Mental illnesses are treatable. The right to choose to have treatment is dependent on the patient’s decision-making capacity. This right is upheld in the primary medico-ethical principle of “patient autonomy.” However, whenever this decision-making capacity is judged to be non-existent, as in medical emergencies, the second principle of “beneficence” supersedes the first. The question of surrogate decision-making arises in this context across all medical fields, psychiatry included. The Mental Health Act (MHA), in its final form, should assure proper care for such patients, who are at the risk of harming either themselves or others. The assessment of capacity in a person with major mental illness is a skilled task and there is guidance on assessment of capacity by doctors in the proposed bill. A robust MHA would be a corollary to the “Rights of Persons with Disabilities Bill 2011” that assures equal rights for people with mental illness. Provisions in the act to make amendments based on feedback from stakeholders will go a long way forward in reducing unnecessary concerns that may arise out of regional variations of needs and societal mores. Overall, the proposal to make access to treatment the right of the patient is revolutionary and laudable.
(Dr. Jayakumar Menon is a neuropsychiatrist at the Royal Adelaide Hospital, Australia. Email: firstname.lastname@example.org )