Women and girls with mental disabilities in India are being forced into mental hospitals and institutions, where they face unsanitary conditions, risk physical and sexual violence, and experience involuntary treatment, including electroshock therapy, campaign group Human Rights Watch (HRW) said Wednesday.
In a new report, HRW found that women forcibly admitted to government institutions and mental hospitals suffer grave abuses and called for the government to take prompt steps to shift from forced institutional care to voluntary community-based services and support for people with disabilities.
“Women and girls with disabilities are dumped in institutions by their family members or police in part because the government is failing to provide appropriate support and services,” said Kriti Sharma, researcher at Human Rights Watch.
“And once they’re locked up, their lives are often rife with isolation, fear, and abuse, with no hope of escape.”
The rights group called for the Indian government to order inspections and regular monitoring of all residential facilities – private and government-run – for women and girls with psychosocial or intellectual disabilities.
India should also take steps to ensure patients can make decisions about their lives and receive treatment on the basis of informed consent, HRW added.
The 106-page report, “‘Treated Worse than Animals’: Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India,” documents involuntary admission and arbitrary detention in mental hospitals and residential care institutions across India, where women and girls with mental disabilities experience are admitted.
The report found a slew of problems such as a “serious” lack of hygiene, sexual abuse of patients, inadequate access to general healthcare and forced treatment which included electroconvulsive therapy (ECT), better known as ‘Shock Treatment’.
Shock treatment involves electrically inducing seizures in patients and is used as a last resort in the treatment of illnesses such as major depression, schizophrenia and mania.
In many countries ECT is administered under strict legal and medical conditions.
The HRW treatment however found that in India, the treatment was practiced arbitrarily.
Researchers studied conditions at 24 hospitals, rehab centres and residential care homes across six cities including the capital New Delhi, Kolkata, Mumba, Bangalore and Mysore.
There are no clear official government records or estimates of the prevalence of psychosocial or intellectual disabilities in India.
The 2011 census estimates that only 2.21 percent of the Indian population has a disability – including 1.5 million people with intellectual disabilities and a mere 722,826 people with psychosocial disabilities (such as schizophrenia or bipolar condition).
These figures are far lower than international estimates by the United Nations and World Health Organization which estimate that 15 percent of the world’s population lives with a disability.
The Indian Ministry of Health and Family Welfare claims much higher percentage of the Indian population is affected by psychosocial disabilities with 6-7 percent (74.2 – 86.5 million) affected by “mental disorders” and 1-2 percent (12.4 – 24.7 million) by “serious mental disorders.”
India’s government launched the National Mental Health Programme in 1982 to provide community-based services, but its reach is limited and implementation is seriously flawed in the absence of monitoring mechanisms, HRW said.
The District Mental Health Programme is only present in 123 of India’s 650 districts and faces a number of limitations including lack of accessibility and manpower, integration with primary healthcare services, and lack of standardized training.
HRW adds that suffering from mental illness exacerbates the condition of women in a country where gender-based discrimination is pervasive.
Women and girls are often shunned by families unable to take care of them with many ending up forcibly institutionalized.
The process for institutionalizing women and men in India is the same. But women and girls with disabilities face unique challenges – including sexual violence and denial of access to reproductive health – that men do not.
“Without appropriate community support and a lack of awareness, people with psychosocial disabilities are ridiculed, feared, and stigmatized in India,” Sharma said.
India ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007. Under the treaty, governments must respect and protect the right to legal capacity of people with disabilities and their right to live in the community on an equal basis as others.
Forced institutionalization is prohibited.
However, India’s laws allow courts to appoint guardians to take decisions on behalf of people with mental disabilities, without the their free and informed consent, and India perpetuates a healthcare system where people with such disabilities are segregated in institutions instead of having access to support and services in the community.
In an attempt to bring its national legislation in line with the CRPD, in 2013, the government has introduced two bills in parliament, the Mental Health Bill and the Rights of Persons with Disabilities Bill.
However, they do not fully guarantee women and girls with psychosocial or intellectual disabilities the right to legal capacity and the right to independent living, as required by the treaty.
“India has an opportunity to move away from a system of isolation and abuse and instead build a system of support and independence,” Sharma said.
“The lives of millions of women with psychosocial or intellectual disabilities are at stake.”