The Hindu : Other States / Karnataka News : Mentally ill or mentally disabled?

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Sunday, Dec 05, 2004

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Mentally ill or mentally disabled?

By Nirmala Srinivasan

BANGALORE, DEC. 4. December 3 was observed as World Disability Day. There are 40-50 million Indians who are officially eligible for benefits under the law of the land because they fit into the Government of India's definition of mental illness (MI) as, "mentally ill person means a person who is in need of treatment by reason of any mental disorder other than mental retardation" vide the Mental Health Act, 1987. A more recent development is the recognition of mental illness as a disability under the Persons with Disabilities (Equal Opportunities Protection of Rights and Full Participation) Act, 1996 (PWD Act). The point at issue is the extent of public awareness about the co-existence of an active illness alongside functional disabilities; while the disability component is an empowering aspect of legislation, the illness component baffles policy makers to the point of excluding it from new disability legislation.

Ignorance more than orchestrated mischief seems to be the root cause of such moves on account of limited awareness about the disability fallouts of mental illness. The invisible nature of the disability as an experiential phenomenon worsens its social credibility and understanding. Hence not surprisingly, even within the range of disabilities, vision, hearing and mobility problems have received the most amount of attention and benefits from the Government.

Social construction of mental illness swings between two extremes — either lunatics, murderers and psychopaths, or Noble Laureates such as John Nash blessed with a Beautiful Mind. Research-based knowledge and clinical evidence of a biochemical brain disorder are not part of public discourse; much less, the personal stories of loneliness and grief. The resultant rift between the legal status of disability and the social stereotypes of lunacy has to be bridged to facilitate official understanding of the illness.

Triple disabilities

Mental disorders are frequently associated with deterioration in cognitive and social performance besides emotional capabilities. Even with medication, most patients suffer from one or more of these functional impairments — cognitive, social and emotional. As of now, there are no specific medications to target the triple disabilities in mental disorders. For example, reduced attention span affects employability of the person; as much as poor social skills inhibits the social life.

Currently, the World Health Organisation has identified 90 or more major and minor disorders. That being the case, etiology-free disability classification and scales are needed as practical tools for the administrators and policy makers. No such efforts are seen in the PWD Act.

Recent developments in disability approaches are to transcend the traditional medical model of disability as a person specific to the new social (environmental) specific. For example, people are considered to have a disability not because they cannot walk but because there are no ramps; and there are no ramps because the political agenda does not allocate budget for a ramp!

Similarly, if the PWD Act advocates a barrier-free environment for the disabled, "barrier" means physical to some and psychological to others. Absence of such barriers, physical or psychological produces disabilities due to socially caused "disablement" and not due to any disease per se. The socio political model of disability characteristic of the WHO's ICIDH-II classification is directly relevant for disability policies, legislations and budgets.

Unfortunately, the PWD Act does not define "disability" except by enumerating the categories of disability recognised by it.) Worse still, not even one section or chapter in the Act is directly applicable to disabilities associated with mental disorders. Otherwise, why should the access to free education vide Chapter V be restricted only up to 18 years of age? Mental illness is a disease of the youth and it occurs usually around 14 years of age; and by the time the regimen reaches the rehabilitation phase, the individual is past 20 or so. Hence the disability becomes a disablement due to official ignorance than cognitive factors per se. Similarly, denial of employment rights to the mentally ill unlike the conventional categories in spite of the Indian Disability Evaluation Assessment Scale (IDEAS) being available for the last few years defies any explanation.

No coordinated effort

It appears that the problem lies in the lack of coordinated efforts to understand the special needs of the mentally ill. The representative lobbies have not participated in the process of policy making and subsequent developments therein. The tragedy for the mentally ill is the threat of falling between two Ministries and not coping with an illness and its disabilities.

(The writer is a trustee of Action For Mental Illness, ACMI, Bangalore. The views expressed here are her own.)

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