The document discusses several issues related to the assessment and certification of disabilities under the Rights of Persons with Disabilities (RPWD) Act 2016 in India. It notes ambiguities in the definitions of mental illness and how different conditions are assessed. It also outlines challenges in certifying temporary versus permanent disabilities for conditions like mental illnesses that can be episodic or fluctuating in nature. Further, it discusses a lack of clear guidelines for accurately assessing and quantifying disabilities related to specific conditions like neurological disorders, speech and language disabilities, and intellectual disabilities. Overall, the document analyzes gaps and inconsistencies between the previous and current disability certification frameworks in India.

1. RIGHTS OF PERSON WITH
DISABILITY
(RPWD) ACT 2016
DISCUSSANT: KOTARI PUTESH

2. DEFINITION –MENTAL ILLNESS
PWD ACT 1995
Mental illness was defined as “ any mental disorder other than mental retardation “
RPWD ACT 2016
Mental illness means a substantial disorder of thinking , mood , perception , orientation or memory
that grossly impairs judgement ,behaviour , capacity to recognise reality or ability to meet the ordinary
demands of life but does not include retardation which is a state of arrested or incomplete development
of mind of a person specially characterized by sub normality of intelligence .
• The Act had replaced the term Mental Retardation with term Intellectual Disability but the definition of
mental illness again uses the term retardation it raises the confusion .
• Mental illness are often fluctuating ,episodic and dynamic in nature .
• Myths , stigma and discrimination of mental illness prevailing within the society can lead to a denial of
their rights .

3. ISSUES RELATED TO CHRONICITY, RELAPSE,
EPISODIC NATURE, AND FLUCTUATION IN
NEUROLOGICAL CONDITIONS
• Definition of chronicity has not been given in guidelines
Suggestions for decision regarding chronicity are available in guidelines
• Any neurological assessments for the purpose of certification have to be done 6 months
the onset of illness
• Exact time period should be decided by the medical doctor who is evaluating the case
• Neurological condition which is reversible and without sequel should not be certified
• Only neurological conditions which are permanent should be certified
• Permanent disability certificate can be issued in irreversible/progressive cases
• In specified cases re-evaluation of disability can be done after a period of 1 year

4. • For few common chronic neurological conditions with disabilities, it is not clearly
mentioned that when and how someone would certify these mentioned conditions.
Diseases: - Examples: -
(i) Relapsing diseases Multiple sclerosis (MS)and chronic inflammatory demyelinating
poly-rediculoneuropathy
(ii) Episodic diseases Migraine, Ataxia, and Epilepsy
(iii) Fluctuating diseases Myasthenia gravis and Parkinson Disease with drugs,

5. ASSESSMENT OF DISABILITY IN MENTAL ILLNESS
• Rehabilitation committee of Indian Psychiatric Society who evolved an
assessment tool
1. IDEAS (Indian Disability Evaluation and Assessment Scale )
2. Intelligence Quotient ( IQ)

6. IQ SCORING
Mild Mental Disability 50- 60
Moderate Mental Disability 35- 49
Severe Mental Disability 20- 34
Profound Mental Disability Below 20

7. IDEAS
IDEAS was initially devised and advocated for four important psychiatric
disorders : Schizophrenia , Bipolar disorders , OCD and Dementia .
Domains:
 self-care
 work
 Interpersonal activities
 Communication& understanding
 Duration of Illness

8. Weightage for duration of illness ( DOI)
Global disability
Total Disability score+ DOI =Global Disability score percentage

9. CERTIFICATION OF MENTAL DISABILITY AS PER THE RIGHTS OF
PERSONS WITH DISABILITY(RPWD) ACT, 2016
•All PMIhavea right to apply for the disability certificate
•Atemporary disability certificate can be given before receiving adequate treatment with respect to dosage and duration
•Permanent disability certificate should be given only if the medical authority is reasonably satisfied that all approved treatments which have been
administered for adequate dose and duration have failed
•Inthe case of newlydiagnosed patients, the disability certificate can be issued after adequate treatment.
•Private institutions can also issue thedisability certificate if the notification from the respective state governmentrules say so
•“Mental illness” and “Intellectual disability” are considered separate disabilities under the RPWD Act. Hence, the formula for “Multiple
Disabilities” needs to be applied
•Inall disability certificates, please mention the duration of validity of the certificate
•Refrain from providing disability certificate without directly assessing the patient

10. CHALLENGES IN INDIAN MENTAL DISABILITY
ASSESSMENT SCALE
1. It is not comprehensive
2.It does not cover all the mental disorders
3.Currently, it becomes difficult to compute the total duration of illness for
episodic illnesses such as Bipolar Disorder and Depressive Disorder. In the
original version, as submitted by the authors, the method used was called “MY
2Y” months of illness during the last two years. It can be used for calculation of
duration of continuous illness in PMI. Hence, IDEAS requires further refinement
in assessing mental disability.

11. AMBIGUITY IN ASSESSMENT OF MOVEMENT
DISORDERS’ DISABILITIES
• Various new disability categories have been notified in RPWD Act 2016 like chronic
neurological conditions, PD(Parkinson Disease). Hence in the new law, there are
provisions that under these new categories, most of disabilities associated with
movement disorders can be certified.
Ambiguity in assessment as per the guidelines of RPWD, Act 2016
New guidelines for evaluation and certification are incomplete in respect of these new disability
categories
New guidelines do not suggest evaluation and quantification of motor disability associated with
PD
It is not clear that disability measurement of parkinson patients should be done during on period
or off period, with drugs or without drugs
No provision for using either Hoehn and Yahr scale and the staging or unified Parkinson rating
scale score for calculation of motor disability of Parkinson which is used in clinical trials
There are no provisions for calculation of disability due to hyperkinetic movement disorders such
as chorea and dystonia under the category of chronic neurological conditions

12. ISSUES OF PSYCHOSOCIAL DISABILITY IN CHRONIC
NEUROLOGICAL CONDITIONS
• The new guidelines suggested that chronic neurological conditions have
multidimensional disabilities, including physical, musculoskeletal (motor/movement) as
well as psychosocial behavior (mental) components.
• It has been recommended that the Indian Disability Evaluation and Assessment Scale
(IDEAS) should be used for the assessment of psychosocial disability.
• IDEAS scale is validated for mental disability in condition who has no associated physical
disability, for example, psychosis and dementia.
• It is very well known that chronic neurological conditions have both components of
physical as well as mental disability.

13. ISSUES OF DISABILITY CALCULATION IN EPILEPSY
PREVIOUS
GUIDELINE
CURRENT
GUIDELINE
There were suggestions available mainly
for posttraumatic epilepsy associated with
physical disability in the form of table.
There was no provision for disability
certification in nontraumatic epilepsy or
posttraumatic epilepsy without physical
disability.
Disability calculation in epileptic
disorders has been removed
There is provision for certification of
nontraumatic epilepsy with or without
physical disability under chronic
neurological conditions
new guidelines are silent about
disability calculation of these epilepsy
patients

14. REMOVAL OF FEW TABLES FROM OLDER GUIDELINES
Newer Guidelines
Person with altered sensorium like patients with vegetative state cannot be certified
No suggestion for calculation of disability for person with altered sensorium
PWD with disability due to the involvement of cranial nerves was also excluded
Nothing described for calculation for facial weakness and/or numbness
Nothing described for weakness of chewing and swallowing muscles
Tables of older guidelines for altered sensorium and cranial nerves can be included again, with
appropriate changes needed

15. NO CORRECTION OF FALLACIES OF OLDER GUIDELINES
In his letter to editor, Murali et al. had expressed their views clearly regarding the fallacies
of 2001 guidelines. In their opinion “Evaluation of the disability in lower motor neuron
lesions is lengthy and takes a lot of time. Other important parameters in upper motor
lesions such as cognitive deficits, swallowing dysfunction, spasticity, dystonia, rigidity,
tremors, and bowel incontinence and so on are not addressed.” These fallacies have not
been corrected in newer guidelines also.
Guidelines 2001 Guidelines RPWD Act, 2016
FALLACIES

16. Hindi version
as
stammering
(Tutlahat)
Hindi version
as stuttering
(Haklahat)
ISSUES RELATED TO TRANSLATED HINDI VERSION OF NOTIFICATION
IN ENGLISH
RPWD ACT, 2016
Speech And Language Disability
Category
Conditions which affect speech
components
Dysarthria
of speech
Apraxia
of
speech
Improper
Translatio
n
Improper
Translatio
n
Exponential increase in
application for
benchmark disability by
persons who either
have stuttering or
stammering
Delay in
assessment
of genuine
PWD
Increase in
the
pendency of
certification

17. OTHER ISSUES RELATED TO GUIDELINES
Increase in application for certification due to digitalization
With digitalization and simplification of the application process for disability and concurrent wide
dissemination of knowledge of various newly added disability categories, applicants of probable
PWD increased exponentially.
Increased Pendency of certification due to incomplete guidelines
But with incomplete and unclear guidelines, pendency of certification has also increased.
Difficulty for medical authority to issue or reject certificate due to short time period from date of
application
It is very difficult for the medical authority to either issue certificate or rejects application with
proper reason in writing within 1 month of date of application.

18. CHALLENGES IN PSYCHIATRIC DISABILITY CERTIFICATION
• As per the gazette notification, disability certificates can be issued for all mental illness
irrespective of the diagnosis. Mental health professionals need to know that disability
certificate is not based on the diagnosis, but the amount of disability experienced by the
individual. Regarding this issue, policymakers in India have thought beyond the conventional
way and included all mental illness for disability assessment and benefit.
• Many psychiatrists express a concern that these patients will use the disability benefit for
procuring other benefits (alcohol or drugs) and hence outrightly reject to assess the disability
in substance use disorders.

19. CHALLENGES IN CERTIFYING TEMPORARY VS
PERMANENT DISABILITY
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.
TEMPORORY CERTIFICATION
Normally, a period of 6 months is considered for such medical conditions. In case of doubt that
there is a possibility of improvement even after 6 to 12 months of treatment, as a rule of thumb, a
temporary disability certificate can be issued. The temporary certificate would be valid for 5 years.

20. CHALLENGES IN TEMPORORY CERTIFICATION
• Variation of disability on Reassessment
If an individual gets his/her disability certificate due to psychiatric illness during the active
phase of the illness and later the illness improves due to treatment and rehabilitation, the
percentage of disability may vary at the reassessment.
• Margin of certification
There will be a margin of error in certification because of the nature and course of the
mental illness.

21. PERMANENT CERTIFICATION AND ITS CHALLENGES
• For permanent disability, certificate once issued is permanent and lifelong. Hence,
before issuing a permanent certificate, members of the medical authority need to
exercise a reasonable degree of caution that improvement in the psychiatric condition
has reached the maximum extent currently possible and that the illness is not likely to
improve further.
• Psychiatrists, ideally, before issuing a permanent disability certificate, need to exhaust all
options to reduce, treat, rehabilitate, and correct the disability. However, given the
practical difficulty and resource constraints and taking a holistic view, a certificate cannot
be denied for want of psychiatric interventions.

22. The RPWD Act, 2016, makes a provision for issue of temporary disability certificates in
certain situations. The treating professional can indicate the duration for which the
certificate is valid and may suggest a periodic re-evaluation. When such duration is not
specified, it is assumed that the certificate is valid for 5 years. This information is not widely
known, and in several instances, such certificates have not been honored by the
concerned administrators and patients have been denied their rights.

23. CERTIFICATION OF THOSE WITH MENTAL RETARDATION
AND ANOTHER MENTAL ILLNESS
In case of certification of a person with both a mental illness and intellectual disability (mental
retardation), as per the notification on January 4, 2018, mental illness and mental retardation
(intellectual disability) are two separate disabilities. In such scenarios, the formula for assessment of
multiple disabilities needs to be applied.
“a” will be the higher score
“b” will be the lower score.

24. IMPORTANT BENEFITS FOR PERSONS WITH
PSYCHIATRIC ILLNESS
1.Disability pension
• Indira Gandhi National Handicapped Pension Scheme (2009 -10)
• Swami Vivekananda nishakthswalamaban prostan Yojana
2.Travel Benefits (Railway) : Mentally retarded persons who cannot travel withoutan escort
3. Insurance Schemes : Ayushman Bharat
4. Employment: The government has reserved four percent posts in Groups A, B, C and Group D positions in
government services, public sector banks and government undertakings for persons with disabilities.
5. Marriage Allowance: Odisha: The amount of incentive is fixed at Rs.50, 000/- (Rupees Fifty Thousand)
only. State Govt. is providing all the amount

25. CONT.….
6. Housing scheme : Indira Awaas Yojana , Renamed as Pradhan Mantri AwaasYojana(2015)
7. Pension transfer
8. Loan: Prominent schemes being implemented by NHFDC (National Handicapped Finance and
Development)
9. DivyangjanSwavalamban Yojana (2015 oct-2)
10. Vishesh Microfinance Yojana (VMY)
11. NHFDC Swavalamban Kendra (NSK)
12. MahilaSamriddhi Yojana

26. UDID CARD AND ITS USES:
UNIQUE DISABILITIES IDENTIFICATION CARD (UDID) IS A DIGITALLY GENERATED DISABILITY CARD. IT IS
VALID PAN-INDIA. PWD CAN APPLY FOR UDID AT THE WEBSITE WWW.SWAVLAMBANCARD.GOV.IN
Card Uses Procedure
● The UDID card will be the single document of identification,
verification of the disabled for availing various benefits in future.
● The UDID Card will also help in stream-lining the tracking of the
physical and financial progress of beneficiary at all levels of
hierarchy of implementation – from village level, block level,
District level, State level and National level.
● Go to UDID web portal
or http://www.swavlambancard.gov.in/Click link
apply online, fill online application, attach scanned
copy of required documents
http://www.swavlambancard.gov.in/pwd/application
● Required documents: Scanned copy of recent colour
photo.
Scanned image of signature (Optional)
Scanned copy of Identity Proof / address proof (Aadhar
Card/PAN Card/Driving License etc)
Scanned copy of Disability Certificate (Only for those
Persons with Disability who have been issued disability
Certificate is by the competent Authority).

27. PROGRESS AND CURRENT STATUS
• The chapter of this act has been asked to conduct surveys in every 5 years
among the school going children's but there is no specific way has been
described .
• 83.3% state have not constituted district committees .
• 79.2% states have not constituted the state fund for implementing the act

28. CONCLUSION
• The implementation of RPWD Act 2016 is not more effective and it should focus
on its terms and definitions are creating ambiguity and need to be modified.
• Lack of awareness cause inadequate promotion of the proper implementation
of act.

29. REFERENCES
• Puri, I., Singh, G., Acharya, R. K., & Goswami, D. (2019). Critical Appraisal of Guidelines for
Evaluation and Certification of Specified Neurological Disabilities. Annals of Indian Academy
of Neurology, 22(4), 373–376. https://doi.org/10.4103/aian.AIAN_165_19
• https://thehansfoundation.org/wp-content/uploads/2019/07/FINAL-Handbook-on-the-RPWD-
Act-2016-ENGLISH.pdf
• https://www.researchgate.net/publication/331490218_The_Rights_of_Persons_with_Disabiliti
es_Act_2016_Mental_Health_Implications/link/5f476a82458515a88b7126e7/download
• Prasad Rohini , Sarkar Sukanth (2015) Violation of Disability Rights .
• Person with Disability Act (equal opportunities ,protection of rights and full participation )
1995 (PWD Act)
http://www.disability affairs .gov.in /upload file/PWD Act pdf
The Rehabilitation Council of India Act 1992 http://rehabcouncil.nic.in