GUIDELINES FOR EVALUATION AND ASSESSMENT OF MENTAL ILLNESS AND

PROCEDURE FOR CERTIFICATION*

GUIDELINES FOR EVALUATION AND ASSESSMENT OF MENTAL ILLNESS AND

PROCEDURE FOR CERTIFICATION*

*Published in the Gazette of India (Extraordinary), Part I, Section 1, dated February 27, 2002

1.Mental illness has been recognized as one of the disabilities under Section 2(i) of the Persons
with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995.
“Mental illness” has been defined under Section 2(q) of the said Act as any mental disorder other
than mental retardation.

2. In order to prescribe guidelines for evaluation and assessment of mental illness and procedure
for certification, a Committee was constituted by the Department of Health, Government of India
vide Order dated 6th August, 2001 under the Chairmanship of Director General of Health
Services on the basis of request made by the Ministry of Social Justice & Empowerment. The
Committee has submitted its report.

3. After having considered the report of the Committee, the undersigned is directed to convey
the approval of the President to notify the guidelines, for evaluation and assessment of mental
illness and procedure for certification. Copy of the Report is enclosed herewith as Annexure A.

4. The minimum degree of disability should be 40% in order to be eligible for any
concessions/benefits.

5. According to the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full
Participation) Rules, 1996 notified by the Central Government in exercise of the powers
conferred by sub-section (1) and (2) of section 73 of the Persons with Disabilities (Equal
Opportunities, Protection of Rights and Full Participation) Act, 1995 (1 of 1996), authorities to
give disability Certificate will be a Medical Board duly constituted by the Central and the State
Government. The Committee has recommended that certification of disability for the purposes of
the Act may be carried out by a medical board comprising of the following members:

(a) The Medical Superintendent/Principal/Director/Head of the institution or his nominee -

Chairperson
(b) Psychiatrist - Member
(c) Physician - Member

6. At least two of the members, including Chairperson of the board must be present and sign the
disability certificate.

7. The State Governments are, therefore, requested to constitute Medical Board as indicated
above immediately.
8. Specified test as indicated in Annexure A should be conducted by the medical board and
recorded before a certificate is given.

9. The certificate would be valid for a period of five years for those whose disability is temporary
and are below the age 18 years. For those who acquire permanent disability, the validity can be
shown as ‘Permanent’ in the certificate.

10. The Director General of Health Services, Ministry of Health and Family Welfare shall be the
final authority, should there arise any controversy/doubt regarding the interpretation of the
definitions/classifications/evaluation tests etc.

(Smt. Rajwant Sandhu)

Joint Secretary to the Government of India

ANNEXURE A
MINUTES OF THE MEETING

Minutes of the meeting of the committee to review the definition of mental illness and
formulating guidelines for assessment of mental illness disability and procedure for certification
held on 27th September 2001 (Thursday) under the chairmanship of DGHS.

A meeting was held under the chairmanship of DGHS on 27th September, 2001 to review the
definition of mental illness and formulating guidelines for assessment of mental illness disability
and procedure for certification.

1. After detailed discussion consensus was reached on the view that the present definition of
“Mental illness” as contained in the Persons with Disabilities (Equal Opportunities, Protection of
Rights and Full Participation) Act, 1995 Section 2(q) may be retained unchanged. This will be
most suitable for the purpose of PWD Act.

2. With regard to assessment of disability related to mental illness it was agreed that the Indian
Disability Evaluation and Assessment Scale (IDEAS) developed by the Rehabilitation
Committee of the Indian Psychiatric Society (IPS) through a task force should be used with
modifications for the purposes of the Act. The modified scale, IDEAS, is appended.

3. The Committee further recommended that certification of disability for the purposes of the Act
may be carried out by a medical board comprising of the following members:

(i) The Medical Superintendent /Principal/Director/Head of the institution or his nominee -

Chairperson.
(ii) Psychiatrist - Member
(iii) Physician - Member
At least two of the members, including Chairperson of the board must be present and sign the
disability certificate.

4. Meeting ended with the vote of thanks to the chair.

INDIAN DISABILITY EVALUATION AND ASSESSMENT SCALE (IDEAS)
A scale for measuring and quantifying disability in mental disorders developed by the
Rehabilitation Committee of Indian Psychiatric Society, December 2000.

General Guidelines on IDEAS:

 IDEAS are suited best for the purpose of measuring and certifying Disability.

 It is therefore a brief and simple instrument, which can be used, even in busy
clinical settings.

 Some training is required in the use of IDEAS.

 This is to be used only on out patients and those living in the community. Not
appropriate for in- patients.

 Rating should be done only based on interviews of the Primary Care Givers.
Case records and patients interviews can be used to supplement information.

 Only in rare instances when no primary care giver is available should be the
rating is based only on patient interview. This should then be documented.

 The gender specification “he” has been used for convenience and refers to both
genders.

 Probe questions help to guide one through the interview and to help identify
dysfunction in one or more activities. Diagnostic Categories:

 Patients with only the following diagnosis as per ICD or DSM criteria are eligible for
disability benefits:

 Schizophrenia
 Bipolar Disorder
 Dementia
 Obsessive Compulsive Disorder

Duration of illness: the total duration of illness should be least two years. For the
purpose of scoring, the number of months the patients was symptomatic in the last two
years should be determined.

Who does the assessment?

Only the Psychiatrist can do diagnosis and certification. Trained social workers,
psychologist, or occupational therapists can do administration of IDEAS
Frequency of Re-certification
Psychiatric Disability will be reassessed every two years and re-certified.

Items:

I. Self Care: Includes taking care of body hygiene, grooming, health including bathing, toileting,
dressing, eating, taking care of one’s health.

II. Interpersonal Activities (Social Relationships): Includes initiating and maintaining

interactions with others in contextual and social appropriate manner.

III. Communication and Understanding: Includes communication and conversation with

others by producing and comprehending spoken / written/non-verbal messages.

IV. Work: Three areas are Employment/Housework/Education Measures on any aspect.

1. Performing in Work / Job: Performing in work/ employment (paid) employment/self-

employment/family concern or otherwise. Measure ability to perform tasks at
employment completely and efficiently and in proper time includes seeking employment.

2. Performing in Housework: Maintaining household including cooking, caring for other

people at home, taking care of belongings, etc. Measures ability to take responsibility for
and perform household tasks completely and efficiently and in proper time.

3. Performing in school/college: Measures performance education related tasks.

Ideas Scoring Sheet

Items 0 1 2 3 4
I. Self care
II. Inter-personal Activities
III. Communication & Understanding
IV. Work

Scores for each item

0 - NO disability (none, absent, negligible)

1 - MILD disability (slight, low)

2 - MODERATE disability (medium, fair)

3 - SEVERE disability (high, extreme)

4 - PROFOUND disability (total, cannot do)

Total Disability Score (A)
Add scores of the four items and obtain a total score

Duration of Illness Score (B)

Interview with informant and case notes if available should be used to determine for how many
months in the last two years the patients exhibited symptoms (scores range 1 – 4)

< 6 months : score to be added is 1

7-12 months : score to be added is 2
13-18 months : score to be added is 3
> 18 months : score to be added is 4

Total Score (A) + Duration of Illness Score (B) = Global Score

Global Disability

Total Disability Score + Duration of Illness Score = Global Disability Score

TOTAL SCORE (I+II+III+IV) Total duration of illness in years (A + B)
(Range 0-16) (Range 1-4) (Range 1-20)

Percentage:

For the purpose of welfare benefits, 40% will be cut off point. The scores above 40% have been
categorized as Moderate, Severe, and profound based on the Global disability score. This grading
will be used to measures change overtime

Score Level Percentage

0 No disability 0 %
1–6 Mild Disability < 40 %
7 – 13 Moderate disability 40 – 70%
14 – 19 Severe disability 71 – 99%
20 Profound disability 100%
MANUAL FOR “IDEAS”

In order to score this instrument, information from all possible sources should be obtained. This
will include interview of patient, the care giver and case notes when available.

I. Self Care
This should be regarded as activity guided by social norms and conventions. The broad areas
covered are:

(a) Maintenance of personal hygiene and physical health.

(b) Eating habits.
(c) Maintenance of personal belongings and living space.
(d) Does he look after himself, wash his clothes regularly, take a bath and brush his teeth?
(e) Does he have regular meals?
(f) Does he take food of right quality and quantity?
(g) What about his table manners?
(h) Does he take care of his personal belongings with reasonable standard of cleanliness and
orderliness?

Scoring

0 = No disability
Patient’s level and pattern of self-care and normal, within the social cultural and economic
context.

1 = Mild
Mild deterioration in self-care and appearance (not bathing, shaving, changing clothes for the
occasion as expected). Does not have adverse consequences such as hazards to his health to his
health. No embarrassment to family.

2 = Moderate
Lack of concern for self-care should be clearly established such as mild deterioration of physical
health, obesity, tooth decay and body odors.

3 = Severe
Decline in self-care, should be marked in all areas. Patient wearing torn clothes, would only
wash if made to and would only eat if told. Evidence of serious hazards to physical health.
(Malnutrition, infection, patient unacceptable in public).

4 = Profound
Total or near total lack of self-care (Example : risk to physical survival, needs feeding, washing,
putting on clothes, etc. Constant supervision necessary).
II. Inter-personal Activities

Includes patient’s response to questions, requests and demands of others. Activities of regulating
emotions. Activities of initiating, maintaining and terminating interactions and activities of
engaging in physical intimacy.

Guiding Questions

a. What is his behaviour with others?

b. Is he polite ?
c. Does he respond to questions ?
d. Is he able to regulate verbal and physical aggression?
e. Is he able to act independently in social interactions ?
f. How does he behave with strangers ?
g. Is he able to maintain friendship?
h. Does he show physical expression of affection and desire ?

Scoring

0 = No
Patients gets along reasonably well with people personal relationships. No friction in inter-
personal relationships

1 = Mild
Some friction on isolated occasions. Patient known to be nervous or irritable but generally
tolerated by others.

2 = Moderate
Factual evidence that pattern of response to people is unhealthy. May be seen on more than few
occasions. Could isolate himself from others and avoid company.

3 = Severe
Behaviour in social situations is undesirable and generalized. Causes serious problem in daily
living / or work. Patient is socially ostracized.

4 = Profound
Patient in serious and lasting conflict, serious danger to problems or other. Family afraid of
potential consequences.
III. Communication and Understanding

Understanding spoken messages as well as written and non-verbal messages and ability to reduce
messages in order to communicate with others.

Questions
a. Does he avoid talking to people?
b. When people come home what does he do?
c. Does he ever visit others?
d. Is he able to start, maintain and end a conversation?
e. Does he understand body language and emotions of others, such as, crying, screaming, etc.
f. Does he indulge in reading and writing?
g. Do you encourage him to be more sociable?

Scoring

0 = No disability
Patient mixes, talks and generally interacts with people as much as can be expected in his socio-
cultural context. No evidence of avoiding people.

1 = Mild
Patient described as uncommunicative or solitary in social situations. Signs of social anxiety
might be reported.

2 = Moderate
A very narrow range of social contact, evidence of active avoidance of people on some occasions
and interference with performance of social rules, causes concern to family.

3 = Severe
Evidence of more generalized, active avoidance of contact with people (leave the room when
visitors arrive and would not answer the door or phone).

4 = Profound
Hardly has contacts and actively avoids people nearly all the time, for example, may lock
himself inside the room. Verbal communication is nil or a bare minimum.
IV. Work

This includes employment, housework and educational performance. Score only one category in
case of an overlap.

Employment

Guiding Questions
a. Is he employed / unemployed?
b. If employed, does he go to work regularly?
c. Does he like his job and coping will with it?
d. Can you rely on him financially?
e. If unemployed does he make any efforts to find a job?

Scoring

0 = No disability
Patient goes to work regularly and his output and quality of work performance are within
acceptable levels for the job.

1 = Mild
Noticeable decline patient’s ability to work, to cope with it and meet the demands of work. May
threaten to quit.

2 = Moderate
Declining work performance, frequent absences, lack of concern about all this. Financial
difficulties foreseen.

3 = Severe
Marked decline in work performance, disruptive at work, unwilling to adhere to disciplines of
work. Threat of losing his job.

4 = Profound
Has been largely absent from work, termination imminent. Unemployed and making no efforts to
find jobs.

Housewives
In similar ways, housewives should be rated on the amount, regularity and efficiency in which
tasks in the following areas are completed. Consider the amount of help required completing
these. Acquiring daily necessities, making, storing and serving of food, cleaning the house,
working with those helping with domestic duties such as maids, cooks, etc., looking after
possessions and valuable in the house.
Student
Assess and score on performance in school/college, regularity, discipline, interest in future
studies, behaviour at educational institutions. Those who had to discontinue education on
account of mental disability and unable to continue further should be given a score of 4.

DISABILITY CERTIFICATE OR IDENTITY CARD

The disability certificate and/or identity card is the basic document that a person with any
disability of more than 40 percent requires in order to avail any facilities, benefits or concessions
under the available schemes. This is not required for getting admission in a school for formal
education.

DISABILITY CERTIFICATE

Persons authorized to give disability certificate

The respective medical boards constituted at a state or district levels are the certifying authority
to issue disability certificate. The board consists of a chief medical officer / sub-divisional
medical officer in the district and another expert in the specified field. For example: an
ophthalmic surgeon in case of visual handicaps, either ENT surgeon or an audiologist in case of
speech & hearing handicaps, an orthopedic surgeon or a specialist in physical medicine and
rehabilitation in case of locomotor handicaps, and a psychiatrist or a clinical psychologist or a
teacher in special education in case of mental handicaps.

- The certificate is issued to persons with disabilities mentioned in the PWD Act, 1995. At
present, disabilities like Autism and learning disabilities are not covered under this Act.

- The certificate is valid for a five year period.

- When there are no chances of variation in the degree of disability, a permanent disability
certificate is given.

- In order to get a disability certificate, a person requires a birth certificate and proof of
residence. If a child is born at home, parents can get the birth certificate from their district
magistrate.

IDENTITY CARD
Presently, various ministries/departments of the central government as well as the state and UT
level government provide a number of concessions/ facilities/benefits to the persons with
disabilities. These benefits are provided on the basis of certain documents. The procedural
requirements are different in each case. Therefore, the persons with disabilities have to do
complex paper work which causes a lot of inconvenience and hindrance in availing various
benefits. The Government of India has therefore issued guidelines (August, 2000) to States and
UTs for issue of identity card(IC) to the persons with disabilities so as to enable them to easily
avail any applicable benefits / concessions.

Eligibility
All those who are certified by an appropriate authority to have a disability, as per the definitions
given in the PWD Act, 1995, will be eligible to obtain the identity card. This card will be issued
to all of the eligible persons irrespective of their age.

Medical Certificate
Medical Certificate obtained from an authorized medical board constituted by the State Govt. /
Defense authority, is a necessary prerequisite for obtaining the card.

Application
Persons with disabilities may apply for their ICs to the appropriate authority. In the case of
persons with mental retardation, autism, cerebral palsy or multiple disabilities, applications can
be made by their legal guardians. Ex-servicemen should apply for IC through the Rajya Sainik
Board, Zila Sainik Board or the Army formation HQs on the basis of disability certificate given
by a competent medical authority in the defense forces. Two passport size photographs would be
required for an application.

Duration of validity
The card has a lifelong validity when issued to a disabled person above the age of 18 years. For
disabled children below 18 years of age, the card is required to be updated once in every five
years. No fresh medical examination is necessary in the case of permanent disability.