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Understanding Mental Health

Mental Health is the capacity of the individual, the group and the environment to interact with one another in ways that promote subjective wellbeing, the optimal development and the use of mental abilities (cognitive, affective and relational), the achievement of individual and collective goals consistent with justice, and the attainment and preservation of conditions of fundamental equality.
                        -Bhargavi VDavar & Deepra Dandekar
                         Centre for Advocacy in Mental Health, Bapu Trust, Pune

Mental illness, to say in the most basic terms, is a state of the psyche where mental and social skills that we usually take for granted cease to function in the manner they are supposed to. To a 'normal' person, the world of a person with mental illness leading to psychosocial disability is a cuckoo's nest: it does not exist, except in the sensory hallucinations of the 'affected' person. Mental illness is often short-term and easy to manage with appropriate treatment and therapy. It is only a very small percentage that becomes chronic with a load of incapacity.

Mental illness could be classified as a disability, because like other forms of disability, it creates "difficulty in the performance and roles expected of the individual in his or her social and cultural milieu." Based on this definition, the inclusion of mental illness in the Persons with Disability Act of 1995 has created a milestone in the Government of India's policies and judgments in courts of law.

Further classifications of disability (which includes mental disability) have evolved out of Indian Disability Evaluation Assessment Scale (IDEAS), a measurement tool for disability developed by the Indian Psychiatric Society and Dr. R. Thara of SCARF, accepted by the Government of India (Gazette of India, February 27, 2002: Number 49, Notified by the Ministry of Social Justice and Empowerment).

This measurement tool defines the following indicators for persons with disability:
  • Self Care: Personal Hygiene, Eating Habits, Personal Belongings, Living Space
  • Inter-personal Activities: Forming and Maintaining Social Relationships, Emotional Response, Physical Intimacy
  • Communication and Understanding: Spoken and Written Language, Ability to Converse, Use of Communication Skills and Devices
  • Work: Employment, House Work, Student Regularity and Competence.

These are currently used as measuring devices for psychosocial disability, on the basis of which services for persons with such disability are expected to be designed. Welfare measures expected from state are also supposed to be planned on this basis - which has actually happened in some states of India.

The Laws of the Land

While the Mental Health Act, 1987, is the only law referring directly to mental health issues - there are many others that apply to and affect, therefore, Indian citizens with psychosocial disability.

The Mental Health Act, 1987, was the first change that the post-,,,1947 Indian Republic formulated to replace the archaic Indian Lunacy Act formed by the British in 1912. The Central and State Mental Health Authority Rules were notified in 1990. All State Governments and Union Territories were directed to establish the State Mental Health Authority in compliance with the Mental Health Act in 1991.

The Indian Lunacy Act of 1912 was based upon the firm belief that people with psychosocial disability need to be segregated and kept in confinement to 'protect' the rest of society from their 'dangerous' presence. The Mental Health Act of 1987 looks in a concentrated manner at this issue of confinement and seeks to lay down in details the norms for institutionalized care and treatment from a perspective definitely more humanistic than the previous Act. One wonders, however, if the need for confinement was still the hidden belief guiding the new law -as seems deducible from the scant reference to the rights of the people it applies to, as also to community-based care. This worry is deepened further when one thinks about the divorce laws of the country specifying psychosocial disability as a ground for divorce, of the prevalent norm of magistrates determining the need for institutionalized treatment and so on so forth. Not to mention that even the scant provisions in the Mental Act of 1987 are flouted within mental health care and treatment services provided by the government.