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Mental Healthcare Act

  • The Mental Healthcare Bill, 2016, aims to for mental and services for persons with mental illness and ensure these persons have the right to live a life with dignity by not being discriminated against or harassed.  The Bill repeals the Mental Health Act, 1987. 
  • 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
    • 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.

Features of the Act

  • Rights of persons with mental illness: 
    • 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  regarding deficiencies in  of mental health care.
    • 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. 
  • Advance Directive:
    • The advance directive has to be certified by a medical practitioner or registered with the Mental Health Board. 
    • If a mental health professional/ relative/ 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.
      • A person with mental illness shall have the right to confidentiality in respect of his mental health, mental , treatment and physical .
      • If a mental health professional/ relative/ 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.
      • A medical practitioner or a mental health professional shall not be held liable for any unforeseen consequences  following a valid advance directive.
  • Central and State Mental Health Authority:
    • Mental Health Establishments: Every mental health establishment has to be registered with the relevant Central or State Mental Health Authority. 
    • The Bill also specifies the process and procedure to be followed for admission, treatment and discharge of mentally ill individuals
  • 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. 
  • Decriminalising suicide and prohibiting  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.   therapy is allowed only with the use of muscle relaxants and anaesthesia. The therapy is prohibited for minors.
  • 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.

Positive Side

  • Mental illness was earlier defined as any mental disorder other than mental retardation. The Bill passed by Rajya Sabha defines mental illness to mean a disorder of thinking, mood, perception, orientation or memory. Such a disorder impairs a person’s behaviour, judgement, capacity to recognise reality or ability to meet ordinary demands of life. This definition also includes mental conditions associated with substance and does not include mental retardation.
  • It also helps provide basic rights and freedoms to those whose life until now had been marred with social stigma.
  • Prime Minister Narendra Modi also spoke about the issue of depression in his monthly radio programme Mann Ki Baat in which he emphasised the need to create a psychologically conducive environment to ensure people have a chance of leading a healthy life.
  • 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.

Issues and Challenges

  • The financial memorandum of the Bill does not estimate the expenditure required to meet the obligations under the Bill nor does it provide details of the sharing of expenses between the central and state governments. Without the allocation of adequate funds, the implementation of the Bill could be affected. The Standing Committee examining the Bill had noted that public health is a state subject. Since several states face financial constraints, the central government might have to step in to ensure funds for the implementation of the law.
  • The biggest impediment to the proper and widespread implementation of the provisions provided by the bill is the percentage share of the budget allocated to the health sector. With a meagre one to two percent of the Union budget dedicated to the entire health sector, India cannot reasonably hope to make a visible change in eradicating the mental health crisis. This is abysmal, compared to developed countries who dedicate 10 to 12 percent of their budget towards providing.
  • India spends 0.06 percent of its health budget on mental , which is significantly less than what Bangladesh spends (0.44 percent). Most developed nations spend four percent of their budgets on mental health research, infrastructure, frameworks and talent pool, according to this 2011 World Health Organisation (WHO) report.
  • The bill mandates the provision of medical health services run or funded by the government be available in every district of the country. However, with already inadequate medical infrastructure at district and sub-district levels, the financial burden to be borne by the state governments will be massive unless the central government allocates a larger chunk of the budget to incur the expenditure.
  • The implementation of the bill will vary across different parts of the country with southern states of Tamil Nadu or Kerala receiving better coverage due to the already adequate primary health infrastructure than the states like Bihar or Uttar Pradesh.
  • Advance Directive
    • Provision essentially allows the person suffering from mental illness to specify the form of treatment to be provided in advance and also empowers that person to nominate a representative to ensure that directives are being adhered to. It fails to consider the position of those suffering from severe mental disorders (like schizophrenia and psychotic disorder) who refuse to acknowledge their mental state, let alone be capable of making rational decisions and giving consent in writing, regarding their treatment. The bill is being criticised for failing to provide alternate courses of action based on the severity of the mental disease rather than having a generalised process applicable across the spectrum.
  • Inhabitants living in extremely gross and inhumane conditions in a severe case of human rights violation by the management. The sanitation and hygienic conditions were reported to be deplorable with toilets as well as some corridors found covered in urine, excreta and menstrual blood. Such instances are often reported across the nation, yet rarely do these institutions have to face the scrutiny and consequences for their violation of human rights.

Facts of the Issue

  • The medical healthcare experts have called out the bill on the lack of its practical approach, citing the acute shortage of doctors, especially psychiatrists, clinical psychologists and psychiatrist social workers. A recent WHO report, titled ‘Depression and Other Common Mental Disorders – Global Health Estimates‘, estimated that roughly 7.5 percent of India’s population suffers from some form of mental illness (major or minor). The report revealed that the total number of cases recorded in 2015 of depressive disorders were nearly 57 million or 4.5 percent of the population while those of anxiety disorders were roughly 38 million or 3 percent. Immediate expert intervention is required as it is further suggested that this statistic is likely to rise up and affect about 20 percent of the population by 2020.
  • According to government data, it is estimated that there are 3800 psychiatrists, 898 clinical psychologists, 850 psychiatric social workers and 1500 psychiatric nurses in the country, most of which are working in metropolitan or tier-two cities, ruling out the possibility for people living in districts and sub-districts of getting appropriate medical attention.
  • Another WHO report reveals that for every million people in India, there are just three psychiatrists, and even fewer psychologists, 18 times fewer than the  norm of 5.6 psychiatrists per 100,000 people.