Human Rights and Mental Health

A couple of years back, I worked on a book called ‘Psychiatric Hospitals in India’. I took on the project as a content advisor and morphed into a co-researcher out of sheer interest. I was interested since psychiatry is a field I did not know the ABC of. But as I went deeper into writing, compiling, advising, designing sheets upon sheets full of everything to do with mental hospitals, illnesses, problems and recommendations, I realized it was not just that mental health was a lesser known field but also that it was not covered as extensively by popular media in my surroundings as maybe other similar concerns had been. 

Because in so many countries still, mental illnesses are stuff that stigma is made of. And a mental asylum a building housing men, women and even children who have been disowned by their families.

And more often than not, the hospitals are far from asylums but places which, knowingly or otherwise, violate human rights of the mentally ill patients. And this is something that you and I do not read about in the national dailies. Because somewhere, we either tend to not notice or make unseen that semi-nude “mad man” with a matted beard talking to the trees on the side of the road.

Today, on Blog Action Day, I pen a few paragraphs of information on Mental Health and Human Rights. I am no human rights activist in the true sense of the word. I am not even taking action on the patient’s behalf in this case. I am simply showing you the picture and the perspective that I gathered along the way. Maybe hoping to bring about a change, a change in the mindset which still uses words like ‘mental’, ‘psycho’, ‘schizo’ and ‘retard’ in a loose, irresponsible and utterly insensitive way. 

Health, as a right, was included only recently in the United Nations ‘Universal Declaration of Human Rights’, as Article 25 (Universal Declaration), stating ‘Everyone has a right to a standard of living adequate for health and well-being of himself and his family...’ When we talk of Mental Health, it took a series of revolutionary minds across the globe to emphasise that persons suffering from mental illness shall enjoy the same human rights and fundamental freedoms as all other citizens. They shall not be the subject of discrimination on grounds of mental illness. They have the rights to professional, humane and dignified treatment and will be protected from exploitation, abuse and degradation. Elimination of prejudice and stigma attached to mental illnesses will be aimed at and regardless of age, gender, ethnic group or disorder, they will be treated in the same manner as other citizens in need of health care. 

In short, the world recognized the fact that the basic human rights and freedoms of the mentally ill should be respected at all costs. The relationship between mental health and Laws of the Land was established, and even though a dynamic one, laid down set criterion for the treatment of the mentally ill under various governments and nation states. 

The Indian scene 

We revel in our heterogeneity. On good days we celebrate it, on bad days we have an identity crisis and want to enforce our own. Multiplicity of political systems and social ideologies add to the diverse scenario. Under the circumstances, not just availability and accessibility of mental health care but the implementation of human rights issues itself becomes a problem. Varying ideas of privacy, social stigmatization of patients, interpretations of right to refuse treatment add to the problem of implementing a universal idea of human rights of the mentally ill. But where once the ‘asylums’ were prisons for the hopeless, things are a changing for the better.

Health security for the entire population is being accepted as an essential requirement that should be guaranteed by the government. The Mental Health Act of 1987, a national statute, recognised the lack of humane treatment of the mentally ill and codified guidelines about the human rights of the mentally ill much before National Human Rights Commission was even established. The landmark judgments included no mentally ill person shall be subjected, during treatment, to any indignity or cruelty. No mentally ill person shall be used for purpose of research unless such research is of direct benefit to him, or such a person’s consent (or guardian’s consent) has been received in writing. Many more movements and efforts towards ensuring protection of human rights have followed, with the Supreme Court and the National Human Rights Commission acting as catalysts towards bringing about a constructive change in mental institutions as well as treatment of patients. What was espoused? 

That ‘everyone in need should have access to basic mental health care.’

This principle components of this idea gave birth to a list of human rights that the mentally ill enjoy (published in 2008 by NHRC). Let us see some of them here:

1. Right to a decent life.

2. Legal safeguards against abuse.

3. Right to appeal, rehabilitation services, privacy, freedom of communication.

4. Right to necessary treatment in the least restrictive setup.

5. Right to social and economic security.

6. Right to family and community life, employment.

7. Right to protection against discrimination. 

The human rights of psychiatric patients in India are in conformity with the developed nations.

The problems?

Despite progressive legislations and zealous spread of awareness, conflicts and vagaries arise when human rights of the mentally ill are under question, not just in India but universally.

What happens when a mentally ill patient refuses treatment, drugs, hospitalisation or food? Is force-feeding ethical under all circumstances? Control and restraint of violent conduct of patients and seclusion of such patients in psychiatric institutions is another contentious issue. Is exclusion from voting necessary, and does it not encroach on the human rights of the mentally ill? How do you deal with the social stigma attached to mental illnesses and mentally ill, which leads to infringement of rights of the patients in a social context?

Grey areas remain in the legal technicalities and implementation, questions of ethics and professionalism. Grey areas are also housed within our own minds, and mentalities, in our social attitude towards our mentally ill. These being the two biggest deterrents in ensuring human rights of the mentally ill.  

To you and me, no amount of knowledge about the issue is enough. But what can be more than enough is spreading the little knowledge that we have. Human rights are a social issue. Apart from information and awareness, a deep-rooted Concern for a fellow-human can weave miracles. This here was just a step towards facilitating a better understanding of mental health and human rights. I hope it helps, even as it informs, in stimulating our collective consciousness towards creating a more humane and accepting environment for the mentally ill in particular and other beings in general. 

Human rights matter. Because humans do. 

[With information drawn from 'Psychiatric Hospitals of India' and a heartfelt thank you to it's author and world-renowned psychiatrist Dr. Sridhar Sharma]