Inter-linkages between mental health and employment: A case study of 100 Socio-economically disadvantaged Clients of The Banyan’s Out Patient Clinics.’

The aim of the research

Studies have shown that persons who suffer from mental health issues are less likely to be employed than the general population (Padmavathi, 1998; Gopinath et al. 1985). In an epidemiological study (Padmavathi, 1998) of an urban population of 100000 in Chennai it was discovered that nearly one-third of 261 schizophrenic patients were found never to have received treatment. A number of characteristics were recorded, of relevance only the employment status of men was measured. In the untreated group of patients 35 per cent were currently employed whilst 49 per cent of the treated or previously treated schizophrenic patients were currently employed. The findings of the study suggest that treatment of schizophrenia may have a significant effect on employment status, however this cannot be assumed. An interventional study (Gopinath et al. 1985) carried out in an occupational day centre in Bangalore concluded that the schizophrenic patients most likely to have a poor work performance were those whose symptoms were persistent, those with poor social support and those who were previously unemployed.

The aim of this research project is to investigate the linkages between mental health and employment in a cohort of outpatient clients of the psychiatric outpatient clinics of The Banyan in an urban setting (Chennai) and rural setting (Kovalam in Kanchipuram district) in Tamil Nadu, India. The outpatient clinics of The Banyan provide free treatment and medication for men and women of low socioeconomic status. Using standard tools like the IDEAS Scale (to assess severity of disability) and family burden scale in addition to schedules on the socioeconomic status (National Sample Survey Organisation) on a sample of 100 outpatient clients of The Banyan and in-depth interviews with a small sample, alongside the clients’ clinical information, data will be collected with regards to their medical history, treatment history and employment history in order to investigate the patterns of employment amongst the clients. As The Banyan does not have a diagnostic classification of the clients’ illness (ICD-10 or DSM-4), an analysis will be made of the clients’ case records on the symptoms recorded and whether there has been a reduction, improvement, no change or worsening of the symptoms alongside any changes in dosage of medicines during a one year period (retrospective). The employment history will also be collected for a one year period—data will collected for each quarter of the last one year. The client will be asked about her/his employment status for the larger part of each quarter—this becomes necessary due to the dependence of the low socioeconomic status groups on the informal sector. This information coupled with that on the clients’ symptom status for the past one year will offer some evidence or suggestions of links between employment and mental health.

The Objectives of the Research are to:

1. Show the socioeconomic profile of Outpatient clients of The Banyan at the Urban Mental Health Programme (Chennai) and Community Mental Health Programme (Kanchipuram) with the help of The Banyan OP database.

2. From the Outpatient client list draw a second stage sample of clients with mental illness who are employed and not employed to understand:

i) Mental health of the client.
ii) Duration of illness and treatment history of the client
iii) Employment history of the client.
iv) Variation in workforce participation rate (WPR) according to treatment history and type of symptoms.
v) Severity of disability (IDEAS scale) and family burden of clients who are employed and not employed.

Sample size:

• 50 clients from Urban Mental Health Programme OP
• 50 clients from Community Mental Health Programme OP
• Case study of 25 clients

This research study is being undertaken by Ms Gayathri Balagopal, Senior Research Associate, BALM and Ms Chaitali Shetty, Project Coordinator, Urban Outreach.

The study started in March 2009 and will be completed by May 2010.