Seeking a paradigm shift in mental health care

Source: The Hindu 

Relevance: Mental health-related issues have become a major aspect of the health care structure in India. Reading all aspects linked to it are important from an exam point of view.

Synopsis:

Persons with mental health conditions need a responsive care system that inspires hope and participation, without which their lives are empty.

Background:

• Recently, a High Court suggested that homeless persons with mental health conditions be branded with a permanent tattoo when vaccinated against COVID-19. This would enable the tracking of a floating population. 
  • Earlier judgments have also suggested ‘round ups’ of such persons to facilitate pathways into care. 
• These are well-intended directives, but may create hardships for the homeless. They might get pushed into overcrowded shelters without their consent in order to control the virus spread.

Challenges faced by Mental Health care patients:

• Deplorable conditions: In many countries, persons with severe mental health conditions live in shackles in their homes, in overcrowded hospitals, and even in prison. On the other hand, many persons with mental health issues live and even die alone on the streets.
• Inadequate Laws: Far-sighted changes in policy and laws have often not taken root, and many laws fail to meet international human rights standards. Many also do not account for cultural, social, and political contexts, resulting in moral rhetoric that doesn’t change the scenario of inadequate care.
• Social Exclusion: The attitude of society is based on traditional prejudices. This results in an “othering” of persons who seem different from dominant groups.
• Poor degree of Care: It is largely based on a colonial mindset. Individual preference and indigenous culture were substituted with what the coloniser thought was appropriate.
  • For instance, doctors interpreted a patient’s refusal to wear clothing as a sign of morbidity, and clothing became a way of civilising the savage. 

Learn from best practices –  The Guidance on Community Mental Health Services:

• It was recently launched by the World Health Organization. The Guidance addresses the issue from ‘the same side’ as the mental health service user.
• It focuses on the co-production of knowledge and on good practices built around the key themes of crisis services, peer support, supported living, community outreach, hospital-based services, and comprehensive mental health service networks. 
• Drawn from 22 countries, these models balance care and support with rights and participation.
  • Tupu Ake, a New Zealand-based recovery house service, welcomes ‘guests’ from various ethnicities. 
  • Atmiyata in Gujarat employs a stepped-care approach using community-based volunteers. They identify persons in distress, offer counseling support, and enable access to social care benefits.
  • Naya Daur in West Bengal works with local networks and volunteers who support homeless persons through their outreach programme. This enables access to food, clothing, counseling, shelter, and housing. 
  • Home Again, a programme of The Banyan in Tamil Nadu, facilitates residence options in regular neighbourhoods. It also offers graded levels of supportive services for persons with severe disabilities.
    • It emphasizes socio-cultural participation, ‘neurodiversity’, and normalisation of mental health conditions.

Way Ahead:

• The government should adopt an inclusive and harmonious approach for vaccinating and monitoring homeless people having mental health conditions. It should provide a network of services – 
  • soup kitchens at vantage points
  • mobile mental health and social care clinics, 
  • non-intimidating guest homes at village panchayats with access to toilets and the comfort of a welcoming team, and 
  • Well-being kiosks that offer a basic income and/or facilitate livelihoods.

Small emergency care centers and long-term inclusive living options should be made available for valuing diversity and celebrating social mixing. This will reframe the archaic narrative of how mental health care is to be provided.