Wednesday, 16 October 2013

Human Rights and Mental Health




A couple of years back, I worked on a book called ‘Psychiatric Hospitals in India’. I took on the project as a content advisor and morphed into a co-researcher out of sheer interest. I was interested since psychiatry is a field I did not know the ABC of. But as I went deeper into writing, compiling, advising, designing sheets upon sheets full of everything to do with mental hospitals, illnesses, problems and recommendations, I realized it was not just that mental health was a lesser known field but also that it was not covered as extensively by popular media in my surroundings as maybe other similar concerns had been. 

Because in so many countries still, mental illnesses are stuff that stigma is made of. And a mental asylum a building housing men, women and even children who have been disowned by their families.

And more often than not, the hospitals are far from asylums but places which, knowingly or otherwise, violate human rights of the mentally ill patients. And this is something that you and I do not read about in the national dailies. Because somewhere, we either tend to not notice or make unseen that semi-nude “mad man” with a matted beard talking to the trees on the side of the road.

Today, on Blog Action Day, I pen a few paragraphs of information on Mental Health and Human Rights. I am no human rights activist in the true sense of the word. I am not even taking action on the patient’s behalf in this case. I am simply showing you the picture and the perspective that I gathered along the way. Maybe hoping to bring about a change, a change in the mindset which still uses words like ‘mental’, ‘psycho’, ‘schizo’ and ‘retard’ in a loose, irresponsible and utterly insensitive way. 

Health, as a right, was included only recently in the United Nations ‘Universal Declaration of Human Rights’, as Article 25 (Universal Declaration), stating ‘Everyone has a right to a standard of living adequate for health and well-being of himself and his family...’ When we talk of Mental Health, it took a series of revolutionary minds across the globe to emphasise that persons suffering from mental illness shall enjoy the same human rights and fundamental freedoms as all other citizens. They shall not be the subject of discrimination on grounds of mental illness. They have the rights to professional, humane and dignified treatment and will be protected from exploitation, abuse and degradation. Elimination of prejudice and stigma attached to mental illnesses will be aimed at and regardless of age, gender, ethnic group or disorder, they will be treated in the same manner as other citizens in need of health care. 

In short, the world recognized the fact that the basic human rights and freedoms of the mentally ill should be respected at all costs. The relationship between mental health and Laws of the Land was established, and even though a dynamic one, laid down set criterion for the treatment of the mentally ill under various governments and nation states. 

The Indian scene 

We revel in our heterogeneity. On good days we celebrate it, on bad days we have an identity crisis and want to enforce our own. Multiplicity of political systems and social ideologies add to the diverse scenario. Under the circumstances, not just availability and accessibility of mental health care but the implementation of human rights issues itself becomes a problem. Varying ideas of privacy, social stigmatization of patients, interpretations of right to refuse treatment add to the problem of implementing a universal idea of human rights of the mentally ill. But where once the ‘asylums’ were prisons for the hopeless, things are a changing for the better.

Health security for the entire population is being accepted as an essential requirement that should be guaranteed by the government. The Mental Health Act of 1987, a national statute, recognised the lack of humane treatment of the mentally ill and codified guidelines about the human rights of the mentally ill much before National Human Rights Commission was even established. The landmark judgments included no mentally ill person shall be subjected, during treatment, to any indignity or cruelty. No mentally ill person shall be used for purpose of research unless such research is of direct benefit to him, or such a person’s consent (or guardian’s consent) has been received in writing. Many more movements and efforts towards ensuring protection of human rights have followed, with the Supreme Court and the National Human Rights Commission acting as catalysts towards bringing about a constructive change in mental institutions as well as treatment of patients. What was espoused? 

That ‘everyone in need should have access to basic mental health care.

This principle components of this idea gave birth to a list of human rights that the mentally ill enjoy (published in 2008 by NHRC). Let us see some of them here:
1. Right to a decent life.
2. Legal safeguards against abuse.
3. Right to appeal, rehabilitation services, privacy, freedom of communication.
4. Right to necessary treatment in the least restrictive setup.
5. Right to social and economic security.
6. Right to family and community life, employment.
7. Right to protection against discrimination. 

The human rights of psychiatric patients in India are in conformity with the developed nations.

The problems?

Despite progressive legislations and zealous spread of awareness, conflicts and vagaries arise when human rights of the mentally ill are under question, not just in India but universally.

What happens when a mentally ill patient refuses treatment, drugs, hospitalisation or food? Is force-feeding ethical under all circumstances? Control and restraint of violent conduct of patients and seclusion of such patients in psychiatric institutions is another contentious issue. Is exclusion from voting necessary, and does it not encroach on the human rights of the mentally ill? How do you deal with the social stigma attached to mental illnesses and mentally ill, which leads to infringement of rights of the patients in a social context?

Grey areas remain in the legal technicalities and implementation, questions of ethics and professionalism. Grey areas are also housed within our own minds, and mentalities, in our social attitude towards our mentally ill. These being the two biggest deterrents in ensuring human rights of the mentally ill.  

To you and me, no amount of knowledge about the issue is enough. But what can be more than enough is spreading the little knowledge that we have. Human rights are a social issue. Apart from information and awareness, a deep-rooted Concern for a fellow-human can weave miracles. This here was just a step towards facilitating a better understanding of mental health and human rights. I hope it helps, even as it informs, in stimulating our collective consciousness towards creating a more humane and accepting environment for the mentally ill in particular and other beings in general. 

Human rights matter. Because humans do. 

[With information drawn from 'Psychiatric Hospitals of India' and a heartfelt thank you to it's author and world-renowned psychiatrist Dr. Sridhar Sharma]





51 comments:

  1. Well said indeed and honestly many pointers were enlightening.

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  2. This was such an informative post and goes on to highlight how much research you had actually done for this particular project. I have used this link in a post which I have scheduled for 9 AM today as part of my Blog Action Day post.

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    1. The research was done when I worked on the book. But compiling it did take a bit of an effort. Glad you found it useful.

      'Scheduled at 9am' meaning? Great to know you included my post! :)

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  3. You have correctly stated that "we either tend to not notice or make unseen" mentally ill persons.

    We need to understand that a psychiatrist treats the brain just as a cardiologist treats the heart, etc. The brain is just another organ of the body. We must remove the stigma associated with mental health issues.

    We don’t look down on diabetics or heart patients. Why should we look down on ‘brain patients’ (persons having mental health issues)?

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  4. This is such a pertinent post, Sakshi. It is so important to raise awareness for mental health in India when so much of stigma is still attached to it. In such a scenario, the human rights of mentally-ill patients are certainly not even considered.

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    1. Stigma to the extent that either we cover up those suffering from mental ailments or totally reject them. Our own blood! :)
      Thanks for reading, Shilpa.

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  5. We look at other patients with sympathy but shy away from people with mental health problem and shun the person affected and his family too. The affected person's family try to keep the illness under wraps fearing social stigma. well-researched post.

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    1. Absolutely right.

      Thanks for stopping by, Kalpana.

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  6. The way we are going, mental health will become an epidemic after a decade. A timely well researched post Sakshi.

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    1. I am afraid I have to agree with you, Alka. The real stories I gathered when I was researching for this book are difficult to share even.

      Thanks for reading.

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  7. Informative post. Loved it

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  8. "Because somewhere, we either tend to not notice or make unseen that semi-nude “mad man” with a matted beard talking to the trees on the side of the road."

    That's so true Sakshi! Most of us tend to just give a sympathetic look or are scared to even look at them. That's one reason I admire Narayanan Krishnan of Akshaya Trust (http://www.akshayatrust.org/, who cooks and feeds the mentally ill people on the streets of Madurai. A close friend has personally witnessed the noble deed being undertaken.

    A well researched and informative post.

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    1. Yes, we are scared of them, Rekha. I was, until I was informed that they only react to actions they see as threats to their own well-being. Who wouldn't? :)

      Thanks for this link. I will check it out.

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  9. Fantastic to be reading this kind of thing from India. Mental health issues are still a stigma in Australia too but they don't have to be, and fortunately are probably less of a stigma than they are in India. I really connected with this line "Apart from information and awareness, a deep-rooted Concern for a fellow-human can weave miracles."

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    1. Thanks for stopping by, Alex. Good to have got a perspective on Mental Health issues in Australia.

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  10. Yes mental health has so much stigma attached to it in India. People are extremely wary to even approach counselors. Just going to a psychiatrist feels like a taboo. I have seen parents who struggle with parenting issues but will not approach a Counselor because they feel that such an action is only for the mentally ill. Interesting post with a lot of information, Sakshi! I have been fascinated by the field of psychology for a while now. I love to read on the subject and my knowledge nowhere close to yours. And some of the treatments meted out to mental health patients are equally abhorrent.

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    1. There is quite a lot of public debate on controversial and coercive treatments, including shock therapy, tying them up, isolation, etc. The post was heavy with information already, so had to summarise in nearly 1500 words. :) You are right, Racha, We are a nation of cover-up or ignore when it comes to mental health issues too. Sad.

      Thanks a lot for reading!

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  11. There is always a cause behind mental illness . Some kind of abuse/poverty / Disease/lonliness etc . Eliminating those causes will help to improve mental health . So not just treating mental health of one person will help . We need a society where equality and justice are given importance than Power and money

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    1. Absolutely the right approach. Eliminating the CAUSE behind the problem. And I love how you link it up to Power and Money. I think that takes this whole issue to a very socio-culturally topical level which seems very very relevant today!

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  12. It is a beautiful post, Sakshi. In fact, I vacillated between Mental health and child poverty and the latter won. You know, a friend of mine has an autistic son, and refuses to move back to India, much as she'd love to only because of all the stigma attached to a special needs child. It is painful. There, where she lives, these children are treated the way they should be and helped live normal lives. In India, sadly, they're labeled and any association with psychiatric help is seen very infra dig.

    Thank you for this great "voice" Hugs! I repeat, you're very love-able!

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    1. Sadly, I will have to agree with you and your friend. I have interacted with about 60 psychiatric hospitals in India and let me tell you, not even 6 are worthy of receiving a patient. However, and like I always like to believe, immense work is being done in the field - the Act has been re-done, community is pooling in with day care centres, rehabilitation and occupational facilities are being created better than before and generally, the whole idea of Mental Health is gaining some much needed limelight.

      Thank you for the 'love-able', Vidya. :)

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  13. Very informative write up...Loved it

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  14. There has always been a stigma about mentally challenged people who need just as much help and acceptance as those who are physically challenged. Very informative and really shined a light on the rights of those that suffer mental illness.

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    1. Thank you Kathy. I am happy you liked this post. :)

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  15. Mental health always seems to be the "poor relation". This ought not to be the case. Thank you for highlighting these issues. "Sue’s Trifles"

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  16. It's sad that we have still not learnt how to treat the mentally ill as we would any other ill person, Sakshi. The labels, the stigma, the fear, the pretence that they don't exist, it is shocking. What's more we have very inadequate support systems for for the families of special children too.
    Thank you for focusing on this aspect of human rights!

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    1. Thanks a lot for reading, Corinne! :)

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  17. More than the help these people need our support and that's what is always denied. When all the other illness are cared or looked upon with utter most care and love mentally challenged people and like Corinne said special kids are kind of neglected.

    Very informative post. :)

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    1. Support actually forms a very integral part of their treatment and rehabilitation - social support as well as familial support. Thanks for reading!

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  18. So well documented, Sakshi. It is a real education reading your study on mental illness. Till, we don't battle our in-built prejudices, the battle is not conquered. Thanks for sharing.

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  19. Mentally ill, the treatment, their rights, social stigmas, a well written post. Thanks for making me aware of many crucial pointers.. Congrts for being one of the three best!

    manjulikapramod.com

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  20. This comment has been removed by a blog administrator.

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  21. Thanx sakshi to sharing this article with readers , Human Rights and Mental health , this article shows how much u research on this and aware all of us about mentally-ill patients human rights .

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  22. Hi
    Sakshi Nanda

    Thanx for sharing Blog with us , very informative and i loved it. thanx

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  23. Psychiatry and psychology are overlapping professions. Practitioners in both -- psychiatrists and psychologists -- are mental health professionals. Their area of expertise is the mind -- and the way it affects behavior and well-being. They often work together to prevent, diagnose, and treat mental illness. And both are committed to helping people stay mentally well..... psychiatry , Aerophobia

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    1. Thanks for an informative comment, Tushar. :)

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  24. Yeah, another nice and awesome post by author. Keep it up.

    Thanks!

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