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Background: There are limited accounts of community-based interventions for common mental disorders (CMDs) in low and middle-income countries. The Atmiyata programme is a community-based mental health intervention focused on promoting wellness and reducing distress through community volunteers in a rural area of the state of Maharashtra, India from 2013-2015.Case presentation: This case study describes the content and the process of implementation of the Atmiyata community-based intervention and how community volunteers were trained to become Atmiyata champions and mitras. The Atmiyata programme aimed to provide basic counselling to community members with CMDs, facilitate access to mental health care and social benefits, improve community awareness of mental health issues and promote well-being. Challenges to implementation included logistical challenges (difficult terrain and weather conditions in the field site chosen for implementation), content-related challenges (securing some forms of social welfare benefits for people with CMDs), and partnership challenges (turnover of public health workers involved in referral chain, resistance from public sector mental health specialists). Conclusions: The case study focuses on how such a human resource model can be sustained over time at low cost. The next steps of the programme include evaluation of the impact of the Atmiyata intervention through a pre-post study and adapting the intervention for further scale-up in other settings in India.
2.Nardodkar R, Pathare S, Ventriglio A, Castaldelli-Maia J, Javate KR, Torales J, et al. Legal protection of the right to work and employment for persons with mental health problems: a review of legislation across the world. International Review of Psychiatry. 2016 Jul 3;28(4):375–84.
Abstract: The right to work and employment is indispensable for social integration of persons with mental health problems. This study examined whether existing laws pose structural barriers in the realization of right to work and employment of persons with mental health problems across the world. It reviewed disability-specific, human rights legislation, and labour laws of all UN Member States in the context of Article 27 of the UN Convention on the Rights of Persons with Disabilities (CRPD). It was found that laws in 62% of countries explicitly mention mental disability/impairment/illness in the definition of disability. In 64% of countries, laws prohibit discrimination against persons with mental health during recruitment; in one-third of countries laws prohibit discontinuation of employment. More than half (56%) the countries have laws in place which offer access to reasonable accommodation in the workplace. In 59% of countries laws promote employment of persons with mental health problems through different affirmative actions. Nearly 50 years after the adoption of the International Covenant on Economic, Social, and Cultural Rights and 10 years after the adoption of CRPD by the UN General Assembly, legal discrimination against persons with mental health problems continues to exist globally. Countries and policy-makers need to implement legislative measures to ensure non-discrimination of persons with mental health problems during employment.
3.Bhugra D, Pathare S, Nardodkar R, Gosavi C, Ng R, Torales J, et al. Legislative provisions related to marriage and divorce of persons with mental health problems: a global review. International Review of Psychiatry. 2016 Jul 3;28(4):386–92.
Abstract: Realization of right to marry by a person is an exercise of personal liberty, even if concepts of marriage and expectations from such commitment vary across cultures and societies. Once married, if an individual develops mental illness the legal system often starts to discriminate against the individual. There is no doubt that every individual’s right to marry or remain married is regulated by their country’s family codes, civil codes, marriage laws, or divorce laws. Historically mental health condition of a spouse or intending spouse has been of interest to lawmakers in a number of ways from facilitating divorce to helping the individual with mental illness. There is no doubt that there are deeply ingrained stereotypes that persons with mental health problems lack capacity to consent and, therefore, cannot enter into a marital contract of their own free will. These assumptions lead to discrimination both in practice and in law. Furthermore, the probability of mental illness being genetically transmitted and passed on to offspring adds yet another dimension of discrimination. Thus, the system may also raise questions about the ability of persons with mental health problems to care, nurture, and support a family and children. Internationally, rights to marry, the right to remain married, and dissolution of marriage have been enshrined in several human rights instruments. Domestic laws were studied in 193 countries to explore whether laws affected the rights of people with mental illness with respect to marriage; it was found that 37% of countries explicitly prohibit marriage by persons with mental health problems. In 11% (21 countries) the presence of mental health problems can render a marriage void or can be considered grounds for nullity of marriage. Thus, in many countries basic human rights related to marriage are being flouted.
4.Bhugra D, Pathare S, Joshi R, Nardodkar R, Torales J, Jr EJLT, et al. Right to property, inheritance, and contract and persons with mental illness. International Review of Psychiatry. 2016 Jul 3;28(4):402–8.
Abstract: Discrimination against people with mental illness is rife across the globe. Among different types of discrimination is the policy in many countries where persons with mental illness are forbidden to inherit property, and they are not able to enter into a contract in a large number of countries. Using various databases, legislations dealing with law of contract, law of succession/inheritance, and law relating to testamentary capacity (wills) of all UN Member states (193 countries) were studied. With respect to federal countries, the laws of the most populous state as a representative state in the respective country were studied. Only 40 Member States (21%) recognize/allow persons with mental health problems to enter into contracts. Of these, however, only 16 Member States (9%) recognize the right of persons with mental health problems to enter into a contract without any restrictions. The remaining 24 Member States (12%) allow a contract entered into by a person with mental health problems to be invalidated under certain conditions. These countries also make the validity of the contract subject to the capacity to consent or based on the level of understanding of the person with mental health problems. They may allow persons with mental health problems to enter into contracts only for transactions of an insignificant nature or of personal rights. Only 9% of the countries allow people with mental illness to enter into contracts in an unrestricted way. Furthermore, there remain variations between high income and low-income states. In spite of international laws in many countries, laws remain discriminatory.
5.Pathare S, Nardodkar R, Shields L, Bunders JF, Sagade J. Gender, mental illness and the Hindu Marriage Act, 1955. Indian journal of medical ethics. 2015 Jan;12(1):7–13.
Introduction: Section 5(ii) of The Hindu Marriage Act, 1955 (HMA) states that under certain circumstances, mental illness is accepted as a ground for the annulment of marriage, while Section 13(1)(iii) states that mental illness is a ground for divorce. There is little data on how this provision is used and applied in matrimonial petitions. This paper assesses judicial practices in divorce cases, exploring the extent to which gender and the diagnosis of mental illness affect the decision to grant annulment or divorce.
Methods: The paper analyses judgments related to annulment and divorce at the Family Court in Pune and at the High Courts in India.
Results: In the Family Court at Pune, 85% of the cases were filed by husbands, who alleged that their spouse was mentally ill. Medical evidence of mental illness was presented in only 36% of the cases and in many cases, divorce/nullity was granted even in the absence of medical evidence. In 14% of the cases, nullity/divorce was granted even when both spouses were not present. Of the Family Court cases reaching the High Court, 95% were filed by male petitioners. The High Courts reversed the lower courts’ judgments in 50% of the cases.
Discussion: Our analysis highlights the need for standardised guidelines for lower courts on what constitutes adequate medical proof of mental illness when hearing a petition related to nullity or divorce under HMA. It also provides a critical review of Section 5(ii) of HMA.
6.Pathare S, Shields L, Nardodkar R, Narasimhan L, Bunders J. What do service users want? A content analysis of what users may write in psychiatric advance directives in India. Asian J Psychiatr. 2014 Nov 13.
Abstract: Although psychiatric advance directives give service users control over their care, very few studies exist on the content of PADs. This paper aims to contribute to this evidence base by presenting the content of psychiatric advance directives in India. Participants were 75 clients seeking outpatient care at a mental health services organisation in Tamil Nadu, India, who agreed to draft a PAD. Most clients were comfortable with appointing a representative (usually a family member) to make decisions on their behalf during a period of decisional incapacity or relapse, were willing to accept admission to the hospital/clinic and take medication if required, wanted to have a trusted person to discuss their mental health problems. No client used the opportunity to outright refuse treatment. This study highlights an important first step in improving the quality of mental health care by documenting user preferences for care in India. More in-depth research is needed to elicit rich descriptions of experiences of care and user-centred understanding of rights.
7.Pathare S, Shields L, Sagade J, Nardodkar R. The need to reform mental health legislation in Commonwealth countries [Guest Editorial]. International Psychiatry. 2014;11(1):28.