The Mental Health Bill passed on Monday in the Lok Sabha after almost a six-year-long wait is expected to revive the way mental illnesses are dealt with in the country. While the Bill has been termed as progressive by the fraternity, a particular clause that emphasises on advanced directive from the patient has been debated widely.
Pune-based psychiatrist Dr. Saumitra Pathare, who had drafted the Bill along with Professor Jaya Sagade, said the Bill will turn good a lot of aspects in mental healthcare. “For the first time, there is an emphasis on rehabilitation within the community. The Bill talks about the patients right to live within the community and not in seclusion. This changes the perspective with which we look at mentally-ill patients.”
Dr. Pathare added that the Bill has a clause that mandates the government to increase the number of mental health workers. It also talks about free access to medication from the levels of Community Health Centres (CHCs) and above.
“These two points will make a big difference at the ground level,” said Dr. Pathare adding that the focus can now shift to implementation. “We need to ensure that all the talks are now turned into reality,” he added.
Ire over ECT
The Bill prohibits Electro Convulsive Therapy (ECT) for minors. In adults, ECT can be given only after the use of anaesthesia or muscle relaxant. While this therapy is used by few medical practitioners who are rooted to age old treatments, retaining ECT in the Bill has not gone down well with many progressive doctors who don’t believe in this therapy. The Bill also restricts medical institutions from chaining patients or keeping them in seclusion.
The Bill states that a mentally-ill person shall have the right to make an advance directive that states how he wants to be treated and who his nominated representative shall be. “However, this is an dicey clause. How will a person who has illusions, or feels that everyone is conspiring against him or her, be in the state to give such a consent,” asks psychiatrist Dr. Rajendra Barve.
The Bill further adds that the advance directive has to be certified by a medical practitioner or someone registered with the Mental Health Board. If a mental health professional/ relative/care-giver does not wish to follow the directive while treating the person, he can make an application to the Mental Health Board to review/alter/cancel the advance directive. Doctors say that this could result in them just making application after application.
Some positives
The Bill empowers every person to access mental healthcare and treatment from services run or funded by the government. The right to access mental health care includes affordable, good quality of and easy access to services.
In another progressive step, the Bill has made it mandatory for insurance companies to cover hospitalisation due to mental disorders.
