Where the mind is without fear…

Unlike in the case of physical disabilities and even MR, MI is characterised by “disguised disabilities” in cognitive, emotional and social skill sets. There is no evidence of a precise and comprehensive tool in the survey design to capture the disabilities that are unique to mental disorders for planning the rehabilitation services and facilities required. Better insights into MI might have led to more disclosure than the present 9 per cent in rural and 5 per cent in urban areas out of the total sample of 75,979 persons from 45,571 rural and 24,731 urban households across the country. State-wise distribution shows highest prevalence of mental illness in UP followed by West Bengal, Kerala and perhaps Bihar. The survey makes significant contributions on marital status, living arrangements, literacy rates, socio-economic and livelihood issues of the mentally-challenged individuals.

The livelihood choices of MI compares fairly well with that of other disabled persons. Out of a sample size of 5,819, only 12 are unemployed; casual labour of 252 or 4 per cent exceeds self employment in agricultural and non- agricultural occupations and is less than the 7 per cent for all disabled persons. Only 7 per cent of the sample are engaged in domestic duties as compared with 13 per cent for all other disabled persons.

The fact that the mentally-challenged are employable, questions the ethics of their exclusion from the job quotas fixed for the physically handicapped persons under the PWD Act. This discrimination is unwarranted especially in view of the fact that MI is a measurable disability today. Enumeration on living arrangements of disabled persons shows that the family system provides the largest single kind of residential support for all disabled persons. Out of 1,000 persons in the MI category, 729 depend on the family base for residence; this is only next MR which is 891 as compared to 656 among all disabled persons.

Age and sex-wise distribution of living arrangements indicates the higher dependence of MI persons on family support as compared to other disabled persons. Out of 1000 males, 961 rural and 984 urban live in their respective families as 678 rural and 960 urban females in family set up. The lower figure for rural females is probably because there are more wandering mentally-ill women in rural areas than urban areas. Gender bias is noticeable even in family care of MI persons, especially in rural areas. The NSS Report has successfully debunked the popular myth that families abandon their mentally-ill wards.

One cannot rule out the likelihood of mistaking MR for MI. The 593-page report does not mention a word on psychotherapy, counseling or psycho-social interventions that constitute the repertoire of rehabilitation in MI. Comparison with the physical disabilities shows that the mentally-challenged are not poor performers in education. Out of 1000, 979 all disabled and 982 MI persons have not attended any vocational courses. Among those who have attended engineering and other courses, for MI persons it is 14 as compared to 20 for all disabled individuals. However, the reasons for drop-out in case of MI persons is due to illness, unlike in case of the others where it is due to non-availability of special facilities.

Unfortunately, the PWD Act provides for free education only till 18 years of age vide Ch V.26.(a) ; a provision that does not facilitate rehabilitation of persons, especially youth, with mental disorders. In terms of its implications for rights of the mentally challenged persons, data on dropouts and education profile as reported in the NSS Survey calls for an immediate amendment to the PWD Act to relax the upper age limit for free education.

The approach to MI lacks scientific rigour especially relating to investigation and interpretation of rehabilitation. Probably the NSS 58th Round has been handicapped by the disablement of the Ministry of Social Justice and Empowerment to empanel the premier institute NIMHANS, Bangalore as an expert resource on par with other national institutes for disabilities. A unified approach to mental health care linking treatment needs with rehabilitation services seems to be the ideal. Unless the two monoliths , the Ministry of Health and Ministry of Social Justice work in tandem, this is a far cry.

Dr Nirmala Srinivasan is founder trustee of Action For Mental Illness, Bangalore. She is also the Founder President of AMEND self-help group, Bangalore.