Section 32 of the Rights of Persons with Disabilities (RPWD) Act 2016 mandates that a minimum of 5% of seats should be reserved for persons with benchmark disabilities (PwBD) in all higher educational institutions funded by the government. PwBD is defined as a person having not <40% of disability, due to one or more of the specified disabilities described under the annexure of the RPWD Act 2016, measured as per the assessment guidelines issued by the Government of India (GOI). Mental illness is one of the 21 specified disabilities under this Act, and Section 32 has created scope for the rightful inclusion of PwBD with mental illness in all higher education courses, including medical graduation.
The Medical Council of India (MCI), the statutory authority, constituted several expert committees to frame regulations for medical education. The committees submitted their recommendations to the president of MCI for approval in the year 2018. These guidelines were criticized as unfair, discriminatory, and unlawful by disability advocates. Finally, MCI had notified the Graduate Medical Education Regulations, (Amendment), 2019, which appeared to be more inclusive for PwBD.
Section 4 (2) of Appendix H-1, of these guidelines, describes that persons having 40% or more disability due to mental illness are unfit to pursue graduate medical courses. Surprisingly under the same regulations, PwBDs with visual impairment and hearing impairment can avail the reservations under the clause “if disability can be reduced under 40% by using assistive devices.” MCI had not extended the same consideration for persons with mental illness, though there is evidence that adequate and appropriate treatment in people with mental illness can reduce disability, even possibly below 40%. This raises critical questions about the MCI's approach to the inclusion of PwDs, irrespective of the type of disability a person may have.
Some statements in these regulations carry the potential to further propagate discrimination and exclusion of persons with mental illness. A statement that “admission of PwBD with mental illness is currently not recommended due to lack of an objective method to establish presence and extent of mental illness. However, the benefit of reservation/quota may be considered in future after development of better methods of disability assessment,” questions the validity of psychiatric diagnosis made by the qualified psychiatrists, and validity of disability assessed by the Indian Disability Evaluation Scale (IDEAS), developed by Rehabilitation committee of the Indian Psychiatric Society. IDEAS was developed by eminent Indian psychiatrists including experts from the National Institute of Mental health and Neurosciences, and gazetted by the GOI.
A second statement from the regulations that “persons with equal to or more than 40% disability due to mental illness are not eligible for medical courses,” lacks evidence, amounts to arbitrary exclusion, and is discriminatory. It conveys inaccurate and false messages about the strengths and abilities of people with mental illness, further increasing the stigma in the community and among other medical professionals. It fails to acknowledge that medical professionals may suffer from disability due to mental illness in their lifetime, after their graduation.
Another statement in this document with respect to PwBD with mental illness and their entry into medical courses is that “standards may be drafted for the definition of fitness to practice medicine, as are used by several institutions of countries other than India.” While it would be appreciable for any provisions to ensure competencies in clinicians throughout their career, explicitly applying it only to the PwBD with mental illness is discriminatory.
Disability must be conceptualized as existing on a continuum and across different dimensions of life. Using the MCI's exclusionary stance as a precedent, other higher educational institutions could also exclude PwBDs with mental illness from admission into courses. Exclusion of any person with or without disability should be on a case by case basis, based on the merits in such a case. The MCI should revise its admission guidelines for the entry of students with disabilities due to mental illness, using the lens of the social model of disability. If medical professionals cannot appreciate the impact of an invisible disability due to mental illness, one cannot expect the lay public to do so.
Indian Psychiatric Society and other advocacy groups fighting for the cause of inclusion of persons with mental illnesses (PMI) should flag this to the appropriate authorities for the removal of such arbitrary provisions with the potential for exclusion of PMI.
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