Wednesday, February 17, 2016

Going Beyond the Ramp - Making Accessibility Work for People with Mental Disabilities

(Guest post by Ashna Ashesh)

In the conclusion to their book, Disability and New Media, Kate Ellis and Mike Kent make an incisive observation about the choice of modes of providing accessibility – “These choices are often portrayed as merely technical decisions but they are highly political and can betray a disturbing trend of ableist assumption that serve to exclude people with disability.” Does this observation, made in the context of the virtual world (the Internet), apply to corresponding choices made in the real world?

In India the framework for enabling access and the choice of modes of accessibility are detailed by legislation and policy.Law’s understanding of accessibility caters predominantly to the accessibility needs of those with physical disabilities. However, it does factor in the accessibility needs of the mentally ill as well, albeit to a limited extent.

Policy, on the other hand, characterizes accessibility such that it caters exclusively to the needs of persons with physical disabilities. It conceives of access as palpable, i.e., as enabling a barrier free physical environment. Further, it seeks to provide access through tangible modes such as ramps and disability friendly signs.

What it does not capture are the accessibility needs of persons with mental disabilities. For persons with mental disabilities what is inaccessible is not so much the physical space, but the intangible social space. While a ramp may cater to the needs of a paraplegic, a person with schizophrenia will have no use for it.

In excluding persons with mental disabilities, the relevant policy (the Accessible India Campaign) is at odds not just with law’s understanding of access, but also with its own stated objective of enabling universal access for persons with disabilities (PwD - an umbrella term that covers people with all types of disabilities).

In this piece, I argue that the accessibility needs of those with mental disabilities are inadequately addressed by the law and completely ignored by policy on account of a myopic understanding of access.  I do not however, engage in proposing a unifying principle to cater to the accessibility needs of persons with mental disabilities. This is partly on account of the fact that the needs vary depending on the nature of the mental disability and partly because they vary in different contexts such as employment, healthcare, and social settings. This is not to say that it is impossible to cater to these needs (in fact I conclude by positing non-exhaustive approaches to accessibility needs as possible ways to think about these needs). It is because characterizing these accessibility needs is a mammoth task, one that cannot be accomplished in a blogpost.  

Currently, the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 [the PwD Act] provides a framework for the empowerment and the social integration of PwDs. It does so through a two-pronged approach. First, it enables access in general by mandating the creation of barrier-free physical environments. Second, it provides for reservations in education and employment. In order to be eligible for benefits through reservation, a person must qualify as a person with disability as per Section 2 of the PwD Act and satisfy the forty percent threshold for disability. The Indian Disability Evaluation and Assessment Scale (IDEAS) determines whether a person satisfies the threshold requirement of forty percent. The IDEAS is constituted by a series of questions designed to help determine the level of disability (physical or mental) an individual is afflicted with. The questions that aid in quantifying disability are categorized under four heads – self-care, interpersonal activities, communications and understanding, and work (which includes employment, education and housework. Subsequent to being rated on the IDEAS, the PwD must procure a certificate from a medical board that attests to his or her eligibility for benefits.

Though the PwD Act aims to enable access, on certain counts it serves as an impediment to accessibility. For instance, the definition of mental illness excludes mental retardation. The definition has been lifted from the Mental Health Act, 1987. The Mental Health Act is primarily a treatment-focused legislation and excludes mental retardation as it is considered untreatable by the medical community.  The PwD Act however, as an access-enabling legislation should not be concerned with treatability as a qualifying criteria. The fact that mental retardation is not considered treatable does not mean that persons with this affliction are without accessibility needs. In excluding them from the ambit of the definition, the Act is enabling their exclusion from social spaces as well and impedes access.  

To be fair, for those who qualify as mentally ill, the legislation does provide for integration in social spaces through its provisions for integration in mainstream education, and provisions on non-discrimination. Even this is a rather narrow conception of access.

The Rights of Persons with Disabilities Bill, 2014 (the Bill), which will repeal the Act, offers a broader conceptualization of accessibility. For instance, it expands the definition of disability, provides for access to justice, reproductive rights, voting, among others. Further, unlike the Act, it recognizes legal capacity in the context of mental illness and mandates for supported decision making only when required. Though this provision leaves much wanting, with advocacy groups demanding a more substantive recognition of legal capacity, it is nevertheless an improvement on the existing legislation, albeit a symbolic one. 

The Bill, and to some extent the Act, recognize the need for catering to the accessibility needs of persons with physical disabilities and persons with mental disabilities. Providing access goes beyond creating an accessible physical environment to enabling inclusive social spaces. However, the relevant policy – the Accessible India Campaign – falls short of doing this.

 The Accessible India Campaign was launched by the Prime Minister in December, 2014. The goal of the Campaign is to secure universal accessibility for PwDs so as to enable their meaningful participation in an inclusive society. To operationalize this campaign the Government has issued something known as the Strategy Document. This document details the broad framework of the Campaign and an immediate plan of action.

The Campaign adopts a two pronged approach - “creating and enabling a barrier-free environment” and launching an awareness campaign. The deliverables of this campaign comprise accessible physical spaces through the installation of ramps and other disability friendly infrastructure, accessible public transport and accessible information and communication services through formats such as daily captioning and Braille among others. 

Two inferences can be drawn from a perusal of the Strategy Document. First, accessibility itself is understood as access to a concrete, physical space save for the realm of information. It is to be enabled through tangible infrastructural tools such as ramps and disability friendly signs. Second, all measures undertaken cater to the accessibility needs of those with physical disability. 

It is important to note that the document is silent on the accessibility needs of persons with mental disabilities. This effectively excludes 2.7% of the total number of persons with disabilities reported in the Census, 2011. Therefore, the Campaign as it stands does not provide a comprehensive plan for enabling universal access for PwDs.

A campaign that aims to universalize access for PwDs must take into account both physical and mental disabilities. This campaign however, betrays a lack of understanding vis a vis the difference in accessibility needs of PwDs. The Campaign’s conceptualization of accessibility is limited for the most part to accessing the physical space. The need to make the intangible social spaces more accessible however, seems to have evaded its imagination.

Persons with mental disabilities are excluded from being gainfully employed, accessing social relationships, entering into contracts and engaging as citizens in meaningful political activities, among other things. Thus, in the context of mental disability enabling access entails engineering more inclusive social spaces, not just physical spaces.

How then, does one calibrate universal access to accommodate accessibility needs of people with mental disabilities?

In order to meaningfully enable universal access both, law and policy, need to articulate more inclusive definitions of disability and a more inclusive notion of accessibility that goes beyond physical access. A comprehensive and nuanced understanding of accessibility is a pre-requisite to figuring out the specifics of operationalizing access.

There are various ways to address the issue of specifics. For instance, in the workplace, employers can provide for in house psychologists or psychiatrists. These mental health professionals would not only seek to cater to the therapeutic needs of PwDs, but also sensitise the workplace about mental disability. Psychological counselling is known to improve mental well-being, and as such, a heightened level of well-being would boost the productivity of all employees. From an employer’s perspective this would be a worthwhile investment of resources. For a person with mental disability, it would make the workplace more accessible by helping him cope with the demands of his or her job.

Going beyond the professional sphere, accessibility can be increased in the personal realm too. In the context of mental disability, denying PwDs the membership of social institutions such as family and marriage is a common occurrence. As of now, there exists an information blackout vis a vis sexual and reproductive health rights of these individuals. Such measures, coupled with other coercive actions such as forceful sterilization hinder people with mental disability from fostering meaningful familial and other social relationships. One possible way to obliterate inaccessibility in this sphere is for primary health care centres to actively work towards disseminating relevant medical information on these aspects to persons with mental disability and to the larger community. Further, advocacy campaigns, such as the Accessible India Campaign should sensitise both PwDs and the rest of the community about the sexual and reproductive rights of PwDs.

In terms of specifics, the above is only an illustrative account. The intangible nature of the barriers faced by people with mental disabilities makes it difficult to posit solutions that cater to their needs. There are no easy answers. That does not mean however, that the following question is not one worth asking – should the promise of universal accessibility be limited only to disability friendly signs and ramps. 

(Ashna Ashesh is a Graduate Fellow at the School of Policy and Governance, Azim Premji University, Bangalore)

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