#BridgetheCareGap - Lobbying Effectively for Social Change
Evolving Mental Health Care Laws in India
For decades, mental healthcare in India was governed by the Mental Health Act of 1987 which at the time seemed progressive on various fronts. The Act was instrumental in de-stigmatizing mental health terminology and proactively safeguarded the rights of persons with a mental illness. However, it also fell short on several measures, including addressing the needs of marginalized persons (for example, homeless persons or wandering persons with a mental illness). Under the Mental Health Act of 1987, decision-making power still rested with caregivers and service providers, not the user-survivor. Therefore patients were not allowed to challenge doctors’ decisions, and in most cases, were incarcerated or treated against their wishes1.
Lobbying for Social Change
It took three decades of lobbying to rework mental health care legal provisions in India. Advocates worked to weave ‘individual agency’ into the fabric of the new mental health care act and called for a ‘rights-based’ approach to mental health. Dr. Pathare (psychiatrist and Director, Centre for Mental Health Law and Policy, Indian Law Society, Pune), who was instrumental in drafting India’s new Mental Health Care Act, shares how it was painstakingly debated and edited over the course of seven years. A key lesson learned in the process of passing the new Bill, was that influencing a paradigm shift in mental health care policy takes time. But passing a progressive law is only half the battle. It requires collective action, extensive collaboration, and rallying to ensure that legal provisions are implemented on the ground.
“I think the biggest risk is that everybody just pats themselves on the back and goes back to sleep. We can be happy about having put an act in place. The involvement of advocacy organisations and civil society organisations to get involved in the implementation is a crucial ingredient.”- Soumitra Pathare2.Therefore it became evident that to ensure all the progressive provisions within the new Mental Health Care Act translated into action on the ground—would require a people’s movement of sorts. Because the ‘right to health care of any kind’ has become a legal provision for the first time in India, implementing this was bound to be challenging to all stakeholders. The government healthcare system isn’t prepared to provide quality, affordable, accessible mental health care to over 1.5 billion people—therefore, without a public nudge, we’d likely see no change in the status quo. If we want change—we will all need to rally.
How to Lobby Effectively?
A crucial provision in the new Mental Health Care Act is the creation of a State Mental Health Authority. This committee includes caregivers, users and organisations working in the field of mental health—who are designated (legally) to implement the Act. Another vital component of the Act is ‘budgetary provisions’—the Center is now legally bound to ensure that quality mental health care is available (and affordable) to all citizens. Thus, advocating with the Central and State Governments on both fronts is key.
Once we had decided to chase those in office, the next question was—when? Finding the right moment and striking while the iron is hot are pivotal strategies to ensuring a campaign gains traction. Given that elections were just around the corner, a collective of stakeholders in mental health (Mariwala Health Initiative, Center for Mental Health Law and Policy, Anjali, Anubhuti Trust, Dr Ketki Ranade, Tata Institute of Social Sciences & Mr Keshav Desiraju) planned a campaign to demand that mental health receives due priority. Bridge the Care Gap campaign was thus born.
As members of the coalition, we shared these plans with groups at a grass-roots level as well as multiple civil society organisations so that we could have a larger consultation. The initiative invited everyone associated with mental health across sectors to join a nation-wide campaign on ‘bridge the care gap’, to give their suggestions on how to prioritize mental health in the political agenda, and to effectively implement the Mental Health Care Act,2017 and the National Mental Health Policy, 2014 in India. The idea behind specifying these 2 stipulations was that the law and policy is already passed by the executive arm of the government, so, it is a matter of holding our political leaders accountable.
As political parties were currently working on their election manifestos, coalition members met with political representatives of multiple parties to explain our demands and provide inputs for use in political manifestos. As part of this, we designed an easy to understand kit on mental health as well as short films around mental health centering user-survivor voices and caregivers.
Alongside meeting politicians, a public advocacy campaign has been running - asking citizens to sign a petition saying that their vote will be influenced by the political attention paid to mental health. #BridgeTheCareGap campaign collaborators leveraged a mixed bag of communication tools, including generating a buzz on social media to sign an online petition, in-person interviews with political parties prior to drafting their political manifestos, radio interviews with stakeholders, video-documentaries of first-person accounts from user-survivors, and influencer voices.
With the videos, we have looked to expand on the stereotypes of persons with mental illness - we have 3 mental health professionals with lived experience - this includes a queer and trans narrative. We also have user-survivors talking of their experiences of living with schizophrenia and bipolar disorder. With these videos, we aim to reframe the idea of mental health as a spectrum as well as located in psychosocial factors. The videos talk of multiple paths towards resilience - therapy, medication, art therapy and how support is important. There is a large dearth of mental health materials in English, thus, our videos had to be across languages like Marathi, Bengali and Tamil.
The videos have succeeded in raising public engagement with mental health. Initially, we received positive responses from mental health practitioners and persons with lived experiences. Now, we see a much larger portion of the population interacting with these videos.
Linkages
A scan of the major petition sites tells us that the Bridge The Care Gap petition is already the most signed petition on mental health in India. Another promising result is the assurances received from several political parties, to indeed, prioritize implementing the new Mental Health Care Act and ensure budgetary provisions for mental health.
Bridge The Care Gap has also seen support from many other mental health organisations such as The Live Love Laugh Foundation, White Swan Foundation, Banyan, Society for Nutrition Iswar Sankalpa, Bipolar India, Patients Engage - with their work areas ranging from knowledge on mental health, service delivery and user-led advocacy. As part of this campaign, we also reached out to multiple organisations who do not work on mental health - but on child rights, women’s rights, law and policy, LGBTQ concerns, human rights and livelihood. Approximately 50 organisations have endorsed this petition and supported it by publicizing materials or sharing details with the communities they work in.
This campaign has foreshadowed plans for a global campaign on mental health, coordinated by United For Global Mental Health. As one of the Indian actors engaging with this global movement, it is an important pilot for any concerted work that lies ahead of the Indian entities who are partnering on the global campaign - whether it is sharing information or partnering as a coalition. This in fact, would not only lay the ground for another campaign but also be able to build on it to accelerate the effectiveness of both campaigns.
What next?
Once, political parties put mental health on their political agendas, the #BridgetheCareGap consortium will need to follow-up to ensure that the elected party makes good on that promise. Therefore, round-two of the campaign envisions monitoring implementation of legal provisions in mental health care and creating ‘report cards’ to flag shortfalls and place greater emphasis on accountability as well as more accurate on the ground knowledge of the mental health ecosystem in India.
As we have reached out to civil society beyond organisations working on mental health, we hope to strengthen bonds amongst civil service organisations - including those who work on child rights, livelihood, women’s rights as mental health is an inter-sectoral issue. This wider participation should be crucial to inspire a wider user-survivor led, inter-sectoral advocacy movement in India.
Update
Indian National Congress includes the implementation of National Mental Health Policy 2014 & Mental Health Care Act 2017 in its manifesto:
'We will ensure that mental healthcare professionals are appointed in all public district hospitals and that mental healthcare services are provided in such hospitals.’
Access additional resources and information on MHI’s #BridgetheCareGap campaign:
- Why India needs to invest in mental health
- Read the mental health manifesto
- Sign the petition
- Reframing funding in mental health Report
Footnotes:
- Excerpt from Dr. Soumitra Pathare’s interview with White Swan: The right to mental healthcare is the heart of the Act
- Duffy RM, Narayan CL, Goyal N, Kelly BD. New legislation, new frontiers: Indian psychiatrists’ perspective of the mental healthcare act 2017 prior to implementation. Indian J Psychiatry 2018;60:351-4.
