Mental health care in India: restoring hope and dignity
It took some time for Shamma’s family and teachers to understand why she was struggling at school.
“Teachers complained that my daughter fought with other girls because they called her names,” says Shamma’s father, Mohammad Yusuf Mansuri. “The problem got worse. People began saying she had been possessed or fallen under black magic.”
On the brink of despair, Mohammad found hope through a mental health facility in their home state of Gujarat, India, where Shamma was diagnosed with schizophrenia. Here, at last, she was able to get the help she so desperately needed.
The facility is 1 of just 43 government-funded mental health hospitals, which provide services for an estimated 70 million-plus people living with mental disorders. For every 1 million people, there are just 3 psychiatrists, and even fewer psychologists.
In Gujarat state alone, the facility is 1 of 9 that has implemented the Quality Rights Project to improve access to mental health services, while respecting the human rights of the people treated there. Established in 2014, the project is being implemented by the Ministry of Health and Family Welfare of Gujarat and the Centre for Mental Health Law and Policy at the Indian Law Society and is supported by WHO and partners. The project is funded by Grand Challenges Canada, a Canadian government-funded nongovernmental organization.
Seeing the person and not the disease
Consultant psychiatrist, project coordinator of the Quality Rights Project and coordinator of the Indian Law Society’s Centre for Mental Health Law and Policy, Dr Soumitra Pathare, explained the project was launched to address a range of issues. One challenge was to change the prevailing mind-set among the community that people with mental illness lack the capacity to make meaningful decisions about their lives.
“The hardest part of this project is changing the attitudes of health workers and the community towards people with mental illness,” says Dr Pathare. “To provide holistic care, you must see the person and not just their illness. You have to treat them as individuals with hopes and dreams."
The Quality Rights Project goes beyond conventional treatment, by advising service users and caregivers on how to access social grants and giving career guidance. Through the project, mental health providers, caregivers and people using the services undergo training on a human rights approach to care.
Implementation follows the step-by-step guidance provided in WHO's Quality Rights Tool Kit, which includes a list of human rights standards that must be applied along with practical tools and training materials for restructuring and improving the mental health facility, and suggestions for evaluating progress.
“The Quality Rights project emphasizes recovery by putting individuals’ goals and aspirations to lead fulfilling lives in their community at the forefront,” explains Dr Michelle Funk, Coordinator for the Mental Health Policy and Service Development team at WHO.
“By implementing recovery-oriented policies we can help mental health service users’ reintegrate into the community, benefiting the user, the caregiver and broader society,” she adds.
Through its focus on human rights, the Quality Rights Project aims to empower those requiring its services.
“We now place a lot of emphasis on empowering service users to decide on the type of treatment they wish to receive,” says Dr Ajay Chauhan, State Programme Officer for Mental Health in Gujarat. “They start to feel better about themselves and that choice.”
Community support groups
In Shamma’s case, the support she receives at the facility through the Quality Rights Project, including via Saathi, a peer support group for caregivers that meets regularly, has provided an invaluable source of hope for both her and the family, according to her father, Mohammad.
“I have felt a lot of discrimination in life, but Saathi is a space where people are sharing their difficult experiences,” he says. “There has been a shift in the way I think. I find myself taking more time for my daughter and talking about her life, feelings and needs.”
Chinmay Shah, a 36-year-old engineer diagnosed 20 years ago with schizophrenia, attests to the project’s merits.
“I am doing much better and am able to work part time,” he says. “I visit Saathi and other facilities providing mental health care services, sharing my experience and advocating for the use of a human rights approach at these facilities. In this way, I can help others going through this.”
“It takes a long time to recover, but it is possible.”