The present scenario in India

1. HUMAN RIGHTS
AND
MENTAL HEALTH
Dr. Santanu Ghosh
Research Scholar,
Department of Psychology,
Tripura University

4. August 6, 2001
Place: Ervadi of Tamil Nadu
“ The chain is blackened & the ring is
hereby twisted but still fastened to the
charred stump-of a leg. Mentally challenged
& physically shackled he was, yet he had
desperately tried to free himself ……27
more mentally ill people died in the early
hours of the day when a fire engulfed the
thatched roof of the Morideen Badhusha
mental home”
The story is old,…. but memory is still alive-

5. This unfortunate incident (or is it an eye
opener?) alarmed the government, the
judiciary and public and human right
activists in the whole country.
“ PERSONS WITH MENTAL ILLNESS ARE
DEPRIVED OF THEIR BASIC HUMAN
RIGHTS AND RIGHT KIND OF TREATMENT
NOT ONLY MEDICAL BUT FROM CIVIL
SOCIETY ALSO”

6. What is human rights?
It means, “one that ought to be claimed as
entitlement (i.e. human rights) those minimal
things without which it is impossible to develop
ones capabilities and live life as human beings”
- Richard wasserstorm
In contrast to mentally ill persons
• not only refers to their privileges
• but also against protection against infringement of
their human & other statutory right.

7. Evolution
1948
Universal Declaration of Human Rights(UDHR)(more general)
1971
Declaration on Rights of Mentally Retarded Person
1975
Declaration on the Rights of the Disabled person
1982
National Mental Health Programme

8. Contd…
1987
Mental Health Act(India)
1991
United Nations Principles for protection of persons with mental
illness for improvement of mental health care
1992
World Psychiatric Association Declaration in Hawaii
1995
Persons with disability Act

9. Contd…
1996
The international convent on Economic , social & cultural Rights
(ICESCR)
&
WHO developed the Mental Health Care Law ( 10 basic principles)
2001
Incident at Erwadi
Supreme Court Judgment

10. HOW & WHY MENTAL ILLNESS PARTICULAR CONCERN
FOR SUPREME COURT & NHRC IN INDIA?
First:
• At the sight of magnitude of the problem :
as per WHO projection; by 2020
depression would be the main cause
of worry.
• Total global burden of mental, neurological illness &
substance abuse raised from
11.5% in 1998
to
15.5% in 2020

11. Contd…
Second:
The cause of worry is as Mental Illness
• Affects health, freedom, security and well being of
individual, family, entire communication and the
society & nation.
• ↓ ability to cope with stress
• In childhood withers away in wilderness
• cripples the productive and reproductive phase of
life
• In elderly- causes seclusion, helplessness &
abandonment
• Alcohol & substance abuse –impaired quality of life
and so on

12. Cont’d…
Third:
• While article 21 of the constitution maintains “ Right to
Life” and right for health has grossly been violated for
mentally ill person
• The Supreme Court & NHRC felt that
“ what is ideal is not the ground level reality; we
live in a midst of highly stigmatized, callous and
insensitive society”

13. Contd…
Fourth
Between 1980 to 1990 several cases including P.I.L
were filled in the Apex court against the violation of human
rights among mentally ill person by various social activists and
NGOs.
Worth mentioning one of 237 of 1989
Sheela Barse Vs Union of India
Another
1988 Chander Kr. Banik Vs State of West Bengal
1900 Upendra Boxi Vs State of UP & other

14. Mental health concern:
The pith and substance of these judgment in
which the human rights comes out clearly with
concern are:
- Mental Illness is not a curse, not a fatality.
- Every mentally ill person can be effectively
treated, cured and can resume a normal life.
- He/she can be fully and effectively reintegrated
in to the mainstream of society

15. Mental health concern (contd…)
• Patients should not be subjected to any cruelty or
indignity.
• He can not be used for the purpose of research
except when the research is of direct benefit to
him.
• Health itself is a neglected area in the budgetary
allocation.
• Health sector received less than 1%.
• Over 70% of the health care expenditure of the
country was born by the public

16. • Most of the states do not consider necessary
to mention separate allocation for mental
health.
• Thanks to changed perception in the Ministry
over the past few years there is a significant
change.
• In the 9th Five Year Plan allocation for
mental health was mere 26 crores which
rose to 190 crores in 10th Five Year Plan.
• As health is a state subject implementation
of the program related to the mental health
must be materialized with the state.
Mental health concern (contd…)

17. • India has a big gap between mental illness&
treatment.
• Over 10 million persons in our country with
severe mental disorder and over 50 million
persons with some minor mental disorder (The
Ministry of Health in 2003 estimate).
• There were only about 30,000 psychiatric
hospital beds in the government and private
sector and less than 5000 trained mental health
professionals.
• Only 10% of mentally ill persons actually have
access to mental health services in a hospital.
Mental health concern (contd…)

18. WHAT WAS THE MANDATE OF NHRC ENTRUSTED BY THE
SUPREME COURT & HOW HAD THE SAME BEEN
DISCHARGED?
• In the last case Supreme Court requested the NHRC – to supervise mental
hospitals at Agra, Ranchi and Gwalior (1977)
• An investigation research was assigned to NIMHANS, Bangalore under the
leadership of Dr. S. M. Channavavasana former Director V.C. of NIMHANS
as principal investigator
• The team visited 37 Government mental hospital and intensively reviewed
the functioning.
• The findings and the experience gathered by the team named “ Quality
Assurance in Mental Health” contains 12 chapters with recommendation

19. What had been observed?
• Most mental hospital established on 19th
century during British rule
• Separate hospital for British patients
• The mentally ill were called lunatics
• Long years of living had detrimental effects on
their loss of functional & social skills

20. Contd…
• Findings revealed two types of mental hospitals –
First type: Doesn’t deserve to be called
‘hospitals’ but simply they are ‘dumping
grounds’ of families (for economic reason,
social stigma etc.)
Second type: Which provide basic amenities,
provide food, shelter and treatment. Very little
or no effort to enhance their daily living skills.

21. Some of the salient features in recommendations
made:
I. Provision for out patient service:
 Regular OPD(9:00 AM – 3:00PM)
 Basic amenities viz. toilet
 Essential drugs
 Modified ECT
 Psychotherapy & behavioral therapy
 Lab facilities
 Medical store for 24 hours

22. Contd…
II. Causality & emergency service:
 24 hours service
 Emergency ward 5to 10 beds equipped with
emergency medications
III. Short stay ward for observation:
 5-10 beds

23. Contd…
IV. In patient services
Open wards so that relatives can stay with the patient-
reduces the number of nurse and hospital staffs.
- No floor bed
- Closed ward should be limited only to the
unmanageable cases. No cells allowed
- 90% should be open ward & 10% in closed wards
- To wear their own cloths
- All basic amenities to provide
- Maintenance of patient’s record
- Adequate deposit( 3 times the fare) at the time of
hospitalization
- Provision for dining hall

24. Separate Intensive Care Unit:
With separate nursing staffs, ward attendants &
sweepers
Supportive services:
A. Kitchen & dietary services
 Service of dietician
 Fixed food time
 Well balanced diet: 3000 cal for male & 2500 cal for
female

25. Contd…
• B. Laundry:
Should be mechanized and have
modern facilities
• C. Medical store
• D. Medical record section
Should keep 3 moths stock of
stationary & other items viz. forms
etc.
• E. Waste disposal and management
• F. Liaison services with other NGOs

26. General guideline for hospital management
Hospital administration:
• Adequate administrative staff-M.S/ Director
• Hospital management committee
Rehabilitation services:
• Training in activities of daily living skills
• Vocational training viz. tailoring, candle
making etc.

27. General guideline for hospital management contd…
Day care Centre: (9AM to 5 PM)
• For discharged patients who are not
engaged in any work
• To provide structured activity schedule
• Occupational therapies
• Psychiatric social worker for working with
families

28. Human resource development & training
Existing scenario
• Psychiatrist 1 per 100,000 population (ideal per 10 100
patients)
• Clinical psychologist 1.5 per 100,000 population(1 per 25
100 patients)
• Psychiatric social worker 1 per 100,000 population (1per
25 100 patients)
• Psychiatric nurse
1 per 3 patients (in teaching hospital)
1 per 5 patients (in non teaching hospital)

29. Human resource development & training contd…
Mental health resource map
• Major & minor mental disorder =61,521,790
• Number of beds(Govt.) = 20,893
• Number of beds(Private) = 5096
What we would need as per norms?
• Psychiatrist-9698
• Clinical psychologist-13259
• Psychosocial worker- 19,064

30. Human resource development & training contd…
What we have now
• Psychiatrist- 2219
• Clinical psychologist- 343
• Psychosocial worker- 290
In other words, the vacancy in each category is
huge, such as-
• Psychiatrist- 7477
• Clinical psychologist- 12,926
• Psychosocial worker- 17,118

31. MHA 1987:
It was amended in 2007 in terms of-
• 1 Psychiatrist per 10 in patient to per 100
in patients
• 1 clinical psychologist, 1 psychiatric
social worker & 1 doctor(MBBS) per 100
in patients
• 1 nurse for 10 patients to 50 patients has
been allowed

32. MHA lacunae:
• On 8th May, 2008 in a meeting of the Health
Secretaries and Mental Health Authorities held at
NIMHANS, Bangalore.
-Justice Shri. Y. Bhaskar Rao made the
following observations concerning the Mental
Health Act 1987.
-He mentioned the various lacunae and failure
to fully protect the rights of the patient in the
mental hospitals.

33. Various lacunae of MHA ‘1987
1.No mention is made of incorporating General
Hospitals and Centers in this Act. Rather they
are prohibited. Such Hospitals if taken along
may provide better health care.
2.Much stress is laid on hospital based admission
and treatment. This again increases the cost
of health care. No provisions are made for
home based treatment.
3.Although the acts provides for a simpler
discharge procedure but no provisions are
made for after discharge care and
rehabilitation of patient.

34. various lacunae of MHA ‘1987 (contd..)
4.In case no relative come forward to discharge of
patient, will that person be detained
indefinitely in hospital ?Who will bear the
expenses in such case ? If Govt. Then how
long ?
5.Once a person is admitted to Mental Hospital
he is termed insane or mad by society. Thus
there should be provisions in the act to
educate the society against these
misconceptions.

35. Hope in mental health
To summarize:
• Govt. of India has taken active interest and followed the
recommendation of the NHRC –
• As finance & human resource has been the main crunch of
improving mental health care in the country, Government has taken
active initiation to remove these barriers like -
1982 – We have, NMHP- with provisions for
training & recruiting mental health professionals as
a measure for human resource development and
research in mental health

36. Hope in mental health contd…
1987 – Mental Health Act(the process of
suggesting the government for
amendment of some chapters by the IPS is
on process )
• 9th Five Year Plan allocation Rs. 28 crore,
• 10th Plan allocation 190 crore
• 11th Plan allocation Rs. 1000 crore
• NMHP has been re-organized with
emphasis or integrated approach to
treatment, training, teaching and
research.

37. Hope in mental health(contd..)
• In 1997, the NHRC, made a project on
“Quality Assurance in Mental Health”.
• Some of the recommendations are in
respect to Rights of the mentally ill
are –
 The right to be treated humanely and
with respect for the inherent dignity
of the person.
 Right to personal liberty.
 Right to bodily integrity and
appearance.
 Right to privacy.

38. Hope in mental health(contd..)
 Right to be protected from cruelty and
involuntary servitude.
 Right to appropriate treatment and
rehabilitation.
 Right to be respected.

39. Hope in mental health(contd..)
 Right to protection against exploitation or
discrimination and a right to protection
against abuse or degrading treatment.
 Right to community and family life once
improved rather than a life of incarceration.
 Right to refuse treatment.

40. conclusion
Let us hope that in future with the intervention of
the NHRC, Supreme Court, and development of
human resources, adequate funding and the will of
the Government in both central and state level and
also involvement of all section of public to safeguard
the rights, respect & dignity of mentally ill person;
and to receive adequate treatment and rehabilitation
in our country will no more be an unrealistic
expectation or a myth, but will be a reality.