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Date	30 December 1899	Source	Times of India
Title	I want to break free: Amita Dhanda
LEADER ARTICLE: I Want To Break Free times of india: edit article: 5.01.2006 AMITA DHANDA The rights of persons with psychosocial disability are conspicuous by their absence. The institutional 'treatment' to which they are subject runs against Article 21 of the Constitution, which provides that no person shall be deprived of his right to life and liberty except according to procedure established by law. Over the decades, the Supreme Court has ruled that this deprivation cannot occur by way of any procedure incorporated in legislation but one which is just, fair and reasonable. The Mental Health Act, 1987, provides care and treatment of persons with psychosocial disability primarily through the compulsory deprivation of life and liberty. It leans overwhelmingly in favour of compulsory care. It lays down procedures by which a person who has voluntarily sought mental health treatment can be compulsorily detained; however, there is no reverse process where hospital authorities are obliged to seek consent for continuance from the institutionalised person. Those convinced of the benefits of compulsory care view health and healing as passive processes in which only the provider of treatment is seen to have a role. However, many survivors say that the continuous humiliation of compulsory care negates whatever benefits such treatment might have to offer. Those who cite cases of persons who lost their lives due to absence of compulsory treatment do not mention those who took their lives due to the indignity of such treatment. Even if one concedes that compulsory institutionalisation is required, it is necessary to examine whether institutions live up to their role. Government affidavits, fact-finding commissions and journalistic investigations suggest that institutional conditions are counter-therapeutic. The facilities are not adequate to meet the requirements of the estimated number of persons with psychosocial disability. There are 42 mental hospitals unevenly spread over different parts of the country — some regions have as many as seven institutions, while others have none. This shortfall caused the Supreme Court to rule that at least one mental hospital shall be established in every state. The directive was issued without considering whether mental health can be promoted in total institutions (Goffman's concept and term) far away from home. The kind of treatment meted out in institutions is another important issue. Electro-convulsive therapy is administered without anaesthesia in a number of such institutions. Even as a petition in the Supreme Court seeks a ban on this therapy, the Indian Psychiatric Society has tried to demonstrate how anaesthesia is contra-indicated for some persons with mental illness. It is argued that if electro-convulsive therapy is to be provided only with anesthesia, the cost will place it out of the reach of many. Except in war-like situations, doctors seek therapies other than surgery if anaesthesia is contra-indicated for a patient. This rule of routine medical practice is not available to persons with psychosocial disability. If electro-convulsive therapy is integral to the treatment of persons with psychosocial disability, then would not their right to life require that such treatment be made available without considerations of cost to the recipients? The issue has been played out as a scientific controversy in the apex court, with the recipient of such therapy having no say in the matter. There is also a controversy over the drugs administered at the psychiatric institutions. Earlier, a budget limit would determine what kind of drugs could be administered to persons with psychosocial disability. However, the Supreme Court in the Ranchi Hospital petitions lifted the budgetary constraint and ruled that the therapeutic needs of the patient and not the cost of the medicines should determine what kind of drugs shall be prescribed. Despite this ruling, one keeps hearing that drugs are in short supply. Most troublesome of all drug-related reports are those which describe how the inmates of psychiatric institutions are used as subjects of drug trials. Superintendents of psychiatric hospitals defend the practice as providing much-needed treatment to the inmates. Section 81(2) of the Mental Health Act bars a "mentally ill person" under treatment to be used for purposes of research except with his consent; if he is incompetent to provide such consent, consent of his guardian is required. The statute thus allows a mentally ill person to be used as a guinea pig, since the guardian could well be the superintendent of the psychiatric hospital. Even a person wrongfully admitted into a psychiatric hospital cannot engineer her own exit unless she has external assistance. Section 81(3) does prohibit the interception of correspondence of an inmate. However, this prohibition is also not absolute and can be breached if the communication would be prejudicial to the treatment of the ill person. To conclude, the Mental Health Act 1987 has not been premised on the rights of persons with psychosocial disability. A rights based law would unequivocally accept the humanity of the rights holder and allow her opportunity to assert it. Constraints would be the exception and freedom the rule. The writer is professor of law, NALSAR, Hyderabad.