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Empowerment of mentally ill clients for obtaining employment in Kalmunai region.

Dr. P. Judy Ramesh Jeyakumar MBBS, DPM,SFMH, In charge, MHU-Kalmunai &Mr.M.R.M.

Hameem PSW, Nursing Officers’ Mental Health Unit, BH-Kalmunai

Kalmunai region contains more than 300,000 people, the costal belt extending from
Thurinilavani up to Potuvil runs for about 80 km. Tamils and Muslims are the majority
communities in the area but Sinhala families too live in the region. Almost the whole population
was very badly affected by the 3 decades of the civil conflict and the "Tsunami” of 2004. There
are many widows, orphaned children, and torture survivors with multiple trauma. People from
the region who were internally displaced to the Vanni have resettled in the area after the end of
civil conflict, but still some people search for their relatives in prisons and detention camps.

Psychosocial and mental problems are many and our resources at Kalmunai Mental Health Unit
are very limited. Although we mainly focus on the major mental disorders, there are huge
psychosocial needs among the traumatized people of Kalmunai. The mental health facilities as
Base Hospital at Kalmunai comprises an acute inward with 12 beds, a rehabilitation unit with 10
beds with vocational training and GBV unit. We have just 15 members of staff (3 doctors, 8
nurses, 1 psychiatric social worker, and 3 minor staff) but get help from various government and
non government organizations locally and internationally. Kalmunai Mental Health Association
(, a registered charity organization under the social service ministry, works
closely with the Mental Health Unit.

There are 15 out reach clinics in the region providing follow up of ex-in patients for supervising
medication. There are over 2000 people who are chronically mentally ill currently on
medication; some have been on medication for more than a decade. Their functional level, daily
activities and income generation are affected by chronic illness and they suffer from stigma and
drug side effects. Families often do not appreciate their presence at home often scolding them
and keeping them inside the home not allowing them to socialize.
"To analyze the role of employment and empowerment in management of mental illness”
This study was conduct between August 2009 and August 2010. 150 clients (70 males and 80
females) aged between 20 and 60 years and diagnosed with chronic mental illness were selected
by community support officers, nurses and the PSW from clinic records of patients admitted to
the Kalmunai rehabilitation unit. Their family back grounds and social status were noted. All had
been educated up to ordinary level. These 150 people were targeted by the staff for help in
obtaining employment with the help of employers, INGO’S, and NGO’S or in obtaining micro
credit finance to start an income generation activity. Information on their progress was collected
from clinical records and the follow up register of the rehabilitation unit and from direct clinical
observation during monthly visits.

Results & Observations

It was found that nearly 120 clients (50 males and 70 females) had got employment during 2009:
They were composed of 50 in age group 20 - 30; 30 in age group 30 – 40; 20 in age group 40 –
50; and 20 in age group 50 – 60. Of these 120 people, 70 (58%) were Tamils and 50 (42.7%)
were Muslims. 100 (83.3%) of the 120 had sustained their jobs.
10 (8.33%) clients did not attend follow up clinics, had stopped their medication for more than 6
months, developed symptoms, and were re-admitted again to the ward. 110 (91.67%) were
clinically stable and functioning well with daily routines. 80 (66%) clients (50 females and 30
males) had bank accounts and regular monthly deposits; 20 (18.33%) (12 males and 8 females)
had got married. 50 clients had got micro credit loans and 45 re-paid 90 % monthly. The staff got
the impression that clients who were in employment attend to their family commitments and that
their family members had good attachment and more concern than they had previously. The
Multi Disciplinary Team (MDT) that
visited their homes observed that they had good relationships with their family members and that
the latter did not report any complains about the clients. In several instances members of staff
were invited to family functions such as like weddings, birthday parties and puberty ceremonies.

Discussion and Conclusions

We propose that economic activity and employment are generally assumed to increase the well-
being of individuals. All politicians – left, right and centre – pay homage to it. Yet, the policies
that are pursued often turn out to be antithetical to it. Much of traditional economics has indeed
provided considerable comfort to those politicians who have a different agenda, and created
considerable confusion for those who are sympathetic.
A second proposition is that individuals who lose their jobs also lose a sense of self; it is not just
the loss of income that matters. Some individuals can keep themselves happy and gainfully
“employed” without a job, but for many, employment – the fact that someone else recognizes
their “contribution” by paying them – is important. Unemployment is associated with a variety of
problems and pathologies, from higher divorce rates, higher suicide rates to higher incidence of

The study reported here is limited by the lack of a control group of people with mental illness
who have not been targeted for help with employment, but the results are suggestive of the value
of such targeting. It shows that helping people diagnosed with chronic mental illness to obtain
employment or participate in income generating activity raises their quality of life and
acceptance by their families. Our study shows that focusing on employment is an
important part of rehabilitation of people recovering from serious mental illness.

We are very grateful to Dr.Prasantha De Silva Directorate of Mental Health, Ministry Of Health,
Dr.Magesh Rajasuriya Consultant Psychiatrist, Dr. Margaret Kuruppu VSO, Dr.Suman Fernando
Honorary Senior Lecturer in Mental Health, UK,Prof.Parameswara Deva,Malasiya and Prof .Daya
Somasundaram, Australia for their advice and valuable comments on early drafts of this paper.
International Medical Health Organization(IMHO) USA-CANADA of their valuable grands for the micro
credit project and Vocational training, Sri-lankan Psychiatrist Association(UK) valuable grand of our CSO

Mr.M.R.M.Hameem (one the authors) was helped in follow up of clients by Mr.T.Sivaganaseelan,

Community Nursing Officer, Mr.K.Alagaratnam Nursing Incharge Rehabilitation unit, and the MDT team.
The study would not have been possible without the co-operation of service users and their relatives in
providing information.