The World Health Organisation (WHO) reports that 450 million people worldwide are affected by mental, neurological or behavioural problems at any time. Furthermore, according to the WHO, most middle and low-income countries devote less than 1% of their health expenditure to mental health. Consequently, mental health policies, legislation, community care facilities, and treatments for people with mental illness are not given the priority they deserve. Barriers to effective treatment of mental illness include lack of recognition of the seriousness of mental illness and lack of understanding about the benefits of services. Policy makers, insurance companies, health and labour policies, and the public at large – all discriminate between physical and mental problems.

Every woman, man, youth and child has the human right to the highest attainable standard of physical and mental health, without discrimination of any kind. This is enshrined in our Indian Constitution and the Universal Declaration on Human Rights. Enjoyment of the human right to health is vital to all aspects of a person's life and well-being, and is crucial to the realization of many other fundamental human rights and freedoms. Furthermore, the social right of victims of crime and their sensitive needs for mental health support is based on the Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power, 1985. (Resolution adopted by the UN General Assembly, non-binding principles upon member nations.)

Yet everyday, disparity in health care takes place in our country. People, needy, less fortunate or those born outside the system with mental health disorders are tied to their ward beds in the name of health care. Violation of their rights to dignity and respect are not uncommon.

The Indian institutional mental care experience

Despite remarkable international and national developments, the links between child abuse, child labour and the care for a child's mental health are still absent. Indian case law is also missing coverage of mental health and rehabilitation obligations.
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The Indian experience on institutionalised mental help as well institutionalisation of patients itself has not been civilising. A report prepared for the National Human Rights Commission (NHRC) in 1999 after an empirical study of mental hospitals in the country made a condemnation of the state of mental health institutions. "The findings reveal that there are predominantly two types of hospitals," the report said. "The first type do not deserve to be called 'hospitals' or mental health centres. They are 'dumping grounds' for families to abandon their mentally ill member, for either economic reasons or a lack of understanding and awareness of mental illness. The living conditions in many of these settings are deplorable and violate an individual's right to be treated humanely and live a life of dignity. Despite all advances in treatment, the mentally ill in these hospitals are forced to live a life of incarceration."

"The second type of 'hospitals',"the NHRC report continues, "are those that provide basic living amenities. Their role is predominantly custodial and they provide adequate food and shelter. Medical treatment is used to keep patients manageable and very little effort is made to preserve or enhance their daily living skills. These hospitals are violating the rights of the mentally ill persons to appropriate treatment and rehabilitation and a right to community and family life".

The NHRC released its report 6 years ago, but the conditions of persons with mental illness in institutions remain an urgent cause for human rights concern. In Gwalior Mental hospital, for instance, it was found that persons with mental illness were left in nakedness; the explanation was that they tore their clothes if they were given them.

Similarly, at Erwadi in Tamilnadu, patients who were chained to each other at a home for the mentally ill caught fire and killed 28 people in 2001. The press raised the issue. Chaining of mentally ill patients was also a practice, and has since then been outlawed by the reforms introduced by the Supreme Court of India that ensure that the fundamental rights of institutionalised patients are not violated. The ruling also set the climate for increased sensitivity on mental health support through actual mental health professionals.

Victims of crime and their mental care needs

Research and professional experience shows that secondary victimisation, generated either by institutions or individuals, is often experienced by victims in the aftermath of crime and leaves them in need of help. Secondary victimisation involves a lack of understanding of the suffering of victims which can leave them feeling both isolated and insecure, losing faith in the help available from their communities and the professional agencies. The experience of secondary victimisation intensifies the immediate consequences of crime by prolonging or aggravating the victim's trauma; attitudes, behaviour, acts or omissions can leave victims feeling alienated from society as a whole.

Secondary victimisation most recently appeared in an Indian courtroom on the 3 May 2005, when a convicted rapist proposed marriage to his victim.