Rajya Sabha has recently passed a Mental Health Care Bill for providing right to health care and insurance to the individuals with mental illnesses. The Bill seeks to replace the Mental Health Act, 1987.
What is mental illness?
It is defined as: “Such a disorder which impairs a person's behaviour, judgment, capacity to recognise reality or ability to meet ordinary demands of life”.
What is the need of such bill?
In 2007, India ratified the United Nations Convention on the Rights of Persons with Disabilities, which requires signatory countries to change their laws to give effect to the rights of persons with mental illness. Accordingly, Article 1 defines the purpose of the Convention:
“To promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity”.
India already had an act to deal with it named as The Mental Health Care Act, 1987, the act did not adequately protect these rights, and a need was felt to provide them with better treatment and improve their access to health services.
The flaws were:
• There were no provisions for punishing the relatives and officers requesting unnecessary detention of a person to such hospitals.
• Once a person is admitted to mental hospital he is termed insane or mad by the society. There were no provisions in the act to educate the society against these misconceptions.
• Much stress had been laid on hospital admission and treatment. This again increases the cost of health care. No provisions are made for home treatment.
• Although the act provides for a simpler discharge procedure but no provisions were made for after discharge care and rehabilitation, of patients.
• There were contradictory provisions e.g. it sought to protect society from mental persons while the present will care is focused on mentally ill.
What are the rights provided under the bill?
The key features of the Bill are:
• Rights of persons with mental illness: Every person shall have the right to access mental health care 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.
• Advance Directive: A mentally-ill person shall have the right to make an advance directive that states how he wants to be treated for the illness during a mental health situation and who his nominated representative shall be.
• Central and State Mental Health Authority: These are administrative bodies are required to (a) register, supervise and maintain a register of all mental health establishments,(b) develop quality and service provision norms for such establishments, (c) maintain a register of mental health professionals, (d) train law enforcement officials and mental health professionals on the provisions of the Act, (e) receive complaints about deficiencies in provision of services, and (f) advise the government on matters relating to mental health.
• Mental Health Review Commission and Board: The Mental Health Review Commission will be a quasi-judicial body that will periodically review the use of and the procedure for making advance directives and advice the government on protection of the rights of mentally ill persons.
• Decriminalizing suicide and prohibiting electro-convulsive therapy: A person who attempts suicide shall be presumed to be suffering from mental illness at that time and will not be punished under the Indian Penal Code. Electro-convulsive therapy is allowed only with the use of muscle relaxants and anesthesia. The therapy is prohibited for minors. Currently section 309 of the IPC criminalizes suicide.
• Insurance: The Bill requires that every insurance company shall provide medical insurance for mentally ill persons on the same basis as is available for physical illnesses.
What are the challenges in its implementation?
India already has short budget allocation for health sector comparative to other countries, out of that only 1% of health Budget is used on mental illness. Therefore there will be lack of fund for infrastructure, medicines and treatment.
The bill also seeks to provide services in every district, but the bill does not specify how the expenditure will be met and how it shall be divided among centre and states. Therefore, it might be on mercy of states.
Further, there is SOCIAL STIGMA prevailing, there is lack of awareness in society as society still treats depression as a mental state rather a medical condition.
The country is dealing with poor infrastructure; it has only about 3,500 psychiatrists. Therefore, the government is confronted with the problem of lowering this gap significantly over the next decade.
The Centre has adopted a medicalised approach to suicide, treating it as the outcome of severe stress. The bill rightly blocks the application of the Indian Penal Code section that criminalises it. A duty is also cast on the authorities to care for and rehabilitate such individuals. Reliable and free professional counseling must be widely offered.
Further government should take initiatives and awareness campaigns to decrease the social stigma attached to the individuals suffering from mental illness.