QUESTION : Explain the major challenges faced by homeless persons during covid-19 pandemic and What measures have been taken by Indian government to address their mental health and homelessness ?
Topic- THE MENTAL HEALTH NEEDS OF THE HOMELESS
- Addressing the Mental Health of Homeless Persons
WHY IN NEWS ?
- As many as 66.1% of those worst affected in India during the Spanish Flu belonged to oppressed classes and suffered the consequences of multidimensional poverty. Similar trends persist today.
MORE ABOUT THIS NEWS :
- The inability to adhere to public health protocols that prescribe distancing and use of hygienic products, the absence of private toilets and basic amenities, and the lack of adequate nutrition are all realities in lower- and middle-income countries.
- Amongst those most affected are homeless persons and the ultra-poor, many of whom are employed in the informal sector.
- Major cause that led to homelessness include abject poverty, conflict, natural or man-made disasters, lack of access to health and mental health care, social hardships, disruptions in care-giving and domestic violence
PROBLEMS FACED BY HOMELESS PERSONS LIVING WITH A MENTAL ILLNESS :
- They are at risk of violent victimisation, assault and long-term incarceration. In India, 2 million individuals sleep rough; 35% of them live with one or the other mental health concern.
- They are exposed to greater adversity against the backdrop of intergenerational social disadvantage and lack of social security.
- Historically, some religious societies started to address the mental illness issue of homeless persons; however, the majority were feared, found to be repulsive and often treated as objects of ridicule. This has resulted in their occupying a lowly place in society’s hierarchical structure even today.
- In India, homeless persons with mental illness are also the largest number of long-stay patients in State mental hospitals. Besides a few exceptions, services for this group are scarce globally.
- As they are susceptible to physical co-morbidities and co-occurring substance misuse, and unshielded against the consequences of homelessness, malnutrition, sexual violation, loss of support networks and kinship, homeless persons find their longevity impacted.
- Further, their experience of loneliness and hyper-segregation contributes to their low sense of self-worth and shrunken group identity, weakening their collective ability to influence change.
RIGHTS OF PERSONS WITH MENTAL ILLNESS :
- Right to Access to Healthcare– Every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate government. It also assures free treatment to those who are homeless or below the poverty line. The Act also requires insurance policies to place mental health treatment at par with physical health.
- Right to live with dignity: Every person with mental illness shall have a right to live with dignity.
- Right to Confidentiality: A person with mental illness shall have the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare
- There are 1.77 million homeless people in India, or 0.15% of the country’s total population, according to the 2011 census consisting of single men, women, mothers, the elderly, and the disabled. However, it is argued that the numbers are far greater than accounted by the point in time method. For example, while the Census of 2011 counted 46,724 homeless individuals in Delhi, the Indo-Global Social Service Society counted them to be 88,410, and another organization called the Delhi Development Authority counted them to be 150,000.
INTERNATIONAL AND REGIONAL EFFORTS :
- The UN set up a fund of $2 billion to alleviate the distress of the ultra-vulnerable, including those living with disability or chronic illness.
- Along similar lines, Tamil Nadu government, taking cognisance of the mental health needs of homeless persons, will take to scale Emergency Care and Recovery Centres (ECRC) that will support the treatment and community inclusion of this vulnerable section in 10 districts.
- The Department of Health, the National Health Mission, the Institute of Mental Health in Chennai, and The Banyan, a mental health care establishment, will together pursue the goal of improving mental health access and mitigating social and opportunity losses.
WHAT MEASURES TO BE TAKEN ?
- States must re-examine the role of social determinants of health in perpetuating unjust structures that normalise deprivation.
- Data suggest that deaths by suicide and common mental disorders have also been on the rise during the pandemic. Hence, states must consider relative poverty and its co-relation to mental health in their health policies.
- Early enrolment in care centers may result in reduction of exposure to harm, injury and starvation, and better prognosis.
- Additionally, facilitation of social needs care and livelihoods may reduce the recurrence of episodic homelessness, critical to sustaining and enhancing well-being gains.
- The mental health team that anchors the Centre may should lend further support to District Mental Health Programmes, and should offer counselling support to address mental health issues in the context of the pandemic.
- While efforts similar to Tamil Nadu government is a powerful start to acknowledge the need to focus on minority mental health, other governments should also take feedback to further build on care plans and mental health systems for the vulnerable.
WAY FORWARD :
- The government should make appropriate budgetary provisions to address the existing infrastructure gaps.
- Proper survey should be conducted to identify shortages in mental health professionals and operational barriers to effective implementation of mental health programs.
- There is an urgent need of easily available diagnostic test and low cost treatment to provide better primary mental health care. Further, the government should ensure insurance covers for mental illness to reduce the economic burden.
- Early Interventions: There is a need to create living conditions and environment that support healthy mental health. It is important to develop a society that respects and protects basic, civil, political, and cultural rights
- We must remember that issues of homelessness and mental ill health even independently present intractable problems; in combination, one may confront ethical dilemmas and emerging constraints and challenges.
- Also, the pandemic has made a sound case for increased investments in the health and social sectors.
- Hence, three sectors — the government, development and corporate sectors — should partner to ensure that the lives of those who live on the fringes matter.
QUESTION :Assess the state of democracy in India and suggest the role that the pillars of government need to play to improve the state of affairs in the country.
Topic -SEEING DYSTOPIA IN INDIA’S DEMOCRACY
- Assessment of the state of democracy in India.
WHY IN NEWS ?
- The United Nations has declared September 15 as ‘International Day of Democracy’. It has a provision which says that it reviews the state of democracy in the world. This calls for an opportunity to review the state of democracy in India.
Basic forms of democracy are:
- DIRECT DEMOCRACY: Citizens participate in the decision-making personally. Example- Switzerland.
- REPRESENTATIVE DEMOCRACY: Elected officials represent a group of people. It is an element of both parliamentary and presidential systems of government. Examples – United Kingdom, India, USA, etc.
WHAT IS THE STATE OF INDIAN DEMOCRACY ?
There are two ways in which the state of democracy in a country can to be assessed. They are:
- Procedural state.
- The state of outcome because of democracy.
PROCEDURAL STATE :
The factors that need to be taken into concern while assessing the procedural state of democracy in India are:
- There are multiparty elections with universal suffrage subjected only to age restriction.
- There is smooth changeover in government after elections.
- There is an existence of an independent press and
- judiciary,and the guarantee of civil liberties justiciable in courts of law.
All these suggest that procedurally it very rightly holds its ground as the largest democracy in the world. However this is only a partial evaluation and the outcome also needs to be assessed to get the right picture on the state of democracy.
BUILT BY THE PEOPLE :
- Two leaders who had recognised this criterion in their engagements with the public were Jawaharlal Nehru and Sarvepalli Radhakrishnan.
- Nehru was explicit in his speech on August 15, 1947 when he stated that the goal of independence was to create institutions which will ensure justice and fullness of life to every man and woman.
- Note that Nehru had not promised that the government will create these institutions.
- He was far too aware that democracy is not synonymous with statism; it is about the people.
- Ultimately, the institutions that enable persons to lead fulfilling lives are built by the people themselves.
- Let us look at the examples, all from the United States. In the 1960s, that country saw movements for black empowerment, women’s emancipation and sexual liberation.
- These movements were remarkably successful in the outcomes they achieved, while receiving no support from the U.S. state.
- This is the sense in which it may be said that it is the people who build the institutions that matter.
- That said, however, the state has a role
The Human Development Index (HDI):
- It is a summary measure of average achievement in key dimensions of human development: a long and healthy life, being knowledgeable and having a decent standard of living. The HDI is the geometric mean of normalized indices for each of the three dimensions.
- The health dimension is assessed by life expectancy at birth, the education dimension is measured by mean of years of schooling for adults aged 25 years and more and expected years of schooling for children of school entering age. The standard of living dimension is measured by gross national income per capita.
- Responsiveness of the government to the needs of people
- In the UN’s World Happiness Report for 2020, the list of top 10 countries is heavily loaded with the democracies of western Europe. The U.S. barely edges into the top 20. India, on the other hand, is ranked 144 out of the 153 countries evaluated. Along with this, there has been a slide in recent years meaning the condition isn’t improving.
- Endowment with capabilities: According to Amartya Sen, capabilities are the endowments that allow individuals to undertake the functionings, or do the things, that they value.
- In the UN’s Human Development Index 2019, India ranked 129th out of 189 countries. Judged in terms of human development, Indian democracy is severely challenged.
- The outcome of democracy points to a sorry state of affairs. Though democracy may be a form of government but surely the people have come to adopt this particular form of government with a goal in mind. We may safely assume a fulfilling life is that goal. Authoritarianism is not compatible with such a life, only democracy, which at least in principle grants individuals a voice in governance, is. Second, people adopt democracy so that they can participate in their own governance. They cannot but have foreseen that they must be endowed with capabilities if this is to be possible at all. Thus, liberty and capability are conjoined as the ultimate aspiration in a democracy.
INTERNATIONAL DAY OF DEMOCRACY :
- The International Day of Democracy is celebrated by United Nations since 2007. Its preamble says that “democracy is a universal value based on the freely-expressed will of people to determine their own political, economic, social and cultural systems, and their full representation in all aspects of life.”
- The International Day of Democracy is important to see the limitations of achieving democracy and how it can be improvised Demands of localising democracy (local self-government) have been there. Movements in the recent years like Occupy Wall Street (United States), Arab Spring, Crisis of Brexit suggest that representation in democracy needs to be improved effectively.
Essential elements of Democracy are:
- Respect for human rights
- Holding periodic, genuine elections by universal suffrage.
It aims at:
- Looking ways to invigorate democracy
- Tackling economic and political inequalities
- Making democracy more inclusive
- Making democracies more innovative and responsive to emerging challenges (like migration and climate change).
DEMOCRACY IN INDIA :
- Ancient India had democratic republic even before 6th century BCE and India has seen democratic rule through ages. Vaishali (in present day Bihar) is considered one of the first republics around 6th century BCE. Republics at that time were called ‘Mahajanpadas’ and Sabhas and Samitis (assemblies) existed. Panchayat systems were also used in some of these republics.
- Anti-colonial movements in India brought democracy in picture during British rule in India. Nehru, Gandhi, Ambedkar, etc helped in bringing universal adult franchise, at a time when literacy rate was very low in the nation.
- Government of India Act, 1935 laid foundation of democratic rule in India.
- India became independent from British rule in 1947.
- Although Gandhi wanted village republic as a basic unit, India went for Westminster (United Kingdoms) type of political model. But India granted Universal Adult Franchise under Article 326 of its Constitution effective since 1950 giving a strong base for democracy.
- Indian democracy has stood the test of time that witnessed events like partition of India and Pakistan, massive exchange of population with Pakistan, integration of over 500 princely states and some of the wars in later years with Pakistan and China.
- It has evolved from a single majority party after independence to a multi-party system.
- Indian Republic at present has a parliamentary system of democracy and a federal structure in which leaders are elected by citizens of various castes, classes, religions, etc.
- Dystopia was imagined as a place where the people experience great suffering as they fend for themselves under the watchful eyes of an authoritarian state.