Updated: Jun 09, 2017 22:41 IST
By Rohan Sabharwal, Hindustan Times
Last week, as I began to co-write this piece with clinical psychologist and psychotherapist, Prachi Vaish, I called my father.
I needed answers to questions I’d never dared to ask. Specifically, what was it like dealing with the police each of the three times I had attempted suicide.
Even 14 years later, I could sense the discomfort in his voice. He talked about how he had to deal with their questions even before he could talk to his son in hospital.
“What else could I say? I kept saying, ‘I don’t know’. ‘What happened?’ ‘I don’t know.’ ‘Why did he do this?’ I had no answer.”
Too many parents of people with mental illness have had to go through this.
I was 24 the first time. I still feel like ending it all almost every night.
This is one of the major symptoms of the illness I’ve been diagnosed with, Borderline Personality Disorder. It has nothing to do with my day-to-day problems; it is not a cry for help. It is a symptom.
In March, the Lok Sabha passed the Mental Health Bill, 2016, which will replace the Mental Health Act of 1987. The best thing about the bill, for me, is the decriminalisation of suicide.
People with mental illness will no longer be penalised, barred from travelling abroad, given criminal records.
Their families will not have, added to their sense of shock, disbelief and extreme emotional stress, the burden of dealing with interrogations and FIRs.
Decriminalising attempted suicide also takes away the shame and guilt that survivors have had to face.
2014 haunts me every day. Not because I had a severe mental breakdown. Not because I look at my arm each day and the unfathomable damage I did to it. Not because I am ashamed to meet people who knew me then and know I was in a mental facility.
It haunts me because I know that the only reason I got the treatment I needed was because my family could afford it. Mental illness is evenly distributed, but treatment is not.
It’s criminally expensive. Even those who earn well will barely be able to afford it.
One month of hospitalisation cost my family close to Rs 10 lakh and one month of rehabilitation after that cost them Rs 3 lakh.
There is relief for patients and families now, in the fact that they can potentially avail of medical insurance to help treat mental conditions.
Chapter 5 of the Bill states: “Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”
However, mental health care doesn’t end at hospitalisation and medication. Many disorders require sustained non-medical but highly crucial services such as counselling. Others need sporadic treatment. Often, two people with the same diagnosis may be treated differently, even in controlled hospital settings.
I’m interested to know how the law will accommodate this range of alternatives. How one would, for example, categorise repeated hospitalisation after self-harm, psychosis or suicide attempts; how premiums will go up or down based on various factors; and how claims will be handled in the area of mental health.
I remember the morning in 2014 when I woke up with the sense that I needed help so desperately, that I went to a hospital some distance away, on my own, and tried to check myself in. This hospital had one of the few psychiatric wards in the city. When I got there, I was particularly disoriented. I was talking to myself. I was extremely paranoid and trusted no one.
I told the doctor I just wanted to stop feeling the way I did and would do anything to take the pain away.
At that point the last resort was Electroconvulsive Therapy (ECT) and one of the side effects of ECT is retrograde amnesia. It is a controversial form of treatment only made worse by its depictions in popular culture, but when administered correctly can be sufficiently mild, completely painless, and can help.
When I was discharged after a month, though, I was angry because I didn’t remember having consented to the 12-odd ECT sessions. The fact is that I did.
Three years later, I’m here. I believe it helped. I know that it was a decision taken in my best interest.
Now, the new bill does not make adequate allowances for such ambiguities.
Its Advance Directive clause is a good step towards recognising the agency and dignity of the patient. It allows a person to appoint someone or state their preferences on future healthcare decisions in the event that they become unable to make those decisions themselves.
But what of patients suffering from paranoid / persecutory delusions that form a part of certain psychiatric disorders. Won’t their treatment decisions be affected?
An article published in the Journal of the American Academy of Psychiatry and the Law beautifully outlines the ethical and legal dilemmas regarding psychiatric advance directives, both from the point of view of the patient and the mental health professional.
“The bill does provide for caregivers to contest an advance directive if they find it unreasonable,” points out Vaish, “but that involves a lengthy and cumbersome process and holds great potential for misuse. A simpler solution would be to have specially trained lawyers appointed by the central authority who have expertise in drawing up these advance directives.”
I hope the bill moves towards this in future amendments.
Over the years, I have realised why I never felt “helped” by any of the dozen or so therapists and counsellors I’ve visited. Most were either very young and inexperienced, or were not qualified to handle my case but took it on anyway.
Each came highly recommended by a friend or well-wisher. I spent a lot of money. Most of the time all I got in return were vague shots in the dark — ranging from vague and undefined therapy goals to downright misinformation.
Borderline Personality Disorder is admittedly a very tricky illness to treat. The young shrinks I met could have said so. I wish they had.
What did eventually help me was the medication I took for a few months after my hospitalisation, which succeeded in stabilising my moods to a great extent.
The idea of a proposed Central Mental Health Authority governing state-level Mental Health Authorities is a welcome move because, in principle, it will address the confusion and ambiguity that surrounds finding the right professional help.
Anyone who has ever tried to pick a psychologist knows that there are hundreds of under-qualified graduates and postgraduates working as clinical psychologists with no one asking if or where they have interned, no one overseeing their work.
Young doctors are not allowed to practice before completing a residency and then procuring a licence, but young and inexperienced psychologists can freely practice privately almost as soon as they are done with their degrees without any mandatory supervision. This must change.
“A layperson may not know, for instance, that there is a huge difference between an MA in psychology and an MPhil,” says Vaish.
“One concern I have is that the bill includes under ‘mental health professional’ practitioners from the homeopathy, Unani and Ayurvedic systems of medicine. Maybe the CMHA can look into defining the qualifications best suited to each condition, so the patient can make a truly informed choice.”
Last year, an acquaintance sent me a message congratulating me on the work I was doing. “People with depression are generally quite unreliable,” she said.
I smiled and replied that people without depression were extremely unreliable too.
But her comment stayed with me, because it represented so clearly the two extremes I encounter when it comes to mental illness — a romanticised view at one end of the spectrum, a bunch of misconceptions at the other.
Nowhere in the bill does the right to live a life free of stigma appear. The patients’ rights it stipulates should extend to aspects such as employment.
I have always found it hard to get work even though I’m suitably qualified and my work is meticulous.
While researching and shooting my documentary on mental health in India, I came across several people with mental illnesses who had either not been hired because they had declared their condition, or been fired upon declaring it.
Others had not sought help because they did not want to deal with the tags that come with every diagnosis.
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“The mentally ill are not pariahs who are being ‘allowed to’ re-integrate into mainstream society; they are important citizens and many of them are educated, qualified and contributing denizens — like actors, filmmakers, artists and writers,” says Vaish. “The focus needs to be redirected towards making sure they achieve smooth transitions from hospitalisation to halfway homes to real employment worthy of their qualifications.”
Rohan Sabharwal is a filmmaker, stand-up comedian and mental health advocate