Marginalization of the mentally ill
Dr. Pradip Kumar Sarma
(The writer is a Consultant Psychiatrist, Tezpur, Sonitpur, He may be contacted at : 9435081237 (M))
Mental health problems have been recognised as major public health issues worldwide. These disorders contribute significantly to the disability, morbidity and mortality of the sufferers. The impact of the illness is many folds and hence contributes significantly to the burden of diseases. The National Mental Health Survey (NMHS), India, 2015-16 pointed that nearly 15 % of adults are in need of active interventions for one or more mental health issues; common mental disorders, severe mental disorders and substance use problems. A large percentage of people with mental illness remain untreated for life. Even in those who get treatment, there is a huge gap between the treatment required and the treatment received. As per NMHS, this gap is 82.58%. Factors related to this gap, as stated in the survey, are limited awareness about mental disorder and low perceived need for treatment, socio-cultural beliefs about mental disorders leading to help seeking from local quacks or faith healers, stigma, inaccessibility to health service, insufficient and inequitable distribution of mental health professionals and lack of knowledge, training and reluctance of primary health care professional to treat mental health problems. Stigma is the foremost reasons why people do not seek or receive mental health care. Stigma contributes to marginalization of mentally ill.
The behaviour shown by mentally ill is often viewed as irrational, dangerous and unpredictable in nature. In untreated mentally ill, deviation is seen in personal hygiene, social skill and communication, and employment status. The homeless mentally ill portraits a dismal picture of mental illness. There is a misconception that mental illness is not a true illness and hence, the individuals or their families are held responsible for their illness. This misconception results in stigmatization of individuals with mental illness and their families.
World Health Organization defined stigma as a mark of shame, disgrace, or disapproval which results in an individual being shunned or rejected by others. Stigma includes negative attitude and stereotypes directed at persons with mental illness as well as their families.
Stigma is a complex social phenomenon which is modified by the culture and context in which it occurs. It is a social force that can have powerful consequences for stigmatised people and for the society. Stigma interferes with the willingness of people to seek help which results in treatment delay; subsequently, leading to a more severe manifestation of the illness which again results in more stigmatization. Stigma puts barrier to mentally ill person’s full integration into the community. As such, stigma can reduce life opportunity, limit social networking, reduce self esteem, and overall reduces quality of life. Additionally, stigma adversely affects academic performance of children and adolescents. According to World Health Organization, children and adolescents are particularly vulnerable to stigma. As a whole, the society is adversely affected and burdened by stigma.
Fight against stigma needs a coordinated proactive approach. Person with mental illness needs to be understood, treated and make them fully functional so that they can lead a productive life. The understanding of mental illness means understanding of the symptoms of mental illness and how they affect behaviour of the individuals with the illness. It also requires understanding the need for treatment and the role of psychological and environmental factors in precipitating relapse. Two important developments that contributed to fighting stigma and hence fighting marginalization of mentally ill are availability of treatment of mental illness at general hospital and shifting of care and support of mentally ill from mental hospital to home. The District Mental Health Programme (DMHP) is another step forward. The objectives of DMHP are (a) to provide sustainable basic mental health services to the community and to integrate these services with other health services. (b) Early detection and treatment of patients within the community. (c) To reduce the stigma attached towards mental illness through change of attitude and public education. (d) To treat and rehabilitate mental patients discharged from the mental hospital within the community and (e) to shift focus and take off burden from Mental Hospitals. Unfortunately, all districts are still not covered and all objectives are yet to be worked on. Mental illness has been recognised as one of the disabilities under the Right of Persons with Disabilities Act, 2016. The opportunity should be given to the beneficiaries in letter and spirit.
Other common approaches of anti-stigma campaigns are protest, education and contact. The media are key influencers of public opinion. Media can build public opinion against stigma. Unfortunately, at the same time, media can reinforce stigma by portraying mental illness based on misunderstanding and discrimination. Protest is an active way to reduce offensive and demeaning representation of mental illness in the media. Hence, proactive approach against stigmatizing representation of mental illness in mass media is advocated. Violation of rights of mentally ill persons is a common reality. Advocating for the rights by village leaders, teachers, NGO people can boost them morally. Respecting the rights of person with mental health problem will reduce stigmatizing and discriminatory behaviour in the community.
Education can influence people’s perception about mental illness, and at the same time, can alter perception of stigmatised people about themselves. Education may be imparted through various media. Exhibition cum sell of articles made by mentally ill patients can be a way of sensitising people that are mentally ill, if given opportunity in a suitable way; can be engaged in productive activities. Contact prevents exclusion. Communications with mentally ill gives people an opportunity to have firsthand knowledge about the illness and to dispel misgivings. Contact gives mentally ill a sense of belongingness.
It can be said that this pervasive social force called stigma is embedded in our mind. Uprooting stigma needs a systematic coordinated approach. All sections, professional or non-professional, need to be involved. The National Mental Health Policy, 2014 lays stress upon measures for removal of stigma. It clearly states that persons with mental health problems face stigma and discrimination in many ways. Governments, opinion builders, media and community leaders should encourage discussions for better understanding of the nature of mental health problems. There is a need for compassion and responsibility in our interaction with persons affected by mental health problems instead of stigmatizing them.