Dr.T.Sivakumar is the additional professor at the department of Psychiatry at NIMHANS, Bengaluru. He has been working in the psychiatric rehabilitation program for over 10 years. Dr. Sivakumar is also actively involved in inclusive, community living projects. He is the recipient of the KJ Triveni award in 2021. A member of various professional bodies including Indian psychiatric society, Indian association of social psychiatry, he has published many papers as well. He is also the associate editor of the Journal of Psychological rehabilitation and Mental Health.
Here is the interview. The UDID card and the Niramaya scheme have been discussed in detail.
1) How does one get a UDID card?
The UDID is a digitally created disability certificate. People need to log in to the official website, https://www.swavlambancard.gov.in . Click on the link to apply for a disability certificate & UDID card. Fill in the details and upload the relevant documents. (Photo, Signature, Identity card) Once this is done, you will receive the UDID application number. The website will also give you a list of hospitals for disability assessment and issuance of a UDID card. We can search the list of hospitals which do disability assessment and issue UDID card for the entire country at the link https://www.swavlambancard.gov.in/findNearestMedicalAutority . Contact one of the hospitals listed for your district, get the assessment done according to the Government of India gazette guidelines, and then the respective hospital will issue the UDID card.
2) If the process is to be done at NIMHANS, what is the procedure to be followed?
At NIMHANS we can access details of applicants only from South Bengaluru. As I mentioned, approach the hospitals listed for you in the swavalambancard website. For those who come from different places, we do the assessment and give a letter stating the disability assessment done and the disability percentage. The letter can be given to the nearest, empanelled government hospital of the applicant. Based on this letter and assessment by the hospital, they can get an UDID card.
At NIMHANS, they can come on any working day, request for a disability assessment and UDID certificate. They will need to bring the UDID application details, identity card (Aadhaar), latest photo, old treatment records including the old disability certificate, as the case maybe. If the applicant is less than 18 years of age, they need to go to the child and adolescent psychiatry department. If the applicant is over 18 years of age, the department of psychiatry will make the card. They need to be here before 11.00 am, so that we can complete the registration process.They will be given a date for the assessment. Once the assessment is done, a discussion with the consultant follows. Subsequently, the hospital will issue the UDID card. You can do track online on the website mentioned above.
3) What is the validity of the UDID card? Does it need to be renewed for applicants under 18?
The UDID card issued is valid for the timeframe mentioned in the card. For some, they may issue an UDID card with lifelong validity. For some, they may issue a temporary UDID card, which may be valid for a few years after which a reassessment needs to be done.
For applicants with an intellectual disability under 18 years of age, the assessment needs to be done at 5, 10, and 18 years of age. The UDID issued at 18 years of age for the applicant with intellectual disability is valid lifelong.
It is important to get this card, because over a period, this is going to be one document that you will need to avail the benefits. The GOI wants to provide the intended services to the beneficiaries of the card. Another important aspect here, it helps the government to have a census of the disabled population. This helps in planning and implemetation of various schemes. Right now, there is a need to go to different places to get welfare benefits. What we understand from our discussions with the government officials is that from now on, this one card will avail all the benefits, and additional documentation will not be required in the long run.
There are many benefits to having a card. In the state of Karnataka, one can get a disability pension. If the percentage of disability is 40-75% , the beneficiary can get Rs.800 as a monthly pension. If the disability is over 75%, then the pension amount is Rs.2000 a month. In Karnataka, this pension is restricted only to people with a BPL card. There are travel benefits. Both the BMTC and KSRTC , issue an annual bus pass for Rs.660. This is for a calendar year, January- December and you can travel anywhere within a radius of 100km from the place of issue of this card. There are also railway concessions and the quantum of allowance could go up to 75%, depending on the train and class you travel in.
Although there is a stigma attached to the label of autism, awareness of autism is improving. People may actually want to avail the benefits, especially in education.There is a 5% reservation for persons with disabilities in government institutes. There is a 4% reservation for persons with disabilities in government jobs of which 1% is for people with IDD, mental illness, autism spectrum disorder, specific learning disability and multiple disabilities. People with autism have the unique ability to perform certain tasks very well.
6) Could you tell us about the Niramaya scheme?
This scheme comes under the National trust Act. Currently, there are no other health insurance schemes available for people with disabilities. All persons with disabilities under the National Trust Act with valid disability certificates will be eligible and included.
In this scheme you get up to Rs.1,00.000, insurance cover.If the person is above the poverty line, in the state of Karnataka, the first enrollment fee is Rs.500, subsequent renewal costs Rs.250 per annum.For people below the poverty line, the first enrollment fee is Rs.250, subsequent renewal costs Rs.50 per annum. The Government of Karnataka pays this fee for persons below the poverty line.
The benefits of this scheme are, they have recently hiked the OPD coverage to Rs.15,000, which includes any regular medical check up,treatment of physical ailments like fever,or comorbidities like epilepsy, or any other psychiatric comorbidity conditions. It also includes preventive dental care for Rs.4000. Totally, there is a coverage of Rs.19.000 for OPD treatments.
There is a provision for ongoing therapies as well. There is a coverage of Rs.20,000, which includes physiotherapy, behavioural therapy,which the child may require. It provides alternative medicine cover up to Rs.4000. It covers transportation costs, up to Rs.2000 per annum. More details are available at the link https://thenationaltrust.gov.in/content/scheme/niramaya.php
https://thenationaltrust.gov.in/content/registered_organization.php In this link, you can search for registered organisations in various districts across the country that accept applications to issue Niramaya card. It is not a cashless treatment. The money for the treatment has to be paid upfront and claims for reimbursement should be put up in a month's time.More details about the claim settlement process is available at the tab ‘claim settlement’ at the lhttps://thenationaltrust.gov.in/content/scheme/niramaya.php The claims need to be submitted to Raksha TPA. It is advisable to get the claim form, duly signed by the attending doctor, and submitted within 30 days of availing treatment. The claim will be scrutinised and the money transferred to your bank account.
7) What are the documents required for the Niramaya scheme?
For the Niramaya scheme, you require the UDID card, the latest photo of the applicant, Aadhar card, BPL card and details of your bank account.
8) What are the registered organisations that can issue a Niramaya card in Karnataka?
The website of National trust allows you to search for registered organisations (https://thenationaltrust.gov.in/content/registered_organization.php ), that can help you with getting a Niramaya card. Under Bengaluru Urban Ngos, there are 4 organisations registered under the national trust act, that facilitate the registration process. SEVA- in- Action, KPAMRC, ALFAA, Shristi special academy.
At NIMHANS , we direct our patients to SEVA-in-Action, where they get enrolled in the scheme. Our patients are also availing the benefits of the scheme.
It is a neuro developmental condition and persons with autism are at higher risk of developing co-morbidities, including psychosis, ocd , bipolar disorders and other related problems.Sometimes, there can be difficulties in sleeping, and aggressive behaviour. In such conditions, we may have to use medication. But there are no medications to treat autism. The co-morbid conditions may actually benefit from medication.
If there are behavioural issues, it is best to consult a psychiatrist, who will analyse the problem behaviour and prescribe medication if required. Based on a formal assessment, in consultation with the parents, and indication of any co-morbid conditions, we shall decide on the medication.
Based on genetic vulnerabilities, and tests conducted, the doctor may advise some bio medical intervention on an individual case basis. For instance, we would not recommend a gfcf diet for all persons with autism. Presentation of autism differs across the spectrum. Even when the presentations or symptoms may appear the same, the underlying causes why they landed on the spectrum also may differ.
11) How far has psychiatric care treatment come in India in terms of accessible treatment centres and medication?
It has come a long way. We have the district health program that covers almost the entire country and offers free psychiatric treatment. Care for psychiatric illness is available both at the district and taluk level. Recently we have the TeleManas initiative which is a 3 tiered system. It is as simple as making a phone call. They will guide the person to where they can seek mental health care, from the closest point from where they are calling. There are e-health initiatives and free, including medicines. Mental care act of 2017, says that psychiatric care should be provided free of cost to patients, at a place accessible to them. https://telemanas.mohfw.gov.in/#/home
With this tele manas initiative, the government has noted the burgeoning health issues in the country. In terms of medications, we have newer ones, with less side effects.
12) What are the problems encountered in rural areas?
Accessibility is the issue, but with the district level mental health programs, we have resolved this issue to a great extent. The government of Karnataka is doing a pilot project for taluk mental health program in about 10 taluks in Karnataka.
Once the taluk mental health care program is implemented, it will take care of things at PHC level as well. In Karnataka, the government has added the psychotropic medications to the essential drug list. By next year, issues pertaining to availability of medications may also be resolved.
The team, at the taluk level, consists of one psychiatrist, psychologist, social worker and nurse. They do not have occupational therapists. Alternatively, they can be referred to the early intervention district or the regional centres for a multidisciplinary treatment.
13) Are there any specific issues to be considered for the girl child and women?
In rural areas, families are reluctant to bring them to the government psychiatric medical facilities because of stigma. They prefer to keep it under wraps or get them treated in private hospitals.
14) When does the need for rehabilitation residential care arise?
There are two types here, short term and long term residential care set ups. From a medical viewpoint, one needs to see if the person requires medication. If the medication is for a long term, they need to be under the continued care of a psychiatrist. Many of our patients, we feel, can continue to live with their families. The person requires a clinical assessment, and the medication administered properly. Lifestyle interventions can make a huge difference.
Only a small fraction actually needs to be institutionalised. Only if the family cannot accommodate, do we need to think in terms of rehabilitative residential set ups.
Thank you Dr. Sivakumar, for taking time out and for sharing your inputs on the UDID card and Niramaya scheme. It has also given us a better understanding of the various government initiatives.
Comments