Lacunae of disability certification in mental health

Sir,

Despite increase in burden of mental illness in the society, mental health has never been a priority of policy makers. The trend continues in the cases of disability certification. A recently published article1 raised some important points regarding the issues, like right to health, discrimination by authorities, rehabilitation of disabled and disability measurement. Issues raised by the authors are very important and are results of keen observation and analysis of current social situation and system of disability certification in mental health. Although the authors have provided a comprehensive review of shortcomings1, they missed certain issue worth mentioning.

Conceptualization of disability is an important issue faced by the service providers as well as by the relatives of the patient. For other disabilities it is clearly stated that if the condition is curable, person would not qualify for disability benefits. In cases of mental illnesses, a clear line between curable and non-curable cannot be drawn. This ambiguity leads to apprehension in the service providers, to whom the benefits can be given. Since it is not specified in the guidelines2 if the patients with acute illness with short duration or the untreated patient can be benefited. Thus, certain criteria like minimum duration of illness and requirement of regular treatment prior to qualifying for disability benefits should be formulated to ensure clarity. Further, it is also observed that relatives frequently bring untreated patients to receive only disability benefits, since they believe that mental illness is untreatable. Purpose of certification, in such cases remain certain exemptions, property matters or obtaining travel pass or pension; patient's benefit is rarely an issue. Issuing certificate in such cases will further strengthen the misconception of non-treatability of mental illness, and will increase the stigma.

Developing such criteria will have dual benefits; first, the caregivers will be encouraged to provide regular treatment to the patient, that will ensure ‘Right to Health’ for patient with mental illness; second, it will increase the number of beneficiaries due to clearly defined criteria.

Permanent disability is another important issue. Although it is difficult to define, there should be some evidence based criteria to establish permanent disability and provide regular benefits. These deficits have left the guidelines somewhat incomplete and ambiguous.