December 3 is World Disability Day. It’s also been 20 years since the enactment of the Persons with Disabilities Act, 1995 in India, which is the main legislation governing the social protection and other entitlements of the persons who are recognized as persons with disabilities by this law. This day is marked by events and marches and prize distribution ceremonies to honour persons with disabilities who have excelled in their respective fields. The pride on display is in stark contrast to the persons who, every day, struggle to hide the impairments that hinder their participation in society “ persons with mental illness.
The United Nations Convention on the Rights of Persons with Disabilities, ratified by India in 2007, formally mandates the paradigm shift from ‘mental illness’ to ‘psychosocial disability’. The understanding of disability has changed from being synonymous with impairment. The social model of disability is an inclusive definition, including those who have long-term physical, mental, intellectual or sensory impairments, which, in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. Looking at it from the perspective of mental health, a mental disorder of any kind “ bipolar disorder, schizophrenia, depression, to name a few examples “ is a disability, because when it interacts with barriers, the participation of these persons in society is hampered.
What are the barriers that persons with psychosocial disabilities face? Attitudes and stigma are often said to be the biggest barrier for people facing mental disorders. While some mental disorders, like depression, have gained greater understanding and empathy among the public, others like schizophrenia and borderline personality disorder evoke a sense of fear and often, hatred.
This deeply embedded prejudice against persons with psychosocial disabilities is reflected in the laws of many countries. These laws often create exceptions from commonly accepted rights of persons “ including allowing for deprivation of liberty, forced treatment, revocation of legal capacity and disqualifying persons from universal adult franchise.
It is seen that mental health laws in the Asian region appear to create two mechanisms “ asylums, and laws. The British began setting up asylums for persons labelled as ‘lunatics’ or ‘idiots’. Soon after, laws were introduced to regulate the entry into these institutions. This usually happens by court order or police direction. The colonial laws also facilitated the appointment of guardians and the disposal of their property. As the approach moved from criminalizing mental health to ‘treating’ it as a mental illness, asylums were fashioned as ‘mental health institutions’ and everything else remained the same “ including specific legislation to regulate both them and their resident patients.
It has been long argued that the existence of a separate legislation and procedure for persons with psychosocial disabilities has created the perception that persons with psychosocial disabilities need to be treated differently, and with suspicion. The only way to break this deep-rooted practice would be the resetting of standards from the human rights perspective.
For persons with psychosocial disabilities the general principles of the CRPD contained in Article 3 are some of the most meaningful words used in the context of mental health. The idea that persons with psychosocial disabilities were entitled to “respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of person” is a marked departure from the coercive medical model of mental health treatment.
Recognizing persons with psychosocial disabilities as part of human diversity and accepting difference is also a huge departure from the normative focus on curing mental illness. In some contexts, ‘mad pride’ is gaining popularity. An interesting parallel is the Deaf community and State supported cochlear implants to ‘cure’ deafness.
The idea that persons with psychosocial disabilities should not be discriminated against is a novelty when compared to the centuries of jurisprudence justifying different treatment. The right to full and effective participation and inclusion in society recognizes persons with psychosocial disabilities to be more than just patients - and casts an obligation on the State to take positive measures to realize this.
The question that the psychosocial community is now grappling with is what accessibility means in this context. The Sugamya Bharat Abhiyan (Accessible India campaign) is quite an important step towards ensuring accessibility in the built environment and in communication. If we look at accessibility from the perspective of overcoming barriers, the answer is quite clear “ and it is up to the community to gear up for this.
Article 19 of the UNCRPD gives a right to persons with disabilities to live independently and within the community. This does not mean dumping people with a high restriction in participation in a housing complex. A reading of this forward-thinking rights provision makes it clear that persons with disabilities have the right to live in the community, as opposed to institutionalization, and with the support that they require. This support extends to the support that their caregivers require.
It is unfortunate that the extreme situation of violent acts by persons with a history of mental illness is taken as the reason to continue these draconian laws. There is public scepticism regarding the ability of persons to ‘get away’ with murder claiming insanity defences. Recognition of capacity also involves recognition of responsibility. Statistically, persons with psychosocial disabilities are more at risk at being victims of violence than perpetrators of violence. In both situations, there is a dire need to relook at our criminal justice systems to accommodate persons with psychosocial disabilities and recognize their capacity - both as persons testifying as witnesses and as persons who are accused in criminal cases.
This disability day it would be useful to remember that no one should be left behind, even if it is the group that will involve the largest overhaul of our customs, thinking, and legislation. It will result, doubtlessly, in a better world for us all.
Amba Salelkar is a lawyer working on gender and disability law and policy. She tweets at @MumbaiCentral though she lives between Chennai and Goa and is with the Equals Centre for Promotion of Social Justice
