In the Spotlight

Approaches to Mental Disability Inclusion in India

By Jessie Wusthoff, Public Awareness and Education Program Manager

Updated on 10/10/2024 at 11:35 a.m. to clarify language around referenced disabilities.

India is making increasingly significant investments in disability inclusion, with various initiatives focused on improving the lives of people with disabilities.[1] In this article, we examine some of the challenges at present for those with mental disabilities and highlight some impactful initiatives working to create a more inclusive society.

A major challenge in advancing disability inclusion is the collection of accurate data, a global issue that India shares. In a 2019 study reviewing disability rates across India, researchers found up to a 450% discrepancy in state-level data across three major sources. Researchers also found significant changes in data over a single year, despite similar survey wording across data sets.[2] These differences raise concerns that data sets may be undercounting the number of people with disabilities for reasons unknown and even unintended.

The World Health Organization (WHO) launched the first large-scale pilot and evaluation of its QualityRights Initiative with the State of Gujarat in 2014. The program initiative “…aims to promote the human rights of persons with psychosocial, intellectual and cognitive disabilities globally through changing the attitudes of policy-makers, mental health professionals and other stakeholders.” People with disabilities are involved in driving the work and early evaluations showed improvements in their experience using services.[3]

This impact is particularly critical in India, where provider options are limited; there are only three psychiatrists, and even fewer psychologists, for every one million people.[4] This lack of health professionals may contribute to undercounting which can easily result in underfunding, creating difficulties for both government organizations and NGOs looking to support people with psychiatric disabilities.

Recently, we connected with Ramesh Duraikannan to talk about his work as the founder of Resource Education and Charitable Trust (REACT) in Madurai, India, an organization focused on improving the economic prospects for people with disabilities.[5] They do this through creating awareness about disability within the community, providing job skills training, introducing assistive technology to boost the job candidates’ productivity, sensitizing parents, educators, and employers, and securing jobs for individuals with disabilities in organized sectors.

When Duraikannan relocated to his hometown of Madurai, he spent three months researching various NGOs and felt like disability-focused work required more investment: “when it comes to supporting people with physical disabilities, it’s not too tough to secure work. We wanted to focus on groups having additional difficulties finding work.” Duraikannan continued to explain that, much like in the United States, different mental disabilities are confronted with different societal responses. In his observations he has found that, “For people with Down Syndrome, there’s a kind of acceptance. They are hired in large numbers in hospitality and retail industries and there are schools providing them with education.” People with other disabilities have a much harder time securing education and employment:

Getting a job for a person with [psychiatric disabilities] is very difficult. Many companies are reluctant to hire them, and even medical professionals may hesitate to recommend them for any roles. As a result, individuals with mental illness are often excluded from traditional employment sectors.

Duraikannan interviewed around 30 individuals with mental disabilities at a non-governmental organization (NGO) in Madurai that supports people with psychiatric disabilities and offers inpatient accommodations. He found that many of these individuals already had desirable skills, but stigmas were a significant blocker. According to Duraikannan:

In India, disability is often stigmatized as a family curse. Mental health issues, in particular, face significant challenges due to societal stigma.[6] Many individuals with mental illness struggle to accept their condition, fearing isolation.

Unfortunately, some individuals with mental illness in India are subjected to inhumane treatment, such as being chained or confined.[7] Many individuals with mental illness are abandoned on the streets, relying on local NGOs for basic necessities like food and shelter. While awareness is increasing among affluent communities, the poor continue to face significant barriers.

The painful reality is that this is the state of affairs non-profits and people with psychiatric disabilities have to navigate. Stigma that may prevent someone from pursuing care, lack of medical services that would enable a referral to participate in helpful programs, and both stigma and inaccurate data potentially jeopardizing funding are all factors coming together to create significant hurdles for people with psychiatric disabilities to integrate fully into society. This is a familiar equation to those of us in the United States. QualityRights and REACT’s trainings within organizations are working to change stigmas, but it will take time. Duraikannan’s research found that Madurai does, fortunately, have services for mental health, but there were additional gaps that needed filling for developmental disabilities.

In addition to organization trainings, REACT’s economic empowerment initiatives directly serve individuals with a range of disabilities with an emphasis on developmental disabilities, autism, and attention-deficit/hyperactivity disorder (ADHD). One track is training (e.g. typing, email writing, common office software suites, and digital security) and hiring events with partner corporations. Alternatively, families can engage in their entrepreneurship program, where an individual with a disability and a family member learn the skills needed to co-found their own to-go bakery. By circumventing the issues created by some corporations, their entrepreneurship program is putting greater independence and flexibility in the hands of people with disabilities. REACT recently secured a contract and funding from the local district administration to offer vocational training for 200 youth, job placement support for 200 youth, and entrepreneurship orientation for 100 youth.

India’s progress in disability inclusion is marked by both challenges and opportunities. While issues like data collection and stigma persist, initiatives are demonstrating diverse ways to address the needs of individuals with disabilities and provide opportunities to play a critical role in building a more inclusive future in India.

[1] India began its Sugamya Bharat Abhiyan (Accessible India Campaign) in 2015 and solidified much of these efforts law in 2016’s Rights of Persons with Disabilities Act.

[2] The three sources were the Annual Health Surveys (AHS) from 2010 – 2012, the District Level Household Survey (DLHS) from 2012-2013, and the 2010 Census.

Dandona, R., Pandey, A., George, S., Kumar, G.A., & Dandona, L. India’s disability estimates: Limitations and way forward. PLoS ONE 14(9): e0222159, pg. 1. (September 6, 2019). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222159. Last accessed September 27, 2024.

[3] World Health Organization. Global report on health equity for persons with disabilities. (December 2, 2022), pp. 94, 226. https://www.who.int/publications/i/item/
9789240063600. Licence: CC BY-NC-SA 3.0 IGO. Last accessed September 27, 2024.

[4] World Health Organization. Mental health care in India: restoring hope and dignity. (November 7, 2015). https://www.who.int/news-room/feature-stories/detail/
mental-health-care-in-india-restoring-hope-and-dignity. Last accessed September 27, 2024.

[5] Interview with Ramesh Duraikannan, Founder, Research Education and Charitable Trust (REACT), in San Francisco, Cal. (August 28, 2024).

[6] See also: World Health Organization, supra note 4.

[7] Unfortunately, this is not an uncommon practice in many countries. See also: People with Mental Health Conditions Living in Chains. (October 6, 2020).  https://www.hrw.org/news/2020/10/06/people-mental-health-conditions-living-chains. Last accessed October 4, 2024.

PWDF Profile

Who We Are

People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant’s disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney’s fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF’s educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.