How a billion can help a fraction
Compassion has to be combined with the dogged pursuit of justice to treat issues related to mental health
Nearly six months ago in Mumbai, Radha died homeless. She never did think of herself as homeless though. “My family will be happy to see me,” she once said with pride, and added that she was from Borivali. “I’d like some hot tea and then I’ll doze off for a bit,” she continued in perfectly intonated English. But when asked for directions to her house, or details about her family, Radha wasn’t as lucid. She vaguely referred to a life in Dubai with obscure details. Her memories of the times with her parents, however, were filled with joy and longing. Her unrealistic and yet determined hopefulness of being reunited with her family, juxtaposed with flashes of doubt, symbolised the fragility of the human condition. Radha’s mind was sharp even as her body seemed ready to give up. She had clearly endured a lot of suffering: maggots crawled out of her ears, broken arm, and shrivelled body; yet she displayed indomitable optimism and grit. In what can only be described as a dismal state of affairs, the doctors in the hospital that she was taken to refused to touch or treat her until her body was “sanitised” even as the police responded swiftly to our distress call.
As John Rawls said, justice is best served when the most vulnerable in society are benefited, and when life trajectories are not shaped on the basis of a person’s place of birth, endowments, and related privileges or lack thereof. Radha was not supported by this sensibility of justice. Instead, she lay on the fringes of society, ignored, as her basic constitutional rights were violated and a life of dignity denied.
All it takes to be a Radha is a plausible twist in fate, or some unsurmountable distress, poor access to healthcare, social disadvantage, abject poverty, collapse in relationships and networks, a serious and untreated mental illness. All these can spiral a rapid descent into homelessness when family, friends, bystanders and even the state let go.
I am reminded of Rudyard Kipling who said: “For the strength of the pack is the wolf, and the strength of the wolf is the pack.” Indeed, if we do not build a cohesive, interdependent society, our development will be skewed, insular and selfish with disastrous consequences. Good education alone is not enough; compassion as a value must be imbibed early in life, and the youth must be taught to pursue justice doggedly.
Multiple vulnerabilities
Unfortunately, the Mental Health Care Bill and the National Mental Health Policy, both developed over two years ago, languish in Parliament and in a state of inertia. Both documents address issues around multiple vulnerabilities, and emphasise the mandatory rights of the homeless and poor to access mental health and social care, including disability benefits.
According to the 2011 Census, 1.78 million homeless people sleep rough, exposed frequently to scarcity and harm; typically a quarter of them are known to be affected with mental health issues. These statistics may be gross under-representations, but what cannot be contested is that such people suffer many losses: of identity, citizenship and personhood challenged, and access to health and socio-material networks compromised. Similar losses are sometimes endured by those who reside in State-run mental hospitals and who experience long-term mental health needs. Socially excluded and sometimes abandoned by their families, many of them have made a home of the hospital. Others who resist this life have been presented with limited options or access to supportive housing or independent living. Persons living with persistent mental health or neurodevelopmental issues and dependent on their caregivers again run the risk of experiencing similar losses, in the event of the sudden death of their parent, partner or friend. Unfortunately, losses suffered are not just ontological: the loss of kinship and a sense of affiliation are equally grievous. Thus models developed to address these problems should be cognisant of the nuances and diversity of such composite needs.
Regrettably, our response today is to disregard the existence of such problems or formulate quick-fix and linear solutions. While hospitals, rehabilitation homes and shelters may serve as desired destinations in some cases, others require robust and individualised responses. All this calls for strong political and societal will, and significant allocation of financial resources on the part of the state, and corporate social philanthropy budgets.
It did not seem like Radha had given up on life. She longed for human connection. Society, however, chose to give up on her — consciously. All of us have the ability and power to address these inequities in small measure. The process is undoubtedly complex and the balance between when, how, and how much is often delicate and personal, depending on individual resources, emotional strength, and propensity. The idea is not to judge this state of inaction or disengagement but to implore thought. We are a billion. And the acutely vulnerable, a fraction.
Vandana Gopikumar is co-founder, The Banyan and BALM, and Professor, School of Social Work, Tata Institute of Social Sciences, Mumbai.
