Passions of the mind

June 16, 2013 10:11 am | Updated 10:31 am IST

State institutions need revamping. Photo: Mohammed Yousuf

State institutions need revamping. Photo: Mohammed Yousuf

The Mental Health Care Bill, 2013, approved by the Union Cabinet, is a rights-based approach to mental health care with citizens getting the right to access mental health care. It seeks to provide access to mental health care and services for persons with mental illnesses and to protect and promote and fulfil the rights of patients with mental illness during the delivery of mental health care and services.

Drafted in consonance with international commitments, the Bill — that will repeal the Mental Health Act, 1987 — widens the definition of mental illness; the proposed law defines such disorders as “a disorder of mood, thought, perception, orientation and memory which causes significant distress to a person or impairs a person’s behaviour, judgement and ability to meet the demands of daily life and includes mental conditions associated with the use of alcohol and drugs but does not include mental retardation”.

India is a signatory to the United Nations Convention on the Rights of Persons with Disabilities which obliges it to introduce legislation that protects the rights of the disabled.

On May 27, 2013, the World Health Assembly adopted the Comprehensive Mental Health Action Plan 2013-2020 — a first in the history of WHO — which is a commitment by all 194 member states to take specified actions to improve mental health and to contribute to the attainment of a set of agreed global targets.

The action plan focuses on four key objectives: to strengthen effective leadership and governance for mental health; provide comprehensive, integrated and responsive mental health and social care services in community-based settings; implement strategies for promotion and prevention in mental health; strengthen information systems, evidence and research for mental health.

It is for the first time that specific and measurable global targets and indicators have been agreed upon as a way to monitor implementation, progress, and impact. The targets include a 20 per cent increase in service coverage for severe mental disorders and a 10 per cent reduction of the suicide rate in countries by 2020.

The Mental Health Care Bill, 2013 makes a clear assertion that all persons have a right to access mental health care and treatment from mental health services run or funded by the government. Such services should be affordable, of good quality and available without discrimination.

The introduction of Advance Directives [AD] (Section 5 of the Bill) entitles a person who anticipates for fear the possibility of involuntary admission at some point in the near future makes it clear through an AD that such a step is not taken. A person with mental illness can appoint a nominated representative to take decisions for him. A person with mental illness has the right to live in, be part of, and not segregated from society. The government has an obligation to provide for halfway homes and community caring centres. The person has a right to be protected from cruel, inhuman and degrading treatment like electro-convulsive therapy without anaesthesia and de-criminalising attempted suicide. The present Bill provides that any such person “should be presumed unless proved otherwise, to be suffering from mental illness and shall not be liable to punishment under Section 309 IPC and be accordingly treated”.

India has a huge burden of mental illness which is increasing. In 2005, the National Commission on Macroeconomics and Health, reported 10-20 million persons (one to two per cent of the population) suffered from severe mental disorders such as schizophrenia and bipolar disorder and nearly 50 million or five per cent of the population suffer from common mental disorders such as depression and anxiety. These estimates are now nearer to 3 and 10 per cent respectively.

The prevalence of mental disorders is higher among women, homeless, poor and those living in urban areas.

Other than the reputed institutes of mental health, there are 38 State institutions where conditions are bad with over-crowding, unhygienic atmosphere, poorly staffed and under-regulated with many doctors doing private practice and almost all reporting instances of violation of rights.

While there may be about 40 million persons in India with severe mental disorder, there are only 25,000 beds in mental health institutions, private psychiatric nursing homes and psychiatric wards in general hospitals. The Bill tries to address this issue also.

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