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.
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 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.