The Mental Health Care Bill covers many gaps in treatment and services
This recognition of suicide as a mental health related problem would allow for greater dialogue around this issue that had been frequently dismissed and relegated to the backgroundUpdated: Mar 29, 2017 16:59 IST
Mental health has become a much-talked-about subject in India after having been relegated to the sidelines for decades. The prominence it has gained in the last few months is not surprising given the quantum of mental health related problems in the country. A brief glance at these numbers can make any Indian shudder, particularly the staggering deficit in the availability of services as against the number of people requiring them. Estimates of mental health related problems place their prevalence rates at 5% of the population, which amounts to roughly 50 million individuals. Mental health contributes to 11.6% of the global burden of disease and the fact is that only 14.52% of those afflicted receive treatment which approximates to 7.26 million. Despite this there is a 300% shortage of experts in India.
There is substantial evidence that attests to the significant importance of providing comprehensive mental health related services with easy accessibility for the population to ensure the continued health, productivity and overall well-being of individuals. For individuals with severe mental health related problems there is a need for frequent visits to mental health professionals and hospitalisation. Severe problems relating to mental health can result in homelessness and entanglement with the criminal justice systems.
Frequently we see premature deaths and suicides that are associated with severe mental health related problems, particularly when they go untreated or when timely treatment is not made available. It is rather apparent that mental health related illnesses cast a significant negative influence upon the individual and the family’s economic and financial condition.
The Mental Health Care Bill, 2013, passed recently, seeks to replace the Mental Health Act of 1987. There are some significant positives that the amendments to the bill would be instrumental in bringing forth. Let us look at a few of these.
A big step forward has been the broadening of the definition of what mental ill health is. It is now defined 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 or drugs but does not include mental retardation which is a condition of arrested or incomplete development of mind of a person, specially characterised by subnormality of intelligence”. This broadening has brought under the purview of mental health the various aspects of disordered cognitive, emotional or behavioural functioning which impact the individual’s ability to perform his primary functions.
Second, the new bill decriminalises suicide. This recognition of suicide as a mental health related problem would allow for greater dialogue around this issue that had been frequently dismissed and relegated to the background, hidden and cast aside. Greater empathy around what can lead individuals to consider harming their own selves will enable the development of methodologies and programmes to prevent it in the future.
Third, the Bill allows for an affected individual to provide directives pertaining to his treatment in advance as well as the determination of a representative to ensure that the directives are followed. This gives greater autonomy to the patient as well as takes away from the traditional conceptualisation of mentally ill individuals as unable to take any decisions or make choices.
Another significant shift which the bill proposes is the entry of insurance in the mental health sector. Thus far mental health has not had any insurance associated with it. However, the chronicity and long-term duration of a large proportion of mental health related problems increase the burden of cost. The provision of insurance would help ease the burden of cost for a large proportion of the population and take away the challenge that a lot of families face in taking care of their loved ones.
Psychosurgery and electroconvulsive therapy are prohibited under the new bill which allows for psychosurgery only when it is approved by the district medical board and electroconvulsive therapy for adults only with proper care provision.
Finally, the Bill bats for criminalisation of inhuman treatment of the mentally ill. The dignity and rights of patients suffering from mental illness have long being neglected and resulted into various forms of ill treatments given to them. It’s important for us as a society to value the human rights of the mentally ill.
Points for consideration
•Formulate criteria for other mental health professionals. The mental health arena employs the services of numerous other professionals besides psychiatrists and clinical psychologists who find a place in the bill. It is important to recognize the role these other professionals play including counsellors, psychoanalysts, art therapists to name a few.
•Insurance should cover psychological interventions. Insurance at this early stage is not going to be made available for therapy and this would be something that would need to be looked at as well since counselling and therapy form an integral part of the treatment paradigm and are long term processes as well.
•Fill the expertise gap: The large population of our country demands a larger number of experts to be trained to handle the problem of mental health. For this more number of academic institutes need to engage in training programmes and other professionals need to be provided with basic skills to be able to handle mental health related problems.
•Focus on preventive mental health and skill building: Focusing on skills building, coping and life skills, for school and college students as a start and to ensure various crisis helplines for people struggling with stress, and imparting awareness to improve quality of life needs to become another focused effort for the future.
For mental health to reach everybody, it’s important that public private partnership, along with a cohesive effort from all stakeholders, media and the society at large need to be sustained for the next few years to ensure that all mentally ill people get help and clinical treatment and are able to lead a healthy lifestyle.
Samir Parikh is director - mental health and behavioural sciences, Fortis Healthcare
The views expressed are personal