29 July 2024 : The Hindu Editorial Analysis

1. Recasting care models for mental illness, homelessness

(Source – The Hindu, International Edition – Page No. – 8)

Topic: GS2 – Social Justice

Context

The article discusses evolving approaches to supporting homeless persons with mental illness (HPMI) in India. It critiques traditional rescue and institutional models, highlights progressive efforts like the integration of emergency care and recovery centres, and advocates for more inclusive and agency-respecting support frameworks.

Socio-Normative Representations and Rescue Missions

• Homeless persons living with mental illness (HPMI) are often viewed as refuge seekers, leading to rescue missions aimed at relocating them to mental hospitals, shelter homes, beggars’ homes, or prisons.
• The prevailing assumption is that HPMIs must be removed from the streets due to safety concerns, although this approach can be overly simplistic.

Historical Perspective and Changing Views

• Two decades ago, the focus was on providing shelter and treatment rather than considering HPMI’s agency, choice, and place-making.
• Social order can sometimes limit imagination and constrain responses to only conventional narratives, even if well-intentioned.

Challenging Notions and Integration Efforts

• Engaging with those with lived experiences can challenge traditional notions of care and responsiveness.
• HPMIs often form affiliations with local support networks, including fellow homeless individuals, local eateries, and pets, providing them a self-curated sense of belonging.
• Despite this, HPMIs face oppression, scarcity, abuse, exposure to harsh weather, and worsened mental health symptoms.
• The narrative surrounding HPMIs needs to reflect this complexity rather than a rigid binary view.

Successful Integration Initiatives

• Collaborative efforts in India involving the National Health Mission, Tamil Nadu Department of Health, Institute of Mental Health, The Banyan, Azim Premji Foundation, and local civil society organisations have led to the establishment of Emergency Care and Recovery Centres (ECRCs) within district hospitals.
• This model aims to replace large asylum-style treatment spaces with smaller, well-staffed units that offer more personalised care and immediate crisis response.
• These efforts address overcrowding, limited staff, and inadequate personal attention prevalent in traditional care settings.

Policy Shifts and Need for Critical Examination

• Recent policy changes show progress but require deeper engagement and long-term commitment.
• There is a need to critically examine when rights are stripped away, assess societal and professional attitudes, and develop adaptive leadership and governance systems.
• In particular, the symbolism of appearances, like matted hair or shaven heads, should not be conflated with mental illness without careful consideration.

Problems with Institutional Spaces

• Approximately 37% of individuals in state psychiatric facilities and care homes have long-term needs, with median stays of six years, often starting from police or judicial intervention.
• The Supreme Court mandated rehabilitative measures in 2017, but the concept of community re-entry remains limited, with options often resembling semi-institutional or trans-institutional settings.
• These options risk perpetuating custodial existence and rights violations, with limited conceptualization of who is deemed “cured” and “ready for discharge.”

Global and National Initiatives

• Large-scale housing initiatives such as Housing First and Tarasha offer comprehensive care and demonstrate the feasibility of such models for individuals with disabilities and clinical needs.
• The ‘Home Again’ collaborative, initiated in 2018 and scaled up with support from Grand Challenges and Rural India Supporting Trust, provides housing support and social care across nine Indian states.
• This model has also been adopted by the Government of Tamil Nadu and other stakeholders.

Reframing Support Measures

• Support for homeless individuals with mental illness needs to shift from paternalistic interventions to strategies focused on liberation and empowerment.
• Providing a modest disability allowance or out-of-work allowance, addressing bureaucratic hurdles in securing Aadhar and banking access, and enhancing financial inclusion are critical steps.
• Structural issues such as discrimination, violence, segregation, and deprivation need to be addressed alongside these financial measures.

Strengthening Social Care and Post-Discharge Support

• Integrating social care and post-discharge support within the District Mental Health Programme is essential.
• Initiatives led by state and non-state actors have resulted in a 75% service engagement rate among mental health service users post-discharge from ECRCs, higher than global averages.

Conclusion

• Economic justice for HPMIs requires confronting systemic barriers, elevating insights from marginalised groups, and creating transformative models for inclusion.
• Workforce participation should be facilitated through meaningful engagement, with social cooperatives offering a promising avenue for fostering community and purpose.
• Affirmative action policies and efforts to build social capital are necessary to achieve substantive socio-economic, cultural, and political inclusion.

Practice Question:  How can India’s current policies and practices be improved to better support homeless persons with mental illness, ensuring both their agency and integration into society? (250 Words /15 marks)

2. The NITI Aayog suffers from both structural and functional issues

(Source – The Hindu, International Edition – Page No. – 8)

Topic: GS2 – Indian Polity

Context

NITI Aayog, established to replace the Planning Commission and promote cooperative federalism, faces criticism for its limited advisory role and lack of authority in resource distribution. Structural and functional issues include reduced State consultations, perceived bias towards BJP-ruled States, and a shift to “competitive federalism” metrics.

Structural Issues with NITI Aayog:

Advisory Role Only:

• NITI Aayog functions solely as an advisory body with no authority to distribute resources or allocate funds to States.
• This contrasts with the Planning Commission, which had direct involvement in resource distribution and consultations with States.

Lack of Decision-Making Power:

• Unlike the Planning Commission, NITI Aayog cannot make binding decisions on grants or projects, limiting its influence on State development.
• Resource allocation decisions are exclusively handled by the Finance Ministry, reducing NITI Aayog’s role in federal coordination.

Functional Issues with NITI Aayog:

Competitive Federalism:

• The shift to NITI Aayog has led to “competitive federalism,” where States are evaluated based on indices rather than cooperative planning.
• This focus on evaluation and ranking has replaced the cooperative approach previously facilitated by the Planning Commission.

Limited State Consultations:

• Post the Planning Commission’s dissolution, there has been a reduction in meaningful consultations with States regarding their development needs and allocations.
• The NITI Aayog’s role in facilitating discussions and addressing State-specific concerns is minimal compared to its predecessor.

Perceived Bias:

• Opposition-ruled States have criticized the Centre for favoring BJP-ruled States in investment projects, exacerbated by the absence of NITI Aayog’s consultative role.
• The perception of bias is heightened by the BJP’s use of the “double engine” government narrative in State elections.

Institutional Gaps:

• The current structure does not adequately address growth through infrastructure and capital investments at the Centre, leaving a gap in supporting State-level development.
• There is a call for re-envisioning NITI Aayog to incorporate some responsibilities of the Planning Commission to enhance cooperative federalism and address developmental needs effectively.

NITI Aayog:

Establishment: NITI Aayog (National Institution for Transforming India) was established in January 2015, replacing the Planning Commission. Mandate: Aims to promote cooperative federalism and holistic development through a bottom-up approach, focusing on policy innovation and implementation. Role: Functions as an advisory body to the Union Government, providing strategic and policy recommendations. Structure: Composed of a Governing Council, chaired by the Prime Minister, and includes Chief Ministers of States, Lieutenant Governors of Union Territories, and other members. Functions: Facilitates cooperative federalism by evaluating state performance through indices, but lacks authority to allocate resources or grants.

PYQ: How are the principles followed by the NITI Aayog different from those followed by the erstwhile Planning Commission in India? (250 words/15m) (UPSC CSE (M) GS-3 2018)

Practice Question:  Discuss the structural and functional issues of NITI Aayog in comparison to its predecessor, the Planning Commission. How have these issues affected its role in cooperative federalism and resource allocation? (250 Words /15 marks)