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Introduction
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
(www.kamha.org), 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.
Objective:
"To analyze the role of employment and empowerment in management of mental illness”
Methodology
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.
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
payment.