title: Barriers to discharge of patients from a government-run day-care psychiatric rehabilitation center in India.
abstract: OBJECTIVE
  Many psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place.
  
  
  METHODS
  In a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place.
  
  
  RESULTS
  The majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively.
  
  
  CONCLUSIONS
  Educating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Vivek H
authors.initials: VH
authors.lastname: Phutane
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Jagadisha
authors.initials: J
authors.lastname: Thirthalli
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Palanimuthu T
authors.initials: PT
authors.lastname: Sivakumar
authors.affiliation: Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Vivyn
authors.initials: V
authors.lastname: Mathew
authors.affiliation: Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Abish
authors.initials: A
authors.lastname: Antony
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Nalini
authors.initials: N
authors.lastname: Reddy
authors.affiliation: Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: B P
authors.initials: BP
authors.lastname: Nirmala
authors.affiliation: Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: N
authors.initials: N
authors.lastname: Jamuna
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Chaturvedi
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore 560029, India.
authors.forename: Bangalore N
authors.initials: BN
authors.lastname: Gangadhar
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D003631:Day Care, Medical; D005239:Fear; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007194:India; D008607:Intellectual Disability / Q000534:rehabilitation*; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation; D010351:Patient Discharge; D000067250:Psychiatric Rehabilitation; D012047:Rehabilitation Centers; D012050:Rehabilitation, Vocational; D012559:Schizophrenia / Q000534:rehabilitation*; D014481:United States; D000066477:Work Performance; D055815:Young Adult