Mental Health Care and Human Rights Editors D Nagaraja Pratima Murthy National Human Rights Commission New Delhi National Institute of Mental Health and Neuro Sciences Bangalore Title: Mental Health Care and Human Rights D Nagaraja Pratima Murthy Technical and Editorial Assistance Y S R Murthy, Director (Research), NHRC Utpal Narayan Sarkar, AIO, NHRC Joint copyright: National Human Rights Commission, New Delhi and National Institute of Mental Health and Neuro Sciences, Bangalore. First Edition: 2008 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright holders ISBN- 978-81-9044117-5 Published by: National Human Rights Commission Faridkot House, Copernicus Marg New Delhi 110 001, India Tel: 23385368 Fax: 23384863 E-mail: [email protected] Website: www.nhrc.nic.in Design and printed by Rajika Press Services Pvt. Ltd. Cover: Biplab Kundu Table of Contents Editors and Contributors............................................................... 5 Foreword........................................................................................ 7 Preface............................................................................................ 9 Editors’ Introduction.................................................................... 11 Section 1 Human rights in mental health care: ........................................... 15 an introduction Lakshmidhar Mishra Human rights initiatives in mental health .................................... 37 care in India: historical perspectives G. Venkatasubramanian Mental health legislation: .............................................................49 an Indian perspective Suresh Bada Math, D Nagaraja Judicial interventions and NHRC ............................................... 69 initiatives in mental health care Pratima Murthy & D Nagaraja Quality assurance in mental health: ............................................ 85 a blueprint for change Kiran Rao A decade after the NHRC quality ............................................ 101 assurance initiative: current status of government psychiatric hospitals in India Pratima Murthy & K Sekar Health as a fundamental right: the national ............................. 143 mental health programme initiative D Nagaraja & Suresh Bada Math Realising the objectives of the ................................................. 157 national mental health programme: a look at states and innovations Kishore Kumar & Pratima Murthy Human resource development ................................................. 183 in mental health care B.N. Gangadhar Psychiatric Rehabilitation in India ............................................. 197 T. Murali & Prashant K Tibrewal Human rights in the community: ............................................... 205 user perspectives and the role of NGOs Nirmala Srinivasan Insurance and mental illness: ................................................... 219 concerns and challenges S Kalyanasundaram Women and children: mental health dimensions ..................... 233 Kanchan Kumari Human rights and disaster: psychosocial ............................... 243 support and mental health services K. Sekar Resource convergence ............................................................ 267 and mental health care Aruna Sharma Future directions for mental ..................................................... 281 health care in india D Nagaraja & Pratima Murthy Section 2 NHRC/NIMHANS 2008 update ............................................ 291 on government psychiatric hospitals K. Sekar & Pratima Murthy Appendix: 1 ............................................................................... 431 Appendix: 2 ............................................................................... 433 Report of the NHRC’s national conference ........................... 439 on mental health and human rights Editors and Contributors Editors D Nagaraja, DPM, DM (Neurology) is Director and Vice-Chancellor and Professor of Neurology, NIMHANS University. He has the unique distinction of specialising in both psychiatry and neurology. He has been very closely involved with the restrategisation of the National Mental Health Programme for the 11th Five Year plan. Pratima Murthy, MD, DPM, is Professor of Psychiatry and heads the De-Addiction services at NIMHANS, Bangalore. She was a co-investigator in the the NHRC/NIMHANS 1999 Quality assurance in mental health project. Contributors Suresh Badamath, MD, DNB, PGDMLE, is Assistant Professor in Psychiatry at NIMHANS, Bangalore. He is actively involved in clinical services and research in forensic psychiatry and obsessive compulsive disorder. BN Gangadhar, MD, is Professor and Head, Department of Psy- chiatry and Medical Superintendent, NIMHANS, Bangalore. His areas of research interest include schizophrenia, ECT and yoga. S Kalyanasundaram, MD, is the Chief Executive of the Richmond Fellowship Society (India) located in Bangalore, and is also the Principal and Professor of Psychiatry of the Richmond Fellowship Post-Graduate College for Psychosocial Rehabilitation. Kishore Kumar, DPM, is a senior psychiatrist, Department of Psychiatry, NIMHANS. He has been associated with community psychiatry and has been involved in several innovative collaborative projects in community mental health. Lakshmidhar Mishra, IAS (Retired), is Special Rapporteur, National Human Rights Commission, New Delhi. Dr Mishra has undertaken monitoring visits to several psychiatric hospitals in the country. He has authored a book, Child Labour in India in 2000. T Murali, MD, DPM, is Professor of Psychiatric and Neurological Rehabilitation at NIMHANS, Bangalore. He has been actively involved in community based initiative in mental health care. He is the President of the Tenth World Congress of the World Association for Psycho Social Rehabilitation to be held in Bangalore in November 2008. Kiran Rao, PhD, is Professor of Mental Health and Social Psychology at NIMHANS, Bangalore. She is actively involved in research on stress, coping and well-being. She was a co- investigator in the NHRC/NIMHANS quality assurance in mental health project in 1999. K Sekar, Ph D, is Professor and Head, Department of Psychiatric Social Work, NIMHANS, Bangalore. He has contributed extensively to mental health issues in disaster. He was a co- investigator in the NHRC/NIMHANS quality assurance in mental health project 1999. Aruna Sharma is Joint Secretary, National Human Rights Commission, New Delhi. She has been actively involved in the review of mental health initiatives in the country, particularly from the purview of the NHRC. Nirmala Srinivasan, PhD, is Founder President of AMEND, Director and Trustee, ACMI and member of the core advisory group of Lancet GMH group 2007. Prasanth K Tibrewal, MD, is Senior Resident in the Department of Psychiatric and Neurological Rehabilitation. G Venkatasubramanian , MD, is Assistant Professor in the Department of Psychiatry, NIMHANS. His areas of research interest are schizophrenia and neuroimaging. Kanchan Kumari is Research Assistant, National Human Rights Commission, New Delhi. Justice S. Rajendra Babu National Human Rights Commission Chairperson Faridkot House, Copernicus Marg (Former Chief Justice of India) New Delhi 110 001 Tel: 91-11-2338 2514 Fax: 91-11-2338 3012 E-mail: [email protected] Foreword Mental health is an important component of the overall health of any individual. This was long recognized in ancient India, where in addition to the medical dimension, philosophical, religious, moral and ethical dimensions shaped and provided the ground for normal mental health and contributed to an integrated healing and welfare system for mental illness. The Vedic times provided a broadly conceptualized model of mental health and illness, supported by an ethos of nurturance, support, caring and family responsibility in treatment and rehabilitation of these mental disorders. During the early Twentieth Century, care of mental ill became mainly limited to institutions which were rife with abuse and discrimination. The attention of both mental health professionals and the courts were drawn to human rights abuses of mentally ill persons within institutions. This led to Judicial interventions awakening of the administration to the needs of the mentally ill. The approach to people with disabilities both nationally and internationally, has, for far too long, been built on charity and the assumptions that disability is an individual pathology, a condition grounded in the psychological, biological or cognitive impairment of the individual. In the last few decades, the world in general and India in particular has seen a shift towards a rights based approach to mental illness. The Universal Declaration of Human Rights in 1948 proclaimed the basic human rights for all people, including people with any kind of infirmity. The zenith of the inclusive human rights approach has been the Convention on the Rights of Persons with Disability whose aim is to promote, protect and ensure the full enjoyment of human rights and fundamental freedoms by all persons with disabilities and to promote respect for their inherent dignity. Persons with disability include those who have long- term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis