The International Journal of Psychosocial Rehabilitation

Social Work Intervention for Disability Management
of Persons with Schizophrenia in India with reference to Rural Areas

 


L. Ponnuchamy

Assistant Professor of Psychiatric Social Work, School of Social Work
DMI-St.John the Baptist University, Malawi, Central Africa.


 


Citation:
Ponnuchamy L (2012). Social Work Intervention for Disability Management of Persons with Schizophrenia 
in
India with reference to Rural Areas  International Journal of Psychosocial Rehabilitation. Vol 16(2) 36-49  

 

 

Author for correspondence:
Dr. L. Ponnuchamy    M.A.(SW), M.Phil.(PSW), Ph.D(PSW) (NIMHANS),
Assistant Professor of Psychiatric Social Work,
School of Social Work,
DMI-St.John the Baptist University,
Mangochi,
Malawi,
Central Africa.
Email: ponnupsw@gmail.com

 


Abstract
Schizophrenia is one of the major mental disorders affecting one to two percentage of the general population. It usually affects young people both men and women equally, predominantly between the ages of 15 to 45 years. In-spite of vigorous treatment with continuous medication, about 30% of chronic psychotic persons suffer from certain disabilities in term of asocialization, apathy, alogia and amotivation
The aim of the present study is to ascertain impact of structured Social Work Intervention for the disability management of persons with schizophrenia in rural areas. The study is followed a Before-After Experimental Research Design Without Control Group.  The sample for this study consisted of thirty persons with schizophrenia and thirty significant family members.  A proportionate sample covering heterogeneous socio demographic background was drawn for the present study.  The results reveal that extent of disability was highest in the domain of participation in society, followed by understanding and communicating, self care, getting along with people, life activities before Social Work Intervention.  Also, it reveals that extent of disability of the persons with schizophrenia was reduced significantly in all the domains after Social Work Intervention.  It is indicated that the social work intervention has contributed to reduce the level of disability and improves the functioning of the patients in rural areas.

Key words: Schizophrenia, Disability, Social Work Intervention


Introduction
Schizophrenia is one of the major mental disorders severely affecting both men and women predominantly between the ages of 15 to 45 years.  Schizophrenia may develop so gradually that no one realizes as something wrong with person for a long period of time.  Sometimes it may also develop suddenly with dramatic changes in behaviour occurring over a period of few weeks or even a few days.  Emil Kraeplin, who first term this illness as ‘Dementia Praecox’ described it as progressive and deteriorating course of illness.  Accordingly schizophrenia destroys the inner unity of the mind and weakens volition and drive that constitute our essential (Kraeplin, 1971).  The persons with schizophrenia are incapacitated to engage and sustain social bonds, and even the society reacts negatively to the social and personal deviance caused by the illness.  Because its manifestations are so personal and social, it elicits, fear, misunderstanding and condemnation in society instead of sympathy and concern.

Severe disability is the result of both positive and negative symptoms of schizophrenia.  This inturn affects the individual’s ability to understand and act according to social cues would diminish markedly.  Patients experience unemployment, social isolation, homelessness and dependency on family members.  Their relationship with family members and peer groups changes partly because of their unexplained behaviours and the stigma associated with the illness.  Similarly, cognitive deficits like decreased attention, concentration and lack of motivation lead to deterioration in their work capacity and are responsible for unemployment among these patients.  This further leads to social maladjustment (Appelo, et al., 1992).

Disability is associated with all diseases and its minimization is an important concern of all health practitioners.  Mental disorders account for about a quarter of the world’s disability.  The mental disorders which contribute most to the disability include schizophrenia, major depression, alcohol abuse, bipolar affective disorder and anxiety disorders.  Schizophrenia causes a high degree of disability.  In a recent 14-country study of disability associated with physical and mental conditions showed that active psychosis was ranked the third most disabling condition (WHO, 2001).

According to WHO (2001) about 30% of chronic psychotic persons suffer from certain disabilities in term of asocialization, apathy, alogia and amotivation in-spite of vigorous treatment with continuous medication.  This has given rise to the need for specific modes of treatment in the community, which are more comprehensive in nature encompassing variety of therapeutic approaches, to enable the mentally ill patient function optimally and live satisfactorily in the community.  This comprehensive therapeutic treatment is known as Psychosocial Rehabilitation.

Psychiatric Social Work as a professionalized activity that focuses on reducing the psychosocial problems of clients.  The Psychiatric Social Work practitioners have postulated that the psychosocial functioning or dysfunctioning was mostly determined by the interaction between the individual needs, aspirations and functional capacities on one side, and environmental (situations) expectations, opportunities and resources on the other side.  Linn et al., (1979) emphasized on the modification of client system and the environmental system for better psychosocial functioning.

Review of Literature:
Hogarty and Goldberg (1973) have conducted an evaluation study of Major Role Therapy (MRT) with 374 schizophrenic patients for 2 years.  The MRT consisted of Social Case work and Vocational Rehabilitation Counselling.  Initially the patients were stabilized on Chlorpromazine.  After 2 months the patients were assigned to drug and placebo emerging at four groups - placebo alone, placebo and MRT, drug alone, drug and MRT.  The result showed that MRT was found to be lowered the relapse rate significantly after 6 months.

Linn, et al., (1979) have studied the efficacy of social treatment with schizophrenic patients.  The intervention focused on enhancing patient’s social interaction skills, providing a place to socialize and engaging in productive activities and creating stimulating environment for patients.  The analysis of data obtained from randomized groups of patients revealed that social treatment was effective in maintaining patient’s social functioning.

Stein and Test (1980) have conducted a study on the efficacy of an environmental intervention namely ‘Training in Community Living’ (TCL) with chronically mentally disabled patients to gain living skills to secure material resources, developing support systems for patients and involving environmental systems in the rehabilitation.  The subjects were randomly assigned to TCL group and control group. They were assessed before and at every fourth month thereafter for twenty eight months on standardized scales to measure symptom severity, community adjustment and self esteem.  The results based on series of t-tests and Analysis of Co-variance indicated that after 14 months the TCL group was better than control group on measure like independent living, satisfaction with the life situation, symptom severity and degree of interpersonal contacts.

Bentley (1990) studied the effects of a short term model of intervention on schizophrenic out patients and their relatives.  The Intervention package consisted of in-home ten sessions educational and skill training programme adopted from existing model.  The author reported significant improvement in the social functioning, relative’s attitude and family stress in sample of 4 cases.  The improvement in social measure was found to be significantly associated with improvement in clinic status.

Viswanath and Padmavathi (1992) have conducted a study on family intervention in schizophrenia through Group Work. The sessions were agenda based and conducted in an interactionary style.  A Psychiatric Social Worker acted as the facilitator for the sessions.  Assessments were made a week after the completion of the programme. There was a change in the attitudes towards the patient.  Significant knowledge gains were noticed, particularly in the management of specific problems, while there were not significant changes in the burden scores, the members felt they could face the burden better.  The interviews also revealed that members were making attempts to involve other relatives in the care of the patient.  In conclusion, conducting a family group in the management of schizophrenic and related problems appears feasible. 

In summary, the review of literature indicates the concept of disability is much relevant to the field of mental health as most of the mental illnesses contribute to the psychological, social disturbances to the patient and family members. Psychoeducation as well as Skills Training are conceptualized to be the essential element of psychiatric social work intervention.  Outcome researches in schizophrenia have shown long standing disabilities among the patients.  The social interventions particularly provided by the Psychiatric Social Workers found to have meaningful benefits with persons with schizophrenia in the west.  In the Indian context particularly in rural settings, studies on the effectiveness of Psychiatric Social Work intervention with persons having disability due to schizophrenia are inadequate. 

Materials and Methods:
Many Psychiatric Social Work interventions have yet to receive adequate testing and scientific evaluation.  Recognizing suitability of particular interventions for particular practice situations must be supported by adequate scientific evidence, which will further contribute to Psychiatric Social Work practice.  Further, recognizing that social work research especially in the context of service delivery is a prerogative for social workers.  The existing intervention studies (Linn, et al., 1979; Stein and Test, 1980; Hogarty and Goldberg, 1973; Bentlay, 1990; Viswanath and Padmavathi, 1992) in the areas of psychiatric social work practice in Mental Health field are urban based and involves long duration of intervention.  Rural areas do not have sufficient inputs from the mental health professionals.  In
India, the National Mental Health Programme envisages implementation of Mental Health services through District Mental Health Programme, in which a team of Psychiatrist, Psychiatric Social Worker, Psychologist and Psychiatric Nurse deliver the services.  In this context, it is needed that how far the management of disability among schizophrenic patients in the rural areas is effective if it is done through Monthly Rural Mental Health Camps.  There is no intervention study through Monthly Rural Mental Health Camp in the rural areas in the field of mental health.  There is a lacunae in this area.  Hence, an attempt is made to focus in this direction. 

The aim of study is to ascertain impact of structured social work intervention for the disability management of persons with schizophrenia in rural areas through monthly rural mental health camps.  The present study is undertaken to understand the level of disability both before and after the persons are exposed to the psychiatric social work intervention package.  The course of study is aimed to develop and implement the psychiatric social work intervention package with the significant family members and the patients in the conjoint sessions.  It has been decided to test the efficacy of the intervention at the end of two months, fourth months and six month intervals after the intervention.  In view of this nature of research work, a “Before-After Experimental Research Design Without Control Group” is considered for the present study.  In this design a single test group is selected before the introduction of the intervention.  The intervention package is then introduced and its effectiveness is measured again.  The efficacy of the intervention was demonstrated by the changes that occur after the intervention was administered as against the baseline assessments.

All the patients and the significant family members who are availing the services of Monthly Community Mental Health Camp conducted by the Richmond Fellowship Society Sidlaghatta Rural Branch, Sidlaghatta, in rural
Karnataka, India consisted the universe of the study.  About fifty three cases were diagnosed to have schizophrenia (all type) by the psychiatrist in the Monthly Rural Mental Health Camp during the period from January 2004 to till July 2005.  Out of fifty three patients, eight patients were not included in this study due to exclusion criteria.  Off these patients, the researcher has drawn thirty samples using Simple Random Sampling technique.  The size of the sample for this study consisted of 30 persons with schizophrenia and their significant family members.  A proportionate sample covering heterogeneous socio demographic background was drawn. 

The inclusion criteria are person having a diagnosis of Schizophrenia (any type) as per tenth version of International Classification of Diseases – 10 (ICD-10) of WHO (1992) diagnostic criteria, and age group between 18 to 45 years.  The exclusion criteria are persons with any associated psychiatric problems like substance abuse, mental retardation, affective disorders or any other disorders,  and patient who is actively symptomatic.

Tools used for data collection:   
1. Socio Demographic Data Sheet:
The proforma is intended to collect information on age, gender, education, religion, marital status, occupational status, income, duration of mental illness and the diagnosis of patients.  The profile of the family members consists of relationship with the patient, age, gender, education, types of family, occupational status and income.  

2.  Disability Assessment Schedule – II, (DAS - II) WHO (2000):
The World Health Organization Disability Assessment Schedule (WHODAS – II) is a new measure of functioning and disability that is conceptually compatible with WHO’s recent revision (WHO, 1997) to the International Classification of Functioning and Disability (ICIDH-2).  The WHODAS – II distinguishes itself from other measures of health status in that it is based on an international classification system, is cross-culturally applicable to all disorders.


WHODAS-II (2000) assesses disability at the individual level instead of disorder-specific level.  Domains of functioning assessed by the WHODAS-II include Understanding and Communicating, Getting Around, Self Care, Getting along with others, Life activities, and Participation in society.
The 89 item version of WHODAS-II was field tested in 21 sites and 19 countries based on psychometric analyses and further field-testing in early 1999. The measure was shortened to have 36 items and a 12-item screening questionnaire was also developed.  The WHODAS-II has undergone for its reliability and validity tests in 16 centers across 13 countries.  Health services research studies (to test sensitivity to change and predictive validity) were conducted in centers throughout the world in the year 2000 and relevant modifications in scoring of the scale were suggested.  Analysis of data from different patient groups indicates that the degree of disability experienced by those with mental or substance use disorders was similar to or greater than that experience by those with physical disorders. 

Several versions of the WHODAS-II are available.  These include interviewer-administered version, self-administered version, and proxy version.  Varying lengths are also offered.  The present study is adopted 36 items, interviewer administered version of the WHODAS-II (2000).  This version provides the most complete assessment of functioning.  Scores for six domains of functioning, as well as an overall functioning score, can be calculated. 
Process of social work intervention:

Thirty patients and significant family members involved in the study were divided into 3 groups.  Each group was exposed to two group sessions.  The intervention package consisted of two components (psychoeducation and skills enrichment) for a group of patients and families.  The period of intervention was 2 months i.e., two monthly sessions.  Each session lasts for 90 minutes were used.

Data collection and Analysis:
The data was collected from patients and family members at the beginning of the intervention, immediately after intervention, second month after intervention and fourth month after intervention.  The sample was divided into three groups according to the convenient of geographical areas with the help of staff of Richmond Fellowship Sidlaghatta Rural Branch at Sidlaghatta, Kolar District.  Each group consisted of 20 members.  Quantitative analysis was carried out using Statistical Package for Social Sciences (SPSS Version 11).  The objectives of the quantitative analysis were to understand the distribution of the sample on the socio demographic and other variables, to assess the efficacy of the intervention package.  To meet these requirements, descriptive statistical techniques such as frequency, percentage, mean, standard deviation were used on the individual, family and illness variables.  Paired t-test was used to test the difference between baseline scores and immediately after intervention assessment, between baseline scores and second month after assessment, between baseline scores and fourth month after intervention assessment. In addition Repeated Measure Analysis of Variance was used to assess the extent of changes in the variables over the period of intervention and during second month after intervention and fourth month after intervention on


Disability Assessment Schedule. 

Informed consent:
Enough freedom was given to the participants to either participate or not participate in the intervention programme.  Informed consent was acquired from all the participants after explaining the purpose of the study and procedures involved in this study.  Information collected was used only for research purpose and confidentiality was ensured.

Results:
I.  Socio-demographic Characteristics of Rural Persons with Schizophrenia:
Social Demographic data of the patients displays that majority (73.4%) of the patients were between 21-40 years of age group.  Overall, 62.1% of the patients were male and 86.7% of them were Hindus.  Also shows that the majority (53.4%) of the patients were married and 46.7% of them were illiterate.  A majority (60.0%) of the patients were not working and had no personal income.  Overall, 46.7% of the samples had mental illness for 2 to 4 years.  A majority (80.0%) of the patients had the diagnosis of Paranoid Schizophrenia. 

II. Socio-demographic Characteristics of Family Members of Rural Persons with Schizophrenia:

Social Demographic data of the family shows that majority (36.7%) of the family members were between 51 – 60 years old.  Around 53.3% of the family members were female and 46.7 of them were male.  Majority (50.0%) of the family members were illiterate. A majority (56.7) of the families were nuclear and 66.7% of the family members were coolies.  Majority (38.9%) of the families had a monthly income of Rs.1001 – 2000 per month.

III. Extent of Changes in Disability Domains:
1. Extent of Changes in Disability Domain (Understanding and Communicating) over different time periods among Rural Persons with Schizophrenia: (1=Before intervention,    2=Immediately After intervention, 3=Second month After intervention,    4=Fourth month After intervention)
The results of Repeated Measure ANOVA conducted on Understanding and Communicating to verify the differences in the mean scores across the four time intervals (1 – 2, 1 – 3, 1 – 4, 2 – 3, 2 – 4, 3 – 4 assessments).  It shows that there was a significant (P<0.001) reduction in the mean score on this domain of Disability during this period.  Moreover, the results also indicate that improvement in the Understanding and Communicating was sustaining during the subsequent assessments followed by the Psychiatric Social Work Intervention.  The overall change in the mean value of this domain is shown in figure: 1.

   



2. Extent of Changes in Disability Domain (Getting Around) over different time periods among Rural Persons with Schizophrenia: (1=Before intervention,    2=Immediately After intervention, 3=Second month After intervention,    4=Fourth month After intervention)


The results of Repeated Measure ANOVA conducted on Getting Around to verify the differences in the mean scores at four time intervals (1 – 2, 1 – 3, 1 – 4, 2 – 3, 2 – 4, 3 – 4 assessments).  It shows that there was a significant (P<0.001) reduction in the mean score on this domain of Disability during this period.  Moreover, it indicates that improvement in the Getting Around was sustaining during the subsequent assessments followed by Psychiatric Social Work Intervention.  The overall change in the mean score of this domain is shown in the figure: 2.




3. Extent of Changes in Disability Domain (Self Care) over different time periods among Rural Persons with Schizophrenia: (1=Before intervention,    2=Immediately After intervention, 3=Second month After intervention,    4=Fourth month After intervention)      
The results of Repeated Measure ANOVA conducted on Self Care to verify the differences in the mean scores at four time intervals (1 – 2, 1 – 3, 1 – 4, 2 – 3, 2 – 4, 3 – 4 assessments).  The mean score on Self Care of Disability domain has significantly (P<0.001) reduced during this period.  Moreover it also indicates that the improvement in the self care was sustaining during the subsequent assessments followed by the Psychiatric Social Work Intervention.  The overall change in the mean value of this domain is shown in figure: 3.



4. Extent of Changes in Disability Domain (Getting along with People) over different time periods among Rural Persons with Schizophrenia: (1=Before intervention,    2=Immediately After intervention, 3=Second month After intervention,    4=Fourth month After intervention)
The results of Repeated Measure ANOVA conducted on Getting along with People to verify the differences in the mean score at four times intervals (1 – 2, 1 – 3, 1 – 4, 2 – 3, 2 – 4, 3 – 4 assessments).  It shows that there was a significant (P<0.001) reduction in the mean scores on this domain of disability during this period.  It also shows that improvement in the Getting along with People was sustaining during the subsequent assessments followed by the Psychiatric Social Work Intervention.  The overall change in mean value of this domain is shown in figure: 4




5.  Extent of Changes in Disability Domain (Life Activities) of over different time periods among Rural Persons with Schizophrenia: (1=Before intervention,    2=Immediately After intervention, 3=Second month After intervention,    4=Fourth month After intervention)
The results of Repeated Measure ANOVA conducted on Life Activities to verify the differences in the mean scores at the four time intervals (1 – 2, 1 – 3, 1 – 4, 2 – 3, 2 – 4, 3 – 4 assessments).  It shows that there was a significant (P<0.001) reduction in the mean score on this domain of Disability during this period.  Moreover it also indicates that improvement in the Life Activities was sustaining during the subsequent assessments followed by the Psychiatric Social Work Intervention.  The overall change in mean value of this domain is shown in figure: 5



6. Extent of Changes in Disability Domain (Participation in Society) over different time periods among Rural Persons with Schizophrenia: (1=Before intervention,    2=Immediately After intervention, 3=Second month After intervention,    4=Fourth month After intervention)

The results of Repeated Measure ANOVA conducted on Participation in Society to verify the differences in the mean scores at the four time intervals (1 – 2, 1 – 3, 1 – 4, 2 – 3, 2 – 4, 3 – 4 assessments).  It shows that there was a significant (P<0.001) reduction in the mean score on this domain of Disability during this period.  Moreover it also indicates that improvement in the Participation in Society was sustaining during the subsequent assessments followed by the Psychiatric Social Work Intervention.  The overall change in mean value of this domain is shown in figure: 6.




Discussion:
I.  Socio-demographic Characteristics of Rural Persons with Schizophrenia:
  Majority (72 %) of the samples were in the age range of 18 – 40 years. Among these samples 36% of them were in the age group of 21 – 30 years and highlighting the fact that most individuals affected by the schizophrenia were in the economically productive age group.  The gender wise distribution of the sample indicated that sixty two percent of the samples in the study were male patients.  Several studies have documented the reason for the under utilization of health services by women in
India was lack of access to health care (Ramalingaswami, 1987; Khan et al., 1982).  With regard to marriage, 53% of the samples in the study were married while 30% were never married.  A majority of the patients were Hindu (86.7%) and Muslim contributed 13.3% of the sample.  The unequal representation of the sample is due to national characteristics.  Majority (30%) of the subjects in the samples were primary school educated.  On the whole the highest educational qualification among the respondents was higher secondary which was done by 6% of sample.  Majority of the respondents 46% were illiterate.  Educational impairment was well documented in literature on Quality of Life in patients with schizophrenia (Calvocoressi et al, 1998).

The occupational status of the respondents is also an indicator of disability related issues.  Around 60% of the sample in the study was unemployed due to schizophrenia and 26.7% of the samples were coolies.  Many of the respondents who employed are performing poorly and may be in danger of losing their jobs.  As far as the income of the respondents is concerned 60% of the respondents did not have any income of their own, 30% percent of them had a monthly income of below Rs.500 and only 6.7% had a monthly income of Rs. 1001 – 2000.  The group was characterized by low educational levels, poor occupational status and low income levels.  These findings reflect the low per capita income of unorganized sector in our country.  Lower income can also intensify the problems in the family following the diagnosis of Schizophrenia.    With regard to duration of illness 46% of the samples had illness for 2-4 years, 16% of them had illness between 6-8 years and 23% of the subjects had illness more than 10 years.  Majority (80%) of the respondents had the diagnosis of paranoid Schizophrenia.

II. Socio-demographic Characteristics of Family Members of Rural Persons with Schizophrenia:

In this study, majority (56.7%) of the caregivers belong to nuclear family, reflecting the changing structure of families in the Indian society and changes in the social support system networks that can result to this. Indian families are in a state of transition and the joint family structure is undergoing radical changes resulting in the nuclear households as a means of adaption.  This shrinkage of the family size also results in narrowing down the supportive networks that is essential in the coping process with schizophrenia more during the symptomatic stage.     

With regard to the age distribution of care givers of the respondents, majority (36.7%) of the family members were between 51 – 60 years, and about 53.3% of the care givers were female and majority (66.7%) of them were working as coolies.  Care giving is a complex and challenging phenomenon and women often face the dual challenge of care giving and dealing with their own vulnerability.  As Bharat (1995) pointed out, in countries like
India, care givers would either be the elderly parents, often physically and financially weaker, or wives or partners who mainly occupy position of dependency.  Thus, on the whole the subjects in the study are heterogeneous in nature covering several background variables.

III. Extent of Changes in Disability Domains (Effects on Disability among persons with Schizophrenia in Rural Areas):
One of the aims of Social Work intervention in the field of psychosocial rehabilitation is to improve the level of disability of persons with severe mental illness like Schizophrenia. As far as the effects of Psychiatric Social Work intervention is concerned, the findings of the present study showed that overall, there was a significant reduction in the mean scores of all the domains of Disability like Understanding and Communicating, Self Care, Getting along with People, Life Activities, and Participation in the Society except Getting Around.  The improvement in disability was consistent at different level of assessments such as immediately after intervention, second month after intervention and fourth month after intervention.  Similar to these findings, Chandrasekhar-Rao (1994), who reported that the Social Work intervention was shown significant improvement in persons with depression consistently over different time periods.

After the Psychiatric Social Work Intervention, there was a significant reduction in this domain of disability namely-Participation in Society.  Hogarty, et al., (1979), who reported that during the total period of intervention, the effect of Social Work intervention was significantly more in reducing the level of disability along with psychopharmacology drugs.  The improvement in this domain was sustained during the subsequent assessments such as second month after intervention and fourth month after intervention.   There was a significant reduction in the mean score of this domain-Getting along with people.  The finding of the present study is similar to the findings of Thara and Latha (1998), who have reported that the schizophrenic patients had significant improvement in the area of dealing with people after intervention.  The improvement in this domain was sustained even in the second month after intervention and fourth month after intervention.  There was no significant change in the domain of Getting Around immediately after the Social Work intervention.  But there was a significant change during the subsequent assessments such as second month after intervention and fourth month after intervention.

Overall, after the Social Work Intervention, there was a significant reduction in the mean scores of all the domains of disability like Understanding and Communicating, Self Care, Getting along with People, Life Activities, Participation in the Society, and Getting Around.  This proves that the Social Work Intervention could reduce the disability and improve the social functioning of persons with schizophrenia in rural areas.  This is consistent with earlier research studies (Hogarty and Goldberg, 1973; Linn et al., 1979; Stein and Test, 1980; Bentley, 1990; Viswanath and Padmavathi, 1992).

Limitations of the Study:

The limitations of the present study are as follows:
1)    The sample size for the intervention group was only 30.    This size is not big enough for generalization of the findings.
2)    The inclusion criteria of the sample ensured that only patients who were not actively symptomatic included in the study.  This excludes a number of patients who have serious symptomatology.  Whether Social Work intervention is useful for them or not, cannot be gauged from the study.
3)    Owing to time constrains, the assessment after intervention was restricted to 2nd month and 4th month assessments only.


Conclusion:
The purpose of this research work was to establish Psychiatric Social Work Intervention model for persons with schizophrenia in the rural areas.  In doing this, factors that are associated with the development of the intervention model and the outcome in terms of disability management were specifically studied.  It is evident from the findings that Psychiatric Social Work Intervention is effective in helping the persons with schizophrenia in reducing their disability and improving their social functioning.  The study established the usefulness of a Group Work Approach in dealing with patients suffering from schizophrenia in rural areas.  Conducting similar studies in different settings, would contribute the Social Work knowledge so as to make this profession more meaningful in future.


 

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