#India- Acute shortage of mental health care staff #humanresources


      SPECIAL CORRESPONDENT, The Hindu Jan 14, 2013

India faces an acute shortage of mental health care professionals, including psychiatrists, considering the high prevalence of mental health disorders.

Studies suggest that approximately 13 per cent of the entire population may actually be suffering from some kind of mental disorder — 10 per cent with minor ailments such as stress, anxiety and depression while the remaining with serious disorders such as schizophrenia. Alcoholism and psychotropic addiction are also included in this.

According to a Mental Health Survey carried out by the Directorate General of Health Services in 2002, there were only about 2,219 psychiatrists in the country, against the required 9,696. The number of clinical psychologists was 343, against the desired 13,259. Similarly, psycho-social workers available were only 290, against the required 19,064, while the number of psychiatric nurses was not available, though over 4,000 such trained nurses were required then. Also, while there were about 21,000 beds for mental health patients in the government sector, the number was just about 5,100 in the private sector.

The country has 43 government mental health facilities, though a huge number of private facilities, known as psychiatric nursing homes, have come up. Delhi alone has 16 such facilities. The State governments are authorised to register these private facilities.

The number of psychiatrists and nurses may have marginally gone up since then and the number of patients too would have gone up substantially.

“I think we need to address mental health issues, both by addressing demand for and supply of services, and by services I mean evidence-based medical and psycho-social interventions that can address a wide range of mental health problems, including their prevention,” said Dr. Vikram Patel, eminent mental health expert and Professor, London School of Hygiene and Tropical Medicine.

This required multiple actions, from awareness building in communities and in the health workforce, to the creation of new community-based human resources skilled in providing psycho-social interventions and building capacity of primary health workers for delivery of medical interventions, he told The Hindu.

There is a huge debate going on in the country over the nature of treatment that must be provided to people with mental disorders. While a majority believes it should be home and community based — considering the condition of mental homes and public facilities — there are others who believe institutional care is also required, particularly for women, as people with mental health issues are often disowned by families and hence vulnerable to exploitation.

 

#India-Train judges handling sex crimes in psychiatry #Vaw #Justice


 

DHNS
BANGALORE : The judiciary, especially judges handling cases related to sexual abuse against women, must have basic training in psychiatry and mental illness to handle the sensitivity of the subject, said the Indian Psychiatric Society president Prof Indira Sharma.


At the 65th annual national conference of Indian Psychiatric Society which began here on Thursday, Prof Sharma said, “It is unfortunate to hear cases about sexual abuse of women with mental illness. There is a need to relook into the judicial aspect of handling such cases,” she added.


Prof Sharma said there was no standard mental health policy in place and made out a case for having one. Referring to the recent Delhi gang-rape incident, she said there is a need to frame elaborate guidelines on handling rape victims and recommended that the amended anti-rape law be called the Jwala Act.


Prof Norman Sartorius, former director, Mental Health, World Health Organisation, Geneva, said due to rapid urbanisation and globalisation, the number of people suffering from mental illnesses has increased over the years. “It is unfortunate to hear that today’s world which measures everything in terms of economics has also tagged health as a commodity wherein you pay more, you get more even in terms of cure for illness,” he added.


Briefing about the recommendations sent to Justice Verma committee on amending laws against sexual abuse, Dr R Raghuram, Head, Department of Psychiatry, Kempegowda Institute of Medical Sciences, said rape victims should be counselled regularly in tandem with the legal process.


The four-day conference will witness a host of lectures by psychiatrists from across the world and will be attended by over 3,000 delegates including psychiatrists and clinical psychologists.

 

MFI Alternative Radio this Saturday – Mary Ellen Copeland #mentalhealth


 

 

 

 

 

Mary Ellen Copeland

 

and Magdaline Volaitis

 

 

 

 

 

 

FIRST SHOW OF 2013! Join MARY ELLEN COPELAND, MAGDALINE VOLAITIS, and

guest host SOPHIE FAUGHT to discuss how we can replace harsh and invasive psychiatric interventions with personal empowerment, self-help, and recovery for people in mental/emotional distress! LIVE on Saturday, 12 January 2013, at 2 pm ET, 11 am PT; we’ll be taking your calls at (646) 595-2125.


Listen at www.blogtalkradio.com/davidwoaks
Our guests:
– MARY ELLEN COPELAND is nationally and internationally recognized for her work in studying how people recover from mental health challenges using simple, safe, non-invasive, widely available and usually free self-help resources (including WRAP – Wellness Recovery Action Plans). Her focus is on shifting the system of mental health care away from the use of psychotropic medications and harsh traumatizing treatments, and to personal empowerment, self-help, prevention and recovery through natural supports, education, training, and research.

Learn more about Mary Ellen Copeland’s work on her website, http://www.mentalhealthrecovery.com.

– MAGDALINE VOLAITIS (photo on right) Magdaline works closely with Mary Ellen Copeland as the Outreach Director for WRAP and Recovery Books. She is the first line of communication to Mary Ellen, manages the website, and writes the bimonthly e-newsletters. Magdaline became a WRAP facilitator in 1999 and finds WRAP to be one of the most useful tools for all aspects of her life.

Join MARY ELLEN, MAGDALINE and guest host SOPHIE FAUGHT (coordinator of MindFreedom International‘s I GOT BETTER campaign to raise awareness of recovery in mental health) for an exciting dialogue about replacing invasive and sometimes harmful psychiatric practices with more holistic and empowering alternatives, achieving a stable and lasting recovery from mental and emotional distress!

(more information at: www.mindfreedom.org/radio-mecopeland)

***

Tune in live at www.blogtalkradio.com/davidwoaks, and join the conversation yourself!

Do you have ideas about how we can avoid invasive psychiatric practices and promote recovery through self-empowerment instead? Do you have experience with WRAP (Wellness Recovery Action Plans) you’d like to share? We’ll be taking your calls at (646) 595-2125.

OR

Listen to the archive any time you like, at

www.blogtalkradio.com/davidwoaks

***

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At the start of the show, 2 pm ET or 11 am PT, you can listen by going to the Blog Talk Radio site hosting this monthly “Second Saturday” show, here:

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Call-in Number: (646) 595-2125.

You can listen and call-in live and free by either computer or phone from anywhere in the world.

USA: 11 am Pacific, 12 noon Mountain, 1 pm Central, 2 pm Eastern

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Online, you can also join a live chat with MFI Web Radio Show.

You can call in via phone, BlogTalkRadio web site or Skype.
~~~~~~~~~~~

More about MindFreedom International:

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MFI has zero funding from the mental health system, governments, drug companies or religions.

All are welcome. While a majority of MFI’s members identify as psychiatric survivors, members include family members, advocates and concerned mental health workers.

That means YOUR membership and donation are CRUCIAL to MindFreedom International’s campaigns for human rights alternatives.

Join or donate now:

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#INDIA- Mental Health Law Reform: Challenges Ahead


Posted on December 23, 2012by 

by Aditya Ayachit

mentalMental disorders are complex physiological infirmities of the nervous system. While they continue be the tough riddles in the field of medical research, they pose even more daunting challenges in the socio-economic and legal contexts. In recent times the mental health laws across the world have undergone a significant change. A policy of segregation has been abandoned in favor of a policy of integration and protection. Theprima facie reason for this shift appears to be the increasing influence of the Human Rights discourse over laws and policy making. Thus, a new mental healthcare paradigm has emerged which advocates that the mentally ill are not objects of charity or social protection but are subjects with rights and States and the International bodies are under an obligation to provide them with the means of enforcing these rights.The international consensus about the new paradigm was strongly conveyed by the near unanimous acceptance of theUnited Nations Convention on the Rights of Persons with Disabilities 2006(commonly known as the Disability Convention’) and Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (or simply the MI Principles).

India is a signatory to the Disability Convention. However, it has failed to bring its laws and institutions in tune with the standards set by the convention. To fulfill its commitments under the Disability Convention, 2006 and MI principles of 1991, India needs a major overhaul of its disability laws and policies dealing with mental health care. The Ministry of Health and Family Welfare (MHFW) recently came out with the Mental Health Care Bill 2012 responding to this formidable legislative challenge. The reactions to this bill were mixed with some groups lauding provisions decriminalizing attempted suicide by a mentally ill person, ensuring the availability of insurance for treatment of mental illness at par with physical illness and prohibition of certain medical procedures like the Electro Convulsive Therapy (in case of minors), Sterilization and Chaining, while others opposing the bill on the ground that its provisions curtailed patient autonomy and liberalized the laws for involuntary admissions to mental institutions. This post does not aim to comprehensively review the bill. Rather, it attempts to map the issues that the Bill appears to address and contrasts the status quo with the regime the bill seeks to establish.

Few Mental Health Practitioners and Institutions in India

A recent statistic from the MHFW indicates that about 7 percent of the Indian Population suffers from some form of mental disorder. Another startling statistic is that 90 percent of these disorders remain untreated. The leading cause behind this paradox is the acute shortage of mental health institutions and qualified mental health practitioners in India. Our large and populous country of 1.2 billion people has about 40 mental health institutions, 3,500 psychiatrists, 500 clinical psychologists, 300 psychiatric social workers and 1,000 psychiatric nurses to treat its mentally ill citizens. In addition to this, most of the institutions and practitioners are located in urban areas. This creates a serious problem in a country like India where over 70 percent of the population lives in rural areas.

mAccording to the National Family Health Survey, the private medical sector remains the primary source of health care for the majority of households in both urban areas (70 percent) and rural areas (63 percent) of India. While private players contribute immensely to the health care industry, it remains the case that they generally shy away from investing in mental health institutions.  This is mainly due to low policy priority given to mental health sector, strict licensing requirements under the Mental Health Act 1987 and the lack of any special incentive for investing in this sector. Today in India, government health policies mainly focus on communicable diseases like HIV/AIDS, malaria and tuberculosis or on child malnutrition or on reproductive healthcare. Mental healthcare rarely finds mention in the policy. This underscores the importance of this sector and makes the investment environment in such services unattractive and discouraging.

Another factor that reduces the likelihood of private investment in mental health care is the strict licensing regime set up by the Mental Health Act 1987; the legislation that currently governs the mental health sector. This Act lays down a complicated procedure of issuing a non-transferable and non-heritable license to a person who wishes to open a mental healthcare institution. The act further discriminates between government established institutions and privately maintained institutions by exempting the government institutions from the statutory requirement of obtaining a license. If private participation is to be encouraged, this system of licensing needs to be rationalized.The Mental Health Care Bill 2012 goes a long way in this regard. The bill replaces the stringent licensing system with a simpler system of registration. The registration unlike a license is not linked to a particular person and is freely transferable for instance on the sale of the institution. It also allows the institution an appeal to the High Court if the grant of registration or renewal of registration or cancellation of registration is refused by the appropriate authority. While the bill seeks to relax the laws governing the setting up of mental health institutions it must ensure via its provisions that this does not in any way affect the quality of health care provided in these institutions. The issue of quality of health care will be taken up further in this post.

mental_health_disorders_other_issues_that_fuel_substance_abuseTo ensure that rural areas also benefit from private investment, the incentives given to invest in rural areas could be greater than those given for investment in urban areas. Another way in which the presence of mental health facilities in rural areas can be increased is by proper implementation of the District Mental Health Program which was initiated by the Government of India in 1996. Currently, the program is under implementation in only 123 of the total 657 districts of the country. A proper implementation of the program would go a long way towards ensuring that rural areas have adequate mental care facilities in near vicinity.

Poor Quality of Mental Health Institutions

The second core issue in this area is the unacceptable quality of medical care provided to the mentally ill in the existing mental health institutions in our country. It would not be an overstatement to say that the patients who receive mental health treatment in India are treated in a most inappropriate and inhuman way in our mental institutions. The institutions usually resemble prisons where the mentally ill are debased and deprived of their dignity. They are made to live in unacceptable living conditions and are shackled down in chains for long hours. They are fed unhygienic prepared unwholesome meals, are subjected to painful medical procedures without their consent, are regularly beaten and in some cases are also subjected to sexual assault. Sometimes they are sterilized on the basis of a medical myth that sterilization cures mental disability. In essence, the patients never receive adequate treatment. Rather the treatment aggravates their condition and makes them sick and infirm for life completely eliminating any hope of rehabilitation or a chance of leading a normal life (see here and here for more). Any mental health care legislation must develop a structured mechanism for ensuring that our mental health institutions do not fall short of the internationally accepted standards of treatment and care. The Mental Health Act 1987 and the State Mental Health Rules 1990 provide detailed safeguards to ensure that the health institutions meet the statutory standard. While building upon this legacy, any new legislation must incorporate the minimum standards laid down in the Disability Convention of 2006 and the MI Principles of 1991. Further, steps must be taken to bring government maintained institutions under the purview of these regulatory procedures. It may be noted here that the Mental Health Act 1987 is quite inconsistent with the principles and safeguards laid down in the aforesaid international instruments and as government hospitals are deemed to be licensed institutions under the act, it is unclear whether the procedures laid down for revocation of license in cases of non-compliance are applicable against  government facilities.

Consent of the Mentally Ill Patients

depression-4Another aspect that would have to be substantially addressed in mental health legislations is with respect to consent of the patient to receive treatment. It is a cardinal principle of medical science that no one may be subjected to any medical procedure without his/her express consent and such procedure may not continue after the person has withdrawn his consent. Mental Healthcare raises complex questions regarding consent. The Mental Health Care Bill 2012 provides innovative solutions to the problem of consent. The bill allows persons to register an ‘advance directive’ with the appropriate mental health board. An ‘advance directive’ is a legal document containing details of the kind of treatment a person wishes to receive or does not wish to receive in the event of mental illness. It also contains the details of the person’s nominated representatives who are entitled to give consent on the person’s behalf when he is not in a position to give consent. The bill provides procedures for amendment or cancellation of advanced directives and also gives powers to the Central or State mental health board to review advance directives and to suspend or amend them in some special cases (for instance when the advance directive has been made under force, coercion, undue influence etc. or when it was made without proper knowledge). While many groups are touting advance directive as a foolproof solution to the problem of consent, it remains to be seen how this statutory tool would operate in real life. This provision has been opposed on the grounds that it would be susceptible to gross misuse especially in rural areas where the patients are illiterate and are not aware about their rights.

Rehabilitation and Social Awareness

Another issue that the bill attempts to address is rehabilitation and social awareness. These concepts are inter-related. The extent to which a patient can be restored back in his life (family, community and occupation) depends on the social understanding of mental illness and the attitude of the society towards the mentally ill. A society which rejects the mentally ill or which despises them cannot possibly assist in rehabilitation of the patient. As societal attitudes are shaped to a large extent by education, an awareness program which aims towards creating social understanding about mental illness can directly assist in making the society more suitable for rehabilitation of the patient. Mental Health Act 1987does not contain any provisions regarding social education or patient rehabilitation. The Mental Health Care Bill 2012 addresses this lacunae and creates an obligation on the Central and State governments to spread awareness about mental illness and its appropriate treatments. The Bill lays emphasis on lowering the stigma associated with mental illness so that a patient’s rehabilitation in the society may be facilitated. It may be noted here that a proper implementation of the aforesaid provisions may go a long way in debunking the long standing myths about mental illness (like mental illness is caused due to demonic possession or that mental illness is incurable) and make the society a better place for the mentally ill.

socialHuman well-being in a country cannot be ensured unless its citizens are physically and mentally fit. Mental health is prone to neglect because it is difficult to detect, difficult to cure and also difficult to explain to the people. The Mental Health Care Bill 2012 appears to be a commendable effort towards addressing the long standing problems encountered by patients and practitioners alike in the sector of mental healthcare and restoring the long lost dignity of the mentally ill.

Image Courtesy: herehereherehere and here

(Aditya Ayachit is an Assistant Editor with the Journal of Indian Law and Society)

 

Alternative Mental Health Radio , tune in on Dec8


 MindFreedom International: Michael Cornwall, Ph.D.

LAST SHOW OF 2012! Join guest host SOPHIE FAUGHT and veteran clinician, Mad In America blogger and activist MICHAEL CORNWALL to talk about madness: “If madness isn’t what psychiatry says it is, then what is it?” LIVE on Saturday, 8 December 2012, at 2 pm ET, 11 am PT; we’ll be taking your calls at (646) 595-2125.

Alternative Mental Health Radio by MindFreedom International: Michael Cornwall, Ph.D.Above: Michael Cornwall, guest on MindFreedom’s ALTERNATIVE MENTAL HEALTH RADIO

MindFreedom International presents:

ALTERNATIVE MENTAL HEALTH RADIO

 

On the topic of:

If madness isn’t what psychiatry says it is, then WHAT IS IT?

 

Our guest:

  • MICHAEL CORNWALL, PH.D. (photo on right), went through an intense, lengthy period of un-medicated madness in his early twenties that set the course for his vocation as a therapist.
  • He served for three years in a 20 bed open door, restraint, medication and diagnosis free, extreme states sanctuary called I-Ward, and completed doctoral research on John Weir Perry’s medication free sanctuary, Diabasis House.
  • For over 30 years he has served people in extreme states and other forms of emotional suffering, while also being a community grassroots politics leader in the human rights struggle against the abuses of psychiatry.
  • Michael uses his personal experience of unmedicated madness to ask: “If madness isn’t what psychiatry says it is, than what is it?”

Join Michael and guest host SOPHIE FAUGHT (coordinator of MindFreedom International’s I GOT BETTER campaign to raise awareness of recovery in mental health) for an exciting dialogue about the importance of madness on both the individual and societal levels.

***

Tune in live at www.blogtalkradio.com/davidwoaks, and join the conversation yourself!

Want to ask our guest about his unique experiences of madness? Have observations or experiences of your own to share about the nature of madness for the individual and society? We’ll be taking your calls at (646) 595-2125.

OR

Listen to the archive any time you like, at

www.blogtalkradio.com/davidwoaks

***

Tips About How to Listen and Call-in Live (or hear the archive later)

Mad Live Web Radio!At the start of the show, 2 pm ET or 11 am PT, you can listen by going to the Blog Talk Radio site hosting this monthly “Second Saturday” show, here:

www.blogtalkradio.com/davidwoaks

Call-in Number: (646) 595-2125.

You can listen and call-in live and free by either computer or phone from anywhere in the world.

  • USA: 11 am Pacific, 12 noon Mountain, 1 pm Central, 2 pm Eastern
  • UTC/GMT: 6 pm [18:00]
  • Ireland: 7 pm [19:00]
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To find your local time click here.

 

Can’t get to a computer that day? No problem! You can use the call-in number (646) 595-2125 just to listen, like a teleconference.

Online, you can also join a live chat with MFI Web Radio Show.

You can call in via phone, BlogTalkRadio web site or Skype.

 

#India – Sunderban women trapped in depression


SHARMISTHA CHOWDHURY, The Hindu

  • Women with psychiatric disorders adopt superstition.
    Women with psychiatric disorders adopt superstition.
  • Women are particularly affected. Photo: Women's Feature Service
    Women are particularly affected. Photo: Women’s Feature Service

A recent survey in the Sunderbans region of West Bengal reveals an alarming trend of rising mental health problem among women

Everyday, when Badal, a sturdy young man of Sunderbans returns home at dusk, he finds his mother, Kamala, sitting placidly in the verandah, staring into the distance with strangely unseeing eyes. The house, otherwise, is abuzz with activity. His daughter is bringing in the cows, his sons are clamouring for somemuri (puffed rice) and his sister-in-law is trying to manage a dozen chores at once. The still and silent Kamala is an odd sight in this busy household, but no one seems to mind. The family never forces her to do any work against her will.

Growing up in a remote village in the R-Plot island of the Sunderbans, Badal has always seen that his mother is different from the other women in his village and he has accepted it as a fact of life. When he was a child, his neighbours had told him that his mother had ‘Mathar Byamo’, a colloquial Bengali term for mental health problem. And that was it. He does not remember ever seeing Kamala being treated for her condition. “She is physically very fit,” he asserts confidently, “and can work like a horse when she feels like it.”

Kamala, unfortunately, is not an exception. A recent survey conducted by the Future Health Systems (FHS), an international research programme consortium established in 2005 with support from the UK’s Department for International Development, and the Institute of Health Management Research (IHMR), has revealed an alarming trend of rising mental health problem among women in the Sunderbans.

The Sundarbans, a unique biosphere reserve of mangrove forests and now a UNESCO global heritage site, is a cluster of more than 100 islands located in the extreme south of West Bengal. But juxtaposed with its claim to fame as a global heritage site, is the extreme vulnerability of its nearly 4.5 million people who are struggling against geographical challenges, health, livelihood and all the basic amenities.

Mental health problems, especially among women, threaten to be one of the most critical public health issues here. The FHS-IHMR study reports that the most visible indicator of psychiatric disorders is the prevalence of deliberate self harm (DSH), or ‘attempted suicide’ cases, which, despite its severe limitation in capturing the total mental disease burden, projects the severity of the problem to a large extent.

Shibaji Bose, Policy Influence and Research Uptake Officer with IHMR, says, “The challenging geo-climatic conditions of this region make the male child an object of necessity in every family…Women whose first child or two is a female have to face unimaginable pressure for giving birth to a male child. It is a very common cause of depression.”

Recent evidences on registered DSH cases, collected through the FHS-IHMR survey, reflect an increasing trend in its prevalence. In the period of six months between April and September 2008, a total of 1,181 cases of non-fatal DSH were registered in the 13 Block Primary Health Care Centres, implying that the average of such cases per month in each BPHC has gone up from 11 to 15 between 2001 and 2008. The share of pesticide or chemical poisoning in total DSH cases has also increased to 89 per cent.

According to Dr Barun Kanjilal, Professor (Health Economics & Health System Research) at IHMR, “The livelihood insecurity, which is a product of a complex link between repeated climatic shock and chronic poverty, is the main reason why Sunderban women are disproportionately affected by mental health problems. Ironically, the easy availability of modern agricultural inputs, like insecticide, has made it easier for them to find a ‘solution’ in suicide.”

There is a high presence of stressors in the Sundarbans. Besides poverty and economic stress, there are the ‘modern’ malaises like marital conflicts, alcoholism and resultant torture and extra-marital affairs, increasing trafficking. The most common mental diseases, as found in one study, are major depressive disorders, followed by Somatoform pain disorder, post traumatic (animal attack related) stress disorder, and adjustment disorder.

In villages adjacent to the forests, where communities depend on fishing and collecting forest produce, people are especially vulnerable to animal attacks. Women, who often spend hours standing knee-deep in the water, collecting spawn, are dangerously exposed to sudden attacks by tigers or crocodiles. In addition, there is always the lurking fear of widowhood – every time the man ventures out on a fishing trip or in the forests.

Such mortal terror, which is an intrinsic part of the life of women in the Sunderbans, leads them to adopt a fatalistic coping strategy such as superstitious responses and dependence on local gods and goddesses, such as ‘Banbibi’, and traditional faith healers, known as ‘Gunin’. While these are perceived to be acting as protective shields against anxiety-related and other mental disorders, actually they only serve to intensify the stress.

Compounding the problem is the fact that few women are medically treated for their conditions. The FHS-IHMR study states, “The psychiatric disorders swell with increasing suicide attempts because neither the people nor the providers consider their prevention as a serious health action.” However, now that a series of surveys have revealed the extent and enormity of the problem of mental ill-health among the women, governmental and non-governmental organisations and institutions working in the region will hopefully address the issue.

According to Bose, “the challenge is to bring about positive behavioural changes that will encourage and prompt the community to ensure medical attention to women when they are seen to be displaying disturbed or unstable behaviour.”

(Women’s Feature Service)

 

 

Vidarbha -Every 4th house in this village has a mentally ill person shackled in chains #Indiashame #Wtfnews


In Vidarbha, a village of the damned

Sukhada Tatke TNN, Nov 4, 2012

Unmindful of the scorching heat and the iron chains around his legs and hands, Raju alias Rajendra Dhere crouches on the ground, tracing his name in the mud with a finger. Ask him his age and what he does in life and he is quick to respond with One and Class One respectively. Then he begins rambling incoherently.
The 40-year-old’s plight is, bizarrely enough, reflected in almost every fourth house in Vadura, this village of 1,800 people in the Nandgaon-Khandeshwar block in the heart of Amravati district. Elsewhere in Vidarbha, the issue of poverty-stricken farmers committing suicide has taken precedence over all else. But in Vadura, or “paagalon ka Vadura” as it has come to be called, villagers have a greater concern: the silent demon of mental illness that has been afflicting people over the years and is now begging for government intervention.
The villagers are unaware of the draft Mental Health Care Bill of 2010 which prohibits chaining persons with mental illness. Raju’s family says that chaining Raju is the only way to keep him in “control”. “He tends to get violent. We admitted him to the Nagpur mental hospital thrice, but it has not helped,” says his brother’s wife, under whose care Raju has been since his farmer father committed suicide three years ago. Known as an intelligent boy and swimming expert in his teen years, Raju today bears no resemblance at all to his younger self.

No govt intervention as yet 
Fifty-two year old Laxman Satange, better known as ‘Tiger’ in the village, does not reflect the picture of his youth either. He sits in a corner or roams around his house, engrossed in whatever catches his fancy. If it is a piece of paper, he folds it relentlessly for hours; if a pen, he doodles endlessly. His brother Prabhakar is in the same boat. Until two months ago, he would wander around the village and take his clothes off. Now he talks to himself and spends most of his time sleeping.
Despite the enormity of the problem, it was only last year, after worried villagers saw children behaving oddly in school, that they decided to do something. “The teachers noticed that several kids were not paying attention or looked disturbed,” says resident Purushottam Dhere. “They happened to come from families with mental disorders.
That’s when we approached the Apeksha Homeo Society for help, which co-ordinated with the Amravati health department and organised a medical camp. Psychiatrists and psychologists from private groups were also present.”
The camp was an eye-opener—of the 100-odd people who showed up there, 14 were diagnosed with acute mental illness and 26 others with milder variants. A doctor told TOI that most of the villagers suffered from psychosis and schizophrenia;
mental retardation was also prevalent.
Dr C L Sunkusre, district programme officer of the National Rural Health Mission, admits that the problem in the village is grave. “The prevalence of mental illness in this village is far greater than any other village in Amravati,” he says. “We need to give it special importance. The causes may be genetic, rooted in pregnancy problems or stress-related. We need to get to the root of it and think of solutions.”
According to Dr Pankaj Wasadkar, a clinical psychologist associated with the Manas trust in Vidarbha, Vadura is symptomatic of alarger disquietthat governs rural India: an acutelackof awarenessof mental health issues and treatment. Wasadkar had attended the camp and found that there was no reason that could be pinpointed for certain. “The problem is that there is no epidemiological base to the problem in the villageor even in rural India,” he says. “In this particular village, there has been no disaster or trauma. Some patients have been rendereduntreatablebecause treatment has never been provided to them. Some have chronic illness which came to the fore. Therefore, there needstobe governmentintervention where psychiatric treatmentis made available.Buteven after the health camp, the medicines were not distributed properly.”
Villagers too complain that there has been no follow-up by the health department. “The government is not doing anything,” says Dhere. “All we want is for experts to carry out a survey to examine the reasonssothat moresuchcases don’t occur. What scares us the most is that little children might develop the same problems.
“The signs in school are worrying enough,withkidsimitating the mentally ill they see around. It’s high time the government helped us.”

Mentally-ill Rajendra Dhere, 40, in shackles bears little resemblance to the intelligent boy he once was. In Vadura village of Amravati, almost every fourth house has somebody who has lost his/her mental balance
It was only last year, after worried villagers saw children behaving oddly in school, that the health department decided to take some action

 

# India-Mental illness, choice and rights


October 20, 2012

Harsh Mander, The Hindu

  • Until recently, the law treated persons with mental illness not as persons who deserve treatment and care, but as people who are vaguely dangerous. File Photo: S. James
    Until recently, the law treated persons with mental illness not as persons who deserve treatment and care, but as people who are vaguely dangerous. File Photo: S. James
  • Members of Disabled Rights Group (DRG) and National Alliance on Access to Justice for People Living with Mental Illeness (NAAJMI) staging a protest outside Health Ministry against the Mental Health Care Bill. File Photo: V. Sudershan
    The Hindu Members of Disabled Rights Group (DRG) and National Alliance on Access to Justice for People Living with Mental Illeness (NAAJMI) staging a protest outside Health Ministry against the Mental Health Care Bill. File Photo: V. Sudershan

The new Bill should pitch for free care to mental health patients in public hospitals.

Persons with mental illness have long been subjected to cruelty, neglect, ridicule and stigma. In the last half-century, medical science has made significant strides in finding some cures and palliatives for afflictions of the mind – of emotion, mood, thinking and behaviour. Parallel to this is the evolution in our ethical frameworks: of human rights, and acknowledgment of the equal dignity of all human beings. But changes in the law, social attitudes, and the work of healthcare institutions and psychiatric professionals, have not kept pace with these scientific and normative advances.

The Mental Health Care Bill, 2012, recently released by the government, is an exceptional State-led attempt to correct many of the historical wrongs to which persons with mental illness have long been subject. The draft emerged after a long and engaged process of consultation with persons with mental illness, their care-givers, their organisations, and professionals.

The Bill met immediately with fierce opposition from some radical disability and mental health organisations. Many of their concerns and fears are legitimate. But I believe that this is on balance a humane and progressive Bill, bravely and compassionately navigating difficult ethical and professional terrains.

Until quite recently, it was routine to lock away people with mental illness in jails or jail-like mental hospitals, kept naked or in prison-like uniforms, bound in chains, abandoned and often forgotten for lifetimes. The number of beds in mental hospitals were, however, minuscule, and the large majority of patients were denied any kind of care, except those offered by faith healers and untrained practitioners.

The new Bill contains many protections to persons with mental illness. It bars prolonged hospitalisation, chaining, compulsory tonsuring, forced sterilisation, and electro-convulsive therapy without anaesthesia, and defends rights of patients to privacy, personal clothes and protection from abuse. It also prescribes that all persons with mental illness have the right to dignity, and to live in, be part of, and not segregated from society.

The Bill also mandates that mental health services shall be integrated into general health services at all levels – primary, secondary and tertiary, and that these services shall be available in the neighbourhood. If enforced, this will draw a curtain on the long tragic history of injustices and abuses which characterised large, segregated mental hospitals.

The opening sections of the Bill are forthright in admitting that persons with mental illness suffer discrimination, and that the current law has failed to protect their rights and promote their access to health care. It goes on to assure all persons the right to ‘affordable’ good quality public health care.

I believe this guarantee does not go far enough. In these columns last fortnight, I recounted the story of Rajesh, a young man suffering from hallucinations from full-blown psychosis, badly injured, who was repeatedly refused admission by many major public hospitals in the capital. The story underlines the general experience of growing abdication by professionals and public institutions to take care of impoverished and difficult patients. I believe that the Bill must guarantee nothing less than free care in all public hospitals for all patients who seek or need care, and prescribe deterrent punishments for hospitals and professionals who refuse to provide care.

Against their will

Despite its many progressive and humane features, the Bill is still attacked by some radical associations of persons with mental illness, mainly because it retains provisions in rare cases to admit patients for care, even against their will. This debate has an important history.

Until as recently as 1987, the colonial Indian Lunacy Act, 1912, prevailed, in which persons with mental illness (described as ‘lunatics’ and ‘idiots’), were admitted into mental hospitals through the order of Magistrates. The law treated persons with mental illness not as persons who deserve treatment and care, like any other person who falls ill, but as people who are vaguely dangerous, and therefore it in effect primarily aimed to protect other people from persons with mental illness.

The Mental Health Act of 1987 partially corrected this, by allowing for voluntary admissions, but Magistrates still retained a central role for patients who were admitted to mental hospitals against their will. Mental health activists rightly campaigned against this provision, as it was undignified and stigmatising; and it was on occasion misused to abandon and ‘tame’ assertive and non-conforming women and men.

Radical mental health activists are dismayed because the new Bill still allows involuntary admissions of patients against their will. They are uncompromising that the will of the patient should be absolute regarding whether or not she wishes to accept treatment and care.

On the other hand, many persons with mental illness, and their care-givers, recognise that there are occasions when it is in the paramount interest of some patients to be given care forcefully, even when they refuse it, if the person is in imminent danger of causing harm to herself or to other people. The Bill limits involuntary admissions to only such cases, with many checks and balances. Forced admission is only for 30 days at a time. The Magistrate is removed from the picture completely, and is replaced by mandatory reviews of all such cases by mental health panels, which comprise judges but also administrators and persons with mental illness and their care-givers.

There are moments I have observed – among loved ones, friends and the young people from the streets who are now in our care – when a person is suicidal or hallucinatory, abandons home or is suspicious of loved ones, is compulsively manic, spending or gambling life savings, violent and dangerous to himself or to neighbours. In the name of human rights, no hospital or professional offers them care. But there are deeper human rights in these moments, which cumulatively may temporarily override the right of free choice. These are the rights to empathy, protection, dignity and care. I believe that the Bill is right in the delicate balance it has found, retaining the provisions for involuntary admissions, but limiting these severely with many cautions and checks.

These debates are important, and we need to listen to each other more. But while we discuss, we must welcome a draft law which promises to reverse the cruelty, ignorance and abdication, which still characterises ways the State and professionals still treat people battling demons in their minds and souls, while guaranteeing them empathy, respect, protection and care.

 

India- Scrap outdated #Mental Health Bill- Activists


 

PLEASE  CLICK HERE AND SIGN ONLINE  PETITION TO BE SUBMITTED TO HEALTH MINISTER ON 10TH OCT

Petition health minister over inclusion of archaic psychosurgery and electro-shock treatment, which is banned in many countries #MENTALHEALTH

 

Jyoti Shelar, MUMBAI MIRROR OCT 5TH
Health Minister: Repeal of the   Draconian Mental Health Law

Posted On Friday, October 05, 2012 at 04:15:43 AM

Human rights activists are upset about a new proposed Mental Health Care bill that retains outdated and controversial treatment techniques such as electro-convulsive therapy (ECT) and psychosurgery– neurosurgical treatment for mental disorders.While many term the draft bill as ‘patient friendly’, some activists feel that the bill represents the ‘over-medicalisation’ of mental health when it should instead concentrate on the most effective therapies.

On Thursday, activists started an online petition demanding the bill be quashed. The petition letter, addressed to Health Minister Gulam Nabi Azad, demands that all rights of people with psychosocial disabilities should be covered under the recently drafted Rights of Persons with Disabilities Bill, 2012, and that the MHC Bill be given a quiet burial.

The Rights of Persons with Disabilities Bill guarantees the ‘legal capacity’ and the ‘right to choice’ of all persons with disabilities, including those with psychosocial disabilities.

“The MHC Bill, on the other hand, only looks at medicalisation of mental health issues. We are amazed that the bill retains the archaic and horrendous ECT or shock treatment, which has been banned by most countries,” said Kamayani Bali Mahabal, a lawyer and human rights activist.

According to Mahabal, the bill also retains the option of psychosurgery, which has always been controversial. “Mental health treatment needs to be more therapy-based than medicine-based,” said Mahabal.

The activists are of a view that mental health patients need community-based treatment with groups and peer support, neighborhood care systems, conflict reduction and peace building strategies, supportive counselling, addressing stigma, trauma-informed services, and a range of other alternatives.

According to Dr Sanjay Kumawat, medical superintendent of Thane Mental Hospital, the draft bill may need some modifications, but feels the demand to do away with ECT and psychosurgery is unreasonable. “ECT has proved beneficial for many patients. If ECT is performed following guidelines – using muscle relaxants and anesthesia – and is going to benefit the patient, I don’t see any harm,” said Kumawat.

Psychiatrist Dr Yusuf Matcheswalla agreed. “Patient benefit is the most important factor and I think this bill is extremely patient friendly. There are a few points that need clarity. For example, the bill says that patient’s consent is needed for any psychosurgery. However the bill does not explain if a nominee can give their consent if the patient is unable to do so,” said Matcheswalla.

Dr AK Kala, a senior psychiatrist from Ludhiana, added, “The old type of neurosurgeries, which landed patients in a vegetative state, are not performed anymore. In India, very few psychosurgeries are performed, and the bill is trying to regulate those. It states that a government committee has to approve all psychosurgeries, which is a good thing.”

 

Attn Delhi-Protest-The Draconian Mental Health Care Bill- Oct 10th #Mentalhealthday


 

Disability Rights Group (DRG)

&

National Alliance for Access to Justice for People Living with Mental Illness (NAAJMI)

 

Protest

 

The Draconian Mental Health Care Bill

 

Time: Wednesday, 10th October, World Mental Health Day

 

Time:  11 A.M.

 

Venue: In front of Ministry of Health and Family Welfare office,

at Nirman Bhavan, C Wing, New Delhi

 

 

India is home t0 30-40 million people living with psychosocial disabilities or what we refer to as disability caused due to a ‘mental illness’.

 

The archaic Mental Health Act of 1987, an offshoot of the colonial Lunacy Acts, makes people with ‘unsound’ mind non-human! They are not considered to have opinions, wishes or feelings; and cannot act upon their own will, as per laws.

 

The Disability Act of 1995 defines ‘mental illness’ as a disability. India has also ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) that talks about India’s obligation to respect, protect and fulfill the human rights ofALL persons with disabilities.

 

However, the Ministry of Health & Family Welfare seems to be ‘unaware’ of this. Nothing explains why then it has come out with a Mental Health Care (MHC) Bill, while completely failing to include mental health & well being to the Right to Health Act!

 

The draft of the Rights of Persons with Disabilities Bill 2012 recently unveiled by the Ministry of Social Justice & Empowerment (MSJE) guarantees the ‘legal capacity’ and the ‘right to choice’ of all persons with disabilities, including those with psychosocial disabilities. The Ministry of Health has gone drastically against CRPD and the draft Rights of Persons with Disabilities Bill and has advocated for involuntary incarceration and continuing with electric shock treatments and even lobotomies!

 

  • The rights of people with psychosocial disabilities must be governed by the Ministry of Social Justice & Empowerment. Why is the Health Ministry then overstepping its turf? What is the Health Ministry’s motivation?
  • While the draft Rights of Persons with Disabilities Bill of MSJE talks about ‘full legal capacity’, MHC Bill talks about ‘involuntary incarceration’? What is the Government of India’s stand on the issue if two of its Ministries are talking diametrically opposite on this?
  • Involuntary incarceration, over drugging, mental asylums, electric shock treatment and the rampant abuse & exploitation that goes on in the name of psychiatry and mental health goes against the letter of CRPD that India has ratified. What is India’s answer to the international community?

 

WE DEMAND AN IMMEDIATE STOP TO THE PROCESS OF BRINGING A DRACONIAN MENTAL HEALTH CARE BILL

 

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