The Mental Health Care Act, 2017, which came into effect on May 30 this year, has made some fundamental and vital changes in the way we look, deal, treat and rehabilitate persons suffering from mental disorders. Director of the Institute of Human Behaviour and Allied Sciences (IHBAS) and CEO of the State Mental Health Authority, Delhi, Nimesh G. Desai speaks to The Hindu about the benefits and pitfalls of the Act.
Can you decode the highlights of the Act for the common man and what it means for them?
The new law contains several good points and strengths, including looking at mental health in a holistic manner, making rehabilitation an integral part of the process, respecting the rights of a person with mental illness, setting up State boards for evaluation, etc. The new law allows a person with mental illness to make an advance directive on how to be treated and who his nominated representative will be in the scenario. The advance directive has to be certified by a medical practitioner or someone registered with the Mental Health Board. The law also takes a fresh look at the effectiveness of electroconvulsive therapy. It is also trying to regulate mental health institutions by involving the judiciary in the treatment process. All these steps are welcome. I firmly believe that the heart and spirit of this law is to make mental health available to all while safeguarding the rights of the patients.
What are your views on the challenges of the new Act?
Policies have to be aspirational while programmes have to be realistic and implementable. I fear that this law may not bring about the desired results and may not help patients. Also, if laws become too aspirational, and hence out of touch with ground reality, implementation may hinder rather than help those using the services. The new law states that mental healthcare is a right but doctors want to know how to ensure that this happens. We have to respect the rights of the patient to avail or reject treatment. But we cannot have people who need mental healthcare rejecting treatment and becoming a threat to themselves and society.
As for the State boards that will look at the welfare and treatment plan of the mentally ill, in States like Delhi, Kerala, Tamil Nadu — where healthcare systems are robust — this may work well. But India has an imbalanced spread of mental healthcare specialists. In States that do not have a strong healthcare system, how do you ensure implementation? Also, the law seems to paint caregivers and physicians as adversaries of the patient.
What then is the way out?
I personally feel that this cut-paste method that we have adopted with this law is not easy. India is still a country where we have families who are ready to look after people with mental health issues. However, when laws, boards and consent come into effect — with judicial clauses in everything — things do not remain the same. I fear we may soon have more untreated mental health patients, who have been abandoned by their family. We have to work hard at the implementation of this law.
How has implementation of this laws rolled out so far?
I would like to explain this with an example from Delhi. In 2013, we started a mobile outreach programme for the mentally ill. Sadly, the programme still continues as a pilot project. Until we and the government actually put our might, resources and time behind these projects, the actual long-term benefits will not be passed on to the people. So my question is, when we have not been able to take off in Delhi how can we bring in laws that require massive outreach programmes that need highly evolved State-sponsored social security systems in place to have this new Act implemented? I feel that we are copy-pasting provisions from programmes being run in the United States and European countries without understanding our strengths, and are running into the pitfalls that they are finding themselves in today. We have been working at ensuring that the new law is rolled out without disruption of services
