Mental Health: Centre should stop passing the buck and ensure rehabilitation of patients

In February 2017, the Supreme Court asked the Union Health Ministry to formulate guidelines for the rehabilitation of mental health patients in mental asylums. They gave the Centre eight weeks to come up with these guidelines, stating that it is inhuman and inherently wrong to make them live with those who suffer from mental illness. The Apex Court observed that the issue is immensely “sensitive” and that there is a definite need to have healthcare responses that centre on rehabilitation. [caption id=“attachment_3188074” align=“alignleft” width=“380”] Supreme Court. Reuters[/caption] The Bench, headed by Chief Justice JS Khehar and comprising Justices D Y Chandrachud and S K Kaul, stated that – “It is a very, very sensitive issue. You (Centre) should apply your mind. When a person goes to a mental asylum and after treatment he is cured, nobody is willing to take him back home. You (Centre) should think over it.” The Bench was hearing a petition that alleged that about 300 persons from numerous mental health and psychiatric facilities in Bareilly, Varanasi and Agra in Uttar Pradesh had undergone treatment but were still languishing in these facilities, being subjected to deplorable living conditions; most of these patients were from poorer sections of the society. The Bench, headed by Chief Justice JS Khehar and comprising Justices D Y Chandrachud and S K Kaul, stated that – “It is a very, very sensitive issue. You (Centre) should apply your mind. When a person goes to a mental asylum and after treatment he is cured, nobody is willing to take him back home. You (Centre) should think over it.” The Bench was hearing a petition that alleged that about 300 persons from numerous mental health and psychiatric facilities in Bareilly, Varanasi and Agra in Uttar Pradesh had undergone treatment but were still languishing in these facilities, being subjected to deplorable living conditions; most of these patients were from poorer sections of the society. Last year, on June 18, the Supreme Court comprising of Chief Justice T S Thakur and Justice A M Khanwilkar issued notices to six states – Uttar Pradesh, West Bengal, Jammu and Kashmir, Rajasthan, Kerala and Meghalaya - on this petition seeking the release of such persons. A notice was also issued to the Centre declaring that the issue at hand figured in the concurrent list and therefore, the Centre has the authority as well as accountability to formulate guidelines, and oversee implementation. The petition was filed in the form of a public interest litigation (PIL) by Advocate Gaurav Bansal who stated that there was no tangible policy in place to determine the well-being and aftercare of mental health patients after their release and that this is a gross flaw on the Centre’s part. The petition also spoke about responses that were received under an RTI application regarding the release of the patients at Bareilly, Varanasi and Agra. The Bench vehemently stated to the Solicitor General Ranjit Kumar, who was representing the Centre – “They have to be brought back to civil society. You will have to frame a policy (…) It is very easily achievable. You give us a model scheme. We will then put it to the state governments and ask them. Give us a scheme.” However, the Solicitor General has asked for some more time on this as two ministries – Ministry of Social Justice as well as Ministry of Health – is involved in the process. The Bench, thereafter, made it known – “We are of the considered view that the Union of India shall assist us in finalising a national policy or norms that should be adopted in the entire country to deal with persons who have been cured of mental illness and are still being kept in mental hospitals.” It is significant to understand that when it comes to mental health, neither the legislature nor the executive have plans of rehabilitation. Their approach is very reactive, and is founded on the redressal of immediate problems created because of the mental health issue. For example, the Mental Healthcare Bill 2016 passed by the Rajya Sabha last year talks about rehabilitation of victims of mental health issues, but does not put down what these rehabilitation mechanisms are. It also does not talk about the reintegration of mental health patients after their course of treatment. India signed and ratified the Convention on Rights of Persons with Disabilities on 1st October 2007, and seeks to fulfill its obligations pursuant to the Convention. Keeping in line with the Convention, the Bill seeks to provide a more nuanced, rights-based understanding of “mental illness”, as opposed to the Mental Health Act, 1987. However, the Bill moves away from the social model of disability within the Convention, which focuses on how disability is an obstacle to a person’s full and active participation in society. The Bill, instead, looks at mental illness as a phenomenon that hampers the recognition of reality and is often associated with drugs and alcohol abuse; by doing this, the Bill de-recognises the concept of agency and choice within a mental health patient. Without strict policy measures in place, India will continue to look at mental health issues as secondary to tangible health problems and diseases, and will therefore, continue to ignore and neglect victims of mental health victims, subjecting them to horrible living conditions. Earlier this month, the Delhi Commission for Women chief, Swati Maliwal recounted that she was shocked to witness gross human rights violations at an Asha Kiran Home for mentally challenged persons – she said women were roaming naked in deplorable surroundings and unhygienic living conditions. The fact that there are so many cases that indicate similar circumstances in mental health institutions resulting in the violation of human rights, is a sound reason for the Centre to stop passing the buck, and begin formulating feasible guidelines for implementation.