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The Mental Health Bill Isn’t As ‘Historic And Progressive’ As You May Think

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By Jhilmil Breckenridge:

A few days ago, there was much rejoicing and celebrating in the mental health community. The Rajya Sabha on Monday unanimously passed the Mental Health Care Bill, which seeks to provide better healthcare to people with mental illness and safeguard their rights. One of its salient features was giving a person the right to select a representative who would speak for the person if she or he gets diagnosed with a mental illness. Another was creating an advance directive on the mode of care a person would like, for example, if he or she has a manic or psychotic state, how would they like to be treated, should they require treatment or hospitalisation. Said Union Health Minister, JP Nadda, while introducing the bill about the representative a person could select: “This person would be a nominative representative, who has a similar cultural background as the patient and is aware of his likes and dislikes.” He went on to say that the bill was formulated after lengthy discussions with the various stakeholders like academia, experts and political establishment and that the bill focuses on community-based treatment.

While Facebook and Twitter went into a frenzy of sharing, and many people were rejoicing, and indeed, some things are cause for celebration, perhaps just that the government woke up and even considered mental health care, long neglected, and this bill was long overdue, taking more than two years of discussion and deliberation. However, if we consider the sleeping politicians and the empty chairs at Parliament, does a unanimous vote mean anything?

For representation only.
For representation only.

Shouldn’t mental healthcare need the same focus as healthcare? And in a country where the increasingly saffronised government keeps lauding the AYUSH Ministry, shouldn’t yoga, ayurveda and Unani also be integrated into the mental health care space? Or is ‘Big Pharma’ watching and the politics of power always at play?

Let’s examine a few improvements first. M V Rajeev Gowda of the Congress said that of the many good things about this bill, one of the most important ones is the fact that it decriminalises suicide. He went on to say, “When a person attempts to take his or her own life, that person is crying for help, that person is not someone who should be treated as a criminal and thrown behind bars. We need to reach out and find a way to overcome the problems that have caused that kind of action.” The Mental Health Care Bill 2013 says that any person who attempts to commit suicide shall be presumed, unless proved otherwise, to be suffering from mental illness at the time of attempting suicide and shall not be liable to punishment under section 309 of Indian Penal Code (IPC). Until now, a person who attempts to commit suicide is charged under section 309 of IPC as it is considered to be an offence. The bill also bans the use of electric shock therapy for treating children with mental illness and only permits its use on adults after they have been given anaesthesia and muscle relaxants.

Among its various objectives, the bill provides for ensuring healthcare, treatment and rehabilitation of persons with mental illness “in a manner that does not intrude on their rights and dignity.” While this bill is claiming to promote community healthcare, nothing could be farther from the truth. Several distressing questions remain.

Union Health Minister, JP Nadda, while announcing the “historic and progressive bill” said that around 6-7 percent of the country’s population suffered from some kind of mental illnesses, while 1-2 percent suffer from acute mental disease. He went on to admit that there was a shortage of medical staff dealing with mental health in the country and the government is trying hard to have more such specialists. Let’s examine what is behind these words and look at the conversation in the blank spaces in these words. The Bill will encourage more mental health hospitals and institutions. Many more private and government hospitals will sprout up, with the additional funding, and the interest. While it may be argued, that this can only be a good thing, consider this: how are facilities like electroshock therapy (long banned in many first world countries), indifferent staff, and a rampant over-medicating of patients, going to help? How are more facilities going to help? And more importantly, who will they help? The pharmaceutical companies? Kickbacks from and to medical reps? To doctors? So called concerned family members, who want to get rid of a family member, for whatever reason? More institutions will definitely not be a good thing. Instead, there should be a reform of the existing institutions, with art therapy, music therapy, and more. And most certainly, stand alone psychiatric hospitals, also called asylums or places for ‘mad’ people, will not help. There should be a move towards integrating psychiatry with mainstream hospitals, with Psychiatry being just another wing, like cardiac, or ENT etc. There should be a coherent move towards recovery, rehabilitation and engagement with community. More institutions create a divisive world, not an inclusive one. More institutions perpetuate labelling and stigma. More institutions perpetuate power being stripped from the patient.

Consent. This is another tricky word, with loopholes galore. The new bill does not state how they will determine consent. What was earlier involuntary commitment can now be called ‘supported admission’; advance directives can be challenged, capacity can be challenged, and ‘Nothing About Us Without Us‘, the motto of the UNCRPD — UN Convention on the Rights of Persons with Disabilities — does not seem to sit well here at all. Kriti Sharma, a senior researcher at Human Rights Watch, states“Women and girls with disabilities are dumped in institutions by their family members or police in part because the government is failing to provide appropriate support and services. And once they’re locked up, their lives are often rife with isolation, fear and abuse, with no hope of escape. Long-term warehousing of women and girls with disabilities is simply not the answer.” In a report published in 2014, HRW reported abysmal living conditions including overcrowding, lack of hygiene, and inadequate general health facilities. The women were also found to be living under a constant risk of physical and sexual violence.

Vilas Bhailume, superintendent of a mental hospital in the western metropolis of Pune, Maharashtra, said overcrowding was a major problem. “We only have 100 toilets for more than 1,850 patients out of which only 25 are functional. The others keep getting blocked. Open defecation is the norm,” it was said in the report.

I am one of the 52 women HRW interviewed, in that study conducted across six Indian cities between December 2012 and November 2014. My claim to fame being involuntary incarceration twice, once in 2007 and more recently in 2012, by family members who wanted me out of the way to facilitate my ex-husband winning a messy divorce case. Since that time, my ex-husband has left India and the courts of this country, taking my four children with him. But to come back to the involuntary commitment, I cannot see how the new bill is going to change much. In a country rife with misogyny and patriarchy, if a husband or father says, “She is crazy, lock her up,” psychiatrists will jump up to comply. In a shocking incident in Kolkata, a woman was forcefully admitted into a psychiatric facility, injected with sedatives and more, and while being escorted to an asylum at 11.30 PM, was intimidated and subjected to violence, including the fingering of her vagina. Her husband had joined hands with a psychiatrist to turn her into another case of ‘mental illness’. This case is not a solitary one, and unfortunately happens more and more often. The said woman has since been released, and her husband booked into jail, while women’s NGOs rallied around her, helping her to file a case. But many other such women are not so lucky, and languish for years on end in asylums, while their husbands and fathers and family members get away scot-free. And what of the families who admit their children or wives into an asylum giving a wrong address? Institutions today are full of ‘recovered’ people just waiting to go home, but there is no home, or the address has changed or their family has left the country altogether.

International Yoga Day in Kolkata
For representation only. Source: Sonali Pal Chaudhury/Getty

My last point is that of wellness, yoga, ayurveda, and other lifestyle choices. Psychiatric illness is caused by a mixture of genetic disposition and psychosocial conditions. An incident is often an extreme reaction to some distress in a person’s life. Most psychiatric labels like depression, bipolar disorder and more can be addressed through yoga, better nutrition and food choices and changing the distressing condition, and moving towards less stress. In a country like India, with the hugely celebrated AYUSH department, why is there no linkage or encouragement towards food as medicine, or using ayurvedic drugs like brahmi and others for alleviating stress? Exercise, weight loss, getting off social media, healing with nature; all these are proven methods of dealing with many psychiatric disorders. Why then, the excessive labelling? Why then, statements from practitioners like “You have bipolar disorder, you will be on medication for life?” Why? Of course, there are certain mental health conditions which are serious, and may need medical intervention, drugs, and psychosurgery. But these are a very small percentage. Is the answer more sinister? Is it that Big Pharma is lurking everywhere? Is the brainwashing so effective? Does advertising work this well?

Questions abound. While the answers seem simple to me, it appears to me that those in positions of power are not willing to relinquish their authority. The men and women in white coats love dispensing drugs. And while it is now illegal to administer electroshock therapy to children, it is still allowed on adults, albeit with humane muscle relaxants and anaesthesia. Really? In addition, under the bill, psycho-surgery will only be allowed if the district medical board approves it. We all know what a wonderfully corrupt country India is and how easy it may be to sway the attention of district medical boards. I hate being a cynic, but maybe this is being realistic. There are simply too many loopholes. Too many places where families and doctors will still get their way. And the patient will not get patience. And once labeled, they will be forever. And an asylum does not give what it purports to give: asylum.

This article was originally published here.

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  1. Amayaan Wellness

    Brilliant article , very informative and encompassing. This article has truly helped in wholeness and wellness. 

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

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MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform Change.org, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on Change.org has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in Change.org’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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