Serious Mental Illnesses: Schizophrenia Bipolar Disorder in Women

‘Although the prevalence of chronic psychotic illnesses such as Schizophrenia and Bipolar disorder in women may be less than that of Depression, Anxiety they pose an immense problem in management and rehabilitation.’
 - Mental health An Indian perspective 1946-2003’ by the Directorate General Health Services, Ministry of Health and Family Welfare, Government of India

Using the terminology ‘special’ for people with disabilities in India

.....with no inclusion whatsoever of children women or men with mental illness in this ‘special group’.

1.‘Mental illness’ is the seventh disability in the existing Persons with Disability ACT 1995 which exhorts *Equal opportunities, Protection Rights. Full participation*

2.Media in its productions in India are extremely careful in the use of accurate terminology for the six disabilities in the Persons with Disabilities ACT 1995 and for the four disabilities in the wealthy National Trust for disabilities in India, which is governed by a separate law.

3.An example is the piece ‘Providing Insight to Autistic Children’ which appeared in ‘The New Indian Express’ on 3rd December 2014. A link of which is given below.
http://www.newindianexpress.com/cities/kochi/Providing-Insight-to-Autistic-Children/2014/12/03/article2552129.ece

4.Another piece with the word ‘special’ in its title appeared in the same newspaper on 05 September 2014 with the caption ‘Government Job Eludes 'Special' Employee’ going on to say the person was ‘mentally challenged’ and had participated in a certain Special Olympics Asia Pacific Regional Games 2013. The link is given below. 
http://www.newindianexpress.com/cities/thiruvananthapuram/Government-Job-Eludes-Special-Employee/2014/12/05/article2555423.ece

5.Careless blurring of the boundaries between people with mental retardation and people with mental illness is increasing in India, although both disabilities are defined separately in the existing Persons with Disabilities ACT 1995. It is important to point out that Persons with Mental Retardation are included in the wealthy ‘National Trust for disabilities’ covered by a separate law 

6.On the 2nd December 2014 an 8 year old girl died by suicide in Bengaluru by dousing herself with kerosene and lighting herself up. She left behind a suicide note saying that she loved her mother very much. Her mother is a factory worker. She was a student who had not been attending school for several days. Pictures of the school attendance register was shown on television. The related link is given below
http://www.ndtv.com/article/india/amma-i-love-you-wrote-bangalore-10-year-old-in-suicide-note-628900?curl=1418247209
 
7.In response to this suicide, in an interview in a television channel CNN-IBN on the night of 02 December 2014, a mental health professional from Bengaluru stated that, ‘such suicides were due to sexual assault, and parental pressure'. On what basis was such a callous statement made? The repercussion of the costs of not treating mental illness through early intervention is already huge.

8.The Press Information Bureau in the social media on 03 December 2014 tweeted that the Health Minister Honourable Shri J P Nadda, heading the Ministry of Health and Family Welfare of the Government of India had released a ‘Framework for Convergent Action for comprehensive care for children with special needs which is committed to prevention, early diagnosis and treatment of disorders in children with special abilities.' The text of which is given below followed by the link.

9.Health Minister Shri J P Nadda: Committed to prevention, early diagnosis and treatment of disorders in children with special abilities.
 
The Government is committed to prevention, early diagnosis and timely and appropriate treatment of disorders in children, including development disorders so that they enjoy good health and become valuable assets of the country.

The Union Minister for Health and Family Welfare, Shri J P Nadda stated this at the closing of the three day workshop on Neurodevelopment Disorder in Children organised by Ministry of Health & Family Welfare, pediatric department of AIIMS, with support from UNICEF and Norway India Partnership Initiative (NIPI) in health. Today also marks the International Day for Persons with Disabilities.

The Health Minister said that the government through its various efforts is addressing key developmental issues, including developmental delay, intellectual disability, cerebral palsy, Autism, Hyperactivity Disorder, learning disability, vision and hearing impairment. He added that an estimated over 200 million children in developing countries are not reaching their full developmental potential. In developed world 10-20% of individuals have learning or developmental difficulties. In India, estimates suggest that 10% children are affected with developmental delays and are at significant risk of permanent disabilities, Shri Nadda said.

The Health Minister emphasised on the importance of early detection for effective intervention in children with neurodevelopment disorders. He informed that Rashtriya Bal Swasthya Karyakram (RBSK) under National Health Mission (NHM) has comprehensively incorporated early diagnosis and intervention strategies for developmental disorders. The Minister stressed on the importance of collective efforts to provide accessibility to medical services and rehabilitation of persons with disabilities. He said that within the new policies, programs and strategies have been designed to empower children and persons with special needs with equal rights and opportunities in education and employment.

The Health Minister released the Framework for Convergent Action towards Comprehensive care of Children with Developmental Difficulties, at the occasion. This will serve as an indispensible guide to future action plans to be developed by policymakers within various ministries, the Minister said.

Shri J P Nadda also launched a mobile-based microsite for training module for healthcare practitioners.

Celebrating the International Day for Persons with Disabilities with a workshop on Neurodevelopment Disorder in Children renews and reinforces our commitment towards the cause of persons with disabilities and special needs, the Secretary (H&FW), Shri Lov Verma stated. He said that one in every ten children in the country suffer from some form of disability. The big challenges are timely and early diagnosis, and capacity building of frontline workers in early detection, he said. Early detection aids timely intervention. He also emphasised on planning for lifespan care for children with special needs.

Mr. Louis Georges Arsenault, Country Representative, UNICEF highlighted dignity, right and wellbeing of persons with special needs, and the need for creating an all-inclusive society for children to enable them to realise their potential which would include special schools for children with flexible curriculum, and qualified and sensitive teachers.

Ms. Nata Menabde, Country Representative, WHO stated that this issue is relevant to all sections of society irrespective of the socio-economic distinctions. She stressed on need for pro-poor policies and strategies for the marginalised communities and sections of society as they were the ones which bore the burden of disability the most. The need of the hour is integrated delivery of health services through community participation, she said.

Mr. Eivind Homme, Ambassador of Norway to India stated that within the NIPI, commendable initiatives have been taken for maternal and neo-natal health, particularly in states of Bihar, Madhya Pradesh, Odisha and Rajasthan. Early diagnosis and treatment of Neurodevelopment Disorder will reduce the cost on lengthy and expensive care, he said.

The three-day workshop aimed to sensitize the primary health care providers and health professionals dealing with children affected with neurodevelopment disorders. It intended to increase awareness on early identification and expose participants to available tools validated in Indian context for early diagnosis and management. The workshop also aimed to improve the quality of the life of children having neurodevelopmental disorders through convergent action. About 250-300 participants took part in the workshop. These included paediatricians working in the area of child development, RBSK nodal officers from various states and UTs, partner organizations such as WHO, UNICEF, NIPI, IAP, ICMR.

Neurodevelopmental disorder / difficulty is a collective term used for both developmental delays and developmental disabilities. Development delay is the condition in which a child is not achieving skills according to the expected time frame. Developmental Disability refers to a condition where a child becomes mentally or physically impaired and finally resulting in substantial functional limitations in major life activities. Developmental delays are common in early childhood, affecting at least 10 percent of children. However 2% of these children may ultimately suffer from developmental disability despite best of efforts.

Neurodevelopmental disorders include intellectual disabilities, autism spectrum disorder, Attention Deficit Hyperactivity Disorder, Specific Learning Disorder and Communication Disorders. Motor disorders include cerebral palsy and other neuromuscular conditions. Other special sensory disorders include vision and hearing impairment.
***** 
 MV
(Release ID :112450)
http://pib.nic.in/newsite/erelease.aspx?relid=112450

Some Observations:
1. The Ministry of Health and Family Welfare uses the terminology 'intellectual disability' which appears to be an *import* as it does not figure in the existing Persons with Disabilities ACT 1995. 

2. It is a shame that we are importing such terminologies from some countries which have not signed or ratified the UN Convention Rights of Persons with disabilities.

3. The sensitive needs of children with serious mental illnesses have been ignored. Shouldn’t teachers be trained, clinicians sensitized and parents be educated to spot the warning signs of depression, for early intervention before a crisis erupts. Children with serious mental illnesses have a right to treatments, supportive care in order to pursue their education as much as children with other disabilities and be valuable assets.

4. That children with serious mental illness are not even mentioned is to pretend that they do not exist which is cruel. Not to include these children in the announced ‘Rashtriya Bal Swasthya Karyakram’ is reprehensible.

5. People with mental illness are very *special* to their families. That does not mean that they be over looked. The health care of those with Mental illness, the seventh disability in the Persons with Disabilities Act 1995 is as it is grossly neglected.

The genesis of blaming families impacted by mental illness in India

...through a tome which lay in the website of the Ministry of Health and Family Welfare, Government of India for several years . One could access this tome when one clicked on a link titled 'National Mental Health Programme'

The cover of the tome bore the title,‘Mental Health An Indian Perspective 1946-2003 ‘ by Directorate General of Health Services Ministry of Health and Family Welfare New Delhi.

This tome has a Chapter I ‘Mental Health 2003: The Indian Scene’

Beginning rather theatrically with a quote from A Tale of Two Cities by Charles Dickens ‘It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the seasons of light, it was the seasons of darkness, it was the spring of hope, it was the winter of despair,...’

This quote was followed by the writ,'It all began with a fire…’

Referring to the fire that broke out at a private centre, in a place called Erawady where several people with mental illness who were chained, were charred to death. The writers use the word ‘asylum' for a private centre as if the Indian Lunacy ACT 1912 was still in existence at the time of the fire when it was not.

One of the reasons stated by the writers for impacted families leaving their family members in the private centre at Erawady was that ‘stigma and superstitions associated with mental disorders coupled with unwillingness or inability of families to care for their mentally ill relatives appear to be the main contributory factors.’

What was left out (as if the writers were unaware) was that ‘Public mental health education’ was not taking place when it was one of the Plans of action in the National Mental Health Programme. 

For many in India, reading this chapter whilst giving supportive care to their loved ones with mental illness trying their best to keep despair out of their lives its ...a Chapter I ...of incredulous excuses. 


Reference:‘Mental Health An Indian Perspective 1946-2003'  by Directorate General of Health Services. Ministry of Health and Family Welfare New Delhi.



 

There are 65 million Indians with serious mental illnesses

...like Schizophrenia, Bipolar disorder, Major depression…’ states The National Commission on Macroeconomics and Health, Ministry of Health & Family Welfare, Government of India, New Delhi in August 2005.

This sub set population needs ongoing medical attention, treatment, care and rehabilitation otherwise it would grievously impact them... violating their Rights to Health, Life, Equality and Dignity, Rights which are guaranteed under the Constitution of India.

Those who use the term 'service user' for patients with mental illness in India

...as if everyone with mental illness in India are consumers of the Government Electricity Department.

As if *state-of-the-art services* are being provided to all the people with mental illness in India.

The academics, others... who use such terminologies for patients with mental illness in India ...where have these people wandered from ?

So much of ennui.

Really…

That one has to copy terminologies from across the seas like 'service-users'

An isolation technique to take advantage of those really vulnerable with serious mental illness.

Keep them in a state of conflict…suspended animation…hostility.

Wonder if these academics, others... did any study on the banded kraits in Asia in their habitat .

Since they are pretty quiet on employment done piecemeal for persons with mental illness in the Rights of Persons Disabilities Bill 2014 tabled in parliament in India

Also very, very silent on the high risks of violence in people with untreated serious mental illness, mental illness with substance abuse...

No warmth. No caring. These academics, others...who are so poikilothermal ...the *poikilothermic homo sapiens* of the 21st century.

How to make parents/family members docile and subservient in India

...flood them with homilies and top it with the *The Advanced Directive*? As if dealing with a serious mental illness on a daily basis is not enough.

The Advance Directive and Nominated Representatives were last seen in the Mental Health Care Bill with the Standing Committee, in the Parliament of India .....

Some responses to the above:

1. Not seen any valid, empirical or double-blind study in India in the efficacy of turning parents/family members into *nominated representatives* for those with serious mental illness.

2. After the whining noise transformed into reams of print, newspapers, studies,...>about the less than 2000 patients left behind by families in the 40 Government State Hospitals in India comes *The Advance Directive* in a Bill, as an innovation hailed and shouted by its supporters. Whether knowledge of dealing with mental illness on a daily basis was imparted to the impacted families of the less than 2000 patients is conveniently not spoken of. Not to mention that *the Advance Directive* is not an *original*. It is a copycat...

3. Confining parents/family members of loved ones with mental illness into a state of docility. As if the Government of India is like ancient Sparta giving nurturing care to all its citizens with serious mental illness.

4.*The Advance Directive* = a bestowal of a contract to celebrate legal capacity? Giving away one's right to life while still living?

5.The *Advance Directive* is a legal lasso for traditional knowledge transfer.

6. What is the *how that they will be treated* in the much pushed Advance Directive. http://bit.ly/1tz0oUG

7. *Tell me please, pretty please, before my father or mother are turned into *nominated representatives ...* http://bit.ly/1ue1dFd in India
 
8.Those pushing for *the Advance Directive* for mental illness, not pushing one for *fever* ? with and without delirium?

9.Those pushing for * the Advance Directive*, for mental illness, not pushing one for *diarrhoea*? 

10. Government of India is like >giving nurturing care to all its citizens with serious mentalillness (thinking about it brings tears to my eyes) could actually come up with *the Advance Directive* ?

11. Government of India is like >giving nurturing care to all its citizens with serious mentalillness (sobbing at the very thought) could come up with *the Advance Directive* with sim cards?

12. Seen awareness creation of mentalillness through different forms of media by Government of India on Mental Health Day? like HIV/AIDS, Cancer

13. Knowledge transmissions through creating awareness campaigns for mentalillness by the Government of India being left out http://bit.ly/1tz0oUG 

14. Any *Wake Up Directive*? Only Advance Directive?

15. No *Advance Directive* for stroke? All minds in India are in the stomach.  All minds in India are still in a vacuum?

What is the *how* that *they* will be treated in the Advance Directive

... for mental illness, is a legal *lasso* for *knowledge transfer*...right to life?

1.This *knowledge* of *how* is very well known to some *they* a small sub-set of population in India who have been treated/admitted > the *40* Mental Hospitals, Government hospitals, autonomous, mostly private mental health centres offering psychiatric treatments. This small sub-set who have the *knowledge* is a miniscule number of 65 million Indians with serious mental illness.

2. *Knowledge transmission* by the Government of India through intensive awareness campaigns on >*how* *they* will be treated for mental illness to the rest of the population in India> through *awareness campaigns mental illness* in cinema halls, multiplexes, markets, malls, schools, colleges, universities, in its colonies, near water wells and water taps where women congregate, routes in different terrains where women collect firewood, in buses, in trains, on highways, at toll centres where tax is collected,…is ominously missing.

3. *Knowledge transmission* by the Government of India on>*how* *they* will be treated for mental illness to the large set of the population through *awareness campaigns for mental illness* in television, radio, FM .…is not happening.
 
4. *Knowledge transmission* through intensive awareness campaigns Mental illness despite repeated appeals to the Ministry of Health of the Government of India over the years is not happening. 

5. There is munificence in *knowledge transmission* by the Government of India, to the population of India for Cancer, HIV/AIDS, reproductive organs, lungs… 

6. So what is the *how* unknown to most of the people in India 

7. So an *advance directive* mooted, trumpeted, propagated and being compared to a *living will* by some learned people (what moral values they learnt in their process of learning is questionable) for *how* to be treated, when most people in India do not know that treatments exist for mental illness…

8. In a will you *know* what you are bequeathing and to whom. A will comes into force after one’s death. 

9. In an Advance Directive, you are bequeathing your *knowledge* , your *traditional knowledge* , to the entities ... some yet to descend on us, rescue us, with their smooth talk, smiles, words, perfect looks, glamour… and glycerin induced tears. 

10. Advantageous to whom? And to protect …whom? (Yippee… let’s dance…mental illness is exercising legal capacity...contract...right to life...legal lasso)

11. Who would be the *entities*> gaining, making money from the *traditional knowledge transfers* through the Advance Directives? 

12.Which pool of knowledge would this traditional knowledge be going to?

13. SO far no *shared benefits* to those who bequeath *the Advance Directive*, the people of India with mental illness, on the road to becoming mentally ill, attempting suicides… 

14. If an advance directive comes into force after giving it to the >...entities does the Advance Directive translate into giving away one’s Right to Life when one is still alive?


Response to: Tell me please, pretty please before my *father* or *mother* are turned into *nominated representatives* what is the *how* in the Advance Directive.

http://amotherandcaregiverinindia.blogspot.in/2014/11/tell-me-pretty-please.html

"Tell me please, pretty please

...before my father or mother are turned into *nominated representatives*,
 
what is the *how* in the Advance Directive?"

A response to-


'...make advance directives on how they will be treated during mental illness.' - from a media report link of which is  given below

http://blogs.economictimes.indiatimes.com/et-commentary/winter-session-of-parliament-a-chance-to-pass-all-pending-bills/