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
)

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.