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Youth suicide is a public health problem in India, and young people in school, particularly adolescents, experience heavy psychological burden. Prevention programs, involving peer educators (PEs), have proved useful strategies to address this problem, but their impact on the PEs is less understood, particularly in India. This qualitative study aims to explore the changes observed in PE students who were involved in a 'mindfulness' and 'Support-Appreciate-Listen-Team' (SALT)-based peer education program to address suicidal behavior in Indian school students. One hundred and fourteen students were trained as PEs in six high schools in Pune to identify and respond to the needs of students in distress. By listening to the narratives of the PEs, their parents, school authorities, and the associated NGO team, we reflect on perceived social, emotional, behavioral, and cognitive changes in PEs. The PEs demonstrated enhanced caring for those in distress both inside and outside school by improved listening skills, self-awareness, care, and empathy. Furthermore, the program had a positive impact on their broad emotional intelligence and PEs expressed increased ownership of life, taking action, and seeking support where needed. The study concludes that mindfulness and SALT-based peer education (PE) programs are valuable for the PEs. This could be used to motivate PEs to volunteer in such programs. Other results are discussed and further research areas are suggested.

The development of juvenile transfer laws, against the backdrop of significant public outrage against a perceived increase in juvenile crime, has generated multiple debates, mostly centred on issues of child-inclusive justice versus crime mitigation and public safety agendas. The resulting legal developments have sought to instrumentalise punitive justice approaches, that facilitate the criminalisation of a sub-group of children (based on age and severity of crime), by articulating a limited and exclusionary conception of vulnerability. To bridge this gap, this article comprehensively evaluates the core assumptions of the juvenile transfer laws in India, through transdisciplinary considerations that integrate legal, rights-based and mental health perspectives, thereby making the analysis relevant to other legal jurisdictions with provisions for juvenile transfer. Alternative approaches to transfer, that adopt a rehabilitative and capacity-based justice orientation to culpability are discussed, to suggest crime prevention approaches cognizant of adolescent psychosocial vulnerabilities, and the need for mitigation of criminality. [ABSTRACT FROM AUTHOR]

Background: High-quality mental health care is scarce in rural India. The Mental Health Action Trust a Nongovernmental Organization based in Kozhikode, South India, has been providing free mental health services to the economically disadvantaged people in the surrounding districts. Comprehensive multidisciplinary care is provided through existing health-care clinics through training of lay mental health workers (LMHW). The current paper evaluates the classroom training methods employed to educate the LMHW. Materials and Methods: The training module designed after coordination and need assessment was delivered through classroom training sessions by trained trainers over 2 months weekly 6 h and completed by 13 volunteer LMHW (5 males and 8 females and who were in the age range of 22-56 years) could complete all the modules of training. The evaluation of training was done quantitatively and qualitatively. Results: The LMHW's knowledge, attitudes, perceived interpersonal skills, and confidence levels demonstrated a noticeable change following the classroom training program. Conclusion: It is feasible to train LMHWs to deliver psychosocial interventions for people with severe mental disorders and their families in rural India. In addition to classroom training, case-based training and proper ongoing supervision are required to improve their skills, attitudes, and knowledge. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of community home‐based care (CHBC) on self‐management outcomes for chronically ill patients in rural Malawi. A pre‐ and post‐evaluation survey was administered among 140 chronically ill patients with HIV and non‐communicable diseases, newly enrolled in four CHBC programmes. We translated, adapted and administered scales from the Stanford Chronic Disease Self‐Management Programme to evaluate patient's self‐management outcomes (health status and self‐efficacy), at four time points over a 12‐month period, between April 2016 and May 2017. The patient's drop‐out rate was approximately 8%. Data analysis included descriptive statistics, tests of associations, correlations and pairwise comparison of outcome variables between time points, and multivariate regression analysis to explore factors associated with changes in self‐efficacy following CHBC interventions. The results indicate a reduction in patient‐reported pain, fatigue and illness intrusiveness, while improvements in general health status and quality of life were not statistically significant. At baseline, the self‐efficacy mean was 5.91, which dropped to 5.1 after 12 months. Factors associated with this change included marital status, education, employment and were condition‐related; whereby self‐efficacy for non‐HIV and multimorbid patients was much lower. The odds for self‐efficacy improvement were lower for patients with diagnosed conditions of longer duration. CHBC programme support, regularity of contact and proximal location to other services influenced self‐efficacy. Programmes maintaining regular home visits had higher patient satisfaction levels. Our findings suggest that there were differential changes in self‐management outcomes following CHBC interventions. While self‐management support through CHBC programmes was evident, CHBC providers require continuous training, supervision and sustainable funding to strengthen their contribution. Furthermore, sociodemographic and condition‐related factors should inform the design of future interventions to optimise outcomes. This study provides a systematic evaluation of self‐management outcomes for a heterogeneous chronically ill patient population and highlights the potential and relevant contribution of CHBC programmes in improving chronic care within sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Purpose: In Kenya, the employment rate for persons with disabilities is about 1% compared to 73.8% for the general population, and the situation is even worse for persons with mental disabilities. Persons with mental disabilities are often regarded as "mad", and stand little or no chance of employment. We undertook an exploratory study with employers and potential employers to understand factors that hinder or facilitate their employment and to gain insight into employers' perceptions of mental disability. Materials and methods: We adopted a mixed method study design, including in-depth interviews (n = 10) and questionnaires (n = 158) with (potential) employers in Kenya to explore the barriers and facilitators of employment for persons with mental disabilities. Results: Out of the 158 employers who completed the questionnaire, only 15.4% had ever employed persons with mental disabilities. The perceptions that these persons are not productive and may be violent was associated with an unwillingness to employ them (OR: 10.11, 95%CI: 2.87–35.59 and OR: 3.6, 95%CI: 1.34–9.64, respectively). The possession of skills was the highest reported facilitator of employing persons with mental disabilities. Employers suggested that information about mental illness and the disclosure by prospective employees with mental disabilities are relevant for the provision of reasonable accommodation in the workplace. Conclusion: Possession of skills and disclosure by persons with mental disabilities could improve their employability. Information targeted at all actors including employers, employees, government, and policymakers is necessary for balancing employers and employees expectations. Disabled persons' organisations or mental disability programs that seek to improve the employment of persons with mental disabilities should incorporate methods that address employer expectations through dialogue to find mutual benefits. Employers require essential information about mental illness, and guidance and support in order to provide reasonable accommodation in the workplace for persons with mental disabilities. Disabled persons' organisations and inclusive employment programs should share the positive experiences of employers of persons with mental disabilities with employers who are unaware of the work abilities of persons with mental disabilities to stimulate adoption of inclusive practices. [ABSTRACT FROM AUTHOR]

Purpose: To explore barriers and pathways to the inclusion of persons with mental and intellectual disabilities in technical and vocational education and training programmes in four East African countries, in order to pave the way to greater inclusion. Materials and methods: An explorative, qualitative study including 10 in-depth interviews and a group discussion was conducted with coordinators of different programmes in four East African countries. Two independent researchers coded the interviews inductively using Atlas.ti. The underlying framework used is the culture, structure, and practice model. Results: Barriers and pathways to inclusion were found in the three interrelated components of the model. They are mutually reinforcing and are thus not independent of one another. Barriers regarding culture include negative attitudes towards persons with mental illnesses, structural barriers relate to exclusion from primary school, rigid curricula and untrained teachers and unclear policies. Culture and structure hence severely hinder a practice of including persons with mental disabilities in technical and vocational education and training programmes. Pathways suggested are aiming for a clearer policy, more flexible curricula, improved teacher training and more inclusive attitudes. Conclusions: In order to overcome the identified complex barriers, systemic changes are necessary. Suggested pathways for programme coordinators serve as a starting point. Clear and up-to-date information on mental disability is required to engender societal participation; especially that of stakeholders in technical and vocational education and training programmes. Affirmative action and policy implementations of national and international human rights legislations are required to address the challenges of enrolment in technical and vocational education and training programmes. Disability organisations and government should adopt a more open and strengths-based attitude, tailor-made curricula, specific teacher training as well as clearer policies to ensure better inclusion of persons with mental disabilities in technical and vocational education and training programmes. [ABSTRACT FROM AUTHOR]