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Twilight Claims Program

TWILIGHT CLAIMS: ANJALI'S PERSPECTIVE

In keeping with the human rights perspective, Anjali expanded its focus from the micro to macro, and in 2004 initiated Twilight Claims, a program designed to fully realize Anjali’s values of equal human rights for people suffering from mental illness. The mission of Twilight Claims is to raise awareness of the issues surrounding mental illness through education and the shattering of social and cultural myths and misconceptions, through case advocacy, lobbying for policy change and alliance building. In short, Anjali is committed to breaking down the barriers that keep these citizens marginalized and to helping them benefit from the same basic human rights as the rest of society, and to modifying the state governments response of violence to people with mental illness.

Through this report we aim to:
  • Analyze the context
  • Analyze the implementation process
  • Our key learning’s from our partners
  • Identify our achievements and challenges
  • The next steps for the initiative

For those of us who live essentially free lives, outside the confines of an institution, basic human rights are something that we often take for granted, but for for the inmates of state-run mental hospitals as well as others living outside institutions and suffer from mental illness access to those same rights is often a distant dream. Those rights are frequently violated; patients receive treatment without either their understanding or consent, often abused or neglected, kept isolated from society, frequently abandoned by families that are either unable to care for them due to a lack of information or financial resources or because they have simply given up hope. It is in this context that the Anjali program Twilight Claims helped form the National Association for Access to Justice for People with Mental Illness (NAAJMI) and that Bill of Rights was drafted. NAAJMI, a coalition of human rights NGOs from across India, has been drafting a Bill of Rights for people with mental illness. The enforcement of the rights outlined in the bill can be seen as the mission of Anjali's Twilights Claim program, the beliefs on which its foundation rests. Additional information on NAAJMI follows in the section, Working for Systemic Change.

I. PARAMETERS OF CARE
  • Right to Quality Care including:
    1. 1.Right to least restrictive and least intrusive treatment, including prohibition of arbitrary/unnecessary isolation
    2. 2. Individualized plan for care, periodically reviewed & recorded
    3. 3.Preserving and enhancing individual autonomy
    4. 4.Access to multidisciplinary teams and non-medical care
    5. 5.Right to live, work and receive treatment within the community, without any form of discrimination on the basis of religion, caste, age, language, sexual orientation and gender
  • Right to Protection from Cruelty and Torture, with torture being defined as physical torture and unauthorized experimentation
  • Right to Basic Needs like food, space, clothes, personal hygiene
  • Right to Confidentiality
  • Right to Voluntary Treatment, with involuntary commitment restricted to standard protocols for assessing dangerousness to self and others, lack of competence not based simply on diagnostic category, and with right to appeal for review with legal aid available on site
  • Right to information on Care and Treatment, except when dangerousness to self and others has been determined through standard protocols
  • Right to Social Security, including insurance and adequate standard of living, with special provisions for mentally ill persons with multiple disadvantages (e.g. women / children / poor/ homeless / facing calamities and conflict / physical disability)
  • Right to Free Medical and Non-Medical Care at Primary Health Centers and District Mental Health Programme levels, as well as on site and within the community
II. RIGHTS WITHIN FAMILY AND COMMUNITY
  • Right to Information and Education for person with mental illness and family on nature and level of illness, as well as treatment and care needs
  • Right to Accessibility to / Availability of various modes of treatment, help and rehabilitation
  • Right to Work and Gainful Employment under conditions of equal opportunity and equal remuneration not less than the nationally determined minimum wage and entitlements under the Indian Constitution
  • Right to Privacy of Home, Family, Correspondence, Intimate Relationships, Sexual Relationships, including alternative sexualities, Marriage, Giving Birth and Parenting, Living with Children, and Protection of Law against all discriminatory practices
  • Right to Owning Property, with provisions for necessary assistance, depending on the level of incapacity / disability determined through standard protocols, and Protection of Law against all discriminatory practices
  • Right to Voluntary Contraception, including tubectomy, hysterectomy, medical termination of pregnancy for women; vasectomy and sterilization for men
III. RIGHT TO GRIEVANCE REDRESSAL MECHANISMS
  • Right to Information about all Redress Mechanisms, including those relevant to institutions, land & property, marriage, divorce, guardianship, adoption, custody, contracts, work & employment
  • Right of Access to Redress Mechanisms, including legal aid & representation, with special focus on women and children in institutions; in case of inhuman / harmful treatment; and with special provisions for legal safeguards for temporary incapacity / disability
  • Right to Mobilize, Form and be Part of Associations towards effective grievance redressal
  • Right to Protection & Legal Redress against Custodial & Criminal Offences, including offences committed in the Community
  • Right to Legal Redress against Indiscriminate Transfer between custodial institutions, with special focus on homeless persons with mental illness in institutions
  • Right to Legal Recourse Against Being Used as Research Subjects without informed consent

The objective of the Twilight Claims program is to put these theories into practice. There are four basic methods used to this end: awareness raising, advocacy, lobbying for policy change, and alliance building. Through these actions, Anjali is able to work toward its mission of fundamental justice and equality for those who suffering from mental illness. This work must be understood with the awareness of the constant tension between the state and its citizens, as the state is both the guarantor and the violator of these rights. The Twilight Claims program works in tandem with Anjali's other programs. Many of the program goals come from situations and conditions seen in the hospitals where they work as well as from the communities. Although the framework of the the program are on a larger scale than Anjali's other programs, it never loses sight of the individuals that are at the heart of the work.