Ensuring dignity in mental health

The theme chosen by the World Federation of Mental Health for observing the World Mental Health day this year (October 10) was ‘Dignity in Mental Health’. Globally, the World Health Organization (WHO) raises awareness on what can be done to ensure that people with mental health conditions continue to live with dignity, through human rights oriented policy and law, training of health professionals, respect for informed consent to treatment, inclusion in decision-making processes, and public information campaigns.

To ensure ‘dignity in mental health’ becomes a reality in India, we must understand what exactly needs to be done beyond observing the World Mental Health Day. Dignity is defined as the inherent and inalienable worth of all human beings irrespective of social status such as race, gender, physical or mental state. Yet, even today, around the world, people with mental and psychosocial disabilities and disorders are deprived of their human rights and therefore, their dignity.

Among all health disorders, people with mental disorders are among the most socially marginalised in any community, and are subject to mutually complex problems of stigma, discrimination, impairment, diminished social roles, and unemployment—finally resulting in poverty. Hence, people with mental illness even after recovery, face a great challenge of social and occupational exclusion, and meeting even basic needs is a major concern. India is no exception to this critical situation.

India was one of the first low and middle income countries (LAMICs) to launch a national mental health programme in 1982. Over the past three decades, progress has been made in the mental healthcare in shifting from institution-based care to a system of primary healthcare to deliver mental health care.

However, implementation challenges meant that locally available service provision is uneven leading to a large treatment gap—only about 10 per cent of those with mental health problems access effective care. This unmet need for mental health care carries a high burden in terms of suffering disability, stigma and discrimination, premature mortality and, the risk of human rights abuses.

The remarkable step towards improving this critical situation is the new national mental health policy launched in October, 2014. This policy seeks to provide universal access to mental healthcare, especially for the poor, reduce stigma around mental disorders and the number of suicides in the nation and  strong emphasis on ensuring dignity in mental health.

Proactive steps
Now, the question remains what steps would be needed to ensure dignity for people with mental illness and their caregivers. Does involvement of people with mental illness, and their caregivers in the mental health system have potential to ensure dignity for them?

Service user and caregiver involvement in different components of the mental health system has been globally found to be an effective tool to strengthen the system. Additionally, this involvement makes the system more responsive to the needs of the people it is meant to serve and benefits patients directly by increasing the likelihood of recovery. In the mental health system, service user is a person with mental illness who has availed any kind of mental health care, and caregiver is a person primarily responsible for caring for a person with mental illness.

In addition, empirical evidence suggests that service user involvement encompasses WHO’s task sharing approach, can enhance collaboration service providers and service users, and  thus provide a sensitive workforce in a resource constrained setting like India.

Recent studies in mental health care demonstrate very little involvement of service users and caregivers, and the major reported barriers are unmet treatment needs, stigmatising attitude and entrenched power differentials between service providers and service users.

There is a need that this World Mental Health Day should go beyond a day’s observation to be a beginning of a new era. Ensuring dignity in mental health through service user and caregiver involvement should be taken up as a movement to address inequality in the healthcare system. It should pave the way for service user involvement in relation to a range of public health priorities, including non-communicable diseases, injuries and reproductive and child health, thus ensuring dignity not only in mental health but also in the healthcare system.

(The writer is with the Public Health Foundation of India)