We need community-based mental health services, says Dr. Soumitra Pathare

The psychiatrist says there is a need to modify a host of laws that discriminate against people with mental health issues

October 10, 2020 10:27 pm | Updated October 11, 2020 04:29 am IST - Mumbai

Dr. Soumitra Pathare

Dr. Soumitra Pathare

On World Mental Health Day, Dr. Soumitra Pathare, a consultant psychiatrist and director of the Centre for Mental Health Law & Policy at Indian Law Society in Pune, speaks to The Hindu on how society and laws discriminate against people with mental health issues and the need to stop treating them as second class citizens.

Why is it important to have a Mental Health Day?

All the issues attached to mental health are a 365-day affair. But it is important to at least have an annual reminder that we need to pay attention to mental health issues. The data shows that one out of six or seven people in the world have a mental health problem or illness. So it is one day when people try to get over the stigma around it and reluctance to talk about it. It is a good day to introspect on why and how we discriminate against people with mental health issues and treat them like second class citizens. We need to ask ourselves and the governments this question and why this is allowed to continue even in 2020.

Do you think over the years awareness has increased?

Awareness has never been a problem. It is not like people don’t not know of mental health problems. The issue is that there is stigma and discrimination attached to mental health. As a society we very actively and freely discriminate against those who have mental health problems.

How would you explain discrimination and stigma?

Stigma is only an attitude and discrimination is actively behavioural. People discriminate, which has an impact on your life. What anyone thinks about you does not necessarily affect you, but how one behaves with you affects you. That is discrimination. It is active discrimination which makes people’s lives miserable.

Can you give an example of how people are discriminated on the basis of mental health?

Our society discriminates and our government discriminates. If you look at the laws. Our marriage laws, whether it is the Hindu Marriage Act, 1955, or the Special Marriage Act, 1954, if you have a mental illness, then it is a ground for divorce. If mental illness is a health issue, then why is one health problem a ground for divorce and not one other health problem? Even HIV is not a ground for divorce. What a law like this says is if the State can discriminate then it is alright for everyone to discriminate. So that goes on to say that they are lesser human beings and they have lesser rights. There are so many cases of employment – where there is no protection from unfair dismissal if you have a health problem.

What are the other laws that discriminate?

There is a need to look at laws that actively and passively discriminate. There is a host of laws that definitely need to be modified. For example, in the Representation of the People Act, 1951, with respect to voting. Why should somebody with a mental health problem be denied voting? The government will say ‘mental illness’ is not mentioned in the Act and the legislation says with an ‘unsound mind’. However, electoral officers across the country have interpreted that ‘unsound mind’ means mental illness. There is a clear need to clarify that. In the Hindu marriage Act, it is very interesting that when the Act was amended, ‘leprosy’ was removed from it. We got rid of ‘epilepsy’ from the Act almost 20 years ago. However, mental illness still figures in it. Over time, leprosy and epilepsy have been deleted from the law but mental illness still figures in it. It is a discriminatory provision that needs to be removed.

What steps should the government take to handle mental health issues?

There is a need for more services which are acceptable to people. We need to provide community-based mental health services and not large asylums. The world over, what we have seen is that people want community-based mental health services as they are more effective and less costly. Services need to be nearer to people’s homes so that they can continue to get those services. Very few people require long-term institutional care and that needs to be provided in the community-based services. There is no use in building large hospitals with many beds if the government is not going to help people with mental health problems and recovery.

How much of the government’s budget is allocated to mental health?

Simple statistics show that less than 1% of the health budget goes towards mental health. While there is enough data to show that mental health issues constitute 8-10% of the health burden, we do not have enough mental health professionals.

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