*17-MAY-2012*

*NEPAL* : Since the Convention on the Rights of Persons with Disabilities
(CRPD) came into force on May 3, 2008, it not only ensured the rights of
persons with disabilities but it created lots of confusion and controversy
in terms of implementing those rights in reality. In particular, it has
been a constant battle for people who advocate for the rights of persons
with mental and psychosocial disability, to convert those CRPD- guaranteed
rights into the national policy framework.

The CRPD is a complex document. It took three years for me to understand
its spirit and be convinced that it actually works to protect the rights of
persons with mental or psychosocial disability. CRPD clearly defines people
with disabilities as follows: “persons with disabilities include those who
have long-term physical, mental, intellectual or sensory impairments which
in interaction with various barriers may hinder their full and effective
participation on an equal basis with others.”

It is clear that in contrary to the traditional notion of disability—whose
understanding is limited only to physical impairments—the CRPD has endorsed
mental or psychosocial disability as part of the broader disability groups.
There are rights in the CRPD, but we are nonetheless failing to find ways
to create an environment where such rights can be realised and enjoyed.

The CRPD is an international law. It is thus simply a tool of cumulative
rights which forces a change in domestic laws in line with its human rights
standard.  In the context of psychosocial disability rights,
anti-discrimination, equality before law and the right to receive quality
mental health services in the community are centrally important in both the
CRPD and in Nepal. Besides this, there are other issues like quality life,
education, and inclusion, which are also equally important. In addressing
these major issues three bills are currently under discussion in Nepal.
They are: disability bill, health bill, and mental health bill. Questions
have been raised: where should the focus be in order to convert the rights
guaranteed in the CRPD in the national policy framework?  Is it better to
address rights by creating a separate mental health bill for those with
psycho-social disabilities, or to include them in the health bill? Do we
need a mental health bill to protect the rights of persons with
psychosocial disabilities? Or is it better to split the rights between the
health and disability bill instead?

To discuss these issues and give strategic direction to the government, on
May 16, a couple of days ago there was a national consultation meeting
hosted by the Nepal Mental Health Policy Group—a loose group of prominent
politicians and policy makers who are seriously concerned with mental
health and psychosocial disability issues. In the meeting, Indian scholar
and activist, Bhargavi Davar, who herself is a childhood survivor of
psychiatric institutions in India, made a presentation for senior
bureaucrats, politicians and policy makers which forced them to ponder
seriously about the advantages of not having a mental health bill to
promote and protect the rights of persons with  psychosocial disabilities.

Her presentation on the mental health bill was quite interesting.
Generally, the world over, people assume that it’s a great thing to have a
separate mental health bill. Even in Nepal, we have already spent three
years in negotiations to create a mental health bill in line with the CRPD.
But, as pointed out by Davar, if we look at the world history of such
bills, they are all formed in the same way that penal codes are formed.
They mostly carry colonial baggage and are thus oppressive. It’s called a
rights instrument, but it’s a ‘historical perversion’ that locks people up
forcefully in mental ‘asylums’. Ironically, Nepal’s proposed mental health
bill also reflects such a colonial mindset in the name of protecting rights
and providing services.

Davar’s observation, that countries without a mental health bill are
performing well, is true. In terms of community driven initiatives and
other programmatic incentives—as opposed to institutionalisation— in
meeting the needs of persons with psychosocial disabilities, a mental
health bill, because of its inherent colonial roots, is counter-productive.
In the Phillipines, such community-driven initiatives have been possible
precisely because there is no legal documents which forces treatment to
patients. In Nepal’s case as well, in absence of a mental health bill, we
luckily do not have state-sponsored institutions to lock people up in and
provide legally-approved forced treatment.

Considering the likeliness of the colonial baggage a mental health bill
would carry in Nepal, and having considered the alternative of integrating
mental health rights into the health and disability bills, we have begun to
think that a separate bill won’t guarantee any more freedoms, but instead,
take way from an individual’s right to choice. The right to choice, it must
be remembered, is a fundamental human right and must be respected at all
costs.

Even in terms of fighting stigma, offering mental health services at the
community level, protecting rights and promoting integrated mental health
services, is the best way forward. This can be done by distributing the
rights guaranteed in the CRPD between health bill and disability bill in
case of psycho-social disability and beyond. If we can ensure the inclusion
of mental health service-related rights in the health bill, and can
advocate to guarantee civil, political, cultural and social rights of
people with psycho-social disability in the disability bill, a separate
mental health bill seems entirely unnecessary.  This is the direction all
stakeholders should now take. The Nepal Mental Health Policy Group has a
huge task ahead of itself.

http://www.ekantipur.com/the-kathmandu-post/2012/05/17/oped/no-country-for-cuckoos/234999.html

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