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An Open Letter to Dr K K Aggarwal, President Designate of Indian Medical Association

The mentally ill remain our responsibility and being the weakest who can’t speak for themselves, we condemn ourselves to the worst ignominy when we do not speak up for them. I consider that as nothing short of a national disgrace.

Dr Ashoka Jahnavi Prasad
Dr Ashoka Jahnavi Prasad

Dear Dr Aggarwal,


Let me commence by warmly felicitating you on your imminent elevation to the post of President of the Indian Medical Association (IMA). I was personally delighted to learn of this development and look forward to the IMA playing a stellar role in the development of our profession.

Like you, I have also been in the medical arena for more than 40 years and while certain developments have clearly fetched Indian medicine international laurels, all of us appreciate that we still have a very long road to travel before we can ensure that our profession delivers all that it is supposed to.

I have not had the pleasure of making personal acquaintance with you but we do have many common friends who have been panegyrically laudatory about the work you have been doing over so many years and the transformation of mindset that has resulted through your personal endeavours. I therefore am looking forward to your stewardship with a great deal of anticipation.

I was unfortunately abroad for most of this time and only recently relocated to India after several decades having acquired work experience in 11 countries both developing and developed. But on moving back to my country, there is one particular issue that I have been campaigning about and I believe it would be most helpful to have the support of the IMA — the biggest medical association in the world.

The issue, of course, is the denial of human rights to the mentally ill. While this problem is international (that is what prompted me to train as a barrister and work towards a Masters in Mental Health Legislation at Harvard) I believe the problem is excruciatingly intense in our country. I have penned several columns on the issue (including in this news portal) and sent in several petitions to different individuals but have not been reassured by the response and subsequent developments.

I have not known a single democratic country where the mentally ill are left to languish on the roads to fend for themselves and face not just apathy but relentless ridicule. I am sure you would view that as an absolute abomination.

I have not seen another democratic country where the mental hospitals are in the state as they are in India. And perhaps most shocking, I have not known another democratic country where mentally ill are left to languish and suffer within the criminal justice system. Every time I make an unscheduled visit to a prison, I find a substantial proportion of mentally ill incarcerated and until now no one has been able to offer me a satisfactory explanation or suggest a reassuring solution.

The criminal justice system is criminally apathetic. The fundamental principles of criminal justice make it explicit that no one can be held guilty of an act if his/her reasoning is impaired. I have spoken to hundreds of trial attorneys and shockingly a large proportion has expressed ignorance of M’Naghten Rule that governs this process. I have spoken to retired judges with over 30 years of judicial experience and many have confessed that they have never had to rule on a matter involving M’Naghten. I have visited law faculties of 30 universities in the north and not one had provisions for instructions on mental health legislations.

Presence of mentally ill in gaols demeans all of us, as human beings, and our profession in particular. We simply have not given the matter the attention it deserves — and that should put us all to shame.

We cannot simply abrogate our responsibility in this regard. It is pointless expecting anything meaningful from our police nationwide which has allowed unsavoury hoods like Yashasvi Yadav, Sugriv Giri and Maxwell Pereira to fester, Nor can we blame it all onto judicial ineptitude.

The mentally ill remain our responsibility and being the weakest who can’t speak for themselves, we condemn ourselves to the worst ignominy when we do not speak up for them. I consider that as nothing short of a national disgrace.

I should be most grateful if this matter is placed topmost on the IMA agenda. I am confident that with your record of public service you would appreciate the merit in my contention. The relevant legislations all exist on the statute books. India was one of the first countries to have an enlightened Mental Health Act. It is all about its application.

The World Psychiatric Association’s President has set up a Task Force to look into the presence of mentally ill in prisons and kindly co-opted me as a consultant. At the very least, we should campaign for the removal of mentally ill from the prisons where they definitely do not belong.

I have also advocated the appointment of a Mental Health Ombudsman both legally qualified and psychiatrically trained. Some countries already have this provision. As this problem is international I very strongly believe the UN should appoint a Special Rapporteur for Mental Health and India should be at the forefront to campaign for it.

The mentally ill and their families are crying out for help from our profession. We simply cannot let them down any longer.

Yours Sincerely,
Dr Ashoka Jahnavi Prasad

Disclaimer: Views expressed here do not necessarily reflect those of India Medical Times or its staff.

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