Empowering Mentally Ill to Live with Dignity

Dr. H. R. Keshavamurthy Director (M&C), Press Information Bureau, Kolkata. Mental health represents a critical indicator of human development, serves as a key determinant of well-being, quality of life and is the basis for social stability. Social and economic impact of poor mental health is pervasive and far reaching, leading to poverty, high unemployment rates, […]

Dr. H. R. Keshavamurthy
Director (M&C), Press Information Bureau, Kolkata.
Mental health represents a critical indicator of human development, serves as a key determinant of well-being, quality of life and is the basis for social stability. Social and economic impact of poor mental health is pervasive and far reaching, leading to poverty, high unemployment rates, poor educational and health outcomes, among others. There is a need for a wider recognition of mental and emotional well-being as a core indicator of human development, and it is necessary to integrate a mental health and psychosocial perspective into all development and humanitarian policies, programmes.
Persons with mental and psychosocial disabilities represent a significant proportion of the world’s population. One in four people globally experience a mental health condition in their lifetime. Almost one million people die due to suicide every year and depression is ranked third in the global burden of disease, and is projected to rank first in 2030. In India prevalence of mental disorders is 6-7% for common mental disorders and 1-2% for severe mental disorders. Treatment gap for severe mental disorders is approximately 50% and in case of Common mental Disorders it is over 90%.With such a magnitude of mental disorders it becomes necessary to promote mental health services for the well being of general population, in addition to provide treatment for mental illnesses.
Persons with mental and psychosocial disabilities often face stigma and discrimination due to widely held misconceptions about the causes and nature of mental health conditions. Persons with mental and psychosocial disabilities also experience high levels of physical abuse. They encounter restrictions in their exercise of socio-politico-economic rights in the majority of countries, largely due to the false assumption that they are not able to carry out their responsibilities, manage their own affairs and make decisions about their lives.
Though mental health conditions are one of the leading causes of disability, persons with mental and psychosocial disabilities often lack resources to maintain basic living standards. Furthermore, they are one of the most neglected and discriminated groups in development policies and programmes. Integration of mental health into development efforts is a cost effective pro-poor strategy. There are cost effective treatments available for most mental illnesses, and effective treatment is associated with reductions in overall health-care costs. Child development, education, health, social welfare policies and programmes must integrate mental and psychosocial aspects.
In India, National Mental Health Programme (NMHP) was started in 1982 with the objectives to ensure availability and accessibility of minimum mental health care for all, to encourage mental health knowledge and skills and to promote community participation in mental health service development and to stimulate self-help in the community. Gradually, the approach of mental health care services has shifted from hospital based care (institutional) to community based mental health care, as majority of mental disorders do not require hospitalization and can be managed at community level.
During IX five year plan, District Mental Health Programme was initiated (1996) and at present DMHP is covering 123 districts in 30 States and UTs. In addition to early identification and treatment of mentally ill, District Mental Health Programme has now incorporated promotive and preventive activities for positive mental health which includes; School Mental Health services; College Counselling services; work place stress management and suicide prevention services. Efforts are being made to improve human resource availability in mental health sector so that mentally ill gets required attention and persons having a predilection for mentally illness can get good advice, counselling at the initial stages itself. Components of NHMP are being brought under the overall umbrella of National Rural Health Mission so that the States are able to plan requirements concerning Mental Health services as part of the respective project plans. Rs.623.45 crore has been approved as XI plan outlay (upto 2012) for the National Mental Health Programme.
However, recognizing the difficulties/stigma faced by mentally ill persons the Government is in the process of providing a humane, patient centric legal framework for mentally ill patients. The proposed Mental Health Care bill can be a ‘Game changer’ in the life of millions of mentally ill persons who were often victims of inhuman and degrading treatment, abuse and ridicule, both at the community level and at health care delivery establishments.
The proposed Mental Health Care bill is significant in terms of Rights’ Approach that is being adopted to give pre-eminence to the preferences and opinion of the mentally ill person to a major extent. Provisions like ‘Advance Directive’ empowers every person to make directive on how he wishes to be cared and treated for mental illness or not. Other salient provisions are;
A mentally ill person admitted to a mental health establishment shall have a right to receive or refuse visitors, phone calls, mail,etc
A mentally ill person has a right to have treatment in his locality /
residence and can prefer only minimum treatment/care at mental health establishments. This is to ensure that the patient is allowed to live in, be part of and not be segregated from society to the extent possible
· Every patient has a right to protection from cruel, inhuman and degrading treatment and the mental health establishment shall be safe, clean with facilities for education, recreation, religious practices.
· No patient shall be forced to undertake work and subject to compulsory shaving of head and wearing of uniforms.
· Mental illness may be made eligible for medical insurance coverage.
· Government is duty-bound to plan, implement mental health programmes and create awareness about mental health and illness to reduce the associated with mental illness
· Every person will have access to mental health care and treatment at affordable cost, of good quality and of requisite quantity, accusable to the report, their families and care givers
· Government should interpret mental health services into general health care services at all levels in all health programmes.
· Government shall arrange good quality care and treatment in hospitals funded by government and in case of non availability in nearby place; refund the costs of treatment to the patient.
To conclude, a mentally well person means a healthy society and developed nation. It is not enough if we have best health care services, protective legislation unless the stigma, discrimination and widely held misconceptions attached to mental illness are weeded out and community becomes more empathetic towards such persons.
(PIB Features.)

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