Tomorrow, on the 12th August I, as member of the Bapu Trust's Centre for Advocacy in Mental Health's team, shall meet with Maharashtra State mental health policy makers. I will talk about the experience of the user/survivor controlled Hungarian Mental Health Interest Forum on how to bring about changes in mental health policies via a meaningful involvment of the user community. The meeting will be part of the Bapu Trust led Jan Manasik Arogya Abhiyan (JMAA) campaign.
Background information on mental health in Maharashtra
JAN MANASIK AROGYA ABHIYAN [JMAA]
A people's campaign for the fundamental rights and freedoms of persons with a psychiatric disability, MaharashtraConcept Note
History of the movement
The Goals of JMAA
The Objectives of JMAA
Scope of the mental health sector
Condition of mental hospitals in India
Private care
Medico-legal interventions in mental health
Mental health, budgets and spending
State policy in mental health
Mental illness and disability
Mental Health Act, 1987
Traditional knowledge in mental health
Media
Nameless people
Building partnerships
Scope of rights for persons with a mental illness :
Jan Manasik Arogya Abhiyan (JMAA) is a human rights based, people's campaign in the area of mental health. It is a state level forum working in Maharashtra aiming to humanize the mental health system and restore the self determination, rights and dignity of persons with psychosocial disabilities. It is a platform built in order to engage various stake holders on the vital issue of the “right to mental health care”. The people’s campaign aims to press for service related reform in the mental health sector, and good quality mental health care, while being equally concerned about the entire scope of human rights violations in mental health. The JMAA aims to foster and strengthen a societal discourse on “human rights” for persons with psychiatric disabilities based on the values of citizenship for all, full autonomy, personal liberty, total well being and access to justice.
Persons with psychiatric disability are considered by modern mental health discourses (law, science, services, social attitudes) as lacking “capacity” and as non-persons. For example, persons with psychiatric disabilities do not have the right to vote, to hold public office, to marry, to adopt a child, to enter into contract, etc. In the service sector, such persons are seen as not being capable of taking decisions about their own care and treatment. Consent from psychiatric patients is mostly not taken. In society at large, they are seen as not being capable of taking major life decisions. JMAA challenges these negative views.
JMAA also challenges the various legal, scientific and social practices that result from these views. Such views have led to a situation where the rights of persons with the disability are not recognized in any sector: legal, service or societal. Most socio-economic and civil political rights are taken away from them. JMAA endorses the fundamental rights and liberties of persons with psychiatric disability, on a par with all other persons in society. JMAA emphasizes the fact that a regime of equal opportunities and non-discrimination must be created to enhance the quality of life of persons with such disabilities.
History of the movement:Why is there a need to start another campaign? Is it not possible to mainstream the agendas in mental health through other existing people's movements or human rights forums?
Persons labelled with a "mental illness" are the most marginalised in society. They are treated as people without histories and as voiceless people. There has to be a space for their mobilisation and political participation in decisions made about their lives, health and well being. JMAA is founded on principles of "self-determination" of persons with a psychosocial disability.
Maharashtra has seen the emergence of the self help movement in mental health. The first user mobilisation for mental health patients in India was started in Pune, called Sihaya Samooh, leading to the formation of other self help groups. JMAA is linked to these user led initiatives in mental health.
JMAA is also linked to the spirit and vision underlying other movements: health care rights, women’s rights, and other human rights campaigns in the development sector. We however, note that, in these forums, issues of the psychosocially disabled and of those with a mental illness, remain low priority areas or totally invisible. Various mental health forums exist (such as the National Federation for the Mentally Ill) in India, but these do not address the self determination of users of mental health services or issues pertaining to their fundamental rights and freedoms. In other states (e.g. Karnataka) forums exist for influencing the judiciary, the policy makers and the state department in mental health sector reform. In Maharashtra, there is no such forum. We have much to learn from initiatives in other regions of India, which can be consolidated for Maharashtra as well.
The problems of persons with a psychiatric disability are different from other vulnerable groups (e.g. health care patients) and needs to be addressed as an independent area of activism. Bapu Trust initially proposed this Campaign for these reasons.
The Goals of JMAA are:
To build a mental health platform / coalition comprising of diverse groups of organisations and individuals for bettering the quality of mental health services in the state of Maharashtra
To educate various constituencies in society on the civil as well as care and treatment rights of persons with mental illness
To bring forth relevant information and materials on the status of mental health services in Maharashtra and to lobby with the local government and relevant authorities
To advocate the fundamental rights and freedoms of persons with psycho-social disabilities in the state of Maharashtra
To connect with local or national platforms for bringing about changes in thinking and practice within the mental health system in India
The Objectives of JMAA are:
To mobilise users of mental health services in the State of Maharashtra
To spread awareness about the self-determination, and the rights and freedoms of persons with a psychosocial disability in our society
To conduct advocacy research on issues pertaining to the rights of persons with mental illness
To take JMAA to all human rights, policy and legal forums, and to mainstream our issues in other people's movements
To advocate for a human rights compliant law and policy for persons with a psychosocial disability
To bring national and international human rights thinking into the local campaign
Scope of the mental health sectorThere are huge numbers of men and women who are diagnosed with a mental illness every year in India. This is only the tip of the iceberg, however, as psychiatric diagnosis captures only the most disabling layer, viz. those whose distress levels reach a clinical stage. Psychological and psychosocial studies show that a continuum exists from good mental health up to mental illness and disability, and that the number of people in situations of psychosocial distress is quite high. Studies which measure psychiatric symptoms are probably more reflective of community need, than diagnosis based studies. Qualitative studies are even richer in the presentation of community needs. Social vulnerability is surely a dimension associated with mental distress and disability.
It is generally accepted in the Indian context, that approximately 2-3% of the population suffer from Severe Mental Disorders (schizophrenia, bipolar disorders, organic disorders), whereas the prevalence of common mental health disorders, a broader spectrum of clinically significant mental distress, could be in the range of 10-25%, depending on the socio-demographic context (age, educational status, marital status, whether in conflict or disaster situation, economic status, etc.) Sex / Gender are important determinants of being diagnosed with a mental illness. Vulnerable groups (women, elderly, poor, etc.) are picked out more often on such psychiatric surveys than other groups, showing higher levels of stress relating to social inequality, violence, trauma and deprivation. Domestic, cultural and child related abuse and violence are highly pertinent in the context of women’s mental health. Typically also, going by the data gathered from primary health care sites in India as well as elsewhere, physical health and mental health are inter-related. This has particular significance for women, where the prevalence of vitamin and mineral deficiency, malnutrition, anaemia, and thyroidism after pregnancy are quite high, showing up as psychological distress.
Condition of mental hospitals in India:The mental health research in the country has shown a high “need” among communities for good mental health services, particularly those types of services, which will address psychosocial problems (psychotherapies, counselling, community mental health programs, peer support, home visitors, etc.) The condition of mental hospitals in India is described in the NHRC report, 1999.
The NHRC report, 1999, covered 37 government facilities. 37.8% of mental hospitals in India, including Maharashtra, still retain a jail like structure they had at the time of their inception. 56.8% have high walls. Low patient : cot ratio (1:1.3), suggests over crowding in hospitals. Toilet : patient ratio is 1:5. 35% of hospitals had very dirty toilets, where there was no running water. 37.8% had inadequate lighting. 89.2% had closed / locked wards. 51.3% had only closed wards. 43.2% of hospitals had solitary confinement cells. Cells do not have linen, water, beds or toilets. Patients remain locked all the time. They have to urinate and defecate in the cell itself. Criminal wards are worse off than other wards. In gross violation of the Mental Health Act, separate facilities for children were present in just 10.8% of the hospitals. Dinner is served at 5.30 or 6 pm in most hospitals. So patients have virtually nothing to eat for 13 to 14 hours. 70.3% of hospitals had very inadequate maintenance of hospital infrastructure. Privacy for patients in wards was there in only 41% of the hospitals. In 59.5% of hospitals clothes of patients are changed once in 2-3 days. In other hospitals frequency is even less. Case file recording is extremely inadequate. Only 51.4% of hospitals fully complied with the mental health law (Mental Health Act). Even routine blood and urine tests are not available in more than 20% of the hospitals even for the inpatients. Psychosocial investigation facilities are available in even fewer places. This is because of a lack of awareness of a multidisciplinary approach, the lack of trained professionals and absence of role clarity and functions. Direct shock treatment is still practiced in half the hospitals. Rehabilitation therapies are available in only two thirds of the hospitals. Only in 68% hospitals are family members allowed to visit patients. Even in these hospitals, there are restrictions in the visits to the patients in locked wards. Only 2% to 30% of patients used the facility to write letters, possibly because they are not encouraged or helped to write these letters. 75% of hospitals reported that the staff was sensitized about the rights of the mentally ill, but the visits revealed that most staff members were neither aware nor sensitized about the same. Emergency services are available only in 59.5% of the hospitals. Only 32% of the authorities felt that there were adequate facilities in the casualty. 51% of hospital authorities reported that they rated their own OPD service as inadequate. The psychiatrist : patient ratio in a majority of the hospitals are skewed, being as poor as 1:150 or even 1:200, when the ideal prescribed ratio is 1:10. In 21.6%, there are no posts of clinical psychologists. Even where there were posts, half of them were vacant. 50% of the hospitals therefore did not have a clinical psychologist. In 30% of the hospitals, there was no post of a psychiatric social worker. Wherever there are, one third of the posts were vacant. They were deskilled, being reduced to clerical staff or history takers. The MOs do not have any special training in the care of the mentally ill. 51% of the hospitals did not have a post of psychiatric nurse. 10.8% of the hospitals are functioning without the services of any nursing staff. This brief presentation of data shows that the overly medicalised mental health system in India is not able to match the needs even in terms of sheer numbers, not mentioning quality of care.
Studies have shown that
There are fewer beds for women than for men in most mental hospitals. The overall hygiene and environment of the female wards are far inferior to that prevailing in the men’s wards.
The female wards are often closed wards, whereas the men have better access to open spaces and open wards.
Visitors are fewer for the female patients, and long stay patients are higher in the female section.
Women’s emotional expression particularly dissent or anger is seen as a symptom and further treatment begun. Women are expected to conform to their stereotypes to be considered as a “good” patient.
Women’s reproductive health needs are least attended to in the mental hospitals. Menstrual hygiene is not provided for.
Self grooming, an important cultural and social expectation placed before women, is least attended to in these sites. Women’s heads are shaved, their clothing is inappropriate and undignified, other aspects of personal grooming (comb, oil, face powder, mirror, etc.) are not provided for.
Rehabilitation for women is also another huge area where thought has to be processed and work planned in a more gender sensitive manner.
More women than men with a severe mental disorder run the risk of desertion and homelessness, loss of custody of children, family, employment, etc.
Medico-legal procedures for men and women are differential, needing to be reviewed.
These are only examples of the inequality, discrimination and poor opportunity for women in the mental health sector. Other vulnerable groups (children, those with a different sexual orientation, the poor) have equally disempowering experiences within the mental health sector. Various Supreme Court directives, the directives of the High Court (Mahajan Committee Recommendations) and the NHRC recommendations are empty words before these large institutions of Maharashtra.
MaharashtraMaharashtra has a total of 4 state run mental hospitals. The total bed strength is 5695 in the 4 mental hospitals, which is one fourth the entire bed strength of mental hospitals in India. Long stay patients (who have stayed for more than 2 years) is the greatest in Maharashtra, indicating that these facilities are perceived as dumping grounds by the communities.
Thane mental hospital: All wards are locked wards. About 50% of patients have adequate cots and bedding. Most of the wards are overcrowded. The number of mental health professionals is far less when compared to the bed strength (1880 beds). Only 10% admissions are voluntary admissions. All others are involuntary commitments. 26% of patients are “long stay”, who have been there for five or more years. Women are not discharged without an escort. Facilities for medical emergencies are poor. The hospital does not have a casualty and emergency service. There is no short stay ward. The average time spent with an old patient is 5 minutes, and with a new patient is 15 minutes. As a result, interventions are mainly medical. Patients reported that bathing facilities are not adequate and clothes are dehumanizing, as they are not changed as frequently as they would like. Although the quantity of food may be adequate, it is not sufficient in terms of nutritive value. Management of patients is mainly medical, with the use of drugs and modified ECTs. Solitary confinement is being used. Patients complained that they were not being able to contact family members. There is hardly any psychosocial intervention. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities.
Pune mental hospital: Bed strength: 2540. The number of cots is inadequate, at the ratio of 1:5. Existing toilets, fans and lighting arrangements are not adequate. The staff patient ratio is inadequate considering the bed strength. Voluntary admissions: 27%. Female patients are not discharged without escort. There is an absence of psychiatric facilities at the district level, and so the hospital is the only service center. No emergency or casualty services. The average waiting time is 30 minutes to an hour, with 10 minutes being spent with each patient. No individual or family counseling. No separate wards for patients in acute and chronic phase. Both direct and modified ECT are being used. Pharmacotherapy is the mainstay of treatment. Physical restraint and solitary confinement are being used. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities. All are closed wards. Newer drugs are not available.
Nagpur mental hospital: Bed strength: 910. There are no open wards. Bathing facilities, toilets are inadequate. Voluntary admissions: only 14%. 46% of patients are long stay. Female patients are not discharged without escort. No casualty and emergency services. New cases: 15 minutes; follow up: 3-5 minutes. Newer drugs are not available. Direct ECTs are administered in OPD. Modified ECT is being given to inpatients. Psychosocial input is not provided. Pharmacotherapy is the mainstay of treatment. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities.
Ratnagiri: Bed strength: 365. All locked wards. Voluntary admissions: 79%. 25% patients are long stay. Female patients are not discharged without escort. No emergency or casualty services. New cases: 15 minutes; follow up: 5 minutes. Modified ECT administered when required in OPD. No psychosocial intervention. Management of patients is mainly medical, with the use of drugs, direct and modified ECTs. Very few patients attend occupational therapy facilities.
Private care
Population of Maharashtra and the number of doctors / clinical psychologists:There is a huge deficit of mental health services in Maharashtra, as in the rest of India.
Total population: 96752247
Estimated major mental disorders: 967522
Estimated minor mental disorders: 4837610
Existing hospital beds (government sector): 6073
Existing hospital beds (Private): 652
Available psychiatrists: 456; Ideal number: 967; Deficit: 481
Available clinical psychologists: 33; Ideal number: 484; Deficit: 451
Available psychiatric social workers: 44; Ideal number: 1934; Deficit: 1890
Available psychiatric nurses: 117; Ideal number: 672; Deficit: 555
Districts with psychiatric facilities: 17
Districts without psychiatric facilities: 18
Failure of the government machinery to address the mental health needs of communities has led to a surge in the number of private practitioners and rehabilitation centers. Over 70-80% of doctors in Maharashtra are in private practice, often working only in urban areas. While being educated on government subsidy, their contribution to the public health system is negligible. Large numbers of government posts remain unfilled. The local chapters of the professional organisations such as the Indian Psychiatric Society have not set standards of care for mental health practice in Maharashtra. The social context of people's lives is often not considered by the treating doctors. Over prescription, irrational drug treatments, and poly pharmacy plague the sector. Standardised tools for clinical assessments do not exist. Diagnosis is left to the subjective evaluations of doctors. Aspects of preventive and promotive services are overlooked. ECT is unregulated. The abuse of shock treatment in the Indian set up is a human rights issue. In Maharashtra, direct ECT is still being practiced by private mental institutions.
Medico-legal interventions in mental healthIn the medical sector, a clinical action may or may not have legal implications. In the mental health field, a clinical action has at the same time, legal implications. Data in the field shows that out of a 100 divorce petitions filed on the ground of “insanity”, 97% are filed by husbands against wives. This shows structural layers of vulnerability in the community, to a finding of mental illness. Everyday actions and decision making such as managing a bank account, or a property / financial asset, having a family, participating in social functions, etc. becomes extremely difficult given the present scope of the law. Many people who are employed get sacked when their diagnosed status is disclosed. Persons labeled with a mental illness, more significantly the women, live a life of stigma, discrimination and exclusion because the legal administration has allowed it. The law has in no way tried to alleviate this situation. Instead, it has set up its own barriers in every dimension of life.
Every time a person is diagnosed with a “mental illness”, certain medico-legal implications such as the above follow because of the way our laws are written up or executed. These legal implications can be used or abused by others with a vested interest in the personal or other aspects of the diagnosed patient’s life. Medical professionals called upon to execute the law (e.g. certification of legal capacity) often do not have the necessary legal trainings required for this responsible job. Corruption by professionals is not unknown, and neither is legal negligence. Recent cases reported in the press with respect to the Agra mental hospital show that false certification of a woman as mentally ill for purposes of easy divorce is a profitable business.
In order to effect the legal implications of a finding of mental illness, a certification is necessary. Psychiatrists have the power to issue such certificates of mental fitness. However there is no procedure in the profession by which the psychiatrists are trained in law to measure fitness or capacity. Therefore judgments by the psychiatrists become subjective and personal. This increases the risk of causing harm to the person and the risk of unfairly taking away a person's rights. Among all medical professionals, only psychiatrists have the power to direct the course of the lives of their patients legally.
The medico legal sector in mental health is totally involuntary, posing serious ethical contradictions with the larger biomedical sector, which is bound by patient consent and voluntarism. The implications of being diagnosed with a “mental illness” are also not there for a general health care patient. A charge of being of “unsound mind” can take away a range of human rights and opportunity for self determination (contracting, holding public office, employment, being married, adopting a child, voting, etc.) This charge of USM can result in the take over of a person’s life through guardianship arrangements. A charge of being “mentally ill”, in terms of legal scope and format, entails the same status as being accused of a crime, as the care & treatment laws are of a custodial nature. A person is committed to a hospital, often through the use of the many provisions in law for involuntary commitment and forced treatment. Therefore, before the eyes of the law, a person is an alleged mentally ill person, a perception in law which completely undermines the identity of the sick and the disabled. As noted above, most commitments to the mental hospitals in India are involuntary. Four out of the five commitment procedures written in law are involuntary, while even voluntary commitment is determined within the scope of the law.
The recently signed United Nations Convention on the Rights of Persons with Disability [CRPD] is providing an opportunity to foundationally challenge these presumptions. The Convention is giving us an opportunity to create an alternative legal framework for people with psychosocial disabilities.
Mental health, budgets and spending:Mental health is an invisible subject in public health debates and in policy. India spends a fraction of its total health budget on mental health. As we all know, public health itself is a highly neglected area. Money available has been spent mainly on hospital / tertiary care. Upto 80% of the money allocated to psychiatric hospitals are being spent on salaries, leaving very little for user centered programs or client rehabilitation. Recently, under the 10th five year plan outlay a budget of Rs. 190 crores was released to strengthen the mental health sector in India. However, much of this budget is towards upgradation of the mental hospitals and further creation of medical facilities. While the whole world is moving towards community, very little money has been allocated for strengthening the community mental health services. The situation for the XI five year plan does not appear to be very different. Hitherto, monies unutilised on the community mental health program has been returned back by the nodal agencies to the Govt of Maharashtra. The Government needs to also publicly account for the monies received under the X Plan.
Like the health industry, the mental health industry is working for profit. The pharmaceutical and instrumentation industry are economic beneficiaries of private practice. Many private residential facilities charge fees, which range anywhere between Rs. 8000/= to Rs. 20-25000/= per month to care for a client. Psychiatrists may charge between 250/= rupees to 600/= rupees per session. An ECT dose (6-10 ECTs) will cost anywhere between 1000/- rupees to 10000/- rupees depending on the type of facility. Families have to spend a lot of money on an everyday basis on expensive drugs. Often, for what is considered as chronic disability, this expenditure may be life long.
State policy in mental health: Mental health services have not kept pace with the demand or improved as much as the rest of the Health Services. The National Mental Health Program has not been revisited, since 1982. The NMHP emphasised community level interventions through District mental health programs. It resonated with the Alma Ata vision of mental health care for all. In 1996, a blue print for the District Mental Health Program was laid out for India, giving the following guidelines:
To provide sustainable basic mental health services to the community and to integrate these services with other health services
Early detection and treatment of patients within the community itself
To see that patients and their relatives do not have to travel long distances to go to hospitals or to nursing homes in cities
To reduce the stigma attached to mental illness through change of attitude and public education
To treat and rehabilitate mental patients discharged from the mental hospital within the community
The state will set in motion the process of finding suitable personnel for manning the DMH team. They can take in service candidates who are willing to serve in the pilot projects and provide them the necessary training in the identified institution
Catchment Area will be the patients from the district itself and adjoining areas
DMH team will be expected to provide services to the needy mentally ill persons and their families as follows
Most parts of India are largely underserved to address the needs of persons with a mental illness at the community level. India does not have a mental health policy.
The models developed in the state of Karnataka, by NIMHANS, were proposed to be replicated everywhere. In Maharashtra, there are 6 DMHP programs running, of which the one in Raigad district is the oldest. These programs have not been evaluated. The quality of services in these programs is very poor, being limited to drug dispensing at the community level. Psychosocial interventions are absent in all of the DMHPs dotting the country, and also in Maharashtra. It is quite clear that the mental health services are not matching up the service reality.
Mental illness and Disability The Persons with Disabilities Act, 1995, includes "disability caused by psychiatric problems". It is the last category of disability listed in the Act. States like TN and Karnataka are bringing about reforms in the mental health sector. The Maharashtra state government gives very low priority to this disability. There is no state initiative or program for persons with a mental illness. Officers in the commissionerate are not even aware that psychiatric disability is represented in the Act. There is no representation from this disability group in the state level committee. Very few people with a psychosocial disability in the state have received a disability certificate due to lack of awareness and tiring administrative procedure. Complaints filed in the disability department take many months, if not years, to be addressed. There are also inherent limitations of the Act, such as the exclusion of persons with psychosocial disability from job reservations. In a progressive move, a recent Bombay High Court judgment reinstated a mentally ill nurse who was forced to resign by the hospital management.
Mental Health Act, 1987The mental health sector is driven by the mental health law (MHA, 1987). MHA has been criticized for its many problems. It talks only about the procedure for admission. Three out of four types of admissions in the Act are involuntary commitments. The process of applying this Act is humiliating for the patients. Often unlawful deprivation of liberty happens. There are limitations on voluntary discharge. A cardiac patient may be discharged on his own reason and will, but a psychiatric patient will not be so discharged under our present statute concerning the custodialisation of the mentally ill (section 40 –44 of The Mental Health Act, 1987). The Act does not say anything about the rights of users within institutions. The NMHP is community based, whereas the law is completely custodial. There is no relationship between the two. The Act does not talk about rehabilitation at all, or how persons in hospitals can be mainstreamed in society and live lives of dignity. Therefore, it remains organ oriented in its approach. There are active forums now for law reform in this sector, which JMAA will participate in.
Traditional knowledge in mental healthSeveral traditional healing practices exist in Maharashtra, which offer psychological succor to communities. They exist in outlying areas where mental health services are simply not available. There is growing evidence base, which suggests the value of these practices in mental healing. However, the mental health system does not take this aspect into consideration.
Media The media characterises people with psychosocial disability as criminal, bad and violent. They become the subject for humour and ridicule. They are shown as sexually abnormal, helpless, weak and incapable of participating fully in community life. They are shown as a subject for sympathy, pathos or pity. They are shown as a burden on the society. A popular newspaper in Maharashtra literally witch hunted a patient and her family, when she attacked the editor of the said paper. Her photograph was put up in every article concerning the event and her mental health status was open to wide public scrutiny and display. The criminal case filed against her is still alive in a local court.
Mentally ill people are rarely shown as productive members of the community, as students, teachers, workers or as parents. Nor are they ever shown as normal people, with their usual joys and sorrows, who may sometimes have periods of distress. Their potential, capacity and creativity are not shown. Their lives are depicted as one of total and abject misery and lack of capacity.
The nameless peopleMost custodial institutions in Maharashtra (beggars' home, jails, state homes for women, remand homes, etc.) have a large proportion of people who are psychologically disabled. These institutions are literally parallel “mental hospitals”. These people are living in highly degraded conditions without any basic facility or mental health care provision. There is also a huge population of the homeless wandering mentally ill. There is no service facility in all of Maharashtra to serve this population. Mental hospitals, following a human rights PIL in the late ‘80s, have started placing severe restrictions on taking care of this population. The human rights violations of these groups are enormous.
Building partnerships: Through JMAA, we raise a call to solidarity, allying and partnering with individuals, groups, organizations and professionals, working in the field of human rights, people's rights, advocacy, mental health, disability and allied areas in the state of Maharashtra. This collective will give vision, direction, set the agendas and plan action for the campaign.
Scope of rights for persons with a mental illness :Right to life and liberty including
The right to bodily integrity; the right to a safe and violence free environment; the right to survival and to a life of quality; the right to voluntary care and treatment; the right to refuse treatment; Right to full legal capacity including
The right to marry; to enter into contracts (e.g. property, insurance); to adopt a child; to have children; right to work and opportunity; right to receive speedy justice; to hold professional licence; to legal representation; and the right to political representation.
Right to care and treatment including
The right to full information regarding care and treatment; informed choice; right of access to affordable, quality health care; right to non-medical care and treatment approaches; right of protection against cruel and degrading treatments; right to privacy and confidentiality.
Right to Community life and development
The right to education, livelihood, food, employment, housing, cultural life, sports and recreation, social security, the right to have intimate relationships, right to have children, the right to vote and hold public office.
JMAA convenor since 2005: The Bapu Trust, Pune.JMAA co-ordinator: Sadhana Khati (Susamvaad and Bapu Trust, Pune)JMAA organiser: Chandra Karhadkar (Bapu Trust, Pune)
Center for Advocacy in Mental HealthA research center of Bapu TrustKapil Villa, Plot no. 9Survey No. 50/4, Kondhwa KhurdPune-411048Tel: 020-26837644/47Email: wamhc@dataone.in; info@camhindia.org
The Campaign is supported financially by Action Aid India, Mumbai Regional Office.
A people's campaign for the fundamental rights and freedoms of persons with a psychiatric disability, MaharashtraConcept Note
History of the movement
The Goals of JMAA
The Objectives of JMAA
Scope of the mental health sector
Condition of mental hospitals in India
Private care
Medico-legal interventions in mental health
Mental health, budgets and spending
State policy in mental health
Mental illness and disability
Mental Health Act, 1987
Traditional knowledge in mental health
Media
Nameless people
Building partnerships
Scope of rights for persons with a mental illness :
Jan Manasik Arogya Abhiyan (JMAA) is a human rights based, people's campaign in the area of mental health. It is a state level forum working in Maharashtra aiming to humanize the mental health system and restore the self determination, rights and dignity of persons with psychosocial disabilities. It is a platform built in order to engage various stake holders on the vital issue of the “right to mental health care”. The people’s campaign aims to press for service related reform in the mental health sector, and good quality mental health care, while being equally concerned about the entire scope of human rights violations in mental health. The JMAA aims to foster and strengthen a societal discourse on “human rights” for persons with psychiatric disabilities based on the values of citizenship for all, full autonomy, personal liberty, total well being and access to justice.
Persons with psychiatric disability are considered by modern mental health discourses (law, science, services, social attitudes) as lacking “capacity” and as non-persons. For example, persons with psychiatric disabilities do not have the right to vote, to hold public office, to marry, to adopt a child, to enter into contract, etc. In the service sector, such persons are seen as not being capable of taking decisions about their own care and treatment. Consent from psychiatric patients is mostly not taken. In society at large, they are seen as not being capable of taking major life decisions. JMAA challenges these negative views.
JMAA also challenges the various legal, scientific and social practices that result from these views. Such views have led to a situation where the rights of persons with the disability are not recognized in any sector: legal, service or societal. Most socio-economic and civil political rights are taken away from them. JMAA endorses the fundamental rights and liberties of persons with psychiatric disability, on a par with all other persons in society. JMAA emphasizes the fact that a regime of equal opportunities and non-discrimination must be created to enhance the quality of life of persons with such disabilities.
History of the movement:Why is there a need to start another campaign? Is it not possible to mainstream the agendas in mental health through other existing people's movements or human rights forums?
Persons labelled with a "mental illness" are the most marginalised in society. They are treated as people without histories and as voiceless people. There has to be a space for their mobilisation and political participation in decisions made about their lives, health and well being. JMAA is founded on principles of "self-determination" of persons with a psychosocial disability.
Maharashtra has seen the emergence of the self help movement in mental health. The first user mobilisation for mental health patients in India was started in Pune, called Sihaya Samooh, leading to the formation of other self help groups. JMAA is linked to these user led initiatives in mental health.
JMAA is also linked to the spirit and vision underlying other movements: health care rights, women’s rights, and other human rights campaigns in the development sector. We however, note that, in these forums, issues of the psychosocially disabled and of those with a mental illness, remain low priority areas or totally invisible. Various mental health forums exist (such as the National Federation for the Mentally Ill) in India, but these do not address the self determination of users of mental health services or issues pertaining to their fundamental rights and freedoms. In other states (e.g. Karnataka) forums exist for influencing the judiciary, the policy makers and the state department in mental health sector reform. In Maharashtra, there is no such forum. We have much to learn from initiatives in other regions of India, which can be consolidated for Maharashtra as well.
The problems of persons with a psychiatric disability are different from other vulnerable groups (e.g. health care patients) and needs to be addressed as an independent area of activism. Bapu Trust initially proposed this Campaign for these reasons.
The Goals of JMAA are:
To build a mental health platform / coalition comprising of diverse groups of organisations and individuals for bettering the quality of mental health services in the state of Maharashtra
To educate various constituencies in society on the civil as well as care and treatment rights of persons with mental illness
To bring forth relevant information and materials on the status of mental health services in Maharashtra and to lobby with the local government and relevant authorities
To advocate the fundamental rights and freedoms of persons with psycho-social disabilities in the state of Maharashtra
To connect with local or national platforms for bringing about changes in thinking and practice within the mental health system in India
The Objectives of JMAA are:
To mobilise users of mental health services in the State of Maharashtra
To spread awareness about the self-determination, and the rights and freedoms of persons with a psychosocial disability in our society
To conduct advocacy research on issues pertaining to the rights of persons with mental illness
To take JMAA to all human rights, policy and legal forums, and to mainstream our issues in other people's movements
To advocate for a human rights compliant law and policy for persons with a psychosocial disability
To bring national and international human rights thinking into the local campaign
Scope of the mental health sectorThere are huge numbers of men and women who are diagnosed with a mental illness every year in India. This is only the tip of the iceberg, however, as psychiatric diagnosis captures only the most disabling layer, viz. those whose distress levels reach a clinical stage. Psychological and psychosocial studies show that a continuum exists from good mental health up to mental illness and disability, and that the number of people in situations of psychosocial distress is quite high. Studies which measure psychiatric symptoms are probably more reflective of community need, than diagnosis based studies. Qualitative studies are even richer in the presentation of community needs. Social vulnerability is surely a dimension associated with mental distress and disability.
It is generally accepted in the Indian context, that approximately 2-3% of the population suffer from Severe Mental Disorders (schizophrenia, bipolar disorders, organic disorders), whereas the prevalence of common mental health disorders, a broader spectrum of clinically significant mental distress, could be in the range of 10-25%, depending on the socio-demographic context (age, educational status, marital status, whether in conflict or disaster situation, economic status, etc.) Sex / Gender are important determinants of being diagnosed with a mental illness. Vulnerable groups (women, elderly, poor, etc.) are picked out more often on such psychiatric surveys than other groups, showing higher levels of stress relating to social inequality, violence, trauma and deprivation. Domestic, cultural and child related abuse and violence are highly pertinent in the context of women’s mental health. Typically also, going by the data gathered from primary health care sites in India as well as elsewhere, physical health and mental health are inter-related. This has particular significance for women, where the prevalence of vitamin and mineral deficiency, malnutrition, anaemia, and thyroidism after pregnancy are quite high, showing up as psychological distress.
Condition of mental hospitals in India:The mental health research in the country has shown a high “need” among communities for good mental health services, particularly those types of services, which will address psychosocial problems (psychotherapies, counselling, community mental health programs, peer support, home visitors, etc.) The condition of mental hospitals in India is described in the NHRC report, 1999.
The NHRC report, 1999, covered 37 government facilities. 37.8% of mental hospitals in India, including Maharashtra, still retain a jail like structure they had at the time of their inception. 56.8% have high walls. Low patient : cot ratio (1:1.3), suggests over crowding in hospitals. Toilet : patient ratio is 1:5. 35% of hospitals had very dirty toilets, where there was no running water. 37.8% had inadequate lighting. 89.2% had closed / locked wards. 51.3% had only closed wards. 43.2% of hospitals had solitary confinement cells. Cells do not have linen, water, beds or toilets. Patients remain locked all the time. They have to urinate and defecate in the cell itself. Criminal wards are worse off than other wards. In gross violation of the Mental Health Act, separate facilities for children were present in just 10.8% of the hospitals. Dinner is served at 5.30 or 6 pm in most hospitals. So patients have virtually nothing to eat for 13 to 14 hours. 70.3% of hospitals had very inadequate maintenance of hospital infrastructure. Privacy for patients in wards was there in only 41% of the hospitals. In 59.5% of hospitals clothes of patients are changed once in 2-3 days. In other hospitals frequency is even less. Case file recording is extremely inadequate. Only 51.4% of hospitals fully complied with the mental health law (Mental Health Act). Even routine blood and urine tests are not available in more than 20% of the hospitals even for the inpatients. Psychosocial investigation facilities are available in even fewer places. This is because of a lack of awareness of a multidisciplinary approach, the lack of trained professionals and absence of role clarity and functions. Direct shock treatment is still practiced in half the hospitals. Rehabilitation therapies are available in only two thirds of the hospitals. Only in 68% hospitals are family members allowed to visit patients. Even in these hospitals, there are restrictions in the visits to the patients in locked wards. Only 2% to 30% of patients used the facility to write letters, possibly because they are not encouraged or helped to write these letters. 75% of hospitals reported that the staff was sensitized about the rights of the mentally ill, but the visits revealed that most staff members were neither aware nor sensitized about the same. Emergency services are available only in 59.5% of the hospitals. Only 32% of the authorities felt that there were adequate facilities in the casualty. 51% of hospital authorities reported that they rated their own OPD service as inadequate. The psychiatrist : patient ratio in a majority of the hospitals are skewed, being as poor as 1:150 or even 1:200, when the ideal prescribed ratio is 1:10. In 21.6%, there are no posts of clinical psychologists. Even where there were posts, half of them were vacant. 50% of the hospitals therefore did not have a clinical psychologist. In 30% of the hospitals, there was no post of a psychiatric social worker. Wherever there are, one third of the posts were vacant. They were deskilled, being reduced to clerical staff or history takers. The MOs do not have any special training in the care of the mentally ill. 51% of the hospitals did not have a post of psychiatric nurse. 10.8% of the hospitals are functioning without the services of any nursing staff. This brief presentation of data shows that the overly medicalised mental health system in India is not able to match the needs even in terms of sheer numbers, not mentioning quality of care.
Studies have shown that
There are fewer beds for women than for men in most mental hospitals. The overall hygiene and environment of the female wards are far inferior to that prevailing in the men’s wards.
The female wards are often closed wards, whereas the men have better access to open spaces and open wards.
Visitors are fewer for the female patients, and long stay patients are higher in the female section.
Women’s emotional expression particularly dissent or anger is seen as a symptom and further treatment begun. Women are expected to conform to their stereotypes to be considered as a “good” patient.
Women’s reproductive health needs are least attended to in the mental hospitals. Menstrual hygiene is not provided for.
Self grooming, an important cultural and social expectation placed before women, is least attended to in these sites. Women’s heads are shaved, their clothing is inappropriate and undignified, other aspects of personal grooming (comb, oil, face powder, mirror, etc.) are not provided for.
Rehabilitation for women is also another huge area where thought has to be processed and work planned in a more gender sensitive manner.
More women than men with a severe mental disorder run the risk of desertion and homelessness, loss of custody of children, family, employment, etc.
Medico-legal procedures for men and women are differential, needing to be reviewed.
These are only examples of the inequality, discrimination and poor opportunity for women in the mental health sector. Other vulnerable groups (children, those with a different sexual orientation, the poor) have equally disempowering experiences within the mental health sector. Various Supreme Court directives, the directives of the High Court (Mahajan Committee Recommendations) and the NHRC recommendations are empty words before these large institutions of Maharashtra.
MaharashtraMaharashtra has a total of 4 state run mental hospitals. The total bed strength is 5695 in the 4 mental hospitals, which is one fourth the entire bed strength of mental hospitals in India. Long stay patients (who have stayed for more than 2 years) is the greatest in Maharashtra, indicating that these facilities are perceived as dumping grounds by the communities.
Thane mental hospital: All wards are locked wards. About 50% of patients have adequate cots and bedding. Most of the wards are overcrowded. The number of mental health professionals is far less when compared to the bed strength (1880 beds). Only 10% admissions are voluntary admissions. All others are involuntary commitments. 26% of patients are “long stay”, who have been there for five or more years. Women are not discharged without an escort. Facilities for medical emergencies are poor. The hospital does not have a casualty and emergency service. There is no short stay ward. The average time spent with an old patient is 5 minutes, and with a new patient is 15 minutes. As a result, interventions are mainly medical. Patients reported that bathing facilities are not adequate and clothes are dehumanizing, as they are not changed as frequently as they would like. Although the quantity of food may be adequate, it is not sufficient in terms of nutritive value. Management of patients is mainly medical, with the use of drugs and modified ECTs. Solitary confinement is being used. Patients complained that they were not being able to contact family members. There is hardly any psychosocial intervention. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities.
Pune mental hospital: Bed strength: 2540. The number of cots is inadequate, at the ratio of 1:5. Existing toilets, fans and lighting arrangements are not adequate. The staff patient ratio is inadequate considering the bed strength. Voluntary admissions: 27%. Female patients are not discharged without escort. There is an absence of psychiatric facilities at the district level, and so the hospital is the only service center. No emergency or casualty services. The average waiting time is 30 minutes to an hour, with 10 minutes being spent with each patient. No individual or family counseling. No separate wards for patients in acute and chronic phase. Both direct and modified ECT are being used. Pharmacotherapy is the mainstay of treatment. Physical restraint and solitary confinement are being used. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities. All are closed wards. Newer drugs are not available.
Nagpur mental hospital: Bed strength: 910. There are no open wards. Bathing facilities, toilets are inadequate. Voluntary admissions: only 14%. 46% of patients are long stay. Female patients are not discharged without escort. No casualty and emergency services. New cases: 15 minutes; follow up: 3-5 minutes. Newer drugs are not available. Direct ECTs are administered in OPD. Modified ECT is being given to inpatients. Psychosocial input is not provided. Pharmacotherapy is the mainstay of treatment. The occupational therapists have had no training in dealing with psychiatric conditions. Very few patients attend these facilities.
Ratnagiri: Bed strength: 365. All locked wards. Voluntary admissions: 79%. 25% patients are long stay. Female patients are not discharged without escort. No emergency or casualty services. New cases: 15 minutes; follow up: 5 minutes. Modified ECT administered when required in OPD. No psychosocial intervention. Management of patients is mainly medical, with the use of drugs, direct and modified ECTs. Very few patients attend occupational therapy facilities.
Private care
Population of Maharashtra and the number of doctors / clinical psychologists:There is a huge deficit of mental health services in Maharashtra, as in the rest of India.
Total population: 96752247
Estimated major mental disorders: 967522
Estimated minor mental disorders: 4837610
Existing hospital beds (government sector): 6073
Existing hospital beds (Private): 652
Available psychiatrists: 456; Ideal number: 967; Deficit: 481
Available clinical psychologists: 33; Ideal number: 484; Deficit: 451
Available psychiatric social workers: 44; Ideal number: 1934; Deficit: 1890
Available psychiatric nurses: 117; Ideal number: 672; Deficit: 555
Districts with psychiatric facilities: 17
Districts without psychiatric facilities: 18
Failure of the government machinery to address the mental health needs of communities has led to a surge in the number of private practitioners and rehabilitation centers. Over 70-80% of doctors in Maharashtra are in private practice, often working only in urban areas. While being educated on government subsidy, their contribution to the public health system is negligible. Large numbers of government posts remain unfilled. The local chapters of the professional organisations such as the Indian Psychiatric Society have not set standards of care for mental health practice in Maharashtra. The social context of people's lives is often not considered by the treating doctors. Over prescription, irrational drug treatments, and poly pharmacy plague the sector. Standardised tools for clinical assessments do not exist. Diagnosis is left to the subjective evaluations of doctors. Aspects of preventive and promotive services are overlooked. ECT is unregulated. The abuse of shock treatment in the Indian set up is a human rights issue. In Maharashtra, direct ECT is still being practiced by private mental institutions.
Medico-legal interventions in mental healthIn the medical sector, a clinical action may or may not have legal implications. In the mental health field, a clinical action has at the same time, legal implications. Data in the field shows that out of a 100 divorce petitions filed on the ground of “insanity”, 97% are filed by husbands against wives. This shows structural layers of vulnerability in the community, to a finding of mental illness. Everyday actions and decision making such as managing a bank account, or a property / financial asset, having a family, participating in social functions, etc. becomes extremely difficult given the present scope of the law. Many people who are employed get sacked when their diagnosed status is disclosed. Persons labeled with a mental illness, more significantly the women, live a life of stigma, discrimination and exclusion because the legal administration has allowed it. The law has in no way tried to alleviate this situation. Instead, it has set up its own barriers in every dimension of life.
Every time a person is diagnosed with a “mental illness”, certain medico-legal implications such as the above follow because of the way our laws are written up or executed. These legal implications can be used or abused by others with a vested interest in the personal or other aspects of the diagnosed patient’s life. Medical professionals called upon to execute the law (e.g. certification of legal capacity) often do not have the necessary legal trainings required for this responsible job. Corruption by professionals is not unknown, and neither is legal negligence. Recent cases reported in the press with respect to the Agra mental hospital show that false certification of a woman as mentally ill for purposes of easy divorce is a profitable business.
In order to effect the legal implications of a finding of mental illness, a certification is necessary. Psychiatrists have the power to issue such certificates of mental fitness. However there is no procedure in the profession by which the psychiatrists are trained in law to measure fitness or capacity. Therefore judgments by the psychiatrists become subjective and personal. This increases the risk of causing harm to the person and the risk of unfairly taking away a person's rights. Among all medical professionals, only psychiatrists have the power to direct the course of the lives of their patients legally.
The medico legal sector in mental health is totally involuntary, posing serious ethical contradictions with the larger biomedical sector, which is bound by patient consent and voluntarism. The implications of being diagnosed with a “mental illness” are also not there for a general health care patient. A charge of being of “unsound mind” can take away a range of human rights and opportunity for self determination (contracting, holding public office, employment, being married, adopting a child, voting, etc.) This charge of USM can result in the take over of a person’s life through guardianship arrangements. A charge of being “mentally ill”, in terms of legal scope and format, entails the same status as being accused of a crime, as the care & treatment laws are of a custodial nature. A person is committed to a hospital, often through the use of the many provisions in law for involuntary commitment and forced treatment. Therefore, before the eyes of the law, a person is an alleged mentally ill person, a perception in law which completely undermines the identity of the sick and the disabled. As noted above, most commitments to the mental hospitals in India are involuntary. Four out of the five commitment procedures written in law are involuntary, while even voluntary commitment is determined within the scope of the law.
The recently signed United Nations Convention on the Rights of Persons with Disability [CRPD] is providing an opportunity to foundationally challenge these presumptions. The Convention is giving us an opportunity to create an alternative legal framework for people with psychosocial disabilities.
Mental health, budgets and spending:Mental health is an invisible subject in public health debates and in policy. India spends a fraction of its total health budget on mental health. As we all know, public health itself is a highly neglected area. Money available has been spent mainly on hospital / tertiary care. Upto 80% of the money allocated to psychiatric hospitals are being spent on salaries, leaving very little for user centered programs or client rehabilitation. Recently, under the 10th five year plan outlay a budget of Rs. 190 crores was released to strengthen the mental health sector in India. However, much of this budget is towards upgradation of the mental hospitals and further creation of medical facilities. While the whole world is moving towards community, very little money has been allocated for strengthening the community mental health services. The situation for the XI five year plan does not appear to be very different. Hitherto, monies unutilised on the community mental health program has been returned back by the nodal agencies to the Govt of Maharashtra. The Government needs to also publicly account for the monies received under the X Plan.
Like the health industry, the mental health industry is working for profit. The pharmaceutical and instrumentation industry are economic beneficiaries of private practice. Many private residential facilities charge fees, which range anywhere between Rs. 8000/= to Rs. 20-25000/= per month to care for a client. Psychiatrists may charge between 250/= rupees to 600/= rupees per session. An ECT dose (6-10 ECTs) will cost anywhere between 1000/- rupees to 10000/- rupees depending on the type of facility. Families have to spend a lot of money on an everyday basis on expensive drugs. Often, for what is considered as chronic disability, this expenditure may be life long.
State policy in mental health: Mental health services have not kept pace with the demand or improved as much as the rest of the Health Services. The National Mental Health Program has not been revisited, since 1982. The NMHP emphasised community level interventions through District mental health programs. It resonated with the Alma Ata vision of mental health care for all. In 1996, a blue print for the District Mental Health Program was laid out for India, giving the following guidelines:
To provide sustainable basic mental health services to the community and to integrate these services with other health services
Early detection and treatment of patients within the community itself
To see that patients and their relatives do not have to travel long distances to go to hospitals or to nursing homes in cities
To reduce the stigma attached to mental illness through change of attitude and public education
To treat and rehabilitate mental patients discharged from the mental hospital within the community
The state will set in motion the process of finding suitable personnel for manning the DMH team. They can take in service candidates who are willing to serve in the pilot projects and provide them the necessary training in the identified institution
Catchment Area will be the patients from the district itself and adjoining areas
DMH team will be expected to provide services to the needy mentally ill persons and their families as follows
Most parts of India are largely underserved to address the needs of persons with a mental illness at the community level. India does not have a mental health policy.
The models developed in the state of Karnataka, by NIMHANS, were proposed to be replicated everywhere. In Maharashtra, there are 6 DMHP programs running, of which the one in Raigad district is the oldest. These programs have not been evaluated. The quality of services in these programs is very poor, being limited to drug dispensing at the community level. Psychosocial interventions are absent in all of the DMHPs dotting the country, and also in Maharashtra. It is quite clear that the mental health services are not matching up the service reality.
Mental illness and Disability The Persons with Disabilities Act, 1995, includes "disability caused by psychiatric problems". It is the last category of disability listed in the Act. States like TN and Karnataka are bringing about reforms in the mental health sector. The Maharashtra state government gives very low priority to this disability. There is no state initiative or program for persons with a mental illness. Officers in the commissionerate are not even aware that psychiatric disability is represented in the Act. There is no representation from this disability group in the state level committee. Very few people with a psychosocial disability in the state have received a disability certificate due to lack of awareness and tiring administrative procedure. Complaints filed in the disability department take many months, if not years, to be addressed. There are also inherent limitations of the Act, such as the exclusion of persons with psychosocial disability from job reservations. In a progressive move, a recent Bombay High Court judgment reinstated a mentally ill nurse who was forced to resign by the hospital management.
Mental Health Act, 1987The mental health sector is driven by the mental health law (MHA, 1987). MHA has been criticized for its many problems. It talks only about the procedure for admission. Three out of four types of admissions in the Act are involuntary commitments. The process of applying this Act is humiliating for the patients. Often unlawful deprivation of liberty happens. There are limitations on voluntary discharge. A cardiac patient may be discharged on his own reason and will, but a psychiatric patient will not be so discharged under our present statute concerning the custodialisation of the mentally ill (section 40 –44 of The Mental Health Act, 1987). The Act does not say anything about the rights of users within institutions. The NMHP is community based, whereas the law is completely custodial. There is no relationship between the two. The Act does not talk about rehabilitation at all, or how persons in hospitals can be mainstreamed in society and live lives of dignity. Therefore, it remains organ oriented in its approach. There are active forums now for law reform in this sector, which JMAA will participate in.
Traditional knowledge in mental healthSeveral traditional healing practices exist in Maharashtra, which offer psychological succor to communities. They exist in outlying areas where mental health services are simply not available. There is growing evidence base, which suggests the value of these practices in mental healing. However, the mental health system does not take this aspect into consideration.
Media The media characterises people with psychosocial disability as criminal, bad and violent. They become the subject for humour and ridicule. They are shown as sexually abnormal, helpless, weak and incapable of participating fully in community life. They are shown as a subject for sympathy, pathos or pity. They are shown as a burden on the society. A popular newspaper in Maharashtra literally witch hunted a patient and her family, when she attacked the editor of the said paper. Her photograph was put up in every article concerning the event and her mental health status was open to wide public scrutiny and display. The criminal case filed against her is still alive in a local court.
Mentally ill people are rarely shown as productive members of the community, as students, teachers, workers or as parents. Nor are they ever shown as normal people, with their usual joys and sorrows, who may sometimes have periods of distress. Their potential, capacity and creativity are not shown. Their lives are depicted as one of total and abject misery and lack of capacity.
The nameless peopleMost custodial institutions in Maharashtra (beggars' home, jails, state homes for women, remand homes, etc.) have a large proportion of people who are psychologically disabled. These institutions are literally parallel “mental hospitals”. These people are living in highly degraded conditions without any basic facility or mental health care provision. There is also a huge population of the homeless wandering mentally ill. There is no service facility in all of Maharashtra to serve this population. Mental hospitals, following a human rights PIL in the late ‘80s, have started placing severe restrictions on taking care of this population. The human rights violations of these groups are enormous.
Building partnerships: Through JMAA, we raise a call to solidarity, allying and partnering with individuals, groups, organizations and professionals, working in the field of human rights, people's rights, advocacy, mental health, disability and allied areas in the state of Maharashtra. This collective will give vision, direction, set the agendas and plan action for the campaign.
Scope of rights for persons with a mental illness :Right to life and liberty including
The right to bodily integrity; the right to a safe and violence free environment; the right to survival and to a life of quality; the right to voluntary care and treatment; the right to refuse treatment; Right to full legal capacity including
The right to marry; to enter into contracts (e.g. property, insurance); to adopt a child; to have children; right to work and opportunity; right to receive speedy justice; to hold professional licence; to legal representation; and the right to political representation.
Right to care and treatment including
The right to full information regarding care and treatment; informed choice; right of access to affordable, quality health care; right to non-medical care and treatment approaches; right of protection against cruel and degrading treatments; right to privacy and confidentiality.
Right to Community life and development
The right to education, livelihood, food, employment, housing, cultural life, sports and recreation, social security, the right to have intimate relationships, right to have children, the right to vote and hold public office.
JMAA convenor since 2005: The Bapu Trust, Pune.JMAA co-ordinator: Sadhana Khati (Susamvaad and Bapu Trust, Pune)JMAA organiser: Chandra Karhadkar (Bapu Trust, Pune)
Center for Advocacy in Mental HealthA research center of Bapu TrustKapil Villa, Plot no. 9Survey No. 50/4, Kondhwa KhurdPune-411048Tel: 020-26837644/47Email: wamhc@dataone.in; info@camhindia.org
The Campaign is supported financially by Action Aid India, Mumbai Regional Office.
No comments:
Post a Comment