“on men­tal health, all of us need to sup­ple­ment govt’s ef­forts”

Governance Now - - CONTENTS - gee­tan­jali@gov­er­nan­cenow.com

Dr Bharat Vat­wani, Magsaysay Award-win­ning psy­chi­a­trist, on his ef­forts for the men­tally ill

Dr Bharat Vat­wani of the Mumbai-based Shrad­dha Re­ha­bil­i­ta­tion Foun­da­tion – one of the two In­di­ans who won this year’s Ra­mon Magsaysay Award – has been re­unit­ing men­tally ill street-dwellers with their fam­i­lies, fight­ing against all odds.

His mis­sion be­gan in 1997 when he and his wife (Smitha, who is also a prac­tis­ing psy­chi­a­trist) spotted a frail young man drink­ing gut­ter water out of a co­conut shell and took him to their nurs­ing home in Bori­vali. They treated him and re­united him with his fam­ily in Andhra Pradesh. The cou­ple also helped a well-known Sir JJ School of Arts teacher who was suf­fer­ing from schizophre­nia, wan­der­ing in the streets for over two years. Af­ter treat­ment, Dr Vat­wani fought for him to get his job back. This trig­gered an over­whelm­ing re­sponse from art stu­dents who or­gan­ised a fund-raiser ex­hi­bi­tion for Dr Vat­wani’s cause to set up an in­sti­tu­tion for the men­tally ill. Vat­wani speaks to Gee­tan­jali Min­has about his mis­sion:

Men­tal ill­ness is cur­able in most cases, but in In­dia most patients remain un­di­ag­nosed and un­treated due to at­tached stigma. How can we raise aware­ness?

Though cur­abil­ity and stigma are two dif­fer­ent is­sues, both are in­ter­con­nected to­wards the fi­nal out­come. in mas­sive aware­ness cam­paigns both must be ad­dressed specif­i­cally and separately. at­ti­tu­di­nal shift hap­pens when patients’ fam­i­lies per­son­ally have a pos­i­tive ex­pe­ri­ence dur­ing re­cov­ery vis-à-vis the above pa­ram­e­ters. That seals the en­tire process.

How has so­ci­etal at­ti­tude to­wards men­tal ill­ness changed over the years?

Sig­nif­i­cantly yet in­ad­e­quately treat­ment fa­cil­i­ties are pop­u­lar all over the coun­try and over-utilised. due to the short­age of psy­chi­a­trists, the pop­u­la­tion is not be­ing served ad­e­quately but peo­ple are com­ing for­ward for treat­ment. So­cial ac­cep­tance of the men­tally ill is also grow­ing. The fam­ily at­ti­tude to­wards their men­tally ill mem­ber is also un­der­go­ing trans­for­ma­tion and spouses too are more car­ing to­wards their men­tally ill part­ners. divorces due to cases of men­tal ill­ness are com­ing down. Fam­i­lies are mak­ing ar­range­ments for the fu­ture well­be­ing of their men­tally ill fam­ily mem­bers. The so­ci­ety is recog­nis­ing the fact that a men­tally ill per­son is not so of their own bad deeds and ac­cept­ing the fact that men­tal ill­ness is med­i­cal in na­ture and not due to black magic.

In your work, you must have faced many ob­sta­cles.

There were fi­nan­cial dif­fi­cul­ties as donors in in­dia are not sen­si­tized to­wards men­tal ill­ness. There is lack of trained man­power. With our cen­tre lo­cated at Kar­jat, in the in­te­ri­ors, the staff was not ready to stay there. We still do not have an en­try-level as­so­ci­ate res­i­den­tial psy­chi­a­trist or md (medicine) physi­cian.

in 1996 when we wanted to set up a psy­chi­atric in­sti­tu­tion at dahisar in mumbai peo­ple did not want a cen­tre for men­tally ill near their res­i­den­tial build­ings. They put up huge ban­ners against us and took us to court. Fi­nally we won the court case. With the judge pro­nounc­ing that the men­tally ill are a part of the so­ci­ety and de­serve to be treated within the same so­ci­ety. The judg­ment gave them their right­ful place un­der the sun.

There were lo­cal chal­lenges like power breaks, ex­treme weather con­di­tions with patients de­vel­op­ing heat stroke, and tor­ren­tial rains lead­ing to func­tional dif­fi­cul­ties. With med­i­cal in­fra­struc­ture at Kar­jat woe­fully in­ad­e­quate due to health com­pli­ca­tions like heart at­tacks, malaria, ty­phoid and TB, patients have to be shifted to far­away hos­pi­tals, re­sult­ing in loss of man­power and funds.

other func­tional dif­fi­cul­ties are poor in­ter­net con­nec­tiv­ity es­pe­cially dur­ing rains, pres­ence of snakes and scor­pion, use of bor­ing water for drink­ing which some­times causes wa­ter­borne dis­eases, se­vere in­fec­tions in patients, skin wounds (mag­gots), frac­tures, hy­popro­teinaemia, seizures, HIV in­fec­tion and dif­fi­culty in trac­ing out ad­dresses due to mul­ti­ple lan­guages in the coun­try. it is spe­cially chal­leng­ing to re­unite fe­males from tribal ar­eas and patients

from mi­grant pop­u­la­tion with their fam­i­lies as it re­quires trav­el­ling to re­mote in­te­rior vil­lages in­volv­ing bus changes, cross­ing water ways on boats and walk­ing long dis­tances on foot. de­spite all this some­times it is not pos­si­ble to trace out fam­i­lies and at other times fam­i­lies refuse to ac­cept the re­cov­ered des­ti­tute.

De­spite such chal­lenges, what mo­ti­vates you to con­tinue with your work?

com­pas­sion, com­mit­ment, im­mense job sat­is­fac­tion, sup­port of our staff, con­tri­bu­tion of our well-wish­ers and ev­ery tiny con­tri­bu­tion to­wards re­duc­ing hu­man suf­fer­ing, our own per­sonal and pro­fes­sional ex­per­tise in trans­form­ing the patients in pro­mot­ing a suc­cess­ful model till other ngos repli­cate it.

Pres­i­dent Ram Nath Kovind has ac­knowl­edged that In­dia is fac­ing a pos­si­ble men­tal health epi­demic. Yet In­dia spends only 0.06 per­cent of its re­duc­ing health­care bud­get on men­tal health­care. The Na­tional Health Pol­icy 2017 has a tar­get of in­vest­ing a mere 2.5% of GDP on health by 2025. In such a sce­nario due you think the ob­jec­tives of the new Men­tal Health Care Act, 2017, can be achieved?

Yes, but we can­not go on wait­ing and do noth­ing about it. all of us need to sup­ple­ment ef­forts ini­ti­ated by the gov- ern­ment which means the pri­vate, cor­po­rate and phar­ma­ceu­ti­cal sec­tor, ngos, char­i­ta­ble or­gan­i­sa­tions, lo­cal and for­eign fund­ing agen­cies, lo­cal gov­ern­ing au­thor­i­ties, psy­chi­a­trists, nurs­ing col­leges, so­cial work in­sti­tutes, youth or­gan­i­sa­tions, me­dia in­clud­ing so­cial me­dia, Un agen­cies, in­ter­gov­ern­men­tal agen­cies, re­li­gious or­gan­i­sa­tions, ad­ver­tis­ing agen­cies, hu­man re­source devel­op­ment ex­perts, csr funds, tax ex­emp­tion schemes, ed­u­ca­tional in­sti­tutes, vo­ca­tional guid­ance or­gan­i­sa­tions, em­ploy­ment bu­reaus etc., can do a lot.

While the num­ber of patients treated in men­tal asy­lums has in­creased man­i­fold there are not enough men­tal asy­lums. Those that ex­ist are not run well or do not func­tion as in­clu­sive nur­tur­ing places. Your com­ments.

For­tu­nately with many new med­i­ca­tions for men­tal ill­ness, long-term stay is not re­quired for most patients. So the need for mas­sive in­pa­tient care on long-term in­pa­tient care has sig­nif­i­cantly re­duced and not a hur­dle any more.

Some ar­gue that the Men­tal Health Re­view Board pro­posed in the new law to look into juridi­cal as­pects of men­tal health­care may dis­cour­age not-for-profit and pri­vate en­ter­prises from pro­vid­ing men­tal health­care ser­vices that have le­gal im­pli­ca­tions. That may push a large num­ber of the needy to pub­lic hos­pi­tals which do not have suf­fi­cient trained peo­ple and funds. Your com­ments.

although all the laws are in­vari­ably per­ceived as threat­en­ing, in re­al­ity they ex­ist only to sus­tain a dis­ci­plined de­sign in our to­tal func­tion­ing. if our in­ten­tions are pure, lo­cal au­thor­i­ties are al­ways sup­port­ive and if some­thing does get stuck in a bot­tle­neck, courts are al­ways there to mod­ify any­thing that is im­prac­ti­cal. The gov­ern­ment too is open to amend­ments when it helps the smooth func­tion­ing of the sys­tem. There­fore, ngos and pri­vate sec­tors should not feel re­stricted be­cause of this [pro­vi­sion].

Do you think that in tak­ing a rights-based ap­proach for treat­ment and care of men­tal ill­ness, the new law over­looks the is­sue of men­tal health marked by so­cial per­ils like in­equal­ity, hope­less­ness, de­pri­va­tion, poverty and dis­crim­i­na­tion?

We are in the process of devel­op­ment. is­sues of in­equal­ity, hope­less­ness, de­pri­va­tion, poverty and dis­crim­i­na­tion are universal in na­ture and not re­stricted to in­dia alone. While at­tempt­ing to sort out these is­sues we need to pro­tect vul­ner­a­ble cit­i­zens in our so­ci­ety and to that ex­tent the least we can do for them is pro­tect their rights.

When the gov­ern­ment aims to in­crease ac­cess to men­tal health­care ser­vices to vul­ner­a­ble groups, es­pe­cially the home­less, those liv­ing in re­mote ar­eas, dif­fi­cult ter­rains, and eco­nom­i­cally, so­cially and ed­u­ca­tion­ally de­prived sec­tions, how chal­leng­ing will it be in the face of ab­sence of data on trends and preva­lence of men­tal ill­ness in the coun­try?

if ad­e­quate psy­chi­atric ser­vices are in place and wide­spread pop­u­la­tion is get­ting the help it re­quires, i think ab­sence of ac­cu­rate data re­mains only a the­o­ret­i­cal re­quire­ment and that too in plan­ning stage. This should not de­ter us from im­ple­ment­ing a wide net­work of ser­vices till we over­shoot our needs. The data known at pre­sent should at least be in­stru­men­tal in cov­er­ing all dis­tricts of in­dia.

“For­tu­nately with many new med­i­ca­tions for men­tal ill­ness, long-term stay is not re­quired for most patients.”

Dr Vat­wani with in­mates

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