Source:

https://www.thehindu.com/sci-tech/health/a-plan-for-change/article24782364.ece

 

Model Answer:

Introduction:

• The Mental Healthcare Act, 2017 defines “mental illness” as a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognise reality or ability to meet the ordinary demands of life, mental conditions associated with the abuse of alcohol and drugs.
• As per the Lancet study recently released, 37% of global suicide deaths among women and 24% among men occurred in India.  This highlights the growing mental health challenge India is currently battling with.

Body:

The Mental Healthcare Act, is in line with India’s global commitment and PM Modi Sabka Sath Sabka Vikas. It has made paradigm shift from past ensuring right to live a life with dignity guaranteed under article 21. The landmark shift are as follows-

• 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.
• The most notable of all is this provision effectively decriminalises suicide attempt under the Indian Penal Code by mentally ill persons by making it non-punishable.
• The Bill ensures every person shall have a right to access mental health care and treatment from mental health services run or funded by the appropriate government.
• The Bill also assures free treatment for such persons if they are homeless or belong to Below Poverty Line, even if they do not possess a BPL card.
• A person with mental illness shall have the right to make an advance directive that states how he/she wants to be treated for the illness and who his/her nominated representative shall be.
• Community based treatment: It focuses on community based treatment and special provisions for women and health.
• Every person with mental illness shall have a right to live with dignity and there shall be no discrimination on any basis including gender, sex, sexual orientation, religion, culture, caste, social or political beliefs, class or disability.
• A person with mental illness shall have the right to confidentiality in respect of his mental health, mental healthcare, treatment and physical healthcare.
• Mental Health Review Commission and Board:This is a quasi-judicial body responsible for reviewing procedure for making advance directives. It will also advise the government on the protection of mentally ill persons’ rights.

Issues with Mental Healthcare Act, 2017:

1. a) The Act neglects the prevention and promotion of mental well-being and recognizes mental illness as a clinical issue which can only be treated by medicines and clinical procedures.
2. b) The Act does not provide a clear procedure for preparing the Advance Directive. Further, doctors are of the opinion that they are in the best position to take decisions on aspects of treatment since patients or their nominated representatives may have limited knowledge on mental health and mental illness.
3. c) The Act provides a narrow and restricted definition of mental health professionals and does not include psychotherapists, counsellors and psychoanalysts.
4. d) Further, given the infrastructural and human resource constraints, the implementation of the Act poses a huge challenge.
5. e) State subject: Public health is a state subject and several states face financial constraints. This requires support from central government ensuring funds for its implementation.
6. f) Lack of adequate funds: The Bill does not estimate the expenditure required under the Bill nor does it provide details of the sharing of expenses between the central and state governments.

Challenges of mental health care system-

1. Treatment Gap: According to estimates nearly 92% of the people who need mental health care and treatment do not have access to any form of mental health care.
2. Most psychiatrists felt their profession was neglected compared to other branches of healthcare.
3. Infrastructure and Human Resource:

• There are only 43 government-run mental hospitals across all of India to provide services to more than 70 million people living with mental disorders.
• There are 0.30 psychiatrists (compared to China’s 1.7), 0.17 nurses, and 0.05 psychologists per 1, 00,000 mentally ill patients in the country.

3. Social stigma:A potent mix of superstition, social stigma and discrimination and reliance on ‘faith healers’ is a major concern. Lack of awareness and illiteracy contributing to social stigma further aggravates the issues related to mental health and hinders treatment and social inclusion of patients.

1.  Economic Burden: The economic burden of mental illness contributes significantly to the treatment gap in India. There are both direct (cost of long-term treatment) and indirect costs (,the inability of the patient and caregiver to work, social isolation, psychological stress) contribute significantly to the economic burden.
2. Human Rights Violation: Violations of human rights have been reported in mental asylums and also at homes and places of traditional healing. Example:  In 2014, 28 patients who were chained at a home for mentally-ill people died after a fire that engulfed the home in Tamil Nadu.

6. There is comparatively more research on psychological disorders, their trends, other behavioural aspects but less research on the human brain, unlike in west they are working on the entire neural map of brain and what leads to various mental disorders from the perspective of brain chemistry and neural connections.

Way Forward:

1. The government should make appropriate budgetary provisions to address the existing infrastructure gaps.
2. Proper survey should be conducted to identify shortages in mental health professionals and operational barriers to effective implementation of mental health programs
3. Early Interventions:

• There is a need to create living conditions and environment that support healthy mental health. It is important to develop a society that respects and protects basic, civil, political, and cultural rights
• It is important to aim at child development by early childhood interventions like pre-school psychosocial activities, nutritional and psycho-social help
• To reduce the burden of mental disorders in women, there is need to ensure socio-economic empowerment and safety of women.

5. It is important to generate public awareness about the commonness of mental disorders, understanding of mental disorders as illnesses, treatment and the importance of acceptance by the family and the community.
6. Coordinated efforts from all stakeholders (government, medical fraternity, civil society, educational institutions, family, peer group and community) are needed to address the growing concern of mental health in India.

Conclusion:

The Act is the first mental health law framed as per the United Nations Convention on the Rights of Persons with Disabilities provides “rights-based” approach to mental illness by consolidating and safeguarding the rights of fundamental human rights of the patients.