Outcome of wage and self-employment intervention for persons with severe mental illness availing rural community-based rehabilitation project: Experience from South India.

Background: The World Health Organization advocates Community-Based Rehabilitation (CBR) for resource-constrained settings. There is a need for evidence-based models of employment for persons with severe mental illness (referred to as "patients") from such settings.

Aims: To facilitate and study the employment outcome of patients aged 18 to 50 y, availing a rural CBR project in South India.

Methods: Of 98 consented patients, only three men chose wage employment, and eighty-nine chose self-employment. Patients seeking wage employment were offered training and job placement in the nearest metropolitan city. Ten patients were offered loans for self-employment as revolving funds without collateral through the family federation of persons with mental illness. The patients and families were followed up for 10 months after recruitment into intervention. The AIMS-SEEP tool assessed the impact on families that availed of loans.

Results: All three men who chose wage employment in the city discontinued it. Two of ten families did not use it for the intended purpose, and one loan was written off. Seven families chose sheep rearing, and one bought a tailoring machine. Self-employment was a secondary source of income for families and was used for food, clothes, school expenses, health-related costs, household items, and debt repayment. The attendance at monthly meetings of the family federation has more than tripled since loans were issued. Families reported no adverse effects due to the intervention. Only three out of eight families had repaid the loan completely at the end of 10 months. Reasons cited for delay in loan repayment were hospital expenses for a sick family member and children's school expenses.

Conclusion: In impoverished rural areas, patients and their families prefer self-employment locally over shifting to the city for wage employment. Suggestions for implementing livelihood interventions in other resource-constrained settings are discussed. Families must own the initiative to ensure its sustainability.