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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 22  |  Issue : 1  |  Page : 35-39

Perception of human rights temperature of community in persons with severe mental illnesses


1 Department of Social Work, Holy Cross Institute of Management and Technology, Kozhikode, Kerala, India
2 Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
3 Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Web Publication14-Jul-2017

Correspondence Address:
G Ragesh
Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_19_17

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  Abstract 

Background: Despite the rights of persons with mental illnesses (PwMI) are protected by law in India, human rights of PwMI is being violated in many ways. There is dearth of literature on the human rights of PwMI in India. Materials and Methods: This cross-sectional study was conducted to understand the perceived human rights temperature of community in PwMI. Data were collected from PwMI (diagnosed with schizophrenia, bipolar disorder and schizoaffective disorder, and symptomatically stable for 3 years) seeking outpatient psychiatric treatment from private psychiatric hospitals and clinics in Kozhikode (Calicut) district of Kerala state, India. Data were collected using “Taking the Human Rights Temperature of Your Community” which was modified and validated in Indian population and a sociodemographic schedule which was prepared by the researchers. Results: The majority were males (54.2%). Mean duration of illness as 10.42 ± 6.43 years. Mean score of the human rights temperature was 68.31 ± 5.95. Perceived major concerns in the areas of career opportunity (59.5%), discrimination in hiring for work (61.3%), help and care in development of PwMI (64.5%), equal opportunity to avail treatment and cost incurred in it (60.5%), involvement in decision making (46.7%), and responsiveness of the community when any rights violation happens (44.9%). Conclusion: Human rights of PwMI are a major concern. Functioning of the mental health authority and legal aid clinics has to be strengthened to address rights issues of PwMI.

Keywords: Law, legal aid, mental illness, psychiatric disorders, rights violations


How to cite this article:
Shibu B, Adhin B, Ragesh G, George S, Hamza A. Perception of human rights temperature of community in persons with severe mental illnesses. J Mental Health Hum Behav 2017;22:35-9

How to cite this URL:
Shibu B, Adhin B, Ragesh G, George S, Hamza A. Perception of human rights temperature of community in persons with severe mental illnesses. J Mental Health Hum Behav [serial online] 2017 [cited 2019 Jul 20];22:35-9. Available from: http://www.jmhhb.org/text.asp?2017/22/1/35/210701


  Introduction Top


Since the dawn of human civilization, persons with mental illnesses (PwMI) have received the scant care and concern of the community because of their unproductive value in the socioeconomic value system.[1] The stigma and misconceptions related to mental and psychosocial disabilities most often result in people being harassed from their community.[2] In almost all countries in the world, persons with mental and psychosocial disabilities experience violations of their rights (civil, cultural, economic, political, and social rights) and, especially the PwMI often suffer various kinds of human rights violations, and they can be locked away for longer periods, sometimes even for life, despite having the capacity to decide their future and lead a quality life within their community.[3]

As citizens of India, PwMI are entitled to enjoy all those fundamental rights which are guaranteed to each and every citizen by the Constitution of India.[1] Specifically, the rights of PwMI in India are protected by the Mental Health Act 1987.[4] Even though, the human rights of PwMI are being violated in many ways. There is dearth of literature on the human rights of PwMI in India. The current study has made an attempt to understand the perception of PwMI about the human rights temperature in their community.


  Materials and Methods Top


This cross-sectional study was conducted to understand the perceived human rights temperature of community among PwMI; those who were seeking psychiatric treatment from Private Psychiatric Hospitals and clinics at Kozhikode (Calicut) District of Kerala State, India. Researchers approached psychiatrists in various Private Psychiatric Hospitals and clinics (providing both inpatient and outpatient services) and collected data. Persons with serious mental illnesses were selected for the study as persons affected by serious mental illnesses are more likely to experience stigma and discrimination than those with other mental illnesses.[5]

Sample size was calculated based on findings from previous studies and after discussion with experts in the field of mental health and biostatistics.[5],[6],[7] Sample was collected from various hospitals/clinics based on the number of PwMI seeking treatment from these centers and readiness of PwMI to participate. PwMI those who were diagnosed with schizophrenia, bipolar disorder and schizoaffective disorder, and symptomatically stable for 3 years and referred by their treating psychiatrist approached for data collection. Those who were ready to give consent were interviewed. All participants were allowed to withdraw their consent at any point of time during the interview. Institute ethics clearance was obtained to conduct the study.

Sociodemographic schedule was prepared by the researchers to understand the sociodemographic and illness profile of the PwMI. Researchers used “Taking the Human Rights Temperature of Your Community” scale to understand the perception of human rights of PwMI.[7],[8] This instrument is a modified and validated to suit the Indian context with regard to mental illness while retaining the essence of questions.[6],[7],[8] For example, modified the original statement “my community is a place where residents are safe and secure,” to read “my community is a place where mentally ill patients are safe and secure” and Item numbers 12, 17, 18, 21, and 22 were completely changed.[6],[7] According to the Indian constitution and international covenants (International Covenant on Economic, Social and Cultural Rights and International Covenant on Civil and Political Rights); right to vote, right to continuing education, right not to be discriminated were given more importance.[6],[7]

For the present study, the modified “Taking the Human Rights Temperature of Your Community” scale was translated into Malayalam language and face validated (with help of experts from mental health and legal profession). The scale consists of 25 items, each with 5 ratings, ranging from 0 (do not know) to 4 (always). The tool was administered in the face-to-face interview. Data were analyzed using IBM Statistical Package for the Social Sciences version 22.


  Results Top


Researchers approached seven hospitals or clinics in the city area of Kozhikode, in which three hospitals permitted for data collection from outpatients. Of 299 PwMI approached, 225 gave consent and completed the interview. Sociodemographic profile of the respondents showed in [Table 1]. Illness profile [Table 2] showed mean duration of illness as 10.42 ± 6.43 years. Mean score of the human rights temperature was 68.31 ± 5.95 [Table 3].
Table 1: Summary of sociodemographic profile

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Table 2: Summary of illness profile

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Table 3: Pattern of response to the items of in taking the human rights temperature of your community scale

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With regard to the response to the statements in the “Taking the Human Rights Temperature of Your Community” scale [Table 3]; 59.5% reported that “no or rarely” to the statement “availability of equal information and encouragement about career opportunities” [item no 2 in [Table 3]]. The response to the statement, “equal opportunity to avail treatment and cost incurred in it” [item no 4 in [Table 3]] was “no or rarely” (60.5%). The majority (64.5%) responded as “no or rarely” to the statement, “members of my community care mentally ill patient's development and try to help me when they are in need” [item no 7 in [Table 3]]. To another statement, “responsiveness of the community when any rights violation happens;” 43.1% responded as they “do not know” and 44.9% reported “no or rarely” [item no 9 in [Table 3]]. To the statement, “patients in my community are hired to work without any discrimination,” 61.3% responded as “no or rarely” [item no 16 in [Table 3]]. As response to the statement, “involvement in decision-making processes to develop rules and policies,” 38.7% reported “do not know” and others (46.7%) responded as “no or rarely” [item no 19 in [Table 3]].

Comparative analysis of score of the human rights temperature across sociodemographic and illness variables showed PwMI from rural areas perceived higher human rights temperature compared to urban dwellers and a significant difference in total temperature score was found between the categories of diagnosis and it has been observed that patients with schizoaffective disorder had higher mean temperature score (70.17) as compared to schizophrenia and bipolar disorder [Table 4].
Table 4: Comparison of total human rights temperature score across sociodemographic and illness variables

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  Discussion Top


The current study made an attempt to describe the perception of PwMI about human rights temperature of their community. Authors believe that this may be the first study in human rights perspective, conducted in India among PwMI seeking psychiatric treatment from private hospitals.

With regard to the sociodemographic profile of PwMI, the present study also provided evidence that the number of male patients was higher than women who utilized the mental health services.[9] Majority of the respondents were married which indicated higher social support. Higher human rights temperature perceived by PwMI from rural area compared to urban area (P = 0.005). This may be because of that rural community is more socially connected, empathetic, and concerned toward persons with illnesses or difficulties compared to urban or semi-urban dwellers. The reasons for persons with schizoaffective disorder perceiving higher human rights temperature compared to other diagnosis is unknown.

Although overall perceived human rights temperature was high among the respondents; there were some areas in which, the PwMI perceived serious concerns. Problems in “getting equal information and encouragement about career opportunities” or “hire to work without discrimination” were perceived by PwMI. This finding is matching with a study conducted in a tertiary care center in India.[7] Very minimal were unemployed (12.4%) before onset of the illness. However, current situation showed that majority was unemployed after onset of illness. This indicates that the illness-related dysfunctionality or disability or unacceptability for job. Having a tag of “mentally ill” may be one of the reasons for no equal job opportunities and studies have proved that stigma is a cause of employment inequity for PwMI and disability.[10] Access to meaningful and adequately paid work is a basic human right for every citizen including PwMI and PwMI have the right to be employed in a mainstream job, rather than being labeled as a trainee in a training program or a client at sheltered workshop, etc.[7]

Current study explored that there were major concerns regarding the equal opportunity to avail treatment and cost incurred in it, care in development of PwMI and help in need, involvement in decision making, and responsiveness of the community when any rights violation happens. These findings are matching with the findings in the study conducted by Poreddi et al.[7] These findings indicate that the attitude of the society toward the mentally ill need to be changed and PwMI should be involved in the decision-making process from family to panchayati raj and other higher levels of government administration. Community-based psychiatric and psychosocial care on affordable cost and availability of strong legal and social measures to protect their rights has to be ensured. Social inclusion of PwMI in all areas of life has to be ensured and periodic social audit can be recommended to ensure it. These findings also indicate that the functioning of mental health authority has to be strengthened focusing the human rights of PwMI.[4]

Other interesting findings include no indications of perception of significant discrimination or rights violation in general because of having tag of “mentally ill.” Respondents perceived that they have right to live as normal citizen and to participate in cultural life, no significant exploitation, etc. These findings are in contrast to the findings in the study done by Poreddi et al.[7]

Addressing rights issues of each PwMI in different settings such as in hospital, family, and community is important. Multisystem interventions are required to address stigma, discrimination, and human rights violations. Providing education to PwMI and families about their rights during their inpatient or outpatient care in hospitals; conducting awareness programs in community; training programs for mental health clinicians, police and law enforcement personnel, politicians, government officials, etc., may help address the serious issue of rights violations. When rights violations identified or reported; the concerned mental health clinician or authority or anyone with best interest in PwMI should ensure free legal aid services, to get help of police, protective actions, and even placing PwMI in shelter homes, etc. Legal aid clinics established under the Legal Service Authorities Act, 1987 can make differences in the life of PwMI and their family members by providing various kinds of legal aid services such as appointing an advocate to address the legal/protection issues, to get discharge from hospital if unnecessarily detained in hospitals, etc.[11],[12],[13]

In the current study, the majority of the respondents was from rural background, with high school and above education standard, had awareness about their illness, had regular compliance to medications and on regular treatment on outpatient basis, previously employed, currently married, and living in their own house. All these factors may be considered as protective factors to perceive high human rights temperature despite them having chronic and severe mental illnesses and even they were coming from a lower socioeconomic background.

The present study has certain limitations such as authors depended on treating psychiatrists' clinical judgment to understand the illness profile. No structured tool was used to assess illness severity and insight about illness. Data were collected from only outpatients and only one district in the state which may limit generalization of the findings.


  Conclusion Top


The current study showed that PwMI face rights violation issues related to their job opportunity and major concerns regarding equal opportunity to avail treatment and cost incurred in it, involvement in decision making and responsiveness of the community when any rights violation happens. These are the serious concerns to be addressed on a first priority basis by the mental health clinicians and government authorities. Functioning of the mental health authority and legal aid clinics has to be strengthened to address rights issues of PwMI. All the stakeholders should unite together to develop positive attitudes toward mental illness and advocating for human rights of PwMI in the community.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Jermier J, Gaines J, McIntosh N. Reactions to physically dangerous work: A conceptual and empirical analysis. J Organ Behav 1989;10:15-33.  Back to cited text no. 1
    
2.
Drew N, Funk M, Tang S, Lamichhane J, Chávez E, Katontoka S, et al. Human rights violations of people with mental and psychosocial disabilities: An unresolved global crisis. Lancet 2011;378:1664-75.  Back to cited text no. 2
    
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WHO. Investing in Mental Health. Geneva: WHO; 2003. Available from: http://www.who.int/mental_health/media/investing_mnh.pdf. [Last accessed on 2016 Sep 26].  Back to cited text no. 3
    
4.
GOI. The Mental Health Act, 1987. GOI; 1987. Available from: http://www.tnhealth.org/mha.htm. [Last accessed on 2016 Feb 11].  Back to cited text no. 4
    
5.
Saleem T, Valsaraj BP, D'souza A, Ameen S, Tharayil HM. A cross-sectional study of perceived human rights in mentally ill. Kerala J Psychiatry 2015;28:16-25.  Back to cited text no. 5
    
6.
Vijayalakshmi P, Ramachandra, Reddemma K, Math SB. Perceived human rights violation in persons with mental illness: Role of education. Int J Soc Psychiatry 2013;59:351-64.  Back to cited text no. 6
[PUBMED]    
7.
Poreddi V, Ramachandra, Reddemma K, Math SB. People with mental illness and human rights: A developing countries perspective. Indian J Psychiatry 2013;55:117-24.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Flowers N. The Human Rights Education Handbook: Effective Practices for Learning, Action, and Change. Human Rights Education Series, Topic Book. ERIC; 2000.  Back to cited text no. 8
    
9.
Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:629-40.  Back to cited text no. 9
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Stuart H. Mental illness and employment discrimination. Curr Opin Psychiatry 2006;19:522-6.  Back to cited text no. 10
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11.
GOI. Legal Service Authorities Act, 1987. GOI; 1987. Available from: http://www.nalsa.gov.in/actrules.html. [Last accessed on 2016 Jun 14].  Back to cited text no. 11
    
12.
NIMHANS. Legal Aid Clinic, 2011. NIMHANS; 2011. Available from: http://www.nimhans.ac.in/patient-care/legal-aid-clinic. [Last accessed on 2016 Jul 01].  Back to cited text no. 12
    
13.
Math SB, Kumar NC, Harish T. Legal aid in hospitals: An innovative approach. Indian J Med Res 2013;137:440-1.  Back to cited text no. 13
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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