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A daycare centre as the name
directly implies is a day rehabilitation facility for persons
with mental illness. Due to chronic nature of mental illness;
socialization, work and work habits are severely impaired.
As a result, the affected person requires a resocialisation
process, where his life skills need to be re-instilled. At
a daycare centre, the mentally ill individual is motivated
and encouraged to develop these lost skills, so as to become
a functional member of society. The focus of a daycare centre
is therapy which is oriented towards ensuring opportunities
for socialization, productivity and a dignified quality of
life - aspects of life which a mentally ill person loses out
on because of the illness. More importantly, the fact that
the affected person comes to a daycare centre gives his/her
family the much deserved respite from managing him/her at
home all the time. Another main objective of a daycare centre
is to ensure that a person recovering from mental illness
does not have a relapse, because usually a person recovering
form mental illness due to lack of occupational activities
sits idle at home thereby increasing the chances of a relapse.
In Ashadeep's Daycare centre each individual is assessed
and on the basis of this assessment an individualized structured
program is worked out for each person attending the daycare
centre.
Through such a structured programme, the daycare centre in
Ashadeep tries to address the following aspects of a person
recovering from mental illness
- Living Skills: For
example: Maintaining personal hygiene and physical care,
self help skills which helps the person in day to day living
- Communication Skills:
For example: Emphasis on the right kind of emotional expression,
interaction
- Social Skills: For
example: Emphasis on conducting oneself in a socially appropriate
manner and instilling small social responsibilities like
buying vegetables from the local market, handling one's
own money etc.
- Prevocational Skills For example:
recreational activities which creatively engage a person
like music and art.
- Vocational Skills:
Depending on individual aptitude, interests and abilities
of the person, training is imparted on activities which
could meaningfully engage the person and also be a livelihood
option.
The techniques that Ashadeep uses to instill these skills
are:
, which includes:
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Individual counselling
and therapy |
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Group therapy |
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Family counselling |
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Prevocational activities
like music, dance, art and other creative interventions |
,
which includes
Training in appropriate vocations for rehabilitation
,
which implies
Employment and livelihood generation avenues
Individual therapy is an extremely significant component
of a daycare centre which basically implies individual attention
and care. Individual counseling helps in enhancing the morale,
confidence and social skills of a person and the specific
problems of each person can be addressed in their totality.
The individual slowly develops a sense of belonging in the
daycare centre. This can be therapeutic and can help in overcoming
feelings of worthlessness. Counselling should not be done
with a sense of pity or sympathy. The counselor should be
careful not to convey a false sense of belief that he could
solve all of the affected person's problems.
Group therapy is aimed at improving the social and life skills
of the affected person through a peer-to-peer learning approach.
A simple act of getting together with other affected people,
talking about routine things (like what one ate yesterday/
who all did one meet and what happened in one's house etc)
and sharing one's thoughts with others, proves to be very
therapeutic for the mentally ill person. Peers are equals
and if one person at a certain stage of the illness behaves
in a particular way then there is a natural flow amongst others
to emulate what is appropriate and reject what they are trying
to get over. For example, discussions, conversations, working
together or a general sense of camaraderie immensely the rehabilitative
cycle for mental illness.
This is another very important aspect of a daycare centre.
Families using the facility of a daycare centre can share,
exchange and communicate their concerns. Families can learn
coping and management skills by keenly observing and participating
in the affairs of the daycare centre at times. Usually it
is not advisable for family members to spend time along with
their ward in a daycare center but if families so desire,
they should have a strong reason for doing so. Specific coping
and management skills for the family can also be imparted
in a daycare centre set up. (refer to section 4 -Management
and Coping)
An appropriate therapeutic atmosphere can be created in a
daycare centre by using creative and recreational tools of
prevocational activities. These activities meaningfully occupy
and engage a person with mental illness which is of great
therapeutic value. Prevocational training is more oriented
towards therapy and help in engaging the affected person in
a positive manner. Creative and recreational tools such as
art, music, singing, dancing etc. could be employed at this
stage, to keep the affected person busy and occupied with
some kind of activity. This also helps in introducing or reinforcing
ideas about what it is like to work and to actively do something.
Vocational activity is the next stage of therapy for a person
with mental illness. In vocational training the individual
must be oriented and directed towards a meaningful "work-based"
engagement. Vocational training should not be a mere activity
based engagement to keep the person occupied. Because the
sense of despair and loss at being a non-productive, non-functional
member of society is acute as a result of mental illness,
vocational training which also oriented towards therapy must
provide a structured routine of work which would be more than
"just something to do." The idea of a vocation for
a mentally ill person is to instill the sense that even he/she
is an independent adult who has things to do and that his
or her work also plays an important role. It is very important
to keep in mind that each vocation should be carefully thought
out and should be individual-specific. This means that each
vocation should be tailored to suit the background of the
affected individual in terms of his/her education, position
in society before the onset of the illness, gender, nature
of the illness and other relevant factors which may be context
specific. The vocational training imparted within the set
up of a daycare centre, could also be extended outside the
domain of a daycare centre and could become a centre in itself.
This shift could be effected simply by moving to a new space.
This could be an altogether new stage of therapy for the mentally
ill individual where a person feels that he/she is not visiting
a rehabilitation facility but is actually going to a "workplace".
The involvement of the facilitators of the vocational training
will still be crucial. Focus on recovery and recuperation
through therapy will still be the main objective and not so
much the ends of the vocation.
When a person recovering from mental illness has achieved
an optimum level of functionality and independence through
the above stages of rehabilitation, then it becomes very important
to maintain this level of functionality, motivation and strive
to be a productive working member of society. One way of ensuring
this is a sheltered workshop.
A sheltered workshop needs to be understood as a workplace.
It is a place where persons recovering from mental illness,
at a certain stage of well being are involved in the production
of certain goods and rendering of certain services. These
goods/services are marketed to generate income for the affected
persons as well as for the organization that is involved in
running the daycare centre, through which the sheltered workshop
has come into existence. This concept is perhaps, best suited
to the employment needs of the chronically mentally ill than
other forms of employment in the community. The 'work' in
the sheltered workshop is still therapeutic for the affected
person but the emphasis changes to active livelihood generation.
Within a sheltered workshop, it is always advisable to allow
the recovering person to graduate from simple to more complex
tasks as failure could often lead to setbacks and massive
relapses of the illness. The capabilities of a person must
be assessed with regard to the disability level created by
the illness.
The defining features of a sheltered workshop, as being different
from other rehabilitation facilities like Daycare/ Vocational
training centre are -
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The members will have to
be paid for the work that they do unlike other rehabilitation
facilities which are more therapeutic in nature. |
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At a Sheltered Workshop,
the production of goods/services has to follow a regular
schedule to generate commercial value for the process. |
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A Sheltered Workshop must
have therapeutic back-up to cope with relapses and other
inherent disabilities resulting from major mental illnesses.
This is the only point of distinction between a sheltered
workshop and a purely commercial establishment producing
goods and services, because the inherent feature of mental
illness where relapses can always occur a therapeutic
back up is required. |
A sheltered workshop could eventually run on its own as a
sheltered workshop centre for the mentally ill, which in effect
means a similar shift as stated above with regard to a movement
from a daycare centre to a vocational centre.
A sheltered workshop setting is probably the best suited
avenue for meaningfully engaging a mentally ill person. It
ensures employment opportunities and independence for a mentally
ill person.
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