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Non-Profit Management and Covid 19: A Case Study with Special Reference To Psychosocial Rehabilitation Centers In Kerala.

1Joseph M.K, 2Binson P. Augustine, 3Niva Anie Sunny, 4Reginold John

1Associate Professor,Department of Social Work, Rajagiri College of Social Sciences, Cochin, Kerala, Email:[email protected] , Mob: 7907888124

2Ph.D. Scholar, Rajagiri College Of Social Sciences, Cochin, Kerala, Email: [email protected] , 8547529662

3Psychiatric Social Woker, Divyarakshaka Social and Chartable Society, Thodupuzha, Kerala Email: [email protected], 907501053

4Assistant Professor, Department of Management, Rajagiri College of Social Sciences, Kakkanad, Kerala. Email: [email protected], 9539577797

ABSTRACT

Detrimental effects of Covid-19 have become the central topic of discussion in the 21st century. When it comes to the Non- Profit sector, the challenges and issues would be twice over compared to other industries. This qualitative case study intended to portrait the negative impact of the terrible pandemic Covid-19 with particular reference to seven psycho-social rehabilitation centres in Idukki District, Kerala. Here in this study, the researchers assess the effect of covid-19 on Non- Profit Organizations using direct interviews with the NGO management, Professional staff, supporting staff, and volunteers.

The qualitative responses obtained show the severity of the challenges that the Non- profit Sector has been undergoing in the Covid-19 era. Budgetary impact, Funding sources, and obligations, Limited resources, difficulties in human resources management, Cancellations and Postponement of CSR, governmental and non-governmental projects, Difficulties in implementing the Covid-19 protocols among a vulnerable population, particularly in mentally ill people, Social and Psychological problems are few among the challenges projected during the direct interviews.Moreover, the matter of sustainability of Non- Profit Organizations while struggling to tackle all the reported problems remains an unattended challenge in the Non- Profit Sector. Sound understanding and assessment of the negative impacts of Covid-19 would help the authorities to come up with more feasible solutions to address the issues in the non-profit sectors, particularly in psycho-social rehabilitation centres.

Key Words: Psychosocial, Non- Profit Organizations, Issues, Challenges, Vulnerable, Sustainability, Rehabilitation

1. INTRODUCTION

Without any exemption, the whole world is struggling to get rid of Corona Virus. However, the direct and indirect impact of Covid-19 is severe and different for everyone considering the Age and Living conditions. The psychological, social, political, and economic implications of Covid- 19 is equally devastating as the physical complications made by the Corona Virus.

People became helpless owing to the limitations and restrictions proposed during Lockdown and quarantine. When it comes to the Non- Profit Sector (NPS) conferring various psychosocial support and services to the neglected and deprived population, the impact of Covid-19 is inconceivable. Non- Profit Organizations(NPOs) aim to uplift the poor and marginalized sections of the society and other needy by a group of like-minded people (Thirthahalli C, Shetty P, 2020). When the primary social institutions like the family fail to manage their routine and

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functions in the background of Covid-19, the impact of Covid in a more extensive and complicated social system like psychosocial rehabilitation centres are beyond imagination.

Psychosocial rehabilitation is a process that helps people with mental illness to regain their optimal level of functioning and quality of Life (Saha S, Chauhan A, Buch B, Makwana S, Vikar S, Kotwani P and Pandya A, 2020). The role of such rehabilitation centres is inevitable to prevent and reduce disability, either it may cause mental or behavioural. Earlier, psychosocial rehabilitation centres were a tertiary approach to support mentally challenged individuals through therapeutically oriented medical interventions. But later on, it becomes a body of knowledge /or a primary practice by providing and organizing services for the physically and mentally challenged population. However, when an ordinary system fails to manage its optimal function in such an unprecedented event like Covid-19, the institutions that work with people with psychological, physical, and social issues and concerns would have been suffered a lot. In addition to the severe psychological disturbances, the possible financial difficulties, scarcity of resources, lack of governmental and non-governmental interventions and Difficulties in managing human resources are other significant challenges in the Non- Profit Sector, particularly in psychosocial rehabilitation centres. This study intends to raise awareness about the impact of Covid-19 among the possibly neglected population undergoing psychosocial rehabilitation to ensure sound intervention from the authority.

AIM OF THE STUDY

The aim of this qualitative study is to understand the issues and challenges of Non- Profit Sector, particularly the Psycho Social rehabilitation centres in the background of Covid-19 pandemic in Kerala.

OBJECTIVES OF THE STUDY

1. To understand the economic impacts of Covid-19 in psychosocial rehabilitation centres 2. To understand the technical difficulties faced by psychosocial rehabilitation centres in the

context of Covid-19

3. To understand the specific concerns and issues of psychosocial rehabilitation centres in the background of Covid-19

METHODOLOGY OF THE STUDY 1.1.Design

The design adopted for this study is multiple case studies. This multiple case study consists of management representatives, professional staff, and volunteers from each of the seven

psychosocial rehabilitation participated in the study. The multiple cases were selected as they were considered information-rich sites (Johnson & Christensen, 2012), and it helps to ensure that the key research themes are addressed.

Universe of the Study

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This study takes places among Psycho Social Rehabilitation centres registered under Orphanage Control Board, Govt. of Kerala.

Population

The population of this study consists of seven Psycho Social Rehabilitation centres out of the 14 centres in Idukki District. Rehabilitation Management representatives, Professional staffs and volunteers from each of the participating organizations are involved in this study.

Sampling

The sampling method adopted to this study is Simple Random Sampling where each of the organizations get equal chance to participate in the research process.

Sample Size

There are total of 21 respondents in this study. Three respondents from each participating organization is randomly selected for this particular study.

1.2. Data Collection

Phenomenological in-depth interviewing was conducted with a representative from the management, professional staff, and volunteers to capture multiple views on the impact of Covid-19 in the respective organizations. (Ribbens- McCarthy, Jain R, 2006).

1.3. Data Analysis

Qualitative data analysis was done. The audio recording was used at the interview to capture how the experience was narrated and analyzed the verbatim records.

ANALYSIS AND RESULTS

Twenty-one samples were interviewed from the sample population. The sample population includes management officials, professional staff and Volunteers. A maximum of three samples were taken from each of the organizations.

Graph 1: Sample Population

There are total of 21 respondents in this research. Out of the 21 respondents, seven respondents are professional staffs working in the Psycho Social Rehabilitation centres. They include Social workers, Accountants, Physiotherapist, Nurses etc. Apart from this, there are seven

Professional Staff, 7

Management Officials, 7 Volunteers, 7

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management representatives as respondents in this survey. They include presidents, secretaries, and treasures of the participating organizations. The rest of the seven respondents are volunteers/supporting staff from each of the organizations.

The following are the selected verbatim records of the respondents from each organization composed during the structured interview.

1. Organization 1

Organization 1 is one of the pioneer psycho-social rehabilitation centres in the Idukki District.

The number of residents in the institution is high while comparing with others in the district.

Most of the residents are psychiatric patients, symptomatic and even are under psychiatric medications. They had been experiencing the terrible impact of COVID- 19 for the last two months. Around 95% of their residents and staff were COVID positives. According to them, the infrastructure limitations, the limited number of staff, and the poor financial sustainability were the main challenges. They also believe that the absence of timely interventions from the respective health department makes the situation bit worse in the initial days of the Covid-19 outbreak in the institution.

The social worker in the institution says "... Yes we struggled a lot...we were in a dilemma.

The things were out of our control. In the first few weeks, the positive cases were rapidly increasing day by day. As most of our residents have psychiatric illness, it was challenging for us to manage them and educate them on what to do and how to do. They were not ready to wear the mask. Social distancing was not all practical in their case..."

According to one of the volunteers, "...We did not have sufficient infrastructure to accommodate our infected residents. Unfortunately, most geriatric residents got infected, and we could not isolate them or accommodate them in a separate wing due to the limitations in the accommodation. That increases the risk of other aged people, and we were helpless...Even when an emergency happens, we were not allowed to shift the residents to the hospital without prior permission from the health department; the protocols and restrictions from the authority make us very difficult to manage the patients..."

According to the organization's President, "... Those are the days that we regret to remember...

Financial difficulties limited us from conferring high-quality services and facilities to our infected residents. As the positive cases started increasing, the whole organization, including me, was told to be in quarantine, limiting resources' availability and accessibility of resources.... Financial stress is a big concern as philanthropy and corporate social responsibility (CSR) flow towards COVID 19 relief and healthcare-related works. Most of our CSR funded projects and programmes are at a stagnant condition’’.

According to the Rehabilitation Manger “... participation in the rehabilitation activities are one of the therapies we successfully implemented to make the residents physically healthy and emotionally balanced. The complete adherence to COVID 19 protocol, most of the rehabilitation activities and other therapies were stopped. The physical and mental health of the residents deteriorated. It is quite uncertain that how long does it take to restore the condition’’.

As the organization does not have sufficient staff, the COVID positives without having many physical complications took the care of the rest of the physically weak inmates. They say the

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first stage of the pandemic spread in the organization was too dangerous. More than 100 cases are reported per day. The geriatric session was at high risk, and a few of the residents were going through severe health issues. Two of their inmates died. Only one Nurse was there to manage the sick patients. No house physicians were appointed there till the second stage of the pandemic. Due to restrictions in the protocols and legal formalities, it required considerable efforts to shift the highly sick patients to the hospital.

2. Organization 2

Organization 2 is a psychiatric rehabilitation centre rehabilitating more than 200 patients with various occupational rehabilitation programs. The direct impact of Covid-19 was less in the organizations other than the budgetary impact and other possible limitations while dealing with such as huge population.

According to the Accountant of the organization, "... The financial difficulties that we faced in the last nine months cannot be described in words. As a charitable organization, we heavily depend on private donations and funds, but since the pandemic started, the donations and funds declined in its one-third. We recently had times to wait for donations to come and get the kinds of stuff for the day to day needs..."

Matron of the organization says, "...we forced to say no to come, to all our outside staffs for the work, due to anxiety and fear of getting infected. That makes most of our works pending, and we could not continue the rehabilitation activities as we wish. That hinders the sustainability of the vocational rehabilitation activities..."

According to the volunteer, "... I have been working here for last 14 years, but we have never faced any crisis like this. Economical impact of Covid-19 was huge in our organization. A few of our sanctioned projects became cancelled because of Covid-19, and we couldn't implement another few of our dream projects in the background of the restrictions due to Covid-19..."

3. Organization 3

It is a psycho-social rehabilitation centre in the district having more than 130 residents. The residents include children and female adults, having various psychological, social and behavioural problems.

The social worker says. "...A few of our staff became positive, and the timely action is taken save others from the pandemic. Nevertheless, other impacts due to Covid-19 were distressing.

As a social worker, I feel that the governmental interventions in this sector were minimal, but we were happy to have the optimal support from the community. Though we had financial difficulties, we managed ourselves with the primary commodity donations and other kinds of contribution...But still struggled"

Psychiatric Nurse (Volunteer) of the organization says "...Owing to financial difficulties we could not get a house physician. Every time our inmates get sick we had to take them to the nearby hospital. The lack of isolation facilities and the hesitation of the authority to admit psychiatric patients in their hospital was one of our major challenges in these days..."

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According to the Director of the organization, "... The limited number of residential staff was one of our major challenges. As the lockdown starts, a few staff have gone back to their homes and which make us difficult to manage a large population like this..."

4. Organization 4

The President of the organization says, "...So far we are safe... No one is infected.

Nevertheless, the donations and funding sources decreased as the pandemic started. A few of our regular benefactors have stopped their regular contributions. Those changes affected us badly..."

According to the organization's social worker, "...The community support during the lockdown, days was not that appreciable. To be more clear, it was not up to our expectation.

We were not paid our salary for about three months..."

The nurse of the organization says, "... The change I felt after the onset of the pandemic was, we had to compromise the quality of our care to the residents. Even sometimes the quality of food..."

5. Organization 5

According to the Human Resource Manager of the organization, "...Yes Its been a difficult time for everyone particularly for the people with psychological disturbances..." While discussing the technical difficulties, he says, "...Travel restrictions were one of the major issues that we faced during the lockdown. We could not be able to execute most of our plans during those days..."

According to the social worker, "...Professional interventions were less during that time. The Frequent family sessions, Group meetings, Therapies even psychiatric consultations decreased which in turn negatively affected the mental health of the patients..."

According to the Director of the Organization, "...we feel that the people are not sure about the requirements of a psychiatric rehabilitation centre. Thus it was a bit difficult for us to express our exact demand..."

6. Organization 6

The organization's director says, "...One of our patients was diagnosed as Covid positive a few months ago. Fortunately, we could identify the case in the initial phase and taken all the precautions. Nevertheless, still, the whole centre was told to be in quarantine. For 14 days, we were in quarantine. The donations decreased, and even the lockdown started during those days. We were badly helpless, the donations decreased, and we had to struggle for daily management. Somehow we managed the lockdown period..."

According to a volunteer, "... we took all the possible precautions to limit the spread, we succeeded so far. However, while dealing with such a huge population, of course, we have limitations in the infrastructure, money and the number of employees."

According to a social worker, "...We had many technical difficulties here, moreover, we tried to enlist our names as health care professionals for Covid- vaccinations but we are rejected saying that we are not health care professionals and not able to register for vaccination...here we are looking after more than 100 mentally ill patients and what does it mean..."

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7. Organization 7

The administrator of the organization says, "...It was our dream to renovate this building. As a part of Corporate Social Responsibility (CSR), X (Pseudo name of a company) was agreed to grant 30 lakh for the renovation. The renovation was started but as Covid-19 spread increased, we were forced to stop the works. The first instalment of the fund was received.

However, later as the lockdown started and we have not received the remaining fund yet...

Do not know when we will receive the remaining half..."

Public Relation Officer (PRO) of the Organization "...The community support was incredible.

In our area, the spread was a bit less comparing with other regions. The direct impact was less. Nevertheless, we too had limitations and impacts of Covid-19. We have a welfare shop, as a part of our occupational rehabilitation programs. During those days the sales over there was less and this, in turn, was a challenge against the sustainability of our shop and organization..."

According to a social Work Counsellor at the organization "... As the spread of the disease increased, many of our staffs have gone back from here. The decrease in the number of volunteers and staff was the major difficulties that we felt here...Student interns from different Social Work Colleges used to add to our working forces...But this pandemic has affected internships as we were completely closed.. Despite the role of the person we were demanded to do the duties of caretakers, driver, office management or even sometimes the kitchen duties and the cleaning... As one-third of our patients are geriatric, we were helpless... Medical care was also difficult due to the absence of residential health care professionals..."

DISCUSSION

The impact of Covid-19 on people's lives is an essential topic of discussion in this 21 century.

However, the effects of Covid-19 on a population having severe mental, social and psychological issues are rarely addressed. Here the researcher has studied seven psychosocial rehabilitation centres in Idukki District to identify the social, psychological, physical, technical and economic impact of COVID- 19 in a vulnerable population, particularly the mentally ill.

Among the sample population, one of the organizations subject to the study reported that 95%

of their staff and residents were COVID positives and had gone through a severe crisis on those days. The shortage of staff, Lack of medical support and equipment, absence of timely interventions from health authorities, financial constraints and the possible difficulties in managing psychiatric patients were some of the highlighted issues reported by the particular organization. According to the previous studies the work force and resources in such rehabilitation centers are minimal and thus the economic crisis faced by the organization requires an additional attention to tackle the issues successfully (Fraooq Azham Rathore, Amara llyas, 2020) Furthermore, they say that they could not have the facility to isolate the positive patients separately on account of the infrastructural limitations. Again out of 60 senior residents, more than 50 were seriously sick due to the virus. The deficit in conferring high- quality medical care and interventions makes it difficult for the organization's staff and

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authority to manage the cases. None of the other organizations among the sample population reported such a direct impact of COVID-19.

A few organizations opine that the government and authorities could have taken a more feasible and quick action for the cause. They strongly argue that the authority could have been given more care and attention to the so-called vulnerable population, particularly the patients with mental illness. As majority of the elderly population at the rehabilitation centers are under the medication they are more vulnerable to develop anxiety and tension (Lucc Webb, 2020) particularly in the background of extreme physical pain and distress of Covid-19. The main concern of the NPOs subjected to the study was financial constraints. As charitable organizations, the decreased donations and funds make it all the NPOs challenging to manage the day-to-day activities. Moreover, a few NPOs couldn't pay the full salary of their staff for several months. Another problem reported was the difficulties in executing the pre-planned projects and plans. A few other organizations are in the opinion that postponement of governmental and non-governmental interventions directly impacted their action plans.

A few organizations were concerned about the ethical challenges. They say on account of the difficulties during covid-19, they could not confer quality care and services as they wish to its residents or the service users. Moreover, the limitations in the availability of materialistic and human resources stop them from executing their action plans. Some organization says that community was not sure about the needs and demands of the psychosocial rehabilitation centres. Thus it was tough to express the exact demands and requirements to the community.

The philosophy of psychiatric rehabilitation can be considered as social skill training and social interactions ( Santhosh K Chathurvedi, 2020), but social distancing and other Covid-19 guidelines limited the effort based on the philosophy. Moreover, it is one among the major issues for the residents in rehabilitation centers to practice social distancing, as social interaction for them is considered as a form of therapy (Rob Whitley, Kwame McKenzie, 2005) rather than a means of stress relief or an entertainment in the case of the psychiatric patients. Again, maintaining COVID protocols in the organizations was too difficult, and self- isolation was again risk in the case of the psychiatric residents. According to theoretical and empirical evidences self- isolation for mentally ill is being considered as a negative notion and can have detrimental effects on recovery (Philippe Courtet, Emilie Olie, Christophe Debien, Guillaume Vaiva, (2020)

Besides that according to few respondents of the study, managing admission in the psychiatric centers was a gruelling task. As many of the rehabilitation centres and charitable trusts are intend for the homeless psychiatric patients to limit the admissions was an extremely difficult task (Guidelines of Managing mental illness in hospital setting, Ministry of Health and Family Welfare (2020))

The direct impact of the pandemic has reflected in respondents thoughts. A state wide lockdown and lack of sufficient resources have affected the normal lives of the residents at the organization. In spite of management efforts, the entire organization system remained closed for weeks and months. As per the health records, only half of the residents and staffs got vaccinated. The severity and magnitude of the problems at these humanatarian organizations are beyond imagination.

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In addition to that, Agencies faced challenges in ensuring the safety and security of the professionals working in the organization. Since the Agencies' social workers and management authorities are not part of the health care professionals, the chances of getting vaccination and other government privileges were minimal in the beginning. Considering the facts faced by the psycho Social Rehabilitation centers and the expected challenges ahead, a comprehensive intervention is inevitable for the normal functioning of the centers.

CONCLUSION

To encapsulate the study, the reported impacts of COVID-19 in Non- profit Organizations were hazardous owing to its unique features compared with other social institutions. All the Non- profit psychosocial rehabilitation centres subjected to the study reported some severe impact of COVID- 19 in their daily management, running and sustainability. The Lack of a proper and familiar mechanism to manage the impact of this unprecedented event was one of the highlighted concerns and issues reported by the sample population. A few organizations opine that the government and authorities could have taken a more feasible and quick action to manage the pandemic.

The economical impacts reported in the rehabilitation centers were not negligible. As the whole world has been undergone through severe economical crisis, the proportion of donations and offerings that had been regular to the organizations declined. Economical impacts were projected in terms of quality of food, availability of material items, Wages of workers. Despite the economic issues reported, lack of technical support and deficiency of resources were other significant concerns projected. A few of the organization subjected for the study reported that as the nature of the illness of their patients were different, the organization had to face several inconveniences in attempt of admitting COVID-19 affected patients to general hospitals and while maintaining COVID-19 protocols and guidelines. Therefore it is very much evident that managing differently able and challenged is not that easy as treating or dealing with other normal beings.

Moreover, the cancellations and postponement of projects and funds in COVID-19 devastated few dream projects and hopes of some organizations wishing to improve their quality of service and care. One of the psychosocial rehabilitation centres among the sample population had faced the direct impact of COVID-19 when 95 per cent of its staff and residents were COVID 19 positives. The rest of the other rehabilitation centres do not have such a direct consequence of the pandemic. But still, the indirect impacts affected the sustainability and daily running of the organizations.

When it comes to the specific concerns and issues of psycho- social rehabilitation centres on the background of COVID-19, the findings of the case study were obviously different and unique comparing with other sectors and type of organizations. The insufficient number of staff, Lack of medical equipment, Lack of support from the medical professionals, and the limitations while dealing with the mentally ill population were the significant problems when a large section of the people became COVID positives. However, it cannot deny that the studies and the reports on the negative impacts of COVID 19 in psychosocial rehabilitation centres are rarely done particularly the effect of economical impacts of covid-19 up on psychiatric rehabilitation centers were almost none. Moreover, the identified results are severe and need to

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be tackled urgently to ensure that these Non- Profit Organizations (NPO) continue their services to the society .

REFERENCES

1. Courtet P, Olié E, Debien C, Vaiva G (2020) Keep socially (but not physically) connected and carry on. Journal Clinical Psychiatry.;81

2. Chaturvedi S. K. (2020). Covid-19, Coronavirus and Mental Health Rehabilitation at Times of Crisis. Journal of psychosocial rehabilitation and mental health, 1–2.

3. Johnson, B. & Christensen, L. (2012). Educational Research: Quantitative, Qualitative, And Mixed Approaches. Thousand Oaks: SAGE Publications

4. Ministry of Health and Family Welfare (2020), Guidelines of Managing mental illness in hospitalsetting:https://www.mohfw.gov.in/pdf/GuidelinesforDeliveryofMentalMentalHea lthcareServicesduringtheCOVID19.pdf

5. Rathore FA, Ilyas A (2020) Post-intensive care syndrome and COVID-19: crisis after a crisis? Hear Lung Circ.

6. RibbensMcCarthy, J. R.(2006). Young People's Experiences Of Loss And Bereavement:

Towards An Interdisciplinary Approach. Maidenhead, UK: Open University Press. URL:

http://www.mcgraw-hill.co.uk/html/0335216641.html

7. Saha, S., Chauhan, A., Buch, B., Makwana, S., Vikar, S., Kotwani, P., & Pandya, A.

(2020). psychosocial rehabilitation of people living with mental illness: Lessons

Learned from community-based psychiatric rehabilitation centers in Gujarat. Journal of family medicine and primary care, 9(2), 892–897.

8. Thirthahalli C, Shetty P (2020)Impact of COVID-19 on cancer screening by Non- Governmental Organizations and the way forward. Indian J Cancer;57:485-6

9. Webb L. Covid‐19 lockdown (2020): a perfect storm for older people’s mental health. J Psychiatr Ment Health Nurs. 2020;jpm.12644.

10. Whitley, Rob, Mc Kenzie, Kwame (2005) Social Capital and Psychiatry: Review of the Literature, Harvard Review of Psychiatry: - Volume 13 - Issue 2 - p 71-84

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