Editorials/Opinions Analysis For UPSC 10 December 2025

Content:

1. Care as disability justice, dignity in mental health
2. Charting an agenda on the right to health

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Care as disability justice, dignity in mental health

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 Why is in News?

• A recent opinion piece by practitioners from The Banyan highlights:
  • Deep gaps in India’s mental health-care model
  • The limits of a purely biomedical and deficit-based approach
  • The urgent need for a dignity, equity, and disability justice–centred framework
• The article gains policy relevance due to:
  • Persistently high suicide burden
  • 70–90% global mental health treatment gap
  • Rising concerns over:
    • Institutional abuse
    • Homelessness
    • Continuity of care failures

Relevance

GS-2: Governance, Constitution & Social Justice

• Right to mental health under Article 21 (Right to Life)
• State responsibility for:
  • Rehabilitation
  • Continuity of care
  • Institutional accountability
• Failure of:
  • Community mental health integration
  • Aftercare & housing support
• Mental health as a rights-based welfare obligation, not charity

GS-3: Health Sector & Human Development

• India’s 70–90% treatment gap in mental health care
• Structural neglect:
  • Severe shortage of psychiatrists, psychologists, social workers
• Over-reliance on:
  • Tertiary hospitals
  • Pharmacological solutions
• Weakness of:
  • District Mental Health Programme (DMHP)

Practice Question

• Mental health is no longer merely a medical issue but a question of governance, dignity, and social justice.”Critically analyse.(250 Words)

What is meant by Mental Health & Psychological Disability?

Mental Health (WHO understanding)

• A state of:
  • Emotional well-being
  • Ability to handle stress
  • Productive functioning
  • Meaningful social participation

Psychosocial Disability

• Disability arising from:
  • Mental illness plus
  • Social barriers (stigma, exclusion, poverty, institutional neglect)
• Recognised under:
  • Rights-based disability frameworks
  • UN Convention on Rights of Persons with Disabilities (UNCRPD)

Article’s Core Arguement

• Mental health suffering:
  • Cannot be captured by statistics alone
  • Requires attention to:
    • Lived experience
    • Trauma histories
    • Social abandonment
• Present system:
  • Focuses on “fixing the patient”
  • Ignores:
    • Broken families
    • Violence
    • Homelessness
    • Caste, gender, class marginalisation

The article calls for:

A shift from clinical correction → dignity, justice, and relational care

Data Points

From National Crime Records Bureau (NCRB) suicide data:

• ~33% suicides → Family problems
• ~10% suicides → Relational breakdowns
• Key emotional drivers (largely invisible in data):
  • Shame
  • Rejection
  • Alienation
  • Abandonment

Insight:

• India’s distress is relational and social, not just clinical.

Critical Gaps in Current Mental Health Care Model 

Deficit Lens

• People seen as:
  • “Maladaptive”
  • “Unmanageable”
• Not as:
  • Survivors of:
    • Abuse
    • Structural neglect

Over-medicalisation Bias

• Excess focus on:
  • Neurotransmitters
  • Diagnosis
  • Pills
• Under-focus on:
  • Meaning
  • Purpose
  • Belonging
  • Human relationships

Continuity of Care Failure

• Many patients:
  • Drop out
  • Lose faith in institutions
  • Slide into:
    • Homelessness
    • Chronic despair

Context Blindness

• Social causes not integrated:
  • Housing insecurity
  • Economic precarity
  • Gender violence
  • Caste exclusion
  • Queer marginalisation

Intersectional Model 

The article rejects single-cause explanations and supports overlapping causation:

Domain	Examples
Biological	Neurotransmitters, inflammation
Psychological	Trauma, learned helplessness
Social	Isolation, poverty
Cultural	Loss of meaning systems
Political	Oppression, weak welfare
Historical	Intergenerational trauma, colonial legacy

Key Point:

These act simultaneously, not in competition.

Disability Justice

Disability justice goes beyond:

• Hospital access
• Medication availability

It demands:

• Dignity
• Equity
• Inclusion
• Context-sensitive care

Care becomes:

• A relational process
• Not a transactional service

Reimagining Care

From Treatment → Meaningful Life

Shift from:

• “Symptom reduction”
  To:
• “What does this person need to live the life they want?”

From Linear Recovery → Non-linear Healing

• Accept:
  • Setbacks
  • Relapses
  • Long-term dependence on support

From Institutional Control → Relational Justice

• Trust building
• Honest collaboration
• Dialogic care

From Specialist Monopoly → Lived Experience Practitioners

• Recognise:
  • Peer supporters
  • Community caregivers
• Provide:
  • Training
  • Remuneration
  • Institutional backing

Combined Necessity

Material Needs	Relational Needs
Housing	Belonging
Income	Trust
Medication	Purpose
Food	Identity

The article asserts:

You cannot heal only with a house, and you cannot heal only with medicines.

Implications for Mental Health Education and Research

Education Must Train For:

• Sitting with uncertainty
• Navigating social complexity
• Celebrating small recovery wins
• Ethical discomfort handling

Research Must Shift Toward:

• Implementation science
• Micro-level care processes
• Transdisciplinary methods
• Real-world sensitive evidence
• Longitudinal trust-based outcomes

Conclusion

• India’s mental health crisis:
  • Is not only a medical challenge
  • It is a social, ethical, economic, and governance crisis
• True reform requires:
  • Moving from clinical efficiency → moral responsibility
  • From symptom control → dignified living
• Without addressing:
  • Poverty
  • Violence
  • Social abandonment
  • Discrimination
    → Mental health systems will remain fragmented and ineffective

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Charting an agenda on the right to health

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 Why is in News?

• The National Convention on Health Rights (11–12 December 2025) is being held in New Delhi, timed between:
  • Human Rights Day – Dec 10
  • Universal Health Coverage (UHC) Day – Dec 12
• Organised by Jan Swasthya Abhiyan (JSA), a nationwide civil society coalition active in 20+ States.
• Around 400 public health professionals, activists, and community leaders will:
  • Review lessons from COVID-19
  • Oppose commercialisation and privatisation of health care
  • Renew demands for Right to Health as a Fundamental Right

Relevance

GS-2: Governance, Constitution & Social Justice

• Right to Health under Article 21
• State vs Market in welfare provisioning
• Regulation of private health sector
• Federal health financing gaps
• Discrimination in service delivery

GS-3: Health, Economy & Human Development

• Public health expenditure crisis
• Insurance vs public provisioning
• Medicine price regulation
• Health workforce as economic infrastructure
• Climate & pollution as health risks

Practice Question

• India’s mental health crisis reflects the failure of community-based and continuity-driven care.Discuss with reference to homelessness, relapse, and disengagement from treatment. (250 Words)

What is Right to Health ?

Constitutional Status in India

• Not explicitly a Fundamental Right
• Interpreted under:
  • Article 21 – Right to Life
• Strengthened through:
  • Directive Principles:
    • Article 38 – Social justice
    • Article 39 – Health of workers
    • Article 47 – Duty of State to improve public health

International Basis

• Universal Declaration of Human Rights (1948) – Article 25
• International Covenant on Economic, Social and Cultural Rights (ICESCR) – Article 12
• Embedded in Universal Health Coverage (UHC) principle:
  • Access to quality health services without financial hardship

Core Message of the Convention

“Health care for people, not for profits.”

The convention argues that:

• India’s health system is being pushed towards privatisation
• This threatens:
  • Affordability
  • Equity
  • Universal access
• Health must be treated as:
  • A public good
  • Not a market commodity

Issue 1: PRIVATISATION & PUBLIC–PRIVATE PARTNERSHIPS (PPPs)

What is happening?

• Medical colleges & public health facilities being:
  • Handed over to private players
• Expansion of:
  • PPP-based healthcare delivery

Why is it problematic?

• Weakens:
  • Public hospitals
  • Primary Health Centres (PHCs)
• Increases:
  • Out-of-pocket expenditure (OOPE)
• Converts:
  • Patients → paying customers

Ground Resistance Movements

• Andhra Pradesh
• Karnataka
• Mumbai
• Madhya Pradesh
• Tribal Gujarat

Issue 2: UNREGULATED PRIVATE HEALTH SECTOR

• Private healthcare expansion driven by:
  • Domestic & foreign investment
  • Pro-corporate health policies
• Regulation remains weak despite:
  • Clinical Establishments (Registration and Regulation) Act

Consequences for Patients

• Overcharging
• Unnecessary procedures (especially C-sections)
• Opaque pricing
• Violation of patient rights

Convention Demands

• Rate standardisation
• Transparent pricing
• Mandatory enforcement of:
  • Charter of Patient’s Rights
• Accessible grievance redressal systems

Issue 3: CHRONIC UNDERFUNDING OF PUBLIC HEALTH

Current Public Health Spending

• Only ~2% of Union Budget allocated to health
• Annual per capita public health spending ≈ $25
• Among the lowest globally

Structural Outcome

• High Out-of-Pocket Expenditure (OOPE)
• Insurance-heavy model without:
  • Strengthened public hospitals

Convention’s Key Critique

• Govt health insurance schemes:
  • Claims > Reality
• Demand shifting to:
  • Higher direct public spending
  • Reduced OOPE
  • Universal free public provisioning

Issue 4: JUSTICE FOR HEALTH WORKERS

COVID-19 Exposed:

• Dependence on:
  • Doctors
  • Nurses
  • Paramedics
  • Sanitation & support staff

Persistent Problems

• Low wages
• Insecure contracts
• No social security
• Unsafe working conditions

Convention Demand:

• Decent work, legal protection & workforce rights as a pillar of resilient health systems

Issue 5: ACCESS TO MEDICINES

Key Data

• Medicines = up to 50% of household medical spending
• >80% of medicines outside price control

Market Failures

• Irrational drug combinations
• Unethical marketing
• High retail mark-ups

Convention Proposals

• Stronger price regulation
• Remove GST on medicines
• Expand public sector drug manufacturing
• Enforce rational prescription norms

Issue 6: SOCIAL DISCRIMINATION IN HEALTH CARE

Special focus on:

• Dalits
• Adivasis
• Muslims
• LGBTQ+ persons
• Persons with disabilities

Problems:

• Denial of care
• Poor quality treatment
• Stigma & structural exclusion

Convention Lens:

Health is not just biological — it is deeply social and political

Issue 7: SOCIAL DETERMINANTS OF HEALTH

Health linked with:

• Food security
• Air & water pollution
• Climate change
• Housing
• Employment

Convention Approach:

• Inter-sectoral health governance
• “Health in All Policies” framework

Parliamentary Engagement  

• Convention timed during:
  • Winter Session of Parliament
• Delegates will engage directly with:
  • Parliament of India
• Aim:
  • Influence legislative debate on:
    • Right to Health
    • Public health financing
    • Medical regulation
    • Workforce laws

25 Years of Jan Swastya Abhiyan

• Active since 2000
• Worked across:
  • Women’s movements
  • Rural groups
  • Science collectives
  • Patient rights platforms
• Known for:
  • Pro-people health advocacy
  • Public sector defence
  • Medicines access campaigns

Conclusion

• The National Convention on Health Rights, 2025 represents:
  • A direct ideological challenge to health commercialisation
  • A renewed civil society push for universal, publicly funded health care
• Central message:
  India cannot achieve Universal Health Coverage through privatisation, insurance alone, or weak regulation.
• The future of Indian health must rest on:
  • Strong public systems
  • Adequate government financing
  • Workforce justice
  • Medicine affordability
  • Social inclusion
• Only then can health truly become a Fundamental Right in practice, not just in principle.

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