Indian Disability Evaluation & Assessment Scale (IDEAS) for Mental illness under RPWD Act, 2016

Assessment of Mental (Psychiatry) Disability under Rights of Persons with Disabilities Act, 2016 (RPWD Act, 2016) is based on Indian Disability Evaluation and Assessment Scale (IDEAS) as per the RPWD Act, 2016.

The term “mental or psychiatric disability” is used when a psychiatric illness significantly interferes with the performance of major life activities such as self-care, working, moving and getting around, understanding, communication, interpersonal activities, and participation. Further, attitudinal and environmental barriers hinder full and active participation of Persons with mental illness in the society on an equal basis. Mental illnesses continue to be underdiagnosed, undertreated, and underestimated in official statistics and discriminated against. This situation becomes worse with regard to providing care and social welfare measures to PMI in the low-and middle-income countries. Persons with mental illness face significant challenges during the assessment of disability due to the following reasons;

Psychiatric illnesses are often episodic, fluctuating, dynamic and debilitating. However, for the purpose of certification, mental disability should be assessed when the psychiatrist is satisfied that further psychiatric treatment and rehabilitation is not likely to reduce the extent of the impairment

India signed the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) and subsequently ratified the same on October 1, 2007. The UNCRPD proclaims that disability results from an interaction of impairments with attitudinal and environmental barriers which hinders full and active participation in society on an equal basis.

A person with disability “means a person with long-term physical, mental, intellectual or sensory impairment which, in interaction with barriers, hinders his full and effective participation in society equally with others”

Mental disability cannot be seen, hence it is often called “invisible disability”

In a notification released on January 4, 2018, the Ministry of Social Justice and Empowerment provided guidelines for the certification of the various disabilities specified by the RPwD Act. This document outlines screening, assessment, and certification procedures. The standardized tools to conduct the assessments have been specified and include the Vineland Social Maturity Scale (VSMS) for the assessment of adaptive functions and the Binet Kamat Test of Intelligence (BKT) or the Malin's Intelligence Scale for Indian Children (MISIC) for the assessment of intellectual functioning. In the assessment of mental illness, a clinical assessment by a psychiatrist, rating with the Indian Disability Evaluation and Assessment Scale (IDEAS), and/or IQ assessment by a trained psychologist must be carried out.

The instrument is simple and comprehensive in quantifying mental illness disability. IDEAS was initially devised and advocated for four important psychiatric disorders: schizophrenia, bipolar disorders, OCD, and dementia. However, as per the Ministry of Social Justice and Empowerment, Government of India, gazatted to use IDEAS to assesses disability on five dimensions: (”Self-Care,” “Work,” “Interpersonal Activities,” “Communication and Understanding,” and “Duration”) and to assess the disability for all mental disorders. Compared to IDEAS, administration of the WHO-DAS 2.0 requires more time, and training of the workforce to administer WHO-DAS 2.0 is more difficult. IDEAS have been found to be very useful in the field for assessing mental disability. Hence, IDEAS is more suited to the Indian setting. However, IDEAS has the following pitfalls such as:

a) It is not comprehensive
b) It does not cover all the mental disorders
c) Currently, it becomes difficult to compute the total duration of illness for episodic illnesses such as Bipolar Disorder and Depressive Disorder.

Persons with Mental Illness (PMI) are often stigmatized and discriminated, which hinders their full and active participation in society. This is a much larger issue, especially in women, gender minorities, backward communities, and the poor and the migrated populations. Adding to the complexities, PMIs are often not aware of their illness, refuse the much-needed treatment and often are not in a place to exercise their rights. There is an urgent need to address this issue of attitudinal barrier so that the rights of PMI are upheld.

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