Knitting a safety net: 

Knitting a safety net: 

Context:

Rising cases of mental health disorders need a more proactive approach from the government.

Mental illness in the context of India:

• The 2017 World Health Organisation report, on depression says that almost 7.5% of Indians suffer from major or minor mental disorders that require expert intervention.

According to the report:

1. Depressive disorders are characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.
2. Anxiety disorders refer to a group of mental disorders characterized by feelings of anxiety and fear.

What are the rising factors that affect the mental illness in India?

With time,  reasons for rising cases of mental illness in India are:

• a fast-paced lifestyles,   
• high stress  because of complexities of living,a rural to urban shift
• a breakdown of support systems,
• challenges of economic instability.
• Increased workloads
• Rise in unemployment
• Poverty
• Rising cases of natural calamities

How should the mental health care in India be strengthened?

For an overall strengthening of mental health care in India, the government should eradicate the following barriers:

1. Scarcity of mental health services in the public health services.
2. Poor utilization of available services by the patients in the rural areas.
3. Poor understanding of psychological distress.
4. Limited acceptance of modern medical care for mental disorders among the general population.

Social stigma:

• Due to the stigma associated with mental disorders, nearly 80 per cent of those with mental disorders had not received any treatment.
• Thus, Indians should be able to access healthcare without humiliation of proving their financial status or bitterness of social stigma.
• Within families and across social groups, a mutual sense of responsibility and affiliation towards each other must be reinforced, through rituals and culture, social training or self-learning.
• There is a need to constitute a national commission on mental health comprising professionals from mental health, public health, social sciences and the judiciary to oversee, facilitate support and monitor and review mental health policies.
• Targeted social interventions such as the disability allowance, mandated by the Mental Health Care Act and the Rights of Persons with Disability Act, must adopt an integrated single window health and social care system that will minimize cumbersome bureaucracy.

The Mental Health Care Bill, 2016: Key features:

The Statements of Objects and Reasons to the Bill, state the government ratified the United Nations Convention on the Rights of Persons with Disabilities in 2007.  The Convention requires the laws of the country to align with the Convention. The new Bill was introduced as the existing Act does not adequately protect the rights of persons with mental illness nor promote their access to mental health care.  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. Persons with mental illness also have the right to equality of treatment, protection from inhuman and degrading treatment, free legal services, access to their medical records, and complain regarding deficiencies in provision of mental health care.

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.  The advance directive has to be certified by a medical practitioner or registered with the Mental Health Board.  If a mental health professional/ relative/care-giver does not wish to follow the directive while treating the person, he can make an application to the Mental Health Board to review/alter/cancel the advance directive.

Central and State Mental Health Authority

These are administrative bodies are required to

• register, supervise and maintain a register of all mental health establishments,
• develop quality and service provision norms for such establishments,
• maintain a register of mental health professionals,
• train law enforcement officials and mental health professionals on the provisions of the Act,
• receive complaints about deficiencies in provision of services, and
• advise the government on matters relating to mental health.  

Mental Health Establishments

• Every mental health establishment has to be registered with the relevant Central or State Mental Health Authority.  In order to be registered, the establishment has to fulfill various criteria prescribed in the Bill.

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 advise the government on protection of the rights of mentally ill persons.  The Commission shall with the concurrence of the state governments, constitute Mental Health Review Boards in the districts of a state.  

The Board will have the power to

• register, review/alter/cancel an advance directive,
• appoint a nominated representative,
• adjudicate complaints regarding deficiencies in care and services,
• receive and decide application from a person with mental illness/his nominated representative/any other interested person against the decision of medical officer or psychiatrists in charge of a mental health establishment.

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 anaesthesia. The therapy is prohibited for minors.