The 6th Ad Hoc Committee Meeting of the UN Convention of Rights of Persons with Disabilities is scheduled to be held in early August, 2005. Articles 15-bis to 25 are scheduled for discussion at this meeting. These articles relate to children with disabilities, education, participation in political and public life, accessibility, personal mobility, health and rehabilitation, right to work, social security and an adequate standard of living, participation in cultural life, recreation, leisure and sports and monitoring mechanisms.

After the Tehelka expose about an Agra Mental Hospital psychiatrist committing fraud in the certification process, there is now the story of a fraud committed in the marriage registration bureau. Two young lovers applied to the district wedding officer in Agra for a license to get married in the month of June. Instead of being united in marriage, the officer sent the couple to the Agra mental asylum. The girl’s brother reportedly influenced the officer, who unduly harassed the couple in order to dissuade them from getting married. The brother deposited an affidavit certifying that the girl was mentally unsound and incapable of taking such decisions. Why the boy also was sent to the asylum remained a mystery. The couple was independently examined by the Agra Hospital doctors, who reported findings of sound mind! The admission to the hospital was made under provisions of the Indian Special Marriage Act 1954 section 4(d) and the Indian Lunacy Act. Was the officer from the marriage registration bureau aware of the Mental Health Act? This instance once again is evidence of the many yawning gaps in law concerning those alleged to be mentally ill in our society, allowing easy institutionalisation. [ISI-Human Rights News Bulletin, June 29, 2005. www.isidelhi.com]

FDA intensified its activities relating to the risk of suicidality in adults being treated with antidepressant medications. Several recent scientific publications suggest the possibility of an increased risk for suicidal behaviour in adults who are being treated with antidepressant medications. The FDA has begun a complete review of all available data to determine whether there is an increased risk of suicidality in adults being treated with antidepressant medications. In the meantime, the FDA is highlighting that

Adults being treated with antidepressant medications, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behaviour. Close watching may be especially important early in treatment, or when the dose is changed, either increased or decreased.

Adults whose symptoms worsen while being treated with antidepressant drugs, including an increase in suicidal thinking or behaviour, should be evaluated

It was a routine check-up for my daughter to fix a new pair of spectacles. The eye doctor found some increased IOP (intra-ocular pressure) during the preliminary investigation and advised us to do the Humphry’s field test. As the nursing assistant touched her head, my daughter did not fully co-operate with the testing. Anyhow, the IOP was found to be only marginally higher. We just forgot about the whole thing. The time was November 2002. Her maintenence dosage after her 4th relapse was 800mgs of SIZOPIN (clozapine) and 200mgs of TOPOMAC (Topiramate) daily from march 2002.

As I was watching a TV show in CNBC TV 18 ”Awaaz” I noticed that the anchor was discussing the side-effect of the drug Topiramate on a young bipolar patient. The report was on how the drug increased a patient’s IOP and how she almost went blind. What irritated me during the programme was the attitude of the lady doctor (a high level health department functionary) who was constantly blaming the patient and her carer, for not bringing the IOP increase to the notice of the treating doctor. As if one feels the increased pressure in the eyes! During the programme, it was also mentioned that the marketing drug multi-national, Johnson and Johnson, did not include this warning about increased IOP in the DRUG INSERTS. These inserts accom-panied all drugs sold in India during the introduction of this drug. Such warnings had been included in the DRUG INSERTS released in the

This note is in response to the heartrending expressions “Who am I?”, as appeared in aaina (March 2005). At the outset I am keen to clarify that I neither want to pontificate nor I desire to be judgemental about the issue discussed herein. I only would like to explore the issue with an unbiased alert mind, so that we can expose all the nuances of this issue that are both obvious and hidden.

In a nutshell the essence of the narrative is the issue of “self-identity”, rather, the crisis of “identity”. Arun Dohle has singularly confined his entire research for self-identity to finding out the biological parents and the natural family. This aspect of self-identity is his crisis. It would indeed be an unpardonable blunder on my part if I attempt to trivialise that search. I am deeply sensitive about the issues enumerated. Emotional pangs of human beings are excruciatingly hurtful of our body-mind equipment. Nevertheless, we could journey further to explore the whole issue of “self-identity”.

Immaterial of widely differing life-situations each human being is placed in daily existence. All of us without an exception are in endless search for our self-identity. Whatever the facets of identities our “self” already is in possession, it seems to be not quite fulfilled by them. Hence it looks for newer and newer facets of identities. Through ever multiplying relationships and innumerable material possessions, all of us are constantly struggling to reach the plateau of everlasting self-identity fulfilment! It is universally evident that nobody has ever succeeded in this gruelling search. Each one’s self-identity remains

incompletely patchy. Whereas, hardly few would have realised the futility of such a search by unravelling their own mind–mechanism that compulsively and also vainly indulges in this self-defeating endeavour.

The whole purpose of human existence is to take the initiative to explore relentlessly within oneself for one’s sense of “SELF”. Each one’s “World” spins on the axis of one’s notion of “myself”. This bedrock notion of “myself” is never ever questioned or even reviewed by us. It is taken absolutely for granted that “myself” is not a notion, but a concrete certainty! All other concepts and values that motivate and govern our living are structured firmly on this and also out of this bedrock notion.

We never pause in our maddening rhythm of living to reflect or wonder that if the very fundamental factor of self-identity, i.e., “myself”, is itself only a notion, then what creditability can there be for the subsequent super structure of concepts and values that have cluttered our existence? Is it not essential to dispassionately enquire, “WHO” and “WHAT” is this “myself”? One needs courage in its true sense to conduct this relentless inner enquiry.

All the while in our life, our questions and search for self-identity have been aimed at the outer world. Inspite of innovatively coming up with newer solutions and answers in our above search, we still feel awfully incomplete in establishing an everlastingly fulfilled self-identity. There is a nagging sense of void in us. The anxiety belonging to this mindset prevails in us.

This is the sorry state in which the

humankind are found living both in the past as well as in the present. This being the case, the future cannot be any different for us, unless we set aside our time worn search for newer and newer illusory identities and question the very notional central “entity” of the psychological “Myself”.

We all have an unquestionable sense of “Myself”. Hastily many of us take it to be our spiritual-centre! It is generally taken for granted that one’s sense of identity, the “myself” is an unbroken continuity. This naïve belief makes us give to our sense of self-identity a status of an individual entity. A notional identity is perceived through confusion as an individual ENTITY. Whereas, nature has endowed in each human being a vital clue to crack the enigmatic code of “Myself”!

Without an exception, all human beings experience the discontinuous nature of “Myself”. The irony is that we never take note of this factual experience. Every day, each human consciousness experiences three states of consciousness: waking-dream-deepsleep. Each has a sense of “Myself” in the wakeful hours with its one set of reality pertaining to wakeful situations. Challenges perceived by the wakeful “Myself”, and the corresponding responses, can be called as “Waker”.

When sleep takes over, initially waves of dreams tumble into and flood the consciousness. In the dream state, there is an exclusive sense of “Myself” identity, with its own peculiar challenges as well as responses. The “solidity” of the world that belong to the wakeful period is quite different from the stark “realities” of the dream-period. Our

wakeful world’s problems and as well solutions do not apply to the needs and fears of our dreamtime problems and solutions. The “Myself” identity experiencing dream-time realities is the “Dreamer”. It is a fact that the “Waker” and the “Dreamer” are not compatible in any given moment. Experientially in their respective realm they both cancel the “Other” out!

Subsequently, the state of deepsleep takes over the consciousness. In this state, amazingly both the identities of “Waker” and “Dreamer” dissolve into the state of absolute “not-knowing”. Even this “not-knowing” is only “known” after the consciousness manifests three starkly differing identities of “waker”, “dreamer” and the “deep-sleeper”.

Thus, it is immensely evident that our intimate sense of self-identity is not after all a seamless continuous single reality. On the contrary, it is an ever-changing discontinuous notional image. It is like the images imprinted in a motion-picture film. Each one of these images is only a series of separate and discontinuous still-pictures. The “motion” that is perceived is only an illusion. Motion is only a notion. Earth’s rotation round the stationary sun, makes the cannot-be-doubted reality of ‘sun rise’ and ‘sun set’! In like manner, endless repetition of “waker-dreamer-deep-sleeper” cycle in our mind gives rise to the notion of “Myself”.

The mother of all concepts “Myself” takes possession of our consciousness. Yet it is a deluded state. This delusion, as a parasite, occupies and confuses our consciousness. Our bodily existence is not dependent on this notional self-identity. Quite frequently, this “Entity” only creates problems through illusions. The human mind staggers and its innate intelligence gets clouded by this sense of self-identity. All shades of psychological fears and desires

belong to this self-identity delusion. Though as a part of humankind all of us are born with this delusion and learn through social conditionings to lead erroneous life of conformity, we can also unlearn this hoary distraction and regain the purity of consciousness. Through appropriate scientific insights if we can correct our imperfect perceptions of Reality in the Outer space and as well in the sub-atomic state/realm, our psychological can also be corrected and set right by deeper insight into our own body-mind mechanism. This realm of intelligence is known as spiritual intelligence.

Purified consciousness lives moment-to-moment in a here-and-now state of response. It does not grapple with the dead past, which is operating as a “Myself” identity. The contents of “Myself” is nothing but the dead past events of our life. Freed from the burden of a false sense of “Myself” identity, the pure consciousness does not seek fulfilment through the endless arrays of deluding identities. It learns to treat all forms of identity as tentative co-ordinates to conduct oneself in collective living. It has clearly realised that identities are no more the fundamental certainties to base one’s very existence on them. For peaceful existence, really, there is no necessity for any type of identities. Identities such as: family, religion, caste, creed and even nationality need not have an absolute importance for peaceful existence.

It is everyone’s everyday common experience that 30 to 35% of our lifetime is spend in sleeping. In childhood and old age the sleep occupies almost 40 to 50% of time in a day. Thus in a lifespan of say 75 years, in all we humankind spend almost 30 years in sleep! Hence, if one says that he/she has suffered one’s entire life, it only amounts to 25 years less suffering than previously assumed.

Let us investigate a little further. Even

in our wakeful hours, to what extent can we be continuously focused, exclusively on our misfortunes? At a stretch never more than a few minutes. Time and again our attention wanders away distractedly. These moments of preoccupation without thoughts or misfortune would be less than 20% of our entire life-time. Be it sorrow or joy, our body-mind mechanism cannot bear to stay put with one thought for more than a few seconds at a stretch. Hence our self-conscious “Myself”, repeatedly gives exaggerated importance to bolster its built-up identity, to our bygone unfortunate events. It also arrogates itself with pride, boasting its fortunes. The lasting cure from this malady of make-belief self-identity is only possible if we care to delve deeply into our own body-mind mechanism. If one can dispassionately observe one’s own life, it is quite evident that the content therein is nothing but the anguished demands of one’s self-identity. Both self-esteem and self-pity are two sides of the same coin of one’s illusory self-identity.

One’s make-believe centre needs both type of experiences. One’s chest swell with pride and also correspondingly when this gratification is denied, the chest should sink in depression. This is the reason, Buddha described the whole of human life in just one single word, ‘DHUKKA’ (sorrow). For us the humankind, even our ‘joy’ also paves way only to sorrow. This is because, without realising the truth of its own falsity, our sense of self-identity vainly demands constant mental pressure, movement. As this is not feasible in the balance of nature, the self-identity makes a showdown time-and-again by sinking into depression. All these are pointed out, so as to clearly perceive and profoundly grasp the question Dohle has raised in the article ‘WHO AM I’? After realising the truth, one lives in the world and not of the world. Living based on false identities is only a dream, even a nightmare.

A quality of freedom awaits us when we diligently undertake the exploration within us to unravel the enigma of “Self-identity”. Raising critical questions regarding the way of our human world cannot resolve the conundrum of self-identity in which we are trapped. Each of us should get ourselves psychologically free and then perhaps try to put the outer world in order. Only when we are free, we can genuinely and fully help others. Attaining psychological freedom from the burden of self-identity is each one’s birthright.

Contact: P. Ramakrishnan, Sr. No: 163/3, Madhav Memory, Flat 2, D.P. Road, Aundh, Pune- 411007.

...continued from page 3

must have blackbox warnings about the SIDEEFFECTS

1) increased suicidal behaviour and worsening depression

2) close observation for above if patients are given medication for first time and when dosage is changed.

My questions are, who is issuing these blackbox warnings in India and who are responsible for its implementation? Is it the patient / carer, as told by the doctor in CNBC TV 18? Is it the duty of Drug MNcs through their medical represen-tatives? Or is it the duty of doctors, who must read the drug inserts and inform their patients accordingly?

Captain Johann Samuhanand, S/3, A/ block, Shantiniketan Appts, Arekere, Bannergatta Road, Bangalore 560076. Tel: 080-26591615 (m) 09448459161

“Building musical bridges: Drum circle therapy with autistic children”

at Prasanna Autism Center

A report by Zubin Balsara, Senior Therapist, WCCL Foundation, Pune.
Report authored by Nafeeza S. Pavri and Zubin Balsara

The report describes the use of Drum Circle Therapy, pioneered by Arthur Hull and further developed by Heather MacTavish of the New Rhythms Foundation, USA. Zubin Balsara, of the World Center for Creative Learning Foundation, Pune, has been using Drum Circle Therapy with various groups including the mentally challenged children and children with autism. This report describes the work of WCCLF with children with autism. The report describes the application of DCT, emphasizing that the selection of drums and percussion instruments depends on the special needs of the client population being served. The report also talks about the “safety norms” of using DCT. The report refers to the literature on music therapy and autism. From this literature, it is clear that music can:

The report comprehensively describes the evidence base for the healing power of DCT.

The report itself is evidence of the effectiveness of DCT in the case of autistic children. The method was applied at the “Prasanna Autism Center”, Pune, as a research intervention. The study aimed to explore the use of songs, drums and rhythm based games for teaching functional and emotional languages for both verbal and non-verbal autistic children and breaks their patterns of isolation. Individual case studies are presented of ten children, and study findings summarised. A CD is provided along with, of the sessions.

WCCLF is planning a year long course on DCT and other art therapies from September, 2005, in Pune.

Contact: Zubin Balsara, WCCLF, A/4 Hill View Residency, Baner, Pune 411045, Maharashtra, India. Tel: 020-27898066 Email: wccl@vsnl.net

Health, both physical & mental, forms an important aspect of our lives. We take care of our physical health because so much information is available about the importance and implications of physical problems and well-being. Once persons enter the psychiatric domain, not much information is forthcoming to them either about mental health in general or their own ‘diagnosis’. Another reason is that there exists a lot of stigma about mental health in our society. It is not easy to get information about mental health aspects. People need the right kind of information to take active steps in their own mental well-being. The CENTER FOR ADVOCACY IN MENTAL HEALTH library aims to be such an open forum, for information and awareness building in the mental health area.

Objectives of the resource center

The objective of the resource center is to present expert information in a form that lay people can utilize in their day-to-day care of themselves or of their mentally ill relatives. No doubt medical libraries exist in Pune city, filling an important gap. However these libraries are too technical and do not serve the purpose of community education. Our resource center is four years old, and in our experience, is a very important instrument for information sharing, opinion building & stigma reduction in the area of mental health. Our resource center exists in order to fulfil the following functions.

The resource center first & foremost acts as an information dissemination center and an education center for the community, for users, caregivers and families; NGO’s, academic institutions, departments of psychology,

professionals, activists, develop-ment workers & trainers working in the mental health or related areas, and students from MSW colleges.

Systems

No organized work is possible without organized systems. Every library has to follow certain system (i.e. classification system, yearly stocktaking system etc.) for their daily work & development.

Every library catalogue tells its own story, it’s special interest, and it’s value system, the scope of activities and substance. We have looked at several library catalogues, including the standard international catalogues, the Akshara classification system and other variations that are used in documentation centres in Bombay and Pune. But the space and interest given to mental health and to our special advocacy interests in mental health have been minimal. So we decided to evolve our own.

Computerizing of resource centre

For computerizing of resource centre we use CDS/ISIS package. We make database of our library collection through CDS/ISIS package. CDS/ISIS package is a DOS based package, developed by UNESCO for libraries.

We keep our accession register’s softcopy on Microsoft access, and use Microsoft excel for filing cabinet indexing.

For more information of resource center, visit our website www.camhindia.org. Our library holdings and new additions list are uploaded at our website.

Contact:
Aparna Waikar, Librarian,
Center for Advocacy in Mental Health,
A research center of Bapu Trust
B 1/11 and B 1/12, Konark Pooram, Kondhwa Khurd, Pune 411048
E-mail: wamhc@vsnl.net

	June, 2005, Milan
	Sylvia Caras, PhD, writes

I was asked to be on the advisory committee for this conference organized by World Association for Psychosocial Rehabilitation and WHO, and then invited to come and present. The purpose of this international conference was to organize Italian consumers to create self-help, social employment enterprises, and to help the system continue to improve. By the time we started the conference, about 45 minutes late, people were sitting on the floor leaning against the walls, about 400 people, 75% users, 15% professionals, 10% families. We began with a welcome from Angelo Barbato. He noted that there was no pharma funding and there was considerable audience applause.

Then Benedetto Saraceno (WHO, Director, MH and Substance Abuse) spoke. He was part of the Italian psychiatric revolution in the 70’s. He talked about the relationship between the WHO and users, noting that the history of WHO’s attention to the relationship is poor. For instance three boxes of ignored letters had been found. This became the “Voices from the Shadows” – a WHO publication project, a resource which may be available through a google search.  More involvement is necessary. In the last five years, WHO held a stakeholders meeting in Geneva during the WHO mental health year, which was open to different perspectives; has done systematic consultation with users; aimed to, but didn’t, establish a parliament, a Global Council, though three preparatory

meetings were held (parliame-ntarians, family, users); and has promoted the user movement for instance by giving an African user, Sylvester, the founder of the Pan-African group part of a precious 30 minutes during a health conference; and will publish a resource book about mental health legislation (I’ve seen drafts; it will include suggestions for use of force). Saraceno reiterated the WHO approach to developing nations, including the accent on meeting unmet needs. He talked about creating a global atlas of the movement, and that there was a need to organise in the developing world, to treat in the community and that ECT is controversial. WHO will be hosting a global service users convention in 2009.

Next came a world wide perspective roundtable, me, Elena Chavez, Mary Nettle, Sylvester Katontaka, Chris Hansen. We all were well received, reinforced each other, made good and different points. Perhaps 200 attended the afternoon research panel. Falloon represented the mainstream view of good “evidence” that treatment works, that there is an effective treatment for every mental illness but people don’t get those treatments. The issue is not the science (good) but the application of the science (bad). He talked about educating consumers in best practices so that they can insist and direct their treatment. He was the most provocative of the panelists. According to one question, there’s some momentum to stop using the diagnosis of schizophrenia.

Recovery parallel session - what helps and what hinders:

Farkas, from Boston University noted that “recovery” means taking back one’s life. To be “symptom free” was an inadequate goal. Rehabilitation may or may not contribute to recovery. Begone from EUFAMI gave the carer’s perspective.

Mary O’Hagan from Australia talked about the continuum between institutionalized services to recovery services. Recovery services have a philosophy of self-determination, that the user knows best. They have a purpose of recovery; a view of madness as a crisis of being; that meaning and value are crucial to recovery; that services must be broad, including peer support, comple-mentary treatments, psychotherapy, or whatever else it takes. She emphasised leadership by users. There must be no force, and users take responsibility with chosen supports. 

Iris Hoelling from Germany talked about helpful factors in the process of recovery: the absence of psychiatry, and of drugs; the attitude of supporters towards the person in crisis; full legal capacity at all times and without any exceptions; and harmful factors: psychiatric drugs, psychiatry diagnosis, lack of independent full information, lack of choices, lack of user-controlled spaces. Following psychiatric labelling, it can be a lifetime struggle to re-appropriate one’s own life. Often people have good reasons for going crazy. Iris is calling the medical interventions violent. The concept of violence is comfortable for me, more than that of torture.

Talbott, a professor of bioethics was

excited by consumer-run services. He used a medical experience of his own to compare what helped and what hindered. He talked about the importance of non-medical personnel, faith, religiosity and spirituality. Farkas noted that recovery is not linear. It is individual and unique even though there are techniques and themes that help. He talked about the need for a core set of values - person-oriented services, partnership, choice and self-determina- tion and hope.  The notion of “partnership” versus “leadership” was discussed. Users were invited to come, speak, tell their stories. When a user gets stuck at the microphone, comrades in the audience applaud for a bit, which gives support and some time to focus. It was startling the first time, then was very good to experience. 

Tina Minkowitz (America) and Gabor Gambos (Hungary) spoke about the UN Convention work, including issues and monitoring. Jose Bertolote spoke once again about WHO initiatives, noting that WHO is interested in promoting user groups in developing countries.

Other speakers included David Oaks and the Secretary of WFMH. At least 100 stayed to the end. I put a web page of conference related resources for them at www.peoplewho.org/wapr and there is a link from there also to my presentation
(www.peoplewho.org/wapr/remarks.htm)
WHO is planning to develop a global atlas of the movement and information about existing national organizations. The WHO will also be hosting a global service users convention in 2009. Conference related resources www.people who.org/wapr. There is a call from WNUSP, Mind International, and other user groups to strengthen advocacy and plan the process for the WHO 2009 event.

Sylvia Caras, one of the founders of the WNUSP, can be contacted at sylvia@peoplewho.org

Homeless mentally ill and urban poverty

Aashray Adhikar Abhiyan [AAA], along with Action Aid International, New Delhi, organized a “National Consultation on the Urban Poor” at the Indian Social Institute in July, 2005. Many sessions focused on the plight of the wandering mentally ill people. Justice Krishna Iyer’s note of felicitation talked about how globalization and privatization have created the disease of “afflu-enza”, leading to the mass creation of the “wretched of the earth”. Milind Kothari, the UN special rapporteur on housing rights, talked about the UN report on homelessness. The enormous play of power in private land, land theft, land grabbing and the injudicious policies of the government favouring the privatization of land was questioned.

AAA is involved in the enormous task of mobilizing the homeless, and several testimonies presented here spoke about the atrocities committed by authorities administering the Bombay Prevention of Beggary Act (BPBA), especially the police. The moving testimonies described - the beatings, the risk of life to self and family, police hafta, the loss of dignity in the process of arrest, the appropriation by the police of personal belongings, the struggle for housing and economic rights, a life of degradation and neglect in the beggars’ homes, fraud or arbitrary arrests, the sexual exploitation of women by officers, the use of women in custody for personal work (maalish, etc.), the loss of child when in custody, the corruption in the admission and discharge procedures, the demand of bribe for release on personal bond and the daily abuse (foul language, beatings, etc.).

A panel on the BPBA pointed out that the Act was not picking out the professional beggars, but only innocent people, many of whom were in fact earning their daily bread through honourable means. This Act was a left over from the colonial period, which made institutional arrangements for all peoples not seen as a part of the productive, industrious, work force. Beggary was made a crime in the 1940s. The AAA experience also noted the enormous number of mentally ill people held in custody in the Beggars’ homes in Delhi. Their legal aid program also pointed to gaps in justice administration of the BPBA through the beggars’ courts. Among the many “adverse” remarks that the beggars’ home authorities may make in the Social Investigation Report, “mentally not found to be fit” is also one, making it very easy for the homeless mentally ill to be apprehended and arrested by the police. There was a demand to repeal the BPBA. The role of international law and jurisprudence was brought to bear on the topic of vagrancy.

Experiences from MAITRI project, involving de-institutionalisation of persons in the Ranchi mental hospital, were shared. The untenability and tentativeness of psychiatric labeling of institutio-nalized persons as “manageable”, “untreatable”, and “incapable” was described. When doctors say that someone has a “poor prognosis”, how is this conclusion arrived at? The vegetative states that people are pushed into, especially the long stay, “certified” cases, due to medical neglect, ECT abuse and overmedication was described. Whether a determination of mental illness was based on science or personal judgment was discussed, especially in the context of women. Discussion centered around the role of mental hospitals in mental health care, the steps that needed to be taken to prevent people from reaching the institutions, and the creation of programs in the community. The IHBAS experience showed that such initiatives are possible.

The Banyan experience talked about the right to care, and described their

continued on page14

Why amendments?

1. The legislation needs to be amended to suit the current needs of the mentally ill persons. Currently, the institutions are non-existent; instead it is the family (not community as in the West) that is the mainstay in India. Not a single word in the legislation mentions family care and needs of the care givers to protect the human rights of the mentally ill, ensure their safety and that of their property.

2. The advent of new medicines has made treatment possible on an OPD basis. But support systems for families and patients to access such treatment are not enacted as a rule. As a result, many go untreated.

3. Right to health and rehabilitation besides right to privacy / safety and dignity must be made fundamental rights in the MH Act.

4. Rights of the patient under lucid moments must be emphasized and spelt out clearly. Presently, this is not there. However, a few patients reach a stage of functionality when they are capable of self care and management.

5. Rights of family care givers needs attention too.

6. A separate human rights decla-

ration is sought based on the “International Covenant for Civil and Political Rights and International Covenant for Economic and Social Rights”.

What is to be amended?

2.l - definition of “mentally ill person”. This definition needs to be looked into to make it more inclusive of all major mental illness other than Schizophrenia.

2.q - definition of “psychiatric hospital and nursing home –including convalescence homes “ must be expanded and made explicit to include all psychiatric facilities such as Day care centers, Half way homes etc. wherever the mentally ill are detained and looked after other than their own family homes.

2.t - substitute “relative” with “family care giver or natural care giver”.

Mental Health Authorities - Central and State

3.3 d – Their major responsibility is to ensure implementation of the National Mental Health program from district to state level; states to central level. It is not necessary to waste meager resources like MD Psychiatrists to be the Secretary. Any MD or a senior level medic in the State must be allowed to do this responsibility.

It is necessary to include a new clause for spelling out the composition and membership of the Central and State Mental health authority. Only one-third must be mental health professionals. Others must be drawn form family support groups of parents, guardians and active care givers of the mentally ill persons, legal profession, engineers, Rotarians, PG students, police etc. There must be one member to represent the exclusive interests of mentally ill women including women prisoners.

Sec.6 - Drop the word “asylum”. Definition of care / convalescence homes must be more precise. All such facilities must obtain license under this Act.

Sec 6 - Only those who have had a proven track record of having worked for the mentally ill or having cared for them as a relative must be allowed to start homes so that commercial interests and mercenary expectations are reduced.

A clause must be included that all psychiatric facilities be they treatment centers or care and convalescence centers must get license to practice strictly under the Mental Health Act only. No other Act or certificates or licenses can supersede this legislation. They may get additional licenses but

license under this legislation is mandatory because it is subject to inspection by the Board of Visitors. Such a provision endorses the UN principle of right to supervised care for the mentally ill persons.

It must be made mandatory to display the license in a place that is visible to clients.

All general hospitals and nursing homes need not obtain license but is enough if registered. However, for psychiatry patients, it is desirable for them to include Occupational and Therapy facilities as part of the treatment package.

Sec10 - Spell out what the phrase “prescribed conditions mean.” Substitute this with “Human rights”? The State of Karnataka by the recent notification has notified ‘in exercise of the powers conferred by S.10, read with S.94 of Mental Health Act, 1987, Karnataka with S.94 of Mental Health Act, 1987, Karnataka Psychiatric Hospitals and Psychiatric Nursing Homes (Conditions and Maintenance) Rules 2004. Wherein the minimum standards as to the living conditions in in-patient settings are set out. The Karnataka Psychiatric Hospitals and Psychiatric Nursing Homes (Conditions and Maintenance) Rules 2004 is pending clearance from GOI).

Sec13 - Inspection records are not confidential documents (but patient records are) and must be accessible to public. Reports on inspection and filing of reports on the conditions at the State run hospitals, Institutions including those that come under the purview of the Central government are to be accessible to public.

Sec14 – All OPD facilities should be given license only if they have ambulatory services for shifting patients to hospital or nursing home in a crisis or emergency situation. If they do not run ambulance service

directly, they must at least be linked to such facilities so that the patient and the care givers have easy access to treatment. Such cases will follow same rules as under Involuntary admission in order to protect the ambulance staff and others from legal hassles. Doctors who have clinics at home must provide information to family care-givers as to how to shift and where to shift in case of crisis.

All third party insurance must cover psychiatry consultations contrary to the present practice because it violates the right to health.

Ch. IV

Part II, Sec 19 on admission of mentally ill person under special circumstances – Admission and Detention issues are to be worked out by simplifying these procedures.

Part III Sec 20 on Reception Orders - Many families are made to run around for reception orders though it is neither necessary nor is their responsibility. It is the responsibility of the authorities to procure Reception orders. But just because of the problems involved, patients are sent out without admission.

For exercising his decision to detain a mentally ill person under Sec 20, the definition of who is mentally ill, is important. There are mentally ill persons who have 100% insights into their problems- for example, OCD patients who may have strong harmful impulses but may not be considered mentally ill by law! So how to decide on admission. Hence MI needs to be defined precisely as to what it includes. The advantage of leaving it ambiguous as it is in the present form may also be helpful to give it broader interpretation.

Sec 23 .3 - Duties of the Police needs to be clarified. It says that “every person ……..shall be produced before the Magistrate within a period of twenty-four hours“. This duration is too long a waiting