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REVIEW ARTICLE
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 47-52

Does a woman with mental illness have human rights?


1 Clinical Instructor, CON, Dept. of Nursing, NIMHANS, Bengaluru, India
2 Additional Prof., Dept. of Nursing, NIMHANS, Bengaluru, India
3 Senior Prof. & HOD, Dept. of Nursing, NIMHANS, Bengaluru, India

Date of Web Publication28-Jun-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-1505.261776

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How to cite this article:
Vijayalakshmi P, Ramachandra, Nagarajaiah, Reddemma K. Does a woman with mental illness have human rights?. Indian J Psy Nsg 2013;5:47-52

How to cite this URL:
Vijayalakshmi P, Ramachandra, Nagarajaiah, Reddemma K. Does a woman with mental illness have human rights?. Indian J Psy Nsg [serial online] 2013 [cited 2022 Jan 20];5:47-52. Available from: https://www.ijpn.in/text.asp?2013/5/1/47/261776




  Introduction Top


Meaning, where women are worshiped God gives his grace. With these ideals that are taught to all we find in India one of the most miserable group are the women!! The reason being they are not aware of their rights & equally they are not being implemented. Many obstacles to the realization of women’s human rights in India are social and cultural in nature, deeply rooted in the traditions of its communities. More women than men, the world over, are said to suffer from mental disorders. While women’s organizations across the world have been active against gender based violence, the one aspect which has not been accorded the required attention is that of the mentally ill women.

Women and Human Rights

Women’s rights have traditionally been viewed as separate from human rights. Yet, throughout their lifetime, women are often faced with violations of their human rights, with such violations often taking the form of gender-based violence and discrimination. In a world which defines “human rights” as “men’s rights”, women’s rights are predictably sidelined. Thus, in most countries including India, laws and rights essentially serve to protect social and familial structures rather than women as individuals who are institutionally forced into a subordinate gender role and identity.

The United Nations has played an important role in setting international standards for recognizing the human rights of women. One of the most noteworthy outcomes of its efforts is the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), which was adopted by the General Assembly in 1979 and became effective in September 1981. More than 150 countries including India have ratified the Convention. This convention is the most prominent human rights document concerning the human rights of women, which focuses mainly on elevating the status of women to that of men in the area of human rights.

Another watershed for women’s rights is the Vienna Declaration and Programme of Action, adopted in 1993 by the World Conference on Human Rights, which called for the elimination of violence against women in public and private life[1]. The Fourth World Conference on Women, held at Beijing in 1995, reaffirmed that women’s rights are human rights. The World Health Report (1998) says, “Women’s health is inextricably linked to their status in society. It benefits from equality, and suffers from discrimination. Today, the status and well-being of countless millions of women worldwide remain tragically low.” Issues of female infanticide, rape, dowry harassment, discrimination, and denial of their basic rights continue to be grave issues in Indian society, and all of these carry immense implications for the mental health of women.

Women Mental health issues now and then

Women throughout history have been considered the weaker sex. They are commonly believed to be more susceptible to emotional breakdowns and mental illness as they are deemed to be not as psychologically durable as men.

During the Victorian Era

Women during this time were deemed to be highly susceptible to becoming mentally ill as they did not have the mental capacity of men, and this risk grew greatly if the woman attempted to better herself through education or too many activities. In fact, women were seen as most likely having a mental breakdown sometime during their life as “the maintenance of [female] sanity was seen as the preservation of brain stability in the face of overwhelming physical odds” (Ussher 74). Thus, women often suppressed their feelings, as to not appear mad and reassumed the passive, housewife role. Women became synonymous with madness, as they were deemed to be emotional and unstable. If a woman of the Victorian era were subject to an outburst (due to discontentment or repression), she would be deemed mad.

During 21st century

All of the common mental illnesses for women in today is society centre around women’s oppression. Female depression focuses on women who question their placement in life. They often feel as if they do not serve a specific purpose in society and are thus inferior to many men. Their learned passivity has thus caused them to be unfulfilled. Women who commit suicide are also unhappy with their placement in life. As most are housewives, one can assume their unhappiness also stems from lack of involvement in society. Again, their learned passivity caused them to be discontented. Schizophrenia is an attack on man-like women. These women who exhibit male dominated characteristics are supposedly mad as it goes against traditional gender roles. These women, who thus refused to be passive, are judged as ill because of it. Eating disorders are also a reflection of past repression as these women have learned to maintain status through beauty. These women feel as if their worth is placed solely on their physical appearance, as it has for many years, and they thus must maintain this beauty to achieve power[2].

Though women have suffered from many types of illnesses throughout the years, the common trends persist: women’s madness stems from man’s attempts to maintain power, and the mental illnesses of today are a result of years of oppression. Women are thus not naturally the weaker sex-man has made her so.

An over view of women’s rights with mental illness

The human rights principles provide guidance and set the standards for the fulfilment of rights to which women are entitled, and generally expected to respect. These principles are: the universality, inalienability, indivisibility, equality and non-discrimination.

Women with mental disabilities are entitled to the right to life, right to equality and non-discrimination, right to health, right to reproduction and sexuality and the right to found a family contained in the Universal Declaration of Human Rights, 1948 (UDHR); the International Covenant on Civil and Political Rights, 1966 (ICCPR); the International Covenant on Economic, Social and Cultural Rights, 1966 (ICESCR) and fundamental rights provisions in the Indian Constitution.

  1. The Right to Equality and Non-Discrimination


  2. The right to equality and non-discrimination is among the most fundamental of all human rights. Despite international human rights guarantees, women with mental disabilities still suffer from vast inequality. Women from marginalised communities have even lower health status and access to services than poor women in general, and face even greater levels of discrimination. Women with mental illness have been consistently denied the traditional roles assigned to women. It is assumed that they are incapable of undertaking family responsibilities or obtaining gainful employment. In India, where female foeticide is rampant and the girl-child is unwelcome, women with mental illness, is at the receiving end of even more contempt and neglect[3].

    From the time women become mentally ill, they are mostly socialised into dependence, requiring constant monitoring or supervision and never encouraged to take care of themselves or think independently. Such dependence increases their vulnerability and is used to justify their inability to found a family.

  3. 2. Right to health


  4. A human rights perspective on women’s mental health and well-being clarifies that available, affordable, acceptable and personally and culturally appropriate treatment is a crucial human right[4].

    It is also critical to look at the factors that prevent women from accessing services. For instance, a woman may be unable to come to the primary healthcare centre because her in-laws and husband make most household decisions and do not allow her to leave the house without permission. A woman may not even know that the healthcare centre exists, or fear insensitive or corrupt hospital workers. She may experience domestic violence and physical, mental and sexual abuse that further deteriorate every aspect of her mental, physical and spiritual health. Such factors, which describe the conditions of many women in India, promote self-negation and self-neglect in which a woman consistently places the needs of her husband, family and children above her own. Lack of access to services continues to be a major challenge of the public healthcare system[5].

    A recent study of 431 households in two districts in West Bengal and Jharkhand found that of those in need of health services but not receiving them, 62% and 75% respectively were women[5].


Mental health care and gender differences

Findings from a recent study, conducted in two psychiatric facilities in Andhra Pradesh, are presented which provide further confirmation of this pattern of gender differences in mental health care. The two hospital samples showed a predominance of male patients with 62% of the total sample being men, while only 38% were women patients. Hospital statistics confirm an overall over representation of male patients, although this might not correlate with prevalence rates of distress in the community. The deduction then is that women are under-served by hospital services. .

In India however, the health care services are marked by gender-based inequity of access to hospital care. In such a case, drawing conclusions about the comparative prevalence of mental illness in men and women based upon utilisation data from hospital samples is therefore both questionable and misleading. The hospital based studies conducted in India have recorded a predominance of male patients from which researchers have concluded that there is a greater frequency of mental illness among men. Community surveys, on the other hand, from the 1970s to the 90s have recorded a greater female morbidity. Patterns of mental disorder too vary markedly for men and women, whether data from community surveys or from hospital studies are used. Indian women, especially those from poor and marginalised communities, suffer from poor mental health caused by community and economic pressures, including early and/or forced marriage, violence, dowry, son preference, low status within the family and society and lack of decision-making ability.

The Mental Health Care Principles to protect rights of women are

  • Principle 8.2: Every patient shall be protected from harm, including unjustified medication …
  • Principle 9.4: The treatment of every patient shall be directed towards preserving and enhancing personal autonomy.
  • Principle 10.1: Medication shall meet the best health needs of the patient, shall be given to a patient only for therapeutic or diagnostic purposes and shall never be administered for the convenience of others.
  • Principle 12: Sterilization shall never be carried out as a treatment for mental illness.


Health policies and programmes should be based around the notion that empowering women is a critical first step to good health .Recognising that a woman’s health is unmistakably linked to her social position, there is a strong case for health policies and programmes to be based around the notion that empowering women is a critical first step towards achieving better health outcomes.

Right to Marry

The Schizophrenia Research Foundation at Chennai, India carried out an ethnographic, qualitative study of 75 mentally ill women who were separated or divorced. It was found that all but eight of these separated women lived in their parental homes with the onus of care being borne by the aging parents. Legal separation had occurred only in 16 cases, all of them being educated women. None of them remarried, while 34 of the husbands had done so. The fathers looked after only six of the 26 children. This study sharply brings into focus some issues, which confront women in many developing countries. They are:

  • A lack of awareness of the illness and its disabilities resulting in a widespread belief that marriage is a panacea for all ills. This resulted in the parents of the ill women arranging their marriages, very often suppressing the fact of mental illness from the husband and his family.
  • Absence of legal protection including maintenance for such women.
  • The burden of care of these women goes back to the parents, many of whom are aging and themselves sick.
  • Lack of any state managed programmes, which will offer some kind of physical, sexual and financial security for such women.
  • Negative attitudes of the husband and his parents and sometimes even the extended family hastened the process of separation and sometimes desertion[9].


Right to live

Human rights are what each human being is entitled to allow her/his freedom to live a dignified and secured life of choice. Studies of suicide and deliberate self-harm have revealed a universally common trend of more female attempters and more male completers of suicide. A spate of studies from India in the 90s has reiterated this finding. Biswas et al found girls from nuclear families and women married at a very young age to be at a higher risk for attempted suicide and self harm. Malone et al in Dublin reported a 2:1 ratio of women and men in 100 cases of deliberate self- poisoning to such behaviours as a response to failures in life, and difficulties in interpersonal relationships. It may also be noted that terrorist groups train many women as human live bombs.

However the women in many of these studies were not referred to psychiatric services. This could be due to a variety of reasons such as the need to downplay such behaviours in an attempt not to reinforce them and because of the stigma attached to seeking psychiatric help[8].

Reproductive Rights

The right to physical integrity is recognised as a basic human right. In 1994, forced hysterectomies were conducted on several mentally challenged women between 18 and 35 years of age at the Sassoon General Hospital in Pune because they were incapable of maintaining menstrual hygiene and hospital staff found it a strain on their resources and time. Consent was obtained from the guardians and an intrusive and irrevocable surgery, that was not medically indicated, was carried out. Anita Ghai draws attention to the fact that the hospital made no effort to maintain basic menstrual hygiene as the women were “prevented from wearing pajamas with drawstrings or sanitary napkins with belts” as it was feared that they may use these to commit suicide.

Clearly, the concerns of disabled women remain marginal and are complicated by a failure to comprehend the human rights dimension of issues concerning the disabled and in particular the issue of enforced sterilisation. This is evident from the reaction of the West Bengal Human Rights Commission, which when approached by the father of a 17-year-old girl with mental and physical disabilities, who sought permission to remove her ovaries, was turned away as the Commission “cannot decide on an ethical issue”. A common fear amongst parents is that upon reaching puberty their daughter will be unable to comprehend the changes occurring in her body and owing to her mental disability could be an easy target of sexual exploitation. The consequences in the form of a pregnancy will spell difficulties. The right to reproduction is seen to be dangerous for mentally disabled women as it is assumed that they lack maturity and intellect to be able to take care of another person. The fear of transmission of the disability is also very common. In order to help parents better appreciate what would be in the best interests of their mentally challenged daughter there is a need to organise training workshops and discussions for sharing of technical information. Medical experts can explain the consequences of sterilisation and suggest other less intrusive methods such as contraception measures to prevent unwanted pregnancies.

There is always the danger that decisions may not be in the best interests of the patient but may serve the convenience of the care providers. Their interests may override the rights and entitlement of the disabled woman8. Enforced sterilisation blatantly impinges upon the free exercise and enjoyment of each of the above enumerated rights and is not a mere “ethical issue” but a grave human rights concern.

The Right to free from violence

Violence is the fourth largest killer of women in their reproductive age in India and all forms of violence against women are rapidly increasing. Women with mental illness are significantly more likely to be victims of violent crime than other women. These individuals may have difficulty protecting themselves, thereby increasing their vulnerability to victimization[11]. A WHO report in 1998 called it a priority health issue. Violence against women is emerging as a pervasive global issue and contributes significantly to preventable morbidity and mortality for women across diverse cultures. A 2004 study carried out by the International Centre for Research on Women (ICRW) found that 40% of Indian women face some form of domestic violence. As found by the NFHS- II,(National family health services 1998) more than half of all Indian women believe that husbands may beat wives if they have a valid reason for doing so. Half of the nonworking married women in India do not make personal healthcare decisions. Women who are homeless and have a mental illness may experience increased victimization for a variety of reasons. Violence against women with disabilities can range from neglect to physical abuse to denying them even the traditional roles of marriage and childbearing. The Indian legal framework has to be strengthened to bring it in line with international legislations on the rights of disabled women[4]

Right to education

The work on the national literacy mission in northern India demonstrates the association between female illiteracy and poor mental health. Women belonging to a rural community in Himachal Pradesh had significantly more symptoms of somatic disorders and anxiety than men, and this was strongly associated with the lack of education, poverty and low caste. A community psychiatric survey by Carstairs and Kapur showed that women had higher rates of psychiatric symptoms and that higher levels of education had a positive effect on the well- being of women. While low levels of education did not seem to have a deleterious influence on the mental well-being ofthose in the age group of 15–20 years, lack of education did have a deleterious effect on the age group 21–40 years, a finding that led Carstairs and Kapur (1976)to speculate that low levels of education restricted life opportunities and, therefore, resulted in mental distress at that time of life when individuals were seeking to establish themselves in their worlds. These effects seemed to be particularly strong among women[12].

Right to live with family

Mentally ill women face formidable socio-economic problems such as neglect by family and society, dislocation, abandonment and are vulnerable as easy targets of sexual abuse. With inadequate support and a strong gender bias, the mentally ill women are rarely accepted into the family and are forced to fend for themselves resulting in homelessness. A women with mental illness though of a severe degree is not brought for treatment in the early stages in comparison to her male counterpart. A married woman who is ill, loses the support of the husband and his family and is sent to her parent’s house, where she would be at the mercy of helpless parents, brothers and sisters-in-law. Sometimes, even the treatment is denied to her by the husband who is the lawful guardian. The Mental illness makes the woman incapable of asking for help herself.

Recommendations to protect rights of mentally ill women

  1. To provide to women with psychosocial disabilities sensitive comprehensive health care including mental health care, whenever needed in the life span in the least restrictive and intrusive environments.
  2. To ban inhuman, cruel and degrading treatments, including solitary confinement and direct shock treatment.
  3. To provide gender-sensitive and women-centred training for service providers and professionals across different systems, including police and judiciary.
  4. To induce maternal health services to be more sensitive and responsive to the mental health implications of reproductive health.
  5. To increase the financial and human resources to provide free mental health care (medical and non-medical) for women at Primary Health Centre level with referral to appropriate levels of care.
  6. To make the whole range of mental health services available for women, including crisis centres, treatment, psychotherapy and counselling, non-drug treatments like yoga, meditations and art-based therapies, at all the care levels, with support services including rehabilitation homes, self-help groups and vocational training.
  7. To include rational psychotropic drugs in the essential drug list for use at all levels including PHC.
  8. To develop and provide effective, efficient and adequate community-based mental health care, including promotion, prevention, treatment and rehabilitation, with linkages to the primary, secondary and tertiary health services.
  9. To establish adequately staffed Crisis Intervention Centres for specialised psychiatric care at District Hospital level; to establish guidelines of practice for such centres, including rational assessments of mental health status, risk and treatment
  10. To institute mechanisms for regulation of private mental health care providers including standard treatment protocols and an accreditation system.
  11. To protect confidentiality and enable informed consent for treatment.
  12. To oppose the use of ‘aversion therapy’, particularly in the name of ‘curing’ homosexuality and other such irrational and harmful practices, and to monitor and restrict the indiscriminate use of electro-convulsive therapy (ECT).
  13. To protect women from physical and emotional cruelty and torture, as well as from unauthorised or non-consensual experimentation.
  14. To recognise a person prone to mental illness as a ‘person’ before the law with due respect for her capacity to act on the basis of will and preferences.
  15. To restrict involuntary commitment, following standard protocols for assessing ‘danger to self and others’; to assure the right to appeal for review and to legal aid.
  16. To ensure inclusion of coverage for mental health care expenses in both public and private insurance schemes.
  17. To promote both social justice and security for mentally ill persons, ensuring adequate standard of living and prioritised treatment and care in times of calamity, strife or conflict.
  18. To protect women’s right to voluntary contraception without coercion, and to oppose tubectomy and hysterectomy operations on girls and women under institutional or non-institutional custody and care.
  19. To protect a woman’s right to make decisions about her children, and to the custody and care of them, or to adequate access to them, and also her right to give her up child in adoption; to not assume that she is incapable because she is mentally ill.
  20. To protect mentally ill and disabled women’s rights to liberty, to freedom of speech, to all life choices including treatments, and to spirituality.
  21. To provide independent living options with community support and after-care supervision programmes, and to address quality-of-life issues such as education, work, income, sport, leisure and relationships.
  22. To create mass awareness about mental health, including the gender aspects of vulnerability care and rehabilitation, through community and school programmes13.




 
  References Top

1.
Elisabeth Reichert “Understanding Human Rights- An Exercise book” 1st Edition, Sage publications, California 2006, Pp no 78-80.  Back to cited text no. 1
    
2.
Katie L. Frick “Women’s Mental Illness A Response to Opression” women’s issues now and then, May-2002  Back to cited text no. 2
    
3.
Women’s Mental Health Conference January 11, 2007 also available at http://www.suffolk.edu/research/25057.html.  Back to cited text no. 3
    
4.
Swagata Raha “Protecting women with disabilities from violence” InfoChange News & Features, May 2009 www.careindia.org  Back to cited text no. 4
    
5.
Rana, Kumar et al. The Pratichi Health Report, Pratichi (India)Trust and TLM: Number 1, 2005, pg 49.  Back to cited text no. 5
    
6.
Department of Human Services and Health, 1994, alia 1994. AGPS, Canberra.  Back to cited text no. 6
    
7.
R.Thara and V.Patel “Women’s Mental Health: A Public Health Concern”: Regional Health Forum WHO South-East Asia Region,Volume 5, Number 1.  Back to cited text no. 7
    
8.
“Reproductive Rights and Women with Disabilities: A Human Rights Framework” center for reproductive rights January 2002, also available at [email protected]  Back to cited text no. 8
    
9.
Violence against Women with Mental Illness, New York, NY: Council of State Governments Justice Center,2007.  Back to cited text no. 9
    
10.
Mental Health An Indian Perspective 1946-2003 Directorate General of Health Services/Ministry of Health & Family Welfare supported by WHO  Back to cited text no. 10
    
11.
International Women’s Day and the seminar on “Mentally Ill Women - is Destitution the only Answerfi” in New Delhi, March8, 2007.  Back to cited text no. 11
    
12.
The Indian Women’s Health Charter, March 2007  Back to cited text no. 12
    




 

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