The right to mental health

A new report shows how rising mental ill health is causing mounting disabilities, early deaths and fuelling cycles of poverty.

The term “mental health” has become a euphemism for “mental illness”. This is in stark contrast to what it should be, for mental health is the most valued asset we have, the most treasured aspect of our humanity. This is precisely why, when people are asked to compare different health conditions, mental health problems are ranked as the ones they fear the most. This is not surprising, for we rely on the diverse capabilities our mental health underpins to successfully learn and master the skills that make our lives meaningful and worthwhile. So, one would expect that mental health would be the most prioritised of all issues facing the world. Sadly, that is quite far from reality.

Today, the medical journal, Lancet, publishes a report by its Commission on Global Mental Health. The report was launched on Tuesday at the first ministerial on global mental health, hosted by the UK government in London. It not only documents that mental ill health is on the rise worldwide, but that this increase is causing massive amount of disability, early deaths and fuelling cycles of poverty. Most people with mental health problems do not receive care, which prolongs suffering and leads to colossal societal and economic losses. Even worse, they are often subjected to human rights abuses and discrimination. Perhaps no other cause of suffering has been so profoundly neglected.

The situation in India is on par with amongst the worst country-level mental health indicators in the world. In India, suicide is now the leading cause of death of young people, alcohol use is blatantly promoted by commercial interests and its abuse has been relegated to a moral issue to be addressed by primitive, punitive policies rather than through a public health approach, tens of thousands of people with severe mental health problems languish in horrific conditions in mental hospitals or on the streets and appalling deprivations — from under-nutrition to neglect — that affect the development of the brain in childhood remain unchecked. There are virtually no community-based mental health services in the country.

The Sustainable Development Goals (SDGs) represent an exponential advance from the Millennium Development Goals, with a substantially broader agenda that affects all nations and requires co-ordinated global actions. The specific references to mental health and substance use as targets within the health goal reflects this transformative vision.

To help achieve these targets and, indeed, the SDGs themselves, the Commission outlines a comprehensive blueprint for action. It has three unique guiding principles. One, our approach to mental health must cover its full spectrum, from day-to-day wellness to long-term, disabling conditions. We know how to promote mental health, prevent mental disorders and enable recovery. It’s time to use this knowledge to benefit entire populations. Two, mental health is the product of psychosocial, environmental, biological and genetic factors interacting with neurodevelopmental processes, especially in the first two decades of our lives. Because our experiences in childhood and adolescence shape our mental health for life, it is crucial that these years unfold in nurturing environments, which promote mental health and prevent mental disorders. Three, mental health should be respected as a fundamental right by putting people living with mental health problems at the centre of planning services. Everyone is entitled to dignity, autonomy, care in the community and freedom from discrimination.

Achieving these aspirations will require several actions. First, mental health services must be scaled up as an essential component of universal health coverage. Second, barriers and threats to mental health, such as the pervasive impact of stigma, must be assertively addressed. Third, mental health must be protected by public policies and developmental efforts led by the country’s top leadership. This endeavour should involve a wide range of stakeholders within and beyond health. Fourth, new opportunities must be enthusiastically embraced, in particular those offered by the innovative use of community health workers and digital technologies to deliver a range of mental health interventions. Fifth, substantial additional investments must be urgently made as the economic and health case for increased investments in mental health is strong. There is also an immediate opportunity for more efficient use of existing resources, for example, through the redistribution of budgets from large hospitals to district hospitals and community-based local services. Finally, investments in research and innovation must harness diverse disciplines to advance understanding of the causes of mental disorders and develop more effective interventions to prevent and treat them.

Mental health is a global public good. Our reframing of mental health is aligned with the central principle to “leave no one behind” and to the contemporary notions of human capabilities and capital. We believe both in the inherent right of every person to mental health, and that mental health is a means of facilitating sustainable socio-economic development, more complete health, and a more equitable world.

Urgent action to fully implement our recommendations will not only hasten the attainment of the health SDG, but indeed many of the other SDGs as well. While diverse legislation and programmes, from the Rashtriya Bal Swasthya Karyakram to the Mental Health Care Act, provide a robust policy foundation for realising these aspirations in India, we need to ensure that these are implemented. For this, we will need a genuine partnership of a diverse range of groups — from the mental health and development communities to policy makers and civil society — coming together to transform mental health across the country.

Source: Indian Express, 10/10/2018

The Rohingya Reversal

By allowing refugee deportation, judiciary has stepped back from its own principles

At the annual session of the executive committee of the UNHCR held in Geneva, India stated, “We are a responsible state with a functional democracy and rule of law.” On the same day, October 3, seven Rohingya men were being taken to the Indo-Myanmar border for a scheduled deportation. Ironically, they had no access to legal counsel, courts or the UNHCR, which is mandated by the government to conduct refugee status determination of Myanmar nationals.

The men had entered Assam in 2012 without documentation and were prosecuted for illegal entry under the Foreigners Act. At that time, the Rohingya were already fleeing Myanmar. After completing their three month-sentence, the men were moved to “administrative detention” in Silchar where they languished. State officials claim that in 2016 the men expressed the desire to return to their families. In mid-September, the local media reported that pursuant to negotiations with Myanmar, India would be deporting the men on October 4. The decision to deport was surprising given that a case challenging the government’s move to carry out en masse deportation of Rohingya refugees is still pending before the Supreme Court.

As the last resort, an intervention application was filed before the SC on September 29 seeking a stay order. Despite the stated urgency, the SC listed the matter for a hearing only on October 4. The government argued that the detainees had consented to return and that the Myanmar Embassy had confirmed that the men were “citizens”. When counsel for the petitioners pointed out that the detainees were “refugees” as they were at the risk of persecution, the matter was dismissed by the Bench noting that they were “illegal immigrants”.

In NHRC v. State of Arunachal, the Court extended protection under Article 14 and 21 to refugees. Further, various high courts have upheld the customary international law principle of non-refoulement in deportation cases and have referred the detainees to UNHCR. In view of these principles, the deportation of Rohingya refugees is in contravention of India’s obligations both under the Constitution and international law.

With regard to the argument that the men were “illegal immigrants”, it should be noted that, given the circumstances that cause them to flee, refugees often cross borders without prior planning or valid documentation. If anything, this should reinforce their status as “refugees”. In the present case, given the overwhelming evidence to show that the Rohingya deported to Myanmar are at risk of being tortured, indefinitely detained and even killed, the deportation potentially violates Article 21, and India’s international obligations.

The argument that the men are “citizens” and therefore not in need of protection is without legal basis. Refugees frequently, though not always, are citizens of the state they are fleeing from. What is also troubling is that the affidavit submitted in court by the government states that the men have been accepted as “citizens” by Myanmar. The root of the plight of the Rohingya is the denial of citizenship. In Myanmar, they are being issued the controversial National Verification Card which does not recognise their religion or ethnicity — and definitely does not confer citizenship.

In the absence of a domestic law for refugee protection, it has been up to the judiciary to extend minimum constitutional protection to refugees. By allowing this deportation, the SC has set a new precedent that is contrary to India’s core constitutional tenets. However, it is important to not overstate the implications of this order, which ultimately was based on the notion that the men had consented to return. In cases where there is no consent, this cannot apply as a precedent.

Source: Indian Express, 10/10/2018

Time for Goal-Setting

Many feel life is passing by too quickly. We move from one season to the next and wonder where time went. Days, months and years fly by at tremendous speed and we can’t seem to get anything we want done. At some point in our lives, we start to wonder if we are accomplishing all that we set out to achieve. We feel like we waste much of the precious gift of our life’s breaths and our time in useless pursuits. There is a saying to remind us about the importance of every breath, “Think about each moment. For what are we trading it away?” Do we want to trade it away for thoughts of anger or greed? Do we want to trade it away to brood over the past or worry about the future? Or do we wish to spend the moment in doing something to discover who we really are and to find out why we are here? It would be valuable to engage in goal-setting by deciding what is important in life. If we wish to develop our body, our mind, or our soul, we need to allot time to it. If we wish to uncover the luminosity and riches of our soul, spending some time daily in meditation can help us reach that goal. The more time we can put in for this quest, the better. By sitting like this for some time each day, we would find that we would be using our time for lasting spiritual gains. The byproduct of this is that it also has an effect on improving our physical, mental and emotional health and wellness.

Source: Economic Times, 10/10/2018

Highest spike in road deaths in Jamshedpur

B’luru Saw Biggest Dip In Fatalities In 2017

The steel city of Jamshedpur recorded the highest spike in road deaths among the 50 million-plus cities while Bangalore saw the biggest dip in fatalities in 2017 as compared to the previous year, according to the latest report of road accidents in India. Delhi retained the top rank while Chennai and Jaipur registered second and third maximum number of road deaths last year. Data show that most cities of Maharashtra, including Nashik, Nagpur, Mumbai and Pune, recorded lesser number of road deaths. Same was the case with Gujarat where Ahmedabad, Vadodara and Surat registered fewer fatalities. The two cities of Punjab, which are known for people owning expensive cars — Amritsar and Ludhiana -—also saw a decline in road deaths. However, cities like Dhanbad, Varanasi, Faridabad, Kannur and Srinagar recorded significantly higher number of accidents and fatalities in 2017 over 2016. According to the report based on data provided by state police departments, there were 2,872 fewer deaths in 2017 as compared to the previous year and around half of the people killed in road accidents, which was about 73,800, were in the age group of 18-35 years. Fifteen states, including UP, Tamil Nadu, Maharashtra, MP, Karnataka, Rajasthan, Andhra and Gujarat, accounted for 90% of total road fatalities. The composition of 15 states largely remain same with that of 2016 except for Kerala, which moved out with Chhatisgarh entering the club last year. An analysis of the report shows two-wheeler occupants were not just the most impacted road users in accidents, this category of vehicle also caused the maximum number of crashes last year. The accidents caused by two-wheelers claimed 44,092 lives in 2017 and left almost 55,500 seriously injured. As per the annual accident report, a maximum 48,746 two-wheeler occupants died in crashes and that was highest among all categories of road users. The number of car occupants killed was around 26,900. About 17,200 truck and lorry occupants were killed in accidents, the report said. Road safety experts said the actual number of deaths could be more and the present system of data collection in form of FIRs needs to be changed. “The source of data must change from the police to the health system to accurately capture the number of deaths,” said Piyush Tiwari of Save Life Foundation. Rohit Baluja of Institute of Road Traffic and Education said the situation won’t improve until the government puts in place a robust system for scientific investigation of accidents.

Source: Times of India, 10/10/2018

The diaspora and disasters

As the Kerala floods have shown, the diaspora can shape political and economic responses 

Between August 8 and 20, the devastating floods in Kerala claimed nearly 500 lives, displaced over a million people, and directly affected over a sixth of the State’s total population. The State government’s latest report estimates the losses to be more than the State’s annual plan. In the fiscal 2017-18, Kerala’s annual plan outlay was pegged at Rs. 26,500 crore. Moreover, according to the just concluded Kerala Migration Survey (KMS) 2018 — conducted by the Centre for Development Studies in Kerala — while remittances received in Kerala accounted for approximately Rs. 85,000 crore, much was used for housing and improving human development.

This was the worst flood in Kerala since 1924. In the deluge then, the State received 650 mm of rain compared to 2,344 mm this time. However, the impact was similar.

The difficult task of rebuilding the State has begun and contributions to the Chief Minister’s Distress Relief Fund (CMDRF) have crossed more than Rs. 1,680 crore. The Chief Minister is confident that the State would be able to overcome the shortage of funds by mobilising its own resources and through support from different quarters. For Kerala, the most important support system is the Malayali diaspora across the world.

Migrant data

According to the KMS 2018, there are over 2.1 million Malayali emigrants globally and 1.3 million return migrants. The Department of Non-Resident Keralite Affairs, headed by the Chief Minister of Kerala, looks after the welfare of the 3.4 million migrants globally, in addition to the nearly 2 million internal migrants within India. These are Keralites who have direct connections to their households — fathers, mothers, spouses, and, in some cases, elderly children. Of course, there are also Malayalis who have moved from Kerala permanently with their family and live within the country or abroad (non-residents from Kerala). They number around 2-3 million (over the last 60 years since the formation of the State in 1956).

The advantage Kerala has at this point is to engage with its migrants and diaspora who have been instrumental in rebuilding the destination economies after natural calamities and economic crises. The standing of the Malayali diaspora is evident from the extraordinary support Kerala has received from other sovereign states with large diaspora populations such as in West Asia, multinational corporations employing Malayalis, and by the diaspora itself. With the depreciation of the Indian rupee, the State can relaunch foreign currency deposit schemes such as the hugely successful India Millennium Deposit Scheme which was introduced in 2000 by the Centre to leverage higher values of foreign currencies so as to overcome financial and economic crises.

Pivotal role

Unfortunately, ‘not much attention has been paid to the role of diaspora groups in post-disaster situations. Yet, in a globalised world, the international dimensions of disaster response and recovery, and the significant policy role played by the diaspora can be critical’. For example, after the earthquake in 2010 in Haiti, ‘the Haitian diaspora in the U.S. served as a conduit for doctors, nurses, engineers, educators, advisers and reconstruction planners. Haitian-Americans continue to be vital in long-term recovery — as supplies, remittances, sharing human and financial resources, lobbying governments, international organisations and corporations for disaster relief and redevelopment funding, and in facilitating eased travel restrictions’.

In Nepal, after the 2015 earthquake, the Non-Resident Nepali Association collected $2.69 million, mobilised over 300 volunteers including doctors and nurses, and pledged to rebuild 1,000 disaster resilient houses. In the tsunami in South Asia (2004) and the Pakistan earthquake (2005), diaspora and migrant remittances flowed generously, demonstrating the counter cyclical nature of remittances.

In Kerala, the migrant community and diaspora moved swiftly to organise an Internet-driven response. By sharing and re-sharing vital information on affected regions and people, supplies, and precautionary measures (on social media platforms), they were instrumental in expanding the flow of information that would later be used by politicians, private and military rescue operations, and relief workers.

Successful diaspora groups are among the largest contributors to the CMDRF. They will be invaluable in mobilising resources, talent, and knowledge which will be integral in rebuilding the State. For example, a Kerala Health Department report has made it clear that there will be a 100% increase in the demand for pharmaceutical drugs. These can be sourced quickest through transnational diaspora networks. As the diaspora is one of the greatest assets of Kerala, communities should improve relations with diaspora groups. Return migrants should also act as liaison agents.

Diaspora communities will also inevitably shape political and economic responses to a disaster. The linking of social capital between diaspora, civil society organisations, advocacy groups and government institutions, although necessary during rehabilitation, is bound to lead to unanticipated and undesirable outcomes. At least temporarily, the State may witness higher rates of emigration among the common people as they try to mitigate losses caused by the floods. For example, the KMS shows that migrants use over 40% of their remittances in purchasing land, construction and repayment of mortgage debt. Finally, we need to investigate the relationship between rehabilitation and migration further.

More questions

Kerala has close to 3 million migrants from other States to replace Keralites who left to West Asia (also known as replacement migration). Have they been affected by the floods? Are they likely to participate in the reconstruction of the economy of Kerala or leave for their home States for better opportunities? The preliminary results of the KMS indicate a decline in emigration. Finally, we should ask ourselves what the future of emigration, return emigration, internal migration and remittances from Kerala will be in the coming years.

S. Irudaya Rajan is Professor, Centre for Development Studies, Thiruvananthapuram, Kerala

Source: the Hindu, 9/10/2018

Fight the good fight

Some moments in the life of a patriarchy provide points of confrontation — and also openings for change

Ever since ugly stories about sexual abuse at the workplace began crawling out of the woodwork, from corporate offices, army, even the judiciary, one knew something major was stirring in the belly of the earth. First women abused by bosses, by boyfriends, politicians, their husbands’ superior officers, and by highly-respected members of the judiciary began to reveal brokenly what Susan Faludi calls “a problem with no name”. Within a few decades, they have broken their isolation, begun sharing their experiences on multiple fora and discovered a whole new terminology to articulate their anger in public. The latest result of this is the #MeToo movement that began in the US and went viral.

The testimonies that have surfaced since this hashtag was created are making it clearer by the day that when applied to women, the term sexual is not an adjective defining the personal pleasure of predatory powerful males. It is, simultaneously, also their power-locomotive that carries forward a far broader agenda, subtly defining social, legal and official hierarchies in which women in homes, offices, streets, railway coaches, hotel rooms and flight cabins must submit to the will of the man. Even if they do not wish to give their consent, as one “Baba ji” said (in the case of the young woman at the centre of the December 16 2012 rape case), the woman must address the rapist as her brother and appeal to his sense of mercy!

The finance minister’s outburst against the recent Supreme Court rulings that decriminalised same sex relationships and adultery among consenting adults as also permitted young (possibly menstruating)women into the Sabarimala temple is further proof that any challenge to entrenched male-crafted archaic laws or religious taboos will be interpreted by the power lobby as a challenge to the System itself.

Feminism is perhaps the first theory to emerge from the personal experiences of those whose interests it defines, and whose equality it simultaneously affirms. In 1995, 17 of us senior women journalists decided to plant the seed for what is now a flourishing club for women journalists. In creating the Indian Women’s Press Corps, the idea was to form a collective in the heart of our capital city, for working women journalists, most of whom worked part time or as free lancers then. For, as the poet Adrienne Rich has articulated so well “. those despised and endangered … are not merely the sum of damages done to them”. Reading the testimonies of victimised women three decades later, one realises that the first large batch of female journalists entering the profession in the ‘70s, too, had experienced similar interactions in offices. At that time, like the first wave of all immigrants upon foreign shores, those nasty “happenings” were mostly shrugged off as insignificant or, at best, shared in hushed tones among ourselves. The concept of sexual abuse grievance cells was not even a gleam in the eyes of the System at that point.

This is why the second and third generation of those immigrant females, stronger and supported by many pro-women changes in Indian law and life, are now systematically and clearly laying bare the dark underbelly of Indian workplaces. They are talking about how many times a male colleague or a celebrity interviewee had, by a certain “look” or hug or suddenly or by “accidentally” feeling her body parts, left a female journalist feeling deeply violated, depressed, and degraded. What sort of power does it give a man when he will, with a passing glance, a lingering feel or deliberate brush, send a message of sexual dominance and hierarchies of deference where he is in command? As for women working in smaller towns in the language media, their voices and experiences are yet to surface. But the recent suicide of a senior editor has sent up a swarm of dark tales about the murky lives of young and ambitious women journalists in the language media where most women must confirm their self worth by trying to measure up to the “expectations” of their editors and company owners/managers, which may go well beyond the purely professional.

It is clear by now that gender is not just sex, it is genderised sex that divides power disproportionately between men and women. It is therefore a political system that keeps women subjected to physical insecurity, sexual denigration and deprived of respect, credibility and resources compared to their male counterparts everywhere. Courts do intervene now and then, but only in properly “factualised” cases. Even there, in women’s experience, the law will legitimise itself as reflecting its view of societal norms, but it is society itself that has conferred rationality upon laws. Hence the puzzling dissent note from the lone female judge from the panel that permitted women to enter the Ayyappa temple, on grounds that religion is above rational rules. So lawyers like Arun Jaitley are quick to support her by implying that since law is society in its state form, it must support society’s age-old understanding and application of gender hierarchies and marriage by rising above the rational viewpoint.

Such moments in the life of a patriarchy provide points of confrontation, and also openings for change. Like Arjun in the Mahabharata, Indian women, convinced as a group of the justness of their cause, are determined not to plead guilty or flee (na dainyam na cha palayanam). But still they find themselves gripped with a sudden hesitation. Even if a cause be just, must they raise their weapons against their own?

Interesting, that at this point in one of the earliest recorded game of thrones, Krishna (in Gita) will invoke not Arjun’s patrilinear lineage (or his lily livered father Pandu), but the warrior’s strong-willed mother Kunti. Addressing him not as Pandava but Kaunteya, he says: “Hato va prapsyasi svargam, jitva va bhokshyase mahim,/Tato uttishth Kaunteya, yuddhay krit nishchayah!” In this battle, if you die, you become a heavenly warrior. And if you win, you will enjoy what is true temporal power. So O son of Kunti, be ready to fight a good fight.

Equality, in short, requires total change, a new jurisprudence, a new relation between our lives and law. It will be said that such a change will not be sustainable. But this is premature. As Gandhi, one of India’s biggest dissenters, said, “I have found that it is our first duty to render voluntary obedience to the law, but whilst doing that duty, I have also seen that when law fosters untruth it becomes a duty to disobey it.”

Source: Indian Express, 9/10/2018

Defining Dignity

The concept is being invoked by Supreme Court, but not in a uniform manner

With decisions on Aadhaar, IPC 377, and the right to privacy, the Supreme Court (SC) has reaffirmed the centrality of human dignity to the Constitution. The concept was invoked 120 times in the privacy decision, and 128 times in Navtej Johar. Despite the enthusiasm of the courts, there is growing scepticism about the application of dignity.

The SC’s application of dignity perhaps reflects the commitment in the Universal Declaration of Human Rights. The value of dignity, however, is contestable. The concept has been characterised as “culture-relative”, a “smokescreen” for the subjective preferences of judges, and famously by Schopenhauer, as “the shibboleth of all empty-headed moralists”. Dignity sceptics particularly highlight two grounds that deserve attention: The liberty restricting potential of dignity, and its indeterminacy.

The liberty-restraining potential is famously illustrated by the “dwarf throwing case”. In 1991, the Mayor of Morsang-sur-Orge in France banned a dwarf-tossing competition in the interest of law and order. Manuel Wackenheim, one of the dwarves to be tossed, contested the mayor’s decision asserting that not being allowed to choose his employment violated his dignity. Cruelly, dignity went against him in all courts. In abortion cases in the US, dignity figured in both pro and anti-choice camps.

Restricting liberty for the sake of other values is undoubtedly justified. However, grounds for restricting it on a low bar undermines liberal-democratic values. Indeed, casual recourse to dignity frequently ends conversation on the demands to balance and flesh out competing constitutional values.

Judicial enthusiasm with dignity also overlooks the challenges posed by indeterminacy. In the last five years, the SC employed dignity as a value when upholding rights of transgender persons, as a norm while rejecting challenges to criminal defamation and as the core uniting all fundamental rights in the privacy decision. Though seemingly pedantic, such distinctions are material in constructing legal arguments. The current availability of each might stretch the concept too thin.

Indeterminacy clouds the status of dignity. In Francis Coraile Mullin, the Court held dignity to be a part of the right to life, which implied that the limitations on the right applied to dignity. However, in other decisions, including Puttaswamy (privacy), dignity was held to be absolute. Even in the privacy decision, the court makes mysterious claims: First it held that dignity is the core of all our rights, and later that privacy is the core of dignity. The court also states that dignity cannot exist without privacy. Though one can infer the intention of these statements, clarity demands a nuanced elucidation of the relationship between constitutional values. It is conceivable that issues such as manual scavenging or caste-based humiliation concern dignity, but not privacy. Indeed, protecting dignity requires sacrificing traditional privacy protections, as in women and child rights cases.

Overcoming dignity-scepticism requires as much attention to reasoning, as to emancipatory outcomes. How then should courts develop an emancipatory dignity jurisprudence? Perhaps a closer focus on the content of dignity and existing research on dignity in law and other disciplines is a first step. Collective reflection by members of the higher judiciary would go a long way in preventing potential contradictions such as the individualistic vs community concept of dignity that surfaced in the Aadhaar decision.

Second, sparing application of the concept to specific dignity arguments might lend more clarity. Third, courts might do well to shun the easy recourse to holism: The view that all our constitutional values are united. Rather, paying individual attention to instances and literature on each value might help us appreciate their connected nature.

Scepticism over the application of dignity reminds us that in the face of moral disagreement, cherished assumptions demand closer reflection to vindicate their value. The assumed value of human dignity needs careful elucidation, lest it become a Trojan horse in the judiciary’s armoury meant for protecting rights and enforcing duties.

Source: Indian Express, 9/10/2018