Raising public awareness is done directly through family and community meetings in the context of the rehabilitation program but on a larger scale through the Twilight Claims. One important method used is mental health/human rights workshops. These intensive workshops are customized to meet the specific needs of the participants based on their occupations, although all the workshops are framed by the human rights perspective.
Twilight Claims' Outputs
In 2006, 24 workshops of 8 sessions each were conducted with psychiatrists from the government hospitals in West Bengal. The curriculum for psychiatrists in medical school includes diagnostic training and treatment methods as well as the ethics of treatment, but does not frame it within the human rights perspective or address issues surrounding the Mental Health Act. These workshop included: the historical perspective of rights, economic, social, and specifically the rights of those suffering from mental illness, domestic and international human rights instruments, issues surrounding custodial settings, the Mental Health Act and other legal issues, and future action and evaluation plans. The workshops were all conducted by both a person from an academic background as well as a practitioner. The sessions included role-plays, video clips, and open dialogue with the participants.
In general the response from the participants was quite positive. They all agreed that significant change is needed in both the Act and hospital conditions. Most of the problems related to rights abuse or neglect in institutional settings was attributed to lack of funds, lack of infrastructure support, their inability to take decisions and changes, as they feel bound by bureaucracy and norms of their service rules. One of key issues that emerged was the need to raise awareness among family members about acceptance of patients who are ready to be discharged by the hospitals. The participants unanimously agreed that the families treated hospitals as ‘dumping grounds’ and that was a major cause of the crumbling infrastructure. The legal system is mired with procedural details making it difficult for the hospital authorities to function and to protect the rights of the mentally ill persons. The psychiatrists felt that it was imperative that they have the opportunity to discuss their concerns develop ways to overcome them. They also agreed on the need for Group D staff training and internal organizational change in order to be able to successfully work toward larger systemic change that would allow for the protection and promotion of the rights of people with mental illness.
From November 2006, workshops were conducted with the Group D staff in Pavlov and Lumbini Park Hospitals. In spite of the fact that the Group D staff have the most consistant contact with patients they have no mental health or caregiving training. These workshops provided participants with detailed information about mental health and human rights issues, They learned about different types of mental illness, the causes and social factors that may both influence onset, symptoms, and prognoses. In addition to providing basic information on illness, the workshops focused on care and treatment from a human rights perspective, national and international, comtemporary and historical. They explored through interactive discussion the custodial settings for people with mental illness in India, issues of custodial space, voluntary versus involuntary commitment, patients' consent for treatment or the right to refuse it, different treatment options, the right to information, confidentiality, staff, service, and infrastructure, the right to be treated with dignity and respect and to receive rehabilitation. At the completion of the workshops, the trainees were given information kits that provided overviews of the following topics: anxiety disorders (generalized,panic attacks, various phobias, PTSD), depression and its symptoms, psychotic disorders (schizophrenia, manic depression (bipolar)), as well as different types of treatment and myths about mental illness.
Additionally, the Twlight Claims program has organized lecturers from the National University of Juridical Sciences in the fields of sociology and mental health to lead workshops explaining the Mental Health Act to psychiatrist from both private and from the state-run hospitals. This training is currently absent from the psychiatric curriculum in India. Although the ethics of practice are taught in their training, the psychiatrists are at liberty to practice these ethics as they choose, leaving the public at their mercy. Future trainings are currently being planned for nurses and nursing students, social workers and social work students, sociology students, and members of the media.