Kilpauk Medical College

Employment is a key factor aiding in the recovery and social reintegration of persons with mental illness (PwMI). However, the PwMI demographic in India faces high rates of unemployment, highlighting a need for the development of structured, culturally sensitive, and regionally adapted supported employment programs.

This study aimed to develop and pilot test a supported employment program designed to enhance job opportunities for PwMI in Chennai, India.

A desk review was conducted to examine existing employment support models for PwMI in India. Qualitative interviews were held with key stakeholders, including PwMI, caregivers, mental health professionals, and employers, to identify employment barriers and facilitators. An expert panel used these insights to co-design and develop a locally relevant supported employment program. The program was pilot-tested in Chennai from May 2023 to May 2024. Job placement and dropout rates were used to assess feasibility and effectiveness.

Of the 213 participants, 63 secured competitive employment, 37 were enrolled in skill training programs, and 40 remained in active job placement efforts. However, 54 individuals were deemed not readily employable due to functional limitations, and 16 dropped out. A total of 12 employers and 20 training organizations partnered with the program, contributing to its 62.8 % job placement rate.

The study demonstrates the operational potential of a regionally adapted supported employment program for PwMI in India. Future research should examine long-term job retention, workplace integration, and employment sustainability.

Systemic scleroderma is an autoimmune disorder caused by microvascular dysfunction, excessive collagen deposition, and progressive fibrosis affecting the skin and other organs. CREST syndrome, also known as limited scleroderma, is an acronym for calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasias. Among patients with systemic sclerosis (SSc), anticentromere antibodies are typically associated with the CREST syndrome variant. These antibodies are considered disease-specific and are known to correlate with the extent of disease progression. The pathogenesis of SSc is complex, with unusual presentations increasingly seen among patients. Gastrointestinal (GI) hemorrhage can be observed in CREST syndrome as an uncommon but serious complication. Endoscopic interventions are warranted in such patients to evaluate and manage bleeding. This report aims to raise awareness among physicians that CREST syndrome can present with GI hemorrhage, with skin signs such as calcinosis and sclerodactyly. In our case, H2 blockers and proton pump inhibitors were administered as part of the management plan to reduce acid-related mucosal injury and mitigate GI bleeding. Due to chronic mucosal hemorrhage, anemia was noted and corrected with parenteral iron therapy. The prognosis of CREST syndrome is relatively good when compared to the diffuse variant. Further research is needed to understand the pathophysiology of CREST syndrome, reliable biomarkers for early diagnosis, and targeted preventive treatment for this condition. Sensitizing clinicians regarding the changing disease pattern will help in prompt diagnosis.

From the Indian settings, there is a critical gap in understanding and addressing the significant unemployment rates among Persons with Mental Illness (PwMI). This survey aimed to explore the employment landscape of PwMI in Chennai, South India, focusing on employment outcomes, challenges, and the need for supported employment programs. We conducted a cross-sectional survey using a semi-structured questionnaire, among PwMI attending the out-patient department of a tertiary mental health center in Chennai between January 2023 to March 2023. We recruited a total of 434 participants for the study of which 174 (40.1 %) participants were unemployed and 260 (59.9 %) participants were employed during the survey. We observed that 71.3 % of the unemployed and 37 % of the employed participants actively sought new job opportunities, revealing a high demand for employment and job support. We found significant associations between employment status and socio-demographic factors such as gender, education, and marital status among the study participants. Our results also affirm PwMI can secure and sustain employment. There is a need for comprehensive support systems to address job dissatisfaction, workplace accommodations, and career advancement.