Overall Goal
To liberate the chained mentally ill persons and reintegrate them into the Society.
Specific Objectives
- To identify mentally ill persons who are kept in chains by their carers or others
- To approach the caregivers and start treatment of the these patients, including hospitalization whenever necessary
- To release these patients from chains and start rehabilitation activities to reintegrate them into the Society.
Inauguration
Mukti programme was inaugurated by Sh. Rajendra Singh Rathore, Hon’ble Minister of Health, Government of Rajasthan, on 26th February 2014 at Sangaria in district Hanumangarh (Raj.). A number of community leaders, MLAs and other public representatives, and health officials were also present. A gathering of about 600 people of public from various parts of district attended the Inauguration Ceremony.
Programme Execution
Programme is managed by Nishkam Volunteers (Sewaks) and members of collaborating organizations at village, block and district level. After getting information about a chained patient from any source, our volunteers verify the information and motivate family to agree for the treatment of the patient. Then Block level team along with district level coordination team members visit patient at his/her home and make preliminary assessment. Subsequently a psychiatrist accompanies the team and start treatment after assessing the patient. Regular monitoring of progress is carried out by making periodic home visits and patient’s chains are opened after patient improves and there is no risk of absconding or violence. Some of the patients, who show poor response to treatment or have complex health and social issues, are admitted to psychiatric in-patient facilities, including involuntary hospitalization under the Mental Health Act if required. Once patients are released from the chains, they continue to receive treatment and the Nishkam Mukti teams continue to provide psycho-social intervention to improvement their functioning with aim to rehabilitate and reintegrate them into the society. A strategic thrust of the programme is to involve families in providing treatment and care to their mentally ill members. Our field teams ensure adequate support and help to enable families to do so successfully.
Mukti Care Teams: A Mukti Care Team (MCT) comprising of 6-8 persons is formed to take care of each of the chained patients registered under the programme. MCT members include family members, Nishkam volunteers, village community leader and doctors.
Nishkam Mukti Prerak: One of the MCT member is designated as Nishkam Mukti Prerak. He is a Nishkam Volunteer from village or block who monitors and coordinates overall care and treatment of the patient. His main role is to constantly motivate and engage the family members in the treatment process.
Nishkam Mukti Sanrakshak:
We try to ensure maximum participation by families of chained patients in their treatment, including buying medicines. In case, the family is unable to afford medicines, we look for somebody in the community who is willing to pay for the medicines of the patient for the treatment period which in some cases would last life-long. We call these philanthropists as Nishkam Mukti Sarankshak.
Mukti Advisory Team: A Mukti Advisory Team guides the activities of the programme and advises the Mukti Progamme Committee and Mukti Core Coordination Committee from time to time. The Advisory Committee comprises of experienced and accomplished professionals from various fields of life such as medicine, psychiatry, administration, law and media.
Four steps of Mukti
Intervention under the Mukit programme for each of the patient is individualized and is implemented in four stages named as ‘Four Steps of Mukti’ (Mukti Ke Chaar Kadam). These stages are:
- To find out a chained mentally ill person- Mostly through indirect sources such as media, volunteers, family members/relatives of previously treated patients, community health workers and community organizations. Occasionally family members of chained patients have also approached us directly.
- To initiate the treatment- Treatment is initiated by a qualified doctor- usually a qualified psychiatrist or a psychiatric trainee after telephonic/skype consultation with a senior psychiatrist. The treatment is started after obtaining written and video recorded consent from the key family member. Subsequently a senior psychiatrist makes a home visit with team and develops comprehensive management plan based on a thorough assessment of the patient, discussion with family members and consultation with the Mukti team members. Mukti Care Team is also formed to ensure the comprehensive and constant care of the patient and to monitor his/her progress.
- To release the person from chains- Based on the risk assessment by the psychiatrist and Mukti teams as well as risk perception of the family members, the chains are opened at an appropriate stage when the risk of absconding or violence (two commonest reasons for chaining) is mitigated. In many instances the chains have been opened by the family members themselves (alone or with the help of follow villages) while in others Mukti teams opened (even cut open!) the chains to release the patients.
- To reintegrate the person with the mainstream Society- Home based community level intervention continues after release of the person from chains. The efforts at this stage are focussed on ensuring continuity of treatment to prevent relapse, improvement in functioning, and gradual engagement of the released person in family, social and occupational activities. The ultimate goal for every person enrolled in the Mukti programme is to reintegrate him/her into the Society. The Mukti teams also envision an ultimate goal for each and every enrolled chained mentally ill person. Thus for someone it may be to obtain a job and get married while for someone else it may be to participate fully in his/her children’s marriage.