Context

Recently, a High Court suggested that homeless persons with health conditions be branded with a permanent tattoo, when vaccinated against COVID-19.

Issue

• In many countries, persons with severe mental health conditions live in shackles in their homes, in overcrowded hospitals, and even in prison.
• On the other hand, many persons with mental health issues live and even die alone on the streets.
• Three losses dominate the mental health systems narrative: dignity, agency and personhood.
• Issues with the laws: Far-sighted changes in policy and laws have often not taken root and many laws fail to meet international human rights standards.
• Many also do not account for cultural, social and political contexts resulting in moral rhetoric that doesn’t change the scenario of inadequate care.
• There is also the social legacy of the asylum, and of psychiatry and mental illness itself, that guides our imagination in how care is organised.

Way forward: A responsive care system

• We must understand mental health conditions for what they are and for how they are associated with disadvantage.
• These situations are linked, but not always so, therefore, not all distress can be medicalised.
• Adopt WHO guidelines: Follow the Guidance on Community Mental Health Services recently launched by the World Health Organization.
• The Guidance, which includes three models from India, addresses the issue from ‘the same side’ as the mental health service user and focuses on the co-production of knowledge and on good practices.
• Drawn from 22 countries, these models balance care and support with rights and participation.
• Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance.
• This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
• Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
• Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.
• Small emergency care and recovery centres for those who need crisis support instead of larger hospitals, and long-term inclusive living options in an environment that values diversity and celebrates social mixing, will reframe the archaic narrative of how mental health care is to be provided.

Conclusion

Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.

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