Note4Students

The Mental Healthcare Bill aims to provide for the right to better healthcare for mentally ill patients and decriminalises suicide. It is important to know its provision and the challenges India faces in providing better mental health care.

Introduction

The Parliament has passed the Mental Healthcare Bill, 2016 that decriminalizes suicide attempt by mentally ill people and guarantees the right to better healthcare for people with mental illness.

What is mental illness?

“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.

As per the National Mental Health Survey 2015-16 conducted by NIMHANS, 5.2% of the Indian adult population suffers from depression in some form or the other.

Key Features of Bill

Rights of persons with mental illness:

1. It gives every person right to access mental healthcare from services operated or funded by the government. It also includes good quality, easy and affordable access to services.
2. It also provides right to equality of treatment, protect such persons from inhuman treatment, access to free legal services, medical records and right to complain in case of deficiencies in provisions.
3. It also includes mental conditions associated with the abuse of alcohol and drugs.
4. It assures free treatment for homeless or people Below Poverty Line, even if they do not possess a BPL card

Right to confidentiality: A person with mental illness shall have the right to confidentiality in respect of his mental health. No information regarding the person can be released to the media without his consent.

Advance Directive: It empowers a mentally-ill person to have the right to make an advance directive that explains how they want to be treated for the requisite illness and nominate their representative.

Mental Health Establishments:

1. Every mental health establishment must register with the respective Central or State Mental Health Authority.
2. For registration, the concerned establishment must fulfill different criteria as mentioned in the Bill.
3. Procedure and process: It also outlines the procedure and process for admission, treatment and subsequent discharge of mentally ill persons.
4. Community based treatment: It focuses on community based treatment and special provisions for women and health.

Mental Health Review Commission and Board:

• 1. It will be quasi-judicial body responsible for reviewing procedure for making advance directives.
  2. It will advise the government on the protection of rights of mentally ill persons’. It will constitute Mental Health Review Boards in states’ districts will help of state governments.

Decriminalizing suicide:

1. It effectively decriminalizes suicide attempt under the section 309 IPC(attempt to commit suicide) by mentally ill persons by making it non-punishable

Prohibits electro-convulsive therapy:

• 1. It prohibits the use of electroconvulsive therapy (ECT) to mentally ill adults without the use of muscle relaxants and anesthesia

Challenges

1. India urgently needs to make a transition from old-fashioned approaches to providing care for those suffering from mental illnesses. Something that China, for example, has achieved through state-led policy reform.
2. Lack of professionals
3. India has ratio of 0.3 psychiatrists for 100,000 people (with marginally higher numbers taking independent private practitioners into account), compared to China’s 1.7.
4. Lack of availability of trained clinical psychologists and psychiatric social workers.
5. The National Mental Health Programme has not been sufficiently funded within the health budget; neither has capability been built in most States to absorb the meagre allocation.

Criticism

1. Global Burden of Disease Study shows that in 2013, 50% of all disease burden in India was caused by non-communicable diseases, while mental disorders accounted for about 6% of the total disease burden.
2. 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.
3. At the macro level, the proposed health expenditure of 1.2% of GDP in the Budget for 2017-18 is among the lowest in the world.
4. In real terms, public health expenditure has consistently declined since 2013-14. Of the total health budget, a mere 1-2% is spent on mental health.
5. Treatment gap (the difference between those suffering from mental illnesses and those seeking medical/psychiatric care) is widened because of the social stigma attached to such illnesses.

Way forward

1. Raising effective primary and district-level coverage of mental health services for the general population, without requiring people to travel long distances to see a specialist and get medicines, should be a priority.
2. There should be use of trained general practitioners as the first line of contact.
3. With a concerted effort, primary care physicians can be trained to help people with mild and severe problems, ranging from anxiety disorders to depression, psychoses and conditions arising from alcohol and substance abuse.

Professional counselling

1. Being able to get professional counselling will reduce the complications arising from extreme stress, often the trigger for suicide.
2. Modern treatment approaches rely more on family and community support.
3. The new Central and State regulatory authorities should speedily weed out shady non-governmental rehabilitation organisations in this field.

Questions

Q.) Discuss the features of Mental Healthcare Bill, 2016 and the challenges it could face in its implementation

Q.) Analyse the objectives of and concerns raised against the Mental Health Care Bill 2016