Mental Health and India
Amongst the myriad of issues that plague India’s healthcare system, there is one in particular that has escaped the view of the public, only to be buried deep underneath hordes of stigma and misinformation, and that is the issue of mental health. The well-being and safeguarding of patients afflicted by poor mental health has occupied a low rung on the ladder of India’s public health system for years now – in fact, according to a World Health Organisation report, the Indian government spends a miserly 0.06% of its health budget on addressing this issue. On the other hand, the Indian Ministry of Health and Family Welfare claims that over 6-7% of the population has psychosocial disabilities, yet there is a single psychiatrist for every 343,000 people and only 43 state-run mental hospitals – not nearly enough for a population of 1.2 billion individuals, but just about all you can do with a crumb of this country’s total budget.
…the Indian government spends a miserly 0.06% of its health budget on addressing this issue…
In the year 2007, the Indian Government signed the United Nations Conventions on the Rights of Persons with Disability (UNCRPD) and thus, under the mandate of this body, was required to revise all disability laws effective within the country. Several years later, in 2014, the nation saw this government’s first concrete step, in the modern era, toward addressing the woes of those afflicted by mental disabilities through the unveiling of new legislature, entitled the Mental Health Care Bill. The Mental Health Care Bill was preceded by the Mental Health Act of 1987, an arguably half-baked medley of inadequate policies that lacked provisions for rehabilitation after discharging a patient, for educating the society on the importance of proper mental health care, and all in all, adopted a myopic view on the basic human rights of mentally ill persons.
…there is a single psychiatrist for every 343,000 people and only 43 state-run mental hospitals…
Although the bill passed by Parliament isn’t one that is revolutionizing the Mental Health Care Industry, or even one that is capable of doing justice to the odd 75,000,000 patients it aims to help, it is definitely a step away from the archaic practices previously employed.
The new bill aims to ensure the rights of all individuals to avail affordable and quality mental health services without discrimination; to prevent persons of mental illness (PMI) from having to travel long distances to access services through the establishment of halfway homes, sheltered accommodation, rehabilitation centers, and other services to support the families of these individuals at the state level. A special emphasis has been placed on the necessity of basic human rights for the afflicted and to this end, mentally handicapped people are allowed to access their mental health records, reserve the right to personal contact and communication, and the right to report any deficiency in services to mental health officers.
The bill allows individuals to create an advanced directive, which is a document created beforehand to dictate the terms on which they wish to be treated should they suffer from a mental illness in the future. The establishment of a State Mental Health Authority and a Central Mental Health Authority, besides a Mental Health Review Commission, is part of the bill’s provisions as well.
The Bill has garnered its fair share of criticism too, for a plethora of issues including lacking provisions that account for General Hospital Psychiatry Units (GHPU) thereby allowing them to continue practice without a proper license; the shortsighted ban on unmodified Electroconvulsive Therapy (ECT) despite the fact that it is often instrumental in saving lives; and the accused perpetuation of institution-based care instead of shifting to a community-based model of services.
While the MHCB has taken a wide spectrum of measures which aim to make change for the better, it is not being implemented correctly. The ever-weakening adherence to the laws set down by the Bill has led to the misuse of what was initially created to help those suffering from mental disorders. Unfortunately, the victims of this crafty misuse of the law are predominantly women.
The stigmatisation of having mental disorders has made seeking psychiatric help a taboo, an act of weakness, and typically, a sure-shot method of getting yourself thrown into a vermin-infested government institution that seems to have been picked straight out of a horror story. These negative connotations that shroud the mental health industry in India has forced those affected by mental disorders to visit temples and other places of worship to appeal to God and other higher powers, rather than trusting in certified doctors, and there is a certain amount of justification for this.
…the victims of this crafty misuse of the law are predominantly women.
The feeble legislation allows women, and of course others, to be very easily and efficiently admitted to a mental hospital without the individual actually being mentally ill or handicapped. This has been the case for hundreds of women around India, who have been declared mentally unstable by family members or spouses, often driven by motives such as property affairs or custody battles. Once these women have successfully been admitted, they are no longer privy to even the most basic human rights.
The rampant neglect, abuse, and sexual violence that come hand in hand with being admitted to a mental hospital or institution worsen the already terrible living and hygiene conditions. Sexual predators recognise them as easy targets, simply because anything they say can be nullified due to their mental state, and so, these women are raped and often have unwanted pregnancies and forced abortions. It has also repeatedly been brought to the public’s attention that there are serious deficits of toilets, soap, showers, not to mention that the premises are often plagued with rodent infestations.
There are many that have attempted to make a positive impact and create change in terms of this serious issue, including countless NGOs such as Anjali, an NGO based out of West Bengal, where they are active in three mental institutions. They organize programs such as cognitive and occupational therapy, and even how to reconnect with the real world. Such organisations are mere cracks in a castle of glass; there is much more that needs to be done before one can feel safe when asking for mental health care in India.