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All that you need to know about Mental Health Care – issues and possible solutions; Mental Healthcare Bill 2013 ; Mental Health Policy

For the first time, India has a Mental Health Policy. This makes the topic of mental healthcare extremely important.

Nothing stops the examiner from asking questions related to mental healthcare system in India. You need to understand the issue and its multiple facets completely to tackle any question. The question can be as direct as listing the provisions of the bill, and it can be an indirect one like Gender and mental health.

I have done a comprehensive analysis of the issue for you. Read further to find out.

First the basics.

 What is Mental Health? 

Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

 What is mental illness and how is it caused? 

A mental illness is a health problem that significantly affects how a person thinks, behaves and interacts with other people.

Factors which can cause it are:

  • long-term and acute stress
  • biological factors such as genetics, chemistry and hormones
  • use of alcohol, drugs and other substances
  • cognitive patterns such as constant negative thoughts and low self esteem
  • social factors such as isolation, financial problems, family breakdown or violence

Now that you have understood the basics, you should know how our government is tackling it.

 What is the status of mental healthcare in India currently? 

  • According to 12th five year plan, the total budget for the National Mental Health Program is almost 5.4 billion rupees .
  • Government spends 0.06% of its health budget on mental health, according to the World Health Organization’s Mental Health Atlas of 2011.
  • Mental Health Act, 1987 – not a holistic law.
  • National Mental Health Programme – <Redundant schemes>

Like every other sector, this too is a highly neglected one.

 What are the major shortcomings in the mental health sector of India? 

  • Mental disorders remain concealed in social suffering, discrimination and humiliation, human rights violations.The reasons for these attitudes are complex and varied, and are deeply embedded within local cultures. Not much has been studied about psychiatry in India that is based upon local problems including ethnic conflicts, poverty, dowry deaths, farmer suicides, etc.
  • Very few trained psychiatrists in India and insufficient infrastructure:  There is paucity of doctors and hospitals. Most government hospitals have relegated their worst wards with the fewest beds to mental illnesses. There is an acute shortage of mental health professionals – only 3,500 psychiatrists, according to WHO.
  • No insurance for mentally ill: This happens to be one of the sad truths — insurance companies do not provide medical insurance to people who are admitted in hospitals with mental illnesses. Shocked?
  • Costly treatment: Consultancy and drugs both are prohibitively high.
  • No rehabilitation facilities: The rehabilitation period is important, that is the period between recovery and reintegration. Unfortunately, it is abysmal in India.
  • Insensitive outlook of people: People use words like asylum carelessly. It is perceived to be so negative when you say you need help, that, people are ashamed to admit it. Faith healers are also an obstacle. Yes, the Rampal kinds.
  • Suicide is treated as criminal act; not enough helplines: It has not been realized, that a person who tries to commit suicide needs psychiatric counselling. He should not be viewed as a criminal.
  • Mentally ill people are discriminated in jobs: They are not received well in the job market, which further adds on to their anxiety and frustration.

 How can the Mental health sector of India be improved? 

  • Address the accessibility issue – Policy interventions are needed to increase the level of access to appropriate mental healthcare services. Additional financial resources need to be allocated. Within the health budget it is imperative that allocation to mental health be increased, taking into account the burden of mental health problems.
  • Integrating mental health with primary care: Services provided through primary care have higher acceptability. There are fewer stigmas associated with seeking help from primary healthcare services because these services provide both physical and mental healthcare. Community-based primary care services are also less likely to result in human rights violations for persons with mental disorders. For integration to succeed it is important that the number of primary care staff has to be increased and imparted training and skills.
  • Availability of psychotropic drugs at the primary level: Psychotropic drugs provide an essential first line of treatment for mental disorders as they can reduce symptoms, shorten the course of mental disorders and prevent relapses. Psychotropic drugs should be included in the essential drugs lists so as to improve their availability at the primary care level.
  •  Inter-sectorial collaboration: This includes collaboration within the health sector and outside the health sector i.e. the private sector, civil society. For example, there are many general practitioners in the private sector who can provide community-based care, with adequate training and supervision. Masum, an NGO working with rural women in Maharashtra integrates mental health issues in all its programs.
  •  Community participation and awareness: It can help in development of services that address people’s needs. Community participation also has the added advantage of handling the stigma and discrimination associated with mental disorders.
  • Increasing public awareness: The media can play a role in highlighting information about mental illness and the availability of effective and safe treatments.

It is important that we develop mental health policies, programmes and legislation to increase access to mental healthcare and promote respect for the human rights of persons with mental disorders.

This brings us to the next segment of the article. Mental Health Care Bill,2013 has not been passed and a new Mental Health Policy has been unveiled.

 

  Mental Health Care Bill, 2013 

The Mental Health Care Bill, introduced in parliament in August 2013, is pending in Rajya Sabha. Once passed, it will replace Mental health Act,1987. Let me list some of the important provisions of the bill.

  •  Acts of suicide will not be criminalized. All those who attempt suicide will be considered as mentally ill until proven otherwise. People who attempt suicide will be exempted from the present provisions of Section 309 of Indian Penal Code.
  • Various rights of the mentally ill people,like right to privacy and right to dignity are ensured.
  •  The bill prohibits inhuman practices such as electro convulsive therapy without anesthesia, chaining and tonsuring of heads as well as sterilisation as a treatment for illness.
  •  The bill seeks to establish a mental health system integrated into various levels of general healthcare.
  •  The bill provides for Advance Directive to be furnished in writing by the person that states how he wants to be treated for the illness.
  • Mental Board at both central and state levels need to register every mental health establishment.

You should be able to analyse the highlights of the bill. Its positives and negatives. So, what is our takeaway from the bill ?

Decriminalises attempted suicides: Finally, it has been recognised that people who commit suicides are not criminals but those in need of treatment. The bill makes it clear that act of suicide as well as mental health of a person who commits suicide, are inseparably linked and so these two should be seen in unison. Such people’s rights will be protected during delivery of mental healthcare services. This is for the first time a right based approach for mental health is considered. Finally we get rid of the archaic law.

The ability to choose treatment options: People can write a statement explaining how they want to be treated in case they suffer from a mental illness.

Medical insurance to cover mental health treatment: The is path-breaking and will also provide legal protection for those who suffer from mental illnesses and are at the mercy of care-givers.

Ensure equality and dignity for the mentally ill: The essence of the bill is to safeguard the right to access to mental healthcare facilities, the right community living, right to protection from cruelty, inhuman treatment and right to equality and non-discrimination. The bill looks to ensure that mental healthcare facilities are available to all.

Ban on archaic and barbaric treatment methods is also a very progressive step.

However, there is no mention about the huge resource-mobilisation that is required . Without penal provisions that would force authorities to act, functionaries are unlikely to extend various promised services to concerned beneficiaries.

Tired? This is the last segment. And, the latest, (not-so)burning Current Affairs topic.

 

 Mental Health Policy 

First Mental Health Policy was launched. The policy objectives are in consonance with the provisions of the Mental Healthcare Bill.

Some of the major objectives of the policy are :

  • To provide universal access to mental healthcare.
  • Reduce prevalence and impact of risk factors associated with mental illness.
  • Protect the rights of the people affected.
  • Enhance skilled manpower in mental healthcare sector.
  • Increase financial allocation for mental health promotion and care.

The policy is backed up by Mental Health Action Plan 365 which spells out the specific roles to be carried out by government, private sector, civil society.

Is the policy only lofty words or substantial? 

The policy is progressive and sensitive to the social impact of mental illness, like stigma and poverty. The emphasis of the new policy is on the rights of the mentally ill, including the suggestion that attempted suicide should be decriminalized . Though, implementation will be tough and depends largely on the passage of the mental health bill that is pending in parliament.

Listen to this brilliant discussion on All India Radio on the bill.

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