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Jan-Mar2003-11(1)
DISCUSSION
Of human bondage: glimpses
into the human rights situation of the mentally ill in West Bengal
Ratnaboli
Ray
"The mentally ill person deserves the same privileges enjoyed by any other human being," wrote the National Human Rights Commission in its report Quality Assurance in Mental Health published in 1999. The mentally ill person is protected by the Declaration on the Rights of the Disabled, adopted by the UN in 1975. The Declaration specifies many rights including the rights to treatment and rehabilitation, to privacy and autonomy, to a life within the community, to protection from abuse and exploitation, and so on. What are the realities in India?
The UN Declaration recognises the right to
"necessary treatment in the least restrictive set up and as far as possible to
be treated and cared for in the community". The Mental Health Act of 1987
(revised over the Indian Lunacy Act of 1912) explicitly mentions the right to
appropriate treatment and rehabilitation, the right to personal liberty, and the
right to improved community and family life rather than the life of
incarceration. However, the Act also empowers the judiciary and the police to
take any mentally ill person in custody and remand him or her to a custodial
hospital. Thus, patients are herded from prisons to hospitals without any
commitment to reintegrating them.
Even the best among the state-run mental hospitals
in our country have no visiting facilities for patients. There are no fixed
visiting hours for family members to meet an institutionalised patient, no
visiting rooms, no permission to enter the wards. When family members show
enough interest to visit, they must talk from the other side of bars -
illustrating the prison-like situation in which mental patients live when in the
state's custody. It is also a comment on how interested such hospital
authorities are in involving family and community members in the treatment and
recovery process of the mentally ill.
Not one of our State-run mental hospitals has the
provision for voluntary admission and discharge.
Protection against exploitation and
discriminatory, abusive or degrading treatment
Not long ago, a participant of ANJALI's
rehabilitation programme was in tears. He sings well and looks forward to
leading the life of a celebrated singer when he is reintegrated. He had a sore
throat and had asked the ward attendant for some warm water for gargling, to
restore his voice. What he got instead was a slap. This was three years after
the NHRC report was published.
One of the standard complaints that we hear
regularly from our participants is that they are refused medicines for
stomachache. Stabilised patients sometimes long for the taste of home-cooked
meals, for a little variation in the bland hospital food. But a request for a
green chilli, something Bengalis are accustomed to having with their meals, is
met with vulgar and abusive responses like: "Do you want the green chilli shoved
up your - ?" Newspapers - which most of us take so much for granted we hardly
think about them as a privilege - are unknown in state-run mental hospitals.
Patients interested in the happenings of the outside world must depend on the
occasional paper packet, carefully unfolding it and removing the creases to read
about reports weeks if not months old.
Rehabilitation, personal autonomy, privacy
Not a single state-run mental hospital offers
rehabilitation facilities. Not just that, it has taken the government two and a
half years to grant an initiative like ANJALI - the only one of its kind in this
region which works in collaboration with the government - permanent permission
to work in the two hospitals that we function in, and to invite us to take up
another district hospital run by the state. Privacy is a dream when the only
secluded moment a patient has is in an isolation cell. Personal autonomy, a
concept culturally ill-understood in our part of the world, is non-existent for
the institutionalised mentally ill, as should be obvious from the anecdotes
quoted earlier.
Family and community: ignorance, disdain
and fear
As the State continues to withdraw from the social
sector, the role of civil society is becoming increasingly more important in
ensuring a better quality of life in all spheres. In fact, the entire human
rights movement depends on civil society to monitor and force the state to
guarantee its citizens basic human rights. This is why we need to also examine
the general societal mindset in India towards the mentally ill, so as to better
understand the situation.
Unfortunately, ignorance, disdain and fear mark the
general attitude towards the mentally ill in our country. In the absence of a
proper understanding of mental health, any form of mental illness being equated
with lunacy. This in turn provokes contempt and dread. Families seek to put
mentally ill members in state-run hospitals through court orders, only to forget
all about them. Giving wrong addresses, refusing to visit institutionalised
patients, tricking patients into giving up property rights, refusing to
reintegrate them into the family even when they have been stabilised - these are
all common occurrences in our part of the world.
One of ANJALI's clients, now in a short-stay home
where he is learning dairy and poultry farming, provides a sad example of how
families treat their mentally ill members. His parents had been caring enough to
leave money and property for him. While under treatment for chronic
schizophrenia, he was forced by his sisters to sign everything away.Then there
is this gentle lady in her mid-50s, currently a participant in ANJALI's
rehabilitation programme, who has spent nearly a decade in incarceration.
Entirely stable now, she is languishing in the hospital as her son continues to
give false addresses and remains untraceable, despite the best efforts by
ANJALI's social workers.
Another client, in her mid-40s, a bright and
talented performer, explained, her voice muffled with suppressed tears, that she
did not like using abusive words but sometimes someone inside her made her use
those words despite herself. She was describing a schizophrenic hallucination.
However, her sister refuses to listen to this candid explanation, choosing
to view the problem as one of 'bad behaviour'. Such selective perception
characterises familial attitudes towards the mentally ill in our country. Use of
strong words by the 'normal', especially by women, is more often than not
accepted as a mark of assertiveness and independence. When it comes from a
mentally ill person, it becomes an indicator of violence, non-conformity and,
therefore, non-acceptability.
Education and employment
In the absence of state-sponsored legal or social
assistance towards education, training, employment and protection of rights, the
mentally ill have virtually no protection against apathy and antagonism. Their
families are often economically poor and socially marginalised - for whom people
unable to earn their own living can prove an unmanageable burden. Given our
poverty and monumental unemployment problems we need a movement towards
awareness-raising and lobbying for special privileges for the mentally ill.
However, civil society entrepreneurs working for development, better quality of
life, and freedom from discrimination for marginalised social groups are
strangely apathetic towards the mentally ill as a special group. In recent years
there have been movements for ensuring better privileges and options for the
disabled. Laws have been changed through successful lobbying. Corporate houses
now have a quota of jobs reserved for the physically handicapped. Public
conveyances and amenities have special arrangements for them. However, the
activists involved have not felt the need to include the mentally ill within
their movement.
In the absence of any comprehensive
awareness-raising drives by either social activists or the government, there is
little scope for the scenario to change in the foreseeable future. Human rights
for the mentally ill will remain a pipe dream.
What is to be done
The recognition of hurdles is the first step
towards removing them. So we believe in ANJALI. The bleak picture painted above
is just an objective description of the situation as it is now. However, there
are bright patches within that general picture of gloom. An endeavour like
ANJALI is an example. We have chosen to act in partnership with the government
because the majority of our population depends on the state-sponsored health
care system. It is important to work inside that system and bring changes from
within, rather than set up alternative systems which will have limited reach. It
is a positive sign that the government has allowed us to function and has
finally acknowledged our efforts through granting us a permanent permission. In
less than three years, we have been able to reintegrate 27 clients into
mainstream society. Some of those families are now partners in ANJALI's efforts,
ready to share their experiences with the families of current clients to
convince them to give their mentally ill members a chance. Pharmaceutical
companies have come forward to further ANJALI's cause by offering financial and
other help. Stores have agreed to stock ANJALI products for sale. Many more such
initiatives need to be identified and utilised if the mental health scenario is
to change substantially.
We must remember that the state is not an abstract
entity but consists of members from this same society and culture. The lack of
understanding and distrust that characterises our attitude to the mentally ill
is, therefore, bound to be reflected in the mindset of the administration. Any
attempt at guaranteeing, securing and protecting the human rights of the
mentally ill has to start with sustained awareness-raising campaigns aimed
simultaneously at civil society and the state.
Ratnaboli Ray,managing
trustee, ANJALI Mental Health Programme, Benubon, Flat A/302, 92/3, Kankulia
Road, Kolkata 700 029 Email:rayram@cal3.vsnl.net.in