

di
D .in
Behavioural Outcome
Individual characteristics and experiences Behaviour specific cognition and affect

E
Perceived benefit of action: Acquiring appropriate and Immediate competing demands
Prior related
adequate knowledge regarding rights of mentally ill in

y
behaviour Low control: age, gender, education,

F
order to protect the rights of patients with mental illness.
occupation, socioeconomic status.
Are existing

r Par
Perceived barriers to action: lack of knowledge Immediate competing preferences
knowledge regarding
regarding rights of patients with mental illness, poor socio High control: improvement of
rights of mentally ill -economic status, unfavourable attitude, influence of knowledge regarding rights of
among caregivers of media, negative responses from health professionals and patients with mental illness and

tebr
religious beliefs readiness to improve the knowledge.
patients with mental
illness and lack of Perceived self-efficacy: Personal competency to
understand and gain knowledge regarding rights of
access to information

csli
patients with mental illness and to protect the rights in Health
their daily life. Commitment to a promoting
plan of action behaviours
Personal factors
cna
Biological: Age, gender
Activity related affect: Subjective positive feelings like
readiness and motivation to improve knowledge regarding
Acquire adequate
knowledge regarding
Gain adequate
knowledge
w. M
rights of patients with mental illness and protect the same rights of patients with regarding rights
Psychological factors: and subjective negative feelings like inadequate mental illness and of patients with
awareness and attitude knowledge and lack of readiness modification of
regarding rights of mental illness
practices and
ww i n

patients with mental and to protect

Interpersonal influences Family members, relatives, knowledge to protect
illness the rights. Providing
the rights of
friends, neighbours and health care providers patients with
information leaflet on
Sociocultural factors: rights of patients with mental illness
Situational influences Cultural practices, socioeconomic
ed

religion, education, mental illness

occupation, monthly status, perception regarding disease, accessibility to
income, marital status, health care, availability of services and exposure to mass
relationship with patient media like TV, health magazines and radio
at

Figure 1: Conceptual frame work of the study based on Nola J Pender’s Health Promotion Model

22
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CHAPTER 2

d it
REVIEW OF LITERATURE

nE
Knowledge regarding rights of patients with mental illness among:

DyF.i
General public

Patients with mental illness and caregivers of patients with mental illness

Health care professionals

aPr
ebrr
cslti
.Mcna
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at
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CHAPTER 2

d it
REVIEW OF LITERATURE

Review of literature is the key step in research process. Review of literature is

nE
the systemic identification, selection, critical analysis and reporting of existing

information on the topic. The purpose of the review of literature for this study is to

DyF.i
obtain in depth knowledge and information regarding the rights of mentally ill among

general public, patients with mental illness and caregiver of patients with mental illness

aPr
and various health care professionals.

The literature reviewed is categorized and organized under the following headings.

ebrr
Knowledge regarding rights of patients with mental illness among:

 General public
cslti
 Patients with mental illness and caregivers of patients with mental illness
.Mcna

 Health care professionals

Knowledge regarding rights of patients with mental illness among general

public:
winw

People with mental disorders are vulnerable to abuse and violation of their basic

rights. Such abuse or violation may occur from diverse elements in society including

institutions, family members, caregivers, professionals, friends, unrelated members of

ewd

the community, and law enforcing agencies. Such protective mechanisms include

legislative provisions and policies to ensure that the rights of this vulnerable group are
at

protected. In the undeniable context that every society needs laws in various areas to
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or
maintain the well-being of its people, mental health care is one such important area that

d it
requires appropriate legislation. 33

A descriptive cross-sectional study was conducted among 140 community

people of Nepal. Non probability convenient sampling technique was adopted to collect

nE
the data. Data was collected through face-to-face interview using a structured

questionnaire. Results showed that 46.40% of the community people had inadequate

DyF.i
knowledge regarding human rights of mentally ill patients. There was no significant

association between demographic variables and knowledge score of the respondents.

aPr
The study showed that more than half of the respondents (51%) had belief that mental

illness is not related to physical health. Among participants 36.4% believed mental

ebrr
illness is caused by supernatural power and evil and 30% believed that marriage can

cure mental illness.34

cslti
A descriptive study was conducted to assess the level of knowledge regarding

human rights of persons with mental illness among 400 adults from selected urban areas
.Mcna

of Pune city. Sample was selected by using non probability purposive sampling

technique. The result showed that male was more than female; maximum was in the

age group of 25-31years with 35%. most sample were educated till higher secondary.
winw

Majority were from joint family with 53.25p%. With regard to marriage status 69 %

were married. Most of the samples were of Hindu religion. In Occupation most of them

were unemployed. With regard to knowledge level 74.25 % had good knowledge level
ewd

with mean score of 10.45 and SD- 1.55. There is no association found between the

knowledge level and demographic variables as the p-value is greater than 0.05. 35
at

A descriptive study was conducted to assess the knowledge regarding human

rights of mentally ill among adults in selected rural area of South India. Data was
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or
collected from 80 samples. The samples were selected by using non-probability

d it
sampling technique with help of structured questionnaires. The results showed that

1.2% have good knowledge, 71.2% have average knowledge and 27.5% have poor

knowledge. There was a statistically significant association between the type of family,

nE
number of family members and educational status and knowledge level of human rights

of mentally ill at 0.05 levels.36

DyF.i
A cross-sectional study was conducted to understand the perceived human

rights temperature of community in patient with mental illness. Data were collected

aPr
from patient with mental illness (diagnosed with schizophrenia, bipolar disorder and

schizoaffective disorder, and symptomatically stable for 3 years) seeking outpatient

ebrr
psychiatric treatment from private psychiatric hospitals and clinics in Kozhikode

(Calicut) district of Kerala state, India. The results of the study showed that majority
cslti
were males (54.2%). Mean score of the human rights temperature scale was 68.31 ±

5.95. The study concluded that human rights of person with mental illness are a major
.Mcna

concern. Functioning of the mental health authority and legal aid clinics has to be

strengthened to address rights issues of Person with mental illness.37

A cross sectional study conducted to assess the rates of stigma and (Mental
winw

Health Knowledge) MHK and the association between MHK and stigma among a

Chinese adult population. The results of the study showed that a sizable proportion of

participants responded that others would hold a negative attitude towards (former)
ewd

mental patients, especially with regard to engaging in closer personal relationships.

Most people were not familiar about the causes, treatments and prevention of mental

illness. Resident area, age, education level, Per capita family income and employment
at

status were related to devaluation score and MHKQ score and MHK was negatively
re

associated with public stigma.38

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or
A cross sectional descriptive survey study was conducted to assess the

d it
knowledge on mental health law and attitude towards mental illness among the

members of the legal profession, attorneys in Benin-City, Edo State, South-South,

Nigeria, using a 21-item knowledge/attitude questionnaire. Convenience sampling

nE
techniques were used for sample selection. The results of the study showed that 75

attorneys who filled the questionnaire were in the age range of 23 and 65 years, with

DyF.i
more males (69.3%), more married (60.8%), and more private defence attorneys

(79.2%) participating. A greater proportion (64.8%) had not adjudicated for persons

aPr
with mental illness, and a few (22.2%) would not agree to solicit for them. Only a few

were accurate about when the Nigerian mental health law was enacted (9.3%), what it

ebrr
says about the treatment of the mentally ill persons (3.0%), and the handling of the

property of the same (3.1%). Although only a minority (7.1%) were familiar with the

provisions of the insanity defence under section 28 of the criminal code, most (85.9%)
cslti
identified correctly the disposal of a mentally ill person found unfit to plead according

to the criminal procedure act.39

.Mcna

Knowledge regarding rights of patients with mental illness among patients and

caregivers of patients with mental illness:

winw

A meta and Systematic review conducted to determining the mental capacity

of psychiatric patients for making healthcare related decisions is crucial in clinical

practice. The results of the review showed that from eleven publications were
ewd

reviewed. Variability on methods across studies makes it difficult to precisely estimate

the prevalence of decision-making capacity in patients with mental disorders.

Nonetheless, up to three quarters of psychiatric patients, including individuals with

at

serious illnesses such as schizophrenia or bipolar disorder may have capacity to make
re

medical decisions in the context of their illness. Most evidence comes from studies

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or
conducted in the hospital setting; much less information exists on the healthcare

d it
decision making capacity of mental disorder patients while in the community. Stable

psychiatric and non-psychiatric patients may have a similar capacity to make

healthcare related decisions. Patients with a mental illness have capacity to judge risk-

nE
reward situations and to adequately decide about the important treatment outcomes.

Different symptoms may impair different domains of the decisional capacity of

DyF.i
psychotic patients. Decisional capacity impairments in psychotic patients are temporal,

identifiable, and responsive to interventions directed towards simplifying information,

aPr
encouraging training and shared decision making. The publications complied

satisfactorily with the AMSTAR II critical domains.40

ebrr
An exploratory was conducted to assess the knowledge of family members on

the rights of individuals affected by mental illness among 18 families in Brazil. A semi-
cslti
structured interview was used for data collection. The results of the study showed that

Eighteen family members were participated in the study. Age of participants ranged
.Mcna

from 48 to 74 years; 16 family members were female and 2, male. Most participants

were the patients' mothers, followed by sisters, father and spouse. Education level

varied from illiteracy to complete higher education. Two participants were formally
winw

employed and the others were either retired, unemployed or not formally employed and

the interviewed family members were aware of rights related to medication,

transportation and the basic food basket.41

ewd

A descriptive study was conducted in a tertiary teaching hospital in south India,

among 100 primary caregivers of patient with mental illness. Sample were collected

using convenient sampling technique. Results of the study showed that majority of care
at

givers were having poor knowledge (47%), followed by (31%) had average knowledge
re

and (22%) of them had good knowledge regarding rights of mentally ill person.

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or
Significant association found between demographic variables such as age, education,

d it
occupation, residential area, and type of family.42

A cross sectional study was conducted to compare perceived human rights in

persons with mental illness to a group of individuals without mental illness. Data were

nE
collected from two groups: the first group comprised of 72 mentally ill (MI group)

attending the community mental health clinics of Kannur district in Kerala, and the

DyF.i
second group comprised of 72 individuals without mental illness (non-MI group. A

demographic proforma tool, Human Rights Questionnaire (HR-14), and HR–Work

aPr
supplementary tool (HR-Work) were used to collect information. Results showed that

MI group reported significant deficits in overall fulfilment of perceived human rights,

ebrr
specifically in the in the interindividual and work domains. Significant deficits were

also detected in certain items related to health care and community in the MI group and
cslti
concluded that mentally ill perceive considerable deficits in the fulfilment of human

rights in various areas. These findings are relevant in many respects. 27

.Mcna

A descriptive study was carried out to compare persons with psychiatric illness

and their caregivers’ perceptions regarding the human rights status of people with

mental illness in the community among randomly selected asymptomatic psychiatric

winw

patients and their caregivers (N=200) at a tertiary care centre in Nepal. Data was

collected through face-to-face interview, using a structured questionnaire. Results

revealed that the caregivers than psychiatric patients perceived negatively to the
ewd

statements i.e., ‘Receiving equal information and encouragement about career

opportunities’, ‘Opposing discriminatory actions, slurs’ (P<0.050) ‘Resolving the

conflicts with people with mental illness through nonviolent ways’ (P<0.000),
at

‘Responding to the complaints of harassment or discrimination against the people with

re

mental illness’(P<0.001), ‘Encouraged to continue their education’ (P<0.023)

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or
‘Exploitation by the community members’ (P<0.001) and working under fair conditions

d it
(P<0.009). 43

A descriptive study was conducted to compare the awareness about human

rights among the male and female caregivers of patients diagnosed with Psychiatric

nE
disorders. The study conducted among 50 male caregivers and 50 female Caregivers at

the Psychiatric OPD and Inpatient wards of a tertiary hospital in Chennai were

DyF.i
considered as the subjects and over a period of 4 weeks, samples were selected based

on the sampling criteria. The results showed that among the male caregivers 62% were

aPr
having poor awareness and 38% of them were having average awareness and majority

of the female caregivers (82.0%) were having poor awareness and 18% of them were

ebrr
having average awareness and none of them were having good awareness. 44

An exploratory study was conducted among caregivers of patient with mental

cslti
illness. A semi-structured interview was used for data collection. Eighteen family

members were interviewed at a psychosocial care centre (CAPS) and a civil society
.Mcna

organization (CSO) located in a municipality in the state of São Paulo, Brazil. The

results showed that in addition to drug-based therapy, mental health services must

provide therapeutic activities. Family members of those affected by mental illness were
winw

unaware of the Brazilian Psychiatric Reform Law and mentioned the following rights:

welfare benefits, free public transport, basic food basket and medications. 45

A descriptive study was conducted to assess the impact of socio-economic

ewd

status in meeting the human rights needs among randomly selected recovered

psychiatric patients (n = 100) at a tertiary care centre. Data was collected through face-
at

to-face interview, using structured Needs Assessment Questionnaire. The revealed that

the participants from below poverty line were deprived of physical needs such as
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or
‘electricity facilities’ (p < .009) ‘safe drinking water’ (p < .004) and purchasing

d it
medications (p < .019). Conversely, participants from above poverty line were

dissatisfied in emotional needs dimension i.e., ‘commenting on physical appearance

(p < .040), afraid of family members (p < .000). 46

nE
A literature review identified and examined human rights violations

experienced by individuals with mental illness on a global level. In addition, the intent

DyF.i
is to explore how current legislation either reinforces or supports these violations. The

authors conducted an extensive review of the existing literature on mental health and

aPr
human rights violations. Individuals with mental illness are experiencing human rights

violations on a global scale both within and outside of psychiatric institutions. These

ebrr
violations include denial of employment, marriage, procreation, and education;

malnutrition; physical abuse; and negligence. It is evident that more supports need to
cslti
be instilled, especially within the context of low- and middle-income countries lacking

adequate staffing and accessible services. Furthermore, legislation needs to be

.Mcna

modified, updated, or created with relevant systems in place to make these laws

enforceable.19

Knowledge regarding rights of patients with mental illness among health care
winw

professionals:

A descriptive study conducted to determine the level of knowledge and attitude

of health care providers (physicians and nurses) in primary health care centres in Iraq
ewd

toward patient rights. A sample group of 333 of health care professionals (physicians

and nurses) was enrolled from 16 primary health care centres. A self-administered
at

questionnaire was used to assess the knowledge and the way in which patients’ rights

are perceived by the sample group. The Results showed that slightly more than one
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or
third of the participants (36%) knew the patients' rights (40.4% of doctors and 34.2%

d it
of nurses).Despite the poor knowledge of physician on patients' rights, the majority held

good attitude toward many of these rights particularly the rights of care and respect

(73.7%), privacy and confidentiality (76.8%), and the right to sue authorities about

nE
ignorance (70.7%).47

An exploratory study was conducted to assess the knowledge about human

DyF.i
rights of the mentally ill among the mental health professionals and the mass media in

Bangalore, India. Mental health centres and English newspaper offices in the city of

aPr
Bangalore were randomly selected and a total sample of 62 subjects, consisting of 32

mental health professionals (psychiatrists, social workers, psychologists and psychiatric

ebrr
nurse; n=8 in each group) and 30 health journalists working in English newspaper

offices was drawn. The results showed that both the groups have good knowledge about
cslti
the human right of persons with mental illness (approximately 86.3% right responses);

there was a trend towards MHP having better knowledge compared to HJ.48
.Mcna

A descriptive survey study was conducted to assess the level of knowledge

regarding human rights of mentally ill among 33 Post Basic B. Sc. Nursing students in

Krishna Institute of Nursing Sciences, Karad, Maharashtra. Non probability convenient

winw

sampling technique is used for sample selection and structured knowledge

questionnaire to assess the knowledge regarding human rights of mentally ill. Results

showed that 85% of the nursing students had average knowledge and 15% had poor
ewd

knowledge regarding human rights of mentally ill and there is no significant association

between demographic variables and knowledge score of Post Basic B. Sc. nursing

students.49
at
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or
A descriptive cross-sectional study was conducted among health care providers

d it
in a medical college and hospital in Mangalore. The Survey method was used to collect

the data. The study population was professionals and medical and nursing interns taking

care of mentally ill. The Sample size was 154. Purposive sampling technique was used.

nE
The data were collected using structured questionnaires after which it was analysed

using frequency, percentage, chi-square test, fishers exact test. Results showed that

DyF.i
there is only moderate awareness. Hence, it is recommended that the health care

providers should be given more awareness regarding the human rights of the mentally

aPr
ill.50

A descriptive survey study was conducted to assess the level of knowledge

ebrr
among nursing students regarding human rights of mentally ill among 400 nursing

students from nursing colleges of Bangalore South East area. Two-stage random
cslti
sampling technique were used for sample selection. Results showed that none had good

level, 30.25% of students had adequate knowledge and 69.75% of students had
.Mcna

inadequate knowledge. There was significant association between knowledge score

with gender (p<0.01), exposure to psychiatric/ mental health setup (p<0.05), having an

acquaintance with mental illness (p<0.001) and experience with human rights
winw

commission cell (p<0.05). There was no significant association between knowledge

score and age, year of the course and marital status.51

A descriptive study was conducted to assess knowledge and attitude of staff

ewd

nurses regarding human rights of mentally ill patients among 50 staff nurses working

in psychiatric wards of general hospitals and in psychiatric hospitals of Bangalore and

were selected through purposive sampling technique. A structured knowledge

at

questionnaire was used to assess level of knowledge and a four-point Likert scale was
re

used to assess attitude of nurses regarding human rights of mentally ill patients. Results

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34

or
showed that overall mean knowledge score was 50 percent and the overall mean attitude

d it
score was 68.65 percent among the staff nurses and concluded that there was a

requirement of continuing education of staff nurses regarding human rights of mentally

ill patients.52

nE
A quasi experimental- non-equivalent pre-test - post-test control group study

conducted to assess the effectiveness of structured teaching programme on knowledge

DyF.i
regarding the human rights of mentally ill among 80 staff nurses at selected hospitals

of Mysore. Non-probability convenient sampling technique was used to select 80 staff

aPr
nurses, 40 in each experimental and control group. The findings of the study revealed

that the structured teaching programme was highly effective educative method in

ebrr
improving the knowledge of staff nurses regarding the human rights of mentally ill. No

significant association was found between the pre-test knowledge levels and selected
cslti
personal variables of staff nurses except for exposure to any other educational

programme on human rights of mentally ill. 53

.Mcna

A descriptive study was conducted to assess the knowledge and attitude

regarding Human Rights of Mentally ill among the Staff Nurses working in selected

hospital for mental health of Gujarat state. Convenient sampling method was used to
winw

select 100 samples. A 40 question Structured Knowledge Questionnaire was used to

assess knowledge and 20 question Likert Attitude Scale was used to assess attitude of

Staff Nurses regarding Human Rights of Mentally ill. The results showed that 52%
ewd

respondents had good knowledge, 40 % respondents had average knowledge and 8 %

respondents had poor knowledge regarding Human rights of Mentally ill. In terms of

attitude 57% respondents had positive attitude, 43 % respondents had negative attitude
at

regarding Human Rights of Mentally Ill.54

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or
A descriptive study was conducted to assess the knowledge questionnaire

d it
regarding human rights and legal responsibilities of mentally ill among nursing

students. Data was collected by administering structured knowledge questionnaire

regarding human rights and legal responsibilities of mentally ill. The study was

nE
conducted among 60 III-year BSc nursing and GNM III-year students who were

selected by using non probability convenience sampling technique. The study results

DyF.i
revealed that 70% of nursing students had average knowledge, 21.6% had poor

knowledge and 8.4% had good knowledge among students.55

aPr
A descriptive study was conducted to explore the attitudes of mental health

professionals, psychiatrists and nurses, towards mental health patients and to determine

ebrr
the level of knowledge towards their rights. The study was carried out among a sample

of 166 mental health professionals (psychiatrists and nurses). A questionnaire,

cslti
consisting of four parts, was designed for the purpose of the study. The results showed

that 68.7% were nurses and 25.3% were psychiatrists and higher level of education is
.Mcna

associated with a more positive attitude towards mental health patients, the attitude of

mental health professionals towards the patients depends on the knowledge they have

of their rights and also that psychiatrists who have a mental health patient in their family
winw

have a more positive attitude towards these patients than nurses.56

A descriptive study was conducted to assess the knowledge of the staff nurses

regarding legal and ethical responsibilities in the field of psychiatric nursing at selected
ewd

psychiatric centre of Jaipur, Rajasthan. Total of 30 nurses were selected conveniently

and questioned using demographic sheet and Structured Knowledge Questionnaire

which contains items related to law terminology, acts and ethical issues. The results of
at

the study revealed that majority (90%) of the nurses possess moderate level of
re

knowledge. There was no significant association found between the knowledge with

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or
age, sex, marital status, designation of nurses, total clinical experience and in-service

d it
education while professional qualification and their psychiatric experience was

significantly associated with the knowledge level of the nurses.57

A quasi-experimental study was conducted to assess the effects of an

nE
educational intervention on psychiatric nurses’ knowledge regarding legal and ethical

issues associated with psychiatric patient treatment, in a tertiary hospital, Egypt. The

DyF.i
results of the study showed that Nurses’ satisfactory knowledge before the intervention

ranged between 4% for legal aspects to 62% for violence and neglect. All areas of

aPr
knowledge significantly improved after the intervention, with satisfactory knowledge

ranging between 76% for definitions to 98% for neglect and unprofessional practices.

ebrr
Overall, only one (2%) nurse had satisfactory total knowledge before the intervention,

which increased to 90% after the intervention.58

cslti
A cross sectional descriptive study conducted to assess the awareness regarding

the Healthcare Rights and General rights of the mentally ill among health care
.Mcna

providers. The study was conducted in a medical college and hospital in Mangalore.

The Survey method were used to collect the data. The study population were

professionals and medical and nursing interns taking care of mentally ill. The Sample
winw

size were 154 and samples were selected using purposive sampling technique. The data

were collected using structured questionnaires after which it was analysed using

frequency, percentage, chi-square test, fishers exact test. The results of the study
ewd

showed only moderate awareness and study recommended that the health care providers

should be given more awareness regarding the human rights of the mentally ill. 59
at

A quasi-experimental study conducted to assess the level of knowledge of the

psychiatric nurses regarding legal responsibilities about patient care. Convenient

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37

or
sampling technique was used to select 60 samples from the selected Hospital Bangalore.

d it
The results of the study showed that the staff nurses had deficit knowledge regarding

legal responsibilities in patient care. Total mean score was 16.88, which shows that the

knowledge deficit is around 50%. 60

nE
An experimental study was conducted to assess the effectiveness of self-

instructional module on knowledge and attitude regarding legal aspects in psychiatric

DyF.i
care among staff nurses at selected psychiatric hospital in Thrissur. Simple random

sampling technique were used to select 30 staff nurses working in Elite Mission

aPr
Hospital, Thrissur. The results of the study revealed that the mean pre-test knowledge

score was 11 and mean post-test knowledge score was 22.83 with standard deviation of

ebrr
2.393 and 2.640 respectively. The significant p value (p<0.001) suggested that the

administration of SIM was effective in changing the knowledge and attitude of staff
cslti
nurses regarding legal aspects in psychiatric care.61

Summary
.Mcna

This chapter dealt with relevant literature about the knowledge regarding rights

of patients with mental illness. From the literature reviewed the investigator identified

the importance of assessing the knowledge regarding rights of patients with mental
winw

illness among general public and patients and caregivers of patients with mental illness.

It also facilitated the investigator in formulation of hypothesis and selection of research

methodology. The literature review helped the investigator to design the study and
ewd

develop the tool.

at
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or
CHAPTER 3

d it
METHODOLOGY

Research approach

nE
Research design

Variables

DyF.i
Schematic representation of the study

Setting of the study

aPr
Population

ebrr
Sample and sampling technique

Inclusion criteria
cslti
Exclusion criteria

Tool/ Instruments
.Mcna

Development of the tool

Description of the tool

winw

Content validity

Reliability of the tool

Translation of the tool

ewd

Pretesting of the tool

Pilot study
at

Data collection process

re

Plan for data analysis

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or
CHAPTER 3

d it
METHODOLOGY

nE
Research methodology includes the steps, procedures, strategies for gathering

and analysing data in an investigation. This chapter deals with the research

DyF.i
methodology adopted for the study. It includes the research approach, research design,

variables, schematic representation of the study, population, sample, sampling,

description of the tool, pilot study, setting of the study, population, sample, sampling,

aPr
description of the tool, pilot study, data collection process and plan for data analysis.

The present study aims to assess knowledge regarding rights of mentally ill among
ebrr
caregivers of patient with mental illness.

Research approach
cslti
The research approach is an overall plan or blue print chosen to carry out the
.Mcna

study. This study was aimed to assess the knowledge regarding rights of mentally ill

among caregivers of patients with mental illness. A quantitative non experimental

descriptive approach is used for the study since the purpose of the study is to assess the
winw

knowledge regarding rights of mentally ill among caregivers of patients with mental

illness.

Research design
ewd

Research design consists of blue print for the data collection, measurement and

the analysis of data. A Non-Experimental descriptive survey design was adopted to

at

assess the knowledge regarding rights of mentally ill among caregivers of patients with

mental illness.
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or
Variables

d it
Variables are the central blocks of a study

Research variables: knowledge regarding rights of mentally ill among caregivers of

nE
patients with mental illness.

Selected variables: includes socio personal variables and clinical variables.

DyF.i
Socio personal variables: includes age, gender, religion, education, occupation,

marital status, family income of the caregiver and relationship with the patient.

aPr
Clinical variables: includes diagnosis, duration since diagnosis, mode of treatment,

frequency of readmissions, last hospitalization, duration of last hospitalization,

ebrr
psychiatric comorbidities such as depression, anxiety and substance use and physical

comorbidities such as diabetes, hypertension, thyroid abnormalities, obesity and

cslti
extrapyramidal side effects of patient with mental illness.

Schematic representation of the study

.Mcna

Schematic representation of the study is given in figure 2

winw
ewd
at
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r
to
41

di
D .in
E
Extraneous variables
Tools
Population Outcome
Variables  Age

y
Caregivers of patients Tools

F
with mental illness  gender
Socio personal

r Par
Setting of the study variables of  religion education
caregivers of  occupation
Outpatient clinics, Semi
patient with
Department of structured  marital status
mental illness and
Psychiatry, interview

tebr
clinical variable The knowledge
Government Medical schedule  family income of the
of patients with regarding rights of
College Hospital caregiver
mental illness mentally ill among
Kozhikode caregivers of  relationship with the patient
Sample patients with mental

csli
illness  diagnosis
Caregivers of patients  duration since diagnosis
with mental Illness Preparation and
distribution of  mode of treatment
cna
attending Outpatient
clinics of Department
Knowledge
regarding rights
Semi structured
interview
information leaflet
on rights of patients  frequency of readmissions
w. M
of psychiatry, Govt
of mentally ill schedule to with mental illness.
medical college  last hospitalization
among caregivers assess the
Hospital, Kozhikode.
of patients with knowledge  duration of last
hospitalization
ww i n

Sampling technique mental illness regarding rights

of mentally ill
Consecutive sampling  psychiatric comorbidities
among
Sample size: 120 caregivers  physical comorbidities of
ed

patients with mental

disorder
at

Figure 2: Schematic representation of the study to assess the knowledge regarding rights of mentally ill among caregivers of patients with mental
illness

41
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or
Population

d it
The population is the set of people or entities to which the results of the study

are to be generalized. In the present study the target population is caregivers of patients

with mental Illness.

nE
Setting

DyF.i
The setting is the physical location and condition in which data collection takes

place in a study. The study will be proposed to conduct at Outpatient Clinics,

aPr
Department of Psychiatry, Government Medical College Hospital, Kozhikode. It is a

tertiary referral centre located in the north east of Kozhikode that serves 40% of the

population of Kerala. Bed strength of this hospital is 3025. The OPDs within the New
ebrr
Medical College Hospital (NMCH) have an average census of 2387 patients coming

from different areas of Malabar region, for consultation and treatment It is a 3025
cslti
bedded Tertiary level hospital.
.Mcna

Sample and sampling technique

Sample is the subset of population that is selected for a particular study. In the

present study the sample consisted of 120 caregivers of patients with mental Illness
winw

attending Outpatient Clinics, Department of psychiatry, Govt Medical College

Hospital, Kozhikode who fulfilled the selection criteria. The researcher used

consecutive sampling technique for obtaining participants for the present study.
ewd

Sample size and calculation

4 pq/d2, P=56%, q=44, d=11.2, 4*56*44/ (11.2)2=9856/125.44=80, If precision taken

at

as 9%, N=9856/81=122, The sample size is 125

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or
The sample size is calculated according to Shanthi.S (2009) conducted a study to assess

d it
the awareness of human rights among caregivers caring for mentally ill. Total 30

samples were selected by convenient sampling. Knowledge questionnaire on human

rights had 20 items used to assess awareness regarding human rights. The data were

nE
analyzed using both the descriptive and inferential statistics. The study revealed that

56.7% had inadequate knowledge regarding rights of patients with mental illness.62

DyF.i
Inclusion criteria

Caregivers of patients with mental Illness who are:

aPr
 Attending outpatient clinics of department of psychiatry, Govt Medical College

Hospital, Kozhikode


ebrr
Willing to participate in the study

 Able to read and write Malayalam

cslti
Exclusion criteria

Care givers of patients with mental illness having:

.Mcna

 Severe hearing impairment

 Known case of mental illness

winw

 Personality disorders, mental retardation and substance use disorders

Tools and technique

The tools used in the present study for collecting the data consist of semi
ewd

structured interview schedule to assess the socio-personal data of the caregiver and

clinical data of the patient. Knowledge regarding rights of mentally ill among caregivers

was assessed by semi structured interview schedule which contains 25 questions which
at

is divided into 5 domains.

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or
Development of tools

d it
The tool was selected on the basis of research problem.

The following steps were taken in preparing the tool

 Review of literature to provide adequate content area and information

nE
 Consultation and discussion with experts of concerned areas

 Discussion and consultation with research statistician

DyF.i
 The finalization of the tool was done after the discussion and suggestions from

experts

aPr
Description of the tool

Tool 1: Semi structured Interview schedule to assess the socio-personal data of the
ebrr
caregivers and clinical data of the patients.

Tool 2: semi structured interview schedule to assess the knowledge of caregivers

cslti
regarding rights of patients with mental Illness.

Tool 1: Semi structured interview schedule to assess socio personal data of the
.Mcna

caregivers and clinical data of the patients.

Tool 1 consists of section A and section B.

winw

Section A: consists of socio personal data of the caregivers, it includes 8 items: age,

sex, religion, educational status, occupation, socioeconomic status, marital status and

relationship with the patient. Section B: consists of clinical data of patients includes
ewd

diagnosis, duration since diagnosis, mode of treatment, frequency of readmissions, last

hospitalization, duration of last hospitalization, psychiatric comorbidities such as

depression, anxiety and substance use and physical comorbidities such as diabetes,
at

hypertension, thyroid abnormalities, obesity and extrapyramidal side effects.

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or
Tool 2: semi- structured interview schedule to assess the knowledge of caregivers

d it
on rights of patients with mental Illness.

The semi structured interview schedule consists questions in five domains

nE
 Civil rights of patients with mental illness

 Criminal rights of patients with mental illness

DyF.i
 Fundamental rights

 Rights related to diagnosis and treatment

 Rights related to rehabilitation and special circumstances.

aPr
The tool contains 25 questions and each question have three options (right, wrong,

don’t know) participants have to put tick mark against the appropriate space provided.
ebrr
The estimation of knowledge is based on total score. Score 16-25 indicates good

knowledge, score 9-15 indicates average knowledge and score 1-8 indicates poor
cslti
knowledge.

Content Validity:
.Mcna

All the tools were given to nine experts for ensuring content validity and

appropriateness of the tool. The experts include seven experts in psychiatric nursing
winw

one psychiatrist, and one psychiatric social worker. The researcher had discussion with

the experts for clarifying the vital aspects of the tool. Based on the opinion of the

expert’s necessary modifications were made. In tool 1, section A there was 100%
ewd

agreement of experts, in section B 70% of experts suggested to add 2 items regarding

last hospitalization and duration of last hospitalization. In tool 2, 80% of experts

instructed to change the multiple-choice question to right, wrong and don’t know
at

options and other necessary modifications were done.

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Reliability of the tools

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The reliability of the tool is the degree of consistency with which it measures

d it
the attribute it is supposed to measure. The reliability of tool 2 was checked by

Cronbach’s alpha and it was 0.79

nE
Translation of the tool

The tools were given to expert in Malayalam for translation and were

DyF.i
retranslated into English. It was found that the language used in the tools was clear,

simple and unambiguous. They were able to understand and respond to the items in the

tools.

aPr
Pre testing of the tool

ebrr
Malayalam tools were administered to 5 participants similar to study population

by the researcher and it was found that the language used is clear, understandable and

unambiguous.
cslti
Pilot study
.Mcna

After obtaining approval from Institutional Ethics Committee, Govt. College of

Nursing Kozhikode, Kerala University of Health Sciences, formal administrative

sanction from Medical Superintendent and Head of Psychiatric Departments Govt.

winw

Medical College Hospital Kozhikode, the data were collected from 12 caregivers of

patients with mental illness who met the inclusion criteria. The data was collected from

01.03.21 to 12.3.21. Participants were selected from outpatient clinics, departments of

ewd

psychiatry, Govt Medical College Hospital, Kozhikode those who met the inclusion

criteria using consecutive sampling technique. Investigator introduced herself and

at

developed good relationship with the participants, explained the purpose of the study

and also assured the confidentiality of the information. Research objectives were clearly
re

explained to the participants as well as the care givers and informed consent was

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47

or
obtained from participants. Socio personal of caregiver and clinical data of the patients

d it
were collected by using the semi structured interview schedule. knowledge regarding

rights of patients with mental illness were assessed using semi structured interview

schedule which contains 25 questions. It took nearly 15 minutes for a participant to

nE
collect the data. The tool was found to be appropriate, data amenable to statistical

analysis and the study was found to be feasible.

DyF.i
Data collection process

After getting approval from Institutional Ethics Committee of Government

aPr
College of Nursing, Kozhikode and approval from KUHS, permission for data

collection was obtained from Principal and Medical Superintendent of Govt. Medical
ebrr
College Hospital, Kozhikode. The data collection was performed from 22.03.2021 to

1.05.2021 at Outpatient clinics of Department of Psychiatry, Govt. Medical College

cslti
Hospital, Kozhikode. A total of 120 caregiver of patients with mental illness satisfying

the inclusion criteria were selected. Participants were selected from OPD using
.Mcna

consecutive sampling technique. The OPD starts to function at 8am and the services

extend up to 2pm on every day. The investigator daily visited OPD except on Sundays.

OPD have a waiting area in which seating facilities are provided. Participants were
winw

comfortably seated in the waiting area of OPD. Investigator introduced herself and

developed good relationship with the participants, explained the purpose of the study

and also assured the confidentiality of the information. Research objectives were clearly
ewd

explained to the participants as well as the care givers and informed consent was

obtained from participants. The Socio Personal data of the caregiver and clinical data

of the patients were collected by using semi structured interview schedule. Knowledge
at

regarding rights of patients with mental illness among caregivers were also collected
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using semi structured interview schedule contains 25 questions divided into five

d it
domains.

It took nearly 15 minutes for a participant to collect the data. As there is covid

scenario the average number of participants vary from 5 to 15 in a day. All participants

nE
were cooperative and the investigator collected data from 120 samples within 4 weeks.

DyF.i
Plan for data analysis

Analysis is the process of organizing and synthesizing the data so as to answer

aPr
research question and test hypothesis. The data obtained analysed by using both

descriptive and inferential statistics based on the objectives and hypothesis of the study


ebrr
The socio personal data would be analysed using frequency and percentage.

The knowledge regarding rights of mentally ill among caregivers of patients

cslti
with mental illness would be analysed using frequency, percentage, mean and

standard deviation.
.Mcna

 Association between the knowledge regarding rights of mentally ill among

caregivers of patients with mental illness and selected variables would be

analysed using chi-square test and tested at 0.05 level of significance.

winw

Summary

This chapter deals with research approach, research design schematic

representation of the study, description of the setting, population, sample, sampling

ewd

technique, development and description of the tool used for data collection content

validity and reliability of the tool, details of the pilot study, data collection and plan for

data analysis.
at
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CHAPTER 4

d it
ANALYSIS AND INTERPRETATION

nE
Section 1: Participant characteristics

DyF.i
A) Socio personal characteristics of caregivers of patients with

mental illness

B) Clinical characteristics of patients with mental illness

aPr
Section II: Knowledge of participants regarding rights of patients with

mental illness
ebrr
Section III: Association between knowledge of participants regarding

rights of patients with mental illness and selected variables

cslti
.Mcna
winw
ewd
at
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CHAPTER 4

d it
ANALYSIS AND INTERPRETATION

This chapter deals with the analysis of collected data and interpretation of the

nE
results. The study was intended to assess the knowledge regarding rights of mentally ill

among caregivers of patients with mental illness.

DyF.i
Data from 120 care givers of patients with mental illness were collected,

organized, tabulated and subjected to descriptive and inferential statistics with the help

aPr
of statistical package for the social science software. The obtained data has been

analysed based on the objectives and organized under the following sections.

ebrr
Section I: Participant characteristics

A) Socio personal characteristics of caregivers of patients with mental illness

cslti
B) Clinical characteristics of patients with mental illness
.Mcna

Section II: Knowledge of participants regarding rights of patients with mental illness

Section III: Association between knowledge of participants regarding rights of

patients with mental illness and selected variables

winw

Section I: Participant characteristics

This section deals with frequency and percentage distribution of the socio
ewd

personal characteristics of participants and clinical data of the patients with mental

illness. The socio personal characteristics includes age, gender, religion, educational

status, occupation, socioeconomic status, marital status and relationship with the
at

patient. The clinical data of patients with mental illness includes diagnosis, duration

since diagnosis, mode of treatment, frequency of readmissions, last hospitalization,

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duration of last hospitalization, psychiatric comorbidities and physical comorbidities.

d it
The findings were presented in the following tables and figures.

A) Socio personal characteristics of caregivers

nE
Table 1

Distribution of participants based on age, sex and religion.

DyF.i
(n=120)

Characteristics f %

aPr
Age in years

21-30

31-40
ebrr 21

27
17.4

22.3
cslti
41-50 29 24.8

>51 43 35.5
.Mcna

Sex

Male 54 45

Female 66 55
winw

Religion

Hindu 47 39.2

Islam 51 42.5
ewd

Christian 22 18.3
at

Table 1 shows that, 35.5% of the participants belonged to the age group of >51 years, among

them 55% were females and 42.5% belonged to Islam religion.

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Distribution of participants based on education status is shown in Figure 3

d it
40
36.7
35.8
35

nE
30

25
Percentage

19.2
20

DyF.i
15

10 8.3

aPr
5

ebrr
Education
cslti
Figure 3: Distribution of participants based on education status
.Mcna

Figure 3 depicted that among the participants, 36.7 % attained secondary education

and 35.8% participants had primary education.

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Table 2

d it
Distribution of participants based on occupation and monthly income.

(n=120)

nE
Characteristics f %

DyF.i
Occupation

Government employee 6 5

aPr
Semi government employee 12 10

Private employee 24 20

Business/self employed 12 10
ebrr
Agriculture 10 8.3

Home maker 38 31.7

cslti
Unemployed 18 15

Socioeconomic status
.Mcna

APL 40 33.3

BPL 80 66.7
winw

Table 2 shows that 31.7 % were home makers and 20% were private employees and

more than half (66.7%) of the participants were from BPL families.
ewd
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Distribution of participants based marital status is shown in Figure 4

d it
nE
6%
11% Married

Unmarried

DyF.i
15% Divorced/widower/widow

Seperated

aPr
68%

ebrr Marital Status

cslti
.Mcna

Figure 4: Distribution of participants based marital status

Figure 4 depicted that among the participants 68% were married and 15% were

unmarried.
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Table 3
Distribution of participants based on relationship with patient

d it
(n=120)

nE
Characteristics f %

DyF.i
Relationship with patient

Father/mother 26 21.7

aPr
Grandfather/grandmother 9 7.5

Children/grandchildren 21 17.5

ebrr
Brother/sister

Husband/wife
41

21
34.2

17.5

others 2 1.6
cslti
Table 3 shows that 34.2% of participants were either brother/sister of the patient and
.Mcna

21.7% were father/mother of the patient.

winw
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B) Clinical characteristics of patients with mental illness

d it
Table 4
Distribution of the patients based on diagnosis and duration of diagnosis

nE
(n=120)
Characteristics f %

DyF.i
Diagnosis

aPr
Schizophrenia 66 55

Bipolar affective disorder 54 45

<1
ebrr
Duration since diagnosis in years

1 8

1-10 71 59.2
cslti
11-20 29 24.2

21-30 19 15.8
.Mcna

Table 4 shows that the diagnosis of 55% patients were schizophrenia and 59.2% were
winw

had 1-10 years duration since diagnosis.

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Table 5
Distribution of the patients based on mode of treatment

d it
(n=120)
Mode of treatment f %

nE
Allopathy 57 40.5

Ayurveda 1 8

DyF.i
Ayurveda+ Allopathy 13 10.8

Homeo/ Unani+ Allopathy 10 8.3

aPr
Faith healing+ Allopathy 31 25.8

Faith healing+ Ayurveda+ Allopathy 5 4.1

ebrr
Faith healing+ Homeo/ Unani+ Allopathy 3 2.5
cslti
Table 5 shows that 40.5 % of patients received allopathic treatment only 25.8% received

Faith healing+ Allopathy.

.Mcna
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Table 6

d it
Distribution of patients based on frequency of readmissions

(n=120)

nE
Frequency of readmissions in number f %

DyF.i
No readmission 4 3.3

1-10 42 35.5

aPr
11-20 40 33.1

21-30 29 24.0

31-40 5 4.1
ebrr
cslti
The findings in Table 6 shows that 35.5% patients were readmitted 1-10 times and

33.1 % were readmitted 11-20 times.

.Mcna
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Table 7

d it
Distribution of patients based on last hospitalization and duration of last

hospitalisation

nE
(n=120)

Characteristics f %

DyF.i
Last hospitalization

aPr
No admission 4 3.3

Less than 1 month 1 8

ebrr
1-6 months 21 17.4

6m-1 year 78 64.5

cslti
1-5 years 16 13.2
.Mcna

Duration of last hospitalization

No admission 4 3.3

Less than 1 month 35 28.9

1-6 months 81 66.9

winw

The findings in Table 7 shows 64.5 % patients were hospitalized within 6 months to 1
ewd

year and 66.9 % were hospitalized for 1–6-month duration.

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Distribution of patients based on psychiatric comorbidities is shown figure 5

d it
7.5

nE
DyF.i
without comorbidities
with comorbidities

aPr
ebrr 92.5

Psychiatric Comorbidities
cslti
.Mcna

Figure 3: Distribution of participants based on psychiatric comorbidities

Figure 4 shows that 92.5% patients were without comorbidities and 7.5% having

comorbidities such as depression, anxiety and substance use.

winw
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Table 8

d it
Distribution of patients based on physical comorbidities

(n=120)

nE
Physical comorbidities f %

DyF.i
Without comorbidities 30 25

With comorbidities 90 75

aPr
ebrr
The findings in Table 8 shows among patients 25% had no comorbidities, 75%% were

having comorbidities such as diabetes, hypertension, obesity, EPS and thyroid

abnormalities.
cslti
Section 2: Knowledge of participants regarding rights of patients with mental
.Mcna

illness

This section deals with the frequency, percentage, minimum, maximum, mean and

standard deviation of knowledge of participants regarding rights of patients with

winw

mental illness. Knowledge is categorized as,

Good knowledge (16-25), Average knowledge (9-15) Poor knowledge (1-8)

ewd
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Distribution of participants based on level of knowledge regarding rights of patients

d it
with mental illness was shown in Figure 6.

50
43.9

nE
45
39
40

35

DyF.i
30
Percentage

25

20 17.1

aPr
15

10

5
ebrr 0
Good Average
knowledge
Poor
cslti
Figure 6: Distribution of participants based on knowledge regarding rights of

patients with mental illness

.Mcna

Figure 6 depicted that 17.1% had only good knowledge and 43.9% participants had

poor knowledge regarding rights of patients with mental illness.

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Table 9

d it
Distribution of participants based on minimum, maximum, mean, standard
deviation of knowledge regarding rights of patients with mental illness

nE
(n=120)

Knowledge Obtained score Mean SD

DyF.i
regarding minimum maximum score
rights of patients
with mental illness

aPr
ebrr
Total knowledge (25) 1 22 9.81 5.01

Table 9 shows that mean knowledge of sample regarding rights of patients with mental
cslti
illness was 9.81 with a standard deviation of 5.01
.Mcna
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Table 10

d it
Distribution of participants based on minimum, maximum, mean, standard deviation

of section wise knowledge regarding rights of patients with mental illness.

nE
(n=120)

Knowledge regarding Obtained score Mean SD

rights score

DyF.i
of patients with mental
illness
Minimum Maximum
Civil rights (0-5) 0 5 1.59 1.14

aPr
Criminal rights (0-4) 0 4 0.95 1.07

Fundamental rights (0-6) 0 6 3.94 1.37

ebrr
Diagnosis and

treatment related rights (0-8) 0 8 3.18 1.94

Rehabilitation and
cslti
special circumstances (0-2) 0 2 0.52 0.73
.Mcna

Findings in Table 10 shows that:

Mean knowledge of sample regarding civil rights, criminal rights and fundamental
rights were 1.59, 0.95 and 3.94 respectively and standard deviation were 1.14,1.07
winw

and 1.37.

Mean knowledge of sample regarding diagnosis and treatment related rights,

rehabilitation and rights in special circumstances were 3.18, 0.52 respectively and
ewd

standard deviation were 1.94,0.73.

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Table 11

d it
Distribution of participants based on knowledge regarding civil rights of patients
with mental illness

nE
(n=120)

Civil rights of patients with mental illness Correct Incorrect Don’t

response response know

DyF.i
f (%) f (%) f (%)

aPr
1 Transfer of property 19(15.8) 8(6.7) 93(77.5)

2 Own a property 22(18.3) 8(6.7) 90(75)

3 Law regarding marriage of mentally ill 100(83.3) 4(3.3) 16(13.3)

4
ebrr
Appointment of legal guardian for 16(13.3) 3(2.5) 101(84.2)

managing properties
cslti
5 Law regarding will of mentally ill 20(16.7) 5(4.2) 95(79.2)
.Mcna

Findings in table 11 shows that

Among participants 75% were not aware that it is possible for a mentally ill person to

own property
winw

Majority of the participants (84.2%) were unaware that the court can appoint a legal

guardian for a person with mental illness who is unable to manage the property.
ewd

More than half of the participants (79.2%) were lack knowledge regarding the will

written by person with mental illness is valid or not according to our mental health

legislation.
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More than half of the participants (77.5%) were not aware about the transfer of the
property of a person with mental illness is invalid in circumstances where a rational

d it
decision cannot be made.

Table 12

nE
Distribution of participants based on knowledge regarding criminal rights of patients
with mental illness

(n=120)

DyF.i
Criminal rights of patients with mental Correct Incorrect Don’t
illness Response Response Know

aPr
f (%) f (%) f (%)

1 Sexual offences and POCSO act 57(47.5) 3(2.5) 60(50)

2
ebrr
Legal protection on crime due to mental 32(26.7) 12(10.0) 76(63.3)

illness
cslti
3 According to rule 84(McNaughton rule) 3(2.5) 6(5.0) 111(92.5)

of IPC, imprisonment for a crime

.Mcna

4 Law regarding suicide attempt of 10(8.3) 18(15.0) 92(76.7)

mentally ill
winw

Findings in table 12 show that:

Most of the participants (76%) were not aware about legal procedures in criminal
offences of patient with mental illness
ewd

Majority of the participants (92%) were not aware regarding rule 84 of IPC,

imprisonment for a crime

at

Majority of participants (76.7) were lack knowledge regarding law procedures of

suicide attempt of patient with mental illness

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Table 13

d it
Distribution of participants based on knowledge regarding fundamental rights of

patients with mental illness

(n=120)

nE
Fundamental rights of patients Correct Incorrect Don’t

with mental illness Response Response Know

DyF.i
f (%) f (%) f (%)

aPr
1 Knowledge on community 9(7.5) 105(87.5) 6(5.0)

participation

3
ebrr
Right to equality

Right to receive visitors

11(9.2)

107(89.2)
101(84.2)

0
8(6.7)

13(10.8)

4 Right to receive free legal services 31(25.8) 0 89(74.2)

cslti
5 Right to privacy 9(7.5) 74(61.7) 37(30.8)
.Mcna

6 Right to access their basic medical 28(23.3) 38(31.7) 54(45)

records
winw

Findings in table 13 shows that:

Majority of the participants were not aware regarding the rights of community
participation (87.5) and rights of equality (84.2)

Majority of participants (89%) lack knowledge regarding free legal services provided
ewd

by the government
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Table 14

d it
Distribution of participants based on knowledge regarding diagnosis and treatment

related rights of patients with mental illness.

(n=120)

nE
Diagnosis and treatment related Correct Incorrect Don’t

rights of Response Response Know

DyF.i
patient with mental illness f (%) f (%) f (%)

1 Knowledge regarding diagnosis of 60(50) 4(3.3) 56(46.7)

aPr
mental illness

2 Voluntary admission of patient 21(17.5) 82(68.3) 17(14.2)

4
ebrr
Free treatment services

Knowledge regarding consent and right

88(73.3)

63(52.5)
3(2.5)

9(7.5)
28(23.3)

48(40.0)

to decision making.
cslti
5 The privacy of a person with mental
.Mcna

illness is a threat at the time of threat 20(16.7) 3(2.5) 97(80.8)

to others.

6 Rights to complain regarding 89(74.2) 6(5.0) 25(20.8)

deficiencies in provision of care,

winw

treatment and services

7 Right to refuse treatment 8(6.7) 99(82.5) 13(10.8)

ewd

8 Right to appoint nominated

representative to take care of that person 18(15.0) 2(1.7) 100(83.3)

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Findings in table 14 shows that

d it
Majority of the participants (80.8%) were lack knowledge regarding the privacy of a

patients with mental illness is a threat at the time of dangers to others.

nE
Most of the participants (83.3%) were not aware regarding the rights to appoint nominated

representative to take care of that person

DyF.i
Majority of the participants (82.5%) think that person with mental illness not had the right

to refuse treatment

aPr
Table 15

Distribution of participants based on knowledge regarding rights of rehabilitation

ebrr
services and rights of mentally ill in special circumstances.

(n=120)
cslti
Rehabilitation and special Correct Incorrect Don’t
circumstances Response Response Know
f (%) f (%) f (%)
.Mcna

1 Patient rehabilitation services 22(18.3) 2(1.7) 96(80)

2 Treatment of a minor 35(29.2) 39(32.5) 46(38.3)

winw

Findings in Table 8 show that:

Majority of the participants (80%) were lack knowledge regarding patient

ewd

rehabilitation services ensured under mental health legislation.

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Section 3

d it
Association between the knowledge regarding rights of mentally ill among

caregivers and the selected variables

nE
This section deals with association between knowledge regarding rights of mentally ill

among caregivers and the selected socio personal variables such as age, gender,

religion, education, occupation, socioeconomic status, marital status and relationship

DyF.i
with patient and clinical variable of patients such as diagnosis, duration since

diagnosis, mode of treatment, frequencies of readmission, last hospitalization, duration

aPr
of last hospitalization, psychiatric comorbidities and physical comorbidities.

In order to find out the association between knowledge regarding rights of mentally ill
ebrr
and selected variables the following null hypothesis was stated and tested at 0.05 level

of significance using Chi-square test.

cslti
H01: There is no significant association between knowledge regarding rights of patients

with mental illness and socio personal variables

.Mcna

H02: There is no significant association between knowledge regarding rights of patients

with mental illness and clinical variables

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Table 16

d it
Significance of association between knowledge regarding rights patients with mental
illness and socio personal variables

(n=120)

nE
Socio personal variables χ 2 value df P value

Age 25.132 4 0.001**

DyF.i
Gender 0.587 2 0.746

Religion 1.947 4 0.745

aPr
Education 67.385 10 0.001**

Occupation 25.710 4 0.012*

Socioeconomic status 4.157 2 0.125

ebrr
Marital status 13.063 6 0.042

Relationship with patient 27.720 2 0.002*

cslti
*Significant at 0.05 level **significant at 0.01 level

Table 16 shows that there is a statistically significant association between

.Mcna

knowledge regarding rights of patients with mental illness and age, education,

occupation and relationship with patient. The computed p value for age (χ 2 (4) =

25.132, p<0.01), education (χ 2(10) =67.385, p<0.01), occupation (χ 2(12) =25.710,

winw

p<0.05) and relationship with patient (χ 2(10) =27.720, p<0.05) is significant as p value

<0.05. Hence null hypothesis is rejected for age, education, occupation and

relationship with patient.

ewd

It is inferred that there is statistically significant association between

knowledge regarding rights of patients with mental illness and age, education,
at

occupation and relationship with patient

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Table 17

d it
Significance of association between knowledge regarding rights patients with mental
illness and clinical variables

(n=120)

nE
Clinical variables χ 2 value df P value

diagnosis 2.267 2 0.322

DyF.i
Duration since diagnosis 10.752 6 0.096

Mode of treatment 15.93 12 0.194

aPr
Frequency of readmission 10.766 8 0.215

Last hospitalization 8.420 8 0.394

ebrr
Duration of last hospitalization

Psychiatric comorbidities
0.777

10.522
4

6
0.942

0.104

Physical comorbidities 47.912 10 0.020

cslti
.Mcna

Table 17 shows that there is no statistically significant association between

knowledge regarding rights of patients with mental illness and clinical variables such

as diagnosis, duration since diagnosis, mode of treatment, frequency of readmissions,

last hospitalization, duration of last hospitalization, psychiatric comorbidities

winw

includes depression, anxiety and substance use and physical comorbidities incudes

diabetes, hypertension, thyroid abnormalities, obesity and extrapyramidal side

ewd

effects. Hence null hypothesis is accepted for clinical variables.

at
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Table 18

d it
Significance of association between knowledge regarding rights of mentally ill and

age of participants

nE
(n=120)

Characteristics Category Knowledge category χ2 df P value

DyF.i
value

Good Average Poor

aPr
f (%) f (%) f (%)

Age in years 25.13 4 0.001**

21-30 12(10) 5(4.2) 4(3.3)

ebrr 31-40 4(3.3) 14(11.7) 9(7.5)

41-50 2(1.7) 19(15.8) 8(6.7)

cslti
>51 2(1.7) 11(9.16) 30(25)

**Significant at 0.01 level

.Mcna

Table 18 shows that 25% of participants belonged to >51 years had only poor

knowledge regarding rights of patients with mental illness.

winw

There is a statistically significant association between knowledge regarding rights of

patients with mental illness and age and the computed p value for age is (χ 2 (4) = 25.132,

p<0.01).
ewd
at
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Table 19

d it
Significance of association between knowledge regarding rights of mentally ill and

education of participants

nE
(n=120)

Characteristics Category Knowledge category χ 2 value df P value

DyF.i
Good Average Poor

f (%) f (%) f (%)

aPr
Education 67.39 10 0.001**

Primary 1(0.8) 14(11.7) 28(23.3)

education
ebrr Secondary 3(2.5) 27(22.5) 14(11.7)

education
cslti
Higher 2(1.7) 3(2.5) 5(4.2)

secondary
.Mcna

Degree/ 15(12.5) 5(4.2) 3(2.5)

Professional

/ technical
winw

**Significant at 0.01 level

Table 19 shows that participants with primary education had poor knowledge
ewd

(23.3%) regarding rights of patients with mental illness.

There is a statistically significant association between knowledge regarding rights of

patients with mental illness and education of the participants and the computed p value
at

for age is (χ 2 (4) = 67.385, p<0.01).

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Table 20

d it
Significance of association between knowledge regarding rights of mentally ill and

occupation of participants

(n=120)

nE
Characteristics Category Knowledge category χ2 df P value
value
Good Average Poor

DyF.i
f (%) f (%) f (%)

Occupation 25.71 12 0.012*

Govt 3(2.5) 1(0.8) 2(1.7)

aPr
employee

Semi govt 5(4.2) 4(3.3) 3(2.5)

ebrr Private 4(3.3) 14(11.7) 6(5)

employee
cslti
Business/self 2(1.7) 4(3.3) 6(5.0)

employed
.Mcna

agriculture 1(0.8) 4(3.3) 5(4.2)

Home maker 1(0.8) 17(14.2) 20(16.7)

unemployed 6(5.0) 3(2.5) 9(7.5)

winw

*Significant at 0.05 level

Findings in the table 20 show that:

ewd

Among the participants 31.7% were homemakers and 16.7% of them had poor

knowledge regarding rights of patients with mental illness and there is a statistically

significant association between knowledge regarding rights of patients with mental

at

illness and occupation of the participants. The computed p value for occupation is (χ
re

2 (4) = 25.710, p<0.05)

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Table 21

d it
Significance of association between knowledge regarding rights of mentally ill

and relationship with patient

nE
(n=120)

Characteristics Category Knowledge category χ 2 value df P value

DyF.i
Good Average Poor

f (%) f (%) f (%)

aPr
Relationship with patient 27.720 10 0.002*

Father/ mother 2(1.7) 8(6.7) 16(13.3)

ebrr Grandfather/ 0 0 9(7.5)

mother
cslti
Children/grand 8(6.7) 7(5.8) 6(5.0)

children
.Mcna

Brother/sister 8(6.7) 20(16.7) 13(10.8)

Husband/wife 3(2.5) 12(10) 6(5.0)

Others 0 1(0.8) 1(0.8)

winw

*Significant at 0.05 level

Table 21 shows that 34.2% of participants were either brother/sister of the

patients and 16.7% of them had average knowledge regarding rights of patients with
ewd

mental illness.

There is a statistically significant association between knowledge regarding rights of

at

person with mental illness and relationship with the patient and the computed p value

for relationship with patient is (χ 2 (4) = 27.720, p<0.05)

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Summary

d it
This chapter dealt with the analysis and interpretation of findings of the study.

The analysis was organized and presented under various sections and were analysed by

applying descriptive and inferential statistics. The socio personal data was analysed

nE
using frequencies and percentage. Knowledge and performance score were calculated

using frequency and percentage; they were graded by using mean and standard

DyF.i
deviation. Chi- Square test was used to find out the association between knowledge and

selected variables. These statistical procedures enabled the researcher to reduce

aPr
summaries, organize, evaluate, interpret and communicate numeric information

ebrr
cslti
.Mcna
winw
ewd
at
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CHAPTER 5

d it
RESULTS

nE
Objectives

DyF.i
Hypotheses

Results

aPr
ebrr
cslti
.Mcna
winw
ewd
at
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CHAPTER 5

d it
RESULTS

This chapter presents the major results of the study. The present study was

nE
aimed to assess the knowledge regarding rights of mentally ill among caregivers of

patients with mental illness.

DyF.i
This chapter is organized mainly under three headings – objectives, hypotheses

and major results of the study.

aPr
Objectives

 Assess the knowledge of care givers regarding rights of patients with mental
ebrr
Illness.

 Find out the association between the knowledge regarding rights of mentally ill
cslti
among caregivers of patients with mental illness and selected variables.
.Mcna

Hypotheses

H1: There will be significant association between the knowledge regarding rights of

patients with mental illness and selected socio-personal variables.

winw

H2: There will be significant association between the knowledge regarding rights of

patients with mental illness and selected clinical variables.

ewd
at
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Results

d it
Following were the major findings of the present study.

Section I. Participant characteristics

nE
A) Socio personal characteristics of caregiver

 The study revealed that, 24.8% of the participants belonged to the age group of

DyF.i
41-60 years,22.3% belonged to 31-40 years and 35.5% belonged to the age

group of >51 years.

aPr
 It was found that 55% were females and 42.5% belonged to Islam religion.

 Among the participants, 36.7 % attained secondary education and 23.3%

ebrr
participants had primary education.

 The findings of the study show that 31.7 % were home makers and 20% were
cslti
private employees
.Mcna

 More than half (66.7%) of the participants were from BPL families.

 Among the participants 68% were married and 15% were unmarried.

 The study showed that 34.2% of participant were either brother/sister of the
winw

patient and 21.7% were father/mother of the patient.

B) Clinical characteristics of patients with mental illness


ewd

The study revealed that 55% participants were patients with schizophrenia and

59.2% were had 1-10 years’ duration since diagnosis.

 The study shows that 40.5 % of patients were received allopathic treatment only
at

25.8% were received Faith healing+ Allopathy.

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 The study shows that 35.5% of patients were readmitted 1-10 times and 33.1 %

d it
were readmitted 11-20 times.

 It was found that 64.5 % patients were hospitalized within 6 months to 1 year

and 66.9% patients were hospitalized for 1–6-month duration.

nE
 Majority of patients (92.5%) were without comorbidities and 5.8% were

depressed.

DyF.i
 The findings shows that 24.6% patients had no comorbidities, 10.7% were

diabetic, 11.5% were obese, 12.3% had hypertension along with diabetes, 9%

aPr
were obese and diabetic, 9.8% had obesity along with hypertension and diabetes

mellitus.

ebrr
Section 2: Knowledge of participants regarding rights of patients with mental

illness.
cslti
 The study revealed that 43.9% participants had poor knowledge and 17.1% had

only good knowledge regarding rights of patients with mental illness.

.Mcna

 It was found that mean knowledge of sample regarding rights of patients with

mental illness was 9.81 with a standard deviation of 5.01.

Section a: Civil rights of patients with mental illness

winw

 The study shows that Mean knowledge of sample regarding civil rights of mentally

ill were 1.59 with standard deviation 1.14

 Among participants 75% were not aware that it is possible for a mentally ill person
ewd

to own property

 Majority of the participants (84.2%) were unaware that the court can appoint a
at

legal guardian for a person with mental illness who is unable to manage the

property.
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or
 More than half of the participants (79.2%) were lack knowledge regarding the will

d it
written by person with mental illness is valid or not according to our mental health

legislation.

 More than half of the participants (77.5%) were not aware about the transfer of the

nE
property of a person with mental illness is invalid in circumstances where a rational
decision cannot be made.
Section b: Criminal rights of patients with mental illness

DyF.i
 The study revealed that Mean knowledge of sample regarding criminal rights of

mentally ill were 0.95 with standard deviation 1.07

aPr
 Most of the participants (76%) were not aware about legal procedures in criminal

offences of patient with mental illness

 ebrr
Majority of the participants (92%) were not aware regarding rule 84 of IPC,

imprisonment for a crime

cslti
 Majority of participants (76.7) were lack knowledge regarding law procedures of

suicide attempt of patient with mental illness

.Mcna

Section c: Fundamental rights of patients with mental illness

 It was found that Mean knowledge of sample regarding fundamental rights of

mentally ill were 3.94 with standard deviation 1.37

winw

 Majority of the participants were not aware regarding the rights of community

participation (87.5) and rights of equality (84.2)

 Majority of participants (89%) lack knowledge regarding free legal services

ewd

provided by the government

Section d: Diagnosis and treatment related rights of patients with mental illness
at

 The Mean knowledge of sample regarding diagnosis and treatment related rights
of mentally ill were 3.18 with standard deviation 1.94
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 Majority of the participants (80.8%) were lack knowledge regarding the privacy of

d it
a patient with mental illness is a threat at the time of dangers to others.

 Most of the participants (83.3%) were not aware regarding the rights to appoint

nominated representative to take care of that person

nE
 Majority of the participants (82.5%) think that person with mental illness not had

the right to refuse treatment

DyF.i
Section e: Rehabilitation and special circumstances

 The study revealed that Mean knowledge of sample regarding rehabilitation

aPr
rights and rights in special circumstances of mentally ill were 0.52 with standard

deviation 0.73


ebrr
Majority of the participants (80%) were lack knowledge regarding patient’s
rehabilitation services ensured under mental health legislation.
cslti
Section 3

Association between the knowledge regarding rights of mentally ill among

.Mcna

caregivers of patients with mental illness and socio personal variables

 There was a statistically significant association between knowledge regarding

rights of patiets with mental illness and socio personal variables of caregiver
winw

such as age, education, occupation and relationship with patient. The computed

p value for age (χ 2 (4) = 25.132, p<0.01), education (χ 2(10) =67.385, p<0.01),

occupation (χ 2(12) =25.710, p<0.05) and relationship with patient (χ 2(10)

ewd

=27.720, p<0.05) is significant as p value <0.05.

at
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Association between the knowledge regarding rights of rights of mentally ill

d it
among caregivers of patients with mental illness and clinical variables

 There was no statistically significant association was found between knowledge

regarding rights of patients with mental illness and clinical variables of patients

nE
such as diagnosis, duration since diagnosis, mode of treatment, frequency of

readmissions, last hospitalization, duration of last hospitalization, psychiatric

DyF.i
comorbidities and physical comorbidities.

aPr
ebrr
cslti
.Mcna
winw
ewd
at
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or
CHAPTER 6

d it
DISCUSSION, SUMMARY AND CONCLUSION

nE
DyF.i
Discussion

Summary

aPr
Conclusion

ebrr
Nursing implications

Limitations
cslti
Recommendations
.Mcna
winw
ewd
at
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or
CHAPTER 6

d it
DISCUSSION, SUMMARY AND CONCLUSION

This chapter deals with the major findings of the present study, including

nE
summary of the study, conclusions drawn from the findings, discussion and limitations

of the study, nursing implications and recommendations for future research.

DyF.i
Discussion

The present study was intended to assess the knowledge regarding rights of

aPr
mentally ill among caregivers of patients with mental illness. The findings of the study

are discussed under the following headings.

ebrr
Participant characteristics

Section A: socio personal variables

cslti
Section B: Clinical variables
.Mcna

Caregivers’ knowledge regarding rights of patients with mental illness

Association between knowledge regarding rights of mentally ill among caregivers of

patients with mental illness and selected variables

winw

Participant characteristics

Section A: Socio personal variables

ewd

The findings of present study show that

24.8% of the participants belonged to the age group of 41-60 years,22.3% belonged to
at

31-40 years and 35.5% belonged to the age group of >51 years.

55% were females and 42.5% belonged to Islam religion.

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36.7 % attained secondary education and 23.3% participants had primary education.

d it
38 % were home makers and 24% were private employees

More than half (66.7%) of the participants were from BPL families.

nE
68% were married and 15% were unmarried.

The study showed that 31.7% of participant were either brother/sister of the patient and

DyF.i
20% were father/mother of the patient.

These findings are concordance with

aPr
The findings of a study conducted in community mental health clinics in Kannur

district of Kerala among general population and mentally ill patients which shows 54%
ebrr
had secondary education, 73.6% belonged to BPL status and 50% were married. 24

The findings of a cross sectional descriptive survey study conducted to assess

cslti
the knowledge on mental health law and attitude towards mental illness among the

members of the legal profession, Nigeria. The results of the study showed that 75
.Mcna

attorneys who filled the questionnaire were in the age range of 23 and 65 years and

more married (60.8%).31

winw

The findings of a descriptive study were conducted to assess the level of

knowledge regarding human rights of persons with mental illness among 400 adults

from selected urban areas of Pune city. With regard to marriage status 69 % were
ewd

married. In Occupation most of them were unemployed.33

The findings are not consistent with the results of a descriptive study conducted
at

among general public in Pune city, revealed that male was more than female, maximum

was in the age group of 25-31 years. Most of the samples were belong to Hindu religion.
re

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The findings of a comparative study conducted to assess the perceived human

d it
rights of mentally ill in Kannur district. The study results showed that 45.8%

participants had secondary education and most of the participants are married and

73.6% belonged to BPL socioeconomic status.24

nE
Section B: Clinical variables

DyF.i
The findings of present study show that

The study revealed that 55% were patients with schizophrenia and 59.2% were had 1-

aPr
10 years duration since diagnosis.

The study shows that 40.5 % of patients were received allopathic treatment only 25.8%

ebrr
were received Faith healing+ Allopathy.

The study shows that 35.5% of patients were readmitted 1-10 times and 33.1 % were
cslti
readmitted 11-20 times.

It was found that 64.5 % patients were hospitalized within 6 months to 1 year and 66.9
.Mcna

% p were hospitalized within 1–6-month duration.

The findings are not concordance with

winw

A comparative study conducted in Kannur district to compare the perceived

human rights of mentally ill and non-mentally ill group shows that 44.4% diagnosed

with schizophrenia and 55.6% had BPAD on remission. 24

ewd

knowledge regarding rights of patients with mental illness

The present study revealed that 43.9% participants had poor knowledge and
at

17.1% had only good knowledge regarding rights of patients with mental illness.
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It was found that mean knowledge of sample regarding rights of patients with mental

d it
illness was 9.81 with a standard deviation of 5.018.

The present study revealed that majority of participants (89.2%) were aware regarding

the right to receive visitors.

nE
The findings are consistent with the results of a descriptive cross-sectional

DyF.i
study carried out to assess the knowledge on human rights of mentally ill among

community people in Nepal, which revealed that 46.4% of participants had inadequate

knowledge regarding rights of mentally ill.32

aPr
The findings are consistent with the results of a descriptive cross-sectional study

conducted among caregivers of patient with mental illness in Uttarakhand, India

ebrr
revealed that that majority 47% subjects were have poor knowledge, 31% have Average

knowledge and only 22% have good knowledge regarding rights of mentally ill
cslti
person.39
.Mcna

The findings are in harmony with a descriptive cross-sectional study was

conducted among 140 community people in Nepal. The study results show that (46.4%)

have inadequate knowledge regarding human rights of mentally ill patients. 32

winw

The findings are consistent with a descriptive cross-sectional study conducted

to assess the knowledge on human rights of mentally ill among community people in

Nepal, which revealed that 85.7% participants are aware the rights to have visitors. 32
ewd

The findings are divergent with the results of an exploratory study conducted

among the mental health professionals and the mass media workers in Bangalore, India
at

that assessed the knowledge about human rights of the mentally ill. The findings

showed that 86.3% of the participants have good knowledge.44

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or
The findings are not in harmony with the study conducted to assess the

d it
knowledge regarding human rights of mentally ill among post basic students in Krishna

institute of nursing sciences, karad, Maharashtra, which revealed that 85% of the

nursing students had average knowledge and only !5% poor knowledge. 48

nE
The present study shows that more than half of participants (61.7%) were not

aware regarding the rights to privacy of medical records of patient with mental illness

DyF.i
and 82.5% were not aware regarding right to refuse treatment. This finding is

inconsistent with a descriptive cross-sectional study carried out to assess the knowledge

aPr
on human rights of mentally ill among community people in Nepal, which revealed that

69.3% are aware regarding the right to confidentiality of medical records and 75.7%

ebrr
were have knowledge regarding the rights to refuse treatments.32

Association between knowledge regarding rights of mentally ill among caregivers

cslti
of patients with mental illness and selected variables

There was a statistically significant association between knowledge regarding rights of

.Mcna

patients with mental illness and age, education, occupation and relationship with

patient.

The findings are consistent with a descriptive study to assess the knowledge
winw

regarding human rights of mentally ill among adults at selected rural areas of

Moradabad which revealed that the knowledge of adults regarding human rights of

mentally ill was significantly associated to educational status.34

ewd

The findings are similar with the results of a study conducted among 80 adults

in selected rural areas of south India, where there is a significant association between
at

level of knowledge regarding rights of patient with mental illness and educational status

of the samples. 34
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or
These findings are contradictory with results of a descriptive survey study

d it
conducted among 400 nursing students from nursing colleges of Bangalore, south India.

Results showed that there is no statistically significant association between knowledge

score and selected variables such as age, education and occupation.50

nE
This finding is consistent with the results of a descriptive cross-sectional study

conducted among caregivers of patient with mental illness in Bangalore, India. Results

DyF.i
showed that statistically significant association found between demographic variables

such as age, education, occupation.46

aPr
SUMMARY

This study was conducted to assist the knowledge regarding rights of mentally
ebrr
among care givers of patients with mental illness. The objectives of the study were to

assess the knowledge of care givers regarding rights of patients with mental illness, find
cslti
out the association between the knowledge regarding right of mentally ill among care

givers of patients with mental illness and selected variables. The conceptual framework
.Mcna

used in the study was based on health promotion model of Nola J Pender. The literatures

reviewed for the present study were organised under the heading of knowledge

regarding rights of mentally ill among common people, caregivers of patients with
winw

mental illness and health care professionals. Present study used a descriptive research

design to assess the knowledge regarding rights of mentally ill among caregivers of

patients with mental illness. Study samples consisted of 120 caregivers accompanying
ewd

patients who are attending outpatient clinics of department of psychiatry, government

medical college hospital, Kozhikode who are selected by using consecutive sampling
at

technique. The data were collected using semi structured interview schedule. The
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or
content validity of the tool was ensured with the help of experts from nursing and other

d it
related fields and the tools were found to be reliable and feasible.

The pilot study was conducted among 12 caregivers from 01.03.2021 to

12.03.2021 and the tools for the study proved to be feasible and data found to be

nE
amenable to statistical analysis.

DyF.i
The data collection for the main study started after getting permission from the

principal and medical superintendent, government medical college hospital, Kozhikode

from 22.03.2021 to 01.05.2021. Based on the objectives and hypothesis of the study,

aPr
data were analysed using both descriptive and inferential statistics, after analysis the

major results were obtained.

ebrr
C) Socio personal characteristics of caregiver

 The study revealed that, 24.8% of the participants belonged to the age group of 41-
cslti
60 years,22.3% belonged to 31-40 years and 35.5% belonged to the age group of
.Mcna

>51 years.

 It was found that 55% were females and 42.5% belonged to Islam religion.

 Among the participants, 36.7 % attained secondary education and 23.3%

winw

participants had primary education.

 The findings of the study shows that 38 % were home makers and 24% were private
ewd

employees

 More than half (66.7%) of the participants were from BPL families.
at

 Among the participants 68% were married and 15% were unmarried.
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or
 The study showed that 31.7% of participant were either brother/sister of the patient

d it
and 20% were father/mother of the patient

B) Clinical characteristics of patient with mental illness

nE
 The study revealed that 55% were patients with schizophrenia and 59.2% were had

1-10 years duration since diagnosis.

DyF.i
 The study shows that 40.5 % of patients were received allopathic treatment only

25.8% were received Faith healing+ Allopathy.

 The study shows that 35.5% of patients were readmitted 1-10 times and 33.1 %

aPr
were readmitted 11-20 times.

 It was found that 64.5 % patients were hospitalized within 6 months to 1 year and
ebrr
66.9 % p were hospitalized within 1–6-month duration.

 Majority of patients (92.5%) were without comorbidities and 5.8% were depressed.
cslti
 The findings shows that 24.6% patients had no comorbidities, 10.7% were diabetic,

11.5% were obese, 12.3% had hypertension along with diabetes, 9% were obese
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and diabetic, 9.8% had obesity along with hypertension and diabetes mellitus.

Section 2: Knowledge of participants regarding rights of patients with mental

illness.
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 The study revealed that 43.9% participants had poor knowledge and 17.1% had only

good knowledge regarding rights of patients with mental illness.

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 It was found that mean knowledge of sample regarding rights of patients with

mental illness was 9.81 with a standard deviation of 5.018.

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Section a: Civil rights of patients with mental illness

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 The study shows that Mean knowledge of sample regarding civil rights of mentally

ill were 1.59 with standard deviation 1.14

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 Among participants 75% were not aware that it is possible for a mentally ill person

to own property

 Majority of the participants (84.2%) were unaware that the court can appoint a legal

DyF.i
guardian for a person with mental illness who is unable to manage the property.

 More than half of the participants (79.2%) were lack knowledge regarding the will

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written by person with mental illness is valid or not according to our mental health

legislation.

 ebrr
More than half of the participants (77.5%) were not aware about the transfer of the

property of a person with mental illness is invalid in circumstances where a rational

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decision cannot be made.

Section b: Criminal rights of patients with mental illness

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 The study revealed that Mean knowledge of sample regarding criminal rights of

mentally ill were 0.95 with standard deviation 1.07

 Most of the participants (76%) were not aware about legal procedures in criminal
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offences of patient with mental illness

 majority of the participants (92%) were not aware regarding rule 84 of IPC,

imprisonment for a crime

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 majority of participants (76.7) were lack knowledge regarding law procedures of

suicide attempt of patient with mental illness

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Section c: Fundamental rights of patients with mental illness

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 It was found that Mean knowledge of sample regarding fundamental rights of

mentally ill were 3.94 with standard deviation 1.37

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 Majority of the participants were not aware regarding the rights of community

participation (87.5) and rights of equality (84.2)

 Majority of participants (89%) lack knowledge regarding free legal services

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provided by the government

Section d: Diagnosis and treatment related rights of patients with mental illness

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 The Mean knowledge of sample regarding diagnosis and treatment related rights


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of mentally ill were 3.18 with standard deviation 1.94

Majority of the participants (80.8%) were lack knowledge regarding the privacy of

a patients with mental illness is a threat at the time of dangers to others.

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 Most of the participants (83.3%) were not aware regarding the rights to appoint

nominated representative to take care of that person

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 Majority of the participants (82.5%) think that person with mental illness not had

the right to refuse treatment

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Section e: Rehabilitation and special circumstances

 The study revealed that Mean knowledge of sample regarding rehabilitation rights

and rights in special circumstances of mentally ill were 0.52 with standard deviation
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0.73

 Majority of the participants (80%) were lack knowledge regarding patients

at

rehabilitation services ensured under mental health legislation.

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Section 3

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Association between the knowledge regarding rights of mentally ill among

caregivers of patients with mental illness and socio personal variables

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 There was a statistically significant association between knowledge regarding

rights of patients with mental illness and socio personal variables of caregiver

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such as age, education, occupation and relationship with patient. The computed

p value for age (χ 2 (4) = 25.132, p<0.01), education (χ 2(10) =67.385, p<0.01),

occupation (χ 2(12) =25.710, p<0.05) and relationship with patient (χ 2(10)

aPr
=27.720, p<0.05) is significant as p value <0.05.

Association between the knowledge regarding rights of rights of mentally ill


ebrr
among caregivers of patients with mental illness and clinical variables

There was no statistically significant association was found between knowledge

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regarding rights of patients with mental illness and clinical variables of patients

such as diagnosis, duration since diagnosis, mode of treatment, frequency of

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readmissions, last hospitalization, duration of last hospitalization, psychiatric

comorbidities and physical comorbidities.

Conclusion
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The following conclusions were derived based on the findings of the study.

 The study revealed that among caregivers of patients with mental illness 43.9%
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participants had poor knowledge and 17.1% had only good knowledge regarding

rights of patients with mental illness

 The mean knowledge of sample regarding rights of patients with mental illness was
at

9.81 with a standard deviation of 5.01.

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 There was statistically significant association between knowledge regarding rights

d it
of patients with mental illness and age, education, occupation and relationship with

patient.

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Nursing Implications

The findings of the study have implications in nursing practice, nursing

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administration, nursing education and research.

Nursing practice

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Nurses are key personals in the health care system. The role of nursing

professionals in wellness promotion, prevention of mental health problems, care and

ebrr
treatment of persons with psychiatric disorders and in taking up anti-stigma activity is

of immense importance. Reducing stigma has been acknowledged as a global priority

to improving mental health.

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Nurses are in a unique position to make a positive impact on the public and thus
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can use their position of trust, to help the public recognize the role and opportunity for

advocacy to end stigma. Psychiatric nurses should require the necessary knowledge,

skills and confidence to competently perform the role of providing education to the
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public. Assessing the existing knowledge and attitude of public regarding mental

health, mental illness and treatment of mental disorders and 93 providing adequate

education to people accordingly, helps to eliminate the existing myths and

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misconceptions.Nurses working in community setting, school health sector, psychiatric

ward can plan and conduct training programs to improve the level of knowledge

regarding rights of mentally ill. The public health nurses must focus the students in the
at

educational institutions and provide information with regard to rights and different
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aspects of protection of rights and services provided for the patients with mental illness.

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This study emphasis in improving the knowledge regarding human rights of

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mentally ill through educative measures. Teaching programme can be conducted for

caregivers of mentally ill clients. Health education can also provide with media,

pamphlets which will help the caregivers to increase the knowledge regarding human

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rights of mentally ill among care givers. Nurses should focus on psychiatric

rehabilitation in the community setting by using health teaching regarding human rights

DyF.i
of mentally ill to caregivers. Sources of knowledge can have a great effect in building

the knowledge and attitude.

aPr
Social discrimination against mentally ill patients and the treatment modalities

used in treating mental disorders still persist in our society, nurses and other health care

ebrr
providers have the responsibility to be a vital patient advocate, assuring that patients

with mental illness and their relatives receive accurate information regarding rights of
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mentally ill.

Nursing education
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Nursing is addressed to meet the requirements of the health care system for

meeting the health care needs of the society. Nurses can do much to educate the patients

with mental illness, their family members and general public about the rights of patient
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with mental illness.Curriculum should equip the students to update the knowledge

regarding rights of patients with mental illness and legal procedures, services, property

management to plan and conduct health education programs or awareness programs for
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various age groups regarding various aspects of mental health legislation in different

settings like schools, colleges, communities, hospitals and other health care agencies.
at

Conferences, workshops and seminars can be held for nurses to impart

knowledge on human rights of mentally ill. Nursing students can be offered with short
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or
term training course on the human rights of mentally ill. Suggestions can be given to

d it
include the human rights of mentally ill in the nursing curriculum for its better

understanding to care givers. Get their full active participation and involvement, and

utilize their skills for improving the public knowledge regarding rights of patients with

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mental illness.

Nursing Administration

DyF.i
Nursing administrators should take limitation in formulating policies and

protocols for short- and long-term health teaching. The nursing administration should

aPr
motivate the subordinate for participating in various educational programmes and

improve their knowledge and skills.

ebrr
There should be series of workshops and seminars for the nursing students

regarding the importance of eliminating the myths and misconceptions regarding

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mental illness and treatment of mental disorders. Nurse administrator can encourage

these types of studies to update the knowledge among fellow professionals and students.
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Nurses working in community setting such as ASHA workers, JPHN having

direct contact with the general population, so arrange educational programmes for them

to gain knowledge regarding rights of patients with mental illness.Nurse administrator

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should encourage the involvement of family members and relatives in the treatment of

patients with mentally ill and in clarifying doubts regarding rights of patients with
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mental illness.

Nursing Research
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The nursing researcher should be aware of new trends in the existing health care

system and emphasis should be laid on research in the area of the various interventions
re

for the improvement knowledge regarding rights of mentally ill client. There is a better

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scope for nurses to conduct research studies in this area, to find out the effectiveness of

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various teaching strategies on the different types of interventions to educate the

caregivers with inadequate knowledge. The effectiveness of the research study can be

made by further implication of the study. The study can be utilized for evidence-based

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nursing practice as a rising trend.

Limitations

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o Generalization of the findings is limited.

o Difficulty in data collection due to COVID pandemic

aPr
Recommendations

ebrr
Keeping in view the findings of the present study the following

recommendations are made. Since this study was carried out on a small sample and also

due to the non-probability sampling technique, the results can be used only as a guide
cslti
for further studies.
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 The similar study can be conducted with a larger sample size in different setting

for generalization of findings

 Similar study can be conducted in different population like professionals or

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professional students.

 An experimental study can be conducted to assess the effectiveness of different

information education strategies in improving knowledge regarding rights of

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mentally ill among caregivers of patients with mental illness.

 A comparative study can be conducted to assess knowledge and attitude

regarding rights of mentally ill among staff nurses working in psychiatric and
at

non- psychiatric setting.

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cslti
62. Shanthi S. Awareness of human rights among caregivers caring for mentally ill.
.Mcna

Indian journal of psychiatric nursing.2009 Dec 1(1),26-28)

winw
ewd
at
re

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110

or
APPENDIX A

d it
APPROVAL LETTER FROM INSTITUTIONAL ETHICS

COMMITTEE

nE
DyF.i
aPr
ebrr
cslti
.Mcna
winw
ewd
at
re

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111

or
APPENDIX B

d it
PERMISSION LETTER FROM PRINCIPAL OF GOVT.

MEDICAL COLLEGE, KOZHIKODE

nE
DyF.i
aPr
ebrr
cslti
.Mcna
winw
ewd
at
re

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112

or
d it
nE
DyF.i
aPr
ebrr
cslti
.Mcna
winw
ewd
at
re

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113

or
APPENDIX C

d it
LIST OF EXPERTS FOR CONTENT VALIDITY

1. Dr. Harish M T 6. Dr Ragesh

nE
Professor Psychiatric social worker
Department of psychiatry IMHANS, Kozhikode
Govt medical college

DyF.i
Hospital, Kozhikode

2. Dr. Roy K George 7. Mr Nabeel

aPr
Director Academics Assistant professor
Baby Memorial Hospital Govt college of nursing
Kozhikode Kozhikode
ebrr
3. Mr Sreejesh P K 8. Mrs Rejina Ravindran
Associate professor Assistant professor
cslti
EMCH college of nursing MHN
Kozhikode Baby memorial CON
.Mcna

Kozhikode
4. Prof. Dr Jibby George
HOD, Mental health nursing 9. Mrs Alka Raju
Baby memorial college of nursing Nursing tutor
Kozhikode IMHANS, Kozhikode
winw

5. Dr Reena George
Assistant professor
ewd

Department of psychiatric nursing

IMHANS, Kozhikode
at
re

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114

or
APPENDIX D

d it
INFORMED CONSENT

In signing this document, I am giving consent to be a subject for the study

nE
conducted by Mrs Shahana.S, MSc nursing student, Govt College of Nursing,

Kozhikode. I understand that I will be a part of the research study titled “knowledge

regarding rights of mentally ill among caregivers of patients with mental illness”.

DyF.i
I have been informed that my willingness to participate in the study is entirely

voluntary and in the course of the study, I can withdraw from the study at any time. I

aPr
have been told that my answers to question will be utilized only for the study purpose

and will be kept confidential. I also have been informed that I have no financial

ebrr
commitments for the study.

If I have any question about the study or about my right as a participant, Mrs
cslti
Shahana.S, is whom I should contact.

I will honour all agreements.

.Mcna

Respondent’s signature:

Name and address:

Investigators Name
Mrs. Shahana.S
winw

MSc Nursing student

Govt College of Nursing
Kozhikode
Phone no: 8606713515
ewd

Place:
Date:
at
re

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115

or
APPENDIX E
TOOL-1

d it
SEMI STRUCTURED INTERVIEW SCHEDULE TO ASSESS THE
SOCIOPERSONAL DATA OF THE CAREGIVER AND CLINICAL DATA OF

nE
THE PATIENTS.

Instructions to the interviewer:

DyF.i
 Ask questions listed in the schedule using one to one interview technique
 The interviewer has to put [ ] tick mark against the appropriate spaces

aPr
provided and fill up wherever necessary according to the response of
participant.

SECTION A
ebrr
cslti
SOCIOPERSONAL DATA
.Mcna

1.Age (in years) ( )

2.Gender
a) Male ( )
winw

b) Female ( )
c) Transgender ( )
3.Religion
d)Hindu ( )
ewd

e) Islam ( )
f) Christian ( )
g) Others specify ……………………..………
at
re

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116

or
4.Educational status
a) illiterate ( )

d it
b) Primary ( )
c) Secondary ( )
d)Higher secondary ( )

nE
e) Degree and above ( )
f) Professional/technical ( )
5.Occupation

DyF.i
a) Govt job ( )
b) Semi Government ( )
c)private sector ( )

aPr
d)Business ( )
e) Agriculture/farmers ( )
f) coolie ( )
ebrr
g) unemployment
i) housewives/homemade
(
( )
)

6.Monthly income
cslti
a) APL ( )
b) BPL ( )
.Mcna

7. Marital status
a) Married ( )
b) Unmarried ( )
c) Divorced/separated/widower ( )
winw

8. Relationship with the patient

a) Father/Mother ( )
b) Grandfather/grandmother ( )
c) Children /grandchildren ( )
ewd

d) Sibling ( )
e) Others specify ( )
at
re

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117

or
SECTION – B – CLINICAL DATA OF THE PATIENTS WITH MENTAL
DISORDER

d it
1.Diagnosis of the patient (…………….)

nE
2.Duration since diagnosis (……………..)

3.Mode of treatment Specify (……………..)

DyF.i
4.Frequency of readmissions (………………)

aPr
5. Last Admission (………………)

6. duration of last admission (……………….)

ebrr
7.Psychiatric comorbidities (………………)
cslti
8.Physical comorbidities (……………..)
.Mcna
winw
ewd
at
re

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118

or
d it
APPENDIX F
TOOL 2
QUESTIONNAIRE TO ASSESS THE CAREGIVER’S

nE
KNOWLEDGE REGARDING RIGHTS OF PATIENTS WITH
MENTAL ILLNESS

DyF.i
Instructions to the interviewer:

 Ask questions listed in the schedule using one to one interview technique

aPr
 The interviewer has to put [] tick mark against the appropriate spaces
provided and fill up wherever necessary according to the response of
participant
SI
NO
ebrr QUESTIONS YES NO I
DON’T
KNOW
cslti
CIVIL RIGHTS OF PATIENTS WITH MENTAL ILLNESS

1 Transfer of property of a person with mental

.Mcna

illness is invalid in circumstances where a rational

decision cannot be made
2 It is possible for a mentally ill person to own
property
winw

3 Marriage is legally valid only if both parties must

be mentally healthy at the time of marriage
4 The court can appoint a legal guardian for a person
with mental illness who is unable to manage the
ewd

property
5 According to mental health legislation a will
written by person with mental illness is invalid
at

CRIMINAL RIGHTS OF PATIENTS WITH MENTAL ILLNESS

re

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119

or
6 Sexual offences against children are considered
seriously and punishment will be severe under

d it
POCSO act
7 A person who has committed a crime due to
mental illness has legal protection

nE
8 According to rule 84(McNaughton rule) of IPC, a
person who commits a crime on the basis of
mental illness should be imprisoned

DyF.i
9 Attempted suicide by a person with mental illness
is punishable the IPC
FUNDAMENTAL RIGHTS OF PATIENTS WITH MENTAL ILLNESS

aPr
10 A person with mental illness should always be
isolated from society and hospitalised
11 ebrr
Special clothing should be provided to identify a
person with mental illness
12 A person with mental illness admitted to mental
cslti
health establishment shall have the right to receive
visitors
13 Patients undergoing treatment at a mental health
.Mcna

facility are entitled to receive free legal services

14 Any information/pictures of a person with mental
illness undergoing treatment in a psychiatric
hospital shall be published without the consent of
winw

the patient
15 A person undergoing treatment for mental illness
have no right to access their basic medical records
ewd

TREATMENT RELATED RIGHTS OF PATIENTS WITH MENTAL

ILLNESS
at
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120

or
16 Mental illness shall be diagnosed in accordance
with nationally/internationally accepted medical

d it
standards
17 A patient can be admitted to a mental health
establishment for treatment on their own

nE
18 Free treatment services for patient with mental
illness is available at government mental health
facilities

DyF.i
19 According to mental health legislation all
treatment procedure must started with the consent
of the patient or legal guardian

aPr
20 The privacy of a person with mental illness cannot
be maintained in situations where the safety of
others at risk
21
ebrr
A person with mental illness shall have the rights
to complain regarding deficiencies in provision of
care, treatment and services in a mental health
cslti
establishment
22 Under the mental health legislation, the person
.Mcna

with mental illness has the right to refuse

treatment
23 Person with mental illness has the right to appoint
nominated representative to take care of that
winw

person

REHABILITATION AND SPECIAL CIRCUMSTANCES

24 Patient rehabilitation services must be ensured

ewd

under mental health legislation

25 A minor person with mental illness shall be
treated among adult mental ill patients
at
re

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121

or
APPENDIX G

d it
ABBREVIATIONS

nE
WHO World Health Organisation

NMHS National Mental Health Survey

DyF.i
OPD Outpatient Department

aPr
ICCPR International Covenant on Civil and Political Rights

MHCA Mental Health Care Act

MHK
ebrr
Mental Health Knowledge

CSO Civil Society Organization

cslti
.Mcna
winw
ewd
at
re

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122

or
APPENDIX H

d it
k½X]{Xw

tImgn-t¡mSv Kh¬saâv \gvknwKv tImtf-Pn _ncp-Zm-\´

- c _ncpZ
\gvknwKv hnZymÀ°n-\n-bmb jl-\.-Fkv ""am\-kn-I-tcm-Ka
- pÅ hyàn¡v ]cn-N-

nE
cWw \ÂIp-¶-h-cn am\-kn-It- cm-Kn-If
- psS Ah-Im-i-§-sf-¡p-dn-¨pÅ Adnhv''
F¶ ]T-\-amWv \S-¯p-¶-sX¶v ]dªp a\-Ên-em¡n X¶n-«p-­v.

]T-\h
- n-t[-b³ F¶ \ne-bn-epÅ Fsâ k½Xw XnI¨pw kzta-[bm DÅ-

DyF.i
Xm-W-F¶pw A`n-ap-J-¯n-eqsS F\n¡v D¯cw \ÂIm-Xn-cn-¡q-hmt\m A`n-ap-J-
¯n \n¶pw ]n·m-dp-hmt\m Ah-Im-i-ap-s­¶pw F\n¡v t_m[y-am-bn-«p-­v.
tNmZy-§Ä¡pÅ Fsâ D¯-c-§Ä bmsXm-cmÄ¡pw shfn-s¸-Sp-¯n-I-bnÃ

aPr
F¶pw Ah ]T-\m-h-iy-¯n\p th­n am{Xta D]-tbm-Kn-¡p-I-bpÅq F¶pw
Fs¶ ]dªp a\-Ên-em¡nbn-«p-­v. Cu ]T-\-¯n ]s¦-Sp-¡p-¶X
- n\v F\n¡v
bmsXmcp hn[ km¼-¯nI _m-[y-XIfpw- D­m-hpIbnsöpw Rm³ a\-Ên-em-
¡p-¶p. ebrr
Cu ]T-\-s¯¡p-dn-¨pÅ tNmZy-§Ä¡pw, kwi-b-§Ä¡pw jl-\.-Fkv
s\ _Ô-s¸-Sm-hp-¶-Xm-Wv.
cslti
hmbn¨p tI«v a\-Ên-em¡n

hyàn-bpsS H¸v :
.Mcna

t]cv :

taÂ-hn-emkw :

K-th-jI
- -bp-sS H-¸v:
winw

taÂ-hn-emkw : jl-\.-Fkv

H¶mw hÀj Fw,-F-kv.kn \gvknwKv hn-ZymÀ-°n-\n-

K-h¬-saâv \-gv-knMv tIm-tf-Pv

ewd

tIm-gn-t¡m-Sv

t^m¬:8606713515
at

Øew:
re

Xn¿-Xn:

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123

or
APPENDIX I

d it
SqÄ 1
]cn-Nm-c-IsâkmaqlnIhyàn-KX hnh-c-§fpwtcmKn-bpsSNnIn-Õm-hn-h-c-
§fpwtiJ-cn-¡p¶-Xn-\pÅA`n-apJtNmZym-hen

nE
A`n-apJhàm-hn-\pÅ \nÀt±-i-§Ä:

1. A`n-apJw D]-tbm-Kn¨p ]T-\-hn-t[-b\

- m-Ip¶ hyàn-I-fpsS {]Xn-I-cWw

DyF.i
D]-tbm-Kn¨pA`n-apJtNmZym-hen ]qcn-¸n-¡p-I.
{Ia \¼À: Xn¿Xn:

`mKwFþ ]cn-Nm-c-IsâkmaqlnIhyàn-KX hnh-c-§Ä

aPr
1. hbÊv:

2. enwK-w
ebrr
F) ]pcp-j³ ( )

_n) kv{Xo ( )
cslti
kn) `n¶-enwKw ( )

3. aXw
.Mcna

F) lnµp ( )

_n) CÉmw ( )

kn) {InkvXy³ ( )
winw

Un) aäp-Åh ( )

4. hnZym-`ym-k-tbm-KyX
ewd

F) \nc-£-c³ /\nc-£c ( )

_n) {]mY-anIhnZym-`ymkw ( )

kn) sk¡âdnhnZym-`ymkw ( )
at

Un) lbÀsk¡âdnhnZym-`ymkw ( )
re

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124

or
C) _ncpZhpwAXn-\p-ap-If
- nepw ( )

d it
F^v) s{]m^j-WÂ /sSIv\n-¡Â ( )

5. sXm-gnÂ

F) kÀ¡mÀ ( )

nE
_n) AÀ²-kÀ¡mÀ ( )

kn) ss{]-häv ( )

DyF.i
Un) _nkn-\Êv ( )

C) IÀj-I³ ( )

aPr
F^v) sXm-gn-en-Ãmbva ( )

Pn) ho«-½-amÀ ( )

6.
ebrr
amk-h-cp-am\w

F) F.-]n.-FÂ ( )
cslti
_n) _n.-]n.-FÂ ( )

7. ssh-hm-lnI \ne
.Mcna

F) hnhm-ln-X³ /hnhm-lnX ( )

_n) Ahnhm-ln-X³ /Ahnhm-lnX ( )

kn) _Ôw-thÀs¸-Sp-¯n-b-hÀ ( )
winw

Un) thdn«pXma-kn-¡p-¶-hÀ ( )

C) a-äp-Åh ( )
ewd

8. tcm-Kn-bp-am-bpÅ _Ôw

F) Aѳ / A½ ( )

_n) ap¯-ѳ / ap¯Èn ( )

at

kn) a¡Ä / t]c-a-¡Ä ( )

re

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125

or
Un) ktlm-Z-c³ /ktlm-Zcn ( )

d it
C) aäpIpSp-_mw-K§
- Ä ( )

`mKw _n
am\-kn-I-tcm-K-apÅhyàn-bsSNnIn-Õm-hn-h-c-§Ä

nE
1. tcmKw ( .......................................................................... )

2. tcmKw \nÀ®-bn-¡-s¸-«XvapX-epÅImem-h[n (.........................)

DyF.i
3. NnIn-Õm-coXn ( .............................................................. )hyà-am-¡pI

4. Bip-]{Xn {]th-i-\-¯nsâF®w ( ................................................ )

aPr
5. Ah-km-\-a-ambn Bip-]{Xnbn {]th-in-¸n-¨Xv ( ................................... )

6. Ah-km\ AUvan-jsâ Imem-h[n ( ................................................ )

7.

8.
ebrr
sskIym{SnIvsImtamÀ_n-Unän ( ........................................................)

^nkn-¡Â sImtamÀ_n-Unän ( ............................................................)

cslti
.Mcna
winw
ewd
at
re

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126

or
APPENDIX J

d it
SqÄþ2
am\-knI Akzm-Øy-apÅ hyàn-bpsS Ah-Im-i-§Ä kw_-Ôn¨

nE
]cn-Nm-c-Isâ Adnhv ]cn-tim-[n-¡p-¶-Xn-\pÅ tNmZym-hen

\nÀt±-i-§Ä

DyF.i
1. tNmZym-h-en-bn ]d-bp¶ FÃm tNmZyhpw H¶n\p ]pdsI H¶mbn tNmZn-
¡pI
2. tNmZy-IÀ¯mhv Hmscm tNmZy-¯n\pw A\p-tbm-Py-amb tImf-¯n ( )
Sn¡v F¶v AS-bm-f-s¸-Sp-¯pI.

aPr
{Ia- tNmZyw AsX AÃ Adn-
\- bnÃ
¼À
1.
ebrr
am\-kn-It- cmK \nÀ®bw \S-¯p-¶Xv
tZiob/A´ÀtZ-iob NnInÕm am\-Z-
cslti
WvU§
- Ä A\p-k-cn-¨mWv.
2. am\-kn-Im-tcmKy Øm]-\-¯n tcmKnsb
kzta-[bm NnIn-Õbv¡v {]th-in-¸n¡mw.
.Mcna

3. kÀ¡mÀ am\-kn-Im-tcmKy Øm]-\-§-fnÂ

kuP\y am\-knI NnInÕ e`y-amWv.
4. am\-knI Akp-J-apÅ hyàn¡v kz¯v
ssIh-im-h-Imiw km[y-amWv.
winw

5. hnhm-l-_Ôw \nb-a-]-c-ambn km[q-I-cn-¡-

W-sa-¦n hnhm-l-k-a-b¯v c­p I£n-
Ifpw am\-kn-Im-tcmKyw DÅ-h-cm-bn-cn-¡-
Ww.
ewd

6. kz¯v ssIImcyw sN¿m³ Ign-hn-Ãm¯

am\-knI Akp-J-apÅ hyàn¡v th­n
tImS-Xn¡v c£m-[n-Im-cnsb \nb-an-¡mw.
at

7. am\-knI Akp-Ja
- pÅ hyàn-bpsS Xocp-
am-\-{]-Imcw Fgp-X-s¸« hnÂ]{Xw Akm-
[p-hm-Wv.
re

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127

or
8. Ip«n-IÄ¡v FXn-sc-bpÅ ssewKnI Ipä-
Ir-Xy-§Ä Kuc-h-ambn IW-¡m-¡p-Ibpw

d it
in£ ITn-\-am-¡p-Ibpw sN¿p-¶Xv
t]mIvtkm \nb-a-{]-Im-c-am-Wv.
9. am\-knI AkzmØyw aqew Ipä-IrXyw

nE
sNbvX hyàn¡v \nb-a-]-c-amb ]cn-c-£-bp-
­v.
10. C´y³ in£m \nb-a-{]Imcw amknI

DyF.i
Akp-Ja
- pÅ hyàn Bß-l-Xy¡v {ian-
¡p-¶Xv in£mÀl-am-Wv.
11. am\-knI Akp-J-apÅ hyànsb FÃm-
bvt¸mgpw kaq-l-¯n \n¶v thÀXn-cn¨v

aPr
Bip-]-{Xn-bn {]th-in-¸n-¡W
- w.
12. am\-knI Akp-Ja
- pÅ hyànsb Xncn-¨-dn-
bp-¶X
- n\v {]tXyI hkv{X-§Ä [cn-¸n-t¡-
ebrr
­-Xp-­v.
13. am\-knI BtcmKy Øm]-\¯
- n NnIn-
Õ-bn Ign-bp¶ tcmKn¡v kµÀi-Isc
cslti
kzoI-cn-¡m-\pÅ Ah-Imiw D­v.
14. am\-knI BtcmKy Øm]-\¯
- n NnIn-
.Mcna

Õ-bn Ign-bp¶ tcmKn-IÄ¡v kuP\y

\nba tkh\w e`n-¡m³ Ah-Im-i-ap-­v.
15. Bip-]-{Xn-bn NnIn-Õ-bn Ign-bp¶
am\-knI Akp-J-apÅ hyàn-bpsS hnh-c-
§tfm/ Nn{X-§tfm tcmKn-bpsS k½-X-an-
winw

ÃmsX ]c-ky-s¸-Sp-¯m-hp-¶-Xm-Wv.
16. am\-knI Akp-J¯
- n\v NnIn-Õ-bn Ign-
bp¶ hyàn¡v Ah-cpsS ASn-Øm\
saUn-¡-Â tcJ-IÄ ImWm-\h
- -Im-i-an-Ã.
ewd

17. am\-knI BtcmKy \nb-a-{]-Imcw GXp

NnInÕm \S-]-Sn-IÄ kzoI-cn-¡p-¶-Xn\p
ap¼pw tcmKn-bp-sStbm \nb-a-]-c-amb c£m-
at

[n-Im-cn-bp-sStbm k½Xw hmt§-­-Xm-Wv.

18. am\-knI Akp-J-apÅ hyàn-bpsS kzIm-
cyX aäp-Å-h-cpsS kpc-£n-X-Xz-hp-ambn
re

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128

or
_Ô-s¸« kml-N-cy-§-fn \ne-\nÀ¯m³
km[y-a-Ã.

d it
19. Bip-]-{Xn-bnse ]cn-N-cWw NnIn-Õ-bpsS
tkh-\-§Ä F¶n-h-bnse Ipd-hp-I-sf-Ip-
dn¨v tcmKn¡v ]cm-Xn-s¸-Sm³ Ah-Im-i-ap-

nE
­v.
20. am\-knI BtcmKy \nb-a-{]-Imcw tcmKn-
bpsS ]p\-c-[n-hmk tkh-\-§Ä Dd-¸p-h-cp-

DyF.i
t¯-­-Xp-­v.
21. am\-knI BtcmKy \nb-a-{]-Imcw am\-knI
Akp-Ja
- pÅ hyàn¡v C.-kn.Sn/tjm¡v
NnIn-Õ-t]m-epÅ NnIn-Õm-co-Xn-IÄ \nc-

aPr
kn-¡m-\pÅ Ah-Imiw D­v.
22. am\-kn-It- cm-K-apÅ hyàn¡v ]cn-N-c-W-
¯n-\mbn \ma-\nÀt±iw sN¿-s¸« {]Xn-\n-
ebrr
[nsb \nb-an-¡m³ Ah-Im-i-ap-­v.
23. {]mb-]qÀ¯n-bm-hm¯ am\-knI Akp-J-
apÅ hyànsb apXnÀ¶ am\-kn-I-tcm-K-
cslti
apÅ hyàn-I-fpsS IqsS NnIn-Õn-¡m-hp-
¶-Xm-Wv.
.Mcna

24. bpàn-k-l-amb Xocp-am\w FSp-¡m³ Ign-

bm¯ kml-N-cy-§-fn am\-knI Akp-J-
apÅ hyàn-bpsS kz¯v ssIamäw sN¿p-
¶Xv Akm-[p-hm-Wv.
25. C´y³ in£m-\n-baw 84-þmw (atám-«³
winw

dqÄ) N«-a-\p-k-cn¨v am\-kn-I-tcm-K-¯nsâ

ASn-Øm-\-¯n Ipä-IrXyw sNbvX
hyànsb Pbn-en {]th-in-¸n-¡-Ww.
ewd
at
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or
APPENDIX J

d it
LEAFLET

am\-kn-I-tcm-K-apÅ hyàn-I-fpsS Ah-Im-i-§Ä

nE
GXp kaq-l-¯n-sâbpw \ne-\n¸n\v AwKo-Ir-Xa
- mb \nb-a-hy-hØ

AXym-h-iy-am-Wv. hyàn-]-chpw kmaq-ln-I-]-c-hp-amb A¨-S¡w ]ptcm-K-Xn¡v

DyF.i
AXym-h-iyamWv. temI-s¯-hn-sSbpw \oXn-\ymb hyh-Ø-bn at\m-tcm-Kn-

IÄ¡v {]tXyI ]cn-K-W-\-IÄ \ÂIp-¶p-­v. at\m-tcm-Kn-I-fpsS NnInÕ ]e

\nb-a-hy-hØ
- -Ifpw ]ment¨ \S-¯m-\m-hq. F¦nepw Ah-cpsS Ah-Im-i-§fpw

aPr
aqey-§fpw Ahsc ]cn-]m-en-¡p-¶h
- À Adn-ªn-cn-t¡-t­Xv AXym-h-iy-am-Wv.

at\m-tcm-Kn-I-fpsS Ah-Im-i-§Ä
ebrr
knhn \nb-a-hy-hØ A\p-k-cn-¨pÅ Ah-Im-i-§Ä
cslti
 knhn \nb-ah
- y-h-Ø-bn hnhm-lw, hnhm-lt- am-N-\w, kz¯-hI
- m-iw,

kz¯p-¡Ä {Ib-hn-{Ibw sN¿m³ DÅ Ah-Imiw apX-em-bh DÄs¡m-Åp-

.Mcna

¶p.

 HcmÄ at\m-tcm-Kn-bm-sW¶v sXfnªp Ign-ªm Abm-fpsS kz¯p-¡Ä

kzX-{´-ambn ssIImcyw sN¿m³ AbmÄ¡v Ah-Im-i-an-söv hcp-¶p.

winw

hyà-ambn sXfn-bn-¡-s¸-SWw F¶p-am-{Xw.

 tcmKnsb aäp-Å-hÀ NqjWw sN¿m-Xn-cn-¡m\pw tcmKnsb D]-tbm-Kn¨v

Abm-fpsS _Ôp-¡Ä NqjWw sN¿-s¸-Sm-Xn-cn-¡m\pw th­n-bm-Wn-Xv.

ewd

sSÌvsaâdn I¸m-knän

 knhn \nb-a-¯nse kp{]-[m-\-am-sbmcp hIp-¸mWv CXv. .bp-àn-k-l-amb

at

Xocp-am-\§
- -sf-Sp-¡m-\pÅ Ign-hpt­m F¶mWv CXn-eqsS ]cn-tim-[n-¡s
- ¸-

Sp-¶X
- v.
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 hnÂ]{Xw Fgp-Xp-t¼mÄ, hkvXp-¡f
- psS {Ib-hn-{Ibw \S-¯p-t¼mÄ km£n

d it
]d-bp-t¼mÄ C§s\ \nc-h[n kµÀ`-§-fn sSÌvsaâdn I¸m-knän {]k-à-

am-Ip-¶p.

nE
{Inan-\ \nb-a-hy-hØ A\p-k-cn-¨pÅ Ah-Im-i-§Ä

 {Inan-\Â \nb-ah
- y-h-Ø-bn Ipä-Ir-Xy-§-fpsS D¯-c-hm-ZnXzw Btcm-]n-¡-

DyF.i
s¸-Sp-t¼mÄ tcmKn-bpsS am\-kn-Im-hØ
- bv¡v {]tXyI ]cn-KW
- \ \ÂIp-¶p-

­v.

 Ipä-IrXyw \S-¯p-t¼mÄ B IrXy-¯nsâ kz`mhw AXnsâ A\-´-c-^ew

aPr
F¶n-h-sb-¡p-dn¨v tcmKn¡v Adn-hp-­m-bn-cpt¶m F¶ tNmZyw {]k-à-am-

Wv.

Sp-¶X
ebrr
 CXns\ Bkv]-Z-am-¡n-bmWv {Ian-\Â sdkvt]m¬kn-_n-enän \nÀ®-bn-¡s

- v. AXv CXn-\p-th-­n-bm-Wv. at\m-tcmK NnInÕ sN¿p-¶h

- ¸-

- sc hnZKv[
cslti
km£n-I-fmbn tImS-Xn-bn hnkva-cn-¡p-¶p.

 Ipä-IrXyw sN¿p-t¼mÄ {]Xn-bpsS am\-kn-Im-hØ F´m-bn-cp¶p F¶v a\-

.Mcna

Ên-em¡n tImSXn Abmsf shdpsX hnSp-I-tbm, in£n-¡p-ctbm sN¿p-¶p.

 shdpsX hn«mepw Abm-fpsS NnIn-Õbpw tcmK-ia

- -\hpw Dd-¸p-h-cp-¯m³

th­ \S-]S- n-IÄ tImSXn kzoI-cn-¡pw.

winw

kmaq-ln-Ia
- mbn Pohn-¡p-¶-Xn\pÅ Ah-Imiw

 am\-kn-It- cm-K-apÅ Hmtcm hyàn¡pw kaq-l-¯nsâ `mK-ambn Pohn-¡p-¶-

Xn-\pÅ Ah-Imiw \nbaw Dd¸p \ÂIp-¶p.

ewd

 am\-knI tcmKn-bmb HcmÄ¡v IpSpw-_t- ¯msS _Ôp-¡t- fm-sSm¸w Xma-kn-

¡m³ Ign-bm¯v kml-N-cy-¯n AsÃ-¦n am\-kn-It- cm-Kn-bmb Hcp

at

hyànsb IpSpw-_mw-K-§tfm _Ôn-¡tfm Dt]-£n¨ kml-N-cy-¯n \nb-

a-k-lmbw DÄs¸-sS-bp-Å-hÀ¡v kÀ¡mÀ DNn-X-amb ]n´pW \ÂIp-¶p.

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a\p-jy-c-ln-Xhpw Xcw-Xmgv¶ NnIn-Õ-bn \n¶pw ]cn-c-£Ww e`n--¡p-¶-Xn-
\pÅ Ah-Imiw

d it
 am\-kn-It- cm-K-apÅ Hmtcm hyàn¡pw A´-tÊmsS Pohn-¡m-\pÅ Ah-
Imiw D­m-bn-cn-¡pw.

nE
 kpc-£n-XXzw ipNn-Xz-apÅ A´-co-£-¯n Pohn-¡m-\pÅ Ah-Imiw
 hnZym-`ym-kw, hnt\mZw F¶n-h-bv¡pÅ Ah-Imiw
 kv{Xo-IÄ BÀ¯h ka-b¯v Bhiyw Btb-¡m-hp¶ hyàn ipNn-Xz-¯n-

DyF.i
\pÅ Ah-Imiw
 \nÀ_-Ôn-X-ambn Xe-apSn apdn-¡p-¶X
- n\pw tjhnMv sN¿p-¶X
- n-s\-Xnscbpw

aPr
Øm]-\-¯nsâ bqWnt^mw thW-sa-¦n \nc-kn-¡p-Ibpw kz´w [cn-¡p-
¶-Xn-\p-apÅ Ah-Imiw.

hnth-N-\-¯n\pw H¶pw Ak-a-Xz-¯n\pw FXn-sc-bpÅ Ah-Imiw

ebrr
 enwKw, PmXn, aXw, kwkvImcw, kmaq-lnI AsÃ-¦n cmjv{Sob hnizm-k-

§Ä hÀ¤w ,ssh-Ieyw F¶n-h-bpsS ASn-Øm-\¯

- n am\-kn-I-tcm-K-apÅ
cslti
hyànsb thÀXn-cn¨v ImWmsX aäp imco-cnI AkzmØyw DÅ

 tcmKn-Isf t]mse- Xs¶ ImWp-¶-Xn-\pÅ Ah-Imiw.

.Mcna

 Bw_p-e³kv tkh-\-§Ä BtcmKy Øm]-\-¯nse PohnX \ne-hmcw Dd-

¸p-h-cp-¯p-¶-Xn-\pÅ tkh-\-§fpw e`y-am-Wv.

 BtcmKyØm]-\-¯n NnIn-Õ-bn-epÅ kv{XobpsS 3 h bÊn\p Xmsg-

winw

bpÅ Ip«nsb A½-sb¶pw thÀs¸-Sp-¯msX 3 hb-Ên\pw tijw am{Xw

aäpÅ ]p\-c-[n-hmk tI{µ-¯n-te¡v amäp-¶-Xn-\pÅ kuI-cy-§fpw e`y-am-

Wv.
ewd

hnh-cm-h-Im-i-¯n-\pÅ Ah-Imiw

am\-kn-It- cm-K-apÅ hyàn¡pw \ma-\nÀt±iw sN¿-s¸« {]Xn-\n-[n¡pw

at

hyàn-bpsS am\-knI tcmK-¯nsâ kz`m-hhpw \nÀ±njvT NnInÕ ]²-Xn-bpw,

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or
\nÀt±-in¨ NnIn-Õ-sb-¡p-dn¨pw Adn-b-s¸-Sp¶ ^e-§-sf-¡p-dn¨pw hnh-c-§Ä
Adn-bp-¶X
- n-\pÅ Ah-Imiw \nbaw Dd¸p \ÂIp-¶p.

d it
kzIm-cyX Dd-¸p-h-cp-¯p-¶-Xn-\pÅ Ah-Imiw

nE
 am\kn-I-tcm-K-apÅ Hmtcm hyàn¡pw Ahsâ am\-knI tcmKw NnIn-Õ,

imco-cnI tcmKw F¶n-h-bn kzIm-cyX ]peÀ¯m-\pÅ Ah-Im-i-ap-­v.

 C¯cw hyàn-IÄ¡v NnIn-Õbpw ]cn-N-c-Whpw \ÂIp¶ FÃm BtcmKy

DyF.i
hnZ-Kv[cpw C¯cw hnh-c-§Ä cl-ky-ambn kq£n-¡m³ IS-s¸-«n-cn-¡p-¶p.

 Poh\p `ojWn XS-tb­ kml-N-cy-¯n aäv GsX-¦nepw hyànsb

aPr
AXn \n¶v kwc-£n-t¡­ kml-N-cy-¯n _Ô-s¸« t_mÀUnsâ

sslt¡m-SXn kp{]ow-tIm-SXn F¶n-h-bpsS \nÀtZ-i-{]-Imcw Cu Ah-Im-i-

ebrr
¯n amäw D­m-tb-¡mw.
saUn-¡ÂtcJ-IÄ ]cn-tim-[n-¡p-¶-Xn-\pÅ Ah-Imiw
cslti
 tcmKw DÅ FÃm hyàn-IÄ¡pw Ah-c-hpsS {]mY-anI tcJ-IÄ ]cn-tim-
[n-¡p-¶X
- n-\pÅ Ah-Im-i-ap-­v.
 A¯cw hnh-c-§Ä e`n-¡p-¶-Xn-\mbn _Ô-s¸« t_mÀUn-sâbpw Øm]-
.Mcna

\-s¯tbm k½Xw hmt§-­-Xm-Wv.

hyàn-KX _Ôw ]peÀ¯p-¶-Xn\pw Bi-b-hn-\n-abw \S-¯p-¶-Xn\v DÅ Ah-

Imiw
winw

Hcp am\-knI BtcmKy Øm]-\-¯n {]th-in-¸n-¡-s¸« hyàn¡v kµÀi-Isc

kzoI-cn-¡mt\m Csa-bn Ce-Ivt{Sm-WnIv hgn ktµ-i-§Ä kzoI-cn-¡m-\pÅ

Ah-Im-iap­v.
ewd

\nb-a-k-lmbw t\Sp-¶-Xn-\pÅ Ah-Imiw

am\-knItcmK-apÅ hyàn¡v kuP\y tkh-\-§Ä e`n-¡p-¶-Xn-\pÅ AÀl-X-

at

bp-­v.
re

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or
aPn-kvt{S-äv, t]meokv DtZym-K-ØÀ A¯cw IÌ-Un-bn Npa-X-e-bpÅ hyàn
F¶n-h-cpsS ISa Bbn-cn¡pw CXv.

d it
am\-kn-I-tcm-Kn-I-fpsS NnInÕ kw_-Ô-amb Ah-Im-i-§Ä

nE
am\-kn-Im-tcm-Ky-tI-{µ-¯n InS¯n NnIn-Õn-¡p¶ tcmKn-Isf Xmsg-¸-d-
bp¶ A©v hn`m-K-§-fn H¶n DÄs¸-Sp-¯mw.

DyF.i
1. kzta-[bm AUvan-j³ hm§p-¶-hÀ

2. {]tXyI kml-N-cy-¯n AUvanäv sN¿-s¸-Sp-¶-hÀ

3. Aeªp \S-¡p¶ aäp-Å-hÀ¡v D]-{Zhw Btb-¡m-hp¶ at\m-tcm-Kn-IÄ

aPr
4. tcmKnI-fmb XS-hp-ImÀ

5. hnNm-cW t\cn-Sp¶ XS-hp-Im-cmb tcmKn-IÄ

ebrr
kzta-[bm AUvan-j³ hm§p-¶-hÀ

 kzta-[bm {]th-in-¡-s¸-Sp¶ tcmKn-Isf Hcp saUn-¡Â Hm^o-kÀ ]cn-

cslti
tim-[n¨v km£y-s¸-Sp-¯n-bm aXn.

 AUvanäv sN¿m³ Bh-iy-amb tcJ-IÄ D­m-hWw hn.-_n.t^mw BWv

.Mcna

CXn Gähpw {][m-\-s¸-«-Xv.

 C¯cw tcmKn-Isf _Ôp-¡Ä IqsS \nÀ¯nbpw NnIn-Õn-¡m-hp-¶-Xm-Wv.

tcmK-i-a-\-¯n\v CXmWv IqSp-XÂ DX-Ip-I. F¦nepw ]ecpw IqsS

winw

\n¡m³ X¿m-dm-hn-Ã.

AUvan-j\v X¿m-dm-hm¯ tcmKn

ewd

 AUvan-j\v X¿m-dm-hm¯ tcmKnsb Bip-]-{Xn-bn InS¯n NnInÕ

AXym-h-iy-am-sW¶v I­m AUvanäv sN¿m-hp-¶-Xm-Wv.

 CXn\v tcmKn-bpsS _Ôp-hn-sâtbm kplr-¯n-sâtbm At]£ thWw.

at
re

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or
 XpSÀ¶v c­v saUn-¡Â Hm^o-kÀamÀ (A-Xn-sem¶v at\m-tcmK hnZ-K[
v ³

d it
Bbn-cn-¡W
- w) tcmKnsb kzX-{´-ambn ]cn-tim-[n¨v kÀ«n-^n-¡äv \ÂI-

Ww.

 C¯cw tcmKn-Isf 90 Znh-k-¯n IqSp-X Bip-]-{Xn-bn InS-¯m³

nE
]mSn-Ã. XpSÀ¶pÅ NnIn-Õbv¡v tImS-Xn-bpsS A\p-hmZw hm§-Ww.

Ae-ªp-\-S-¡p¶ tcmKn-IÄ

DyF.i
 tcmKnIsf X\n¡pw aäp-Å-hÀ¡pw A]-ISw hcp-¯m³ km[yX DÅ-hÀ

t]meo-kp-ImÀ IÌ-Un-bn-se-Sp-¯p tImS-Xn-bn lmP-cm-¡p-¶p.

aPr
 H¶p aPn-kvt{Säv Ahsc ]cn-tim-[n¨v am\-kn-I-tcmKw Ds­¶v t_m[y-

s¸-«m NnIn-Õ-b¡
v mbn at\m-tcmK Bip-]-{Xn-bn-te¡v Ab-¡p-¶p.
ebrr
 kwi-b-ap-Å-hsc at\m-tcmK hnZ-Kv[sâ A`n-{]m-b-¯n\pw kÀ«n-^n-¡-än-

\p-ambn ]¯p-Zn-h-ks¯ \nco-£-W-¯n-\mbn am\-knI BtcmKy tI{µ-

cslti
¯n-te¡v amäp-¶p. tUmIvSÀ¡v \nco-£W Imem-h[n 30 Znhkw hsc

\o«n hm§m-hp-¶-Xm-Wv.
.Mcna

 XpSÀ¶v \ÂIp¶ kÀ«n-^n-¡äv ASn-Øm-\-¯n tcmKnsb XpSÀ¶v NnIn-

Õn-¡m³ AYhm UnkvNmÀÖv sN¿mt\m DÅ D¯-chv tImSXn \ÂIp-

¶p.
winw

am\-knI BtcmKy tI{µ-¯nse {]th-i\w

 Btcm-Ky-tI-{µ-¯nse {]th-i\w saâ sl¯v BIvSv 1987 A\p-k-cn-

ewd

¨mWv \S-¯p-¶-Xv. Cu BIvSv at\m-tcm-Kn-I-fpsS s]mXp-hmb NnIn-

Õbv¡v th­n cq]-I-ev]\ sNbvXn-«p-Å-Xm-Wv.

at
re

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or
tcmKnI-fpsS kzIm-cyX

d it
 tcmKn-bpsS hnh-c-§Ä NnIn-Õ-bp-ambn t\cn«v _Ô-s¸-Sm¯ asäm-cmsf

Adn-bn-¡p-¶Xv tcmKn-bpsS A\p-hm-Z-t¯msS a{Xta BIm-hq.

 Nne {]tXyI kµÀ`-§-fn Cu \nbaw ewLn-¡-s¸-Sp-¶-Xm-Wv.

nE
 DZm-l-c-W¯
- n-\mbn Hcp tcmKn Hcmsf sImÃm³ ]²-Xn-bn« hnhcw a\-Ên-

em-bm Adn-bn-¡m³ aSn-¡-cp-Xw. Cu hnhcw Adn-bn-¡msX Ccn-¡p-

DyF.i
Ibpw aäv hyàn¡v A]-ISw kw`-hn-¡p-Ibpw sNbvXm AXv Ipä-I-c-

amb A\m-Ø-bm-Wv.

aPr
k½-X-]{Xw

GsXmcp NnIn-Õ¡pw aäp ]cn-N-c-W-¯n\pw ap¼pw tcmKn-tbmSpw tcmKn-

ebrr
bpsS _Ôp-hn-t\mSv Imcy-§Ä ]dªp a\-Ên-em¡n tcJm-aq-e-apÅ k½Xw
hmt§-­-Xm-Wv.
cslti
at\mtcmKn-I-fpsS auen-Im-h-Im-i-§Ä
.Mcna

 D¯-a-amb NnInÕ t\Sp-¶X

- n-\pÅ Ah-Imiw

 DNn-X-amb am\-kn-Im-tcmKy tkh-\-§fpw Bfpw [\-kl

- m-bhpw

kÀ¡mÀ Hmtcm hyàn¡pw Dd-¸p-h-cp-¯p-¶p.

winw

 anX-amb \nc-¡nÂ, \Ã \ne-hm-ca

- p-Å, aXn-bmb Af-hnÂ, enwKw , aXw

,Pm-Xn, kmaq-lnI cmjv{Sob hnizm-k-§Ä hÀ¤w F¶n-h-bpsS ASn-

Øm-\-¯n hnth-N-\-an-ÃmsX am\-kn-I-tcmKw DÅ-hÀ¡pw Ah-cpsS

ewd

IpSpw-_§
- Ä¡pw kzoIm-cy-amb ]cn-N-cWw \ÂIp-¶p.
e`y-amb tkh-\-§Ä

 A]-tI{µ A`-b-tI-{µ-§Ä
at

 KmÀlnI ]p\-c-[n-hmkw
re

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or
 Ip«n-I-fpsS am\-kn-Im-tcmKy tkh-\-§Ä¡pw hmÀ[Iy am\-kn-Im-tcmKy

d it
tkh-\-§Ä¡pÅ hyhØ

 Zmcn-{Zy-tc-Jbv¡v Xmsg-bp-Å-hÀ¡pw `h-\-c-ln-XÀ¡pw BÀ¡pw

bmsXmcp \nc¡pw km¼-¯nI Nne-hp-an-ÃmsX am\-kn-Im-tcmKy NnInÕ

nE
tkh-\-§Ä¡pw DÅ Ah-Imiw \ÂIp-¶p.

 tcmKn AUvanäv Bbn-cn-¡p¶ Øm]-\-¯nse saUn-¡Â Hm^o-kÀ AsÃ-

DyF.i
¦n Npa-X-e-bpÅ am\-knI BtcmKy hnZ-Kv[À kuP\y tkh-\-§Ä¡v

hyàn¡v AÀl-X-bp-s­¶v Adn-bn-¡p¶ D¯-chv \ÂIp-¶X

- m-bn-cn-¡pw.

aPr
e`n-¡p¶ tkh-\-§-fpsS Ipd-hn-s\-Ip-dn¨v ]cm-Xn-s¸-Sm³ DÅ Ah-Im-iw.

 am\-kn-It- cm-K-apÅ GsXmcp hyàn¡pw AsÃ-¦n \ma-\nÀt±iw sN¿-

ebrr
s¸« {]Xn-\n-[n¡pw AUvanäv sN¿-s¸« BtcmKy Øm]-\-¯nse ]cn-N-c-

Ww, NnInÕ tkh-\-§Ä F¶n-h-bnse A]-Im-XI

- -sf-Ip-dn¨v ]cm-Xn-s¸-
cslti
Sm-\pÅ Ah-Im-i-ap-­v.

 Øm]-\¯
- n\v Npa-X-e-bpÅ saUn-¡Â Hm^o-kÀ AsÃ-¦n am\-kn-Im-
.Mcna

tcmKy hnZ-Kv²À _Ô-s¸« t_mÀUv, CXn kwXr]vX AsÃ-¦nÂ

kwØm\ AtXm-dnän F¶n-h-bp-ambn _Ô-s¸-Sm-hp-¶-Xm-Wv.

am\-kn-Im-kzØyw DÅ-hÀ¡v Ah-cpsS hyànXzw Im¯p-kq-£n-¡m³ Ign-bp-

winw

¶n-Ã. F¶Xpw Ah-cpsS Ah-Im-i§

- Ä ewLn¡s¸Sp¶p F¶-Xp-amWv C¶v

kaqlw t\cn-Sp¶ Gähpw henb {]Xn-k-Ôn. Hä-s¸-S-ep-IÄ ac-W-s¯-¡mÄ

`oI-c-am-Wv. ]mÀiz-hÀ¡-cn-¡-s¸-Sp¶ C¶s¯ kaqlw am\-kn-I-tcm-Kn-Isf

ewd

]cn-l-kn-¡p-Ibpw Hä-s¸-Sp-¯p-Ibpw sN¿p-¶p. C¯cw {]h-WX

- I
- Ä ]cn-l-cn-

¡p-¶-Xn-\mbn tcmKn-bpsS Ah-Im-i-§Ä, AhÀ¡v \nbaw \ÂIp¶ ]cn-c-£-

sb-¡p-dn¨v a\-Ên-em-¡p-Ibpw Dd-¸p-hc

- p-¯p-Ibpw sNt¿-­Xv \½psS IS-a-bm-
at

Wv.
re

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