Mental Illness as Disability
The issue of mental illness needs to be brought to the centre stage.
Worldwide, there are believed to be around 450 million people suffering from mental or behavioural disorders. 14 per cent of all global disease burden is attributed to mental disorders. There is one psychiatrist for 10,000 people in high income countries and one for 2 million people in low income countries.
In India, there are considered to be just 4,000 psychiatrists for the whole country. According to the National Human Rights Report 2000, 20 to 30 million people “appear to need some form of mental health care” and according to the National Commission for Women, five million of these are women. Yet, mental health, either in the form of health policies or budgetary allocations, are no where on the radar of government
When one looks at The Persons with Disabilities (Equal Opportunities, Protection Of Rights and Full Participation) Act, 1995, which does little more than list mental illness as one of the seven disabilities in its definition and The Mental Health Act 1987 (which came into force in 1993) one will realize that they are woefully inadequate with numerous lacunae.
According to The Mental Health Act 1987, a person with mental illness is defined as “a person who is in need of treatment for any mental disorder other than mental retardation”.
The law is silent about emergency care. Any person with a mental illness picked up by the police first needs a reception order from the Judicial Magistrate before being admitted to an institution. According to the Act, there should be one psychiatrist for every ten mentally ill patients and a cured patient cannot be discharged from a hospital except to a guardian.
Thus, patients who have long since been cured continue to languish in mental institutions as family members refuse to accept them back. Many who work with the mentally ill say the Act is biased towards people with mental illness and it speaks little on rehabilitation and post care treatment. What is noticeable is that even while mental stress continues to increase, pushing growing numbers of people like women and youth to the brink of insanity, our mental health institutions continue to remain like virtual jails, austere steel cages where people are not encouraged to socialize and lead normal lives.
The treatment, of the mentally ill is largely medical and does not address the root causes that led to the onset of the illness. Rehabilitation facilities continue to be concentrated in urban areas and the majority of the rural poor resort to quacks and local healers in search of a treatment.
Mental illness itself is a highly marginalized issue among the general disability debate even the National Policy for Persons with Disability 2006 makes nothing more than a passing mention of mental illness in some of its sections.
Thus, the issue of mental illness needs to be brought to the centre stage, focused upon and mainstreamed into the general disability debate. The stigma around mental illness also needs to be addressed through a wide spread media campaign that helps people identify mental illness and treat it early.
Children in schools and people in their work place need to be taught to address their mental stress in healthy ways through the presence of psychologist and counselors. Governments need to make appropriate and adequate budgetary allocations to address the growing problem of mental illness.
Many people with a mental illness require medication for the rest of their lives and this medication needs to be provided free of cost for people who are living below the poverty line. There is a need for half way homes where people who have recovered from mental illness can be rehabilitated by learning a vocational skill and from where they can be integrated into their families. These homes will also offer shelter to those not accepted back by their families.
There is also a need for more mental health institutions and with all probability these should be in the form of additional wings in the district hospital rather than segregated hospitals that further stigmatization.
(The author is a founding member of disAbilityFirst, a disability group working on advocacy issues.)
The above article was published in the Bangalore Edition of Deccan Herald on 24th December 2007